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It’s All in Your Head

This year, Suzanne O’Sullivan has won the Wellcome book prize for her first book, ‘It’s All in Your Head’. The book explores the concept of psychosomatic illness, how it is handled and recognised by people in the medical profession and how a diagnosis of ‘functional’ illness impacts a patient. Through a series of case studies, O’Sullivan deftly takes the reader through her encounters with psychosomatic symptoms, the mistakes she made early on in her career and the lessons she has learnt as a consultant neurologist diagnosing and communicating with these patients.

With no specialist knowledge assumed, this book serves as a superb introduction to the power of the mind on the physical body, which could prove invaluable in helping the lay person accept the nature of functional illness and better appreciate how differently people can respond to the same physical or mental stresses.

To a medical professional, however, the more important message is that of the value of communication, and this is made relevant to a wide range of professions. A running theme of the book is how differently patients respond to a diagnosis of functional illness and how the effectiveness of their treatment is so dependent on this response. O’Sullivan stresses how important the patients’ first encounters with doctors are, and how the way in which the cause of their symptoms is explained can drastically alter how the patient perceives their illness. Subtle differences in the language used to explain the diagnosis can be the difference between a patient being told their symptoms are real, imaginary, or faked and changes how they interpret the way the medical profession perceives their illness. This book is a fantastic way to pick up on these subtleties without having to make the mistakes of countless doctors before.

The downside however is that, since O’Sullivan is a neurologist, there are very few cases where a satisfactory conclusion is reached; her patients are either treated by a psychiatrist or move away from her care. If you can cope without knowing all the ins and outs of an illness though, which is inevitable with psychosomatic disease, this case series is an enjoyable and insightful read.

Jen Todd is a sixth year medical student at Harris Manchester College


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