It's All in Your Head

by Suzanne O'Sullivan

A neurologist's insightful and compassionate look into the misunderstood world of psychosomatic disorders, told through individual case histories

Genres: Nonfiction, Psychology, Science, Medicine, Medical, Health, Mental Health

326 pages, Hardcover

First published June 4, 2015

About the author

Suzanne O'Sullivan is an Irish neurologist working in Britain who is the winner of the 2016 Wellcome Book Prize. She won for her first book, It's All in Your Head: True Stories of Imaginary Illness, published by Chatto & Windus in 2015. The book also won the Royal Society of Biology General Book Prize.

Reviews

[Petra X · Rating 4 out of 5]

I well knew the power of the mind over the body since I was 13 and 'gave' myself appendicitis. I had a test on Anna Karenina and hadn't read the 800 page book. I said I had a tummy ache and went to the school sick room and read all day.

That night I had to go to Hebrew school and I had forgotten about a test so I said I had a tummy ache and drew a picture until my father came to pick me up and I went straight to bed to read Anna Karenina for the test next day still feigning pain.

At midnight I woke in excruciating agony with tummy ache. At 4 a.m. I had an emergency appendectomy and was so ill I was in hospital for 3 weeks (and missed the Anna Karenina test and won third prize in a national art competition since my parents sent off my drawing. I got a WH Smiths gift voucher.)

Fairly early on in the book, the author says that there was a test with a CAT scan. There were three elements to the test. First the sufferer of the psychosomatic illness which had intractable physical symptoms had a scan. Secondly normal students then had a brain scan. Then the students were asked to pretend to be ill with the same symptoms.

You would think that the scans from the pretence and the "all in the head" patient would be identical wouldn't you? But they weren't. All three scans were different. A psychosomatic illness is quite genuine, it's not the consciousness faking it, it's the brain reacting to an issue with physical symptoms. No one would know they were doing it, it's not under their control, if it was they could stop it and wouldn't have worked their way up through many doctors and tests to seeing a consultant neurologist.

Yet the doctor, nor anyone else it seems tells ME sufferers of these scans that would prove their illness is not imagined (despite the stupid eye-catching title no doubt imposed by the publisher), that they are not faking it, that just because the symptoms have a psychosomatic rather than pathological base, whether they started from a physical issue or not, their illness is very real.

ME/CFS Quote from the author: "To include ME/CFS in a book primarily concerned with the description of those suffering psychosomatic illness is foolhardy to say the least. A fierce argument has raged for decades between those who consider this to be a purely organic disorder and those who view it as psychologically driven."

So she knew what she was getting into! However some of these ME sufferers are really out of order. The UK's prime researcher into ME/CFS has endured years of abuse and even death threats for his work instead of praise. His "crime"? He is a psychologist!

The cases are interesting to a degree, but we never learn what happens in the future - do they get something else psychosomatic as I do, or are they cured, and if so exactly what treatment physical (the symptoms are real and often treatable with drugs or physiotherapy) and psychological helped. What we learn is extreme details of the patient's life, their every symptom, the possible causes of the psychosomatic illness, their resistance to not having it diagnosed as a physical illness which either caves in or it doesn't, but one way or another, the author, a neurologist doesn't see them again.

The book goes into too much unnecessary detail. It needed an editor to say, 'get to the point; and it needed a less sensationalist and fake title. A five star book for interest, but 4 stars for reading quality.
_________

Notes on reading I do not feign illness! But I do have a real problem with psychosomatic ones. We all get stress headaches, children get tummy aches a lot, stress becoming physical is common. But I have the unfortunate mind/body connection that I suffer from them quite often and I never know what symptoms they will exhibit. My son says when I get some symptom or other again, "Well it's not as a bad as the last one," or "you are stressed again." I don't feel my symptoms are any less real because my mind rather than a bacteria caused them because I accept the opposite too: positive thoughts can often help heal a pathological illness. I still go to work, I do not let some of the really rather awful symptoms like hayfever that affected me for hours each day stop me from anything.

Luckily I haven't got any right now.

[Nasim Marie Jafry · Rating 1 out of 5]

I imagine the publisher was excited by Dr O'Sullivan's 'ideas' - I saw the words 'groundbreaking' and 'controversial' in one of the blurbs. Imaginary illness carries notions of madness across the centuries, as readers we are intrigued - and seduced. However, having read in detail the chapter 'Rachel', which deals with a young woman with 'ME/CFS', I can say that the book is certainly not groundbreaking, but rather, in the case of ME, an irresponsible recycling of a dying - very dangerous - narrative which has been perpetuated by psychiatrists since the nineties. And having dipped into the other chapters, I'm afraid I find her style to be rather unengaging and toneless, though I wonder also if that is a kind of clinical constraint.

So her *ideas* must be sparkling and new if I am to be pulled in.

While vigorously suggesting that patients with myalgic encephalomyelitis (ME) have false illness beliefs, she then bases the entire chapter on her *own* beliefs. There is no evidence whatsoever to prove that ME is psychosomatic. There is however growing robust evidence that ME is a complex, multi-systemic neuroimmune illness, and the key to unlocking the puzzle is ever nearer - biomedical researchers worldwide are excited and hopeful about finding a unique biomarker. Dr O'Sullivan acknowledges that there is evidence of immune abnormalities but then chooses to ignore them completely and goes off on her wild somatisation spree. She seems not to *want* the science to progress, so zealous is she in her beliefs.

The whole chapter on 'Rachel' is manipulative and incoherent, illuminating only in what it omits. I know what the gaps are, so I can see the huge holes. She wrongly says that graded exercise (GET) is the most effective treatment, even although this treatment has been thoroughly discredited, it makes patients worse. This psychologising of ME is extremely harmful to patients, as patients and true specialists have been pointing out for years.

I have had virally-triggered ME since 1983 - I was nineteen years old, an undergraduate, unlucky to get a nasty enterovirus - and was diagnosed by a consultant neurologist, after EMG and muscle biopsy and many blood tests, which confirmed abnormalities. I had been ill for eighteen months at the time of diagnosis, steadily getting worse, and, of course, had never heard of ME then, few people had (I didn't go upstairs to my room and google). My initial treatments included a plasma exchange with immunosupression, and anti-viral drugs. And yet Dr O'Sullivan denies hotly in her book that immunotherapy is used for ME, anywhere. She also seems unaware of the anti-cancer drug trial going on in Norway just now. The scientists have recently been in London discussing their trial at an annual ME conference, which attracts scientists from all over world.

She also fails to mention the huge confusion caused by the different criteria for ME - the CFS (chronic fatigue syndrome) label was introduced in late eighties in UK and the criteria for ME were widened and diluted, with the result that anyone with unexplained 'chronic fatigue' was being diagnosed with ME. This conflation of 'classic ME' and CFS has caused a major headache for patients (no pun intended). Patients who *do* have psychiatric-based fatiguing illness are sometimes being misdiagnosed with ME. The conflation has, naturally, caused immense problems with research; moreover, severely ill/bedridden patients with actual ME are not being included in trials.

O'Sullivan also makes no reference to post-exertional malaise (PEM), which is unique to ME - exhaustion (physical and mental) after trivial exertion - she talks only generally of 'fatigue'. She ignores the disabling cognitive dysfunction - Rachel has some concentration problems but O'Sullivan does not describe the classic ME 'brain fog', which all of us w ME experience as a kind of 'dementia'. We routinely forget everyday words, we mix words up, we forget people's names, we cannot remember simple facts, we leave taps on. Neither does she mention orthostatic intolerance, the inability to be upright, stand for long, another cardinal feature. Indeed, many people with ME have full-blown POTS (postural tachycardia syndrome). She basically excludes all the symptoms of ME in her discussion, bar 'fatigue'. She seems to think managing ME is managing fatigue, and Rachel 'fails' in her management. Naughty Rachel.

I honestly wonder if Dr O'Sullivan truly believes what she has written or if she needed to pad out her book as she didn't have enough real psychosomatic illnesses for the pot. And she knows writing about ME as a psychiatric illness will be immediately controversial - even when she is wrong. Whatever her motive, she has failed spectacularly to keep up with the research and she has insulted not only ME patients but the whole scientific community engaged in ME research.

