Keeping an open mind

For some, illness and pain can be entirely psychosomatic, but that is not to say their suffering does not exist, explains Dr Suzanne O’Sullivan

What inspired you to write It’s All In Your Head?

I have worked for years with people who have serious medical problems, such as seizures and paralysis, that are caused by psychological factors rather than disease. I have seen many people believe they are alone in this sort of suffering, not realising how common it is. In sharing my patients’ stories, I hope to raise awareness and reduce the stigma around the condition.

Are there common causes for psychosomatic illness?

Certainly stresses and trauma are common causes, but they are not the only triggers. Symptoms can also occur from a patient’s response to injury or be brought on by worry about illness.

How aware is the healthcare sector of psychosomatic illness?

Doctors in every speciality see large numbers of people with symptoms that they suspect to have a behavioural or emotional cause. The medical profession is fully aware of the magnitude of the problem. However, the way that medicine is taught and practiced places all the emphasis on ruling out physical disease with little else to consider other than this approach. Yet the patient still has their symptoms and the consequence is that services to help people who suffer in this way are few and far between.

"Most people would probably be shocked to learn that stress can cause disabilities as profound as blindness, but in fact it is not that unusual"


If psychosomatic illness was more widely acknowledged, could certain cases be more easily resolved?

Yes – just being more open minded to the possibility and noticing how someone’s body changes in response to stress can go a long way in alleviating symptoms. Also, the sooner the diagnosis is made, the more likely a person is to fully recover. It would be great to see a time where people consider this diagnosis like any other. It could also help patients avoid unnecessary investigations and treatments.

You describe one patient’s struggle with blindness. Why did you decide to include this case in the book?

Yvonne was a woman I met who developed psychogenic blindness after an accident. Her experience was that she could not see – and yet all the formal tests of her vision showed that her visual pathways were intact. Most people would probably be shocked to learn that stress can cause disabilities as profound as blindness, but in fact it is not that unusual. Emotional factors can cause any sort of disability a person can imagine – headaches, dizziness, stomach upset, chest pain – anything. Most of us accept that problems like trembling hands can occur in stressful situations, but there seems to be a lack of recognition of the more extreme ways that the body can react to psychological factors. If anybody is suffering with physical symptoms that their doctor has been unable to explain, I would encourage them to at least consider a psychological cause as it could still be cured.

Does our understanding of the relationship between ‘mind’ and ‘body,’ and in turn how we respond and treat psychosomatic illness, need to change?

I think we need to appreciate that the mind can affect the body in many ways and when it does the symptoms that are produced are very real and should be taken as seriously and treated as urgently as any disease would be.

Your book recently won the 2016 Wellcome Book Prize. How does it feel to win the accolade?

I was thrilled to be given this prize. In particular, I think it offers great respect to my patients, which is something they deserve.

Dr Suzanne O’Sullivan is a consultant neurologist at the National Hospital of Neurology and Neurosurgery, London.

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