Head First: How the Mind Heals the Body

by Alastair Santhouse

In the tradition of Lori Gottlieb and Henry Marsh, a distinguished psychiatrist examines his own practice.

Alastair Santhouse knew something was wrong the night he was on call during his medical training and got the news that a woman on the way to the ER had died in the ambulance. That meant he could go back to sleep! But he couldn't. He was overtaken with the sense that his joyful reaction was terrible failure. That night began his long journey away from the ER and into psychiatry.

Head First chronicles Santhouse's many years treating patients and his exploration of the ways in which our minds exert a huge and underappreciated influence over our health. They shape our responses to symptoms that we develop, dictate the treatments we receive, and influence whether they work. They even influence whether we develop symptoms at all.

Written with brutal honesty, deep compassion, and a wry sense of humor, Head First examines difficult cases that illuminate some of our most puzzling and controversial medical issues--from the tragedy of suicide, to the stigma surrounding obesity, to the mysteries of self-induced illness. Ultimately he finds that our medical model has failed us by promoting specialization and overlooking perhaps the single most important component of our health: our state of mind.

Genres: Nonfiction, Psychology, Self Help, Medicine, Mental Health, Medical, Health

304 pages, Hardcover

Published August 31, 2021

Reviews

[Fiona Brichaut · Rating 1 out of 5]

I was very disappointed by this book. The description says "eminent psychiatrist Dr Alastair Santhouse draws on his experience of treating thousands of hospital patients to show how our emotions are inextricably linked to our physical wellbeing." I eagerly anticipated reading about all the insights he had gained from this experience, notably his insights into treating psychosomatic problems.

Unfortunately, the 'insight' stops there. Yes, the mind and the body are connected and troubles in the mind cause trouble in the body. Boom. No further information about what to do about this (apart from the implied 'see a psychiatrist'). I have the greatest respect for psychiatry and psychology professionals and their role in treating the mind and psychosomatic illness, but I expect a book on this topic to go a lot deeper than this.

Early in the book, the author decries the fact that modern [mainstream] medicine separates the mind and body ('Cartesian dualism') and fails to recognise that the mind and body are deeply connected.

Then he scornfully dismisses all forms of alternative medicine.:

"Alternative health beliefs are part of a mindset that at one end of the spectrum is a benign and harmless addition to standard medical care, and at the other end merges into overt conspiracy theory and paranoia. [...] many alternative health conceptualizations of how the body works are at odds with accepted science. Illnesses are thought of in simplistic ways that fit the particular alternative medical theory [...] Sometimes [alternative health theories] appeal to common sense in the way that it is common sense to think the earth is flat if you look as far as you can along a sandy beach."

Wow. That's tarring with a broad brush indeed, and it displays a huge degree of ignorance of a whole range of alternative health theories.

Then the rest of the book is just lots of examples to demonstrate that many health issues are actually rooted in people's minds; their traumatic life histories, their unhappiness, their loneliness, etc. Since this very 'insight', the mind-body connection, is at the heart of many, if not most, so-called 'alternative health theories', it is astonishing to see the theme treated like this. He writes the whole book as if the mind-body connection was a 'new' idea that he came up with thanks to his years of experience.

If you are interested in genuinely helpful books about the mind-body connection, psychosomatic illness and - most importantly - how to get relief from or even cure your symptoms, I highly recommend looking into books by Dr John Sarno, Steven Ray Ozanich, Suzanne O'Sullivan, Dr David Clarke or Dr Howard Schubiner, and other books on mind-body syndrome. Or just google mind-body medicine, mind-body syndrome or psychophysiologic disorders. There's a wealth of information out there. And while some might consider it 'alternative medicine' it is certainly not quackery written by flat-earthers.