*I just want to add that this may be one of the most revealing passages in the ME/CFS chapter:

'In my early years training in neurology I encountered many patients with CFS, but more recently neurologists have distanced themselves from this disorder and patients are more likely to seek help from immunologists or endocrinologists. I do not currently see patients for the purpose of diagnosing or treating ME/CFS, but many of my patients with dissociative seizures have a history of ME/CFS, and there is something very interesting in that fact alone.'

There is something very interesting in the fact that Suzanne does not seem to have actually met (m)any patients with classic Ramsay-ME (in 1990s when she was training, the Wessely/CFS/psychiatry school was just taking root, so it's hard to know what was actually wrong with the 'CFS' patients she was seeing).

I reiterate: Rachel, the case study with ME/CFS is, to my mind, an artificial construct, a composite character with the 'behaviours' of ME patients - internet diagnosis, increasingly helpless, 'over-helpful' parents - that the Wessely school adores. Rachel rejects the psychiatric treatment offered her. We never find out what happens to her, though Suzanne says: 'The impact of our emotional well-being on our health is not a trifling problem. I only wish I could convince Rachel of this'.

O'Sullivan also fails spectacularly to describe the experience of probably all of us with ME, of pushing ourselves to 'recover' only to relapse catastrophically. Her apparent lack of contact with patients who actually have ME - coupled with not following the science - would perhaps explain why she felt that including ME in a book of imaginary illnesses was acceptable.

[Emily B · Rating 4 out of 5]

A very interesting and informative read for sure. Many of the case studies in this book have stuck with me since I’ve read this book.
It wasn’t too scientific or medical and therefore was not too laborious to read. IT had a good balance between information and the telling of people’s stories

[Maik Speedy · Rating 1 out of 5]

It saddens me to see that a so badly researched chapter about ME/CFS, a disease which has been classified as a neurological disease by the WHO since 1969, was published in this book.

In February 2015 the IOM, the Institute of Medicine, a prestigious American Institute, came out with a report about ME/CFS concluding that ME/CFS "is a medical—not a psychiatric or psychological—illness"
http://www.ncbi.nlm.nih.gov/pubmed/25...

On the 2nd of April 2015 prof Newton published an article in which she let muscle biopsies from ME patients and healthy controls exercise in the laboratory and found 4 metabolic abnormalities in ME/CFS. Which clearly proves that ME/CFS is a physical disease and that this disease has got nothing to do with false illness beliefs, being psychosomatic etc.
http://journals.plos.org/plosone/arti...

In January 2015 exercise physiologist professor Betsy Keller from New York wrote:
"Given what we have learned in the past eight years about this illness, it is intellectually embarrassing to suggest that ME is a psychological illness." 
http://niceguidelines.blogspot.com/20...

And exercise physiologists measure things like VO2 max, contrary to psychiatrists who don't measure anything.

In October 2011 two Norwegian oncologists published their Rituximab study which suggest that ME/CFS is an autoimmune disease.
http://www.plosone.org/article/info:d...

And these are only a number of the thousands of articles showing physical abnormalities in this disease.

It's very sad to see doctors like Dr O'Sullivan ignore evidence which doctors shouldn't do and as Professor Hooper wrote a few years ago, when does ignoring evidence by doctors become serious professional misconduct ? 
http://www.meactionuk.org.uk/Hooper-s...

It's very clear that Dr Suzanne O'Sullivan ignored all the evidence that what she says is wrong and therefore crossed that line as mentioned by professor Hooper, by a mile.

So what should happen is that this neurologist faces disciplinary action from the GMC, the General Medical Council in the UK. Furthermore, Dr O'Sullivan and her publisher should issue a public apology, the book should be recalled and the chapter she wrote about ME/CFS should be removed from the book.

[Rebecca · Rating 3 out of 5]

O’Sullivan is a UK-based neurology consultant. I picked this up from the bestsellers shelf of the library on a whim because I knew it had won the Wellcome Book Prize, awarded to a fiction or nonfiction book on a medical subject. The kinds of conditions she writes about go by many names: psychosomatic illnesses, conversion disorders, or functional conditions. In every case the patients have normal neurological test results – they do not have epilepsy or nerve damage, for instance – but still suffer from dissociative seizures or lose the use of limb(s). Their symptoms have an emotional origin instead.

“Psychiatric disorders manifesting as physical disease are at the very bottom of [the] pile,” O’Sullivan writes. “They are the charlatans of illnesses.” Indeed, early in her career she was likely to assume such patients were shamming. Although she does describe two patients who through video recordings were found to be faking seizures, in most cases the symptoms are real, but arise from the subconscious rather than a physical cause. Along with cases from her own career, the author writes about early doctors who developed the science of conversion disorders, including Jean-Martin Charcot and Sigmund Freud.

I read the book very quickly, almost compulsively; these are fascinating stories for anyone who’s interested in medical mysteries. That’s in spite of the fact that O’Sullivan does not strike me as a natural storyteller: her accounts of patients’ cases are often no more than just one thing after another, and in reports of her own conversations with patients she comes across as almost robotic and not always very compassionate. Ultimately I believe she does empathize with those with psychosomatic illnesses – otherwise she wouldn’t have written a whole book to illuminate their plight – but it would have taken the writing skill of someone like Atul Gawande for this to be a better book. I’m pretty surprised this won a major prize.

Note: Many of the low ratings you’ll see for this book are in relation to Chapter 7, about CFS/ME/fibromyalgia. These are controversial fatigue disorders, and O’Sullivan is aware that even mentioning them in a book about psychosomatic illnesses is “foolhardy to say the least.” I don’t think what she actually has to say about these conditions is offensive, though (and I say that as someone whose mother struggled with fibromyalgia for years). She allows that there may be physical triggers, but that emotional well-being and traumatic experiences or regular stress cannot be overlooked.

Chew on this: “More than seventy per cent of patients with dissociative seizures and chronic fatigue syndrome are women.” The author’s best guess for why this is? “On the face of it, women turn their distress inward and men turn it outward.”

Many of her patients are outraged by referral to a psychiatrist, as if they’re being told they’re making it all up, but it’s actually a holistic approach: acknowledging that the mind has a big influence on how we feel.

[Petra · Rating 3 out of 5]

Suzanne O'Sullivan is a neurologist consultant based in the UK. In It's All in Your Head: True Stories of Imaginary Illness she details the case histories of various patients who present with neurological symptoms. However, these patients have normal neurological test results, no organic cause can be found for their illness, but they still suffer from e.g. dissociative seizures or have lost the ability to move a limb. They suffer from a psychosomatic disorder. The cause of this is attributed to the patients' subconscious, their emotional well-being relating to present or past emotional stress and/or trauma. As psychosomatic illness is still "a socially unacceptable disorder", many of O'Sullivan's patients react in a defensive, sceptical, or even furious manner when faced with the suggestion to consult a psychiatrist, "so I'm crazy (mad)/a psycho now?"
I was really interested in reading this book because the best and most useful internship I spent during my training were four months in a psychosomatic clinic. In the end, it took me forever to finish this book. That's not to say that it wasn't good, but Ms O'Sullivan isn't a natural storyteller. In addition, the structure of the book made it really difficult to stay with it. The case studies, which I was most interested in, are interrupted by long passages providing historical background covering Charcot, Freud etc.
By the time the author returned to talking about a particular patient again, I often had trouble remembering who that patient was. Ok, maybe my problem as well for having a rubbish memory, but I wish the book had been structured differently.
In general, this is an informative introduction to psychosomatic disorders, especially if you are also interested in gaining some insight into the history of medicine/psychology, but I was keen to find out more about how these patients fared once they were transferred to a psychiatrist and how they dealt with their diagnosis. But I guess that doesn't fall within Dr O'Sullivan's remit, so I appreciate that some information was missing.
Some chapters, as shown by some reviews of this book, are controversial depending on your opinion regarding psychosomatic illness. Overall, I found O'Sullivan's stance respectful and empathetic. She comes across as a compassionate and honest medical professional. The title of the book isn't particularly helpful because the point is that these are not "imaginary" illnesses, as O'Sullivan points out herself, but very real for the tormented patients.
Recommended if you're interested in finding out about the power of the mind over the body and you like a solid introduction to psychosomatic disorders.
I received an ARC via NetGalley.

[Sergio Mori · Rating 2 out of 5]

It has some interesting bits but all in all it has two massive flaws:
1) the title. She doesn't consider them to be imaginary. It's just an annoying marketing ploy.
2) the biggie for me: she doesn't follow up the cases so we don't know if they are success stories or not. For all we know, patients could have been leading a more functional and happier life with the alleged misdiagnosis.

