Book Review: Is It All in Your Head?
Oct. 28th, 2016 08:57 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
osprey_archerMy latest NetGalley book is Suzanne O'Sullivan's Is It All in Your Head?, which I found interesting but frustrating, although the fact that it's frustrating is not really the book's fault.
The first reason that I found it frustrating is that I expected it to be about hypochondria, but there's actually only one chapter about that; most of the book is about psychosomatic disorders, which is interesting in a different way, but it's still frustrating to get a book you think will be about one thing and discover it's about another. (In hypochondria, while there are often physical symptoms, it's the anxiety and not the physical symptoms that are debilitating; a psychosomatic disorder has debilitating physical symptoms with a psychological cause.)
But it's also frustrating, and O'Sullivan herself is clearly frustrated with this, that the medical community doesn't understand psychosomatic problems at all and also doesn't seem to be interested in understanding, despite the fact that something like 20% of patients have problems that may be psychosomatic in origin. If 20% of patients presented with any other problem you'd think the medical community would be falling all over itself to figure out exactly how it worked, but as it's just psychosomatic, well then! Why bother?
The medical community (and indeed the lay community) tend to believe that the only "real" causes are physical causes, so if someone is for instance having debilitating seizures, it's only "real" if it's epilepsy. The fact that the sufferer is debilitated by their seizures apparently isn't real enough.
O'Sullivan is a neurologist, and neurologists have very clear and specific tests they can do to detect different kinds of seizures, so she can diagnose with a great deal of accuracy whether a seizure is epileptic or dissociative (which is another word for psychosomatic in this case). And in fact many of her patients with dissociative seizures do stop having seizures, sometimes as soon as they receive the diagnosis and sometimes after getting psychiatric help, and after they've been taken off their epilepsy medication. The cure seems to me to prove O'Sullivan's diagnosis was correct.
In fact, it struck me that a psychiatric cure seems like the only way, at the moment, to prove that an illness is psychosomatic: otherwise it's not clear at all whether it's psychosomatic or caused by some physical problem that we can't measure. I particularly wondered this in the cases of medically inexplicable paralysis that O'Sullivan examined: the medical establishment couldn't find a cause, but unlike with the dissociative seizures, the diagnosis of a psychosomatic complaint didn't help the paralysis sufferers.
But at the same time I wonder if my doubt is simply that paralysis seems so dramatically debilitating that it's hard to believe that it could be psychosomatic. And yet if you'd asked me before I read this book, I would have been doubtful that someone could have a psychosomatic seizure disorder, because seizures also seem so dramatic. So the fact that it seems to defy common sense may not prove anything except that there are more things in heaven and earth than are dreamt of in our philosophy.
In any case, all this seems like yet another good reason why the medical establishment ought to seriously investigate psychosomatic complaints: not only could they help sufferers, but they could probably also get better at distinguishing psychosomatic illness and illness with a physical cause we don't know how to find yet.
But at the moment psychosomatic symptoms seem to have fallen between the two stools of physical and psychiatric medicine.
***
The book also talked briefly about Munchausen's syndrome, and O'Sullivan made the point that in fact people with Munchausen's are sick, that it is a mental illness, and that most of us don't consider that fact because basically we find the idea of pretending to be sick so disgusting.
The first reason that I found it frustrating is that I expected it to be about hypochondria, but there's actually only one chapter about that; most of the book is about psychosomatic disorders, which is interesting in a different way, but it's still frustrating to get a book you think will be about one thing and discover it's about another. (In hypochondria, while there are often physical symptoms, it's the anxiety and not the physical symptoms that are debilitating; a psychosomatic disorder has debilitating physical symptoms with a psychological cause.)
But it's also frustrating, and O'Sullivan herself is clearly frustrated with this, that the medical community doesn't understand psychosomatic problems at all and also doesn't seem to be interested in understanding, despite the fact that something like 20% of patients have problems that may be psychosomatic in origin. If 20% of patients presented with any other problem you'd think the medical community would be falling all over itself to figure out exactly how it worked, but as it's just psychosomatic, well then! Why bother?
The medical community (and indeed the lay community) tend to believe that the only "real" causes are physical causes, so if someone is for instance having debilitating seizures, it's only "real" if it's epilepsy. The fact that the sufferer is debilitated by their seizures apparently isn't real enough.
O'Sullivan is a neurologist, and neurologists have very clear and specific tests they can do to detect different kinds of seizures, so she can diagnose with a great deal of accuracy whether a seizure is epileptic or dissociative (which is another word for psychosomatic in this case). And in fact many of her patients with dissociative seizures do stop having seizures, sometimes as soon as they receive the diagnosis and sometimes after getting psychiatric help, and after they've been taken off their epilepsy medication. The cure seems to me to prove O'Sullivan's diagnosis was correct.
In fact, it struck me that a psychiatric cure seems like the only way, at the moment, to prove that an illness is psychosomatic: otherwise it's not clear at all whether it's psychosomatic or caused by some physical problem that we can't measure. I particularly wondered this in the cases of medically inexplicable paralysis that O'Sullivan examined: the medical establishment couldn't find a cause, but unlike with the dissociative seizures, the diagnosis of a psychosomatic complaint didn't help the paralysis sufferers.
But at the same time I wonder if my doubt is simply that paralysis seems so dramatically debilitating that it's hard to believe that it could be psychosomatic. And yet if you'd asked me before I read this book, I would have been doubtful that someone could have a psychosomatic seizure disorder, because seizures also seem so dramatic. So the fact that it seems to defy common sense may not prove anything except that there are more things in heaven and earth than are dreamt of in our philosophy.
In any case, all this seems like yet another good reason why the medical establishment ought to seriously investigate psychosomatic complaints: not only could they help sufferers, but they could probably also get better at distinguishing psychosomatic illness and illness with a physical cause we don't know how to find yet.
But at the moment psychosomatic symptoms seem to have fallen between the two stools of physical and psychiatric medicine.
***
The book also talked briefly about Munchausen's syndrome, and O'Sullivan made the point that in fact people with Munchausen's are sick, that it is a mental illness, and that most of us don't consider that fact because basically we find the idea of pretending to be sick so disgusting.
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Date: 2016-10-28 07:12 pm (UTC)no subject
Date: 2016-10-28 11:04 pm (UTC)