From the NZ Listener August 4 2007

Keeping body and soul together

“How much difference do our health choices really make? Author of Think before you swallow, Noel O'Hare argues that staying healthy isn't rocket science... it's a bit more complicated than that.”

In Christchurch, Dr Brian Broom is concerned at a very personal level with the question of why people get ill. Broom trained as a doctor, then gave up a career in the Christchurch School of Medicine to retrain in psychiatry. He had become frustrated at the way clinical medicine compartmentalised mind and body. The author of the recent book Meaning-Full Disease, he sees psychosocial effects at work every day in his work as a doctor specialising in allergies and as a psychotherapist. Broom finds that many of his patients' physical complaints are related to their "story" -the emotional upsets and traumas they've experienced. As a doctor and psychoanalyst he is able to take an integrated approach to his patients' illnesses. "If you look at the biomedical factors and the emotional factors you get a much better [healing] response." As an example, Broom cites the condition of urticaria and Babc angioedema (weals and swellings). "In the 19th century ecc physicians used to call it 'angio-neurotic edema', but in the 20th century the division between physical illness and mental illness became cemented and they removed 'neurotic'. As a result angioedema has been very difficult to treat because allergists contend that urticaria is not a psychosomatic illness but a physical illness; but most [cases] don't have a discernible allergy sitting behind them."

Broom has a particular interest in symbolic illness, "that is, illness that appears to express in the body in a way that tells the same story as the person expressed in words". He tells of a 60-year-old woman referred to him with a facial rash that had persisted for five years. In that time she'd undergone a battery of tests, including having her liver biopsied on suspicion of a carcinoid tumour. Broom could find no evidence of allergic factors. So he asked the "smorgasbord" question he often puts to patients: "What was the most interest- ing problematical, worrying, difficult, frustrating event that was happening in your life at that time?" After some thought she replied, "My husband's depression." Broom asked her how she coped and she said, "Oh, I keep a brave face on it" When she repeated the expression a few minutes later, he drew her attention to a possible link between her facial rash and the phrase "brave face". Later that week, Broom spent a hour with the patient exploring her bottled-up feelings about her husband's depression. Within 10 days of her first visit, the rash was gone for good. "While the mind-body approach is relevant to everyone," says Broom, "it's particularly relevant to chronic illness where biomedicine does not have quick answers or cheap answers, or the answers are a constant drain on the healthcare budget"

Alternative healers sometimes have more success with chronic conditions than orthodox doctors. However, Broom ; says that some so-called natural therapies and diets "are about as mechanistic in their approach to people as giving a person a drug". Medicine should be more "person-centred", he believes. "If a person has a fractured leg, what they need is plaster. On the other hand, if a person has a traumatic background and a persistent rage expressed in a chronic debilitating illness like arthritis, rash, recurrent migraine or back problem, what that person needs is not another technological response but a person to get alongside them and invite them into an acknowledgment and a resolution of that material." .

The term "psychosomatic illness" has come to have negative connotations -"there's nothing wrong with you, it's all in your head" -but Broom has found that patients respond well to the idea that their physical symptoms may be related to their emotional life. "It gives people permission to explore something that they seem to intuitively know: It's the doctors who are most resistant [to mind-body healing], : it's not the patients."

Broom cites the work of Israeli medical sociologist Aaron Antonovsky who, in the 1980s, developed the concept of salutogenesis, now widely used as a research tool in public health. Instead of seeing health and illness in opposition to each other, Antonovsky pictured health and illness as two poles on a continuum. Where you happen to be on that continuum depends on how well you are able to adapt to the stresses in your life and in the social environment. He argued that the key to adaptation was a strong sense of coherence, which he defined as a life that is comprehensible, manageable and meaningful. As an example, Broom points to New Zealand's economic restructuring in the 1980s, with its record job losses. "A lot of those men who got sacked became unwell because the whole purpose and meaning of their lives was thrown in disarray by restructuring."

To Broom, it seems obvious from his experience of treating patients that how we see our
lives, consciously or unconsciously, can play large role in the development of illness, either as a trigger or something that serves to prolong rs it. It's now widely accepted, for example, that many conditions, such as arthritis or " asthma, flare up under stress.

"All illnesses," says Broom, "emerge in a multidimensional, multifactorial arena." Worrying about our intake of antioxidants or the aerobic value of our walk to work may in the end not matter that a much." A good diet and plenty of exercise are important. I don't have any doubt about that," says Broom. "But it's such a simplistic approach to health."

Think Before You Swallow: The Art of Staying Healthy in a Health-Obsessed World, by Noel O'Hare (Penguin, $29,95),