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WORK TITLE: Is It All in Your Head?
WORK NOTES: “It’s All in Your Head” is the title of the original British version published by Chatto & Windus in 2015, MV
PSEUDONYM(S):
BIRTHDATE:
WEBSITE:
CITY:
STATE:
COUNTRY:
NATIONALITY: Irish
https://www.uclh.nhs.uk/OurServices/Consultants/Pages/DrSuzanneOSullivan.aspx * http://www.npr.org/2017/01/22/511048839/treating-imaginary-illness-in-is-it-all-in-your-head * http://www.irishtimes.com/culture/books/it-s-all-in-your-head-true-stories-of-imaginary-illness-by-suzanne-o-sullivan-review-1.2654902
RESEARCHER NOTES:
PERSONAL
Female.
EDUCATION:Trinity College Dublin, M.D., 1991.
ADDRESS
CAREER
Neurologist. Royal London Hospital, neurologist; University College London Hospitals, the National Hospital for Neurology and the Epilepsy Society, 2011-.
AWARDS:Wellcome Book Prize 2016 for It’s All In Your Head.
WRITINGS
Contributor of articles to medical journals, including the Lancet, Clinical Neurophysiology, Epilepsy Behaviour, the Journal of Hand Surgery, the Irish Journal of Clinical Medicine, Irish Medical News, the Irish Medical Times, the Irish Journal of Medical Science, and the Yearbook of Hand Surgery.
SIDELIGHTS
Dr. Suzanne O’Sullivan is a neurologist and consultant at the National Hospital for Neurology and the Epilepsy Society in London, who specializes in clinical neurophysiology, neurology, and epilepsy. She previously worked at Royal London Hospital. She holds a medical degree from Trinity College Dublin in Ireland and has published academic papers on migraines, HIV infection, and neurological aspects of hand surgery in numerous medical journals, including the Lancet, Epilepsy Behaviour, Clinical Neurophysiology, and the Irish Medical Times.
In 2015, O’Sullivan published Is It All in Your Head?: True Stories of Imaginary Illness. The book explores psychosomatic illness and received the Wellcome Book Prize in 2016. In an article in the Irish Times, Wellcome Book Prize judge chair Joan Bakewell commented: “[O’Sullivan’s book is] a really good read.… You really get into the stories, and as they unfold, you realise you’re learning a lot about neuroscience along the way—and this is only possible because Suzanne is such a clear, remarkable writer.”
Delving into the misunderstood area of psychosomatic disorders, the book explores how the mind can take over the body with symptoms of illness. Psychological issues can make people take on disease traits, such as seizures, and lead many doctors to diagnose actual medical conditions. O’Sullivan explains to patients and doctors to look more closely at psychological causes of illness and why certain patients don’t respond to traditional treatment.
In an interview on “Weekend Edition Sunday” on NPR, O’Sullivan told host Lourdes Garcia-Navarro that the way patients are treated needs to change: “I think a lot of people’s lives would be made a lot easier if they could be treated both psychologically as well as having their physical disabilities treated.” O’Sullivan proposes that once a psychological cause is found, doctors should not dismiss patients as hypochondriacs and fakers, because whatever the cause of the illness, it is real illness that needs to be treated. Doctors must realize that just as there is no single cause of psychosomatic illness, there is not one cure.
In Kirkus Reviews, a contributor called the book “an intriguing look at how mental processes affect and alter our views–and feelings–of health and illness.” Bonnie Parker noted in Library Journal that O’Sullivan places a heavy emphasis on the medical theories of Jean-Martin Charcot and Sigmund Freud, adding that “this book provides an appealing viewpoint for readers with a strong interest in psychology.”A Publishers Weekly commented: “If empathy is bolstered by understanding, then this book will bring such sentiments to a rarely understood condition. It will engage readers’ heads, but also quite possibly enter their hearts.”
BIOCRIT
PERIODICALS
Kirkus Reviews, Nov. 15, 2016, review of Is It All in Your Head?: True Stories of Imaginary Illness.
Library Journal, Aug. 1, 2016, Bonnie Parker, review of Is It All in Your Head?, p. 114.
Publishers Weekly, Aug. 8, 2016, review of Is It All in Your Head?, p. 51.