Also, the chapter on ME/CFS feels undocumented and even preposterous, almost as if she had a bone to pick.

But I liked other bits, so it's not a complete fail.

[Elena Papadopol · Rating 4 out of 5]

Un subiect foarte interesant, prezentat sub o forma facila pentru oricine.

,,Furia are un scop. Le spune celorlalti ca nu suntem in regula. De asemenea, are multe in comun si cu simptomele psihosomatice. Poate fi inselatoare fiindca, de multe ori, furia mascheaza un alt sentiment - durerea sau frica. Poate fi interpretata gresit si de catre cei care o simt, si de catre cei impotriva carora este directionata."

,,[...] Majoritatea oamenilor prefera sa se simta bine, dar, unora, boala le ofera o scapare sau o explicatie pentru esec."

,,[...] Oamenii cauta explicatii pentru modificarile pe care le simt in corp, cauta o explicatie pentru absolut fiecare senzatie neplacuta. Oamenii nu sunt dispusi sa accepte ca explicatii factorii comportamentali, emotionali sau efectele imbatranirii. Societatea si mass-media sunt mereu dispuse sa ofere un raspuns mai agreabil si sa mai adauge ceva in rezervorul de simptome."

,,[...] Raspunsul nervului este standardizat, dar reactia noastra la mesajul pe care-l transmite nu este. Undeva in capul nostru are loc interpretarea mesajului si prin aceasta interpretare redevenim indivizi."

,,Poate ca a venit momentul sa nu mai schimbam etichetele si sa incepem sa schimbam atitudinile fata de bolile psihologice."

,,[...] Daca am intelege mai bine modul in care corpul nostru poare pierde controlul doar din cauza unei senzatii din interior, poate ca reactiile mai extreme nu ar mai parea atat de inacceptabile. Pentru ca toti ne somatizam emotiile, fie ca ne dam seama de asta, fie ca nu. Ganditi-va la ras."

[Bonnie · Rating 1 out of 5]

I was sadly, deeply disappointed by this book.

Her writing is fine, she's an obviously experienced doctor with many tales of interest and but if you know anything about psychiatry, psychology or modern neurology, you will find her stories a bit less than fulfilling. She tries really hard to seem compassionate and empathetic but it just appears like a long excuse for having horrible bedside manner and being really poorly versed in anything but her own specialty of seizures. In which case, I'd ask her not to comment on other illnesses, psychogenic or not since she seems to have a bad habit of disbelieving her patients.

Note that her references are from far far back in history - as in deeply irrelevant; also note that whatever she said about chronic pain disorder is completely bollocks - please do a itty bitty research on pain and neuroplasticity. The book left me with a rather horrific sense that we really need better doctors - at least once who understand people better - enough to know if you are a neurologist, don't try pretend to be a psychiatrist.

[Chris Steeden · Rating 4 out of 5]

‘Psychosomatic disorders are conditions in which a person suffers from significant physical symptoms – causing real distress and disability – out of proportion to that which can be explained by medical tests or physical examination’.

I am guessing that this book is controversial in some people’s eyes even though O’Sullivan states ‘I hope to communicate to others what my patients have taught me. Perhaps then, future patients – people like you and me, our friends, families and colleagues – will not find themselves so bewildered and alone’. Right now, ‘Society is judgemental about psychological illness and patients know that.’ Before she gets into the patients’ cases, which are set as different chapters, she says ‘some of the common preconceptions and judgements levelled at those with psychosomatic illness need to change’.




Dr Suzanne O’Sullivan has been a consultant in neurology since 2004 although she qualified as a doctor in 1991. She had always wanted to be a neurologist (Neurology is the branch of medicine concerned with the study and treatment of disorders of the nervous system). In this, her first book, she is looking at those people who ‘unconsciously think themselves ill’. How many of us are ‘aware of the frequency with which our emotions can produce serious disability where no physical disease of any sort exists to explain it?’. She tells us that ‘Psychosomatic disorders are not neurological disorders. They belong to the fields of psychology and psychiatry’. Through her work she has seen many patients who suffer in this way though. It is because the patient has a physical symptom that they seek help from a medical doctor. The physical symptom is masking emotional distress Sullivan states.

Is this book readable? Will I be able to keep up with the doctor writing this? Thankfully the answer is yes, to both. This is not an academic book in the way it is delivered. I found it absolutely fascinating. Some of the patient stories are incredible. These are not symptoms that are put on by the patient. There is something real going on. Well, the brain says there is. The doctors would say, ‘Your tests are normal. There is nothing we can do.’ What can be done though? As stated, each chapter is set out with a specific case and other cases that are like it. You will see the commonalities. The reviews on Goodreads are so insightful especially those that give the book one star. Read the book then read the reviews on Goodreads. It makes for interesting reading. I make no judgement either way.

[Bilen · Rating 3 out of 5]

This book talks about one of the most fascinating disorders in medicine, psychosomatic disorders. Basically, it means your mind, for reasons known or unknown, makes your body feel sick without an actual detectable disease process.

Somatization is something we’ve all probably dealt with before. I know I have! The moment I realized I missed my meningitis vaccine, I kid you not, my neck started stiffening up instantly. coincidence? Maybe!

The book is organized by patients, with each chapter named after the person whose case we’re exploring. It sounds like a good idea, but it got confusing when other names popped up. I kept thinking, "Wait, who is Pauline again?" and had to flip back to remind myself.

That aside, I really enjoyed how much info the book offered. It gives you the history, explains the conditions, and shares the challenges in diagnosing and treating them.

One thing I really liked was how the doctor didn’t shy away from admitting her mistakes and failures. That kind of honesty was refreshing.

[Marta Demianiuk · Rating 4 out of 5]

Ta książka świetnie robi na głowę, jeśli sami nakręcamy się na kolejne problemy zdrowotne, z wyników badań nic nie wynika, ale lekarze o czymś takim jak choroby psychosomatyczne nie mówią.

Ale poza tym jest to po prostu bardzo ciekawie napisany tytuł popularnonaukowy o tym, jakie mózg potrafi robić „psikusy” z powodu stresu czy ciężkich wydarzeń w życiu chorującej osoby.

Polecanko.

[Damaskcat · Rating 5 out of 5]

I thought this book was a truly fascinating read. I have always accepted that there is a strong link between the brain and the body and that the brain can produce symptoms in the body which are wholly unrelated to any physical cause. When I was a child I always used to get a stomach upset on the first day of the school term. Once I was at school the upset disappeared completely. My mother sat me down and explained to me that sometimes the brain plays tricks on the body and that I would feel all right once I got to school. She did of course make sure there wasn't anything I was worrying about at school - and there wasn't because I actually enjoyed school. I did gradually grow out of it as I got older.

I suppose because of my own experiences I didn't find this book hard to accept at all. The author is at pains to distinguish between those patients who are real malingerers and who are making up their symptoms for reasons of their own but are consciously doing it and are in control of their symptoms and those who really do experience their symptoms but have no identifiable physical cause for them. So there is a huge difference between those two cases.

I think many of us have come across those people who can faint at will or who can produce tears on demand but these abilities are a long way away from those who faint for no apparent physical cause but are as distressed by the experience as are the onlookers. How can mental and emotional distress produce symptoms in the body? No one really knows but once the underlying distress is dealt with then the physical symptoms usually disappear.

Unfortunately many people confuse the idea of imaginary symptoms with the idea that an emotional trauma can cause perfectly genuine physical symptoms and see it as an insult if it is suggested to them that a psychiatrist might be able to help them.

The author describes the extreme reactions many people have to any suggestion that psychology might be able to help them. In any illness psychology might be able to help since the brain and the body are so closely linked that one is going to have an effect on the other. People who believe they have epileptic seizures are often very upset to be told that they do not have epilepsy and their seizures are caused by stress or trauma. They frequently do not believe this to be the case even when EEG readings and video footage show they are not having an epileptic seizure.

I think the best way to approach the book is at the very least with an open mind. I found it compelling reading. The author writes well and in an approachable style. I would have liked to see a bibliography included though there is an index. I recommend this book to anyone who is interested in the mind/body link and the way it can affect us.

[Johann (jobis89) · Rating 4 out of 5]

My knowledge of psychosomatic illnesses is very basic, but on a personal level I found this book to be very helpful to me.

