Why a trick of the mind can make you blind

Published by The Daily Mail (18th June, 2015)

It’s All In Your Head by Suzanne O’Sullivan (Chalto & Windus)

Life was good for Camilla. She was a successful family lawyer, mother of two children and happily married to an old college friend who had become a partner in a law firm.

Then one day, while on a work trip to Cumbria, she started feeling strange. Her right hand began to tremble, then her left one.

She tried to ask for help but could not speak. Soon her limbs were flailing. She slumped from her seat, her head banging on the floor despite the best efforts of a colleague to assist.

She was still shaking when paramedics came to cart her off to hospital. ‘I remember being acutely aware of the feeling that my skirt was riding up my thighs and of everybody looking at me,’ she later recalled.

At first, doctors presumed Camilla had a brain tumour, but, after tests, she was diagnosed with epilepsy and started on treatment. She tried to resume her contented middle-class life, but the fits kept recurring.

The traumatic episodes were real; her body was suffering seizures. But there was no physical cause. Instead, they were finally traced back to the buried stress of seeing her first child killed before her eyes when his buggy rolled under a car’s wheels.

This moving story is one of the compelling case studies in an absorbing book by London consultant neurologist Suzanne O’Sullivan, which examines the strange phenomenon of psychosomatic illnesses.

‘They are medical disorders like no others. They obey no rules. They can affect any part of the body,’ says the author, an epilepsy specialist, as she reviews the history of ‘hysteria’ and details a series of sad lives wrecked by seemingly-insoluble conditions.

Cases of those affected by psychosomatic illness can include people who have gone blind, suffered terrible pain and become paralysed.

Yet while the illnesses behind these symptoms are imaginary, she argues that such disorders should be discussed more openly and sympathetically since the scale of their incidence is staggering.

On any day, as many as a third of patients seeing doctors have conditions deemed medically unexplained; in some clinics, they represent more than half the cases. Not all have psychosomatic suffering. Yet the worst afflicted are thought to cost us twice as much as diabetes; one study found 227 patients at just three GP practices in London, costing the NHS £500,000 a year alone.

Even when cases seem obvious, doctors are reluctant to diagnose them as psychological — either for fear of being proved wrong in the future or to avoid offending patients, who feel they are being accused of hypochondria.

Matthew is typical, arriving in a wheelchair and convinced that he has multiple sclerosis. ‘Just because the tests are normal you assume I’m mad,’ he replies when the author suggests there might be psychological causes behind his lifeless legs.

Yet Matthew agreed to see a psychiatrist and after extensive therapy — both mental and physical — he learned to walk again, eventually returning to his work in accounting. His problem? He was subconsciously ‘a man on a treadmill looking for a way off’, because however hard he worked, he felt less successful than his two brothers.

Often patients react in anger — fearing the humiliation of having to tell friends and family that their crippling illness was all in the head. Yet O’Sullivan prefers an angry reaction to one of flat denial. The refusal to accept reality is often shored up by self-diagnosis on the internet.

Her first insight into this strange world came with Yvonne, who believed she was blind after being sprayed in the face with window-cleaning fluid.

She was on disability benefits with a full‑time carer. Yet she could draw a colourful picture of a flower-filled field — ‘I can feel the pencil marks on the paper,’ she explained. A series of doctors could find nothing wrong.

Eventually the cause was traced back to marital tensions and a domineering husband; the doctors sometimes seem more like detectives than scientists. After six months of counselling, Yvonne’s sight was restored.

Since then, writes O’Sullivan, she has seen many such patients desperately searching for a conventional cause for their debilitating physical symptoms, taking every test available before they possibly accept a more disturbing truth.

Sometimes cases can seem obvious, such as Mary, a mother of two girls whose eyes suddenly closed. All routine tests came back showing there was nothing wrong. Her husband was on remand for child abuse, yet she refused to accept her symbolic response might be stress-related.

Then came amnesia. But when shown pictures of famous people and asked if they were dead or alive, Mary got every question wrong — which is statistically almost impossible.

Curiously, only once has O’Sullivan, a consultant at the National Hospital for Neurology and Neurosurgery in central London, seen a confirmed malingerer. She believes they are easy to spot because, unlike other victims of psychosomatic illness, they are the only ones who are not relentlessly looking for a solution to their ailments.

This book offers a fascinating glimpse into the human condition, although it is not without flaws. Some intriguing stories fizzle out with too little explanation and there are also interesting questions left unresolved. Why, for example, are cases of unexplained disruptive conditions ten times more common with women? And why are more than 70 per cent of chronic fatigue syndrome patients female?

Her suggestion seems slightly pat: that men turn distress outward with drink or violence, while women turn it inwards on themselves. Perhaps the reason lies more in the revelation that many patients have suffered sexual abuse in the past.

As O’Sullivan freely admits herself: ‘It has taken me over 20 years to feel I am even close to an understanding of these disorders.’ She has certainly produced a fascinating read, as well as a forceful call for society to be more open about such suffering, however baffling and bizarre the cases.

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