This book builds on the person-centred medicine movement to promote a shift in the philosophy of care of distress. It discusses the vital importance of whole person health, healing and growth. Developing a new transdisciplinary concept of sense of safety, this book argues that the whole person needs to be understood within their context and relationships and explores the appraisal and coping systems that are part of health.
Using clinical vignettes to illustrate her argument, Lynch draws on an understanding of attachment, and trauma-informed approaches to life story and counsels against an over-reliance on symptom-based fragmentation of body and mind.
Integrating literature from social determinants of health, psychology, psychotherapy, education and the social sciences with new research from the fields of immunology, endocrinology and neurology, this broad-ranging book is relevant to all those with an interest in person-centred healthcare, including academics and practitioners from medicine, nursing, mental health and public health.
Table of Contents
Section I-Building a Case for a Shift in Practitioner and Researcher Mindset 1.Transcending Parts to See a Whole–Humpty Dumpty Represents Us All. 2.Reductionist Barriers to Seeing the Whole–Why Can’t the King’s Men Put Humpty Together Again? 3.Transcending Disciplinary Silos: Where the New Science is Leading Us–Seeing All of Humpty at Once. 4.Why Sense of Safety? A Strengths-Based Approach to the Whole 5.Senses Protect Integrity, Connection, and Coherence–Humpty’s ‘Sense of’ His World Matters Section II-Building the COncept of Sense of Safety: Insights from Consultation 6.The Integrative Gift of an Ordinary Phrase–Humpty’s Native Tongue 7.Sense of Safety Whole Person Domains–Mapping How much of Humpty we need to consider 8.Nouns of Disorder and Verbs of Wellbeing: Noticing Dynamics can Build Humpty’s Sense of Safety 9.Dynamics of Sense of Safety–What Processes Build, Protect, and Reveal Humpty’s Sense of Safety? 10.Sense of Safety: A Paradigm Shift That is Sorely Needed–Accompanying Humpty and His Community Towards Wholeness.
Johanna Lynch is a GP Psychotherapist and a Senior Lecturer at the University of Queensland, Australia. She consults on family violence and neglect in primary care and teaches GPs and medical students in whole person care. She was recently awarded her PhD developing the concept of sense of safety as a whole person approach to distress.
‘In winning prose as lucid as it is rich, Lynch accomplishes that rarest of results: a compellingly coherent epistemology of practice that privileges the wide view over the narrow specialization, appreciation of the whole over the reification of parts, and systemic sophistication over decontextualized detail. With a healthy respect for positivistic contributions to healthcare, she nonetheless reaches further, restoring humanity, relationship and meaning as priorities in the helping professions, anchoring her insights about the essential role of "sense of safety" in hermeneutic philosophy, transdisciplinary research, and compelling case studies. I would recommend this book to any theorist striving to understand the broader backdrop of human distress, and to any practitioner looking for concrete cues for assessing and addressing that distress in ways that promote healing and growth of whole persons in their social contexts.’
Robert A. Neimeyer, PhD, Director, Portland Institute for Loss and Transition and author of Constructivist Psychotherapy
‘Johanna Lynch’s wonderful book brings valuable new insights into why generalist care is so important: as a means of generating and maintaining a sense of safety for our many patients who consult with us in distress. Working towards that sense of safety gives generalists a profound moral purpose, a convincing rationale for why we do what we do. Lynch offers us and our patients, together, a coherent understanding of the integration of different elements of the person, not just our bodily experiences, but also our environment, our relationships and our inner sense of meaning. With sensitive case studies drawn from the author’s own life story, and from her experiences as a family doctor with special expertise in trauma care, she encourages us to reflect on key questions and pointers for action: about finding places and people to help us feel safe; about calming our bodies; and about how we can hold on to hope.’
Christopher Dowrick BA MSc MD FRCGP, Professor of Primary Medical Care, University of Liverpool, UK; Chair of Working Party for Mental Health, World Organisation of Family Doctors (WONCA)
‘Johanna Lynch’s book is a precious resource for ambitious primary care clinicians who strive not only to cure and fix in the narrow sense, but to understand, and heal. Sense of safety represents a powerful "threshold concept"; once you have grasped its meaning and scope, there is no way back to not knowing. The argument is innovative, meticulous, and in full accord with contemporary evidence and theory, ranging from cellular biology to existential philosophy. Read this book!’
Linn Getz, MD, PhD, Professor in Behavioral Sciences in Medicine and Leader of the General Practice Research Unit, Norwegian University of Science and Technology
‘The key message of this book – that we need to establish a sense of safety in the moment with others, before we do anything else – is so important. Johanna’s model is brimming with wisdom and compassion. A lot of rich ideas to reflect on. I do hope the concepts in this book take hold in medicine and spread more broadly to society.’