Like this review? You can find all my reviews on my book review site: BelEdit Book Reviews

[8stitches 9lives · Rating 4 out of 5]

After exploring various medical specialities early in his career, Dr Alastair Santhouse found his ‘home’ in psychiatry, a field he’d become interested in as an undergraduate medic at Cambridge University. In Head First: A Psychiatrist’s Stories of Mind and Body, Santhouse draws on his own experiences and observations from a distinguished career straddling medicine and psychiatry, to show how our emotions are inextricably linked to our physical wellbeing. Santhouse knew something was wrong the night he was on call during his medical training and got the news that a woman on the way to the ER had died in the ambulance. That meant he could go back to sleep! But he couldn't. He was overtaken with the sense that his joyful reaction was a terrible failure. That night began his long journey away from the ER and into psychiatry. Head First chronicles Santhouse's many years treating patients and his exploration of the ways in which our minds exert a huge and underappreciated influence over our health.

They shape our responses to symptoms that we develop, dictate the treatments we receive and influence whether they work. They even influence whether we develop symptoms at all. Written with brutal honesty, deep compassion, and a wry sense of humour, Head First examines difficult cases that illuminate some of our most puzzling and controversial medical issues--from the tragedy of suicide, to the stigma surrounding obesity, to the mysteries of self-induced illness. Ultimately he finds that our medical model has failed us by promoting specialization and overlooking perhaps the single most important component of our health: our state of mind. This is a provocative, incisive and fascinating examination of the human mind in which it becomes clear that the author is not only a first-class, perceptive clinician but a truly gifted and empathetic writer, too. Through his clinical case studies, he makes a convincing case that it's practically impossible to separate, or disentangle, physical and mental health from one another. Highly recommended.

[ˋ°•☆&;josie.ೃ࿐ · Rating 4 out of 5]

Very interesting as someone who works in mental health these stories were fascinating, if a little disjointed from one another.

[Nina (ninjasbooks) · Rating 3 out of 5]

This book had lots of potential. The author seems like an empathic therapist, who likes to reflect about his work. What made it mediocre in my opinion was the lack of a read thread. It jumped from subject to subject without natural transition. It felt more like a meandering down a hallway with different doors where you peeked in before walking to the next, never really studying it. I also thought there was too many comments about how the system don’t work or the doctors don’t ask the right question. The author was an interesting character, both being able to know he can also make wrong decision at the same time as he is implying that he sees what other don’t. For example he writes: Even I didn’t see it. The free association sometimes made me irritated as he was originally describing an interesting case. I also felt there was too many details randomly inserted that didn’t add anything to the content.

[Carole · Rating 5 out of 5]

I have just finished reading Dr Santhouse book. Head First.

I am a lady of a certain age, and the book really spoke to me, so much of one's life can be taken up going around in a circle of the medical profession, when you just need someone to maybe ask slightly different questions, and all this worrying about yourself could be stopped.

I know so many people of all ages, who would benefit so much by reading this book.

Thank you for a wonderful read.

[Rebecca · Rating 3 out of 5]

Santhouse is a consultant psychiatrist at London’s Guy’s and Maudsley hospitals. The author draws an important distinction between illness as a subjective experience and disease as an objective medical reality. Like Abdul-Ghaaliq Lalkhen does in a Pain, Santhouse adopts a biopsychosocial approach: “to focus solely on the scientific and neglect he social aspects of illness is a mistake that we continue to make,” he says. Using a patchwork of anonymous case studies, he delves into topics like depression, altruism, obesity, self-diagnosis, CFS, medical mysteries, evidence-based medicine, and preparation for death. He brings the picture up to date with a final chapter on Covid-19. I’ve read so many doctors’ memoirs that this one didn’t stand out for me at all, but those less familiar with the subject matter could find it a good introduction to some ins and outs of mind–body medicine.

Originally published on my blog, Bookish Beck.

[Freddie · Rating 5 out of 5]

This book deals with incredibly sensitive subject matter in a dignified and informative way. Dr Santhouse starts by laying out some well-researched reasoning for his views on psychiatry, and then takes us through an interesting collection of his past experiences.

Dr Santhouse is humble enough to admit when cases did not go his way, and so provides the sort of realistic view into the world of psychiatry I have never seen before. Each patient is so well described I can almost feel them in the room with me, and Dr Santhouse's calm demeanour and clarity of thought jumps out from every sentence.

