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Treating 'Imaginary Illness' In 'Is It All In Your Head?'


It costs the American health care system twice that of treating diabetes. And yet, it's not really a disease. Psychosomatic illness, where your body acts as if it's sick but there isn't anything wrong, is common and also very misunderstood, according to a new book "Is It All in Your Head: True Stories of Imaginary Illness" (ph). In it, neurologist Suzanne O'Sullivan describes some of the extreme cases she has treated and what may be behind them. She joins us now from member station KUOW in Seattle.

Thanks so much for being with us.


GARCIA-NAVARRO: So let's start with a definition. What is psychosomatic illness?

O'SULLIVAN: So psychosomatic illness is a disorder in which people get real physical symptoms that cannot be explained by physical examination or medical tests. No disease can be found to explain them. And there is usually believed to be a psychological or behavioral cause.

GARCIA-NAVARRO: One of the things that's so fascinating about this is how these things manifest themselves. How can you tell when something is imaginary?

O'SULLIVAN: I use the word imaginary in the title of this book. But really, it's to imply that these symptoms come from the imagination, but they're not imaginary. They are incredibly real.


O'SULLIVAN: And when I say that they come from the imagination, it's very much to say that when you develop a disability, it must come from an idea that you have. And that idea exists in your mind. It exists in your imagination, and it's probably drawn from your personal experience. These symptoms are all often based on our ideas about our bodies, what illness we've been exposed to in the past. And then when we're faced with a particular stressful situation, those worries channel themselves into something. And unfortunately, we can make them real in that way.

GARCIA-NAVARRO: In the book, you detail some of the cases that you've dealt with. You introduce us to some of your patients. Talk us through one of your cases.

O'SULLIVAN: So just to give you an example of Yvonne (ph). So even as a woman who suffered a minor injury when cleaning fluid was sprayed into her eyes. She had the appropriate first aid immediately after the accident. But the following morning, she woke up and found herself to be profoundly blind. She was obviously taken to the hospital and fully investigated for this. And they couldn't find any explanation for her blindness. But Yvonne's experience was, to give you an example - in unconscious moments, she would reach out and pick something up off a table that she couldn't possibly have picked up if she had not been able to see it. But if you asked her if she could see it, she would say that she could not.

GARCIA-NAVARRO: So people aren't doing it on purpose. It's mind over matter almost.

O'SULLIVAN: Absolutely. It is a completely unconscious process. I think one of the things that the sufferers really worry about is that they will be accused of doing it on purpose.

GARCIA-NAVARRO: What is the treatment for someone who comes in with a psychosomatic illness of this degree?

O'SULLIVAN: The treatment is very individualized. So it's unlikely that two people will have the disability for exactly the same reason and will require the same treatment. So if you see someone who has suffered a significant psychological trauma that has led them to manifesting physical symptoms, that person will need help of a psychologist and a psychiatrist.

But on the other hand, if you see somebody who has something like a paralysis that has been the result of a maladaptive response to injury, that person isn't going through any specific stress other than the stress of their actual disability. What that person needs is a focus on physical treatments. That person will probably benefit more from a really psychologically-minded, motivated physiotherapist and occupational therapist than they will from the help of a psychiatrist.

GARCIA-NAVARRO: Do you think Western medicine needs to change? When I say Western medicine, this idea that somehow the body and the mind are treated separately - do you think there needs to be a sort of a more holistic approach?

O'SULLIVAN: Absolutely. And I think that this applies to both psychosomatic disorders and to diseases in general. You know, most people with diseases like asthma, diabetes and so on will say that their symptoms are an awful lot worse during periods of psychological distress. So in every sense, our minds and our physical well-being are very closely interlinked. But unfortunately, the way we practice medicine is that the fields of psychiatry and psychology are very separate to the fields of physical medicine. I think a lot of people's lives would be made a lot easier if they could be treated both psychologically as well as having their physical disabilities treated.

GARCIA-NAVARRO: Neurologist Suzanne O'Sullivan, author of the book "Is It All In Your Head: True Stories Of Imaginary Illness."

Thanks so much for being with us.

O'SULLIVAN: Thank you. Transcript provided by NPR, Copyright NPR.