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Should psychiatrists resurrect the body?

Tony Benning. Psychiatrist. Ridge Meadows Hospital, Maple Ridge. 7. th. December, 2016. To appreciate that a broad range of mind-body interactions are relevant to psychiatry. To appreciate the pragmatic implications of the above.

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Should psychiatrists resurrect the body?






Presentation on theme: " Should psychiatrists resurrect the body?"— Presentation transcript:

Slide1

Should psychiatrists resurrect the body?

Tony Benning

Psychiatrist

Ridge Meadows Hospital, Maple Ridge

7

th

December, 2016

Slide2

To appreciate that a broad range of mind-body interactions are relevant to psychiatryTo appreciate the pragmatic implications of the above

Objectives

Slide3

I have no conflict of interest to disclose

Disclosure

Slide4

Dualistic (aka “Cartesian”) separation of ‘mind’ and ‘body’ or ‘psyche’ and ‘soma’ are widespread in modern culture (influence medicine, religion etc.)Purpose of this talk is to take a critical look at mind-body dualism in the field of mental health.Will provide historical and cross-cultural contextWill review recent research findings that suggest a post-Cartesian understanding of mind and body

Introduction/Background

Slide5

Dualism embraces an ‘either – or’ logic. Reveals itself in futile debates about the ontological status of chronic fatigue syndrome, anorexia nervosa as ‘physical’ or ‘mental’. They are both.

Problematizing mind-body dualism: Why is dualism a problem? Some examples…

Slide6

We tend to neglect the somatic and physiological aspects of mental illness. Examples are:-PTSD and Coronary artery disease (Coughlin, 2011)PTSD and Hypertension (Kibler, 2009)PTSD and Elevated lipids (Maia, 2008)PTSD and stroke . Vietnamese longitudinal study (Chan et al, 2015)Bipolar disorder and diabetes (Calkin, 2013). Mechanism not just medication: shared pathophysiology such as mitochondrial dysfunction and shared genetic basis.

Why is dualism a problem?

Examples…

Slide7

Failure to screen for and identify metabolic syndrome in patients with schizophrenia (Crawford et al. 2014) in British Journal of PsychiatrySimilarly, physicians often fail to identify somatic manifestations of depression. Example is pain (Dowrick et al 2005) in British Journal of General Practice

Why is dualism a problem?

Examples…

Slide8

Gordon Parker (1996) Melancholia: A disorder of movement and mood. A phenomenological and neurobiological review.

Example of contemporary post-Cartesian thinking in psychiatry

Slide9

Non-Western healing traditionsThe body in the history of Western psychiatryPhenomenologyRecent research attesting to bidirectional mind-body relationshipsSomatic treatments of mental illnessMental illness and G.I.T. (including research on nutrition)Additional considerationsConclusions

Following themes/headings will be discussed

Slide10

Traditional healing systems of ayurveda, Saiva Bhakti and Siddhi, mind, body and soul are not categorized separately but are, instead, conceived as mutually dependant.Similar ideas in African Zulu medicine systems, and North American indigenous systems. Illness is illness (not necc. Physical or mental )In these traditions and in Taoist medicine and many others others– the harmonious integration of mind, body, and soul is considered key to overall health

Non-Western healing traditions

Slide11

Carl Jung (1930s) - Kundalini yogaErnst Kretschmer - Physical typology (asthenic, athletic, pyknic) and pathology (Sheldon later in USA)Georg Groddeck – Linking psychosomatics and psychoanalysis. Somatic transference and countertransference

The Body in the history of Western psychiatry (

i

)

Slide12

William Reich – muscular armor, character analysis, introduced breath-based practices into psychotherapyReich directly influenced Alexander Lowen (bioenergetics) and John Perakkos (core energetics)Franz Alexander – specificity theory (illnesses to conflicts) eg asthma to frustrated goal achievement. Contemporary research on anger and pain; Type A personality and heart disease

The body in the history of Western psychiatry (II)

Slide13

Merleau-Ponty Embodied subjectivity. Bodysubject (first person experience subverts Cartesian distinction)Modern day psychiatrists influenced by Merleau-Ponty include Ghaemi and Stanghellini: cenesthesia , (diffuse internal bodyawareness cenesthopathy (abnormalities of that awareness)

Phenomenology (

i

)

Slide14

Clinical implications include:1. cenestopathic symptoms prodrome2. respond to body-based therapiesOther experiences in schizophrenia include hyper-automaticity (automatic body-movements that rely on motor memory)and hyper-reflexivity (body parts experienced as external objects)

Phenomenology (ii)

Slide15

Depression involves characteristic changes in the body effecting gait, arm swing, vertical head movements, bodily rigidity etc.Hyperembodiment refers to a finding commonly seen in melancholic depression that manifests in a feeling of heaviness, restriction and resulting inability to react with the immediate environment.

