292 OCCUPATIONAL MEDICINE doi:10.1093/occmed/kqy046 stepped on during a lecture. She was managed for a hairline fracture but several weeks later she developed It’s All in Your Head: Stories From the unexplained focal dystonia. Her fingers were relent- Frontline of Psychosomatic Illness lessly clawed into her palm to the extent that her fin- Suzanne O’Sullivan. Published by Vintage, 2016. ISBN: gernails burrowed into the skin. Through such cases 978-0099597858. Price: £9.99. 336 pp. Dr O’Sullivan highlights the importance of emotional distress in the causation of functional disorders and the benefits of psychological treatment. The human faces make the book very readable; you will find yourself empathizing with the patients, feeling the same frustra- tions as the medical team and becoming curious as to how cases will develop. The author includes information on the evidence base of functional conditions. In one particular section she explains that there is a difference in brain activity seen on a MRI scan in healthy volunteers pretending to be para- lysed compared with those experiencing psychogenic paralysis. This highlights the often neglected notion of the unconscious nature of many of these conditions. She also deals head on with contentious issues, such as the debate surrounding whether chronic fatigue syndrome is purely organic or psychologically driven and talks through the evidence for both. The psychological element of disease is incredibly On many occasions I’ve found myself staring perplexed important in occupational medicine meaning an in- at the person in front of me; all their investigations have depth understanding of psychosomatic illness is essen- been normal, specialists have discharged them and yet tial. I took a great deal from the book from a physician’s unexplained physical symptoms continue. Dr Suzanne perspective, however, medical terminology is very well O’Sullivan’s first book details her journey as she finds explained preventing alienation of readers who either herself drawn into the care of such patients, whose sub- aren’t from a medical background or are worried about sequent diagnoses have been attributed to psychosomatic being blinded by advancements in medicine and the illness. associated terminology. Dr O’Sullivan is a consultant neurologist based in Reading this book has changed my practice, it has London, with a number of publications to her name and opened my eyes to the plight of those who suffer with a special interest in functional neurological disorders. psychosomatic illness. Subsequently, I feel better able When she started her training in neurology her percep- to treat patients as individuals by focusing on the func- tion was that she would be dedicating her life to phys- tional outcome of their diseases as opposed to fixating ical diseases affecting the brain, nerves and muscles. This on aetiology. book describes how she came to realize the huge preva- lence of functional illness, with an estimation that one in three patients presenting to their general practitioner will Rating have medically unexplained symptoms. She explores her involvement and subsequent reflec- ★★★☆ (Buy and keep) tions on anonymized cases of psychosomatic disease, Yvette Martyn such as ‘Shahina’, a university student whose hand was Downloaded from https://academic.oup.com/occmed/article-abstract/68/4/292/5001599 by Ed 'DeepDyve' Gillespie user on 21 June 2018
Occupational Medicine – Oxford University Press
Published: May 23, 2018
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