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Book Review: _Is It All In Your Head_, Suzanne O'Sullvan, MD
Subtitled True Stories of Imaginary Illness
There's only one person in the book (that I can recall) who was outright faking to collect on a lawsuit. And there are only two people in the book (maybe three) who were engaged in some form of Munchhausen's. So if you are looking for that particular kind of hilarity, this isn't the book for you.
This book is about hypochondriasis (health anxiety, etc.) secondarily, and psychosomatic illness primarily. The doctor is a neurologist and placed a ways up administratively in a UK NHS hospital, if I understood the book correctly. She sees people whose seizures do not respond to anti-epileptic drug treatment. Mostly, she keeps them around on video camera and wired up to an EEG for long enough to get both kinds of measures simultaneously on seizures. Generally speaking, in her experience, the non-responsive kinds of seizures don't show up on EEGs, and she attributes this to psychosomatic processes and refers to a psychiatrist. She has occasional amazing, almost faith healing like success, but generally speaking there's a lot of denial.
Her stories make it clear that persistent, no medically known cause patients often are part of family systems which are not very emotionally supportive (like at all) until someone is ill and then they are a lot more emotionally supportive in fact incredibly emotionally supportive, so, you know, incentives. She is not suggesting this is a conscious process on anyone's part, but then neither is that whole Pavlov dog and bell thing, either.
Woven into her excellent, novelistic like stories of patients (suitably adjusted to preserve anonymity and avoid ethical and legal violations), is a brief history of neurasthenia, hysteria, and a variety of related conceptions of these sorts of problems in the past. Anyone who has made a habit of reading Victorian (written or set during the era) novels has a pretty good sense of what these problems have looked like in the past and will not be surprised to learn that women tend to wind up with these labels more than men, then and now (despite the weird history of the theory of neurasathenia).
I had no idea, until I started talking about this book to friends, that so few people knew about seizures that don't show up on EEGs. My sister -- a nurse -- is certainly aware, and told me of a neurologist -- presumably not the only one -- who refuses to accept new patients who don't already have scans. So I absolutely believe the high rates of yeah, these are not the seizures we are accustomed to. I remember the history of hysterical paralysis (very lightly touched on here, sadly); there are psychosomatic syndromes which go through phases, eras in which some particular thing is a Thing, and then it dies down again. Usually once word gets round that the doctors have a test that is 100% accurate.
Really makes you wonder, doesn't it?
If the goal is to get people out of dangerous over-use of medical testing -- and over use of medical testing is incredibly dangerous. If you live long enough and look hard enough, you WILL find cancer. Period. End. We'll all die with it, if we live long enough, even tho far fewer of us will die of it. And many of those logged as dying of it probably died as a result of treatment, a tragedy that will never be adequately accounted for. (The woman whose psychosomatic illness mirrored her mother's breast cancer and death did not trigger any discussion of the evolution of the treatment of breast cancer, and how so much mortality of breast cancer in certain eras is probably directly attributable to the hazards of the treatment.)
If the goal is to get people out of the habit of dangerous over-use of medical testing and to start addressing some or all of their issues via the mental health professions, she's probably going about it wrong. The preventive health services have, on and off, argued against physicals -- going to the doctor to have a bunch of tests done Just To Check. But physicals are a profound form of propaganda for the medical profession. Come here. We'll check you out. We'll tell you what's good, what needs work, etc. And we'll monitor your progress. If you want people to be using mental health services, if you want to destigmatize, if you want the people who NEED mental health services to realize that and make use of it -- and their friends and family to nag at them to do that, rather than to get more unnecessary medical testing done -- maybe we should have mental health checkups. Why doesn't anyone ever suggest that?
In the mean time, O'Sullivan's book looks perfect for book groups. She's overtly compassionate (I don't completely buy it -- I think she's just cautious and covering for her judginess. Believe me when I say, I know what this looks like. I do actually have _some_ self insight). Her descriptions of people and her interactions with them are wonderful -- novelistic and with a nice amount of foreshadowing built into them, along with a lovely sting of had-I-but-known. Under 300 pages, no index, all medical terms explained in relatively accessible ways. It has won at least one non-fiction prize.
So for all that I wish she could have at least _mentioned_ the evolution occurring in somatoform disorder definition, and experiments with DBT and other borderline personality disorder treatments being used for somatization, and for all that I could have wished she had just left allergies and food intolerances right the fuck out of her disquisition on psychological illness popping up with physical symptoms, for all that she managed to leave everything about every treatment modality in bodywork entirely by the wayside, I still think it would be lovely if lots and lots of middle aged women read this book in book group and then started applying some pressure on people who are getting lots of tests that are not leading anywhere useful to at least try seeing a few therapists.
Because in the end, if whatever is going on with us isn't killing us quickly, we'll probably get better faster if there is someone we can talk to about what is going on, and who will help us problem solve so that we can re-arrange our lives to better support our whole selves.
