Purely Psychosomatic: It’s All in Your Head Book Review

The book It’s All in Your Head: Stories from the Frontline of Psychosomatic Illness by Irish neurologist Suzanne O’Sullivan was first brought to my attention by my attentive wife about a year ago. She had found out about this book online and told me about it as she, being in the medical sciences herself, knew me to be a (borderline) hypochondriac. Previously, she would almost always say to me that my problems and ailments were psychological in nature, and I would retort, somewhat angrily, that this was simply not true.

Of course, she was right. But when I stumbled upon this book in our local library, I could not resist to give it a read. Browsing through the pages, I felt a bit discouraged because it was divided by patients’ first names; my first assumption was that it would be merely a collection of case histories and medical accounts and that it would be somewhat dry and boring and, what’s worse, perhaps not very useful to me personally.

And for the second time, I was proven wrong. It is refreshing to have a book like this written by someone who has had extensive and significant work experience with psychosomatic patients and who was firmly grounded in the medical sciences as a practicing neurologist. Apart from interesting and relevant background information about the history of psychosomatic illness via renowned neurologists like Charcot, Janet and, of course, Freud, she also provides up-to-date neurological research on the topic.

Psychosomatic illnesses tend to be purely psychological in origin. These are cases where there is ailment and suffering in the patients but no medical cause can be found or established. Tests and scans turn out negative, meaning that the problem has its origin in the mind. In the past, cases like these were delegated to the condition of hysteria. This would be, in its more extreme cases, paralysis of limbs, although physically there was no discernible damage to muscle tissues; the body was healthy and should have been functioning properly and well.

The ancient Greeks coined the term hysteria mostly due to the fact that many women were afflicted with the condition; hence, they (erroneously) believed that it was the uterus traveling to different parts of the body that caused ailments and diseases in those specific parts. Yet at the same time, Greek physicians like Hippocrates considered hysteria to be an organic disease, namely a disorder of the body and not of the mind. Thereafter, in the Middle Ages, hysteria was equated with witchcraft; it was believed that the condition implied that women were possessed by the devil.

It was not until towards the end of the 19^th century that the medical profession took up the study of hysteria again and when Freud and other physicians showed how these patients could be led to lose the function of their body parts merely with the power of suggestion, that is through the act of hypnosis. These patients (most of them were female but there were males afflicted of the same condition as well) had come to truly believe that they were paralyzed. It was, as Freud demonstrated, due to the unconscious part of our personality since it had a certain amount of control over the body without our knowledge or awareness.

It is important to note that people who suffer from psychosomatic disorders are not imagining or inventing illness; they are indeed suffering and need help. They are also more common than you may think as O’Sullivan estimates that anywhere between a third to half of all patients that come to consultations at medical clinics tend to have underlying psychosomatic issues at heart. 

That means that up to half of the patients a family doctor sees on a daily basis do not have physical problems and hence cannot be cured via physical means, such as medication or surgery. Unfortunately, doctors either do not believe in psychosomatic illness, due to their own prejudices and / or medical training or, and this might be more likely the cause, they feel that patients would not be satisfied and even reproach the doctors for such a diagnosis.

The reason that medical treatments end up working for certain patients suffering from psychosomatic illness is merely due to the placebo effect. The patients think they are taking medication that would help them, and this might calm their fears and anxieties to a certain extent and degree. But it does not treat the underlying psychological cause for which a psychologist or psychiatrist ought to be consulted.

But most of us are reluctant to accept that particular diagnosis. There is a stigma attached to mental health that is harming us and preventing many of us to seek treatment when it would turn out to be essential and vital for our mental health and well-being. While we would not look down on people with so-called “real” diseases like cancer or Alzheimer’s or multiple sclerosis, we tend to see mental health issues as something minor and less “real” and oddly enough as one's own fault.

I have often heard many a misguided suggestion given to insomniacs and people suffering from depression. No, you cannot merely "snap" out of it: you cannot just close your eyes and fall asleep, the same way you cannot just smile and be happy. This kind of advice makes the afflicted person feel even worse, and in addition to their suffering, they would feel guilty about it. They would blame themselves and consider themselves responsible for not being able to “snap” out of it, and they would also be less likely to seek the help and treatment they need.

It is important to note that people with psychosomatic illness do not invent or make up their ailments. In fact, this has been scientifically demonstrated. In an experiment, people were told to pretend to have paralysis, that they should try hard not to move their hand, for example. As they were doing so, electrodes attached to their scalp looked at their brain activity. Those who merely pretended to have paralysis had a different part of their brain light up as compared to those who had psychosomatic illnesses.

It shows us that what is happening to these patients is not within their will and control, but it is controlled by the unconscious parts of their brain. How can psychology affect the body in such drastic ways? How can we possibly be led to believe that we have seizures or paralysis when there are no physical causes for them?

And yet, the evidence is visible to all of us. Imagine you have a public talk to give in front of hundreds of people. How do you feel? You are most likely sweating, your hands may be cold, clammy, or trembling; you may breathe rapidly; your blood pressure as well as blood sugar could go up; you might feel light-headed, and the list of symptoms goes on.

Oddly enough, all this happens despite there being no physical or tangible threat in front of you; this is merely nervousness caused by a possible sense of embarrassment all of which are played out in one’s imagination. If a relatively minor stressful situation like this can cause such physical symptoms in a person and if it is quite difficult to reign in or control those physical responses, how much more could be going on when there is significant psychological trauma within that person? It is certainly not something that can be solved at the wave of one’s hand or the flick of one’s fingers.

Psychosomatic illness is real, and it shows us the power the mind has over our body. It also underscores the importance of one’s mental health and well-being. Most of us do not even realize - myself included - that our symptoms are psychological in origin, and we continue having unnecessary and ineffective treatment that are meant and deemed for biological and physical conditions.

The book gives many examples of seizures, for instance. It is not always due to epilepsy. Through brain scans and video monitoring during seizure episodes, neurologists can often discard that option and determine that the ailment does not have a physical cause. However, many such patients take (and often even prefer taking) medication that comes with potentially serious side effects and complications instead of getting to the root of the underlying problem or health issue.

This book is enlightening especially since we are living in a time where mental health is not given its due and place. But it should be. Fears, anxieties and trauma associated with living in the modern world can take its toll on even the strongest one of us. We need to be open and honest about such issues and not hide behind a fake and pretend mask or a face of toughness. 

We should also treat other people that are suffering from mental health issues not with disrespect or prejudice but with care and concern. And when necessary, we need to push and guide them (and ourselves) to see past inherent prejudices and seek the treatment that is needed.