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

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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 completely 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 conversion disorders have an 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.

Unfortunately, after admirably tip-toeing through this mine field for most of the book, she then tackles chronic fatigue syndrome with out sufficient education or humility. She gets it so wrong, in so many serious ways, that it’s hard to recommend the book without a radical disclaimer: “Tear out the chapter on CFS… but the rest is good!” I’m not going to get into the sordid details here, but suffice it to say that her assertion that CFS and myalgic encephalomyelitis is a particularly good example of a serious error.

item type
a book
Suzanne O'Sullivan
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Chatto & Windus

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