Vintage It's All in Your Head: Stories from the Frontline of Psychosomatic Illness

Amazing book, really fascinating insight into the mind and interesting stories. Really thought provoking and a book everyone should read. Highly recommend.

Bought as an intro to a course but is very interesting

This is the the first time that I have ever been inspired enough to write a review on Amazon. This book truly is life changing for people who have struggle with mysterious illnesses and symptoms for years and who have desperately searched in vain for an answer. As someone who has struggled with "chronic fatigue" for years, I completely relate to the experiences described in this book.The books is a very sympathetic description of a range of patients that the doctor has seen over the years. The stories are heart wrenching while being completely perplexing at the same time. The patients return over and over to the emergency room with a galaxy of mysterious symptoms, but no testing shows any physical problems. Dr. O'Sullivan describes over and over her discussions with these patients, telling them clearly, but politely that their illnesses are not due to physical ailments, but rather due to the unconscious mind's feedback onto to the body. As one partially paralyzed patient says "...the nervous system is like a computer, ... my hardware is intact and the wires are all in the right place, but I have a software problem that keeps my legs from receiving the instruction to move." Dr. O'Sullivan refutes over and over again the accusation that patients with functional illnesses are somehow responsible for their illnesses and that they can simply choose to get better. The ailments are real and recovery is frequently long and difficult. The treatment that she offers is one that should be common sense - a cleaner mental space. Everyone who is in a position where they struggle day to day is susceptible to negative feelings, both conscious and unconscious, and therapy can help, sometimes dramatically. Dr. O'Sullivan's books has convinced me that searching eternally externally for a cause of my symptoms can eventually turn into a fools errand. Sometimes searching within yourself you can find the truth that you have been seeking.There have been some long standing criticisms of treating physical illness with mental health treatments. I believe Dr. O'Sullivan's book addresses these effectively. First, she insists on fully testing all of her patients before concluding finally that they really have functional rather than physical illnesses. Second, if the stories that she tells are true, there are clear cut cases of major physical illnesses caused by psychological issues and successfully treated with therapy. One very prominent case is about a woman who is functionally blind, but regains her vision slowly as she undergoes psychological treatment. There are multiple stories of people with seizures who stop having seizures after treatment. Thus, Dr. O'Sullivan reports cases clearly caused by psychological trauma and successfully treated via mental health interventions. Dr. O'Sullivan gains your trust through her compassion, her erudition, and consummate professionalism. She is the opposite of so many snake oil quacks who foist their books on the desperate public.The weaknesses of the book are twofold. First, Dr. O'Sullivan is not very good about describing patients getting better. She alludes a few times to patients improving, but frequently her stories are disjointed and end abruptly with the patient nearly as ill as when they arrived. While I am sure this was frequently the case, as patients who recover don't return, it leaves the reader with a feeling of hopelessness. It seems an odd choice to tell stories about patients without knowing the conclusions or being able to report significant recoveries.The second major weakness is the frequent pedantic digression into 19th century science. While I am certain that some important first steps were made in the 19th century toward understanding functional illnesses, far more relevant to treatment today is psychology and psychiatry of the 21st century. What specific drugs or treatments available to us today will be effective to treat these illnesses? Dr. O'Sullivan leaves us guessing. She seems to always refer people to psychiatrists rather than psychologists, so she appears to indicate that she prefers a drugged approach.In summary, a fantastic book with some deeply touching stories and some very helpful advice for long time sufferers. It may have changed my life and hopefully also yours.

