MEANING-ful DISEASE; a book review

.................by Stanley

.....The idea that physical diseases can be an expression of problems in a person’s psychological life is not new. It was an essential part of Georg Groddeck’s thinking at the time of Freud. Medical thinking has never really caught up; the idea of ‘psychosomatic’ is very vague and limited. It doesn’t really embrace the notion of ‘meaningful disease’. But more recently the idea has gained popularity from writers like Louise Hay, who has a huge following, particularly among Americans who have difficultly thinking. Hay pushes a simplistic view that each psychological condition has a symbolic and fixed one-to-one physical symptom, like corns on the feet mean ‘a hardening of one’s thought’; or an infestation of tapeworm means a ‘strong belief in being a victim’!!
.....Brian Broom, the author of Meaning-full Disease calls the Louse Hay’s style of reductionism ‘meaning fundamentalism’. The truth is much more complex and much more interesting. A physical disease, if it has a psychological meaning and at the same time is an expression of it, can only be uncovered by the most careful enquiry into the person’s specific life story. And, just as no two stories are alike, no two physical symptomatic correlates are alike.
.....Brian Broom’s book has plenty of examples – mercifully short and succinct case studies – of physical symptoms whose meaning becomes clear as he listens carefully to the person telling their story. The correlation between the physical symptom of which patients complain and certain phrases and descriptions they use to tell their story is remarkable. Often the connection is obvious and jumps out perfectly clearly without any suspiciously clever interpretation. As Broom says, ‘at times the matching of meaning and disease is so vivid that the disease appears to be communicating the meaning’. A case in point was the patient who suffered from a thickening of the skin…..

.....Eunice has generalized thickening of the skin, and tissues under the skin, causing uncomfortable splinting of the chest, and tightness of the arms and upper legs... She startled me by saying that it began when she fell over in the local garden nursery, sustaining injuries to her face and legs ...She described the fall as "shattering." ...I asked what effect this event had had on her. She replied: "I went into my shell for a while." I was immediately struck by the fact she was presenting to me with a thickened shell of skin and here she was using language to match. I invited further comment, and within the next 3 to 4 minutes she used the words "I went into my shell" three times. She was taken back to her home by a friendly gentleman: "I went inside the four walls of my house, and closed the door, and sat and sat and sat." In the few weeks following the injury skin thickening developed first in the legs and then became more generalized... She had actually started to improve by the time I saw her... She said that she improved again as she started to "come out of my shell."
......A somatic metaphor (Broom’s term) like this is relatively straightforward - although very difficult for the medical fraternity to grasp, or even consider, because of the fixed idea that the mind is one thing and the body as a living mechanism is another. Broom examines in detail why there is such resistance to the idea of meaningful disease both in the medical profession and even with patients themselves. He shows us the clear need for a revision of our philosophical and common sense assumptions that will permit us to conceive mind and body as simply two aspects of the same thing, a holistic unity. In every chapter of the book Broom hammers home this same message from many angles.
.....He makes use of the phenomenology of Merleau-Ponty who brought the centrality of the body back into philosophy where it has long laid neglected, sidelined by the emphasis on the non-materiality of the soul, leaving the body as a mechanism to be dealt with by materialistic medicine. Broom gives a good example of the medical dilemma.
....."The old physico-materialistic views of matter would argue that meaning-full disease cannot occur because they imply causation in the wrong direction. The idea was that the general direction of biology is bottom up. Genes (at the bottom) give rise to everything else. At a higher level of organization this means that brain gives rise to mind, and mind gives rise to meaning. The traffic does not go the other way. Interpreted simply, this means that meaning-full diseases cannot occur because they appear to be the result of a top down influence, involving a direction from meaning and mind to brain, and from there to body…In short, the direction is wrong and the transmission of meaning cannot happen anyway because of the mind/body problem. We clearly need different models to explain meaning-full disease.
.....Of course the whole discussion of whether causation goes from ‘from top to bottom or from bottom to top’ is still based on the dualism that mind is one thing and the body is another. This is the very fallacy that generates the problem.
.....Dr. Broom writes with great clarity and gives plenty of examples where the meaning of a disease is clear; and also of where there is a sort of complicity of circumstantial evidence that helps a patient uncover the depth of his difficulties and so find a path back to health. This thoughtful book is thoroughly recommended reading. It’s easy to understand without being over simplistic.

.....Brian Broom is adjunct professor at the Auckland University of Technology, Auckland, New Zealand, and leads the post-graduate programme in MindBody Healthcare. He works as consultant physician (allergy and clinical immunology), psychotherapist, and mindbody specialist, at the Arahura Health Centre, Christchurch, New Zealand.

Meaning-ful Disease: how personal experience and meanings cause and maintain physical illness
is available at the Christchurch Public Library 616.0019 BRO

His other previous book:
Somatic Illness and the Patient's Other Story. A Practical Integrative Mind/Body Approach to Disease for Doctors and Psychotherapists.
also available at the Christchurch Public Library 616.08 BRO

A very short and readable page by Dr Broom:
What is mindbody healing
Is available at the NZ Mindbody Network
http://www.mindbody.org.nz/what_is_mindbody.html