[Breast cancer in context - results of a prospective study and implications for therapy]

56 patients admitted to the surgical clinic for a breast biopsy were interviewed on the day of their admission. The interviewer recorded his impression of the conversation in eight rating scales. The assessments were repeated by an independent rater from edited tape recordings of the interviews. There was a statistical difference between breast cancer patients and patients with a benign node in all eight scales used and the diagnosis cancer was predicted by the interviewer and rater in 80-90% of all cases. A specific mode of therapeutic procedure is discussed in which the cancer is seen as the final link in a chain of similar occurrences, and in which inclusions of the surrounding field is more conclusive to success than working with the individual alone. The basic idea of this approach has for a long time played a part in the work with "difficult" patients: it very positively sanctions the behavior exhibited as a survival feat in an extremely difficult situation and it accepts that for the time being any other behavior is hardly possible. Thus, a paradoxical effect often ensues: the families begin to offer resistance to the doctor's one-sided representation and at the same time call their own behavior into the question.