Rachel Collis MBBS (London), Executive coach and author of Applying Acceptance and Commitment Training to Work-Related Coaching, Sessional Academic at the Graduate School of Business, Queensland University of Technology
‘When systems pull our attention towards fragmentation, Johanna keeps our gaze on the whole person. She explores the way that threat and danger can affect the integrity of every fibre of our being, offering safety as a resource to those looking for ways to understand and respond to pain. This is about illness and healing and so much more. It quietly challenges the traditions of medicine that serve to isolate disease and injury in order to treat it. It gives hope that transdisciplinary efforts can integrate knowledge for the benefit of humanity, carrying with it a commitment to the importance of the body’s lived experience in guiding support and intervention.’
Joe Tucci, PhD, CEO Australian Childhood Foundation
‘In the nineteenth century, medicine became a profession, and then a profession of specialists, who over the subsequent 200 years explored and exploited the tremendous benefits of biological advances in understanding our species. As the joke goes, experts in increasingly narrow fields of study know more and more about less and less with the goal of someday knowing absolutely everything about nothing at all. Johanna Lynch provides a remedy for generalists who treat whole persons. Favouring synthesis and complexity over dissection and linear causality, Lynch finds a paradoxically simple path forward. Attending to Sense of Safety in the face of threat and distress allows a generalist to approach a patient’s "whole story at the appropriate depth." A Whole Person Approach to Wellbeing succeeds in providing an integrative alternative to fractured and siloed perspectives on healing.’
Robert Maunder MD FRCPC, Chair in Health and Behaviour at Sinai Health, Deputy Psychiatrist-in-Chief & Head of Psychiatry Research, Professor, Department of Psychiatry, University of Toronto
‘In this book Johanna displays her deep understanding of, and exceptional capacity to integrate, the complexities of the physical, social and psychological sciences to shine a light on the importance of a "sense of safety" in life and in primary care treatment settings. Her approach provides a map that returns the human heart and soul to the medical consulting room. It behoves us all as practitioners to reflect on the messages in this book.’
Pamela Meredith PhD BA(Hons) BSc BOcThy, Professor and Head of Occupational Therapy, School of Health, Medical and Applied Sciences, Honorary Associate Professor, The University of Queensland
‘This accessible but sophisticated text presents a pathway out of the longstanding tension between wide-ranging breadth on the one hand and narrow specialisation on the other. The author proposes a new concept and language – "Sense of Safety" – which diverse practitioners and stakeholders can share. In presenting "Sense of Safety" as "a robust transdisciplinary concept that is grounded in physiology, relationships and experience", Dr Lynch anchors it in a truly "whole person" approach, "from the cellular to the communal". This is not at the expense of the internal complexity of the person, because "Sense of Safety" is sensitive to the intricacy of the constituent parts. Comprehensively researched yet refreshingly down-to-earth, this text is urgently needed. It should feature not only in the curricula of medical and other health professionals but on reading lists of the general public.’
Pam Stavropoulos PhD, Head of Research, Blue Knot Foundation, Sydney
‘Over the past 25 years, working in hundreds of primary and elementary classrooms, I have seen a significant shift in educators' attitudes towards student behaviour, particularly in regards to students with challenging behaviours. Accompanying this growing awareness of complexity and behaviour as communication has been a desire for better understanding of how schools, classrooms and educators can support both the child in distress and those around them. Johanna Lynch's A Whole Person Approach to Wellbeing: Building Sense of Safety presents an incredible opportunity to develop this insight. For some in education, the text will affirm and strengthen their commitment to whole child relational pedagogical approaches. For others, it will present new ways of thinking about students and themselves. For all educators, A Whole Person Approach to Wellbeing: Building Sense of Safety is an invitation to take a place at the table of key generalists and together, feast on the rich ideas and celebrate the connections presented on every page.’
Megan Connell BA MEd, Deputy Principal Wynnum State Primary School
‘Deeply grounded in the wisdom of practice, Johanna Lynch’s book, A Whole Person Approach to Wellbeing: Building Sense of Safety is worth reading just for the profound understanding it conveys, of the craft of generalism. This craft is the essence of integrated, personalized health care, and conveys larger insights into how to live.
But the book does more. Dr. Lynch has discovered that a vital, healing essence of general practice is fostering a sense of safety. This portable awareness of integrity, connection, and coherence allows people who have suffered traumas – large and small – to integrate conflicting parts of their experience to get in touch with their best selves and live their best life.
