Heimo Gastager

Heimo Gastager

Heimo Gastager (born May 18, 1925 in Salzburg ; † March 29, 1991 in Mattsee ) was a reform psychiatrist and university professor.

Life

Gastager was born in Salzburg in 1925. After graduating from high school, he was drafted into military service and wounded in World War II . After the end of the war he was an American prisoner of war in Italy for almost a year. Gastager financed his studies in Vienna through translations (Italian, Spanish). After completing his medical studies, he initially worked as an unpaid visiting doctor at the Vienna Psychiatric University Clinic (" Klinik Hoff "). In 1956 he married the Viennese teacher and psychology student Susanne Lettmayer. Over the years, five daughters and one son were born. In 1962 the management of the "sanatorium and nursing home" in Salzburg became vacant. This institution was no longer the medieval “ tower of fools ” - there were already forms of occupational therapy: for example, agriculture was carried out. But in principle it was an institution in which the "patients" were locked away. It was closed. Straight jackets were the order of the day. Once inside, the patient had little chance of leaving it. Gastager was interested in the development of psychiatry in other countries at an early age (study visits with his wife in England and the Netherlands). Although the new possibilities of drug treatment in psychiatry were taken up in the German-speaking area, the dynamic personality development was largely ignored.

Opening of the psychiatry

Gastager received the primary care of the psychiatric reception department in 1962 under the direction of Gerhart Harrer , which he held until his retirement at the end of 1990.

Much happened in Salzburg: first of all, the old “institution” was granted hospital status. The new name "Landes-Nervenklinik" contributed to defusing the image of the insane asylum . The doors were largely opened. The patients were given a fork and knife. (Up until then the fear was too great: “Crazy people” cannot be armed with a knife!) The patient was viewed as a person. Creative activities soon became part of everyday hospital life: music, painting, handicraft and psychodrama therapy. The number of forced admissions could be drastically reduced in a short time. The duration of inpatient stays became shorter. This is mainly because there was no longer only one discharge with a lapel . This often overwhelmed the relatives, as the responsibility for the patient was placed in their hands. This often resulted in unnecessary inpatient stays.

Family Dynamics - Phenomenology

Gastager's reform work - repeatedly recognized as the "Salzburg Way of Psychiatry" - would not have been possible despite all the external changes as mentioned above without the aspect of "dynamic psychiatry" as Gastager developed it in his scientific as well as in his practical everyday work:

The rehabilitation of the psychiatric patient - as reintegration into society - is not possible without comprehensive knowledge and consideration of his development . Who is he, how did he become and what were his parents like, what was his childhood like, what expectations should he meet?

Gastager already studied 400 schizophrenic patients in Vienna according to these aspects and wrote his habilitation thesis after these studies: The rehabilitation of the schizophrenic.

One of the most significant of the abundance of interesting results: the "family dynamic position" of the later patient in his childhood has a significant influence on his later rehabilitation chances: was he in a "central position" with his parents, that is, the expectations of him were very high, his chances of rehabilitation are significantly lower than with children in a “peripheral position”, one could say in a “completely normal” parent-child relationship. However, children in a " whipping boy position " have very poor chances .

These and other findings of his research convinced Gastager of the necessity of a multifactorial diagnosis of schizophrenia (personality, family and sociodynamic). Results of this kind required the creation and consideration of “life stories”, that is, far more than “normal” medical histories. They also require a special type of therapy. Gastager drew therapeutic consequences from this in Vienna. Together with Raoul Schindler , he introduced the so-called “bifocal group therapy” for young schizophrenics and their parents because he recognized the importance of family dynamics for the patient even then: one discussion group for the - mostly young - patient, another for the parents.

Heimo Gastager's tombstone at the Mattsee cemetery

Scientific work at the University of Salzburg

Three-person seminar Caruso - Gastager - Revers

In this respect, Gastager was scientifically oriented towards phenomenological psychology: Ey Henry : "consciousness", Maurice Merleau-Ponty : " phenomenology of perception" and others. This very personality-oriented psychology was able to bring new aspects into schizophrenia research.

At the then newly founded University of Salzburg, the professor of psychology, Wilhelm Josef Revers , gave these ideas a lot of space, and he himself published a whole series of publications on them. Gastager received a teaching position in psychopathology .

Igor Caruso , who had founded an independent branch of psychoanalysis (Vienna Working Group for Depth Psychology ) , came from Vienna . Gastager had already been his pupil and friend in Vienna.

The triumvirate Caruso - Gastager - Revers soon became an attraction at the University of Salzburg for students from home and abroad, especially from Germany. You could study a psychology that was deeply rooted in the human and went far beyond the experimental psychology that was prevalent at the time .

The so-called "three-person seminar" (Caruso, Gastager, Revers) also took up social issues and thus became the contact point for the 68 generation . This resulted in concrete social activities, some of which are still effective today (see below).

Social psychiatry

A fundamental opinion of Gastager was that admission to the psychiatric clinic is seldom solely due to illness, but always has a family or social reason as well. This is why family therapy and social psychiatry are so important. A series of dissertations corroborated this view. The first of these dealt with the topic of nonsense (Susanne Gastager, Schwachsinn und Gesellschaft , Jugend und Volk 1973), with many case studies showing that a social occasion always leads to psychiatric admission. This could subsequently also be demonstrated for other diagnostic groups.

This comprehensive approach resulted in the book Die Fassadenfamilie (Heimo and Susanne Gastager) in 1973 - one of the first German-language books on family therapy thanks to the keen interest of Kindler Verlag. Here, these aspects of family dynamics and social relationships are also extended to other diagnostic groups and also viewed in general social terms: the patient, the person in general, embedded in his family and social relationships.

Therapeutic community

A particularly important goal for Gastager was the so-called " therapeutic community ", a term from England: the focus should be on the patient, around him in a horizontal order - from the primary doctor to the cleaning staff (the latter, by the way, due to the increasing number of "Foreign" patients are important for overcoming language barriers). Horizontal, you could say: democratic, equal. Not vertically authoritarian, as is necessarily the case in trauma surgery. As one can easily imagine, Gastager has only partially succeeded in achieving this goal - overcoming the gap between the individual professional groups: in numerous “station conferences”, in “ski seminars” that have become tradition: more or less company outings - during the day Skiing, there were seminars in the evenings. Doctors, nurses, nurses, psychologists, social workers, etc.

Ground for new initiatives and associations

It is understandable that all this work in the practical area could only be carried out with difficulty and against massive resistance from “above” and “below”. Under Governor Hans Lechner , who took the trouble to study Gastager's reform proposals in detail, a number of accompanying measures could be implemented. On the one hand, the clinic itself set up branch offices (external care, social medical service , crisis intervention ). On the other hand, initiatives could arise and flourish in a liberal and open climate: Numerous associations were founded partly by relatives and partly by other committed people:

• 1970: Life counseling
• 1971: Behavioral therapy (first station in Austria)
• 1974: Pro Mente Infirmis
• 1974: Social medical service
• 1975: adult assistance
• 1975: crisis intervention
• 1977: first transition home
• 1978: Adolescent Psychiatry
• 1978: social center
• 1979: meeting point
• 1979: Association of youth welfare
• 1983: arbor
• 1983: drug clinic
• 1985: Members' Association
• 1986: Psychosomatic outpatient clinic
• 1987: Psychohygiene Advisory Board
• 1988: Patients Association

Web links

• Literature by and about Heimo Gastager in the catalog of the German National Library
• Lectures, interviews and radio reports by and with Heimo Gastager in the online archive of the Austrian Media Library