Psychotherapists treating bodily disease: dreaming or realistic goal for healthcare?
Western healthcare is seriously limited by pervasive acceptance of dualistic concepts of mind and body, by entrenched scientific industrial ambition, by a monolithic agenda of evidence-based medicine that renders individual data invisible, and by clinical methods centred upon diagnosis rather than persons and persons-in-relationship. There is much research evidence that subjectivity (story) matters in health and disease. Psychoneuroimmunology research, narrative medicine, the new positive psychologies, the research on the health benefits of traditional values, social networks, and occupation, modern concepts of embodied cognition, and renewed interest in the person-to-person elements of the clinician/patient relationship, all point to a gradual closing of the culturally-assumed gap between mind and body. But there is no such gap. Subjectivity and physicality are dimensions of a unitive being, the person, and co-emergent from conception. They do not separate – separation is an observer construction.
The intimate relations between subjectivity (or story) and disease are best seen in symbolic diseases where the bodily manifestation and the patient’s highly specific and personal life meanings exquisitely mirror one another. But there are strong grounds for assuming that all physical disease normally arises because of both physical and subjective factors. It is time for psychotherapy to claim a rightful role in the treatment of physical disease conditions, particularly chronic medical conditions, the management and economics of which are becoming critical to the viability of Western healthcare provision. Psychotherapists must desist from sitting comfortably on the subjectivity side of the mind and body divide, and actively engage with physical illness
