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It's All in Your Head: True Stories of Imaginary Illness

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Suzanne O’Sullivan
Chatto & Windus
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PainSci notes

This book consists mainly of well-told stories of severe psychosomatic illness. The key take-aways are that psychologically powered illness is common and can be amazingly severe, it’s just as “real” as any other kind of pathology — but is a health problem that defies easy categorization as either physical or mental illness, and it can happen to otherwise sane and healthy people. Emotional states routinely manifest as physical symptoms, so often and harmlessly that they don’t even register as “symptoms” — just a normal part of the human experience — but there’s a wide range of severity, and it becomes disabling as it becomes more extreme.

Dr. O’Sullivan is clearly concerned about the risk of misdiagnosis. She knows that it is always possible that there’s another hard-to-diagnose condition causing the symptoms, or even that functional neurological disorders have a pathological explanation that we do not yet understand. She spends much of the book carefully justifying her clinical opinions, and she is cautious and compassionate enough that I think she mostly gets it right.

There are no citations at all, and that’s a significant weakness in this book. I think I can trust Dr. O’Sullivan’s opinion on most matters, but clearly not all: she tackles chronic fatigue syndrome without sufficient education or humility. She gets it so wrong, in so many ways, that it’s hard to recommend the book without a radical disclaimer: “Tear out the chapter on CFS… but the rest is good!”

~ Paul Ingraham, PainSci Publisher

Related Content

  1. www.YouTube.comSuzanne O'Sullivan @ 5x15 — The reality of imaginary illness on
  2. “Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders,” Espay et al, JAMA Neurol, 2018.

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