ONLINE
Irish Times Online, http://www.irishtimes.com (April 26, 2016), “Irish Neurologist Suzanne O’Sullivan Wins Wellcome Book Prize;” (May 21, 2016), review of Is It All in Your Head?
London Guardian, https://www.theguardian.com (June 7, 2015), review of Is It All in Your Head?.
University College London Hospitals Web site, https://www.uclh.nhs.uk/ (May 20, 2017), professional profile.
Weekend Edition Sunday, http://www.npr.org/ (January 22, 2017), Lourdes Garcia-Navarro, interview with Suzanne O’Sullivan.
< Treating 'Imaginary Illness' In 'Is It All In Your Head?' January 22, 20178:05 AM ET 4:38 Download Facebook Twitter Google+ Email LOURDES GARCIA-NAVARRO, HOST: It costs the American health care system twice that of treating diabetes. And yet, it's not really a disease. Psychosomatic illness, where your body acts as if it's sick but there isn't anything wrong, is common and also very misunderstood, according to a new book "Is It All in Your Head: True Stories of Imaginary Illness" (ph). In it, neurologist Suzanne O'Sullivan describes some of the extreme cases she has treated and what may be behind them. She joins us now from member station KUOW in Seattle. Thanks so much for being with us. SUZANNE O'SULLIVAN: Thank you. GARCIA-NAVARRO: So let's start with a definition. What is psychosomatic illness? O'SULLIVAN: So psychosomatic illness is a disorder in which people get real physical symptoms that cannot be explained by physical examination or medical tests. No disease can be found to explain them. And there is usually believed to be a psychological or behavioral cause. GARCIA-NAVARRO: One of the things that's so fascinating about this is how these things manifest themselves. How can you tell when something is imaginary? O'SULLIVAN: I use the word imaginary in the title of this book. But really, it's to imply that these symptoms come from the imagination, but they're not imaginary. They are incredibly real. GARCIA-NAVARRO: Right. O'SULLIVAN: And when I say that they come from the imagination, it's very much to say that when you develop a disability, it must come from an idea that you have. And that idea exists in your mind. It exists in your imagination, and it's probably drawn from your personal experience. These symptoms are all often based on our ideas about our bodies, what illness we've been exposed to in the past. And then when we're faced with a particular stressful situation, those worries channel themselves into something. And unfortunately, we can make them real in that way. GARCIA-NAVARRO: In the book, you detail some of the cases that you've dealt with. You introduce us to some of your patients. Talk us through one of your cases. O'SULLIVAN: So just to give you an example of Yvonne (ph). So even as a woman who suffered a minor injury when cleaning fluid was sprayed into her eyes. She had the appropriate first aid immediately after the accident. But the following morning, she woke up and found herself to be profoundly blind. She was obviously taken to the hospital and fully investigated for this. And they couldn't find any explanation for her blindness. But Yvonne's experience was, to give you an example - in unconscious moments, she would reach out and pick something up off a table that she couldn't possibly have picked up if she had not been able to see it. But if you asked her if she could see it, she would say that she could not. GARCIA-NAVARRO: So people aren't doing it on purpose. It's mind over matter almost. O'SULLIVAN: Absolutely. It is a completely unconscious process. I think one of the things that the sufferers really worry about is that they will be accused of doing it on purpose. GARCIA-NAVARRO: What is the treatment for someone who comes in with a psychosomatic illness of this degree? O'SULLIVAN: The treatment is very individualized. So it's unlikely that two people will have the disability for exactly the same reason and will require the same treatment. So if you see someone who has suffered a significant psychological trauma that has led them to manifesting physical symptoms, that person will need help of a psychologist and a psychiatrist. But on the other hand, if you see somebody who has something like a paralysis that has been the result of a maladaptive response to injury, that person isn't going through any specific stress other than the stress of their actual disability. What that person needs is a focus on physical treatments. That person will probably benefit more from a really psychologically-minded, motivated physiotherapist and occupational therapist than they will from the help of a psychiatrist. GARCIA-NAVARRO: Do you think Western medicine needs to change? When I say Western medicine, this idea that somehow the body and the mind are treated separately - do you think there needs to be a sort of a more holistic approach? O'SULLIVAN: Absolutely. And I think that this applies to both psychosomatic disorders and to diseases in general. You know, most people with diseases like asthma, diabetes and so on will say that their symptoms are an awful lot worse during periods of psychological distress. So in every sense, our minds and our physical well-being are very closely interlinked. But unfortunately, the way we practice medicine is that the fields of psychiatry and psychology are very separate to the fields of physical medicine. I think a lot of people's lives would be made a lot easier if they could be treated both psychologically as well as having their physical disabilities treated. GARCIA-NAVARRO: Neurologist Suzanne O'Sullivan, author of the book "Is It All In Your Head: True Stories Of Imaginary Illness." Thanks so much for being with us. O'SULLIVAN: Thank you.