I would strongly recommend this book - we could all do with a little more compassion towards mental health in these times, and this powerful insight is exactly what the doctor ordered (sorry).

[Laura · Rating 4 out of 5]

A compassionate and thoughtful discussion around modern psychiatry, with an assortment of patient stories and the doctors own thoughts and observations of care and treatment of common psychiatric conditions.

I enjoyed this book, I thought it was well written and thought provoking. The author discusses one of the more common psychiatric conditions - depression - albeit somewhat briefly, so I would have been interested to read more of his thoughts on how this is identified, treated and managed and if recovery is possible.

A recommended read for those interested in psychiatry, mental health and medical memoirs.

[Ruthy lavin · Rating 4 out of 5]

Very informative and extremely well written.

[Abdullah Iqbal · Rating 5 out of 5]

A magnificent book. Opening my eyes to so much in the health system and the importance of our mental health. The stories of the effects that mental things have on us.

[Nalu · Rating 4 out of 5]

This was hard to get into as I expected to read more about mental illness than this man's career. But the further along I read the more interesting it became. I learned a lot from the way he treats his patients. If I was still working as a pharmacist there would be so much information here that I could have used with patients too. I'm glad I don't have to anymore but I'm also glad I read this. Really eye opening for the interaction of physical and mental health.

[Sophie · Rating 5 out of 5]

It feels like forever ago since I sat down to write a LONG book review but today that all changes as I’m here with a cup of tea and a book with many dog-earred pages.

In this book, Alastair Santhouse takes us through his thoughts on health and wellbeing, the boundary between physical and mental health, the culture of health in the UK, how we can forget to see the holistic view of people in our “relentless pursuit of disease” (Culture, page 45) and so miss vital reasons for why we act, think and feel the way we do.

“Physical or psychological? A more fruitless debate is difficult for me to imagine. Anyone who practices medicine, anyone who understands human nature, understands that there are, in just about any illness you care to mention, both physical and psychological components.” (Exhaustion, 88)

The chapter on suicide and despair, and how he can feel so drained and moved by people’s stories, and how he feels a responsibility towards his patients but one he ultimately has little control over, was powerful. I think it must be necessary as a medical professional to have a sense of distance and dissociation in order to protect yourself (and your patients, no-one wants their doctor crying when giving bad news) but it is important to hear what a patient is telling you and to really listen, and to feel for them on some level, otherwise you’ve lost your humanity and your reason for being there haven’t you? The balance must be a hard one to navigate.

He talks about depressed patients coming to him after antidepressants didn’t have the desired effect, they are labelled ‘difficult to treat’ or having ‘treatment-resistant depression’. “And in nearly all cases, they have not got depression at all, but a life that lacks any higher goals. Their actions are meaningless and the days drift by - who wouldn’t feel sad, hopeless, pessimistic and unhappy in those circumstances?” (Meaning, 163) I think this is such a fascinating point to make, it links in my mind to the social model of disability. So often in our culture when people have a ‘problem’ we feel the need to label, dissect, treat and discharge. When we are always looking for a disease or illness, a root cause, we can miss circumstantial and societal elements to both mental and physical health. He discharges a woman after one session after reminding her that it’s normal to feel sad, it doesn’t mean her depression has returned and she didn’t need to panic or go into crisis, this was the realisation she needed to move on and start really living her life.

There is an example given of a person with hypochondria, who is passed from expert to expert, undergoing numerous tests, which end up not having the desired effect of easing her anxiety but in fact the opposite - she might think if they are doing a scan, there must be something wrong with her, they just haven’t found it yet. Plus invasive procedures come with numerous side-effects creating a spiral. The author comments “her doctors were all diligent and well-intentioned practitioners, and I suspect they must have had their doubts about the wisdom of some of their investigations and the surgeries they subjected her to. It’s just that they were constrained by a system of medical practice that is risk-averse and rigid. It is a culture in which the safe option is always to over-investigate.” (Culture, 45) It is hard to know what to take away from this point as we want treatable disease to be discovered, but it is good to consider that sometimes we let our fear lead the way, in not the most productive or helpful directions.

