Review: It’s All in Your Head – Suzanne O’Sullivan

This was a book I needed to read.

Daniel is twenty-three. He’s never been seriously ill, and he’s perfectly fit and well, but an acquaintance of his has just died of a brain haemorrhage and suddenly the mild-but-niggling headache at the back of his skull has taken on a far more sinister meaning. He hasn’t realised it yet, but his adamancy that he needs an MRI scan – just to make him feel better, just in case – could be the beginning of a very slippery slope into a terrifying world where every twinge is menacing, every blemish needs careful observance, and where something as commonplace as tiredness signals the potentially fatal. Daniel is suffering, but not at the way he thinks he is. His consultant, the author of this book, does not share his concern about his headaches. They are benign, harmless, with none of the warning signs of serious medical issues. Instead, she recommends he seeks treatment for the anxiety that has already begun to worm its way into his every waking moment. It was after reading the four or so pages that discussed Daniel’s plight, nestled in the middle of this already captivating book, that I broke down in tears. Recognising myself so entirely in the words and experiences of a stranger was not an experience I was prepared for.

There’s a huge difference between something originating in one’s mind, and actively making something up. That, essentially, is the message of this book. Daniel’s case is almost a side note. He is a hypochondriac, only really suffering from anxiety, not physically impaired by the symptoms making him worry so much. The rest of the book tells the tales of patients whose bodies really have been disabled. Matthew cannot move his legs. Camilla suffers from frequent seizures. Shahina’s dominant hand is painfully contorted. Yvonne has gone blind. O’Sullivan does not doubt the real-ness of their impairments. But, as a consultant in neurology, it is her job to tell her patients that their test results are normal, and that their ailments don’t have an organic cause. Instead of giving them the medical diagnosis they seek, she must face the inevitable backlash of denial, of frustration, of anger, sometimes, and deliver her diagnosis: “it’s all in your head”.

Our bodies do funny things when our minds are under pressure. A bride and groom sign their marriage certificates, hands shaking. A candidate waits for a job interview with butterflies in their stomach. A particularly tense moment of a film makes our hearts start pounding, and we wipe away sweat drops from our foreheads. Physical reactions like this are things that most of us take completely for granted. We don’t need a doctor to confirm that these are the workings of stress, and nothing more sinister. It shouldn’t be surprising, then, that such reactions can be more extreme, more varied, than those we call normal. O’Sullivan’s diagnosis is never intended as an accusation, but, sadly, it is often received as one. Somewhere, muddled among the implications of lying, and the negative stigma attached to mental health issues, the reality of psychosomatic disorders has been buried. And if, as O’Sullivan describes, the complex possibilities of such issues are little more than a footnote in a medical textbook, leaving even senior consultants confusing them with the results of imagination and deceit, it is hardly surprising that the common patient has such difficulty accepting them.

Writing about ‘science’ for non-scientists requires a delicate balance that O’Sullivan achieves masterfully. Admittedly, this book might be more about what we don’t know than what we know – after all, a diagnosis of a psychosomatic disease is only really made by ruling out possible organic causes – but I was certainly left feeling as though I understood a little more about the incredible and often underestimated connection between mind and body. Interjected with eloquent explanations of medical fact and psychological theory, O’Sullivan intimately recounts stories of patients and their plights. Perhaps what is most striking is the extent of her own involvement: a psychosomatic disorder can only be treated with understanding, and we share her determination to help even those who do not believe she can help them.

I wish I’d seen a consultant as switched on as O’Sullivan when my headaches started in October. It’s All in Your Head was fascinating and completely gripping, with characters painted vividly and a real sense of interest and urgency. For me, it was also incredibly reassuring. I may still be baffled by the human mind and body, but I’m learning to trust it to do its thing.

 

Disclaimer: I’ve never written a book review before. Is this even a review? Is it okay? 

 

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16 Comments

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  1. Ella, this IS a review and it is brilliant. I wanted to say “write for me”, but that sounds arrogant, especially because I have no money to pay writers and am also a writer trying to convince other editors to pay *me*. But I’ve been thinking about starting a feminist/progressive literary review (and am currently looking into doing a similar thing as a podcast, with Esther Brazil, if you know her) – would you be interested, if it gets off the ground?

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  2. It IS a review, and a marvellous one at that. It’s made me want to read the book.

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  3. This is brilliant

    Liked by 1 person

  4. It is a review, but, as with most reviews of this book, there is no attempt to fact-check the claims and stories promoted by O’Sullivan. This is disappointing.

    There has been a sustained campaign within the UK media to exaggerate the role of reversible psychosocial factors in the perpetuation of disability and ill-health, and this has caused considerable harm to the way society views and treats those forced to rely upon disability benefits. Some further reading on this is available here:

    http://www.centreforwelfarereform.org/uploads/attachment/492/in-the-expectation-of-recovery.pdf
    https://ueaeprints.uea.ac.uk/58235/
    http://www.disabilitynewsservice.com/biopsychosocial-basis-for-benefit-cuts-is-cavalier-unevidenced-and-misleading/
    http://www.stats.org/pace-research-sparked-patient-rebellion-challenged-medicine/

    “a psychosomatic disorder can only be treated with understanding, and we share her determination to help even those who do not believe she can help them”

    It is worth bearing in mind that she’s getting paid. If those offering such ‘help’ to patients did not have a financial incentive for doing so, and for exaggerating their own value, I think that we would face less spin and misinformation from them.

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    • Thanks for the links – I didn’t know that, and it is interesting.