Dr Suzanne O'Sullivan
Dr Suzanne O'SullivanTel: 020 3448 3287
Email: Suzanne.O'Sullivan@uclh.nhs.uk
Location:
National Hosptial for Neurology and Neurosurgery
Specialities:
Neurophysiology (clinical) , Epilepsy
Professional background
I qualified in medicine in 1991 from Trinity College Dublin . I am trained in both neurology and clinical neurophysiology. I have been a consultant since 2004 and have been at The National Hospital for Neurology and The Epilepsy Society since 2011. My specialists interests are in epilepsy and in improving services for people who suffer with functional neurological disorders.
Research interests
Functional Neurological Disrders
Publications
First, do no harm
Lancet, June 2015
Impact of non-epileptic attacks on presurgical evaluation
K.Whitehead. S.O'Sullivan, M.Walker
Epilepsy Behaviour 2015 May; 46: 246-8
"Recognition of psychogenic non-epileptic seizures - a curable nerophobia?
S.O'Sullivan, R. Redwood, D.Hunt, S.O'Sullivan
JNNP 2013 84(2): 228-231
“The role of nerve conduction studies in predicting post-surgical outcome in carpal tunnel syndrome”
S.O’Sullivan, P.Mohammed, R.Milner, P.R.W.Fawcett
Clinical Neurophysiology; Vol 118 issue 5; May 2007; 153
“Carpal tunnel syndrome: the correlation between symptom severity and neurophysiological studies”
S.O’Sullivan, L.Longstaff, R.Milner, P.R.W Fawcett
Journal of Hand Surgery 2001 Oct; 26 (5) 475-480
“Carpal Tunnel syndrome: Outcome, symptoms and nerve conduction studies”
L.Longstaff, S.O’Sullivan, R.Milner, P.R.WFawcett
Yearbook of Hand Surgery 2003
“Brown-Vialetto-Van Laere Syndrome: case report and review of the literature”
S.Sathasivam, S.O’Sullivan, A.Nicholson, P.Tilly, P.Shaw
Amyotrop Lateral Scler 2000 Sep; 1 (4): 277-81
“Analgesic overuse headache – genesis, investigation and management”
S.O’Sullivan,
Irish Journal of Clinical Medicine; 1998 Nov; 27 (11)
“Migraine – treatment of acute attacks and prophylaxis”
S.O’Sullivan
Irish Medical News; Feb 1998
“Advances in the treatment of multiple sclerosis”
S.O’Sullivan, R.Murphy
Irish Medical Times; September 1997
“Acetylcholine Receptor Antibody prevalence in HIV infection”
S.O’Sullivan, F.Mulcahy, J.Redmond
Irish Journal of Medical Science May 1997; 71
Irish neurologist Suzanne O’Sullivan wins Wellcome Book Prize
Consultant takes £30,000 award for ‘It’s All In Your Head’ which focuses on psychosomatic illness
Tue, Apr 26, 2016, 08:19 Updated: Tue, Apr 26, 2016, 08:21
Irish consultant neurologist Suzanne O’Sullivan has won the Wellcome Book Prize 2016 for ‘It’s All In Your Head’ which explores psychosomatic illness. Photograph: Thomas Farnetti/Wellcome Book Prize /PA Wire.
Irish consultant neurologist Suzanne O’Sullivan has won the Wellcome Book Prize 2016 for ‘It’s All In Your Head’ which explores psychosomatic illness. Photograph: Thomas Farnetti/Wellcome Book Prize /PA Wire.
Irish consultant neurologist Suzanne O’Sullivan has won the Wellcome Book Prize 2016 for It’s All In Your Head, which explores the common - yet largely misunderstood and seldom discussed - topic of psychosomatic illness.