There is a fascinating part about the link between medicine, psychiatry and social change (he makes the point homosexuality was considered a mental illness right up until 1973). He says doctors are often involved in defining where ‘normal’ stops and illness begins. It makes you think about people that have come to distrust the mainstream medical system, and why that might be the case. John Green, in his book Everything is Tuberculosis, talks about how it’s easy to judge people for mistrusting doctors if you aren’t curious about why, but when you learn more about their experience and the experience of their communities you might come to understand more, and if you know why, then maybe you can do something to challenge those beliefs. There is discussion of the place of paternalism within healthcare which was interesting too.

I loved the part about the psychologist Carl Rogers, acceptance and ‘unconditional positive regard’. There is lots in this book about how our beliefs (both conscious and unconscious) shape how we live and what we pay attention to and some reasons why placebos (medication with no active ingredient) might work. And I loved the switch up of heart-sink patients (who make a doctors heart sink when they walk in the room, stacks of medical notes, endless symptoms, and no clear cause), to considering heart-sink doctors (who are ticking boxes, there to issue prescriptions and move on to the next case without seeming to really care).

I have in the past been hesitantly for assisted dying, whilst understanding that we do not live in a perfect society and it is a system that could go horribly wrong. I just think that I have never lived someone else’s life - if they are saying life is no longer worth it, how can I speak over their own experience when they say it would be the most dignified thing to assist them to end that suffering, to have a death that is as much as possible in their own control. I'd been so focused pondering the complexities of this with regards dementia and mental capacity, I had not previously thought of this in the context of mental anguish and suicidal thoughts, which paints a different light as I would never want a doctor to assist someone to end their own life if there main issue was depression. Why is that? Is it because I believe depression is treatable and you can live a meaningful life living with depression alongside your pain, or because I think people with severe mental illness are not in a place to make a considered decision. But then how do you decide if someone is in the right headspace to make that call, when is it suicidal and when is it a wish for a dignified death. A very complex issue for sure.

I was interested to hear from Santhouse that although the general population is generally in favour of assisted dying, he is not. He says fewer doctors support the idea than the general population, and even fewer of those working in palliative care. “Palliative care physicians understand that for the majority of people, good-quality palliative care means that the desire for death does diminish. My experience has been that when people are asking to die, they are communicating something different. They are asking for help to live.” (Wishing for the end, 210). I could talk about this issue all day as there are so many complexities and I go back and forth on it.

As someone very interested in palliative and end-of-life care I found the Final Days chapter enthralling. He mentions the need to stop trying to fix things and to de-medicalise his thinking in those situations to best support someone at the end of their life. The “small gestures” can often make the biggest difference at these times. He discusses how and why end-of-life conversations are rare in hospitals. “Working as we do in an increasingly technocratic healthcare system, the death of a patient is seen as a failure of medical care, rather than part of the cycle of life. Death is a topic to be avoided.” (Final Days, 246). In opposition to our discussion earlier, that depression can actually sometimes just be a normal reaction to a set of life events, in this chapter Santhouse talks of a person who at the end of their life was clearly depressed, he got them on treatment which helped and enabled them to life their last days in ‘agreeable conversation and human interaction’ and he said “nobody would have blamed me if I’d said or done nothing as ‘it’s understandable to feel like that’”. (Final Days, 250).

I am personally sceptical of “alternative medicines” but I am also aware of the reasons why people feel the need or want to seek them out. Money is a big issue in our world. Drug trials are expensive and funding is an issue that has to be managed. Research will likely not be undertaken on things where the money can not be made back, basically if they can’t sell it they won’t research it (obviously this is a broad generalisation and not true, but comes from a place of reason). The author talks about therapies which have not been researched because the funding is not there, in our ever medicalisation of health over ‘broader consideration of patient well-being’. He says “I have no doubt that everyone who pushed for the new drugs to be released onto the market was acting with the best of intentions, trying to optimise treatment for cancer.” (Final Days, 253) I have to say I’m usually an optimist but in this case I disagree with the author, I hope he’s right though.

