IS THIS WHY YOU FEEL AWFUL?

DEALING WITH PSYCHOSOMATIC ILLNESSES

NEUROLOGIST SUZANNE O’SULLIVAN TALKS TO ANNA MOORE ABOUT THE POWER OF THE MIND TO PRODUCE VERY REAL SYMPTOMS EVEN THOUGH WE’RE HEALTHY

WHEN DR SUZANNE O’SULLIVAN CHOSE TO SPECIALISE IN NEUROLOGY, SHE EXPECTED TO LOOK AFTER PEOPLE WHO HAD DISEASES OF THE BRAIN, NERVES AND MUSCLES; CONDITIONS SUCH AS MULTIPLE SCLEROSIS, STROKE, MIGRAINE AND EPILEPSY. SHE COULD NOT HAVE PREDICTED HOW MANY OF HER PATIENTS WOULD HAVE NO UNDERLYING CONDITION AT ALL – THEIR SYMPTOMS ORIGINATED IN THE MIND. NOW AN EXPERT IN THE FIELD AT THE NATIONAL HOSPITAL FOR NEUROLOGY AND NEUROSURGERY IN LONDON, DR O’SULLIVAN’S AWARD-WINNING BOOK It’s All in Your Head ILLUSTRATES JUST HOW COMPLEX THE EFFECT ON THE MIND IS ON THE WAY WE FEEL. Q WHAT IS A PSYCHOSOMATIC ILLNESS? A IT’S WHEN A PERSON GETS REAL PHYSICAL SYMPTOMS THAT CAN’T BE EXPLAINED BY EXAMINATION OR MEDICAL TESTS – AND ARE THOUGHT TO HAVE A PSYCHOLOGICAL CAUSE. Q WHAT SORT OF SYMPTOMS ARE YOU TALKING ABOUT? A THIS ISN’T AN ILLNESS DEFINED BY ITS SYMPTOMS. “PAIN” AND “FATIGUE” ARE THE MOST COMMON BECAUSE THEY ARE THE MOST COMMON SYMPTOMS IN MEDICINE IN GENERAL. BUT IT COULD BE LOSS OF SIGHT, LOSS OF HEARING,

LOSS OF MOVEMENT, OR MEMORY LOSS – EVERY SINGLE SPECIALIST CLINIC WILL

SEE SOMEONE WHOSE SYMPTOMS ARE PSYCHOSOMATIC. IN MY FIRST CONSULTANCY POST FOR PEOPLE WITH EPILEPSY,

70% OF MY REFERRALS DIDN’T HAVE EPILEPSY. THEIR SEIZURES WERE BROUGHT ON FOR PSYCHOLOGICAL REASONS.

“Pain and fatigue are most common as they’re the most common symptoms in general”

Q HOW IS THIS DIFFERENT TO HYPOCHONDRIA? A WITH HYPOCHONDRIA, THE THING THAT IS DISABLING YOU IS THE ANXIETY – THE SYMPTOMS COULD BE ALMOST NOTHING. YOU FELT A TWINGE AND YOU’RE CONVINCED YOU HAVE A BRAIN TUMOUR. WITH PSYCHOSOMATIC ILLNESS, THE PATIENTS MAY BE ANXIOUS, BUT WHAT’S DISABLING THEM ARE THE VERY REAL PHYSICAL SYMPTOMS. Q CAN THE MIND REALLY MAKE THEM HAPPEN? A YES! OUR BODIES ARE CONSTANTLY RESPONDING TO THINGS THAT ARE “JUST IN OUR HEAD”. IF YOU SEE SOMETHING FRIGHTENING AND YOUR HEART BEATS AT 100 BEATS PER MINUTE, YOU’RE NOT IMAGINING IT – IT’S REAL AND IT’S OUT OF YOUR CONTROL. WE SHAKE WHEN WE’RE NERVOUS. I BLUSH AT THE TINIEST EMBARRASSMENT. IF YOUR BODY CAN REACT SO INSTANTANEOUSLY TO SOMETHING INCONSEQUENTIAL, WE NEED TO ACCEPT THAT BIGGER THINGS CAN CAUSE BIGGER REACTIONS. Q WHAT KIND OF BIGGER THINGS CAN BE THE TRIGGER? A THERE ARE MANY DIFFERENT WAYS IT CAN COME ABOUT. AT THE EXTREME END, IT’S NOT UNUSUAL TO FIND A PRETTY SERIOUS TRAUMA SOMEWHERE IN THE BACKGROUND. SO ONE PATIENT, A CONFIDENT, SUCCESSFUL LAWYER WHO

WAS SUFFERING RECURRING SEIZURES, EXPERIENCED HER FIRST AFTER THE DEATH OF HER SON MANY YEARS BEFORE. HIS BUGGY HAD ROLLED INTO THE ROAD. IS

THERE ANYTHING MORE PAINFUL THAN THAT? SO RATHER THAN FEEL THE PAIN OF WHAT SHE’D LOST, HER MIND WOULD DISASSOCIATE BY SHUTTING DOWN.

