The mad, the bad and the sad. Your number’s up.

Suzanne O’Sullivan (2015) It’s All in Your Head. True Stories of Imaginary Illness.

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I like stories of imaginary illnesses. Dr Faraday in Sarah Waters The Little Stranger errs on the side of caution and attributes a collective form of psychosomatic illness to the aristocratic Ayre’s family staying at rundown Hundreds Hall, and the subconscious as place and time combine, the equivalent of old cartographers whom declared this be the end of the world, here be ghosts. The coroner at Caroline’s death was quite happy to accept that she died while her mind was unbalanced. I thought it was her body that toppled over the balcony, but there you go, it was her mind. The two are inextricably linked.

Wilkie Collins in The Woman in White has private asylums, doppelgangers and rich hypochondriac uncles that can’t bear loud noise, or indeed most everyday noise, as key parts of his plot.

Suzanne O’Sullivan touches on The Devils of Louden and it’s clear that she doesn’t think there was anything devilish about them. O’Sullivan calls for a compassionate response to those suffering from illness, whether mental or physical, because one impinges on the other. Fling in Abigail Williams from The Crucible. It takes more than one to cry witch, to be heard and collective responsibility must be taken seriously. One of my favourite stories wasn’t directly about the sad, the mad or the bad, but the gullibility of the rich for new fads.

I’m biased in that way. Those that could afford a nurse and private asylum in Collins’s time would be treated far better than those in Bethlem Royal Hospital that coined the term Bedlam.  Just before the start of the First World War a young Winston Churchill was calling for the creation of purpose-built asylums where feeble-minded men and women could be segregated from the general population. Sterilisation of women would be compulsory to ensure they did not reproduce. These measures were introduced in some American states. Eugenics is a rallying call against the poor. I like to listen to rallying calls against the rich. If you want to look at how the poor were treated during the First World War for shell shock Pat Barker’s Regeneration novels shows the dichotomy of how anthropologist, ethnologist, neurologist and psychiatrist W.H.R. Rivers treated officers of the ruling class at Lockhart hospital, most notably Siegfried Sassoon and Robert Graves, and how Rivers’s counterparts tortured working-class soldiers until they were reported fit for duty. Post-traumatic-stress disorder treated with electric shocks to make the blind see and the lame walk is nothing new. If you’ve got an imaginary friend you better get on the blower to him quick style.

Julian Barnes short story ‘Harmony’ tells the story of a young musical prodigy Maria, born 15th May 175-. The child’s health was normal, until she woke up blind at the age of three and half. It was held to be the perfect case of amaurosis, there was no fault detectable in the organs of the eyes, but she was blind. Her condition was attributed to some fright the she received during the night. Her musical education continued and the blind infant prodigy was much sought after in royal courts throughout Europe. M—sought to cure her with magnetism, with some success, but Maria’s parents were not blind to society’s measuring rod and blind prodigy was a mere prodigy without her condition.

O’Sullivan notes that whilst psychosomatic disorders may be thought of an illness of perception, there’s no escaping the damning statistic that seventy percent of such disorders are suffered by women. She draws not just on local knowledge but a wide body of research. A 2011 German study, for example, showed that twenty-two percent of those attending the equivalent of our GPs had a somatising disorder. Somatising disorder means that although the illness the patient comes to get treated for is real enough for the patient those treating the patient can find no organic reason why he or she is presenting those symptoms. The World Health Organisation 1997 estimated that twenty percent of those attending their doctor had at least six ‘medically unexplained symptoms’.  More recent pilot studies in London confirms the WHO’s findings. They are the imaginary friend in the room with doctor and patient. Hollywood is good at this kind of thing. Think The Three Faces of Eve, but the patient has only brought two faces into the consulting room and is presenting with a bit of a cough. Some of the cases presented by O’Sullivan are highly symbolic and could be said to be straight forward. The woman that goes blind and is unable to keep her eyes open after her husband is taken to jail for abusing a neighbour’s child. Women that take pseudoseizures (or dissociative seizures) at work. The language is useful and how the patient describes their seizure has been modelled and analyses to differentiate between psuedoseizures and epileptic seizures. One behavioural, the other which can be accurately measured by EEG. With no increased electrical activity in the brain O’Sullivan asks and answers the question are they real? Yes and No.

