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.
Good Luck & Success
Tis all tangled up together, huh Dr. Bob?
Whenever I see someone who has headaches, I ask if they are under any stress. They usually say they are not and then I ask, “Well, if you won the lottery, would your headaches be better ot worse?” (Truth is it might be hard to say, but that isn’t my point here.)
They always smile and say, “Well, Dr. Bibey, maybe the headaches would be a little better,” and then we can talk about it.
-Dr. B
drtombibey.wordpress.com
Thank you Jonah and good luck with your own psychopedia – I look forward to reading it
Hey, Tom Bibey, you should write a book! I love your down to earth, human, practical style. Seriously, people often fail to understand what’s going on because they fail to consider the context of what’s going on. Your question opens the door to that. I also like how you get them to use their imaginations to step outside of their stuckness. Have you ever come across a form of Brief Cognitive Therapy called Solution Focussed Approach? The idea there is to get people to become aware of the circumstances when their headache, for example, is NOT there, then to understand what it is that they are doing that contributes to that.
Thanks for your comment Dr B. As always, much appreciated.
Dr. Bob,
I have studied a bit of Cognitive Behavioral Therapy in my monthly F.P. updates, but I am not an expert on it. I’ll have to take in the brief cognitive therapy book- that sounds like a good one to have in the library.
I am working on a book about life as a country doc and mandolin player. My extensive market research indicates every doctor in the U.S. who plays the mandolin will buy it. The only problem is there are only five. I am not as certain re: foreign markets-in fact I ain’t too certain about much outside here in the County!
All kidding aside, my main reason to write is so those who come along behing me will know what it was like to be a doc in my time. Given once we are gone, there is no way to tap into one’s accumulated life experience, I want to download brain to cyberspace or paper while I am still here. If for no other reason, maybe my family can go back and remember my thoughts.
I find your blog fascinating for the same reasons- You are all the way across the pond, and yet as doc, and human being, are graciously letting us inside your head for a moment to see how you think. Something about that yields a bit of immortality, I think.
Gotta go. Playing the mandolin in church today. Will keep reading- I enjoy what you have to say.
-Dr. B
drtombibey.wordpress.com
I agree with your feelings towards some aspects of psychoanalytic drive theory, and I think it spoilt rather a lot of mid-century psychosomatic research.
By the way, it’s Brian, rather than David, Broom. And not only did ‘ill’ change to ‘sick’ in the US version of our book, they took the ‘do’ away too, so the title is no longer a question. An American offers an explanation here.
With regard to the final paragraph of your post, a further task is to assist in the formation of healthier social structures. Imagine a world in which health and social order were understood to be intricably linked, as the Greeks did, so that we could enjoy the Roseto effect.
If all action is derived from thought and all thought is energy, one would conclude that all energy is thought and thought is a choice than all action is a choice. What do you think?
Thanks David – sorted those two errors – thank you!
Oh I so agree with your final comment – good to have ideals. Especially ones which have actually been shown to work before!
hmm….is thought an energy? Thinking certainly requires energy! But as best I know, thinking requires the brain so there’s a material aspect too – some of the more recent neuroscientific discoveries are advancing our understanding of thought processes and consciousness.
Is all action a choice? Well, conscious action certainly is, and a fair amount of unconscious action (habitual actions for example) are choices at some points, but an awful lot of internal actions of the body (heart beats, digestion, sweating etc) don’t seem to involve choice or be under the control of the parts of us that do the choosing.
🙂
Point them to the account in the biographical book that Patty Duke took part in writing. The Psychologist who co-authored the book spoke of an interview with a Manic Depressive person, who was in such emotional turmoil they said “Even my hair hurts.” I’ve been there.
Hmm, I recall reading the book that Patty Duke contributed to as having a title similar to Touched With Fire, and it did focus on the artistic temperment. However, the second book below seems to be the only one Patty Duke co-wrote, and I know I only read one book about Manic Depression and the artistic personality at the time I am recalling, and it had Patty Duke’s story in it. Odd… My memory of the time must be flawed, and somehow I must have read two books in that timespan. Hmmm… I believe it is the book Patty Duke co-wrote that has the account I spoke of, but since my memory is skewed it could be the other.
http://www.amazon.com/Touched-Fire-Manic-Depressive-Artistic-Temperament/dp/068483183X
http://www.amazon.com/Brilliant-Madness-Living-Depressive-Illness/dp/0553560727
Book recommendation: The Cunning Man by Robertson Davies. It’s fiction, but highly relevant to your discussion here, and very wise about the ways in which spirit and psyche manifest in the body.