The book informs readers’ ways of knowing the world. It is a fountain of practical wisdom gained through caring for diverse people, from a generalist healer who "became a clinician searching for safety in my patients’ lives".’
Kurt C. Stange, MD, PhD, Distinguished University Professor, Professor of Family Medicine & Community Health, Population & Quantitative Health Sciences, Oncology and Sociology, Case Western Reserve University
‘Dr Lynch connects the science from disparate disciplines with wisdom and "humaneness", to make sense of the whole person. It validates the important work of generalists and the courage of those who seek healing. Starting from the intuitive concept of "sense of safety" she builds an approach that provides a roadmap for people in distress and those caring for them. As a general practitioner, the book has taught me the language to better understand and support the journey.’
Mieke Van Driel MD PhD FRACGP Professor and Head of Primary Care Clinical Unit, University of Queensland
‘The time for restoring the generalist craft of healing-centered care has arrived, and Johanna Lynch’s A Whole Person Approach to Well-Being: Building a Sense of Safety will serve as a foundational text for generalism’s renewal. A good word, sewn well, becomes a fruitful seed. A community of good words, carefully chosen, transform a landscape into an ecology of healing. Johanna Lynch offers us a basket of such words with an engaging style that will motivate you to join in seeding the field of generalism and begin nourishing and growing our collective well-being. A Whole Person Approach to Well-Being is a book about words, generative words, and a book about growth, growth into a "sense of safety," written for generalist healers and teachers who use words to help others and themelves grow sense and safety. We learn to move from "nouns of distress" to "verbs of well-being," and how to simultaneously use words that widen, connect, and integrate.
Intellectually stunning, carefully crafted, grounded in decades of deep clinical experience, filled with heart-opening stories and indigenous wisdom, imaginative, and exceptionally well-written, Johanna Lynch’s A Whole Person Approach to Well-Being also welcomes its readers to a festival celebrating and re-imagining the transdisciplinary generalist craft of healing-centered care. Pursuing a pathway for transforming whole person and whole community care, Johanna Lynch, offers us the metaphorically rich and physiologically powerful, "sense of safety," as a healing goal. Readers will learn the importance of eye juggling awareness of self, other, and context in search of that sense of safety that protects integrity, connection, and coherence. As a family physician and teacher of future generalist healers, and transdisciplinary, mixed methods primary care researcher for over thirty-five years, I am, after reading this book, looking wider and making changes to my craft.
Come, engage the words in this book, and discover the magic that happens when a wide scope, relational process, healing purpose, and integrative wisdom combine in Johanna Lynch’s cauldron and a sense of safety emerges.’
William L. Miller, MD, MA, Chair Emeritus of Family Medicine Lehigh Valley Health Network, Professor of Family Medicine University of South Florida Morsani College of Medicine
‘Dr Lynch has provided a scholarly map which undergirds the basic essentials of understanding for any practitioner, and in particular the specialist/sub- specialist, who seeks to promote health. Replete with review of the academic literature, while at the same time proffering an everyday language, this paradigm of "Sense of Safety" encapsulates what is needed for holistic change for anyone – doctor and patient alike, for individual and their societal system. The Safety facilitates the critical process of holistic Sensing, and together join to integrate and further the building of a "Sense of Safety" The wide-angle, broad view of the person within their context allows for the presence of transdisciplinary differences to be brought together in a unity, both with and for that patient. Here, within this "Sense of Safety" silos synergise together in an integrative relationship, opening up the space for safety to emerge. Demarcation disputes from different theoretical models can now all be heard within a harmony, integrating what is needed for holistic change within the person and their system.’
John Warlow MBChB FRANZCP, Adult, Child, and Adolescent Psychiatrist
‘Johanna Lynch looks at health care from a wide, generalist perspective, valuing relationships and a "whole person approach" – opposing the "body parts approach" dominating modern medicine. To transcend the disciplinary silos, she argues, the biopsychosocial model is not enough. She introduces trans-disciplinarity as a possible way forward, and suggests Sense of Safety as a trauma-informed and strengths-based concept for an appropriate approach to the whole person. Building on her own research and a broad literature review, she outlines key themes and questions for the clinician to map a person’s Sense of Safety and to enhance processes that build and protect Sense of Safety. In this book, Lynch combines epistemic courage with clinical utility, a rare gift for the reflective practitioner.’
