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Paul Dieppe, BSc, MD, BS(Lond), FRCP, FFPH

headshot of paul dieppe

Home Institution: University of Exeter Medical School

Field: Rheumatology and Health Services Research

Current Positions:

  • Emeritus Professor of Health and Wellbeing, University of Exeter Medical School
  • Emeritus Senior Investigator of the National Institute for Health Research (NIHR) UK
  • Honorary Professor of Health Services Research, University of Bristol

My Driving Question

What conditions enable healing?

Scholar Project

Having treated hundreds of patients during his 40-year career as a rheumatologist, Dr. Dieppe is now exploring questions about individuals’ healing experiences and the optimal conditions for healing (in contrast to curing). His Institute Scholar project aims to gain a better understanding of healing and to develop new theories that address what works, for whom, and in what circumstances. 

The first part of Dr. Dieppe’s project involved analyzing data from a variety of US- and UK-based healers, the US data coming through many international collaborations, including that with Nova Institute Scholar Dr. Sara Warber. Those interviewed included many different types of healer, as well as practitioners of Western medicine and energy medicine, and members of the public.  Data included interviews with practitioners, observations of healing demonstrations, and pictorial representations of people’s concepts of healing.

Data has also been collected from “healees,” (those who have experienced healing) some of whom provided pictorial representations of their concepts and experiences of healing, and recorded their thoughts. Dr. Dieppe’s research team have been interpreting the data from both healers and healees and compared themes emerging from the US with those from the UK. Dr. Dieppe and his colleagues have also curated the pictorial representations of healing and their related dialogues into an exhibition which has been shown in hospitals in England, at medical meetings in England and the USA, at the Nova Institute for Health, and in The University of Lapland. Further insights into the nature of healing have been gained by interviewing people who have seen the exhibitions.

In another part of his Scholar project, Dr. Dieppe collaborated with University of Exeter drama scholar Dr. Sarah Goldingay and others to explore the value of healing rituals and leverage performance-based approaches to understand healing. With Dr. Rahtz from Exeter and Dr. Warber from Ann Arbor, they also visited the healing pilgrimage site of Lourdes, in South West France, and explored healing phenomena and associated rituals there.  Dr. Dieppe is also collaborating with Professor Jaana Erkilla-Hill and others in Scandinavia to explore the roles of art and creativity in healing.

In the final part of his project he is developing new theories of healing based in part on realist research, a paradigm that recognizes complexity, the importance of individual experiences, and the significance of the ideas, values, and emotions participants bring to the contexts in which interventions are provided.

He is currently writing a book on healing based on his work with the Nova Institute of Health.

Biography 

Dr. Paul Dieppe is among world’s preeminent osteoarthritis researchers and one of a small number of health researchers in the UK to have held the prestigious Senior Investigator award from the National Institute for Health Research. A recipient of a Lifetime Achievement Award from the Osteoarthritis Research Society (2010), he was made a Master of the American College of Rheumatology in 2011.

Over the past 20 years, Dr. Dieppe’s professional interests have increasingly turned to health services research, medical education and subjects such as the placebo response, patient-centered care, and healing. In 2009, he joined the University of Exeter, where he is now Emeritus Professor of Health and Wellbeing, to pursue those interests while continuing research in osteoarthritis and joint replacement.

For 10 years beginning in 1997, Dr. Dieppe was Director of the Medical Research Council’s Health Services Research Collaboration in the UK, overseeing a large national research program with 70 core staff and an annual budget of $2.5 million.

Prior to that, Dr. Dieppe was at the University of Bristol, most recently as Dean of Medicine, from 1995-1997. He was made Professor Rheumatology in 1987, and established one of world’s leading centers for osteoarthritis research, training several people who have gone on to become leaders in the field.

Dr. Dieppe came to Bristol in 1978 as an academic rheumatologist shortly after completing his medical training and education at London University and St. Bartholomew’s Hospital Medical College, London. His first degree was in physiology (First Class Honors BSc 1967) from London University.

In addition to his research career, Dr. Dieppe performed clinical work until 2011. He’s still active in undergraduate and postgraduate teaching in Exeter, Bristol and elsewhere, and speaks at numerous meetings in the UK and overseas.

Education and Training
  • MD, London University
  • MB, BS, St. Bartholomew’s Hospital Medical College, London
  • BSc (1st Class, Physiology), London University
Selected Honors
  • Master of the American College of Rheumatology, 2011
  • Lifetime Achievement Award, Osteoarthritis Research Society, International, 2010
  • National Institute for Health Research (UK) Senior Investigator Award, 2009
  • Member of the Board of the International Society for Behavioural Medicine, 2006-9
  • Fellow (honorary), Faculty of Public Health, Royal Colleges of Physicians, 1999
  • Carol Nachman Medal of the State Capital Wiesbaden for Rheumatology, 1998
  • Jan van Breeman Medal for Outstanding Contributions to Rheumatology, 1996
  • ABI Medical Community Awards, 1990, 1991
  • Roussell International Award for Osteoarthritis Research, 1989
  • Rogers Prize, London University, 1985
  • Heberden Roundsman, 1984
  • Fellow, Royal Colleges of Physicians of the United Kingdom, 1983
  • Margaret Holroyd Prize, British Society of Rheumatology, 1975
  • British Association for Rheumatology and Rehabilitation Annual Award, 1975
Selected Publications

Research Papers

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Over the past thirty years, we’ve been part of a movement to shift the primary approach to health from a focus on disease to a more complete approach. As reflected in our tagline, “For Health of People, Places, and Planet,” how we are building on “person health” and looking at the context of peoples’ lives and communities as well as the health of the planet we all share. 

