Wednesday, 4 April 2007

Brian Broom

Brian Broom is a consultant physician and psychotherapist working in Christchurch, New Zealand. While researching our book I came across his Somatic Illness and the Patient's Other Story, which places particular emphasis on patients suffering from allergies and rashes. Now he has a new book out Meaning-full Disease.

From an article he has written about the book in the Karnac Review:
Z. was referred to me having suffered eight-twelve mouth ulcers continuously for five years. There was no satisfactory medical explanation or treatment. I asked her my 'smorgasbord question': 'What was the most interesting, significant, troublesome, problematic, difficult, stressful, worrisome, frustrating, or hard thing that hapened around the time this problem started?' She said that the ulcers began around that time that her daughter left the Roman Catholic Church. After a moment's silence I asked her what was the hardest thng about that? She said: 'I can't talk to her about it.' I suggested that she talk with her daughter; she did so, and the ulcers disappeared.
Here is the NHS Direct article on the condition. They recognise the role of 'stress' in promoting ulcers, but in the usual problematic way (see here and second comment here):
Try to avoid getting run down by making sure you eat a balanced diet, take regular exercise and learn to manage stress. Make sure your teeth are in good order by regular visits to your dentist.

If you are prone to recurrent ulcers, avoid damage to the inside of your mouth by using a softer toothbrush and avoiding hard, brittle, or sharp-edged foods.
Broom writes an interesting comment about how patients often did not do so well when he referred them to non-medical psychotherapists:
The problem seemed to be that the psychotherapists distanced themselves from the patients' physicality: they often would not respond to patient talk about physical symptoms; most did not feel entitled to discuss bodily issues; typically they suggested that patients discuss physical symptomes with their doctors, effectively silencing any psychosocial exploration of symptoms.
Mind-body duality is writ large in the organisation of health service provision.
When challenged on this, clinicians typically defend themselves on a variety of grounds. Some stand strong in a dualistic scepticism regarding the relevance of mind or body to their respective disciplines. Others protest a lack of skills in one territory or the other: the 'scope of practice' defence. Yet others, constrained by time, perceived priorities, sensitivity to power structures and systems, and by 'ethical' obligations to confine themselves to that which they have been trained in, will protest that a more holistic approach to the patient is impractical. Others simply take the opportunities granted those willing to conform to the dualist and reductionist structures of power and reward within medical and psychotherapeutic culture, and frequently profess no idea as to what we are talking about. Thus, an unbiased observer might conclude that the mindbody clinical problem is really about doctors and therapists, their favourite models, their institutional structures, and where the power lies, rather than the needs of patients.
Powerful stuff! As we note in our book, this dualistic way of thinking may find its echo in the patients themselves, when unprocessed thoughts and emotions provide conducive conditions for physical symptoms. On the other hand, large numbers for whom medical dualism is unsatisfactory are seeking out alternative treatments.

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