THE SEIZURES WERE HER FRIEND IN

A WAY – TRYING TO PROTECT HER, BUT VERY DYSFUNCTIONALLY.

BUT THERE ISN’T ALWAYS STRESS AND TRAUMA AT THE ROOT. SOMETIMES THE SYMPTOMS CAN START SMALL, AND IT’S JUST THE ATTENTION YOU THEN PAY YOUR BODY THAT MAKES IT ESCALATE. WE’VE PROBABLY ALL EXPERIENCED IT ON SOME LEVEL. IF YOUR CHILD COMES HOME WITH HEAD LICE, BEFORE LONG, THE WHOLE FAMILY FEELS ITCHY. THAT’S A PHYSICAL SYMPTOM EVEN THOUGH YOU’RE MENTALLY HEALTHY AND NOT PARTICULARLY STRESSED. SO PERHAPS IF YOU INJURE YOUR ANKLE, YOU BECOME AFRAID TO WALK. YOU THINK ABOUT YOUR ANKLE MORE AND THE PAIN SPREADS. IT CAN

GET OUT OF CONTROL QUITE QUICKLY. Q HOW COMMON IS IT? A WHETHER IT’S A HEADACHE, JOINT PAIN, SUDDEN SEIZURES OR COMPLETE LOSS OF SIGHT, PSYCHOSOMATIC ILLNESSES ARE THOUGHT TO ACCOUNT FOR 20% OF PATIENTS AND ARE TEN TIMES MORE LIKELY TO BE IN WOMEN THAN MEN. Q WHY IS THIS MORE COMMON IN WOMEN? A FIRST, I DEFINITELY THINK THAT MALE DOCTORS ARE QUICKER TO DIAGNOSE THIS IN A WOMAN THAN A MAN. HOWEVER, EVEN THOUGH AS A WOMAN I’M CAREFUL NOT TO MAKE ASSUMPTIONS, MORE OF MY PATIENTS WITH PSYCHOSOMATIC DISORDERS ARE WOMEN TOO. I THINK ONE REASON IS THAT WOMEN ARE MORE VULNERABLE TO SOME OF THE TRAUMATIC EVENTS THAT CAN ACT AS TRIGGERS. THEY ARE MORE LIKELY TO BE VICTIMS OF SEXUAL AND PHYSICAL ABUSE, TO FEEL TRAPPED OR THREATENED, WITH NO MEANS OF ESCAPE.

YOU ALSO NEED TO LOOK AT THE DIFFERENT WAYS MEN AND WOMEN RESPOND TO DISTRESS. MEN ARE MORE LIKELY TO BE ALCOHOLICS, TO END UP IN FIGHTS, INDULGE IN HIGH-RISK BEHAVIOUR OR, VERY SADLY, COMMIT SUICIDE. MAYBE A MORE COMMON RESPONSE FOR WOMEN IS TO TURN THEIR FOCUS INWARDS. Q HOW DO PATIENTS REACT TO THE NEWS? A NO MATTER HOW CAREFUL YOU ARE, SOME PEOPLE WILL FEEL DISMISSED. THEIR LANGUAGE WILL SLIP INTO, “SO YOU THINK I’M PUTTING IT ON?” OR “YOU MEAN THERE’S NOTHING WRONG?” THEY MAY GET VERY ANGRY AND REALLY RESIST THE DIAGNOSIS, AND I CAN UNDERSTAND THAT. IMAGINE YOU’VE BEEN IN A WHEELCHAIR FOR SIX MONTHS

AND TOLD YOUR BOSS, YOUR WORKMATES, YOUR NEIGHBOURS THAT YOU THINK YOU HAVE MULTIPLE SCLEROSIS. NOW YOU HAVE TO GO BACK AND EXPLAIN THAT ACTUALLY, IT HAS A PSYCHOLOGICAL CAUSE. YOU KNOW EVERYONE WILL SEE YOU DIFFERENTLY. THAT’S THE NATURE OF THE STIGMA. IT’S REALLY ABOUT REALISING THAT THIS IS A MEDICAL CONDITION. THE MORE UNDERSTANDING WE ALL HAVE, THE BETTER IT WILL BE. Q HOW DO YOU DIAGNOSE IT? A PEOPLE OFTEN THINK THAT YOU DECIDE SOMETHING IS PSYCHOSOMATIC JUST BECAUSE YOU CAN’T EXPLAIN IT. THAT’S NOT TRUE – AS A NEUROLOGIST, WE CONSTANTLY SEE THINGS THAT WE CAN’T EXPLAIN. YOU DON’T LABEL THEM ALL PSYCHOSOMATIC! IN MY FIELD, THE NERVOUS SYSTEM IS ANATOMICALLY ARRANGED IN SUCH A WAY THAT PSYCHOSOMATIC SYMPTOMS DON’T LOOK ANYTHING LIKE ORGANIC CONDITIONS. SO IF YOU HAVE BRAIN OR MUSCLE