[Liz · Rating 1 out of 5]

I would like to give the book a much higher rating. I admire Dr. Sullivan's understanding and compassion for the very real suffering of patients with psychosomatic illness (but I cringe at the titles of both versions of her book with their long-standing negative connotations for the general public.)

However, applying the label of psychosomatic illness (even in a somewhat modified way as she does) to ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome) is just wrong. To her credit, Dr. Sullivan does say: "Do I know that for sure. No, nobody does." She says her reason for doing so is based on what she believes is the lack of evidence for an organic disease. In reality, (and despite the appalling lack of government funding in the US for research) there is a mountain of evidence which has been collecting since the 1980's from researchers dedicated to the study of this disease in the US and other countries, with some of the most profound research coming in the most recent years, some after the writing of this book.

Dr. Anthony Komaroff at Harvard Medical, both a researcher and clinician in ME/CFS since the 1980's, gives a summary of the evidence of biological disease from the 80's through 2013 in a video that can be googled entitled, "VIDEO: Dr. Anthony Komaroff - CFS Research: Recent Progress and Challenges".

For the sake of brevity in this review I will mention only a couple of recent highlights in research being done with new biological technologies.

Gene expression studies have demonstrated dramatic results in ME/CFS relative to fatigue and other major symptoms of the disease such as immune dysfunction and autonomic system dysregulation, as well as a new understanding of the complexity of the biology of fatigue. (An overview of some of this can be seen in a series of youtube videos by Prof. Alan Light, one titled "60. Gene expression markers of ME/cfs / " )

A name that must be mentioned is Dr. Ron Davis and his Open Medicine Foundation, End ME/CFS Project at Stanford University. Dr. Davis was recently named by Atlantic magazine as one of the 7 most outstanding innovators of the century for his landmark work in the field of genetics including the development of new research technologies (which led to the mapping of the human genome and more); he is presently working with 3 Nobel Laureates, 6 members of the National Academies of Science, and others creating new research technologies that are producing dramatic findings (work published 2016 and 2017).

Davis and his team have been examining energy production through metabolites (particularly relative to the mitochondria at the cellular level). They have found extensive alterations in the levels of over 100 metabolites in the serum of ME/CFS patients. Dr Robert Naviaux's research, according to Davis, marks the most "important and groundbreaking" development in ME research so far. Using 20 metabolites, Naviaux has discovered a 'diagnostic signature' for identification of ME/CFS at a more than 90% accuracy level. The disruptions in metabolism affect 7 systems in the body, not just the production of energy (giving biological evidence of the many other serious symptoms of the disease).

(For a brief insight, google the youtube video: Scientist Ron Davis Tells How We Are "Fast-Tracking" ME/CFS Research )

There is a saying in medicine (which Dr. Sullivan herself has used): FIRST DO NO HARM. ME/CFS patients have been grossly harmed for decades by the labeling of this devastating biological disease with the innocuous sounding name "chronic fatigue syndrome." The National Institute of Health in the US has all but ignored the funding of research. (AIDS gets 3 BILLION dollars; MS 250 million; ME/CFS 5 million--even though ME affects many more people than the other two). More inaccurate labeling of the disease as psychosomatic such as in this book, though I think well meant given Dr. Sullivan's level of information about the disease, is greatly adding to this harm.

If Dr. Sullivan and others are willing to revise their conclusion of psychosomatic disorder for ME/CFS based on the whole of biological research, my admiration for them will increase exponentially. Otherwise I fear, like the doctors of old clinging to their 'hysteria' explanations for epilepsy and multiple sclerosis, these doctors are doomed to come down on the wrong side of history, while ME/CFS patients needlessly suffer much more harm.

See also the outstanding TED talk from ME patient JENNIFER BREA "What happens when you have a disease doctors can't diagnose". Brea has produced a documentary called 'Unrest' which will be aired on Public Television the first part of next year.

[Lavinia · Rating 5 out of 5]

Afectiunile prezentate in aceasta carte sunt foarte interesante, dar aspectul psihologic este cel care mi-a placut cel mai mult. Sunt relatate mai multe teorii despre cum apar bolile psiho-somatice in capul si in corpul oamenilor, iar relatia medic-pacient e acoperita cu punctele de vedere din ambele “tabere”. Pacientul doreste sa i se valideze suferinta, medicul- sa i se accepte competenta. Evident, medicul e cel care trebuie sa isi depaseasca orgoliul ranit atunci cand diagnosticul lui e pus la indoiala si sa dovedeasca empatia de care cel aflat in suferinta are nevoie.
Mi se pare o lectura obligatorie pentru toti cei care prin natura profesiei au de-a face cu afectiunile cu etiologie in inconstient, dar ce bine ar fi daca toti oamenii ar fi cat de cat familiarizati cu categoria aceasta de suferinte, ar avea sanse sa se recupereze mai bine atunci cand li se intampla lor! Deci da, “E doar in capul tau” e o lectura necesara pentru toata lumea.

[Emily · Rating 2 out of 5]

2.5 stars. I found a lot of things frustrating in this book. First of all, the doctor seemed very reluctant to believe anything her patients were saying and seemed determined to prove them wrong.

Also, many of the case studies ended abruptly and we weren't told whether or not the patient recovered. What's the point in only giving us half the story?!

[Bianca Mogos · Rating 1 out of 5]

Update 2024. Actually, no. F**k this book. The more i go through my fibromyalgia and chronic pain experience, and the more I read about people with medical issues who just look for answers and proper diagnosis, who are being dismissed by doctor after doctor who are blinded by their own egos and self perceived brilliance, only to find the proper diagnosis from people who actually listen, the more I dislike this book and what it stands for.

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I don’t know what to think about this book. I am a chronic pain sufferer, with no identifiable physical cause, so psychosomatic illness. I have spent the past 3 years in search for... answers. I’ve been multiple times to my GP and underwent multiple investigations, some of them really not risk free. I’ve spent the past 3 years feeling angry, ashamed, confused, tired, desperate, frustrated, annoyed, humiliated, guilty... you name it. Doctors tried to be nice, but more often than not sounded condescending. I was understanding on a logical level what they were telling me, but the way they treated some made me distrust them and literally hate some of them.

So I was skeptical about this book. This woman tries to be kind and opened about such diagnostic but actually just confirms what I fear most regarding how doctors think. She keeps on pressing how much people with psychosomatic illness cost the system, how she gets annoyed and skeptical towards people, how she sneered at them, and thought less of them, until she “knew better”. She does insist on the point that the complaints of a psychosomatic problem are just as debilitating and should be taken just as seriously as the ones with an organic cause, and does say sometime “after everything else has been ruled out”. However she gets exasperated when people with hypochondria or people with persistent complaints do exactly that: try to rule everything out. Some doctors might be good, and some doctors might miss things. So is a patient really supposed to trust the system he’s in without advocating for himself, especially as a woman, who too often gets TOO easily dismissed as “hysteric”? Women have lost their lives due to misdiagnosed illnesses. And we’ve been trying to scrape the “hysteric” label for a while now.

So what do we do now? Where is the balance? How do we teach compassion? How do you teach patients to stop feeling guilty and shame for “wasting the systems money” and actually address their complaints?

I am very confused on how to rate the book. She did try to touch on every aspect, gave various examples, but I still feel she kinda missed the point. A good book, but as a sufferer, it just rubs me in a wrong way. (3.5?-4?)

[Ruthy lavin · Rating 4 out of 5]

As someone who has been diagnosed with Fibromyalgia and FND, I had particular interest in reading this book and it didn’t disappoint.
More was explained to me here than ever before by any of my neurologists.
This is an informative, excellently written and enlightening book about psychosomatic illness, I would recommend it to anyone who has had a diagnosis that they may not fully understand.

[Mihaela Alexandrescu · Rating 4 out of 5]

Dacă ai avut cel puțin o dată în viață o suferință fizică mai scurtă sau mai îndelungată, mai severă sau ușoară care nu a găsit nicio explicație în rmn, radiografii, analize de sang, ecografii și nici tratamentele clasice nu au dat rezultate, o durere sau un disconfort care-și schimba localizarea în corp, o stare ciudată că pierzi controlul asupra corpului sau orice similar cu asta, cartea aceasta s-ar putea să-ți aducă o perspectivă utilă asupra bolilor psihosomatice care sunt așa de greu de acceptat de pacient (mai ales într-o lume în care încă este mult mai social acceptat să ai o boală fizică cunoscută decât ceva atât de ambiguu cum pare o tulburare psihosomatica).