The chapter on COVID-19 was the one I bookmarked the most. Santhouse discusses the effect on people (mentally and physically) when they are labelled “vulnerable”. He says “hope is a very poor strategy for dealing with a crisis” (COVID-19, 261). Talks about how some people were happier in lockdown than before, for some people (especially those with social or health anxieties) they felt less isolated as everyone was going through it together and their habits were no longer considered odd. For most though, the lack of social isolation and the increased fear was clearly detrimental.

I found the use of the term ‘becoming demented’ (COVID-19, 263) quite jarring. Didn't like that.

When I book an appointment through my GP I am only allowed to discuss one issue, in a 10 minute slot. I understand the reason for this, but when multiple issues are seemingly obviously related the system starts to feel flawed. Santhouse is scathing of alternative medicines - “alternative health beliefs are part of a mindset that at one end of the spectrum is a benign and harmless addition to standard medical care, and at the other end merges into overt conspiracy theory and paranoia… Even at its best, many alternative health conceptualisations of how the body works are at odds with accepted science.” (Belief, 131). I mean, I’m not exactly arguing, I have found myself wildly angry at some of the things I’ve heard when people find out my loved ones have cancer. He does go on to say doctors need to be interested in why people feel the need to take alternatives, and why medicine is not giving people what they need, I agree with that at least.

I could go on and on, this book is so thought-provoking and made for a very enjoyable read. Plus I found it in a bookshop, bought it and read it which I know shouldn’t be an achievement but as we all know buying books and reading them are different hobbies so it feels like it is! :D

[Donna Dyke · Rating 5 out of 5]

Interesting, fascinating and humourous author who restored my confidence in the medical profession. If only all medical professionals were so thoughtful and caring. I personally had an extremely bad experience when I was diagnosed with fibromyalgia and possible rheumatoid arthritis. He made me feel inadequate and foolish.

I enjoyed hearing about his patients in a thoughtful and positive way, alongside the suspected diagnosis.

[Ashley · Rating 5 out of 5]

I found this an informative and most enjoyable read. I especially appreciated the description of his patients. I am impressed with Santhouse’s clear, honest and entertaining style backed up by abundant and relevant research.

[Rachel · Rating 5 out of 5]

I came across this in the Guardian Review of Books and was struck by this pull-quote:

“[…] symptoms are part of life and [...] most of the time, tiredness, pain, dizziness or backache don’t indicate any disease at all.”

It was one of those ‘lie face-down in the carpet and scream with relief’ moments – of recognition from someone else in your position that indeed, the emperor is naked. The book covers different ‘ailments’, titled ‘Melancholy’, ‘Stigma’, ‘Exhaustion’ and so on. Woven between amalgamated patient accounts are Santhouse’s thoughts on modern medicine, which almost perfectly align with my own.

“[…] it does not follow that treating the body as a machine will heal it. But medicine appropriated the idea as the premise for its practice. This is the essence of the current culture.”

Or to push the metaphor another way: people turn up with their brake lights showing, insisting that it’s all down to the car being the wrong colour.

“If the health and well-being of staff is not looked after, then the health of those patients that they are meant to be treating suffers too. It takes a far-sighted chief executive to see this – although, in their defence, they are usually themselves battling intolerable pressures from government or shareholders, and the misery gets passed downwards.”

MY BOY.

“But doctors have always come low down on the list of hospital priorities, and the loss of the doctors’ mess, the loss of consultant dining rooms and the loss of the old ‘firm’ medical structure, with a consultant working with and getting to know his or her team of juniors, has led to a lack of cohesion and loss of the spirit de corps that used to be so essential to morale.”

I witnessed this firsthand as the Irish system went from the old, highly illegal system of 36-hour shifts to the new, still breaking the law but only barely, ‘weeks of nights’. It definitely lessened cohesion, not least because this was a measure instituted with great reluctance and indignation, rather than being treated as a sensible measure with predictable knock-on effects that could be mitigated had anyone cared to think about them.