      I don’t think the payment thing is particularly relevant though. She is getting paid, yes, but so are the other doctors who have failed to help the people she helps. A particularly touching moment in the book is when the mother of a former patient thanks her for alerting her daughter to the possibility of a psychosomatic rather than organic diagnosis, which ultimately resulted in a complete cure.

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      • It’s dangerous to make assumptions about patients being helped based on anecdotes and testimonies, particularly those provided by the practitioner. There are many people making money from quackery who are happy to provide a litany of such stories. There is a problem with people making money from false claims of expertise and ineffective treatments within medicine (including ‘mainstream medicine’ – just google ‘replication crisis’), and I do think that their perverse incentives are part of the problem.

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  5. Hey, Ella, I can see that Suzanne O’Sullivan’s book very much resonated for you, and I fully respect this, but I just want to say that whatever the merits of the other chapters (describing relatively uncommon medical events), the ‘Rachel’ chapter on ME (which affects 250, 000 people in UK alone) is hugely misleading and irresponsible as it ignores recent international and UK research into this devastating neuroimmune illness and simply recycles dangerous myths. She has of course been much criticised for her inclusion of ME in a book about psychosomatic illness.

    I see you have just done a year abroad, I actually got ill during my year abroad in France in 1982/3, but I had a severe enterovirus, which in turn triggered ME, which I still have today. I had to come home from France after 3 months, I was hideously ill, and was unable to complete my joint Honours degree (doing an Ordinary Arts degree instead). I was diagnosed with ME by a consultant neurologist in 1984 after abnormal muscle biopsy and EMG and many blood tests. I still recall him saying I had a ‘full house of abnormalities’. He is a true specialist in the illness, Dr O’Sullivan, on other hand, has no expertise in ME and has simply exploited the illness too pad out her book. I have written more on my blog, which you can look up if interested. My first treatment in 1984 was a plasma exchange and immunosuppression, I was not yet 21. (I have fictionalised all of this, including my year abroad, in my 2008 novel.)

    I have for over three decades lived through the ugly politics of my illness and seen for myself how a poorly understood neuroimmune illness was hijacked by psychiatry in 1990s. O’Sullivan fails utterly to describe the dedicated doctors who were treating and researching ME in the UK in the 1980s – there are just so many holes in her chapter. I am passionate about education and this is why I am leaving this comment.

    Also, I see you talk about a Dr O’Neill later in your review, I was confused, but am guessing you mean O’Sullivan!

    All good wishes, take care, NASIM

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  6. Nasim Marie Jafry June 17, 2016 — 1:35 pm

    Hey, Ella, I can see that Suzanne O’Sullivan’s book very much resonated for you, and I fully respect this, but I just want to say that whatever the merits of the other chapters (describing relatively uncommon medical events), the ‘Rachel’ chapter on ME (which affects 250, 000 people in UK alone) is hugely misleading and irresponsible as it ignores recent international and UK research into this devastating neuroimmune illness and simply recycles dangerous myths. She has of course been much criticised for her inclusion of ME in a book about psychosomatic illness.

    I see you have just done a year abroad, I actually got ill during my year abroad in France in 1982/3, but I had a severe enterovirus, which in turn triggered ME, which I still have today. I had to come home from France after 3 months, I was hideously ill, and was unable to complete my joint Honours degree (doing an Ordinary Arts degree instead). I was diagnosed with ME by a consultant neurologist in 1984 after abnormal muscle biopsy and EMG and many blood tests. I still recall him saying I had a ‘full house of abnormalities’. He is a true specialist in the illness, Dr O’Sullivan, on other hand, has no expertise in ME and has simply exploited the illness to pad out her book. I have written more on my blog, which you can look up if interested. My first treatment in 1984 was a plasma exchange and immunosuppression, I was not yet 21. (I have fictionalised all of this, including my year abroad, in my 2008 novel.)

    I have for over three decades lived through the ugly politics of my illness and seen for myself how a poorly understood neuroimmune illness was hijacked by psychiatry in 1990s. O’Sullivan fails utterly to describe the dedicated doctors who were treating and researching ME in the UK in the 1980s – there are just so many holes in her chapter. I am passionate about education and this is why I am leaving this comment.

    Also, I see you talk about a Dr O’Neill later in your review, I was confused, but am guessing you mean O’Sullivan!

    All good wishes, take care, NASIM

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    • Hi Nasim, thank you for your comment!

      I didn’t know that about ME. I suppose I ought to do a little more research next time I write a review – this was a very personal reflection, and not much more.

      And yes, I meant O’Sullivan – thank you! I have corrected it!

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      • Nasim Marie Jafry June 23, 2016 — 11:16 am

        Hey, Ella, Sorry for duplicate comment above, I had probs posting…I hope my comment has helped you understand a little more about ME; there is great biomedical research going on internationally and I hope soon we will have the elusive biomarker. It is not your fault at all if you did not know the truth about ME, there has been so much nonsense published in media since my own diagnosis in 1980s. The crux is that is conflated with ‘chronic fatigue’ – entirely fault of a core of psychiatrists – and we are in the mess we are in. It is disheartening that O’Sullivan’s book now has the platform of Wellcome prize. Anyway, wishing you all the best with the rest of your studies! I got the impression from some of your tweets you had not enjoyed your year abroad, I am really sorry to hear that. I still grieve that I was unable to finish mine. I was v homesick to begin with (I was only 18 when I went, almost 19) but just as I was settling in, illness struck. All good wishes, NASIM

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