[Ant · Rating 3 out of 5]

Στο βιβλίο της, Όλα είναι στο μυαλό σου, η νευρολόγος Suzanne O’Sullivan, εξετάζοντας συγκεκριμένες υποθέσεις (cases) από το επαγγελματικό της αρχείο, αποκαλύπτει το συχνά παραγνωρισμένο και αχαρτογράφητο πεδίο των «ψυχοσωματικών παθήσεων» στην ιατρική.
Ξεκινά παρέχοντας ορισμένα παραδείγματα: τα δάκρυα, το γέλιο, το αναψοκοκκίνισμα αποτελούν σωματικές αντιδράσε��ς που έχουν ως εφαλτήριο ένα ψυχολογικό ερέθισμα.
Κάποιες φορές, όμως, αυτό ο απλός μηχανισμός, λόγω της επίδρασης του άγχους, καταλήγει να στρέφεται, αυτοκαταστροφικά, ενάντια στο ίδιο μας το σώμα.
Η διαταραχή σωματικών συμπτωμάτων ή, όπως ονομάζεται, η «διαταραχή μετατροπής», όπως εξηγεί η ειδικός, ορίζεται από μια έντονη σωματική συμπτωματολογία, που καταλήγει να διαταράσσει τη φυσιολογική ζωή των ασθενών. Όταν η σωματοποίηση του στρες είναι παροδική, αν δηλαδή το σώμα μας βρίσκεται σε «fight or flight» mode, τότε δεν συνιστά διαταραχή. Η διαταραχή επέρχεται όταν η κατάσταση αυτή καταλήγει να είναι χρόνια, χωρίς άμεσους εκλυτικούς παράγοντες, αλλά εξαιτίας ανεπεξέργαστων τραυματικών εμπειριών του παρελθόντος.
Και ενώ έχουν εγκαταλειφθεί ως ιατρικά ανεπαρκείς οι θεωρίες για τη σύνδεση των νευρικών παθήσεων με την αποκαλούμενη «υστερία», έως σήμερα πολλοί επαγγελματίες υγείας θεωρούν πως η σωματική και ψυχική ευεξία των cis γυναικών, ή ενός ατόμου που έχει έμμηνο ρύση, σχετίζεται με τις φάσεις και τα επιμέρους στάδια της περιόδου, κάτι που είναι αναμφίβολα προβληματικό και επιστημονικά ανακριβές.
Παρά το γεγονός ότι τα ποσοστά των ψυχοσωματικών ασθενειών είναι ιδιαίτερα υψηλά, ελάχιστη σοβαρότητα δίνεται από τους επαγγελματίες υγείας στην έκταση τόσο της συμπτωματολογίας, όσο και της ίασης.
Ο χρόνιος -και συχνά ανεξήγητος- πόνος δεν αποτελεί προτεραιότητα στα νοσοκομεία, αφού η ταξινόμηση σε μια αίθουσα αναμονής γίνεται με βάση την εικόνα των δυνητικά πιο «επικίνδυνων» συμπτωμάτων. Έτσι, σε ένα άτομο με κρίση πανικού που καταφτάνει στα επείγοντα με την πιο άμεση διαταραχή σωματοποίησης του στρες, δηλαδή τα συμπτώματα ταχυκαρδίας, συχνά όχι μόνο δεν παρέχεται ορθή βοήθεια και υποστήριξη, αλλά επιδεικνύεται επίκριση και αδιαφορία.
Η O’Sallivan επικεντρώνεται βεβαίως κυρίως στην ειδικότητά της, δηλαδή τις νευρολογικές διαταραχές και, ειδικότερα, σε όσες διαταραχές προκύπτουν από ψυχολογικούς λόγους και αποτελούν επί της ουσίας «λειτουργικές νόσους» και όχι παθολογικές.
Σε αυτές τις νόσους, παρά το ότι αρχικά το άτομο παρουσιάζεται με έντονη και ορατή συμπτωματολογία (προβλήματα όρασης, επιληπτικές κρίσεις, αδυναμία άκρων), αποδεικνύεται πως η αιτία των συμπτωμάτων δεν είναι οργανική, αλλά ψυχολογική και με την κατάλληλη ψυχολογική υποστήριξη το άτομο μπορεί να ιαθεί.
Πίσω από κάθε τέτοια ασθένεια, όπως αποδεικνύεται και από τα παρατιθέμενα cases, κρύβεται και από μια ιστορία που συνήθως σχετίζεται με ένα αγιάτρευτο ψυχολογικό τραύμα.
Τα τραύματά μας, ακόμα και μετά την πάροδο αρκετών ετών, δύνανται να μας επηρεάζουν με τρόπο καταλυτικό. Η θλίψη κάποιες φορές γίνεται τόσο συντριπτική που δεν αντέχουμε ούτε να την αισθανθούμε, όχι τουλάχιστον με τρόπο άμεσο, κι έτσι εκείνη μασκαρεύεται σε κρίσεις επιληψίας και χρόνιων ταχυκαρδιών, υποδυόμενη με έντονη πυγμή την αφήγηση μιας επικίνδυνης ασθένειας. Στην πραγματικότητα, η ιατρική δεν έχει προχωρήσει ιδιαίτερα ούτε στην κατανόηση των σωματοποιημένων διαταραχών αλλά ούτε και των ψυχιατρικών παθήσεων.
Η νευρολόγος κάνει μια ενδιαφέρουσα αναδρομή στις απόψεις για την υστερία από την αρχαιότητα έως σήμερα. Στην αρχαιότητα, με βάση την ιπποκρατική αντίληψη, η μήτρα αποτελούσε ένα «κινούμενο» όργανο μέσα στο σώμα της γυναίκας. Ανάλογα με το πού βρισκόταν η, υποτίθεται, πολύπλαγκτη μήτρα, μπορούσε να προκαλέσει στη γυναίκα πληθώρα συμπτωμάτων.
Ανάλογη θέση, χωρίς το στιγματιστικό-σεξιστικό υπόβαθρο, κατείχε σε ορισμένες περιπτώσεις και το στομάχι για τους άνδρες.
Η ιδέα ενός κυρίαρχου οργάνου επικράτησε γενικά σε πολλές φάσεις της ιατρικής ιστορίας. Τον 18ο και 19ο αιώνα, με τις ανατομικές και ιατρικές ανακαλύψεις να πληθαίνουν, οι «νευρικές» ασθένειες αποδίδονταν κάθε φορά και σε διαφορετική αιτία, ανάλογα με την κυρίαρχη θεωρία της κάθε εποχής.
Ετσι, η σπονδυλική στήλη κατέληξε να θεωρείται ικανή να μεταφέρει τον πόνο από το ένα σημείο του σώματος στο άλλο, ενώ, προς τα τέλη του 19ου αιώνα, προτάθηκε και η θεωρία του «ρινικού ερεθισμού», στον οποίο αποδόθηκαν ποικίλες ασθένειες, από επιληπτικές κρίσεις μέχρι στομαχικά προβλήματα.Τα πράγματα, βεβαίως, δεν είναι τόσο απλά.
Η ιατρός αναφέρει ότι πολλές φορές για τα ψυχοσωματικά συμπτώματα οι γιατροί κινούνται ανάμεσα στο δίπολο της αδιαφορίας ή της υπερδιάγνωσης (overdiagnosis). Το 1965 ο ψυχίατρος Έλιοτ Σλέιτερ δημοσίευσε ένα άρθρο στο British Medical Journal στο οποίο ανέφερε ότι περισσότεροι από το 25% των ασθενών που είχαν διαγνωστεί με «υστερία» στο παρελθόν, έπασχαν τελικά από κάποια σωματική πάθηση, και αυτό, κατά τη γνώμη της O’Sallivan, επηρέασε τη σύγχρονη ιατρική αντίληψη και το πώς χειρίζονται οι γιατροί τα ανεξήγητα συμπτώματα όταν ο εξετάσεις δεν οδηγούν σε ξεκάθαρη διάγνωση.
Προτιμούν δηλαδή να διαγνώσουν, ακόμα και λανθασμένα, τον ασθενή με «κάτι», παρά να πάρουν το ρίσκο να κάνουν λάθος και να αγνοήσουν μια ενδεχόμενη σωματική πάθηση.
Η ιατρός δεν τα γράφει αυτά τυχαίως. Η άποψη ότι βαδίζουμε ολοταχώς στην εποχή υπερδιάγνωσης αναπτύσσεται και, εν μέρει καταγγέλλεται, συνειδητά από τη συγγραφέα. Στην σελίδα 227 του παρόντος βιβλίου γράφει για τη δυσανεξία στην γλουτένη, αλλά και παρακάτω για την νόσο του Lyme. Και ενώ η υπερδιάγνωση της πρώτης οδηγεί απλώς τα άτομα σε μια πιο προσεκτική διατροφή (σε ορισμένες περιπτώσεις ίσως στα όρια της νεύρωσης), η δεύτερη οδηγεί σε αχρείαστες συνταγογραφήσεις αντιβιοτικών που μπορούν να έχουν μακροπρόθεσμες επιπτώσεις στην υγεία ενός ατόμου και να οδηγήσουν σε εξασθένηση της αντίδρασης του ανοσοποιητικού.
Μάλιστα, η συγγραφέας αναφέρει και παραδείγματα υπερδιαγνώσεων από προηγούμενες δεκαετίες εξαιτίας της κυρίαρχης μιντιακής ρητορικής. Για παράδειγμα, τη δεκαετία του 1990, στα media κυριαρχούσε η παρουσίαση της καντιντίασης και έτσι πολλά άτομα κατέφευγαν στον γιατρό φοβούμενα πως πάσχουν από τα συμπτώματα που τόσο λεπτομερώς περιγράφονταν από τα μέσα μαζικής ενημέρωσης, χωρίς ωστόσο τελικά να πάσχουν από τίποτα σχετικό.

