Meeting of minds
Marjorie Brennan talks to neurologist Dr Suzanne O’Sullivan who says the brain continues to be a mystery despite medical advances in the field of imaging
SUZANNE O’Sullivan has seen and treated thousands of patients in her 20 years as a neurologist, but for her, the brain is still a mysterious entity, her job like a never-ending jigsaw puzzle in which she doesn’t have all the pieces. Hence the title of her latest
book, Brainstorm: Detective Stories from the World of
Neurology. Like her previous book, It’s All In Your
Head, which won the prestigious Wellcome Prize, Brainstorm features some of the most challenging and bizarre cases which O’Sullivan has dealt with, from a man who sees cartoon characters to a woman who plays an imaginary trumpet. Along the way, she works out life-changing diagnoses from the slightest of clues.
“When it comes to understanding how the brain works, we are still at the very beginning of just trying to understand the normal things the brain can do,” she says. “It’s only in the 21st century that we have even have any idea at all of how we can store memories, for example. When we haven’t really unpicked the normal functions, that means we still have a great deal of difficulty explaining the strange things that happen when a brain is diseased.”
O’Sullivan, who is originally from Shankill, Co Dublin, studied at Trinity College, and is now one of the top neurologists in Britain, specialising in epilepsy at the National Hospital for Neurology and Neurosurgery in London. In the book, she describes the brain as a “devious” organ. It sounds like an almost adversarial relationship, I suggest.
“That’s a really good way of putting it actually….it’s more of a relationship where I am constantly surprised and in awe of what I’m encountering. I think I’ve seen everything and then one morning I come in and something has happened that I’ve never seen before. I do think it’s like detective work because everything unfolds very slowly.
“Someone comes in with one odd thing and you can’t quite understand it, you do a test, you get another bit of the jigsaw, you meet them again, and they tell you something else, you get another bit.”
However, O’Sullivan says while getting a diagnosis in itself is an achievement, the next challenge is one that often can’t be overcome.
“When we get to the next stage, which is trying to make somebody better, science just isn’t there yet...even when I figure it out, there is no magic solution.”
While there have been significant breakthroughs in terms of imaging the brain, there are limitations when it comes to treatment, says O’Sullivan.
“Technology has been good at unpicking the brain’s basic processes. I think that has led people to believe that MRI scans have been the answer to everything. But when it comes to actually helping us treat brain diseases, it really hasn’t helped at all. All we are doing at the moment is producing more and more sophisticated ways of seeing the healthy brain.
“Obviously, technology is brilliant for surgery but for medical diseases like multiple sclerosis or motor neurone disease, we can do scans on people but we can’t make those things better. It’s brilliant but there’s a long way to go.”
O’Sullivan says she is hopeful about the potential of genetic manipulation but doesn’t see a cure for diseases such as Huntington’s or Parkinson’s in the foreseeable future.
“If everything keeps going at the present rate, it won’t be in my lifetime unless something miraculous happens. All you need is that one antibiotic moment — I could be wrong, I hope I’m not — where someone spills something on something else and suddenly you’ve invented something brand new. I’d be very hopeful that diseases with more of a genetic basis, that we’ll be able to manipulate those in the near future. I think surgery is going to improve exponentially as well.”
There is still a stigma surrounding epilepsy, a condition that affects 36,000 people in Ireland. Her patients are often discrimi- nated against and also have to deal with other people’s fears around seizures.
“People with epilepsy are not a danger to anybody…no one would look at an asthma attack and think it was deliberate or part of your personality. But as soon as you see something coming from the brain, people have difficulty extricating it from someone’s personality.”
However, O’Sullivan says that writing the book also gave her an appreciation of the kindness often shown towards people with epilepsy. She says her patients also appreciated being given a public voice which they are often denied. “I realised how many positive stories people had to tell about how they were treated by the general public. It is my job as a doctor to go down that negative route of discovering awful things, but in writing the book, I had to think more about the whole picture. It allowed me to see things differently and my patients are so thrilled to have their stories told.”
While medical writing has become an increasingly popular genre of literature in recent years, for O’Sullivan, the original and the best is still Oliver Sacks, who wrote The Man Who Mistook His Wife for a Hat. “I don’t think there is a neurologist in the world who hasn’t read his work and admired it,” she says. She also cites the neuropsychologist Paul Broks, author of Into The Silent Land, a “stunning” book. “Of course, someone like Atul Gawande as well… I love that sort of stuff which wanders between medical writing and philosophy. Those three writers, in particular, take it to another level.”
She has always loved reading and writing and cites the Irish educational system as being instrumental in giving her an appreciation of the arts and science, often seen as exclusive of each other.
“When I got to Leaving Cert, I was doing honours English and honours biology and physics. I was able to be broadly educated right to the point of starting university which meant I retained a love for reading which stayed with me. I enjoyed both... we shouldn’t be forcing children into one box or the other. I think if you want to be a writer, you have to be a reader.”
She nurtures her writing talents. After she won the Wellcome Prize, O’Sullivan went back to study creative writing, gaining a masters from Birkbeck College. “That was like a little present to myself,” she says. “I did it slightly backwards, I did the MA after the book. I really enjoyed writing the book and I wanted to optimise that experience. Also, I entered medical school when I was 17. After I wrote the first book, I decided to take a year off and have at least one year of my life that wasn’t fully dedicated to medicine.”
She has just started her third book, about culturebound syndromes [also known as folk illness]. “It’s about groups of people around the world who get have really strange medical conditions that are specific to their community. There is one in Sweden called resignation syndrome, where children, who are all asylum seekers from Russian families, when they’re faced with deportation they lapse into comas for weeks, months, years at a time. It’s like they legitimise a way of expressing their distress with physical symptoms and it’s different in every culture.”
The excitement in her voice at new cases to be investigated and discoveries made is palpable. I imagine her patients consider themselves lucky to have such a sleuth on their side.