“And I suspect that patients would expect doctors to refuse to operate if the risk was too high, to manage risk for them, in much the same way that I don’t expect to be consulted by my pilot about weather conditions and whether he should fly, even if I desperately want to reach the destination.”

O-HO and THIS. All through medical school I was taught that the most important thing is patient autonomy, only to find that when I hit the wards the first thing people want to do is throw their autonomy in the bin and let you do all the thinking.

“From my perspective as a clinician, treating patients is about pragmatism, about finding a way. I do not offer treatments based on the elegance of the theory behind the treatment or whether it is consistent with an ideological understanding. I base my treatments on what the evidence shows, what trial data are telling us and whether it is likely to work.”

This was in the chapter about chronic fatigue syndrome and how patient advocacy groups have treated researchers so horribly that many walk away. It tallies with my experience, that telling someone they have terminal cancer is far easier than, “The tests are all negative, I suspect this might be … stress …”

“Yet the alternative health industry seems to be even more shameless about its profiteering with hardly a mention of this aspect of the industry. For sure, scepticism is expressed at the efficacy of the treatments, but somehow the industry as a whole is seen as naïve and misguided, rather than greedy and rapacious.”

Ha, this is a good point – especially in comparison to Big Pharma – and one I had not considered before.

“It is undoubtedly harder to help someone frame their problems as a deficit of meaning in their lives rather than a deficit of serotonin in their brains, but having the experience and confidence to be able to do this can make all the difference in the world.”

See above. No one is STRESSED, they just want the FIX-IT PILL, doc.

“Trusting your doctor isn’t the same thing as having capacity, but for most people it seems good enough. I rarely, if ever, get referred this patients […]”

A subtle point but whoa, so true.

“The consensus in medicine, believed by almost nobody individually but practiced almost universally, is that more medicine is better medicine – the fallacy that more investigations and more treatment lead to improved outcomes.”

And this is where one of my two criticisms comes in. Santhouse – perhaps in a demonstration of paternalism? – at no point considers that patients have a role to play in improving the way medicine is delivered. He says:

“It is hard to know whether it is the medical profession driving the individual’s need to have every feeling and emotion validated by a diagnosis or whether medicine is merely reflecting the public mood, but either way it is a substantial step in the wrong direction.”

But patients, while often powerless individually, are extremely powerful in aggregate. The most obvious example is the man who came to Santhouse having undergone ten years of investigations for stress-induced migraines. Yes, that was a lot of wasted time, but … after the first year, even the first six months, it should have been clear to a rational person that this wasn’t a life-limiting problem. Why not throw in the towel then? It’s a fact that patients tend to think if there’s difficulty finding a ‘diagnosis’, it’s because they have something extremely weird and rare, as opposed to the fact that their doctors lack the time and moral courage to have an extremely difficult conversation with them about their psychologically-driven problems. Perhaps patients have a duty to look to their diet, exercise habits, relationships, and coping mechanisms, to see if they can improve anything there, without assuming the doctor is a god-like figure who can wave a magic wand provided their story is dramatic enough.

And then there’s the fact that once or twice Santhouse says things like this:

“Why, at the age of thirty-five, have they never had a relationship that lasted more than a few weeks?”

He also references having multiple sexual partners as being a high-risk behaviour, when in fact the high-risk part is unprotected sex. I’m sure this is a matter of carelessness. I doubt a man as thoughtful as Santhouse really does think that people who are single, but otherwise psychologically well, are irreparably damaged, any more than he thinks people with a high body-count in the bedroom are at risk of mental health disorders. It’s just a point on which he could have been a little more careful. (Unless he really does think these things, in which case go off, I guess.)

“Samuel Daniel, the sixteenth century poet, ‘Striving to tell his woes, words would not come; for light cares speak, when mighty griefs are dumb’.”

Indeed, if more people could tell the difference between mighty griefs and light cares, the hospitals would be quieter places.