Περισσότερα για αυτά τα φαινόμενα που επηρεάζουν τόσο τους γιατρούς όσο και τους ασθενείς, και που καθορίζονται, κατά τη συγγραφέα, σε μεγάλο βαθμό από τα media, αναπτύσσει στο βιβλίο της, The age of diagnosis: How our obssesion with medical labels is making us sicker.Η αναφορά στο 7ο κεφάλαιο στο σύνδρομο χρόνιας κόπωσης (ΣΧΚ) αποτελεί και την πιο αμφιλεγόμενη του βιβλίου, τουλάχιστον έτσι όπως αυτό αξιολογείται από τους πάσχοντες. Το ΣΧΚ στο παρελθόν ανήκε κι αυτό στη γενικότερη κατηγορία-ταμπέλα της νευρασθένειας.
Περιγραφές του συνδρόμου ήδη από το 1869 κάνουν λόγο για μια συντριπτική οργανική πάθηση που προκαλούσε αϋπνία, άγχος, πονοκεφάλους και ακραία αδυναμία. Όπως αναφέρει η συγγραφέας, μέχρι και τις αρχές του 20ού αιώνα, η νευρασθένεια είχε γίνει η «ασθένεια της μόδας» (maladie a la mode) στο Παρίσι. Κατά την O’Sallivan, το σύνδρομο οφείλεται σε μια μίξη οργανικών και ψυχολογικών αιτιών, άποψη που βρίσκει αντίθετα πολλά πάσχοντα άτομα. Ακόμα, όπως και να ‘χει, δεν υπάρχει ξεκάθαρη επιστημονική απάντηση, όπως άλλωστε και για πολλές άλλες ασθένειες, είτε αυτές κατατάσσονται ως σωματικές είτε ως ψυχιατρικές, αφού, πρακτικά, αυτά τα δύο διαπλέκονται: όλα είναι στο μυαλό μας με την έννοια πως ο εγκέφαλος αποτελεί την έδρα για πολλές οργανικές και ψυχιατρικές παθήσεις.

Και ενώ πολλές είναι οι αντιρρήσεις για αυτό το βιβλίο που, ευλόγως, εκφράζουν οι ασθενείς χρόνιων ανεξήγητων ασθενειών, δεν έχουμε παρά να συμφωνήσουμε με την O’Sallivan σε ένα σημείο και να δούμε τα πράγματα από μια ίσως πιο φουκωική οπτική: η υπερδιάγνωση αποτελεί υπό μία οπτική έναν νέο έλεγχο που αφήνουμε να εγκαθιδρυθεί στο σώμα μας, μια, τρόπον τινά, έλλειψη εμπιστοσύνης στον εαυτό μας.
Επιφέρει, παραλλήλως συμπεριφορικές επιπτώσεις, αφού κάθε διαγνωστική ετικέτα δύναται να μας επηρεάσει με πολλούς άμεσους ή έμμεσους τρόπους. Η ιατρός μιλάει και για την πρακτική των πολλαπλών εξετάσεων, χωρίς να μπορεί να απαντήσει και η ίδια πότε πρέπει να μπαίνει ένα φρένο στις διαγνωστικές εξετάσεις και στην αναζήτηση οργανικών παραγόντων όταν αυτοί δεν παρουσιάζονται στον πρώτο κύκλο των εξετάσεων.

Το άγχος υγείας, άλλωστε, μπορεί να επηρεάσει και άτομα που ήδη πάσχουν από κάποια νόσο και δύναται να οδηγήσει σε αρνητικές ψυχολογικές ή οργανικές συνέπειες αν κυριαρχήσει στη ζωή τους με τη μορφή αμέτρητων εξετάσεων. Αναφέρεται μάλιστα και η περίπτωση μιας γυναίκας που, υποφέροντας από χρόνιους πονοκεφάλους και ενώ σε πρώτη φάση όλες οι εξετάσεις της ήταν φυσιολογικές, κάνοντας μια ακόμα πιο εξειδικευμένη εξέταση, διαπιστώθηκε πως έφερε ένα μικρό ανεύρυσμα σε σημείο όμως που δεν ήταν καθόλου πιθανό να σχετίζεται με τους πονοκεφάλους της και που είχε ισχυρές πιθανότητες να μην ραγεί ποτέ. Η ασθενής αποφάσισε να το αφαιρέσει με ένα απαιτητικό χειρουργείο που οδήγησε όμως στη ρήξη του ανευρύσματος και, λόγω της εγκεφαλικής αιμορραγίας, της προκάλεσε χρόνια νευρολογικά θέματα από τα οποία δεν ανέκαμψε ποτέ πλήρως.Η νευρόλογος δεν παραλείπει να επισημάνει και την έμφυλη διάσταση του ζητήματος, κυρίως όμως επικεντρωμένη στο έμφυλο δίπολο.

Πέρα από το γεγονός ότι ο ανδροκρατούμενος χώρο�� της ιατρικής δίνει προτεραιότητα στην έρευνα και αντιμετώπιση παθήσεων που χτυπούν περισσότερο τους άνδρες, ενώ συχνά απαξιώνουν τα συμπτώματα των γυναικών, η νευρολόγος σημειώνει πως ένα μεγάλο ποσοστό των ασθενών με διαταραχή μετατροπής είναι γυναίκες, κάτι που αποδίδει σε κοινωνικούς παράγοντες. Οι άνδρες, εξηγεί, μεγαλώνουν συχνά με την πεποίθηση ότι η αναζήτηση βοήθειας αποτελεί ένδειξη αδυναμίας. Αντίθετα, οι περισσότερες γυναίκες έχουν καλύτερη σχέση με το σώμα τους και προσφεύγουν ευκολότερα σε εξετάσεις (παρόλο που δεν σημειώνεται στ�� βιβλίο, είναι χρήσιμο να αναφέρουμε ότι αυτό το δεδομένο δεν ισχύει μόνο για γενικές εξετάσεις, αλλά και για ειδικότερες, όπως αυτές της σεξουαλικής υγείας)

Σε τελική ανάλυση, το βιβλίο, παρά τα κάποια ελαττώματα, που σχετίζονται κυρίως με το ιατρικό προνόμιο της συγγραφέως, δεικνύει ευστόχως πως όταν το τραύμα δεν βρίσκει λόγια, επιστρέφει ως σύμπτωμα. Και αυτό δεν είναι σε καμία περίπτωση ένδειξη αδυναμίας, αλλά ένα κάλεσμα για φροντίδα. Μια φωνή που η σύγχρονη ιατρική οφείλει να αρχίσει να αφουγκράζεται προσεκτικότερα.

Το πλήρες κείμενο στην bookpress: https://bookpress.gr/kritikes/epistim...