O’Sullivan, who previously worked at the Royal London Hospital and is now a consultant at the National Hospital for Neurology and Neurosurgery, beat five other short-listed candidates to scoop the prestigious trophy and £30,000 prize at a ceremony in the Wellcome Collection’s Reading Room in London on Monday evening.
Now in its seventh year, the Wellcome Book Prize was set up to celebrate “the best new books that engage with some aspect of medicine, health or illness”, across both fiction and non-fiction titles.
A strong mental health theme ran through all the books on this year’s short-list — which also included The Outrun by Amy Liptrot, a memoir of alcohol addiction and recovery, and Neurotribes by Steve Silberman which delves into the history of autism — but the judges were unanimous when it came to choosing the winner.
‘Impressive’
Chairwoman of the judging panel Joan Bakewell, who announced the winner, said there were a number of reasons why the “truly impressive” It’s All In Your Head — O’Sullivan’s first book, which is published by Vintage — stood out.
“First of all, it’s a really good read. It sounds funny to call a medical book a page-turner, but (when you read it) you want to keep going,” said Ms Bakewell. “You really get into the stories, and as they unfold, you realise you’re learning a lot about neuroscience along the way - and this is only possible because Suzanne is such a clear, remarkable writer.”
Marrying her clinical experience of the subject area with a series of patient case studies, including Camilla, a lawyer plagued by unexplained seizures, and Yvonne, blinded at work by cleaning spray, O’Sullivan attempts to highlight and - in many ways - validate an area of medicine that is so often subject to immense stigma and lack of support.
It is believed that as many as one in three people visiting their GP have symptoms that do not appear to have an obvious medical cause, and so it is assumed they are rooted in emotional and psychological causes, yet psychosomatic illness is often dismissed, which is why O’Sullivan says her goal for the book was to “raise awareness”.
“Psychosomatic disorders are really, really common, but for some reason people don’t talk about it. Psychosomatic illness is rarely dangerous, (in the sense that) people don’t usually die from them, but they can still destroy people’s lives, or steal their lives in other ways,” said O’Sullivan. “In my mind, (winning this prize) is a mark of respect for the patients I’m looking after.
“I hope it gives some recognition to the seriousness of the disorders and the need for us to develop better services for it. So I’m personally thrilled to have won but the whole point of the book was to bring awareness to the sorts of patients I look after, and I really hope this is going to make a big difference.”
Mental health
Bakewell notes that the book is a strong reflection of the growing appetite for medical-themed reading, particularly topics that explore the close links between physical and mental health.
“There’s more and more encouragement for writers to write these books — the publishers have got the message because the public are reading them,” she said. “(Some of these topics) might sound rather arcane and unusual, but the public get it, so there are more and more books coming out about this sort of thing.”
O'Sullivan, Suzanne: IS IT ALL IN YOUR HEAD?
(Nov. 15, 2016):
Copyright: COPYRIGHT 2016 Kirkus Media LLC
http://www.kirkusreviews.com/
O'Sullivan, Suzanne IS IT ALL IN YOUR HEAD? Other Press (Adult Nonfiction) $26.95 1, 17 ISBN: 978-1-59051-795-6
Feeling out of sorts? Take two imaginary aspirin and call us in the morning.Trained in both neurology and clinical neurophysiology, British doctor O'Sullivan sometimes strays from both fields to enter the realm of psychology and the within-mind processes that can make an otherwise healthy person feel very sick indeed. As she writes, her early experiences came in a study of people with epilepsy who were not responding to standard treatments--not responding, it turns out, because 70 percent of them were not really suffering from epilepsy but instead from psychological troubles. "And each person I encountered had a story to tell," she writes, "and too often that story was one of a journey through the hospital system that led them to no satisfactory understanding of what was wrong." In all this, long-ignored standards become relevant anew, and diagnosis by way of analysis becomes ever more critical, since, as the author notes, people themselves are rather untrustworthy witnesses to and interpreters of their own experience--and "distressed, frightened people are more unreliable still." Blending well-spun anecdote with a gently worn survey of the current medical art, O'Sullivan examines the strengths and weaknesses of approaches to psychosomatic disorders (which "are noteworthy for how little respect they have for any single part of the body") and stress-related neuroses and illnesses, some of them rare, some of them so commonplace that we scarcely notice whether someone has them or not; some "somatic symptom disorders" happen as a result of readily identifiable trauma, but some are not obvious and even secretive. As a result, the author concludes, just as there is no single cause of psychosomatic illness, neither is there a single cure. "To look for one," she notes, "is akin to looking for the cure for unhappiness." An intriguing look at how mental processes affect and alter our views--and feelings--of health and illness.
