Book Review: It’s All in Your Head


It’s All in Your Head, by Suzanne O’Sullivan, is subtitled True Stories of Imaginary Illness. I found this a tad disingenuous. The case studies that make up a large portion of the text cover a variety of psychosomatic illnesses and are each anything but imaginary. The patients suffer paralysis, debilitating pain, and, because it is the author’s speciality and therefore what she is most often consulted about, seizures that are regularly mistaken for epilepsy. When extensive and detailed tests reveal that there are no physical symptoms to confirm this, or any other physical diagnosis, too many people, some doctors included, wrongly assume that the patient is fantasizing about problems that do not exist. They do, and accepting their existence is vital for the patient’s wellbeing and future treatment.

The author is a consultant neurologist. She starts by explaining her medical background, the ailments she encounters, and the broad therapies recommended. She points out that psychosomatic illnesses occur worldwide, across all cultures and classes. Cases have been documented, albeit under changing names, for centuries. They cost health services billions of pounds each year. They are widely regarded as not real.

Having explained some of the terms that she will use throughout the text she then starts to introduce the reader to particular patients. Their case studies are fascinating. Alongside are notes on background and medical research, as well as the changing attitudes to such maladies across time. These patients cannot just ‘get over it’, but they do need to accept that their problems are not caused by a physical anomaly that can be treated surgically or controlled by drugs. What is required is psychiatric help, and this comes with all the negative connotations that society continues to heap on the mentally unwell.

Such attitudes make telling a patient that their serious, physical problems have psychological roots a challenge. Despite the ubiquity of diagnosis, patients struggle to accept that treatment will not come in the form of a physical intervention or medication. They want an explanation that does not put the onus on them. Friends and colleagues are rarely sympathetic when a problem is regarded as self inflicted.

Despite covering some complex, medical topics the writing remains accessible. I did find my concentration wavering slightly over some of the more detailed sections but on rereading all became clear. What I enjoyed most was getting to know the patients whose lives had been altered so radically by their illness. Many struggled to accept that their personally researched diagnosis was incorrect. Most resisted the notion that their physical ailments could be cured with psychiatric help.

This is an important subject that deserves wider recognition and acceptance. A book such as this can go a long way towards engendering empathy for sufferers of the many illnesses for which there is no medical explanation – IBS, CFS, fibromyalgia, food intolerance to name but a few. If the stigma associated with psychosomatic illness could be lessened, patients may be more open to accepting the only treatment likely to improve their quality of life. The connection between mind and body may not be well understood, but effects are real and deserve respectful consideration.