Gaining permission

PREVIOUS: A person speaks as a whole

a14Many clinicians fear a negative reaction from their patients if they open up emotional aspects, or mention the possibility that ‘stress’ may be a cause of the symptoms. This is partly because as a society we have, unfortunately, split illness into the ‘real’ diseases that supposedly have nothing to do with our stories, and the ‘psychosomatic’ disorders that are ‘caused’ by some kind of emotional weakness or vulnerability. Many patients are rightly angered if they experience or imagine their clinicians perceiving them as ‘nutters’, or the illness is ‘all in my head’, or that ‘I am a hypochondriac’, or that ‘my symptoms are not real’. Many patients come to us having had such experiences.

From a Whole Person Healthcare perspective we see patients as a whole, that mind and body are in the whole together, and that physical and non-physical factors are potentially contributing to all disorders. It is irrelevant whether the main driver for the illness is, for example, genetics or traumatic abuse. Virtually all disorders arise because of multiple factors and influences.

The clinical problem is that if we begin with a patient by just being focused on the body, and then later suddenly turn to the mind or the ‘story’ we are at risk of stirring up the patient’s fears that we are starting to see them negatively.

I try and avoid this. I begin by indicating to patients, in a way that is appropriate to each person and occasion, a mix of the following–that: ‘I am interested in the whole person’; ‘I don’t believe that mind and body are separate’; ‘I believe non-physical elements can be important in any disorder’; ‘If I attend to both physical and non-physical aspects it may enable me to help you better than if I just focus on the physical’; ‘I am hoping to ask about both aspects as we go along’; ‘How do you feel about that?’. It is truly rare for anyone to refuse, and the vast majority say something like ‘that sounds good’.

The clinical problem is that if we begin with a patient by just being focused on the body, and then later suddenly turn to the mind or the ‘story’ we are at risk of stirring up the patient’s fears that we are starting to see them negatively.

Clinicians who have been hitherto working with a person in a body-only way may find it difficult shifting to a whole person approach, without alarming the patient. But it can be done. For example, let’s say my usual physical or body-only approach is not working. To shift to a whole person approach I might say to the patient: ‘I’ve been thinking about you, worrying that though we have done all these tests, tried these treatments, it’s not working that well. I’ve been thinking/reading/wondering about whole person approaches and the way people are not just bodies, and that physical illness is influenced by all kinds of factors, including what has happened or is happening in our lives. I know for myself that is true. I want to keep a close watch on the physical factors but I wonder whether we could have a re-think, another look at when all this started………etc’. If we exercise some imagination, gentleness, openness, and generosity many patients will be willing to participate.

Brian Broom

NEXT:  The Smorgasbord Question

Password Reset

Please enter your e-mail address. You will receive a new password via e-mail.