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Annons
Suzanne O'Sullivan: It is controversial, but if you separate it into the title and the subtitle, which is "True Stories of Imaginary Illness", then I think it explains it a little more.What we're trying to do now in neurology is to move away from the brain and mind as being separate things. They're all one organ, and they're all in your head. That's what is behind the book: the brain and mind are not separate.
Annons
I don't think we had any desire to make it controversial at all. You find these things out afterwards. Our feeling was, 'Brain, mind, it's all in your head.' I see it's been taken in a different way to that – I've had that reaction a lot, and it's very reasonable, but controversy was not our intention at all.You've spoken about the stigma surrounding these illnesses – even within the medical community where practitioners fear labelling an illness as dissociative [the word doctors use for psychosomatic illnesses]. You recount one incident where you were sure a patient's seizure was dissociative, but when you proposed this a fellow doctor was angry, shouting, "No way is that child faking her seizures."
We never say "faking". No one's faking anything. It's subconsciously generated so it's never faked, except once in a blue moon.I gave this diagnosis to Pauline, a girl who had 12 years of illness from the age of 15, beginning with urinary tract infections, turning to joint pain and limb weakness and leading to paralysis and seizures. When I say, "Have you considered the possibility that this physical illness is not all physical in nature?" people like Pauline get extremely angry.But if another doctor avoids this diagnosis so as not to anger or upset the patient, or because they think it is insulting, that has big implications. Doctors are more worried about getting, for example, a diagnosis of epilepsy wrong than of getting dissociative seizures wrong, because they don't realise the harm in that. But they need to. If you miss a diagnosis of dissociative seizures the person will probably end up taking toxic drugs they don't need. There is great difficulty in giving up the diagnosis of an organic disorder and replacing it with a psychosomatic disorder.
Annons
I have to be very careful because I know I'm giving them news that is very difficult to take. If I give the news badly or if I don't prepare the patient adequately, sometimes they get angry and they leave, which is exactly what I don't want them to do because the minute they leave then nobody can help them any further.People have difficulty accepting [that their illness is dissociative] and the problem then is to get them to consider whoever it is who could actually help them; this could be a psychiatrist, a psychologist or a physiotherapist.
You say the power of suggestion is strong, almost something which feeds these illnesses. With that in mind, I wondered if people googling their symptoms added to this?
I don't think the internet has changed things enormously. The problem was always there. Before the internet you learnt about medical things from watching something on television or reading it in the newspaper, so I do think that the power of suggestion is so important.For example, there was that Cryptosporidium outbreak in Lancashire. Once people know there's a bug in the water, and you need to boil it, there will be an increase in people going to their GPs thinking that they are sick because of this.Illnesses are culturally influenced. I was talking to someone earlier about Morgellons – a disease where people think there are little fibres growing inside their skin – which is an illness not many people have heard of in the UK. However, in the States it is more common, and is something we'd call a culturally influenced syndrome. Because it's better known there, I am surmising it's on television shows and in the media and things and people read about it and that leads to people thinking they might have it. Once upon a time Morgellons would have stayed in the States, but now, because of the internet, it will probably come over here.
Annons
Traditionally, psychiatrists are the people who are trained in managing mental problems but the patients don't believe they have a psychiatric problem; they're having seizures or not being able to move their legs. That's where the problem with treating them arises. We need more cooperation and integration between psychology and neurology in the same way we need to stop thinking of the mind and brain as separate organs.So we need a new specialism which overlaps the two?
Something like that is appearing. For example, my particular field within neurology is epilepsy. In my opinion, dissociative disorders should be a subset of neurology in the way epilepsy is, so that you have specialist doctors who are trained specifically in this and therefore develop the psychiatric expertise. That's happened in a couple of places in London, Sheffield and Edinburgh, but it's bad news if you can literally name the people. They should be in every city. There should be so many people I couldn't name them all.So how does this book fit into the history of psychosomatic illness? I mean, you refer to Freud, Charcot, Janet, even the Ancient Greeks…
Until we were able to look at anatomy under microscopes, which was only from the end of the 19th century everything was a guess; people knew so little about anatomy and physiology they were merely guessing what happened inside the body, so they had no way of dividing things up into hysterical or otherwise.
Annons