True Stories of Imaginary Illness

It's all in your head
Wikimedia Commons
It's all in your head

It's All In Your Head: True Stories of Imaginary Illness by Suzanne O'Sullivan

If you had an illness and it was diagnosed as being "functional", a "conversion disorder", "psycho-somatic", or "psychogenic" – all ways of saying, in increasing order of certainty, that the illness was caused not by your body but by your mind – how would you feel? Insulted and angry? Keen for a second opinion?

These are the reactions that the author, Dr Suzanne O'Sullivan, routinely receives in her work as a consultant neurologist, a field in which she estimates that up to one-third of patients have symptoms caused by their emotions. There is, as she argues in this vital, engaging book, an urgent need for destigmatisation.

The author was sceptical as a medical student when she encountered a patient she calls Yvonne, who was selectively blind. Tests confirmed that Yvonne had no eye damage, and she was occasionally caught doing some small sight-requiring task, although she insisted she could not see.

Dr O'Sullivan was drawn to Yvonne, at first with a fascination that was "not entirely honourable", then increasingly with the compassion which is a trademark of this book.

According to Dr O'Sullivan, the body sometimes manifests pain that cannot be faced emotionally. Yvonne's controlling husband had made her resign from the supermarket job she loved, and her temporary blindness was an expression of that. Occupational therapy and psychiatry cured her.

Examples of seizures, paralysis, gastric pain and headaches are all shown here as results of the subconscious at work, protecting the individual from his or her demons. "Sometimes failing through illness feels better than just failing."

We meet a few malingerers – the woman whose one dilated pupil concerned the neurology ward until she was discovered self-administering drops to dilate it – and even for them, Dr O'Sullivan has empathy, explaining that growing up with a parent off work because of illness, you can unconsciously copy that example later in life. Similarly, growing up with siblings who have epilepsy makes you more likely to develop pseudo-seizures. Never underestimate human suggestibility.

Easily combining history of medicine with anecdote, this holds its own with recent bestsellers Do No Harm, the memoir of a neurosurgeon, and The Examined Life, by psychiatrist Stephen Grosz. The tone is lifted by the author's heartfelt appeal for medical reform and wider social awareness. "If a patient can accept the psychogenic component of the illness, they are far more likely to fully recover."