Dear Practitioner
You are reading this message perhaps because a client of yours has asked for your help to uncover their important personal meaning from a disease that most people think of exclusively as a physical illness. Maybe you have an existing interest in the connection between a person’s story and their physical symptoms of disease, and would like to know more.
Whatever your reason for coming to this page, it is likely that you feel reluctant to work with someone in a way which, at first glance, seems to be outside your scope of practice.
We live in a time when the assumption that a person can be divided into a separate body and mind still carries global reach. In the words of MindBody luminary, consultant immunologist and psychotherapist, Dr Brian Broom:
“This separation of mind and story from body and disease is already several centuries underway. And the cost to individual and community health has been enormous.”
No doubt you have thought about this dualistic understanding of personhood from the perspective of your own practice reality. Perhaps you disagree with the dominant assumption of biomedicine that there are no things except physical things…that a person’s experience of mind is secondary and consequential to their body…and that the only truths are mind-independent ones, directly and independently observable and measurable.
To consider practicing outside this established paradigm not only stretches the imagination and forces a rethink of the plausible limits of reality. It must also risk a sense of belonging and place among the traditions and structures of contemporary society. Any departure from normative, safe thinking surely means being buried beneath the colossal weight of the establishment and, by extension, receiving the scorn of your peers. Yet, many others have gone before you.
As a former immunologist, biomedical journeyman and medical communicator for Big Pharma’s interests, I once sat in Dr Broom’s office as a patient. I was there for my second attempt at allergy desensitization when Dr Broom asked me,
“What interesting or meaningful things were going on in your life when you first developed allergy symptoms?”
I looked outside his window where the evidence of spring was in bloom. Privately I thought, “Well, duh!” But in truth his question invoked the memory of my mother’s suicide attempt when I was six years old.
I agreed to read Dr Broom’s article on the role of somatic metaphor in the treatment of physical illness and came back to his office a week later with my questions.
“If what you are saying is correct,” I said, “that somatic metaphor plays a role in the case studies your article describes, then every organic disease has its basis in metaphor.”
Familiar with the skepticism of his learned colleagues, I eventually forgave Brian for what he did next. He schooled me on my dime with his critique of Cartesian dualism, effectively telling me that my thinking was four hundred years out of date. Now at least aware of my unexamined understanding of reality, I agreed to Brian’s less-preferred treatment of allergy desensitization, which I had previously failed as a child. But I also vowed to do some further reading as I had much to (un)learn.
Looking back, my short time with Brian had been a choice point. I turned down the possibility of psychotherapy with him because I had undergone psychotherapy some years earlier for multiple unresolved childhood traumas. Emotionally, mentally and physically I had given myself a pass. Yet my allergies continued along with trichotillomania, gastro-esophageal reflux disease, chronic anxiety, and other forms of suffering besides.
So what point of difference was Brian offering compared with traditional talk therapy? I did not get to find out as Brian’s patient, but my subsequent healing journey led me to enroll years later in his MindBody Healthcare Science practitioner training program at AUT in Auckland, New Zealand. There followed a practical as well as theoretical immersion in case presentations, role play, peer review, practice philosophy, and the MindBody literature.
The following diagram offers a starting point for your own understanding of a two-person MindBody psychotherapy.
Figure: “Intersubjectivity” within a MindBody or wholeperson paradigm captures the formless and formed aspects of a two-person psychology. Personal transformation is the result of deep listening, soft-skills such as pacing and appropriately hosting the relationship, and the emergence of novelty whose roots are embedded in Consciousness.
Both the patient and practitioner are presented as wholepersons. As a wholeperson, we cannot be divided into body and mind compartments. These two aspects of personhood are inseparable. Consequently, story is important in all disease, whether thought of traditionally as physical or mental. Medicine and story go together.
This unitary understanding of mind and body challenges the usual assumptions of boundary and location. Consequently, our self-concept need not start or stop at a recognized physical envelope such as the skin. And since mind is not of body, but instead inseparable from it, our consciousness is not located to a point in space somewhere between the ears. Instead, mind and body co-emerge from a nonlocal foundation that is the organizing substance of the universe. We are free to give this any name we like. The terms energy, field, god, presence, spirit and consciousness have all been used to characterize our experience of the infinite.
