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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
Brian Broom MBChB, FRACP, MSc(Imm), MNZAPConsultant Physician(Clinical Immunology), Psychotherapist,
Department of Immunology, Auckland City Hospital.
MINDBODY HEALTHCARE Post-Graduate Programme,
Department of Psychotherapy,
AUT University, Auckland, New Zealand
Attitudes and Skills
The Clinical Framework
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,
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)
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
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
Physicality and subjectivity
Body and mind
Body and story
Illness/disease and symbol
Illness/disease and meaning
Illness/disease and ‘story’
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.
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.
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!)
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
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
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
comfortable with affective intimacy
using specialists as contract investigators
The Story in the Micro
(Exploring the Fault-lines)
LISTENING VERY CAREFULLY TO
THE PATIENT’S ACTUAL USE OF LANGUAGE
Self–doubt: haven’t got the skills
Fear of medico-legal consequences
Issues of respect
When will the patient be ‘ready’?
The Pursuit of the Particular
Must Go Slowly, and Expect to Find what is Needed in the Little that is Given
The problem specialist
nothing wrong with you)
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” .
Post-Graduate Program in MindBody Healthcare
Diploma and Masters
Part-time, block course-based, multidisciplinary, open to clinicians of all kinds