Source Citation (MLA 8th Edition)
"O'Sullivan, Suzanne: IS IT ALL IN YOUR HEAD?" Kirkus Reviews, 15 Nov. 2016. General OneFile, go.galegroup.com/ps/i.do?p=ITOF&sw=w&u=schlager&v=2.1&id=GALE%7CA469865636&it=r&asid=dad864a049d749f71523ae7d9d5675db. Accessed 27 Mar. 2017.
Gale Document Number: GALE|A469865636
Is It All in Your Head? True Stories of Imaginary Illness
263.32 (Aug. 8, 2016): p51.
Copyright: COPYRIGHT 2016 PWxyz, LLC
http://www.publishersweekly.com/
Is It All in Your Head? True Stories of Imaginary Illness
Suzanne O'Sullivan. Other Press, $26.95 (304p) ISBN 978-1-59051-795-6
By altering the conventional discussion surrounding psychosomatic illnesses, O'Sullivan helps laypeople recognize the reality of a problem that is often treated dismissively, in and outside of the medical field. A consultant in neurology, she is most interested in diseases that occupy the unconscious, their symptoms unmeasurable and their causes unknown--conditions that might be revealed by technologies like MRI but remain essentially mysterious. Each chapter of this book presents a case study, lending vivid life to patients with psychosomatic disorders, along with extensive context for everything including the bygone diagnosis of "hysteria" and the dawn of neurology as a medical profession. Seizures, still difficult to account for and treat, receive extensive attention. And this study is not just about the patients, but the intricacies, the inevitable challenges, of the doctor-patient encounter. Given repeated emphasis is the stigma of diagnosis--a stigma that O'Sullivan combats through her dedication to the individual stories she tells. If empathy is bolstered by understanding, then this book will bring such sentiments to a rarely understood condition. It will engage readers' heads, but also quite possibly enter their hearts. Agent: Kirsty McLachlan, David Godwin Associates. (Jan.)
Source Citation (MLA 8th Edition)
"Is It All in Your Head? True Stories of Imaginary Illness." Publishers Weekly, 8 Aug. 2016, p. 51. General OneFile, go.galegroup.com/ps/i.do?p=ITOF&sw=w&u=schlager&v=2.1&id=GALE%7CA460900387&it=r&asid=3fee9d24ce82aefb089d603f5b766fc5. Accessed 27 Mar. 2017.
Gale Document Number: GALE|A460900387
O'Sullivan, Suzanne. Is It All in Your Head? True Stories of Imaginary Illness
Bonnie Parker
141.13 (Aug. 1, 2016): p114.
Copyright: COPYRIGHT 2016 Library Journals, LLC. A wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
http://www.libraryjournal.com/
O'Sullivan, Suzanne. Is It All in Your Head? True Stories of Imaginary Illness. Other. Jan. 2017. 304p. ISBN 9781590517956. $26.95; ebk. ISBN 9781590517963. HEALTH
Following her 2016 Wellcome Book Prize winner, It's All in Your Head, Epilepsy Society neurophysiology consultant O'Sullivan's latest encourages rethinking the ways in which the subconscious influences physical health, providing a catalyst for discussion about the intricacies of cognitive processes and the organic expressions of maladies. Unlike Jo Marchant's Cure, which concentrates on the mind's ability to alleviate illnesses, this title focuses more on cause rather than remedy. A major weakness is this work's lack of scientific research and data to support its conclusions. However, the anecdotal evidence of the case studies does invite a closer analysis of the origins of the patients' disorders, and the sympathetic tone of the author differs from the typical clinical attitudes toward the mind-body connection. VERDICT With heavy emphasis on the medical theories of Jean-Martin Charcot, Pierre Janet, and Sigmund Freud, this book provides an appealing viewpoint for readers with a strong interest in psychology. It also allows those with medical conditions to explore any overlooked nonphysical causes of their ailments.--Bonnie Parker, Southern Crescent Technical Coll., Thomaston, GA
Source Citation (MLA 8th Edition)
Parker, Bonnie. "O'Sullivan, Suzanne. Is It All in Your Head? True Stories of Imaginary Illness." Library Journal, 1 Aug. 2016, p. 114. General OneFile, go.galegroup.com/ps/i.do?p=ITOF&sw=w&u=schlager&v=2.1&id=GALE%7CA459805115&it=r&asid=db3d8440b9326cf9843a9f8544678e15. Accessed 27 Mar. 2017.
