Two of my library reads from this month were about different aspects of mind–body medicine. I expected them to overlap more than they did, actually, and hoped that the second might serve as a sort of well-written rebuttal to the first, but in the end they stayed in different camps: the first is about psychosomatic illness and psychiatric treatment, while the second is about the placebo effect and how alternative and holistic treatment strategies might be complementary to orthodox medical approaches. Both gave me a lot to think about.
It’s All in Your Head: Stories from the Frontline of Psychosomatic Illness
By Suzanne O’Sullivan
O’Sullivan is a UK-based neurology consultant. I picked this up on a whim because I knew it had won the Wellcome Book Prize, as well as the Royal Society of Biology General Book Prize. The conditions she writes about go by many names: psychosomatic illnesses, conversion disorders, or functional conditions. In every case the patients have normal neurological test results – they do not have epilepsy or nerve damage, for instance – but still suffer from seizures or lose the use of limb(s). Their symptoms have an emotional origin instead. Many of her patients are outraged by referral to a psychiatrist, as if they’re being told they’re making it all up, but it’s actually a holistic approach: acknowledging the influence the mind has on how we feel.
Along with cases from her own career, the author writes about early doctors who developed the science of conversion disorders, including Jean-Martin Charcot and Sigmund Freud. I read the book very quickly, almost compulsively; these are fascinating stories for anyone who’s interested in medical mysteries. That’s in spite of the fact that O’Sullivan does not strike me as a natural storyteller: her accounts of patients’ cases are often no more than just one thing after another, and in reports of her own conversations with patients she comes across as robotic and not always very compassionate. Ultimately I believe she does empathize with those with psychosomatic illnesses – otherwise she wouldn’t have written a whole book to illuminate their plight – but it would have taken the writing skill of someone like Atul Gawande for this to be a better book. I’m somewhat surprised it won a major prize.
Note: Chapter 7 tackles CFS/ME/fibromyalgia. These are controversial fatigue disorders, and O’Sullivan is aware that even mentioning them in a book about psychosomatic illnesses is “foolhardy to say the least.” I don’t think what she actually has to say about these conditions is offensive, though (and I say that as someone whose mother struggled with fibromyalgia for years). She allows that there may be physical triggers, but that emotional wellbeing and traumatic experiences or regular stress cannot be overlooked.
Chew on this: “More than seventy per cent of patients with dissociative seizures and chronic fatigue syndrome are women.” The author’s best guess as to why this is? “On the face of it, women turn their distress inward and men turn it outward.”
Cure: A Journey into the Science of Mind over Body
By Jo Marchant
In this absorbing and well-written work of popular science, Marchant, a journalist with a PhD in genetics and medical microbiology, investigates instances where the mind seems to contribute to medical improvement: the use of placebos in transplant recipients, hypnosis for IBS patients, virtual reality to help burn victims manage pain, and the remarkable differences that social connection, a sense of purpose, meditation and empathic conversation all make. On the other hand, she shows how stress and trauma in early life can set (usually poor) people up for ill health in later years. She also travels everywhere from Boston to Lourdes to meet patients and medical practitioners, and even occasionally proffers herself as a guinea pig.
A relentless scientist, Marchant is skeptical of any claims for which there is no hard evidence, so when she acknowledges that there’s something to these unusual treatments, you know you can believe her. As Jeremy Howick of the Centre for Evidence-Based Medicine, Oxford puts it, “I think it’s more important to know that something works, than how it works.” I finished the book feeling intrigued and hopeful about what this might all mean for the future of medicine. The problem, though, is that most medical trials are funded by big pharmaceutical companies, which won’t be supportive of non-traditional methods or holistic approaches.
Don’t I know Jo Marchant from something else?
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Seems unlikely. She’s a British science journalist with one previous book.
The second one sounds more interesting to me but maybe I am biased because I have tried complementary therapies and found them helpful as an adjunct to the standard NHS approach
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I’m glad to hear that. It’s very encouraging that alternative methods can help.
Very interesting; I think I’d like to read both, actually, although no one still comes up to Oliver Sachs’ standards for medical case histories in my book. I have had hypnosis for fear of medical procedures and learned how to self-hypnotise to make myself my dentist’s most relaxed patient. I like the idea of a rigorous scientist looking into this stuff.
I’ve not read any Oliver Sacks. Which is a good one of his to start with?
I was fascinated by Marchant’s accounts of what hypnosis can achieve. (I’ve read the most bizarre memoir about a man whose crippling fear of dental procedures caused him to combine nitrous oxide with Valium, marijuana, alcohol, etc. — all of which led to him meeting God in an extended vision. It’s called God in my Head by Joshua Steven Grisetti.)
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Oh – you will love him! The Man Who Mistook his Wife for a Hat, then The Anthropologist on Mars. They are A MAZ ING.
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[…] Cure: A Journey into the Science of Mind over Body by Jo Marchant: Marchant, a journalist with a PhD in genetics and medical microbiology, investigates instances where the mind seems to contribute to medical improvement: the use of placebos in transplant recipients, hypnosis for IBS patients, virtual reality to help burn victims manage pain, and the remarkable differences that social connection, a sense of purpose, meditation and empathic conversation all make. I finished the book feeling intrigued and hopeful about what this might all mean for the future of medicine. […]
Hi, Rebecca, I read your review of O’Sullivan and Marchant’s book with interest as I have suffered from ME since 1983, diagnosed by a consultant neurologist after a severe enterovirus in 1982. I had abnormal muscle biopsy and abnormal EMG to confirm my diagnosis. My first experimental treatment was plasmapheresis with immunosuppression. Both O’Sullivan’s and Marchant’s chapters on ME have rightly attracted much criticism, O’Sullivan has never published on ME, she has no expertise in the illness whatsoever and simply parrots a narrative spun by UK psychiatry since early nineties, conflating idiopathic fatigue with poorly understood neuroimmune illness. I agree with you that she does not write very well. Marchant is the better writer but she has sadly been gullible and relies on the hugely flawed PACE trial for her information. I imagine she is a little embarrassed that the trial has been debunked since her book was published, and if she had taken the trouble to actually research properly she would have been aware of all the concerns surrounding the trial. May I suggest you read USA public health journalist/Berkely professor David Tuller on the myriad PACE trial flaws, he is excellent and is found on Prof Vincent Racaniello’s – of Columbia University – virology blog. Sadly, popular science books do not always get it right, and the public are fed nonsense, as in the case of both these writers on ME. I reviewed O’Sullivan’s book on Goodreads last year if you are interested in further conversation. Many thanks!
Hi Nasim, and thank you for your comment. It’s so interesting for me to hear about your experience. Clearly your case does not match up with what O’Sullivan described since you had test results that proved something was wrong. I think she could have dug deeper and shown a wider variety of experiences. Her chapter definitely doesn’t shed much light. What a shame that Marchant’s account also seems to be flawed.
Hey, Rebecca, The illness has been horribly politicised since my own diagnosis in 1983/4, my novel The State of Me (HarperCollins, 2008) is a fictionalisation of my experience, my aim was to get the physical hell of the illness across, but lots of dark humour too. If you wish to read/review happy to send you copy, you can DM me on Twitter, @velogubbed And Happy New Year!
[…] at the National Hospital for Neurology and Neurosurgery. She won the Wellcome Book Prize for It’s All in Your Head, and The Sleeping Beauties picks up on that earlier book’s theme of psychosomatic illness – […]