This ground-breaking book is aimed at the lay and non-specialist medical reader. The author is a classically trained neurologist, who was attracted into the specialty by the idea that diagnoses could be made intellectually by tracing symptoms to lesions in the rails, points, or termini of the central nervous system; but she gradually came to the conclusion that for a number of sufferers it was by no means so simple. In the absence of unequivocally abnormal physical findings the source of these peoples' problems came to be regarded pejoratively as 'all in the mind,' and Dr. O'Sullivan took the trouble to write this book in order to remove this stigma, to explain that there is a part of the 'mind' below and inaccessible to the level of consciousness which can influence both mental and physical processes in ways that we do not at present understand, and to counter the resistance of both the public and the profession to the idea that these can present as genuine illnesses, susceptible to treatment by psychotherapists.Two personal experiences have left me in no doubt that there is a murky uncontrollable subconscious which can shoot unwanted, disturbing, and revealing rockets into our everyday lives. I also believe that there is somewhere a central processing system; how else can one explain the forgotten name that pops up minutes, hours, or even days after one has failed to recall it? Something must have been looking for it.One critic appears to think that MS was regarded as all in the mind until fairly recently. My first hospital job after qualifying in 1945 included the care of some 500 patients in what had been a poor-law workhouse infirmary. I hope I will not be mis-understood when I say that for teaching purposes the wards were a treasure house of patients suffering from chronic untreatable medical disorders, including many with multiple sclerosis, which we had no doubt was a degenerative disease of the nervous system.My only disappointment with this wonderful book is that for the author a successful result was to overcome the patient's resistance to a psychotherapist referral; all too often we don't get to know the ultimate outcome.Very early in the book, as an example of the way in which an emotional experience can manifest itself physically, Dr. O'Sullivan cites the account by Stendhal, the great French novelist, of his reaction to his first encounter with the great frescoes of Florence, and concludes that while his may seem to have been extreme, 'it may seem absolutely obvious that, on the day one first encounters the frescoes of Giotto, one's legs will weaken and one's heart will miss a beat.' Now I dare not contemplate what my subconscious will do to me henceforth if I do not allow the historian in me to point out that the frescoes of Giotto are in the Scrovegni chapel in Padua, where my late wife and I saw them in the 1970s. There is no record that Stendhal ever visited Padua, and in fact he wrote himself that it was the sight of the frescoes of Volterrano on 22th January 1817 that induced 'the profoundest experiences of ecstacy ... and fierce palpitations of the heart.'With all due respect to Giotto, I have to say that what induced physiological changes in me in Padua was the sight of the two stemmata or coats of arms of William Harvey, in the courtyard adjacent to the old anatomy theatre, which is what we had come to see. In the train back to Venice my wife commented that in all our years of marriage she had never seen me so excited. Of course, she couldn't see in the dark.