Gale Document Number: GALE|A459805115
It’s All in Your Head: True Stories of Imaginary Illness by Suzanne O’Sullivan review
Winner of the Wellcome Book Prize 2016, a neurologist writes compelling cases of physical illnesses that have no apparent cause
Suzanne O’Sullivan with the Wellcome award for her book on psychosomatic illness. Photograph: Thomas SG Farnetti
Suzanne O’Sullivan with the Wellcome award for her book on psychosomatic illness. Photograph: Thomas SG Farnetti
Brian Dillon
Sat, May 21, 2016, 01:25
First published:
Sat, May 21, 2016, 01:25
Book Title:
It’s All in Your Head: True Stories of Imaginary Illness
ISBN-13:
978-0099597858
Author:
Suzanne O’Sullivan
Publisher:
Vintage
Guideline Price:
£8.99
As a nervous young thing in my 20s I suffered from an alarming case of the shakes – proper bobblehead-doll stuff, hard to hide – whenever I was faced with an even mildly fraught encounter: academic, romantic or bureaucratic. The tremors only stopped when I taught myself to locate the fear instead in the pit of my stomach; my guts might now be in flitters, but at least I made a less puzzling or comic interlocutor.
As Suzanne O’Sullivan points out in her rich and wise study of psychosomatic illness, we have all been there or thereabouts, converting our emotional turmoil (and even elation) into physical symptoms of greater or lesser gravity.
The more serious somatic disorders have been recognised since the time of Galen, who around 150 AD wrote of a woman whose racing pulse “points to a troubled mind”. But such “imaginary” ailments remain vastly misunderstood by physicians and patients alike – not to mention the family, friends and colleagues whose attitudes to the hapless somatiser may be ruinously enabling or painfully dismissive.
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O’Sullivan, born and educated in Ireland, is a consultant neurologist at the Royal London Hospital. As a medical student she was tempted to laugh at the “worried well”, the transparent hypochondriacs and shameless malingerers who any doctor meets regularly. But 20 years of practice have shown her how much real suffering can be accompanied by so little evidence of organic disease.
Much of her book, which recently won the Wellcome Book Prize for writing about health and medicine, comprises sadly compelling accounts of bodies wracked and lives corralled by real illness with no apparent origin.
There is Pauline, a 27-year-old who has suffered seizures, infections and paralysis since her mid teens. There is Matthew, who thinks he has MS and arrives with a hefty ream of medical articles and a strained-looking wife. And Camilla, a successful lawyer suddenly prey to violent seizures that leave her feeling degraded by medical attention and public scrutiny, even mockery.
Many, or most, of these patients will ardently deny the presence of any stress or trauma that might have brought on their symptoms. This is one of the larger contradictions O’Sullivan describes. We live at a time when it’s readily credited that emotional vexation will lead to physical infirmity, and conversely (for better or worse) that “we can think ourselves better” with a positive outlook or attitude. And yet it is extremely hard for O’Sullivan’s patients to admit to any predisposing backstory.
Illness always seems to have fallen out of a clear black sky; as John Donne put it in his sick-bed Meditations: “This minute I was well, and am ill, this minute.” O’Sullivan’s job is thus, once the presence of physical disease has been ruled out, to lead the patient as sensitively as possible towards the realisation that something else has been causing his or her illness.
The task is just about as difficult as it sounds, given the complex of fear and conviction typically in play. O’Sullivan mostly sticks, in her writing and in the consulting room, to the current medical terminology, describing “conversion disorders” and “dissociative seizures”. But there comes a time when she has to venture to some word with the prefix “psycho” in it, and here is where things go awry. It’s not unusual to have an aggrieved patient say to her: “So now I’m a psycho, am I?”
It is sometimes preferable in these people’s minds to continue suffering their physical symptoms rather than give in to a diagnosis of what they will still, in rage and fear, call “madness”.