DISEASE, SOME OF YOUR MUSCLES WILL BE WEAK, BUT OTHERS WON’T BE. WITH PSYCHOSOMATIC ILLNESS, THEY MAY ALL BE WEAK – OR PERHAPS THE MUSCLES

ARE WEAK, BUT THE REFLEXES ARE STRONG.

WITH SEIZURES, YOU CAN RECORD THE BRAINWAVES AND IF THAT SHOWS THAT THE PATIENT REMAINED CONSCIOUS, WE KNOW IT ISN’T EPILEPSY. IN OTHER FIELDS, IT MAY BE LESS STRAIGHTFORWARD – BUT YOU’RE SEEING MISMATCHES, THINGS THAT DON’T MAKE ANATOMICAL SENSE. YOU KEEP THE PATIENT UNDER YOUR CARE, WATCH THEM

FOR SIX MONTHS, A YEAR, AND EVENTUALLY, YOU CAN MAKE THE JUDGEMENT. Q WHAT’S THE TREATMENT? A THE KEY IS ACCEPTING THE DIAGNOSIS AND ENGAGING WITH TREATMENT TO GET TO THE BOTTOM OF IT. SOMETIMES, IF YOU CAN MAKE A PATIENT UNDERSTAND AND PUT THEIR MINDS AT REST, THAT’S ENOUGH TO MAKE THE SYMPTOMS GO AWAY – BUT NOT ALWAYS. IF YOU CAN’T WALK, YOU’LL STILL NEED A PHYSIOTHERAPIST TO HELP YOU AS WELL AS SUPPORT FROM A PSYCHIATRIST AND PSYCHOLOGIST TO UNCOVER THE ROOT CAUSE AND THE

HEART OF THE PROBLEM. SO IT’S USUALLY A COMBINATION OF TREATMENTS. Q

WHAT SHOULD YOU DO IF YOU SUSPECT A LOVED ONE’S ILLNESS IS PSYCHOSOMATIC? A IT’S A BAD IDEA TO GO BARRELLING IN, ALL GUNS BLAZING. ONE APPROACH IS TO SUGGEST THAT THEY JUST GIVE IT THE SAME CONSIDERATION AS EVERY OTHER POSSIBLE CAUSE. “MAYBE YOUR PAIN IS DUE TO STOMACH ULCERS, YOU SHOULD BE FULLY INVESTIGATED FOR THAT, BUT MAYBE PSYCHOLOGICAL ISSUES ALSO

PLAY A PART, SO CAN YOU INVESTIGATE BOTH AT THE SAME TIME AND GIVE THEM EQUAL CONSIDERATION?” Q CAN ANYONE GET THIS? A ABSOLUTELY! I LEARNED THAT A FEW YEARS AGO WHEN I BROKE MY FOOT AND WAS A VERY DYSFUNCTIONAL PATIENT. I HADN’T BEEN TRAUMATISED, I WASN’T ESPECIALLY STRESSED, BUT I’D NEVER BEEN INJURED BEFORE AND WHEN MY FOOT DIDN’T RECOVER AS FAST AS I EXPECTED, I WENT BACK FOR AN X-RAY. AS I WAITED 24 HOURS FOR THE RESULTS, MY FOOT FELT WEAKER, MY LIMP WORSENED AND BY THE END, I WAS HOPPING.

WHEN THE RESULTS SHOWED THE FRACTURE WAS HEALING WELL, I COULD WALK AGAIN. KNOWING MY SYMPTOMS WERE PSYCHOSOMATIC PUT ME BACK IN CONTROL. EVERYONE HAS A THRESHOLD OR A THING THAT COULD PUSH THEM OVER THE EDGE. THE SOONER WE REALISE THIS, THE LESS STIGMA THERE WILL BE!

Suzanne O’Sullivan’s book IT’S ALL IN YOUR HEAD, STORIES FROM

THE FRONTLINE OF PSYCHOSOMATIC ILLNESS (Vintage) is out now. W&H