Tony Benning Psychiatrist Ridge Meadows Hospital Maple Ridge 7 th December 2016 To appreciate that a broad range of mindbody interactions are relevant to psychiatry To appreciate the pragmatic implications of the above ID: 775162
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Slide1
Should psychiatrists resurrect the body?
Tony Benning
Psychiatrist
Ridge Meadows Hospital, Maple Ridge
7
th
December, 2016
Slide2To appreciate that a broad range of mind-body interactions are relevant to psychiatryTo appreciate the pragmatic implications of the above
Objectives
Slide3I have no conflict of interest to disclose
Disclosure
Slide4Dualistic (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
Slide5Dualism 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…
Slide6We 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…
Slide7Failure 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…
Slide8Gordon Parker (1996) Melancholia: A disorder of movement and mood. A phenomenological and neurobiological review.
Example of contemporary post-Cartesian thinking in psychiatry
Slide9Non-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
Slide10Traditional 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
Slide11Carl 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
)
Slide12William 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)
Slide13Merleau-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
)
Slide14Clinical 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)
Slide15Depression 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)
Slide16Depression 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
Slide17Gallagher (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
Slide18Yoga 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
)
Slide19Empirical 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)
Slide20Gluten 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
)
Slide21Autism 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)
Slide22Emerging 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)
Slide23PEET 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)
Slide24Language:-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
Slide25It 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
)
Slide26Another 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)
Slide27Psychiatry 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)
Slide28A 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)
Slide29Questions/Discussion