The problem is compounded when there hovers a suspicious and supportive community around a preferred diagnosis. O’Sullivan devotes a chapter to the story of Rachel, who clings to the relative consolation of chronic fatigue syndrome and baulks at the notion her thoughts and feelings may be part of the clinical picture.
These patients seem to believe, perhaps despite themselves, in a strict mind-body dualism that historically has had little currency even among the sternest materialists. As O’Sullivan points out, psychosomatic illness has not always felt so shameful. Of course nowadays we recognise that historical ailments such as hysteria and neurasthenia did not really exist as such – there were no wandering wombs, nor flayed nerves – but by the end of the 19th century patients and doctors alike were at ease with the idea that in these diseases mind and body were subtly convolved, and might be therapeutically prised apart.
O’Sullivan interleaves among her case studies a history of medical understandings of the action of feelings on flesh: from 17th-century theories of hypochondria, through the neurologist Jean-Martin Charcot’s studies of hysteria, to Freud’s clinical detective stories about the devious ways the mind acts on the body.
Though she is critically aware that some of these physicians themselves began new trends in imaginary illness, O’Sullivan can seem at times a touch too credulous about the model of the unconscious mind that they developed. Are we really to believe, in a straightforward way that Freud would likely never have countenanced, that emotional problems “leak out” into bodily pain?
Several of the clinical tales in It’s All in Your Head conclude with O’Sullivan sending her patients off for psychiatric assessment or a course of cognitive-behavioural therapy, as if their problems are solved with the realisation they’ve unconsciously contrived their symptoms.
But what if such knowledge is only the start of a more troubling insight into one’s case, or into the state of being a person? What if, like many self-conscious hypochondriacs, you watch the relay between worry and pain play out time and again, till at last a definitive disease comes to take you away?
O’Sullivan’s book does not describe the metaphysical chasms that illness opens up, but it is an impressively vivid and sympathetic argument for the reality of the mind’s more harrowing inventions.
Brian Dillon is the author of Tormented Hope: Nine Hypochondriac Lives. His most recent book, The Great Explosion, has been shortlisted for the RSL Ondaatje Prize
It’s All in Your Head review – enduring mystery of psychosomatic illness
Neurologist Suzanne O’Sullivan’s excellent book reveals that medicine remains as much an art as a science
Hippocrates
Hippocrates noted the role of emotion in illness as far back as 400BC. Photograph: World History Archive/Alamy
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Tim Adams
Sunday 7 June 2015 06.30 BST
Last modified on Wednesday 22 February 2017 18.11 GMT
Suzanne O’Sullivan qualified as a doctor in 1991. She is now a consultant at the National Hospital of Neurology and Neurosurgery in London. This, her first book, is an account of her experience over 20 years of the many conditions that exist in that much disputed no man’s land between psychological and physical illness. The patients she examines in these pages often have dramatic symptoms – blindness, paralysis, seizures, intense pain and chronic fatigue – but they are symptoms related to no identified disease or physical cause. By the time these patients come to O’Sullivan they have generally exhausted every scan and endoscopy the NHS can provide, as well as the patience of doctors and specialists in different fields. She is often there to tell them the last words that they generally want to hear: that the very real agony that they may feel in head or gut or back or limb is all in their mind.
To O’Sullivan that is never a trivial diagnosis, no matter how it sounds. Psychosomatic illness, the experience of physical symptoms brought about by emotional states, is not a new phenomenon, though arguably it has reached pandemic proportions with the self-diagnostic possibilities offered by the internet. O’Sullivan traces it at least as far back as Hippocrates in 400BC, who noted, for example, that emotion alone could trigger sweating and cause the heart to beat double time. As a result of such observations Hippocrates believed that a physician must treat disturbances in the mind as well as the body. Two millennia before Freud he was analysing the dreams of his patients for signs of mental distress that might be causing physical illness.
The evidence for what were later called “hysterical” patients is not only traceable back to the beginnings of medicine, it is also common to all cultures. A 1997 World Health Organisation study showed that rates of illness with “medically unexplained symptoms” were almost identical in developed and undeveloped countries – availability of healthcare had no effect on the numbers – and accounted for 20% of patients worldwide, many of them entirely incapacitated. A 2005 study suggested that the annual cost to the American health system of psychosomatic illness was $256bn – then double that of diabetes.
