Someday it will be Reading Wednesday again
Sep. 6th, 2018 10:04 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
brigdhWhat did you just finish?
It’s All in Your Head: True Stories of Imaginary Illness by Suzanne O’Sullivan. A nonfiction book on psychosomatic illnesses, written by a neurologist. I've always been fascinated by the power of the mind over the body – the placebo effect, for example – so I was interested to read a whole book on the topic.
O'Sullivan is an expert on treating and diagnosing seizures, and she began to encounter a large number of patients who did not improve under treatment for epilepsy. Under closer examination (monitoring heart rates and using an EEG to trace brain electrical activity), the seizures themselves turned out to be very different from epileptic seizures. She learned they were dissociative seizures, ones caused by trauma or other psychological problems. O'Sullivan also has treated paralyzed patients whose MRIs reveal distinct differences from those paralyzed by physical causes. Though they also show distinct differences from experimental volunteers asked to pretend to be paralyzed! In fact, O'Sullivan makes that point repeatedly and thoroughly in the book: these people aren't faking or merely worried, but have real, disabling, life-destroying diseases that they can't 'get over'. It's just that their illnesses originate in the mind rather than body. (I don't know what's up with the subtitle; presumably it was a marketing decision made by someone else.)
All of this fine so far. Unfortunately, the book overall wasn't great. O'Sullivan illustrates her general principles through case studies of patients, but because she's a neurologist and not a psychiatrist, her interaction with them generally ends at the point of diagnosis. We never see if these people recover, or how they go about doing so. What is the treatment of dissociative seizures? I read this entire book and still don't know, other than a vague gesture toward 'therapy, I guess?'. Related to this, O'Sullivan spends a large portion of the book talking about the history of what was often called "hysteria", but never gets past Freud. I realize that Plato, Galen, and Charcot are still influential today, but surely there's some modern psychatriatic theories on psychogenic illnesses that might be important to mention?
I also felt that O'Sullivan generalized from her experience with seizures and paralysis – which seem to be fairly objectively testable – to medical problems like fatigue, pain, muscle spasm, and sensory issues which simply can't be measured in any objective way (at least, not yet) and which are much, much harder to distinguish between physical and psychogenic origins. She seemed fairly blase about allowing the diagnosis of psychogenic illness solely on (known) physical causes being ruled out, but that seemed too simplistic to me. Just because it's not A doesn't mean it's necessarily B. There's a lot of other letters out there. Finally, I worried about the possibility of patients being lost in the cracks of the medical system when O'Sullivan sent them off with a recommendation to see a therapist but with no followup or consistent medical team; she does briefly mention this as a possibility, but I didn't feel like she treated it with the seriousness the issue deserves.
All that said, I did appreciate O'Sullivan's advocation for psychogenic illnesses: that they're real, that they they're not uncommon, that they deserve respect from society and not to be treated as dismissal diagnoses by doctors who think they're a synonym for 'bored housewife'. I can agree with all of that, even if I wish the rest of the book was better-written and more thorough.
I read this as an ARC via NetGalley.
What are you currently reading?
Six of Crows by Leigh Bardugo. Finally getting around to reading this very fannishly-popular book!
It’s All in Your Head: True Stories of Imaginary Illness by Suzanne O’Sullivan. A nonfiction book on psychosomatic illnesses, written by a neurologist. I've always been fascinated by the power of the mind over the body – the placebo effect, for example – so I was interested to read a whole book on the topic.
O'Sullivan is an expert on treating and diagnosing seizures, and she began to encounter a large number of patients who did not improve under treatment for epilepsy. Under closer examination (monitoring heart rates and using an EEG to trace brain electrical activity), the seizures themselves turned out to be very different from epileptic seizures. She learned they were dissociative seizures, ones caused by trauma or other psychological problems. O'Sullivan also has treated paralyzed patients whose MRIs reveal distinct differences from those paralyzed by physical causes. Though they also show distinct differences from experimental volunteers asked to pretend to be paralyzed! In fact, O'Sullivan makes that point repeatedly and thoroughly in the book: these people aren't faking or merely worried, but have real, disabling, life-destroying diseases that they can't 'get over'. It's just that their illnesses originate in the mind rather than body. (I don't know what's up with the subtitle; presumably it was a marketing decision made by someone else.)
All of this fine so far. Unfortunately, the book overall wasn't great. O'Sullivan illustrates her general principles through case studies of patients, but because she's a neurologist and not a psychiatrist, her interaction with them generally ends at the point of diagnosis. We never see if these people recover, or how they go about doing so. What is the treatment of dissociative seizures? I read this entire book and still don't know, other than a vague gesture toward 'therapy, I guess?'. Related to this, O'Sullivan spends a large portion of the book talking about the history of what was often called "hysteria", but never gets past Freud. I realize that Plato, Galen, and Charcot are still influential today, but surely there's some modern psychatriatic theories on psychogenic illnesses that might be important to mention?
I also felt that O'Sullivan generalized from her experience with seizures and paralysis – which seem to be fairly objectively testable – to medical problems like fatigue, pain, muscle spasm, and sensory issues which simply can't be measured in any objective way (at least, not yet) and which are much, much harder to distinguish between physical and psychogenic origins. She seemed fairly blase about allowing the diagnosis of psychogenic illness solely on (known) physical causes being ruled out, but that seemed too simplistic to me. Just because it's not A doesn't mean it's necessarily B. There's a lot of other letters out there. Finally, I worried about the possibility of patients being lost in the cracks of the medical system when O'Sullivan sent them off with a recommendation to see a therapist but with no followup or consistent medical team; she does briefly mention this as a possibility, but I didn't feel like she treated it with the seriousness the issue deserves.
All that said, I did appreciate O'Sullivan's advocation for psychogenic illnesses: that they're real, that they they're not uncommon, that they deserve respect from society and not to be treated as dismissal diagnoses by doctors who think they're a synonym for 'bored housewife'. I can agree with all of that, even if I wish the rest of the book was better-written and more thorough.
I read this as an ARC via NetGalley.
What are you currently reading?
Six of Crows by Leigh Bardugo. Finally getting around to reading this very fannishly-popular book!
