AWC16: It’s All In Your Head by Suzanne O’Sullivan

Review published on October 15, 2016.

Things are rarely what they seem. We all know this, especially with regard to the complexities of the human personality. In this gripping account of ‘True Stories of Imaginary Illnesses’, Suzanne O’Sullivan, a Consultant Neurologist, pulls back the curtain on patients presenting with dramatic physical symptoms, to reveal that the sources of their disabilities sometimes have little to do with flesh and blood.

O’Sullivan talks us through cases she has dealt with where individuals have suffered life changing conditions such as sudden onset paralysis, seizures, blindness or symptoms associated with multiple sclerosis.

But what is different about these cases is that there is no identifiable physical or neurological basis to any one of them. In this book we follow O’Sullivan on her rounds as she investigates each case. We hear her thoughts and peer over her shoulder at case notes as she teases each story apart.

O’Sullivan explains that the conditions presented reflect personal and cultural beliefs about ailments. So, for example, a trauma to the right of the head might lead someone to believe that the right side of their body is paralysed, if they do not know that the right brain controls the left side of the body and vice versa. Similarly, there are parts of the world, she tells us, where people believe in a condition called Koro, in which the penis shrinks. Apparent sufferers present with what they understand to be the symptoms, although the condition does not actually exist.

While some of the tales told seem designed to raise eyebrows, the overall tone of this book is compassionate. It does not point fingers at malingerers or accuse the unwell of deceit. In fact the author is careful to caution the reader against these conclusions, pointing out that just because we can’t yet find a physical basis, does not mean that there is not one. Moreover, she is at pains to stress that the plight of sufferers is often exacerbated by their own feelings of frustration and lack of insight into their condition, for they too are unaware of the true source of their difficulties.

Rather than blame, this book attempts to help us understand that sometimes, when we find the reasons for our emotional pain impossible to face, its only outlet is by transmission, or conversion, to a tangible, physical form.

The conclusion of the tale, however, is not a hopeless one. While people often resist the diagnosis of a psychosomatic condition, O’Sullivan reports that with appropriate psychiatric support, progress is possible. The one frustration with this book is, perhaps, that this part of each story remains untold.

This is an excellent and easy read. For those with enquiring minds but busy lives, its construction allows short bursts of reading without loss of mood or thread. It offers an incredible insight into the workings of our own minds and bodies, reminding us powerfully, as O’Sullivan mentions, of George Orwell’s observation that

‘If you want to keep a secret, you must also hide it from yourself’.

Dorothy Gallagher

It’s All In Your Head by Suzanne O’Sullivan
Vintage978-0-099-59785-8 2016



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