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Gut Reactions: Traumatic Origin of the Irritable Bowel
October 26, 2019 @ 10:30 am - 1:00 pm£15 – £35
This October, we’re delighted to welcome psychoanalytic psychotherapist, Hallam Institute member and retired gastroenterologist, Dr Nick Read, for a talk about his changing impressions of Irritable Bowel Syndrome (IBS).
Despite years of research, there is still no consensus regarding the cause or treatment of IBS; it is one of many medically unexplained illnesses. Since training to be a psychoanalytic psychotherapist, Dr Read has radically changed the way he thinks about IBS and illness in general. In this talk, we will learn why he now regards IBS, not as a disease that warrants a specific treatment, but as an expression of the individual patient.
Here’s what Dr. Read says about this topic:
“The practice of medicine still operates on a model that was developed early in the last century. First establish the diagnosis, then identify the cause and finally apply the treatment. Back then, infectious diseases were the threat. Children were dying of smallpox, meningitis and diphtheria. Tuberculosis meant inevitable wasting and death. Syphilis led to madness and paralysis. The old and frail frequently succumbed to influenza and pneumonia. In 1928, Alexander Fleming discovered the inhibitory effect of penicillium mould on his bacterial cultures, Howard Florey extracted enough penicillin to conduct clinical trials and everything changed. Within the next twenty years, other antibiotics had been synthesised or extracted and specific treatments developed for a host of diseases: ulcers, inflammatory diseases, blood pressure, thrombosis, asthma and even cancer. Medicine experienced a pharmaceutical revolution: a pill for every ill. And with it came ever more sophisticated diagnostic tests and seemingly miraculous treatments. Soon, pundits claimed, human disease would be eradicated.
The nineteen sixties was an exciting time to be a trainee doctor. My colleagues and I learnt the skills that could make a real difference for patients with life threatening disease, but although we did not realise it at the time, we were being indoctrinated into a somewhat paternalistic mode of practice. For us, medicine was a matter of logistics: interrogate the case history, confirm the suspected diagnosis by a careful physical examination and perhaps an X-ray or blood test, prescribe the appropriate treatment and wait for the patient to get better. Over the years, it has become clear that this approach does not work for most ‘ailments’. As advances in medical science allowed more and more illnesses to be named, characterized and treated, it exposed a whole raft of ailments that had neither an obvious cause nor any effective treatment. These were the ‘medically unexplained diseases’; individual long term ailments that encompassed a complex interaction of abnormal features. Despite the efforts of countless committees (or perhaps because of them) at least 30% of people in the UK still suffer from at least one unexplained illness. In the race to cure life threatening disease, modern medicine left the long slow trudge of unexplained illness far behind. Somewhere amid the gleaming concrete and glass hospital towers and state of the art health centres, the individual patient and the social context of their illness got lost.
Irritable Bowel Syndrome (IBS) is one such unexplained illness. Established by a committee of medical experts who met in Rome in 1990, IBS is diagnosed not so much by what it is but by what it is not. Tests screen out other diseases and what’s left is IBS. Despite years of research, there is still no consensus regarding cause or treatment. IBS, like life, is influenced by diet, lifestyle, medications, sleep, exercise and especially by ‘what happens’. It encompasses a range of symptoms, overlaps extensively with other unexplained illnesses and involves non-specific changes in the gut immune system, the microbiome, the enteric nervous system and the gut brain axis.
The way I thought about IBS and illness in general changed radically after I trained to be a psychoanalytical psychotherapist. That was 25 years ago. Before that I worked as a gastroenterologist and clinical scientist, focussing on the effects of different components of food on the physiology of the gut. I travelled the world on diarrhoea, attending conferences, talking to colleagues, forever seeking the elusive breakthrough. These days, I sit and listen to what my patients tell me, read as much relevant literature as I can and try to make sense of it all by writing it down. I now tend to regard IBS, not as a disease that warrants a specific treatment, but as an expression of the individual patient: who they are and what has happened to them. In many cases, their illness seems to function as a survival strategy that protects them from psychological breakdown. If that is correct, medical practice should help people understand their illness narrative and helping them find their own solutions.
This talk is an attempt to collate my changing impressions of IBS.”
Sick and Tired: Healing the illnesses doctors cannot cure. Phoenix, 2006.
The Self Care Programme, The IBS Network. 2008 (revised 2015)
Cooking for the Sensitive Gut. Pavilion, 2015. (with Joan Ransley)