My Career in Social Work

History of Contemporary Home Counseling

Contemporary Home Counselling is often perceived as but one step in a long process of gradual enlightenment and progress along the road to 'whole person medicine'". Official associations, training programmes, publication of journals and books on the subject merely help to formalize and make sophisticated what has existed since the time of wise women, the magician or medicine man, the philosopher or priest. Those who support 'whole person' medicine would have us believe that their 'traditional medical practice' is part of a 'natural' entity, existing in a 'natural world'. This claim, however, reflects just as much the society at the time when it is so perceived as on any objective permanent reality. During the historical ascendancy of 'scientific medicine' the whole person has passed through a period of subjugation. But it is thought that change will be achieved through patients having control 'handed back' to them, assuming they ever had it in the first place (Heron pp.95-110).

Whole person medicine involves the person of the patient as the focal point of medical investigation. The doctor will rely on the idiosyncratic nature of the patient's own account and the body and mind become one1. This is a far cry from early twentieth century medical discourse and practice. The discovery of pathological anatomy and a new structure of medical hierarchy and autonomy had created a practice wherein the sign became separated from the symptom2. The object (the lesion or sign) was no longer part of the subject (the symptom or person). Indeed the symptom had no voice of its own. It remained silent and it was the sign that spoke the truth of the disease. Of course, the lesion could not actually do the talking; the patient's voice spoke for the silent pathology but had no identity of its own. Symptoms (or what the patient said) could provide a hint, but it was what the doctor saw and what he chose to hear that was all important (Evison pp.60-75).

This separation between sign and symptom (body and mind) served the doctor well - his career depended on that separation as he strove to investigate and evaluate the lesion. The teaching manuals of the early twentieth century reflect the dominance of the sign in medical diagnosis. Communication between doctor and patient was hardly addressed. The physical examination was of paramount importance. By 1935, the tenth edition of Clinical Methods by Hutchinson and Rainey was warning doctors that lead questions which might force an opinion on the patient were strictly forbidden, as was asking the same question twice (which only made the doctor look foolish).

Lead questions were permissible, however, when patients were deemed stupid or malingering and in some cases when an account of subjective symptoms was necessary. Others writing in the 1920s and 30s advised that 'if the patient tends to stray into irrelevant matters' or, 'if the history is completely disjointed or the patient be well set for a three hour monologue, lead questions ...