[Charlotte · Rating 5 out of 5]

Really enjoyable exploration into the problems of modern medicine and the benefits of thinking from a psychiatric perspective. Explored concepts such as ‘unexplained symptoms’, stigma in psychiatry and ethical issues that you might occur as a psychiatrist.

[Hannah Powell · Rating 4 out of 5]

I was interested to read this memoir, having suffered from functional neurological disorder myself. The connection between body and mind has both fascinated and frustrated me. Alistair's accounts were interesting and I agree with his thoughts on the issues with the way healthcare has become increasingly specialised. This, he says, mean that "knowledge among specialists is getting deeper and narrower, but at the cost of losing the broader picture". It's a book that would be useful for everyone in the healthcare system to read, particularly those consultants who pass patients from pillar to post without stopping to dig more deeply into what's going on outside of the multiple tests which suggest that 'nothing is wrong' when clearly that's not the case. I myself was told nothing was wrong by a neurologist when experiencing twitches and tics in my torso and limbs in response to sound and touch. He didn't understand why I was upset to be told nothing was wrong. Eventually a psychiatrist mentioned FND some months later when I was sent to him because I was so upset at being discharged from neurology. By then I had found a way to get better by myself with a combination of counselling, alternative therapies and daily nature walks. It seems like the NHS could save a lot of money by investing in psychiatry and holistic health.

I was disappointed that functional issues were mentioned only in passing given that they are the second biggest reason for attending a neurology clinic.

[Joann · Rating 3 out of 5]

Three stars. Although this book did not deliver on its promise on how the brain can heal the body, it did collaborate that the brain plays a huge part in how well a person will respond or not to conventional treatment. I found it an easy read in that Dr. Santhouse explains conditions and treatments in a way that I, as a lay person, can understand. It also clarified for me that each medical 'specialist ' is only concerned and knowledgeable of his area of the body thus the 'whole body gets lost in all the parts. The other practice that also made sense is that there must be a physical reason for symptoms; thus, more tests are needed or more, or stronger medication is required otherwise the symptom is likely imagined It makes sense why medications are so freely given. I didn't agree with his blanket assessment of alternative medicine as I strongly believe that Eastern medicines do work and that there is a reason that people still use them today. An excellent example is acupuncture, which I have used with great success. What I wanted from this book was to read how the mind can be used to actually help heal, and that was not in the book.

[Ann Campbell · Rating 5 out of 5]

This is an outstanding series of essays by a psychiatrist who works with chronically ill patients as well as patients in areas focused on body/mind connections such as eating disorders and chronic fatigue syndrome. He is an outstandingly clear, thoughtful, and curious writer. Each essay imparts fascinating insights about particular areas of his practice. For example, he notes that one of the only ways he can detect if patients are deliberately lying is based on their slowness or inattentiveness to obvious questions such as "what is your birthday." He claims that people put so much energy into preparing to tell a big lie that they lose the narrative of basic straightforward facts in the meantime. I loved this book. It was like being in a seminar with a chatty and brilliant professor of the sort you'd expect to narrate "Masterpiece Theater." I could just image the author in a sweater vest, sipping Scotch in front of a fireplace. And I mean all that in a positive way. I love sweater vests and fireplaces (although admittedly I'm not a big fan of Scotch).

[Carson Jones · Rating 4 out of 5]

This book was very informational on the life that medical doctors go through and even some of the issues with the medical system at large. The author did a great job with relaying his seasoned experience concerning the mind body connection. The only reason I give it 4 stars is because I would have been interested to see some more ways he helped people break out of these issues rather than simply outlining that not every physical symptom is cause for relentless medical examinations. Overall, I’m very thankful I found this book and even more thankful for the reassurance it gave me to know that there are Doctors out there that truly care about the entirety of an individual, not just the symptoms they present.

[Emma Dickson · Rating 5 out of 5]

When I started listening to the audiobook I really didn't think I'd become so interested in the authors work.

