Tuesday 20 February 2018

Suzanne's solution... the need for pyschosomatic illness treatment

Psychosomatic illnesses are more common than people think. Dr Suzanne O'Sullivan stresses that we need to improve services for those who suffer from such problems, and be more sensitive to their very real needs

Improvement needed: Dr Suzanne O'Sullivan: Photo: David Conachy
Improvement needed: Dr Suzanne O'Sullivan: Photo: David Conachy

Joy Orpen

When a certain young man called Matthew (not his real name) went to see a neurologist, he was convinced he already had full-blown multiple sclerosis (MS).

In his mind, everything pointed to that fact. His problems had begun with pins and needles in his foot. Over time, the variety and severity of his symptoms increased, and included numbness and pain. Then, two months later, Matthew's legs became paralysed.

When he was wheeled in to see the neurologist, he said, "I know I have MS." Consulting his copious notes, Matthew then proceeded to back up his claims. The neurologist was not convinced. Matthew had already had a lumbar puncture, blood tests and electrical studies of his nerves, and none of the tests had found any evidence of any disease, let alone MS.

Could Matthew's symptoms have been conjured by his mind, following a trauma of some sort?

It has been observed that a number of people who attend clinics have symptoms because of psychological factors, rather than medical ones. It stands to reason, then, that they would benefit from psychological services. Yet, far too many patients have to fend for themselves, once a conventional medical cause for their symptoms has been ruled out.

Someone who is blazing a trail in changing how medical practioners deal with symptoms that may be psychological in origin, is neurologist Suzanne O'Sullivan (47). She was in Dublin recently to promote her book, aptly titled It's All In Your Head: True Stories of Imaginary Illness. Matthew was, in fact, one of her patients.

Suzanne, who grew up in Shankill, Co Dublin, did well at school. But when it came to choosing a career, she hadn't a clue. "I'd love to be able to tell you I went into medicine for some wonderfully altruistic reason, but that wasn't the case. I didn't know what I wanted. But I got good points in the Leaving Cert, and that got me into Trinity to do medicine," she says.

In 1991, Suzanne qualified as a doctor. Her decision to specialise was sparked by working under two "fantastic" Dublin neurologists. "They were very interesting and very compassionate," she enthuses.

Neurologists specialise in disorders of the brain and nervous system. "You get your actual medical degree when you're about 23, and then it takes about 10 years to become a consultant," she explains. "You rotate under a team of neurologists. One might be interested in muscle disorders, another in MS. There are an awful lot of serious neurological conditions."

In 1999, Suzanne moved to Newcastle in northern England, so she could get the range of experience she needed to become a well-rounded neurologist. She qualified as a consultant in 2004, and more recently has been working at the National Hospital for Neurology, in London, while living in Maida Vale.

Over the years, Suzanne was surprised by the number of patients who were presenting with very real ailments for which no actual medical cause could be found.

"Once disease is ruled out, the patients are often discharged. They may now know they do not have a brain tumour, but they still have terrible headaches. You should be doing more than merely telling them what they don't have," she says.

For example, Suzanne specialised in seeing patients who were experiencing seizures, but were not getting better when given standard treatments.

"What I discovered when I investigated these patients was that 70pc of them had no evidence of brain disease," she says. "In fact, at the average epilepsy clinic, one-in-five patients has seizures for psychological reasons. It's not rare at all."

The explanation for this, she says, is that, in many of these cases, the symptoms are the product of the mind. "Anyone who suffers the right amount of stress at a given time, could experience such symptoms," says Suzanne. "It could happen to any of us."

She says the list of possible ailments is "endless", and ranges from paralysis to blindness, and from seizures to severe pain. She says that while they know the mechanics of some psychosomatic manifestations, such as sweating, palpitations and stomach cramps, they do not yet know how the brain manages to produce symptoms such as blindness, convulsions or paralysis.

"If we could explain how that happens, then the affected patients would find it a lot easier to deal with," she says. Suzanne adds that one of the biggest problems is the sensitivity of the patient, who may have suffered debilitating symptoms for a long time.

"Anything is better than the humiliation of a psychological disorder. People are worried that you're telling them they are 'putting it on', and that they have control over the illness and could stop it, if they wanted," she says.

"But that's not the case at all. Their symptoms are caused by an uncontrollable [if left untreated] and subconscious mechanism."

Suzanne offers the examples of two typical conditions, cancer and psychogenic seizures (non-epileptic attack disorder).

"Both have the potential to ruin your life," she explains. "Yet one [cancer] is treated with respect, while the other is viewed with deep suspicion. I want people to know that even though something is psychosomatic, it's still a very serious and disabling condition."

In her fascinating book, Suzanne gives us an in-depth look at the experiences of several people who have suffered from psychosomatic illnesses. In Matthew's case, she succeeded in getting him to see a psychiatrist. It then emerged, that even though he was successful professionally, deep down, he was looking for a way to get off that treadmill.

Matthew still required the services of various therapists, but he did get back on his feet.

Suzanne says that it's vital that no doctor ever jumps to conclusions. "Even when a psychosomatic diagnosis seems inescapable, it is vital that all possibilities be considered and all tests done. Otherwise mistakes will be made. There are no exceptions to this," she says.

Suzanne says that the chances of recovery from a psychosomatic disorder are good, if the patient gets into treatment at a relatively early stage. However, because of the stigma attached to psychological conditions, patients may be resistant.

So, Suzanne reassures them with these words: "Saying certain symptoms are psychological isn't a dismissal; it's still a very serious illness and it needs to be treated by appropriate professionals."

'It's All In Your Head: True Stories of Imaginary Illness' by Dr Suzanne O'Sullivan, published by Chatto & Windus, €25, is now available at major bookshops

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