Recently I lunched with a younger physician colleague, who is making a significant shift in career, in his forties. Like me, though somewhat differently, he has worked hard at showing, persuading, promoting what can be done when what I call a ‘whole person-centred’ or ‘mindbody’ approach is applied to physical disease, or when we re-focus on our relationships with patients and listen to their ‘stories’.
Again like me, but in a different way, he has been stymied by the algorithmic, doctor-centred, mercantile, techno-centric emphases of modern healthcare, which is buckling to the point of widespread failure as seen from many perspectives including those focusing on inequity, financial incapacity, and the widespread reductionism to belief in tech-salvation, and more.
As I responded to him I found myself re-litigating some aspects of my own experience.
I can swing towards a simple, perhaps simplistic, optimism or hope, that somehow there will come a tipping point, and all the things we already know about healing and healthcare will surface into the consciousness of our healthcare ‘system’. Some of these include: healing as a relational activity; the fact that we are not a collection of dualistic fragments or compartments; treating the body and mind separately is craziness from philosophical, theoretical, commonsensical, epidemiological, sociological, cultural, financial and relational perspectives; our ever-bloating scientistic philosophy of technological and Artificial Intelligence ‘solutions’ will never be the whole answer to healing; epidemiological evidence shows that purpose, meaning, employment and social networks are powerful arbiters of health and longevity; and clinicians are typical humans and follow the money, and also decide what the money gets spent on.
Yes, we hope that one day all these things and more will become clear and genuine motivators of change.
In other words, that our efforts will not have been in vain.
But I also swing back towards a more sober appraisal. What will it take to dent this blind momentum towards an unsustainable healthcare future? It seems the problem in healthcare has much in common with the problems of climate change. There is so much implicit vested professional, scientific, technological and managerial interest in carrying on in the same way that it seems likely that only severe pressure will force a re-think. This view tends towards the apocalyptic, and I dearly want to resist that.
So, all this was going on in my mind as I listened and responded to my colleague as he talked about the changes he has attempted, proposals he has formulated, little things that have changed, hopes for things that might happen, and the ways he is negotiating the past and his possible future.
I was aware of trying to be person-centred, and not to allow my own extensive experience of similar things to unnecessarily skew my response. But then, how could it not?
That night, after the lunch, I woke from a simple dream. It went something like this. There was news of a major but unspecified trauma or crisis far away across the world. On hearing this, I quickly boarded a plane, with two children in tow. I didn’t take time to prepare ourselves or even take luggage, but went precipitously. I was even conscious (in the dream) of the CO2 emissions risk involved in such a drastic move, but it seemed justifiable. I arrived at the scene of the crisis/disaster, in Sweden it seems, because the two colleagues I joined there are living Swedes who have a genuine interest in whole person approaches to health.
But despite the clear and present danger presented by the crisis they and their families seemed strangely unconcerned, disengaged, not inclined to focus on it, or act. At the end of the dream, as we were walking somewhere, still in Sweden, still occupied with the venture, one of the children said to me: “what is the purpose of this?”; which felt like “what’s the point of coming this far, if they react like this?”
I told my wife of the dream, and looked for the essential feeling elements in it. Recklessness? Disappointment? Acceptance? Resignation? Philosophical? Determined? Committed? Puzzlement? Maybe, but they didn’t quite fit. None of these really captured the sense.
She listened and after a bit she said it sounds like you are saying “I have given it my best shot”. And there it was—that is exactly what I did and do feel. And I truly feel satisfied with that.
The dream seems to capture many things. There has been a clear and present danger, within healthcare and to patients, over the three decades I have pursued, deployed and taught whole person non-dualistic approaches to physical illness. And the danger the current biomedical model poses to the overall health of the healthcare system itself is escalating.
In my late thirties, in a massive change of direction, I embarked on a long journey towards addressing this, across a huge divide—between where I was then and towards what I felt needed to be addressed. There has been a huge expenditure of energy. I had no standard equipment. I set off not really knowing what I was going to. I had a young family. I have taken various ‘juniors’ (clinicians) with me and, at times, in the face of the systemic difficulties mentioned above, they have questioned and wondered about the sense of it all. I have met with many people, clinicians, who in principle were very supportive of the need for whole person approaches, but have dissociated, disengaged, denied the realities, because clear and present danger is typically trumped by clear and present comfort.
Nevertheless, I have loved the adventure, the stimulus, the wandering over many new territories - clinical, emotional and intellectual. I feel deeply grateful for my experiences with many patients, for our shared joy in progress as we discover the roots of their suffering, diseases and healing when we consider their whole person. Such work with patients has been deeply worthwhile and satisfying. The stories that have emerged, many symbolic, and all in their own ways unique, have given rise to a novel panorama and complexity unimaginable to most clinicians: they have enriched my understanding of the world and myself, and provided a basis for understanding disease that cannot be got from biophysical measurement.
It hasn’t been an easy journey. The ‘not knowing’ for long periods, the relative isolation from the mainstream, the difficulty of holding psychotherapy and medical forms of practice together, the ways of working that do not fit the dominant and failing template briefly described above, have all brought many stresses. But it has been worth it. I have a deep sense of vocational connection between where I am now and that decision taken at age eight or nine when I announced to my mother I was going to be a doctor.
My upbringing enabled me to set off more or less on my own into an uncertain future and relatively unexplored territories. I had learned to be self-sufficient. This helped me endure the exploration when it got really hard and there was little support. It also helped me entertain new ideas about what I was seeing without being captive to the mainstream, and stifled.
I hope the work done, and that we will yet do, will somehow filter out into the mainstream. There are many around the world who wish for something more whole person-centred in healthcare, and there are oases of activity and hope in many places.
But, in the meantime, I feel I have given it my best, if not my last, shot.
Brian Broom MBChB, FRACP, MSc (Immunology), MNZAP
Consultant Physician (Medicine and Story; Whole Person-centred approaches to physical illness; and Clinical Immunology); Adjunct Professor, Department of Psychotherapy, Auckland University of Technologye-mail: email@example.com