A random sample of 30 patients hospitalized for lumbar disc surgery was studied on four specific occasions: before surgery in a biographic interview; during post-operative treatment by behavioural observations; at discharge from hospital and 15 months on average after surgery in further interviews about their ability to cope with the illness and about their social adaptation. Data analysis was carried out according to the method of structural hermeneutics (Oevermann et al. 1979). By contrastive comparison of the cases, a typology of coping behaviour in patients during the out-patient, in-patient, and post-hospitalization phase was developed. 15 patients showed a consistent type of coping behaviour which we have termed "autonomistic". This finds expression at the behavioural level in a patient-doctor struggle who determines treatment. It is motivated by an ambivalence conflict between fear of and desire for dependence and care. Variants of autonomistic coping behaviour and their dependence on biographic influences are presented using 2 case histories. Against this background the problem of adaptivity is discussed.

In a prospective study 30 patients suffering from a lumbar disc-prolapse and typical neurological symptoms were examined with regard to the predictors of the outcome 15 months postoperatively. Alongside the clinical examination and the raising of illness-anamnesis the Giessen pain questionnaire (Giessener Beschwerde-Bogen), the Giessen-Test, the Freiburg Personality Inventory (Freiburger Persönlichkeits-Inventar), the Mainz pain questionnaire und a pain scale were used. By means of the pain questionnaires two groups were formed. Patients without (N=15) and patients with (N=14) postoperative impairment. On the basis of selected scales of the Giessen pain questionnaire and the characteristic "psychosomatic disorder in the anamnesis" for 90% of the patients the outcome could be correctly predicted. For the estimation of the outcome by means of the estimation of global functioning level the likelihood of correct prediction was 83%. Medical and demographic parameters as well as the other results of psychological testing did not correlate with the outcome. The great importance of psychosomatic factors in a wider sense for the outcome is found to be confirmed in the literature. The significance of this result for the coping is debated with a background of the concept of "somatizing" versus "symbolizing". The conditions in therapy should lower psychological stress in order to reduce the necessity for "somatization" and facilitate "symbolization". This is specified as well for the treatment in regular surgical departments as for specialized pain-programs.