This assumption does not merely provide a theoretical frame without practical application or scientific basis. On the contrary, one may assume consciousness to be the ground of all being in the same way that science has traditionally defaulted to the monistic assumption of physicalism (there are no things except physical things, with matter as the foundation substance of the universe).
Novel scientific investigations—whether of consciousness, physics, biology, medicine, psychology, etcetera—can be undertaken around the assumption of neutral monism. Indeed, existing conclusions based on research in these and other disciplines ought to be re-evaluated given that today’s physicalist scientists continue to ignore their own philosophical assumptions when planning, undertaking and reporting their investigations.
Scientists and clinicians alike are so entrenched in a physicalist worldview that they have become blind to its basis in assumption. In the words of the twentieth century physicist, Werner Heisenberg, science can only ever measure an abstraction of reality, never the whole. “What we observe is not nature itself,” he wrote, “but nature exposed to our method of questioning.” At the heart of any abstraction is an assumption. If we fail to evaluate our assumptions, we will always be blind to the possibilities of the whole.
Whenever I introduce the use of a MindBody frame in discussion with different practitioners, I like to include one of Brian Broom’s own case studies, specifically the one that got my attention all those years ago. It is a case of a woman with a long-term facial rash.
The woman had sought help from numerous doctors over a number of years for an effective treatment for her highly visible and distressing rash. She was variously prescribed topical ointments and emollient creams, topical steroids, then oral corticosteroids and even antidepressants because at least one doctor thought that the rash must be in her head (despite visible signs to the contrary). She was referred eventually to Brian as the doctor of last resort.
Taking an active interest in the woman’s story, he asked her what had been going on in her life when she first noticed her facial rash. She replied, “I suppose that was around the time my husband first developed depression.”
“How did you cope with that?” Brian asked her.
“I put on a brave face,” she said.
If you are at all mechanistic in your orientation—and most practitioners are reluctant at face value to accept any causal relationship between the woman’s story and her symptoms—then you will want to dismiss this example of somatic metaphor from having any clinical utility. After all, how can the woman’s thoughts—with their (presumptive) neurological basis—impact what happens on the woman’s face? You might deflect causation to the more generic stress, preferring a psychoneuroimmunological explanation.
Meanwhile, any mechanistic understanding of the woman’s rash serves only to ignore the underlying dualistic assumption that relegates our experience of mind and story to the brain compartment. Physicalism cannot escape its dualistic origins.
But what if we abandon this normative, safe thinking and risk acknowledging our own uncertainty…that somatic metaphor may well have played a role in the woman’s disease? In choosing not to recognize any division between the woman’s exact words of putting on a “brave face” and her physical experience of facial rash, we begin to see value in the whole.
Dr Broom continued to engage the woman as a wholeperson for the remainder of their session, which became a conversation about shame. This turned out to be the only treatment that she needed: Over the following days her facial rash resolved, without any recurrence. Hers was not an isolated case, with the subjective data of many patients’ experiences of physical illness captured as a result of Dr Broom’s commitment to a wholeperson approach.
Of course, acceptance of the whole need not deny our curiosity around causation. But understanding causation does require that we acknowledge different assumptions from the ones confronting us every day. Different assumptions to the material ones that we currently employ in the clinics, classrooms, boardrooms, court rooms, staterooms, war rooms, and media channels of our reality.
Paramount among these is the assumption that consciousness (or another label of your choice) is nonlocal, transcending any limits of boundary, as well as location. While honoring the individual subjectivities of the patient and practitioner, this nonlocal consciousness allows a shared intersubjectivity that exists beyond any physical limits. This shared space allows that you are another me, and I am another you. It allows that in relationship we are mirrors for one another, and that beyond the apparent plane of our shared physical reality we are deeply and irrevocably connected.
Within this MindBody frame, the logic of mind-independence collapses along with any sense of a meaningful separation between ourselves as observers and what we observe. It follows too that as both the observer and the observed, our act of observing changes ourselves and our other. The emergence of novelty within the intersubjective space is a shared aspect of the patient, practitioner and consciousness itself. As our patients are changed with our care and their fostered self-agency, so too are we changed.
The deep emergence that signifies a shift in both the patient and practitioner is possible because we as practitioners allow ourselves to be affected by some aspect of the patient’s story. This requires that we are attuned not only to the conversation, but to our bodies too in order to experience the resonance of the patient’s story.
