How to develop a

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How to develop a MindBody approach to physical
disorders in medical practice!

• Brian Broom MBChB, FRACP, MSc(Imm),
  MNZAPConsultant Physician(Clinical Immunology),
  Psychotherapist,
• Department of Immunology, Auckland City Hospital.
• Adjunct Professor
• MINDBODY HEALTHCARE Post-Graduate Programme,
• Department of Psychotherapy,
• AUT University, Auckland, New Zealand

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If we desire to be effective as whole person
clinicians there are only three issues!

• Paradigm
• Attitudes and Skills
• The Clinical Framework

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• Meaning-full disease How personal experience and
  meanings initiate and maintain physical illness.
  
• B C Broom (2007) Karnac Books, London
• Somatic Illness and the patients other story. A
  practical integrative approach to disease for
  doctors and psychotherapists.
• B C Broom (1997) Free Association Books,
• New York/London
• Symbolic Disorders and MindBody Co-Emergence. A
  challenge for psychoneuroimmunology.
• Broom, B., Booth, R., and Schubert, C.
• EXPLORE Journal of Science and Healing (IN
  PRESS)

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A case of idiopathic ANGIOEDEMA
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Clinical Paradigm
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In my clinical framework

• Personhood

• Clinically

• People are unitive
• Body and mind, physicality and subjectivity are
  not divided
• Body and mind co-emerge SL3
• Personhood core concept

• Avoid medical dualism SL1
• Avoid the either/or, body or mind default
  position
• Avoid default linearity i.e. body first, then
  mind
• Diagnosis is a role-related activity based on a
  certain way of seeing SL1
• We can have the diagnosis but not have the
  story
• Diagnosis takes its place within a wider view of
  the person
• Think person, think story, think diagnosis

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Co-emergence

• Assumes unbroken continuity between internal body
  processes and external interpersonal meanings and
  influences,
• Asserts that disease-related 'internal' bodily
  changes and collateral external interpersonal
  and environmental fluxes are mutually contingent
  and crucial to the development of the disease.
• Offers an expanded PNI and medical framework

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Co-emergence of

• Physicality and subjectivity
• Body and mind
• Body and story
• Illness/disease and symbol
• Illness/disease and meaning
• Illness/disease and story

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Medical dualism

• the widespread assumption in Western healthcare
  that physical diseases (in particular) can be
  worked with therapeutically without much
  attention paid to mind (subjectivity) factors
  i.e. that mind and body are in essence or
  functionally separated in some way such that mind
  factors may be ignored.

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What is a DIAGNOSIS?

• An observed pattern of dysfunction, recognized by
  a group of people who look at patients and
  dysfunction in the same way, and in a way that
  enables them to use agreed upon therapies, which
  are based on that same way of looking.

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In practice what does this mean?
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Every medical behaviour flows from clinicians
paradigm-the first hurdle to a mindbody
practice

• The first big hurdle is paradigm
• What you say, how you introduce mind, how you
  educate, when you educate
• We Drs are more the problem than the patients
• Patients greatly prefer being treated as persons
  rather than diagnostic objects (they want
  diagnosis as well!)
• Residual dualism
• All disease is multidimensional and
  multifactorial
• Disease is a dysfunction in a whole person
  (system)
• The patients story is always importantin some
  way
• Physicality and subjectivity up front together

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What does this mean in practice?New
patients-beginning issues

• the pre-emptive strike
• declare up front that illness and disease occur
  in a person, not just in a body separated off
  from the rest of them.
• I am interested in the whole of them, and I will
  be asking questions about the whole of them
• we get unwell for both visible and not so visible
  reasons
• transference or baggage from previous
  encounters nutter, hypochondriac, making it up,
  not real
• hope/investigation/normal/pushed away

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Attitudes and skills

• the fix-it mode versus the listening/empathy
  mode
• suspending focus, expanding marginal capacity
• accurate recognition and reflection of story
• honoring the little (you are seeing what is
  already)
• educating about paradigm
• stories, normalisation, universalisation,
  self-revelation
• the smorgasbord question
• prism metaphor
• comfortable with affective intimacy
• using specialists as contract investigators
• avoiding psychiatrisation

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The Story in the Macro The Story in the
Micro (Exploring the Fault-lines) LISTENING VERY
CAREFULLY TO THE PATIENTS ACTUAL USE OF LANGUAGE
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Believing in the Mind/Body Connections against
the Odds. Derailment Organic/functional
dichotomies Selfdoubt havent got the
skills Fear of medico-legal consequences Issues
of respect Humanistic waiting When will the
patient be ready?
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Discovering the undeniable The Pursuit of the
Particular Must Go Slowly, and Expect to Find
what is Needed in the Little that is Given
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Believing in the Mind/Body Connections against
the Odds. Adequate investigation The problem
specialist (overinvestigating/or nothing wrong
with you)
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Symbolic Diseases

• Symbolic diseases (SDs) are defined as occurring
  when the organ system involved, and/or the
  pathological process, and/or the clinical
  phenomenology, appears to be particularly
  congruent with, or appropriate to, the patients
  subjective meanings or story, as ascertained
  from the patients language, life history, and
  behaviours 4.

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HELPING PATIENTS ACCEPT THE MIND/BODY CONNECTIONS

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Auckland University of Technology Dept of
Psychotherapy

• Post-Graduate Program in MindBody Healthcare
• Diploma and Masters
• Part-time, block course-based, multidisciplinary,
  open to clinicians of all kinds

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