I agree that thought is energy, and so is emotion 🙂 And energy always travels in a “circle.” Lotsa symbolic hints, the blood, electricity, the Earth’s rotation, the seasons, clocks, wheels, sooo many circles… “Everything that goes around, comes around” 🙂 So if the energy of dis-ease starts in the mind or heart, it will definitely travel to and adversely affect the rest of the body, and vice versa.
Thanks for the book recommendations Katk and David. I’ll check them out.
Yeah, dovelove, it’s really interesting to consider where dis-ease starts. I agree that wherever it starts it’s going to affect the whole system. I remember how I felt when I trapped my thumb in a car door………it wasn’t just my thumb that felt unwell! And I can remember how I felt when I had my final exams at Medical School……it wasn’t just my mind that felt unwell!
But there’s something in addition that fascinates me and you hint at it with the energy metaphor. Sometimes, we get sick, not through the body and not through the mind but in our whole selves first – there’s something about the way we stay well which isn’t just in the body or the mind, but where what we see in the symptoms are just the manifestations of that disturbance playing out its effects in the body and the mind. An old way of thinking about that was to postulate a third entity – the vital force. I don’t think there is such an entity but we can definitely see that the whole is greater than (and different from) the sum of the parts.
Hello Dr. Leckridge! First of all I’d like to say that I really enjoyed reading this post. I didn’t know of your blog, and this was surely a good way meet it! Can’t wait to read some of the other posts!
On this post, I must start commenting on the damned duality of mind and body that has for so long slowed both our science and philosophy down. This duality is so firmly printed into our culture that even those who are willing to contest it (such as yourself) will hardly go beyond acknowledging that there is a very intimate body/mind interaction. One of the reason why this happens is because almost all proposals to go beyond that point are either ridiculously based on weak or unscientific arguments, or are just to bold and abstract proposals that are seemingly unverifiable (in Popperian terms).
I believe the problem on the so called duality rests on the categorization. The mind, in my opinion, can not be treated as if it was in the same hierarchy as the body, meaning that the mind is a process generated by the body. I think it was Jean Piaget who first proposed to think of the mind as a “secretion” from the brain.
May I make it clear that the paragraph above should not be understood as an undermining of the mind’s importance on the phenomena discussed on this post. It merely means that mind IS body. This statement is strongly based on the writtings of the so-called chilean-strain of biology (specially the works of Humberto Maturana and Diego Varela). This way, it’s no surprise that mental disorders can easily manifest themselves as what you called “lesional illnesses” and vice-versa. Now, let me cut this comment short before I write a whole book in this little screen 😉 Before I go, a short mention on other comments above:
Besensitive: The logic of the thought you posted here becomes hazy when you use “the mind is an energy”, and, of course, when you conclude that “all energy is mind”. Although I love some pseudo-sciences for making bolder claims about the many aspects of reality, assuming those two claims is more than a huge stretch to me. If you’re looking for agreement, check with the guys who produced “the secret”.
Dr Leckridge: I am usually regarded as a scientific dinosaur because I say this (seems to be cooler to say otherwise), but I really believe that the whole is only greater than the sum of the parsts that we know.
Well… thanks for the attention, and I hope my criticism was made politely enough so as to suit this beautiful discussion.
Great New Year for all readers!
Ego84 thank you so much for this comment. I think we are of like mind (even sharing a conception of mind) I find the works of Maturana and Varela exciting and illuminating. The concept of the embodied mind really appeals to me. You’ll find another post on this blog about another author who explores, additionally, the concept of the extended mind too and I think that gives us yet another conceptual tool with which to dismantle primitive dualism.
I do hope you find other posts here which interest you and I look forward to reading your insightful comments
Bob
The mind is not a matterial concept. In Eastern Philosphy, the mind is known as “Aql” and is a function of the Human Spirit.
The body is a material concept.
A human being in this earthly live is a spirit that uses the body as an interaction with other material existences.
So, in hierarchy terms, the body is a sub-ordinate of the spirit.
But despite its superior-inferior relationship, the condition of the spirit is in fact affected with the condition of the body. A damaged body could really altered the spirit, and vice versa.
The spirit has its own potentials, so is the body. But the body is weaker than the spirit. And as the body needs spirit for its existence, the spirit has no need for the presence of the body.
What termed dead is : when the material body no longer has the pre-conditions to be “inhabited” by the spirit, the spirit would simply abandon the body.
I recently stopped by from Bing and needed to say that I appreciate it for the information on controlling headaches. I am hoping this can assist my daughter which is affected with migranes. I must pass this on. Thanks again!