[Jon Morris smith · Rating 3 out of 5]

Now I like a good surgical memoire - my top recommendation is "when he air hits your brain" which is both a memoire, an insight into neurosurgery and an historical journey through the evolution of the discipline... ditto for "Do No Harm"

... however, while enjoyable, I felt that the patient accounts were somewhat incomplete - the conclusion of the cases and the patient's journey to recovery (or not) was often omitted. So these were more 'case studies' if you wish, to serve as illustrations of conditions.

This places the focus on the conditions and a degree of medical insight which comes with that. I did find some of the detail somewhat repetative, and there were some blind avenues which were included for apparently no purpose...

... however there is a recurring topic of "phantom seizures" which present as epileptic seizures but are in fact a manifestation of a response to life event (stress, trauma etc). Brains of patients with these seizures don't exhibit the same electrical 'storms' of epilepsy, which is the key differentiator.

Highly interesting.

Also interesting is that treatment can only start when patients start to see psychiatrists - the stigma attached to that and the question of "are you saying I've got a mental illness" is most telling.

So overall a recommendation - a partial recommendation perhaps, but perhaps more so if you have an interest in how mental illness can affect anyone and how accepting that, and addressing the stigma, is as much a part of the treatment as the help which comes after

[Bryce · Rating 2 out of 5]

When I picked up O’Sullivan’s book, I assumed it would be something like Oliver Sacks’ The Man Who Mistook His Wife for a Hat: Case studies of people with rare and unexplained psychosomatic disorders. Fairly voyeuristic, but interesting for a layman reader.

This book is not that. Not funny or poignant anecdotes that an average person could enjoy and learn from. Instead, O’Sullivan shares stories of complicated patients she’s worked with, her reactions as a professional, and the history and perception of psychosomatic disorders. Some chapters are very dense and technical. I’m fairly certain this book is intended as a class textbook rather than something to read for pleasure.

But I soldiered through. And I found myself really disliking O’Sullivan herself. Not for he reason many other reviewers dislike her: Because she expresses her opinion the ME/CFS is not an organic disease, but rather something based in the psychology of the sufferer. But instead, I disliked how she presented nearly every patient as being childish and unreasonable in their interactions, while she portrayed herself as the picture of patience, virtue and calm understanding. Clearly, an autobiographical book is going to be inherently one-sided, but O’Sullivan portrayed herself with no flaws at all. A medical textbook is not the right place to Mary Sue oneself.

[Monica Willyard Moen · Rating 5 out of 5]

The chances are good that someone you know has a somatic illness and doesn't know it. This empowering, intriguing book explains how the mind can control parts of the body to create genuine symptoms such as pain, blindness, and paralysis, even when all test results are normal. The author doesn't excellent and compassionate job of explaining that while the symptoms are caused by the mind, they are still just as real as if something were physically wrong with the body. Now, scientists are performing studies in an effort to solve this issue and figure out how to help patients find full relief from there symptoms. This book may be of particular interest to those people who have diseases such as chronic back or neck pain, chronic fatigue syndrome, fibromyalgia, Crohn's disease, and lupus. I read the book because I was looking for answers with my own health issues. So if you're reading this review, please don't think I'm dismissing your pain or symptoms. I do think there is a psychological component to some illnesses, and that could be a good thing, because we might be able to control that and find some lasting relief.

[Ioana · Rating 5 out of 5]

i really liked the book. it also has a little bit of psychology, although it is written by a neurologist. i had doubts of my own about people faking illnesses and this books adds a fresh new perspective about that. The illness may not be real, but the pain could, as unbelievable as it would sound.

[Shona Dickson · Rating 2 out of 5]

It has the potential to be interesting but disappoints slightly. It's long winded at times and very repetitive. Having said that, it kept me reading to the end but some of the chapters were spoilt by alternating from patient story to neurology history (some of which was interesting) back to patient story. Sometimes I forgot what the original case study was about.
I've read more interesting books like this such as Henry Marsh's Do No Harm.

[Cav · Rating 4 out of 5]

"The word psychosomatic refers to physical symptoms that occur for psychological reasons. Tears and blushing are examples of this, but they are normal responses that do not represent illness. It is only when psychosomatic symptoms go beyond the ordinary and impair our ability to function or endanger our health that illness results..."

Is It All in Your Head? was an incredibly interesting dive into the topic of the power of the mind over the body.
An upfront warning to readers of this review: It's going to be a long one, so get comfortable...

Author Suzanne O'Sullivan is a consultant neurologist at the National Hospital for Neurology and Neurosurgery in London. The main focuses of her work are epilepsy and improving medical care for people with psychosomatic disorders.

Suzanne O'Sullivan:


O'Sullivan begins the book by giving the reader a short history of her career. She knew she wanted to be a neurologist early on. She talks about the phenomenon of young teenage girls collapsing at rock concerts. While some had physical causes, ie; heat stroke, others did not have any known physical causes.

I found the book to be written in a fairly decent style, although as mentioned, the prose was a tad long and dry at times. A minor gripe; the fascinating subject matter more than made up for it.
[NOTE: I have included a few more quotes from the book than I normally would in a review. Feel free to skip right to the bottom for a summary.]

She continues the quote above:

"...The word psychosomatic refers to physical symptoms that occur for psychological reasons. Tears and blushing are examples of this, but they are normal responses that do not represent illness. It is only when psychosomatic symptoms go beyond the ordinary and impair our ability to function or endanger our health that illness results."

In a field that is sure to be among the next frontiers of medicine, (IMO) she outlines the power of the mind over the body. Commonly known as the placebo effect, it also works in the inverse, and is called the "nocebo effect." When the mechanism becomes pathological, it is called a psychosomatic disorder. She explains further:

"Modern society likes the idea that we can think ourselves better. When we are unwell, we tell ourselves that if we adopt a positive mental attitude, we will have a better chance of recovery. I am sure that is correct. But society has not fully woken up to the frequency with which people do the opposite — unconsciously think themselves ill. Certainly, there are several medical disorders that are already commonly associated with stress. Most of us know that stress raises our blood pressure and makes us more vulnerable to stomach ulcers.
But how many are aware of the frequency with which our emotions can produce serious disability where no physical disease of any sort exists to explain it?"

"...Psychosomatic disorders are conditions in which a person suffers from significant physical symptoms — causing real distress and disability — out of proportion to that which can be explained by medical tests or physical examination. They are medical disorders like no others. They obey no rules. They can affect any part of the body. In one person they might cause pain. Think of the child who gets a pain in the stomach when they are being bullied at school. In someone else they might affect the heart. It is not unusual for somebody going through a period of stress to be troubled by palpitations. These sorts of symptoms are quite common but psychosomatic illness can also manifest in more extreme ways that are less common: as paralysis or convulsions, for example. Almost any symptom we can imagine can become real when we are in distress — tremor, fatigue, speech impairments, numbness. Anything.
On any average day perhaps as many as a third of people who go to see their general practitioner have symptoms that are deemed medically unexplained. Of course, a medically unexplained symptom is not necessarily psychosomatic. Some of these people have transient illnesses that do not reveal themselves in common investigations. Lots of viral infections, for example, do not show up on routine tests. They come, they go, we never know exactly what they were, but once we feel better, the exact cause doesn’t really matter. Other people are clearly unwell and this is demonstrated through abnormal results of physical examinations or abnormalities on tests, but still the cause is not determined. There will always be diseases that stretch the limits of scientific knowledge. Every year scientists discover the cause for previously unexplained medical complaints, so some will get their diagnosis in time. But among those with unequivocal, but undiagnosed, physical symptoms is a large group in whom no disease is found because there is no disease to find. In those people the medically unexplained symptoms are present, wholly or partially, for psychological or behavioral reasons..."

The book is presented as a mixture of case studies from her professional career, as well as some relevant current and historical science. Incredibly, she drops this stat:

"It transpired that approximately 70 percent of the people referred to me with poorly controlled seizures were not responding to epilepsy treatment because they did not have epilepsy.
Their seizures were occurring for purely psychological reasons..."

The naive reader might be tempted to write off these illnesses as isolated regional products. That is not the case, notes the author, and says:

"Psychosomatic illness is a worldwide phenomenon that occurs irrespective of culture or system of health care. In 1997 the World Health Organization carried out a collaborative study to look at the frequency of psychosomatic symptoms in the primary care setting in fifteen cities across the world. Included were cities in the United States, Nigeria, Germany, Chile, Japan, Italy, Brazil, and India. At each center the frequency of “medically unexplained symptoms” (i.e., where a psychosomatic cause is suspected) was quantified. The study showed that while the severest form of psychosomatic disorders are rare, the milder forms are not. The conclusion was that as many as 20 percent of those attending their doctor had at least six medically unexplained symptoms, a sufficient number to significantly impair their quality of life. Interestingly, in this study, rates of medically unexplained symptoms were similar in both developing and developed countries."