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Healing is facilitated through safety, persistence, and trust.

  • Persistence: “People did not simply progress through this sequence and experience healing. The healing journey was a recursive, back and forth process. They found helpers, used the skills/resources that those helpers provided, found other helpers that provided more resources and used those skills and resources. As this process continued, people experienced a gradual amelioration of their suffering. Although many despaired at times, all demonstrated the quality of persistence—they refused to give up.”
  • Safety & Trust: “To connect to helpers, it was essential for people to feel safe in those relationships and able to trust that the person would be a helper and not a barrier to healing. Persons whose wounds included a violation of trust were especially careful about testing the safety of new relationships.”

Resources support us as we heal. They include reframing, responsibility, and positivity. “Making connections enabled participants to acquire and refine resources and skills that were essential in their healing journey. People also brought their own personal strengths to the journey.”

  • Reframing: “A particularly important skill was the ability to reframe—that is to look at suffering through a different lens.” This does NOT mean minimizing trauma or pain, but rather it often means the opposite: understanding what happened was wrong, unfair, or uncontrollable and that we are not to blame for it.
  • Responsibility: While we don’t have control over what happened to us, we are the only ones who can help ourselves heal. “A third essential resource that people acquired or refined was the ability to take an appropriate amount of responsibility for their healing journeys. They participated actively in the process of healing. Once again, some participants already had developed this skill, and some acquired or refined it from their helpers.”
  • Positivity: “Another resource that people acquired or refined during their healing journey was choose to be positive—that is to have some optimism about their situation.” People have varying predispositions to positivity. In the study, positivity was important in helping people heal. This doesn’t mean a toxic positivity, but rather simply finding some good in life and feeling hopeful about our situations.

“Connection to others was an essential part of all the healing journeys.” Humans are social creatures, and even the most introverted of us need close relationships. Friends and family add meaning and value to life and help support us, in good times and bad. 

When we experience relational trauma, relationships can feel scary, but reestablishing safety and trust in relationships is where the healing happens. (To be clear, we do not mean reestablishing safety and trust with abusers, but rather finding other healing relationships.) 

“When safety and trust had been established, people were able to connect with helpers. The nature of the behaviours of helpers that fostered healing ranged from small acts of kindness to unconditional love.”

  • “Moving from being wounded, through suffering to healing, is possible. It is facilitated by developing safe, trusting relationships and by positive reframing that moves through the weight of responsibility to the ability to respond.”
  • “Relationships with health professionals were among these but were not necessarily any more important to the healing journey than other kinds of helpers, which included family members, friends, spirituality and their God, pets, support groups, administrators, case workers and supervisors.”

Healing probably means different things to different people, but one definition that emerged from the study is: “The re-establishment of a sense of integrity and wholeness.” 

Healing was an emergent property that resulted from each individuals’ complex healing journey, a result of bridged connections between resources and relationships. “…they gradually found relief from suffering and began to exhibit emergent characteristics: a sense of hope, self-acceptance, and a desire to help others—the immediate precursors to healing.”

 In varying degrees, “they were able to transcend their suffering and in some sense to flourish.” 

  • Helping Others: We find meaning in helping others. “Understanding that suffering gives the strength and experience to help others in similar situations.”
  • Hope: We begin to have hope that we will not always feel this bad. A Crohn’s patient said, “I think gradually I realized that I was going to feel better. I did have days when I actually didn’t vomit, when I did feel better. And I think gradually I came to believe that maybe I could have a normal life again.”
  • Self-Acceptance: We see our inherent value and understand that we are not to blame for our suffering. A participant living with HIV said, “I’m really proud of myself. I think that now I still want to live. I don’t want to die, and I really love myself a lot. I have a lot of comfort in myself.”

Suffering is the ongoing pain from wounding. 

There is debate about whether or not one actually needs to experience suffering on the path to healing.

Wounding happens when we experience physical or emotional harm. It can stem from chronic illness or by physical or psychological trauma for which we do not have the tools to cope, or a combination of those factors. 

“The degree and quality of suffering experienced by each individual is framed by contextual factors that include personal characteristics, timing of their initial or ongoing wounding in the developmental life cycle and prior and current relationships.”

Characteristics: How predisposed someone may be to wounding/how many tools and resources someone may have to deal with trauma/illness.

Lifestages: Developmental timing plays an important role in the impact of trauma — young children often do not have the same resources as older adults.

Relationships: Relationships can provide solace and support for those suffering, while lack of healthy relationships can prolong suffering.