His viewpoint about how what's going on in a person's mind, past or current issues that affect mental health, and how they can affect the body is a revelation. He describes how doctors only see the "outside" of a person and try to treat the physical symptoms, without digging deeper into their mental health, which can cause more harm itself.

The case stories he tells of people suffering for many years are fascinating. They are constantly returning to the doctors with physical issues that could be quickly and accurately diagnosed, if only there was more time and knowledge to dig into that person's life.

[Clay]

This book is written for the general public - it's very well articulated and covers some of the most interesting and oft misunderstood aspects of psychiatric practice.
It is not a great read for someone working in psychiatry however, because all psychiatrists (even very junior ones) will have experience a lot of what is written about already - so reading about it will be rather tedious.
But for the general public, and even medics in other specialties, I think this is a very good book.
I did find some of the cases interesting and the section on Covid interesting.
I have not given it a star rating because I am not the intended audience of the book...

[P A Ling · Rating 5 out of 5]

Fascinating insight into the mind body connection

I bought this book because I have a long standing interest in health and well being. As a complimentary therapist, I too experience clients dismay at a lack of diagnosis. Often they don't want to be treated by drugs but supported as they work their way into understanding and coping with illness. As a member of The College of Medicine, we know that social prescribing is often better for us than a pill. Alastair's incites into what needs changing in medicine are very welcome.

[Hattie · Rating 5 out of 5]

“Like everything else in medicine, you were just expected to turn up and know what to do without anyone telling you”

“There’s no need to apologise for tears any more than for laughing at a joke”

On remedies being natural “so are ricin, tuberculosis, and anthrax”

“For reasons long forgotten, our emails have adopted the language of Soviet era Politburo members, probably subconsciously stemming from the feeling that the NHS behaves as a kind of badly run totalitarian state”

“In my experience, there are few problems that can’t be made worse by the arrival of Security”

[Jonathan Martin · Rating 3 out of 5]

Interesting, but a bit patronising of other medical specialties (“oh look at all these patients I’m referred when all the other silly doctors don’t know what to do”). Lots of “why didn’t they refer this patient sooner?” about cases that in actual practice most NHS psychiatric services would require a referring doctor to do a number of investigations or trials of treatment before they would be seen, and even if they were seen the wait would be months or years. The author doesn’t really address the issues with that side of mental health care in the UK at all.

[Valerie · Rating 1 out of 5]

While a couple of chapters contain interesting and useful information, this book is the literary equivalent of the guy who hears he's a good cook and insists on opening a restaurant. Does this book want to be a memoir? A self help guide? A meditation on the role of psychiatry in treating physical health? Yes. No. All and none of the above. Stay in your lane, Santhouse; a writer you are not. (Also, we do not especially care that you went to Cambridge.)

[Matt · Rating 4 out of 5]

A skilful book from a medical professional’s wisdom that had me interested on a different perspective.

It wasn’t a surprise that the author seemingly has woken up sooner than others in a poorly run institution affected by the political and financial systems of healthcare.

For now, we’re fortunate to have an individual like this author manage free healthcare. I wonder if consumers of healthcare purchased after the NHS is privatised will spend as long waiting to be listened to?

[Liselotte Horneman · Rating 5 out of 5]

Wise and kind

Alastair Santhouse brings kindness, much needed honesty and humility into the field of medicine. Who would have guessed that medicine is about people - something we lose sight of in this age of technology and medical specialization. Life is infinitely complex, and Santhouse is wise to remind us of that both as a doctor and a human being.

[Kayla · Rating 4 out of 5]

“When your only tool is a hammer you turn every problem into a nail.”
I thought this book was a beautiful exploration to the human mind, and how the mind and pain interact. The mental vs the psychical and so much more. Very interesting, and informative without being too much to take in. Would highly recommend.

[Lauren · Rating 5 out of 5]

Thoroughly enjoyed Dr Santhouse’s collection of stories about how mental and physical wellbeing is entwined. This enjoyable recollection of his work gives a persuasive reminder that (generally speaking) we are in control. An insightful look into pain and the systems created to heal it. I recommend the audio version for those who are interested, the author’s narration is very well done.