Ok, so the obvious question that follows is: What the hell is going on here? Are these people "faking it," or imagining these symptoms? No, says O'Sullivan. The symptoms are real, and the patients are not consciously directing this behaviour. Instead, there is a subconscious mechanism at work here, she posits:

"To my mind, the very manner in which patients with psychosomatic illness pursue a diagnosis provides the most compelling evidence for the subconscious nature of the illness. When Matthew looked for a cause of his paralysis he did so exhaustively. Yvonne had subjected herself to the most minute scrutiny in the hope of finding an explanation for her loss of sight. Pauline had the same tests again and again because she could not believe that no organic disease had been found. A person who is feigning illness has no need of such a search. If I am pretending to be ill, the sophistication of modern medicine becomes a threat to me, and it was no threat to Yvonne or Matthew or Pauline. They could not stop their search because they were looking for something that they were certain was there..."

Further to the above point, she adds:

"The greatest modern advance in thinking about psychosomatic illness has probably been the move away from brain-mind dualism. We are less inclined to think of the brain and mind as separate. It is not the case that the brain is healthy and the mind is sick but instead that the two are interdependent on one another. People with brain diseases like epilepsy and multiple sclerosis often suffer from problems like depression. People with mental illnesses like schizophrenia have been shown to have irregularities on structural brain imaging. Psychosomatic illness may well be an illness of the mind, but there must be something happening physiologically in the brain to produce the disability."

The book appears to have garnered some degree of outrage. A cursory look into a few of the top reviews here shows support for opposition to the author's take (specifically) for her writing on chronic fatigue syndrome, and psychosomatic disorders; in general. Many people - both here, and as described by the author in the book - become angry when a psychiatrist tries to suggest a psychological cause of their illness(es). While I think the author lays out a pretty convincing claim for psychosomatic disorders in general, I can see how some of the disorders she covers here might have resulted in blowback.

She talks about irritable bowel syndrome (IBS); seemingly wanting to label it a psychosomatic disorder as well. As someone who has suffered from IBS for most of his adult life, my IBS was definitely not psychosomatic. Without going into too much personal detail, I was on antibiotics quite often as a child/ young adult. This effectively destroyed my gut biome. IBS can be remediated by rebuilding the gut biome. So, I went from having crippling, quality-of-life impacting IBS for decades, to (now) only occasional mild flare-ups, by changing my diet to include pre and probiotics, as well as other lifestyle changes. The author does not mention a gut microbiome deficiency/imbalance as a possible cause of IBS. She also does not seem to be aware of the importance of the brain-gut connection; via the vagus nerve. She should know better, especially when making bold claims in a scientific book on the topic...

Some more of what O'Sullivan covers here includes:
• German doctor Hans Berger and the EEG machine. Brain waves.
• The historical diagnosis of "hysteria," particularly in women.
• The selective attention test that features an "invisible" gorilla.
• The history of psychosomatic disorders; Freud.
• Many unbelievable case studies of psychosomatic disorders that defy conventional explanation; a "blind" woman, a woman with seizures, a man who was "paralyzed," a woman with cancer.
• "Culture-bound" syndromes.
• The subjective nature of our experiences; fatigue, chronic fatigue syndrome.
• Searching for the causes of psychosomatic illnesses.
• The high prevalence of these illnesses in women vs men; ~70% of cases are found in women.


**********************

The topic of the mind-body connection, and placebo and nocebo effects are incredibly fascinating to me. As touched on above; I think that modern medicine has largely ignored and/or misunderstood this connection. In my opinion, the power of the mind, mindset, and related expectations will be at the forefront of medicine in the very near future.
Despite the writing being a tad dry at times, and my aforementioned criticisms, I would still recommend this book to anyone interested.
3.5 stars.

[Kitty · Rating 4 out of 5]

see oli küll päris põnev raamat. ma olen oma elus üsna vähe mõelnud psühhosomaatiliste haiguste peale, aga... edaspidi vist mõtlen rohkem. eks on nii enda kui lähedaste elus tulnud ette neid juhtumeid, kus kellelgi on selgelt midagi viga (kuskilt valutab, miski ei liigu jne), aga arstid laiutavad käsi, et põhjust nagu ei paista, analüüsid on korras. vot tuleb välja, et põhjus võibki olla peas. mis ei tee tagajärge sugugi vähem reaalseks või problemaatiliseks.

reaalsete haigusjuhtumite kirjeldused olid siin raamatus asjakohased ja ka väga huvitavad lugeda. hulka oli põimitud psühhosomaatiliste haiguste avastamise ja ravimise ajalugu ja arstist autori enda arengu- ja õppimise lugu. kuna ta on ise neuroloog, siis suures osas algasid need lood sellest, et kellegi olid mingid krambihood, aga epilepsiat (mis on diagnoositav haigus) ei olnud... aga oli siin ka igasuguseid halvatusi ja pimedaksjäämisi jne. mulle tuli selle peale meelde Jeesus, kes lasi kellelgi halvatul võtta oma voodi ja kõndida või kuidas see oligi. tuleb välja, et võis täitsa juhtuda!

nukker oli see, et õnneliku lõpuga haigusjuhtumeid oli siin vähe - enamus patsiente oli valmis võtma ükskõik milliseid ravimeid ükskõik kui palju ja kaua, aga mõte sellest, et äkki psühholoog või psühhiaater saaks aidata, tundus neile vastuvõetamatu. seda toredamad olid need paar lugu, kus inimene tõesti võttis pakutud abi vastu ja see aitas ka. siiski, hullult kuluks ära vauimse tervise probleemide destigmatiseerimine siinkohal. need arvud, et kui suurel hulgal USA ja UK perearstide igapäevastest patsientidest on kaebused, mille füüsilisi põhjuseid üles ei leitagi, olid ikka hirmutavad.

[Gosia Treppner · Rating 4 out of 5]

3,5 // Mam problem z oceną tej książki. Jednocześnie jestem zafascynowana neurologicznymi przypadkami i pojęciem chorób psychosomatycznych. Przedstawione tu historie były naprawdę warte uwagi. A z drugiej strony bardzo nudziła mnie część teoretyczna - nawet jeśli referowała ona o psychologii, to była to ta część psychologii, która ze mną nie styka. Przeważająco medyczna strona psychologicznej książki - trochę jakby lekarz medycyny usiadł do pisania książki o psychologii, wierząc w holistykę podejść, a jednocześnie nie umiejąc tego ubrać w słowa?

[Lauren Poole · Rating 1 out of 5]

This is quite possibly one of the most offensive books I have ever read. I could barely get through the first two chapters before I had to stop reading. The author grossly generalises functional, psychogenic, and psychosomatic illnesses (for instance stating functional/psychogenic/non-epileptic seizures are purely due to psychological distress when it's well documented that they can arise from many sources - including hypotension, autonomic and cardiovascular conditions, and alcohol withdrawal). She oversimplifies conditions into two groups: those with biological causes and which can be found through testing or clinical diagnosis; and those whose causes cannot be determined through biological testing/diagnosis. By categorising the latter group as functional and psychogenic, she completely ignores the possibility that any patient might have a condition that has not been properly diagnosed, and the possibility of a disease/condition being not yet known to medical science. One need only point to the discovery of autoimmune encephalitis in the early 2000s (a collection of diseases whose patients were previously considered to be psychiatrically or psychogenically ill) or the ongoing recognition of long-COVID (which was initially dismissed and characterised as malingering) to see how faulty this binary is. At one point she uses the example of unexplained joint pain which appeared and then disappeared - without seemingly understanding that conditions such as Ehlers Danlos Syndrome are commonly misdiagnosed as anxiety, and that patients may stop reporting their symptoms to unsympathetic doctors when they have been repeatedly dismissed. The assumption that doctors are never wrong, never misinformed, but instead somehow omniscient only serves to further stigmatise patients who fall at the boundaries of medical knowledge. Do not read this book if you have a functional or psychosomatic conditions; it is upsetting and misleading.