It is figures such as these that lead O’Sullivan to argue that the medical profession can rarely be an objective science. That diagnosis necessarily starts from the principle that “everybody’s experience of illness is their own… moulded by life experience and personality”. And, further, that “if you take 100 healthy people and subject them to the exact same injury you will get 100 different responses. That is why medicine is an art.”
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Some of its more avant-garde subjects have faced O’Sullivan in her treatment room. Her experience of this type of patient began when she was just qualified as a junior doctor, watching a woman she calls Yvonne being questioned by her consultant. Yvonne, after an accident in which she had been sprayed in the face with window-cleaning fluid, had convinced herself and her family that she was blind. After six months of tests doctors had found nothing wrong with her eyes. She was by this time on disability benefits with a full-time carer, unable to get around her house. O’Sullivan and her fellow junior doctors, certain she could see, found it hard not to suppress giggles as Yvonne described her condition. They were reprimanded by the consultant. The cause of Yvonne’s blindness was psychological rather than physical – a response, it later seemed, to unbearable tensions in her marriage. It was to her no less real, however: she had subconsciously persuaded herself that she had lost her sight. After six months of psychiatric help and family counselling, O’Sullivan reports, Yvonne’s vision was restored.
It is O’Sullivan’s contention that “psychosomatic disorders are physical symptoms that mask emotional distress”. In the 19th century sufferers of such conditions were paraded by the celebrated neurologist Jean-Marie Charcot, who revealed to sold-out audiences how such states could be induced by suggestion and hypnosis. Even with fMRI scans and advances in neural imaging, the means by which thought alone can conjure physical pain is an unfathomable mystery. “One day a woman loses the power of speech entirely and the next she speaks in the voice of a child. A girl has a lump in her throat and becomes convinced she cannot swallow. Eyes close involuntarily and no amount of coaxing will open them.” Each of O’Sullivan’s patients is different; however, buried trauma or stress (itself an undefined cause and effect) seems often to be a trigger.
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Sometimes the proximity to a “real” illness causes transference. A person with a family member with a brain tumour is more likely to experience violent headaches. The close friend of an epileptic is more prone to dissociative seizures. There is some evidence that doctors treating motor neurone patients become acutely aware of their own muscle cramps. Sometimes the media can prompt psychosomatic epidemics. In the 1990s O’Sullivan was inundated with patients who thought they had symptoms related to candida, which had been popularised as being rife at the time. These symptoms had been widely disseminated in magazines and newspapers as a feeling of being run-down, constantly bloated, with itchy ears and a craving for sugar. Almost everyone, if they paid undue attention to their bodies, O’Sullivan suggests, might have noticed those symptoms. A few put them down to candidiasis. “Patients rarely ask me about candida any longer,” O’Sullivan notes. “In the 21st century exactly the same symptoms are more likely to be attributed to gluten sensitivity or allergies.”
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A lot of information can be a dangerous thing. Matthew arrives in her clinic in a wheelchair, apparently unable to walk and utterly convinced he has multiple sclerosis. His problem began when he experienced a feeling of pins and needles in his foot a few times while sitting working. The doctor who examined him told him to “stop thinking about it and it will disappear”. But Matthew was among those individuals who could not stop thinking about it. Months after he started to tick off the other early warning signs of MS – tiredness, dizziness and the rest – he had become housebound and had lost the power to use his legs for no reason other than that belief.
O’Sullivan believes in the “reality” of Matthew’s symptoms in turn, but her suggested referral to a psychiatrist, as so often, is met with anger and suspicion (sometimes, in similar circumstances, she has received legal letters). In reality, her diagnosis in such instances is as much philosophical as medical. It lies in the fact that much about the relation of mind and body is unknown and possibly unknowable. The tendency to respond to every inexplicable bodily sensation may be ignored in most of us, but not in all of us, particularly if it becomes part of a pattern masking or deflecting some other stress. Who is to say that transference is “imaginary”? Certainly no one who has ever blushed, or felt tension in their neck and shoulders because of “stress”. Is there a cure for this human condition? You might begin by reading O’Sullivan’s book, but though it may put some minds at rest, I suspect others will not get far into it before calling their GP for an urgent appointment.
It’s All in Your Head is published by Chatto & Windus (£16.99). Click here to order it for £13.59