David Corfield mentioned ‘When The Body Displaces the Mind’ on his blog. It’s by Jean Benjamin Storr who is a French ‘psychoanalytic psychosomatician’ – Wow! I’ve never heard of such a job, but I do understand both the idea and the relevance of having someone with such skills on a team.
We still have a very materialistic, very reductionist and dualistic concept of illness. It’s very common for illnesses to be divided into “real” diseases, and ones that are “in the mind”. I don’t find this the least bit helpful. I’ve always said I’ve never met a mind without a body and the only bodies I’ve met without minds are in the morgue. People present their whole experience and it’s not possible to have only symptoms related to the body, or only to the mind. OK, not everyone will agree with that, but that’s how I see it. Books like David Corfield’s own one (‘Why do people get ill?’ which is, I believe, now out in the USA with the title ‘Why people get sick?’), and Brian Broom’s ‘Meaning-full Disease‘, are, I found both easy to read and excellent at setting out a compelling case for the consideration of a patient in the wholeness of their suffering.
Stora’s book is not such an easy read. I think this is for a number of reasons. First of all, it’s originally written in French and the French have a way of writing that is really not the same as Anglophones. Even in French it can be challenging to an English speaker. In translation, something is lost. This makes it harder. And in the case of this particular book I think the translation is pretty clunky in places (although I’m sure it wouldn’t be an easy job). The additional complication is that the author is a dyed in the wool Freudian. I haven’t trained in Freudian analysis and the language of that particular approach has never really appealed to me. Of course, I think Freud’s concepts of pre-conscious, unconscious and conscious functions of the mind were amazing breakthroughs and I also think his Id, Ego and Superego were similarly insightful but all the oral/anal fixation, castration anxiety, sadomasochistic and oedipal drives…….nope! It doesn’t work for me! What I mean is that I just don’t find that kind of formulation of someone’s problem to be helpful. This book is steeped in that approach. That said, if you can let the jargon kind of wash over, the insights are still stimulating, and what impressed me most was actually the part of the book after the theoretical introductory chapters. That latter part is completely based on cases and as such I found it quite compelling. I can’t say I’d always sign up for the analysis but if you step up a level out of the Freudian School as such you can see a highly empathic, skilled practitioner, enabling a patient to create a story which pulls together all of the apparently diverse elements of their suffering, their biography and their cultural experience. His final case, of Nina, is totally fascinating because of the cultural overlay and the demonstrated need for the therapist to get onto the same wavelength as the patient to be able to help her.
As Stora himself says -
…the spiritual dimension plays an important role in restoring individual psychosomatic equilibrium for those who have received a spiritual education.
I really appreciate his understanding of complexity science as a way of illuminating illness. He situates illness in the life of the whole embedded person -
I favour a multi-causal approach to somatic patients; human beings are fundamentally integrated in three inextricable dimensions: a somatic; a psychic and a socio-cultural dimension……..the cause of an illness may lie in any one of the three dimensions……..Every therapeutic endeavour ideally should incorporate these three dimensions.
Dr Eric Cassell’s ‘The Nature of Suffering’ describes that extremely well from a clinical perspective.
Stora highlights something of the same kind of finding as Kroenke -
Surveys conducted among people who have consulted GPs reveal 50 – 70% of patients do not have lesional illnesses.
I like that language – ‘lesional illnesses’. Historically we can go right back to another French author, Bichat, who wrote the “Treatise on the Membranes” with one of the earliest descriptions of disease as an identifiable, physical entity, and whilst in his day that was a breakthrough, three centuries on we’re stuck with an inadequate view of illness as either having lesions or not being real.
This book is an interesting addition to the challenge to that way of thinking. However, in it’s introduction I thought it held out more potential than was realised. It remains firmly in the camp of explaining how emotional wounds can be the origin of physical disease, but I’m even more interested in both the other direction – how physical diseases impact on the mind, and then how both the mind and body interact to produce the full picture of the illness. I’m also more interested to know how to identify and effectively treat the great majority of patients who don’t have what Stora refers to as lesional illnesses. And in addition to that how we produce rational therapeutic interventions to treat whole, individual people, not just think the job is done once the pathology has been addressed. Only then will we have a system of health care which is genuinely healing.