Phenomenology (iii)

Slide16

Depression following MI well established relationshipRecent research implicating depression as an etiological factor in heart disease (for furtehr reading see Lesperance & Frasure-Smith)

Mind and Body (bi-directional relationships)

i

Slide17

Gallagher (2005). How the body shapes the mindGesture and movement can influence various parameters of cognition including memory, person recognition, emotion. Potential implications in autism treatments.

Mind and Body (bi-directional relationships) ii

Slide18

Yoga as a treatment of PTSD. 1ST Study. Descillo et al (2009) on PTSD sufferers in aftermath of South East Asian tsunami 2004. 183 patients were randomized to group A: Yoga and exposure therapy. Group B: Yoga alone. Group C: No treatment (waiting list). A Better than B better than C. So best outcome was for yoga plus CBT.Other studies supporting use of yoga in PTSD (Vander Kolk, 2014) females with PTSD. Benefits endured beyond the 10 week program, unlike the comparator (support group).

Somatic treatments of mental illness (

i

)

Slide19

Empirical support for (list not exhaustive)Yoga for obsessive-compulsive disorderTai chi for depression in older adultsRunning for negative symptoms of depressionYoga for negative symptoms of schizophrenia (UK NICE Guidelines)

Somatic treatments of mental illness (ii)

Slide20

Gluten sensitivity linked to schizophrenia (Severance et al, 2012; Kalidijan et al, 2006; Gluten sensitivity linked to bipolar disorder (Dickerson et al, 2010)Many of those and other studies report reversal of psychotic symptoms upon elimination of gluten from diets.

Mental illness and the G.I.T. (

i

)

Slide21

Autism and ADHD also linked to gastro-intestinal disorders. In some cases of childhood autism, clinical improvement has been seen following identification and treatment of GI infections – especially clostridia, such, as, for example, with vancomycin (Sandler et al., 2000).

Mental illness and the G.I.T. (ii)

Slide22

Emerging evidence of links between nutrition and mental illness notably omega 3 fatty acids in psychosis and other mental illnesses

Mental illness and the G.I.T (iii)

Slide23

PEET M. (2008), Omega-3 polyunsaturated fatty acids in the treatment of schizophrenia. Isr J Psychiatry Relat Sci.; 45(1):19-25. Review. PMID: 18587166Jazayeri S, Tehrani-Doost M, Keshavarz SA, Hosseini M, Djazayery A, Amini H, Jalali M, PEET M. (2008) Comparison of therapeutic effects of omega-3 fatty acid eicosapentaenoic acid and fluoxetine, separately and in combination, in major depressive disorder. Aust N Z J Psychiatry. Mar;42(3):192-8.PMID: 18247193PEET M. (2007). Membrane fatty acid deficits in schizophrenia and mood disorders. In: Fatty Acids and Oxidative Stress in Neuropsychiatric Disorders. Editors: Reddy R & Yao J, Nova Science Publishers, NY.FREEMAN M P, HIBBELN J R, WISNER K L, DAVIS J M, MISCHOULON D, PEET M, KECK P E Jr, MARANGELL L B, RICHARDSON A J, LAKE J, STOLL A L. (2006). Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry. Journal of clinical Psychiatry, 67 1954-67.PEET M, STOKES C. (2005). Omega-3 fatty acids in the treatment of psychiatric disorders. Drugs, 65 1051-9.PEET M. (2005). Nutrition and schizophrenia. World Reviews of Nutrition and Dietetics, 95 17-28.

Mental illness and nutrition (references)

Slide24

Language:-Language perpetuates dualistic assumptions. Language is indispensable but inadequate. Derrida’s under erasure, Kendell’s so-called prefix.Organizational: separation of medicine and psychiatry.

Additional considerations

Slide25

It has been argued that psychiatrists neglectthe bodyThe speciality of psychosomatic medicine (consultation-liaison psychiatry) is disposed more than other branches of psychiatry to honour the intimate links between mind and body but organizational separateness from general psychiatry.

Conclusions (

i

)

Slide26

Another issue is psychosomatic medicine’s increasingly narrow mandate as “general hospital psychiatry”A burgeoning literature attests to the intimate links between mind and bodyPsychiatry would benefit from imbibing those research findings into the nuts and bolts of daily practice.

Conclusions (ii)

Slide27

Psychiatry could do a lot worse than being open to ideas from its own history as well as from across cultures. (This would require a critical re-evaluation of its progressivist assumptions)It is regrettable that findings from phenomenology have not been integrated into mainstream psychiatry.

Conclusions (iii)

Slide28

A greater awareness of somatic issues on the part of psychiatrists would likely lead to increased identification of physiological abnormalities that are associated with mental illness.It would also lead to the availability of a broader range of treatment options for mental illness.

Conclusions (iv)

Slide29

Questions/Discussion