Patients with long-term complaints of pain and/ or fatigue require a broader view. The context is important, certainly for patients with autonomic dysfunction such as ME/ CFS, fibromyalgia, spasmophilia but also post-Covid.

LONG-TERM COMPLAINTS: A BROADER VIEW

Patients with long-term complaints usually have a long and diverse experience with medical care. Often without success. Sometimes because of the care offered, but usually because the patient or the environment was not ready yet to accept or believe in the offer. It is important that, if no clear diagnosis can be made, the patient has reached the point where he or she accepts that the complaints are credible, even without medical objectification.

The starting point of the course is the recovery of the patient’s self-reliance by making him/ her an “actient”, the person who no longer “undergoes patiently” but actively takes charge of his/ her recovery.

This is only possible when he/ she believes that he/ she is able to do so and becomes a unity again.

The shift from having a body to being a body is the turning point.

In the YESBODY-program we start from the underlying problems that can hinder or prevent the recovery of patients with long-term complaints. Not from “handling” the complaint.

REDUCE PAIN AND/ OR FATIGUE THROUGH A DYNAMIC APPROACH

People who are in pain or constantly tired will focus their attention on this and are less accessible for guidance and advice regarding the underlying (dys)functions. Energy-saving functioning is a precondition for recovery and reduction of complaints.

Patients are not (or no longer) aware that their way of moving, the movement pattern, is a perpetuating factor maintaining the complaints or even worsening them.

After a functional analysis, a policy can be offered that leads to a more natural way of moving. More exercising and getting stronger comes later.

The YESBODY method is based on specific techniques to help patients to move in a natural way that feels right and just. We do this partly through “touch training”, certainly by providing “representation manipulating cues”. These are “hints” to gradually learn to replace the usual way of holding, reshaping one’s body form, moving, and changing one’s position in space by more efficient ones. The usual, less functional way can be changed for the better by means of linguistic (phrases…) and non-linguistic hints (imagery).

The environment, the significant third, or the work: the patient does not live on an uninhabited island alone. If we want to achieve success, we will have to recognize the role of the wider environment and involve it if necessary.

TRANSDISCIPLINARY: WE SPEAK ONE LANGUAGE

The patient sees other care providers such as GPs or specialists and sometimes tells them different stories or complaints. Different or contrary advice can be given from this. That is detrimental to the recovery.

We, therefore, argue for the same language for the various care providers, based on a joint action plan.

To ensure that communication runs smoothly, we have developed a “field model”. A field model helps to map all possible indicators in various areas in order to streamline communication, also with the patient from there

Below is an example of the two overlapping models, one for the doctors and one for the physiotherapist. How to use and how to communicate and report in a structured way so that a common language can emerge, is discussed in the training.

Both field models, one written for physicians in 2010 and one for physicians published in 2020 can be found under downloads.

WHAT IS OUR TERRAIN?

Science “in itself”, and medical science in particular, is evolving at lightning speed. Findings from various disciplines intersect and pollinate each other. The patient and the type of complaints are no longer as they were decades ago. The field in which we operate, as well as the approach, is both broadened and specialized. Where a patient used to be sick or injured, we now find ourselves more in making a difference between three English overlapping terms: disease, illness and sickness.

Dr. Eite Veening, Ph.D. in philosophy, made a puzzle of these terms (www.triadism.org).

Disease, Ob ill: there is a diagnosis based on objective findings.

Illness, Sub-ill: there are subjective complaints and functional disorders.

Sickness, Soc-ill: man as a social being, the environment plays a role.

For example, someone can have cancer (ob-), be tired (sub-) and complaints arise due to concerns about the future, family, and work (soc-). According to Eite Veening, the patient is “ill” three times or not …

To be able to provide help, we have to work with the various fields. Our terrain? The emphasis is on the “illness”, the sub-ill. This is linked to the functional problems, to how people move, how much (how little?) people move. Not apart from the “sickness” factors, the sic-disease aspects. Always in dialogue with the doctor in his/ her specific domain, the “disease, the ob disease”.

RESILIENCE AND SELF-CARE AS AN ALTERNATIVE

No matter how well we do our job, no matter how solid and efficient our approach, nothing weighs as much as the time the patient spends at home or at work. The time in our practice is minimal compared to the hours outside the practice. So it is up to the patient to make it.

We put it this way: we offer the chance of recovery by means of numerous techniques that should help the patient to see things in a broader context and to strengthen his/ her resilience. The patient takes care of the recovery.

But he/ she doesn’t have to do it alone. Here is an “overview” of the policy:

In addition, follow-up via video calling gives us the opportunity to guide and support the patient at home in a better way when he/ she is having difficulties or wants more information.

An appropriate approach to the “Yes-but” problem is also important. Practical philosophy teaches to ask the right question (and not seek the answer) from the idea that what is now true will not be worthwhile when circumstances change.

In the section ”Motive Motion” you will learn about how we can be as people, as patients, as care providers. Take, for example, Baruch Spinoza (1632-1677),  of whom some thoughts we have converted into an “oath.” The technique to apply this – in guiding patients who become active – is an important part of the method.

THE OATH OF SPINOZA

Almost twenty years ago, the philosopher Ludo Abicht wrote: “When these cases have arisen through targeted information and through the explicit invitation to participate in the healing process, a radical revolution will have taken place in our thinking about disease and cure”.

Subsequently, we issued Spinoza’s oath for physiotherapists, in the role of movement consultant: “We will teach you how to teach yourself to take good care of yourself”. Conatus and Caute are the two elements of it.

Conatus, according to the philosopher Roger Scruton in his book about Spinoza an untranslatable term, which can be interpreted as ‘striving’, also as ‘natural force’. “Conatus” is characterized by a body shape that provides self-confidence, an internal locus of control).

“Caute” (alertness), learning to pay attention, partly on the basis of comments from others, that things could be done better and more safely.

Above there is a figure (courtesy of John A. Appleton) that could portray “caute”. Choosing a direction, here depicted ‘speeding up to the left’, but with alertness from within yourself and/ or other sources for not speeding up.

In this way, the basic attitude of the physician – expressed in the Hippocratic oath – and the basic attitude of the physiotherapist – expressed in the Oath of Spinoza – can be brought together. Linked to ICD, ICF, and ICPC criteria, the ‘puzzle work’ of professionals about “disease, illness, and sickness” can then be simplified. This offers advantages for all involved: the physician, the physiotherapist, and certainly also the patient who has now become an active “actient”.

The article by Ludo Abicht and the published article “Quest for Space” can be found under downloads.

Our method

Opportunities for training

CURIOUS?

Since we now have a lot of experience in guiding patients via video calling and due to a large amount of available images, as well as written manuals, this can be done through our Whereby.com/yesbody channel, for up to three students at the same time. A book is available with the overview and another with the handouts for the patients.

Face-to-face is possible in Ghent, in a safe, prescribed manner.

Here is an intake form in which you can fill in a piece of your history (training, experiences …), the questions you are struggling with, and what exactly you expect from our guidance.

Day and weekend work-shops are of course also possible on request, but only when this is safe.

What is written here is limited, but we have a PDF form with more info. Feel free to request it. If you then want more personal information, you can do so in a 15-minute free video call. Then click on jan@yesbody.be at the top and e-mail us your name and telephone number. We will contact you by e-mail.

You can then virtually knock on our door at a pre-arranged time via www.whereby.com.

Body in Peace and the Doctoral thesis are available at https://www.shopmybooks.com/BE/nl/author/jan-b-eyskens