Review of 'It's All In Your Head'Am I imagining that the original subtitle was 'True Stories of Imaginary Illness'? The copy I've just received appears to have replaced that with 'Stories from the Frontline of Psychosomatic Illness'.This book, which consists of a set of case studies by a highly qualified neurologist setting out medical judgements about the status of her patients (that their illnesses are psychosomatic) has won a prize in a competition which specifies that the books entered must not be medical research. This seems to justify, or even require, the absence of references to the sources of her information.Each chapter includes a section setting out the history of medical thinking about symptoms and illnesses which, depending on the state of medical information for the period, were 'medically unexplained'. (MUS, medically unexplained symptoms, has now become a psychiatric condition in its own right.). From Galen, through Beard, Janet, Charcot, Freud and more recent sociological theorists, we are led to, and encouraged to agree with the contemporary psychosocial thinking which has had such a negative impact particularly on attitudes and policies towards the disabled, especially those disabled by ME/CFS. Mo Stewart, in the article 'The Takeover By the US Private Medical Insurance Industry of the UK Welfare State', published by the Black Triangle Campaign for the rights of people who are disabled details this effect. Several of the psychiatrists who promote the psychiatric model have, or have had financial connections with medical insurers, and with the DWP.A theme which runs through the book is how unwilling her patients are to accept any suggestion that their symptoms might have an emotional/psychological basis; how difficult a task it is for a doctor to impart this opinion to patients without inspiring anger and fierce denial. Patients, according to the author, are blind to their emotional difficulties, they are unreliable reporters, if only they would be willing to see a psychiatrist, their problems could be resolved. In the meantime, she asserts, the symptoms are random, inexplicable, impossible to make sense of. This very randomness is evidence of their origin in emotion, not a physical problem.As a very experienced psychotherapist who has run a centre for people with mental health problems, I find that psychiatric difficulties are far from random and incomprehensible. The patient who is depressed has experienced much to be depressed about. Anxiety develops in a childhood where separations have occurred at an early age, or discipline has involved threats of abandonment. 'School phobia' is often actually concern for the safety of a sick, anxious, or abused parent. 'Blackouts', once physical disorder had been ruled out, turns out to be behaviour 'learned' in a family where mother was too exhausted by a husband with MS and a son with muscular dystrophy to pay attention to his healthy brother. Psychiatric problems do not drop out of the sky and without a narrative that makes sense of my patients' physical symptoms, I would send them for further physical investigation. 'Medically unexplained' does not automatically mean 'psychiatric', it means what it says.In my experience, and Dr. Gary Kaplan, author of 'Total Recovery' which deals with chronic pain and depression, agrees...patients are excellent sources of information and very reliable reporters. All that is needed is for them to be asked, respectfully, the questions that allow them to provide the relevant information, and then to be believed. If, instead of trying to figure out tactful ways to impose her view that her patients has a psychiatric problem, the author took the time to listen to the patient's whole history, not just the medical report, it is likely to become evident to the patient herself that her symptoms are connected to various life events, and therefore realise she could be helped by a chance to revisit and resolve those issues.In the book there are one or two cases in which the narrative leading to psychosomatic symptoms is clearly set out, in others it is hinted at. One patient is caught out as a benefits fraud'; one is clearly a hypochondriac, highly anxious, developing symptom after symptom as each is explained or dismissed.The author discusses the evolution of thinking about psychosomatic illnesses with some significant omissions...according to critics of Charcot and Freud, their patients' 'hysteria' seems in retrospect to fit descriptions of prefrontal epilepsy. Breuer's Anna O (Bertha Pappenheim) is said to have relapsed and been institutionalised for several years. No mention of the fact that she went on to become a major figure in fighting for women's rights and education within the Jewish community, effectively creating the profession of social worker. But emphasising how symptoms can be created through the intense attention and suggestion involved in hypnosis lays the groundwork for this as a feature in psychosomatic conditions, and is undoubtedly part of the mechanism of genuinely psychosomatic conditions.The author continually emphasises that patients are resistant to psychiatric diagnoses, that psychosomatic symptoms are random and variable, that there is no understandable pattern in psychiatrically caused symptoms. Symptoms can be created and magnified just by paying too much attention to them. Patients are unreliable reporters of their own experience.Enter Rachel, and ME/CFS. The groundwork has been laid. ME has lots of variable symptoms, involving many organ systems. Sounds random. But even doctors who 'don't believe in ME' can recognise the complex pattern ... muscle weakness and pain, cognitive problems, problems indicating endocrine dysregulation..disturbed sleep rhythms, control of body temperature, and problems indicating ongoing immune activity (ongoing sore throat, swollen lymph glands, low fever) which vary in location and intensity, and all of which are exacerbated by exertion. A pattern so complex that it would be difficult to construct, or purposely create (and who would want to).The author tells us that the first outbreak was at the Royal Free Hospital in 1955, when 'even the doctors and nurses' got sick. No, in hospital outbreaks, it is mainly the nurses..the most physically active, and the doctors who get sick. The patients, who are resting, rarely get it. No mention of Los Angeles in 1932, when it was called 'atypical polio'. Can't be EBV, everyone has antibodies to that. Everyone had versions of the polio viruses but very few got sick and even fewer got paralysed. (The ones who exercised after they got sick were the ones who ended up paralysed.).Rachel, and other ME sufferers, report happy and relatively stress-free childhoods. No traumatic narrative. The author says this is impossible, she herself experiences stress every day. They are obviously in denial.Rachel is a dancer, desperate to return to her chosen career. She insists ME is physical and wants to be treated with a drug that has been used in the U.S. for treatment of people with viral illnesses. The author points out that no drug has been authorised for use in ME. In fact, many have been tried and benefits found, but research trials don't involve significant numbers of patients, and it's difficult to find funding for research trials except those set up to support the psychiatric model. Such as the PACE Trial, which was funded by the DWP. However it has just been announced that Hemispherx will be trialling Ampligen in an Early Access Programme in Europe and Turkey, so a drug that has benefitted patients in the U.S. for years may now obtain the approvals previously withheld.Rachel reports having been made worse by her treatment (CBT/GET). The author assures her that if a treatment doesn't work the first time, she must try it again. A recent article by Dr Mark Vint, 'The PACE Trial Invalidates the Use of Cognitive Behavioral Therapy and Graded Exercise Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Review', published in the Journal of Neurology and Neurobiology, Volume 2.3, March 2016 points out that any drug treatment with a similar rate of adverse effects would be immediately withdrawn.Pain is a very common symptom, virtually everyone has pain. (No mention of years of severe, untreatable pain, as experienced by many ME patients.).The author believes that ME/CFS is largely if not completely psychological. She says that in these illnesses, we need to consider what the patient may gain from it. In ME, these gains, after losing ones relationships, profession, status, income, home, previous activities such as sport, hiking, travel, may - or may not- include some sort of disability payment, some level of social help. Often not.Who might have something to gain from the publication, favourable reviews, the award given to a book which supports this model of ME/CFS?Or, if, as recommended by the US Institute of Medicine, this illness is recognised as a disease, not a psychiatric condition, in which 'exertion of any kind.....may adversely affect many organ systems'....who has something to lose?