There's only one person in the book (that I can recall) who was outright faking to collect on a lawsuit. And there are only two people in the book (maybe three) who were engaged in some form of Munchhausen's. So if you are looking for that particular kind of hilarity, this isn't the book for you.
This book is about hypochondriasis (health anxiety, etc.) secondarily, and psychosomatic illness primarily. The doctor is a neurologist and placed a ways up administratively in a UK NHS hospital, if I understood the book correctly. She sees people whose seizures do not respond to anti-epileptic drug treatment. Mostly, she keeps them around on video camera and wired up to an EEG for long enough to get both kinds of measures simultaneously on seizures. Generally speaking, in her experience, the non-responsive kinds of seizures don't show up on EEGs, and she attributes this to psychosomatic processes and refers to a psychiatrist. She has occasional amazing, almost faith healing like success, but generally speaking there's a lot of denial.
Her stories make it clear that persistent, no medically known cause patients often are part of family systems which are not very emotionally supportive (like at all) until someone is ill and then they are a lot more emotionally supportive in fact incredibly emotionally supportive, so, you know, incentives. She is not suggesting this is a conscious process on anyone's part, but then neither is that whole Pavlov dog and bell thing, either.
Woven into her excellent, novelistic like stories of patients (suitably adjusted to preserve anonymity and avoid ethical and legal violations), is a brief history of neurasthenia, hysteria, and a variety of related conceptions of these sorts of problems in the past. Anyone who has made a habit of reading Victorian (written or set during the era) novels has a pretty good sense of what these problems have looked like in the past and will not be surprised to learn that women tend to wind up with these labels more than men, then and now (despite the weird history of the theory of neurasathenia).
I had no idea, until I started talking about this book to friends, that so few people knew about seizures that don't show up on EEGs. My sister -- a nurse -- is certainly aware, and told me of a neurologist -- presumably not the only one -- who refuses to accept new patients who don't already have scans. So I absolutely believe the high rates of yeah, these are not the seizures we are accustomed to. I remember the history of hysterical paralysis (very lightly touched on here, sadly); there are psychosomatic syndromes which go through phases, eras in which some particular thing is a Thing, and then it dies down again. Usually once word gets round that the doctors have a test that is 100% accurate.
Really makes you wonder, doesn't it?
If the goal is to get people out of dangerous over-use of medical testing -- and over use of medical testing is incredibly dangerous. If you live long enough and look hard enough, you WILL find cancer. Period. End. We'll all die with it, if we live long enough, even tho far fewer of us will die of it. And many of those logged as dying of it probably died as a result of treatment, a tragedy that will never be adequately accounted for. (The woman whose psychosomatic illness mirrored her mother's breast cancer and death did not trigger any discussion of the evolution of the treatment of breast cancer, and how so much mortality of breast cancer in certain eras is probably directly attributable to the hazards of the treatment.)
If the goal is to get people out of the habit of dangerous over-use of medical testing and to start addressing some or all of their issues via the mental health professions, she's probably going about it wrong. The preventive health services have, on and off, argued against physicals -- going to the doctor to have a bunch of tests done Just To Check. But physicals are a profound form of propaganda for the medical profession. Come here. We'll check you out. We'll tell you what's good, what needs work, etc. And we'll monitor your progress. If you want people to be using mental health services, if you want to destigmatize, if you want the people who NEED mental health services to realize that and make use of it -- and their friends and family to nag at them to do that, rather than to get more unnecessary medical testing done -- maybe we should have mental health checkups. Why doesn't anyone ever suggest that?
In the mean time, O'Sullivan's book looks perfect for book groups. She's overtly compassionate (I don't completely buy it -- I think she's just cautious and covering for her judginess. Believe me when I say, I know what this looks like. I do actually have _some_ self insight). Her descriptions of people and her interactions with them are wonderful -- novelistic and with a nice amount of foreshadowing built into them, along with a lovely sting of had-I-but-known. Under 300 pages, no index, all medical terms explained in relatively accessible ways. It has won at least one non-fiction prize.
So for all that I wish she could have at least _mentioned_ the evolution occurring in somatoform disorder definition, and experiments with DBT and other borderline personality disorder treatments being used for somatization, and for all that I could have wished she had just left allergies and food intolerances right the fuck out of her disquisition on psychological illness popping up with physical symptoms, for all that she managed to leave everything about every treatment modality in bodywork entirely by the wayside, I still think it would be lovely if lots and lots of middle aged women read this book in book group and then started applying some pressure on people who are getting lots of tests that are not leading anywhere useful to at least try seeing a few therapists.
Because in the end, if whatever is going on with us isn't killing us quickly, we'll probably get better faster if there is someone we can talk to about what is going on, and who will help us problem solve so that we can re-arrange our lives to better support our whole selves.