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How to develop a ‘MindBody’ approach to physical disorders in medical practice!. Brian Broom MBChB, FRACP, MSc(Imm), MNZAP Consultant Physician(Clinical Immunology), Psychotherapist, Department of Immunology , Auckland City Hospital. Adjunct Professor

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how to develop a mindbody approach to physical disorders in medical practice

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

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

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

Paradigm

Attitudes and Skills

The Clinical Framework

slide3
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)

in my clinical framework
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

co emergence
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

co emergence of
Co-emergence of

Physicality and subjectivity

Body and mind

Body and story

Illness/disease and symbol

Illness/disease and meaning

Illness/disease and ‘story’

medical dualism
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.

what is a diagnosis
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.

every medical behaviour flows from clinician s paradigm the first hurdle to a mindbody practice
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

what does this mean in practice new patients beginning issues
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

attitudes and skills
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

slide15

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

slide16

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’?

slide17

Discovering the undeniable

The Pursuit of the Particular

Must Go Slowly, and Expect to Find what is Needed in the Little that is Given

slide19

Believing in the Mind/Body Connections against the Odds.

Adequate investigation

The problem specialist

(overinvestigating/or

nothing wrong with you)

symbolic diseases
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].

auckland university of technology dept of psychotherapy

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