Neither Michael Balint nor his second wife Enid were GPs and yet it is entirely appropriate that the names of these two psychoanalysts grace the most recent RCGP blue plaque to be unveiled.1
Michael and Enid met at the Tavistock Clinic, following his emigration from Hungary shortly before the Second World War. By the time of their marriage in 1953, she was already supporting social workers to consider in groups their working relationships with the families they were supporting, a clear precursor to Michael’s approach with doctors. Their contribution to the development of the profession was helping GPs to reflect on their doctor– patient relationships, to improve therapeutic practice. The Balint Society, now in its 50th year, has extended their philosophy and approach to more recent generations around the world.
THE BALINT APPROACH
In one of the RCGP’s oral history interviews undertaken as part of the NHS@70 Project, Oliver Samuel, a participant and former GP, noted the difference between the early Tavistock sessions he attended and later Balint groups. At first, there was an expectation that participating GPs could set aside an hour for an interview with a patient who was causing concern. Taking it in turns, two of the GPs would report back at the group meeting for peer support, which would then be followed by subsequent hour-long appointments with the same patients and further reports back to the group. Observing that this was later dropped as impractical, he stated that it ‘gave you a picture of the patient’s life in a depth that no GP sees these days’ and ‘fleshed out the people as humans’.
Michael and Enid. Image courtesy of Enid’s granddaughter, Susan Lawlor.
Noting that his own initial cases ‘were all patients who had … depression … deeply distressed about what didn’t seem to be particularly distressing’, he learned that the empathy he developed from listening helped him do his job better, as well as helping the patient.
Perhaps less well known is that Michael also ran sessions for medical students at University College Hospital. Another NHS@70 interviewee, former GP Gill Yudkin, reflected on the formative role of the student group to her later practice, as a GP noting that, as an optional extra to her formal studies, it added ‘a total new dimension onto patient care and the doctor–patient relationship’.
It was a real privilege on the evening of the plaque unveiling to hear, on his final public engagement, from the late Marshall Marinker, reflecting on his debt to his mentor Michael Balint. They had first met in 1965, when he and John Hunt had applied to join Michael’s research group. Marshall’s contribution to the 1972 publication The Future General Practitioner: Learning and Teaching helped bring Balint’s ideas to a wider audience.
In passing, Marshall alluded to the late Julian Tudor Hart’s criticism of Balint. Julian considered himself an ‘anti-Balintist’ because, in his view, the Balint approach remained doctor centred, with doctor talk still, in practice, dominating the consultation, and practitioners failing ‘to ask the patients for their own hypotheses about what was wrong with them’ or reflecting on the patient’s perception of the doctor. Nonetheless, even he agreed the Balint approach was ‘a cure for not thinking. It … started people thinking in a … self-critical way which is [a] very important … first step.’
His challenge to all practitioners is that they take the next step of ‘really trying to put themselves in the place of the patient’.
The RCGP blue plaque for Michael and Enid Balint.
The plaque was unveiled by the RCGP President, Professor Mayur Lakhani, at the Balints’ former home at 7 Park Square West, Regent’s Park, on 16 May 2019, at a special ceremony attended by the Lord Mayor of Westminster, Ruth Bush, and President of the Balint Society, Dr Caroline Palmer.
In truth, the event is indebted to Marshall, who campaigned and worked tirelessly with the College archivist, Sharon Messenger. He is worthy of a plaque himself.
- © British Journal of General Practice 2019
