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

1. 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

2. If we desire to be effective as ‘whole person’ clinicians there are only three issues! Paradigm Attitudes and Skills The Clinical Framework

3. Meaning-full disease: How personal experience and meanings initiate and maintain physical illness. B C Broom (2007) Karnac Books, London Somatic Illness and the patient’s other story. A practicalintegrative 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)

4. A case of ‘idiopathic’ ANGIOEDEMA

5. Clinical Paradigm

6. 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

7. 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

8. Co-emergence of Physicality and subjectivity Body and mind Body and story Illness/disease and symbol Illness/disease and meaning Illness/disease and ‘story’

9. 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.

10. 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.

11. In practice what does this mean?

12. Every medical behaviour flows from clinician’s 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 patient’s story is always important—in some way Physicality and subjectivity up front together

13. 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

14. 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

15. The Story in the Macro The Story in the Micro (Exploring the Fault-lines) LISTENING VERY CAREFULLY TO THE PATIENT’S ACTUAL USE OF LANGUAGE

16. Believing in the Mind/Body Connections against the Odds. Derailment Organic/functional dichotomies Self–doubt: haven’t got the skills Fear of medico-legal consequences Issues of respect Humanistic waiting When will the patient be ‘ready’?

17. Discovering the undeniable The Pursuit of the Particular Must Go Slowly, and Expect to Find what is Needed in the Little that is Given

19. Believing in the Mind/Body Connections against the Odds. Adequate investigation The problem specialist (overinvestigating/or nothing wrong with you)

22. 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 patient’s subjective meanings or “story”, as ascertained from the patient’s language, life history, and behaviours” [4].

23. HELPING PATIENTS ACCEPT THE MIND/BODY CONNECTIONS

25. 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