O’Sullivan widens the scope to those outside her practice whom she has come into direct contact with. The estimated 250 000 reported cases classified as Myalgic Encephalomylitis (ME) and/or Chronic Fatigue Syndrome (CFS). Two million CFS cases are documented in The United States.  The disease or syndrome is real enough for those suffering from it. Each new case is looking for a cure, another test, another diagnosis.

The neurologist Weir Mitchell rest cure was a response to Charcot’s definition of hysteria in women extreme fatigue, but geared towards rich men in Philadelphia. The crème de la crème who were thinking too much and suffering from neurasthenia. Patients were force fed fatty foods to build them up. Discouraged from standing. A bedpan was brought to them for their toilet needs. They could not read. Have conversations, or have any type of stimulation. Although this sounds much like my local pub, they were charged extraordinary amounts of money for their cure. If the cure didn’t work, apply more cure.

Our government’s response is  predictable, a wooly response, to place wellbeing at the centre of their strategy; delay of the publication of critical report,  A Five Year Forward View for Mental Health; promises of more money for NHS Mental Health services, a mooted figure of £1 billion to ‘plug gaps in service’; whilst as Daniel Boffey notes ‘incentivising’ the 250 000 with recognised psychiatric conditions to find work by cutting currently classified as disabled from £102.15 per week to 72.40 per week. Using the government’s template those with ME or CFS could be ‘incentivised’ to be cured by cutting disability payments to a more manageable figure of £0.00.

As O’Sullivan notes most ME/CFS sufferers have good reason to be defensive. Whether in or out of employment, they are regarded as the shirkers of the medical system, using up valuable resources that could be used better elsewhere. The government diagnosis of a personal defect poor people suffer from that can be instantly cured by them finding a job and the cynicism of medical staff that grow weary of test after test finding no organic reason for illness and an increasing readiness to find the failing in the patient is a potent mix. O’Sullivan calls for ‘an open mind’ but that door is already closed.

‘Neurasthenia, hysteria, melancholia, depression, chronic fatigue syndrome, chronic fatigue immune dysfunction syndrome, myalgic encephalomyelitis, yuppie flu, dissociative seizures, psychogenic non-epileptic seizures.’

Hippocrates 200 AD suggested hysteria was too much or too little of something: black bile, yellow bile, blood or phlegm. If any of the four humours were in conjunction the trouble may be the master organ of the wandering womb and the sympathetic responses travelling in spirit form induced in the patient. I quite liked the nineteen-century idea of such conditions being down to engorgement of the nasal membrane, but then again I do have a big nose.

‘So now I’m a psycho, am I?’ asks more than one of O’Sullivan’s patients.

‘This is boring now, I think you should get better,’ Jo Marchant’s father says to his daughter in an extract of her memoir Cure.

As O’Sullivan notes, ‘In the twenty-first century psychosomatic illness is a socially unacceptable disorder’. The media plays its part in carrying the symptoms that are spread throughout the general population. But on the bright side we no longer burn people as witches.  Of course the condition, syndrome, illness or whatever label you want it put on it is a matter of perception and the votes are in. Any right-thinking type would know who can be cured will be cured, the others are psychos. In the same way the First World War the Krauts or Bosche needed more cold steel right up them to be pushed back patients with ME/CFS are a small minority of shirkers that need to find work is finding increasing traction. She is a voice of reason, but she is drowned out by those with louder voices, big sticks and the ability to push their agenda through. When we are told it is not a question of money, we can be sure it is.  O’Sullivan tells us ‘laughter can be therapeutic’. Ha. Ha. That sounds like a cheap option, but more tests will be needed.

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