All in the mind? Ben Gray

Somatic Illness and the Patient’s Other Story. A practical integrative mind/body approach to disease for doctors and psychotherapists
Brian Broom
Free Association Books
ISBN 185343379 9

This is a remarkable book. The subtitle suggests that the main audience should be doctors and psychotherapists, but I believe it would appeal to anyone with an interest in the human condition.

Brian Broom is an unusual doctor. Based in Christchurch, he trained first as a physician specialising in allergy and clinical immunology, then did research and clinical training in Birmingham, London and Montreal before returning to New Zealand to teach and set up a clinical immunology department. Finding the physical focus of his work frustrating, he undertook specialist training as a psychiatrist. Finding the current dominant biological ideology of psychiatry also frustrating, he set up in practice combining his two specialties in an attempt to integrate mind and body approaches.

Modern medicine has achieved some wonderful things, but there are many, both practitioners and consumers, who are dissatisfied with the over-emphasis on the physical (and thus treatment with drugs) and the excessive focus on things that can be measured at the expense of the unmeasurable. This is expressed in the current vogue for “evidence-based medicine” and the gold standard of the double blind controlled trial. The presumption in such a trial is that all the people in the trial have the same illness. This denies the individuality of each patient. One of the main aims of such a trial is to eliminate the placebo response: the response determined by the beliefs of the doctor and patient of what will work, in other words to eliminate the “mind influence” over the body.

The existence of the double blind trial underlines the importance of “mind influence” over illness but does nothing to further understanding and learning of how to make use of this influence. This book is valuable because Broom has condensed his experience over many years to provide a guide for others on how to distinguish physical conditions that may be treated by psychotherapy and a practical guide on how to proceed with therapy.

Most people are quite happy to accept that conditions such as headache and stomach upset could be psychosomatic. Before reading this book I would have been very sceptical of the suggestion that cancer and bone fractures could be. Broom convinces me of this possibility by the case histories that he presents. These are not the ravings of a zealot who has decided that every illness is caused by the mind. These are the writings of an unorthodox thinker who has not only managed to break free from orthodoxy sufficiently to see that much somatic illness can only be successfully treated by psychotherapy, but who has himself achieved some remarkable healing.

If the book had stopped at this point, I would have reviewed it as being a useful book for GPs and psychotherapists. However, Broom then moves on from his specific experience of integrating mind and body approaches to illness, to discussing the nature of personhood. This section is harder to read, dealing as it does with concepts deriving from philosophy, subatomic physics and spirituality. The central thesis is to challenge the dominant view in the community of the body as a “machine”. His alternative metaphor is the prism, with different faces reflecting different aspects of the emotional core. The faces he names are the verbal language projection (you talk about what is happening in the core); the action projection (emotional energy maybe acted out through exercise, drugs, hobbies, sex, etc), and the somatic projection (your body reads physically to what is happening in the core). He uses this metaphor when educating patients about the approach he wishes to take. This concept is expanded further in a fascinating discussion of the nature of personhood that concludes that neither body, nor mind, nor spirit, nor relationships have primacy in determining who a person is, but that they are all part of a person, existing simultaneously.

From this perspective, the healer of any person with what Broom calls dis-ease needs to be aware of all dimensions of a person and use their skills to determine what intervention is likely to heal the dis-ease. Our perception of and ability to intervene in the physical domain hugely overshadows our perception and ability to intervene in the psychological, spiritual or relationship domains. The “Other Story” referred to in the title is the story of what has been happening psychologically and relationally that doctors usually fail to elicit from patients with somatic problems. Without eliciting this story the healer cannot know whether it is relevant to the dis-ease.

The usefulness of this analysis is clearly evident if we consider the current “epidemic” of Occupational Overuse Syndrome (OOS). We have tried to deal with this as a biophysical illness. Efforts have been made (largely to no avail) to come up with a pathological diagnosis (what is wrong with the muscles that makes them sore?). We have tried with little success to treat the condition with physiotherapy and by designing ergonomic work stations but again with only limited success. The more astute writers have noted that people with OOS frequently if not always have a dysfunctional family background. It seems to me very likely that we may not be able to successfully treat this condition unless we apply the concepts Broom describes.

Broom outlines the reputable research evidence that indicates that somatisers represent 30-40% of patients who present to a GP. Of these only 9% were recognised as such by the GP. His experience suggests that the proportion who have a somatising element to their illness may be higher:

In the end, though, it is sufficient to assert that the problem of somatisation is extremely common. It is not possible to say what the true level of somatisation is because none of us have sufficient tools, skills or opportunity to discern the influence of mind and other nonphysical factors in each and every case. But if doctors were discovered to be missing urinary infections to the level somatisation is missed, it would be regarded as a medical scandal. The financial cost to the community must be enormous as undiagnosed somatisers receive often repeated unnecessary and costly investigations and medications that do not lead to any satisfactory resolution of the problem.

Broom has a free-ranging, enquiring mind. He has travelled on a journey that attempts to integrate the mind and body experiences of his patients. He has learnt much on the way and then linked his new perceptions gained from the “coal face” with those of other writers in the fields of philosophy, theology and physics. He has reached similar conclusions from considering his own microcosm to those of Fridtjof Capra, John Ralston Saul and many others. The primary interest in this book will be from health workers interested in moving away from a narrow biophysical approach; but I believe that anyone interested in the fundamental issues of our time would enjoy it.

Ben Gray is a Wellington GP.

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