In 1982, in mid-life, I abandoned a flourishing academic clinical immunology career, at the Christchurch School of Medicine, to train in psychiatry. I was responding to an increasing sensitivity to fragmentation. I had been reared within a Christian spirituality largely unaffected by science and modern thought and scholarship. I had trained to high levels in internal medicine which largely ignored subjective experience. And I was yet to discover a psychiatry and psychotherapy largely ignoring the body. I felt that this systemic fragmentation was a fundamental cultural problem, but had little ability to articulate it, let alone convert it into clinical practice.
Thus began a journey specifically undertaken to explore relations between medical practice and patients as whole persons. I had the impulse but no real concept of what it meant and certainly no idea where I was heading. I was not popular. My highly esteemed mentor, senior colleague, and head of the department of medicine, Professor Don Beaven, gave a simple and direct response to this change in direction: “You are an idealist!” and of course he was right. Other colleagues and peers seemed to feel I was betraying an unwritten professional code. The forces maintaining normative cultural structures in medicine are very powerful.
Already having expertise in the body (or at least, diseases of the body), my first move was to embrace the ‘mind’. Entering psychiatry allowed me to begin this process, to maintain my medical functioning, and to earn a sufficient living to sustain my growing family. The four years in psychiatry taught me many interesting and useful things, but I found that as a medical discipline it was pretty much just as deeply embedded in physico-materialist and dualistic assumptions as my previous internal medicine framework. This was not what I wanted. I was seeking to understand persons and the potential for integration of all dimensions of personhood in our understanding and treatment of illness and disease.
Psychiatry does have an interest in those physical illness presentations known as psychosomatic conditions, but had long vacated interest or professional responsibility for mind factors in all the other physical conditions, the ‘real’ (sic) physical diseases. Indeed, mostly, it was felt that the apparently non-psychosomatic conditions had nothing to do with mind or subjectivity.
Psychotherapy, on the other hand, held more promise, and so I veered away from psychiatry. New ‘worlds’ of thinking opened up cumulatively over many years, about the mind or the subjectivity of persons as patients. The most influential emphases were psychodynamic theory, infant development, stages of life concepts, family and systems theory, trauma concepts, object relations theory, interpersonal psychotherapies, self psychology, learning theory, narrative theory, and consciousness studies. These worlds had been entirely invisible to me previously as a clinical immunologist. They remain invisible to the vast majority of medical clinicians working in practice in the Western world. The point I make here is that there is a vast panorama of the subjectivity of persons excluded from the ordinary arenas of medical care.
Psychiatry was not a suitable base for further exploration. I initiated a multidisciplinary Centre (Arahura Centre, Christchurch, New Zealand) committed to the integration of high standard medical practice, psychotherapy, and spiritual values. All of the staff and trainees came from diverse Christian backgrounds and felt similar if not identical aspirations for integration. With two colleagues I mentored this unusual journey of integration. Over the next ten years what developed was a multi-dimensional, multi-factorial, multi-causal, and multi-methodological approach towards disease (vide infra).
Personally, I began a psychotherapy practice and re-ignited my role as a clinical immunologist. There was nothing particularly intentional or inspired about that decision—it just seemed a sensible way to continue my life as a clinician. But, to my surprise, startling and jolting things emerged. Before entering psychiatry I had enacted my clinical life largely by perceiving physical diagnoses and diseases. Now, as both a physician and as a psychotherapist, working with individual patients presenting with a wide range of physical conditions, I was still making diagnoses and treating diseases but also hearing ‘stories’ in the same clinical time/space. And I started to see connections between diseases and stories in many cases. Thus began my work with ‘Medicine and Story’ (Broom 2000).