This is the complete opposite of traditional therapeutic relationships where practitioners are encouraged not to be affected by the patient’s suffering in order to guard against personal involvement and burnout. The paradoxical outcome inevitably is burnout because we are always personally involved: Some aspect of the patient’s story is also our story; and their feelings are our feelings too. If we deny our own feelings, they become an unbearable burden.
If we shed a tear for the patient, it is not the end of the world. Very often this will be the first time our other will have experienced the deep empathetic concern of someone who shows a visceral care for them, and the experience may move them to the core of their pain. Without attempting to colonize your patient, the conversation might look a little like this:
Practitioner: “As I listen to your story, I have a sense of loss that I feel in my chest…and I wonder what is going on for you.”
Patient: “I feel something there too.”
Practitioner: Nods in encouragement, adjusting their breathing to match the patient’s, all the while remaining attuned to their own bodily sensations. Any increased intensity might be an invitation to hold and wait, or open to their own vulnerability knowing that this is always a gift to their patient. Through the intersubjective space, both the practitioner and patient may begin to share the emergence of something they are both able to connect with more deeply. “I feel a terrible sadness welling up inside me.”
Patient: “I feel sad too.” The patient begins to openly weep.
Practitioner: Continues to moderate their own autonomic nervous system to attune with the patient’s while also observing the patient for any change in affect…
Whether it is creating a space for more authentic emotional expression, protracted but meaningful silences, or whatever, practitioners have a role to host the relationship. In order for the relationship to be optimally therapeutic, the practitioner must be committed to their presence in order to listen deeply to the patient’s actual words and their embodied resonances. The patient, much more so than any knowledge or expertise that we bring, will guide us to their core lament. Deep listening is loving.
Fully meeting our other in this way need not drain us of energy. Quite the opposite, the deep emergence encountered within the intersubjective space is there for our own experience, as much as it is for the patient. This is a space that vitalizes and energizes, as indeed we see the patient as whole and vital and energetic.
Of course, there will often be material that opens to us that requires our increased awareness through supervision and other means of self-care. But these necessary attendances—when applied using a MindBody frame—are the means to our own continued growth and unfoldment.
I hope this brief introduction to MindBody sparks your imagination and curiosity, as well as satisfying any initial skepticism (which always has a place in critical thinking). I hope too that you see how our philosophies and related assumptions can both constrain and expand our interpersonal relationships. If you are interested in learning more, I recommend the resources below as a good starting point.
Yours sincerely,
Howard Christian, Ph.D.
References and recommended resources
Beauregard, M., Schwartz, G.E., Miller, L., Dossey, L., Moreira-Almeida, A., Schlitz, M., Sheldrake, R., & Tart, C., (2014). Manifesto for a post-materialist science. Available at: .
Broom, B., (1997). Somatic illness and the patient’s other story. London, UK; Free Association Books.
Broom, B.C., (2000). Medicine and story: A novel clinical panorama arising from a unitary mind/body approach to physical illness. Advances in Mind-Body Medicine, 16(3): 161-177.
Broom, B., (2002). Somatic metaphor: A clinical phenomenon pointing to a new model of disease, personhood, and physical reality. Advances in Mind-Body Medicine, 18(1): 16-29.
Broom, B., (2007). Meaning-full disease: How personal experience and meanings cause and maintain physical illness. Oxfordshire, UK; Routledge.
Broom, B.C., (2010). A reappraisal of the role of ‘mindbody’ factors in chronic urticaria. Postgraduate Medical Journal, 86(1016): 365-370.
Broom, B.C., Booth, R.J., & Schubert, C., (2012). Symbolic diseases and “mindbody” co-emergence. A challenge for psychoneuroimmunology. Explore (NY), 8(1): 16-25.
Broom, B., (2013). In B. Broom (Ed.), Transforming clinical practice using the MindBody approach: A radical integration. Oxfordshire, UK; Routledge.
Broom, B., (2016). Training clinicians in whole person-centred healthcare. European Journal of Person Centered Healthcare, 4(2): 402.
Lindsay, K., Goulding, J., Solomon, M., & Broom, B., (2015). Treating chronic spontaneous urticaria using a brief ‘whole person’ treatment approach: A proof-of-concept study. Clinical and Translational Allergy, 5: 40.