May-Lill Johansen, Associate Professor of General Practice, UiT The Arctic University of Norway
‘It has been a privilege to review this textbook as it is prepared for publishing, and to encourage all who encounter it to read it not as a text to quote but as a challenge to the status quo of your life. Johanna pushes us to think, to consider ways of knowing, to be brave, to challenge systems that are not or may not be safe (or working well enough for those they serve). Johanna encourages us to consider the beauty of the whole that is in front of us and to respond to that one, not a carbon copy or a text book description of a person.
Read with your mind ready to be challenged, and then respond by thinking deeply about the concepts and pictures that she offers. You will be reminded of the times that you have not felt safe, and this excellent book will help you to recognise how others might have less of this experience in the future in our health care systems. My hope is that expands into Life as you consider alternate ways of being with many others in your daily round.’
Carolyn Russell MBBS FRACGP, Dip RACOG Mast Social Science (Counselling) GP psychotherapist, Medical Educator and Supervisor for GPTQ, RACGP, and MPS/Cognitive Institute
‘A Whole Person Approach to Wellbeing: Building Sense of Safety by Johanna Lynch, provides a vision of how the health and social services of the future could step up to respond more fully to people’s experience of mental, social, and physical distress that underpin so many of our community’s complex and chronic health and social problems. A "sense of safety" is the fundamental need to be addressed for people who are distressed and Johanna draws out what this means from her own extensive research. She shows how we can move beyond reductionist approaches to health and incorporate a much greater emphasis on sense of safety and meaning making, leading to a transdisciplinary approach to human distress. This transdisciplinary view integrates the best of traditional scientific approaches to health, along with a more subjective wisdom of people’s experience and meaning making to create a generalist and inclusive meta-theory. Johanna guides us through the wide range of academic literature and artfully introduces the new vocabulary of the generalist medical practitioner supporting a vision for an inherent paradigm shift. All this is grounded in her research which includes the insights and experience of both users and providers of health services. A very useful guide for health professionals wanting to deepen their practice in responding fully and openly to people's distress.’
Hugh Norriss, experienced developer, manager and trainer in community mental health and workplace wellbeing programs. Former Chief Executive of Wellink Trust and Director of Policy and Development at the Mental Health Foundation of New Zealand
‘From the outset, this book delivers a rich, colourful, creative, and challenging story that both encourages and exhorts us all to do healthcare differently.
My emphasis on "do" is deliberate, for Dr Lynch’s aim is to shift practice: through offering a reason why we must, and an account of how we could. She argues that by "looking wide" (at the whole person), through a process of "permanent inquisitiveness" (in attending to distress) we can help others (and perhaps ourselves?) create a Sense of Safety (healing and wellbeing).
A tall order.
In Part One, Dr Lynch outlines why we can and should practice differently. This is a book written by, and for, the expert generalist clinician. It brings together a diverse and fragmented literature, and in doing so perhaps helps creates meaning (and so a sense of safety?) for the general practitioners who look to use these skills. Part one of this book offers us an account of the scientific and philosophical underpinnings for the thesis presented in this book. With person-centred care still too often discussed only as a "soft skill" – the "art" of medicine – it is valuable to see also an account of the "hard" skills. Dr Lynch’s description of a "craft" of generalism offers a valuable new term to use in our conversations. Discussions of the variation in epistemological underpinnings of different elements of medical practice (chapter 2) is a subject still not discussed and taught widely enough in medical education. Yet part 1 also reminds us that integrative wisdom is not just an intellectual "task", but a coherence that is about relationships, healing and sensing. I was left thinking about how the Reframing of Maslow (p49) perhaps offers a vision of growing professional/clinical practice as much as personal development for patients.
In Part 2, Dr Lynch draws on a multidisciplinary and multicultural history of her own practice and a wider literature in order to offer a story that tells us how we might practice differently. We are offered both a map of the terrain, and a rich description of how we might navigate through each element. Many individual elements of this will be familiar to generalist clinicians. Although the discussion of "sense of self" is an underdeveloped area even within generalist practice. Coming as it does at the top of both Maslow and Lynch’s modified hierarchy of needs, this additional contribution is welcome. Once again, Dr Lynch reminds us that person-centred care is more than the "soft skill" sometimes described when she states that this form of practice is "not simply being comforted; [but] about building courage".
Dr Lynch starts her book with a story of the Satin Bowerbird engaged in its daily activity of sifting through objects to find the shiny blue things it needs to build a home. For me, this book offers both a wealth of objects to search through to find my own collection of shiny objects, and the encouragement to be inquisitive. As Dr Lynch says, "[t]o see the whole person requires a capacity to learn…". This book offers a valuable resource to support that learning.’
Joanne Reeve MBChB MPH PhD FRCGP, Professor of Primary Care Research, Hull York Medical School, UK