Brian Broom, immunologist, psychotherapist and CauseHealth senior advisor
Most Western clinicians who pursue a person-centred approach to physical illness experience significant resistance from colleagues and health institutions. At first glance this may seem strange. Wouldn’t everybody want to be person-centred and oriented to the unique patient? Isn’t it obvious that the appearance and development of disease is commonly multi-causal and multidimensional? Surely anyone can see that disease is a manifestation or representation within, and of, the ‘whole’, whether that ‘whole’ is the presenting individual, or a bigger ‘whole’, such as family or culture. But life is not so simple. (This blog post is an extract. Read the long text here.)
Recently, I was in an informal online meeting with a number of clinicians and academic colleagues from Norway and the United Kingdom, all of whom are active in the CauseHealth collaboration, and committed to a dispositionalist, multi-causal approach to the unique patient, which has much in common with our whole person-centred treatment approach here in New Zealand. Most of us contributed chapters to the recent CauseHealth book, and had also participated in the more recent podcasted interviews based on each chapter.
What next?
Naturally enough, the question ‘What next?’ emerged. This quickly morphed into‘What is the ‘right’ language needed to attract and persuade other clinicians and academics towards our approaches?’ I remained silent. There was so much to say. In the shadow of such questions lurk many complex issues, and more questions, notably ‘Is the problem of resistance really about language?’
In this discussion paper, I break out of that silence and explore these questions from the vantage point of our New Zealand experience with the unitive, non-dualistic, whole person-centred clinical approach. I am confident that our experience will resonate with many other clinicians beyond New Zealand. I hope discussion might help configure answers to the ‘What next?’ question.
The problem
We know that generally-speaking clinicians are sticking with the status quo. Given the dominant position of clinicians, we know that politicians will usually follow the advice of the clinicians, unless the public demand something different. Politicians provide the funding. And, risking cynicism, we also know that humans including clinicians tend to follow the money. Thus, the biomedical model retains its dominance.
Resistance to change in healthcare is everywhere and reflecting on these things can be discouraging. What would happen if we focused on the demand side of healthcare, the patients, the suffering public, and the funders of healthcare?
A story
To understand the complexity, we need to start with the people who are the focus of our professional care—the patients. A specific and representative patient story will help ground the discussion that follows:
A 45 year old woman with several years of crippling rheumatoid arthritis, presents unresponsive to all orthodox medical treatments. That is the medical story.
The other story, which had diverse roots, including being adopted at birth, was her sense of stuckness in relationships. It came to a peak with her partner. She felt stifled and hindered. She had repeatedly tried to escape from this feeling.
She said: “I can’t get moving”, “it’s keeping me in a bind like it was with my parents”. She felt: “closed to new directions,” and “I want to loosen up”.
On feeling tied to her partner she said: “I am responsible for his happiness”, “it’s hard to take freedom”, “he still wants me,” “I feel tethered, enslaved”.
Commenting on who she was, she said: “I don’t belong anywhere”, “I don’t know who I am or what I want,” “I lose me in relationship,” “I was quite strong in asserting me as a child, but I’ve stopped asserting me”.
Commenting on her geography: “I hate being in that town, it cripples me”.
She worked determinedly on her feelings. She left her partner, but they remained good friends. She shifted towns. Her arthritis subsided. Checking in with her 6 years later, she remained extremely well.
She reported: “I swim and bike regularly”, “I feel good”, “I hardly get sick”, “I have a new health and happiness”, “I think of the way you wouldn’t accept my bullshit, the image of myself that I had chosen to construct”, “it was very difficult to leave him”, “I love living on my own”, “I was really glad I talked to my mum about being adopted, about six years ago, as a result of seeing you”.
What patients want
Contrary to what many clinicians claim, of all the parties involved in the care of physical illness, patients have the least resistance to whole person approaches. They want to be treated as persons and ‘wholes.’ They know they are wholes because they are alive as wholes. They frequently despair when their clinicians won’t listen. But when warmly listened to, responded to, and educated (simply and briefly), many will open up and work on the multiple factors at play in predisposing them to, and precipitating and perpetuating, their physical (sic) illnesses.
Moving forward
We already have a huge amount of resources that could be presented in a way that is digestible and attractive to the host of humans who know that living as wholes, and being treated as wholes when ill, is intuitively right.
I believe there is an appetite. Over the years, I have presented my work to many different kinds of public gatherings. Again and again, the lament is ‘why isn’t this happening in healthcare?’
Personally, I have preferred to work with patients and with clinicians who are looking for something different. I greatly enjoy and value these activities, and they have sustained my hope of a gradual wider take-up of whole person approaches. But I don’t think this is sufficient. There is a need for a wider discussion of where to go from here.
Mobilising the ‘demand-side’ of healthcare
Many questions arise. Is there a way to mobilise a ‘demand-side’ approach, along with maintaining an excellent academic, clinical and philosophical exploration of the issues? Could there be a will to do this?
Are there people willing to do the preparation of demand-side digestible materials? Is there a larger cohort amongst CauseHealth people and our New Zealand resources (to mention just two possibilities) that would make it a more effective journey? How do we tackle the essential role of virtual and social media in communicating and multiplying the relevant messages? Do we need a significant patient cohort with modern media skills in a steering role? Where do we find funding for this?
Think big
It is a ‘think big’ situation. We only have to glance at climate change pressures and responses, or the Covid19-related mobilisation of resources, to imagine what might be involved as the current model of healthcare moves further into crisis.
Read the full text by Brian Broom here.
Causality, Complexity and Evidence in Health Sciences 