The Suzanne O'Sullivan Show

The Age of Celebrity: Sickness, Health and Why Doctors Have Gone Too Far

Suzanne O'Sullivan, a neurologist who specialises in FND and psychosomatic illness, has been doing the media rounds recently publicising her new book, 'The Age of Diagnosis: Sickness, Health and Why Medicine Has Gone Too Far'. In this she theorises that Long Covid is psychosomatic, and that labelling, medicalising and diagnosing other conditions such as ADHD, autism and cancer has negative consequences. Needless to say there's a few things to point out about the book, the tropes used and her belief-based medicine approach...

The Undiscovered Land

They will tell you that it’s progressive, groundbreaking, science pioneering into unventured territory. That these scientists (err well, kind of scientists) are bravely getting in their jazzy new space rockets to venture into this unexplored grey area of medicine.

Now, there’s one problem. This promised land of medicine has been attempted to be discovered for about several thousand years, or probably since people started trying to heal others.

What is this land? It’s the mysterious terrain of psychosomatic ‘medicine’ where our emotions and mental life are impacting our bodies in a myriad of ways that handily explain every kind of symptom. And phew, especially in complex diseases that medicine doesn’t know much about.

Well, I’m going to tell you a secret. There’s a reason this undiscovered land beyond the horizon hasn’t been found. It doesn’t exist for the vast amounts of illness it proclaims to explain.

The issue is that any symptom can be perceived as psychosomatic. It’s a huge bottom trawler of medicine. Even O’Sullivan states this on the Nine to Noon program on RNZ:

I perhaps don’t think you understand what psychosomatic symptoms are. I see people that have any type of symptoms. I have convulsive seizures and paralysis and blindness and every type of symptoms can be psychosomatic. A concussion, by the way, produces some of the commonest psychosomatic symptoms there are such as feeling dizzy or lightheaded and things like that.

It’s a little like saying Atlantis exists. A wonderful utopia where any symptom can be explained by the cosmic interrelatedness of the mind and body. We just need to solve our emotional and mental problems and poof our symptoms will disappear.

Atlantis by Joseph C Knight

Brave Psychonauts

But, I hear you say, Atlantis, the magical world, is fantasy. You want proof?

Don’t be silly. It’s fine. These brave medical psychonauts are courageous and compassionate. And in O’Sullivan’s case “extreme empathy”. They care:

I am a London based neurologist who cares deeply about reducing the stigma of psychosomatic disorders and normalising the reality of the mind-body connection and the havoc it can wreak. Author Bio

So, because they are pioneering, caring and sympathetic evidence doesn’t matter?

Well, yes, that’s it exactly, and you can even write books, earn money and become famous through it. Don’t you realise the root of all cognitive bias is that because someone perceives themselves as good and they mean well, they can do what they like?

O, phew - that makes it all right. We were getting worried that one might actually have to show where the mind body connection is!

Don’t be a pleb! There’s this really cool trick where you just redirect the conversation to all the big meanies who are annoyingly asking for proof and say they are the problem. And you’re such a misunderstood counter culture warrior for going against the grain.

Yet, unfortunately, the reason this psychosomatic model has been around for centuries is that it is unfalsifiable - it cannot be disproved with a logical empirical test. It’s its blessing and curse.

Once upon a time…

Drawing on the stories of real people, as well as decades of clinical practice and the latest medical research, Dr Suzanne O’Sullivan overturns long-held assumptions and reframes how we think about illness and health. Book Blurb

There is another handy trick used by medics when there isn’t any scientific evidence. That is to reframe yourself as a storyteller, where belief-based medicine is fine, actually better than pesky proof.

The advantage to this is it makes one more relatable and more cultured, as who doesn’t want to cross into the noble land of the civilised literati?

But, here’s the rub. Telling stories is known in the trade as anecdotal evidence. It’s what people do in pseudoscience to convince you their particular snake oil works in place of actual scientific proof.

O'Sullivan might be a storyteller, but it does raise serious issues about consent, and how she mines her patients for anecdotes to prove her beliefs. Do patients really want to go to a doctor, unsure if they are going to be featured in the next spurious book?

The moral of the story is that if someone is trying to persuade you a medical theory is true with a story, even with real, not imaginary people, it’s time to start pinching salt - and maybe throwing it over one’s shoulder with a large shovel!

Reality Baby!

There should be nothing offensive in my view at all here because my position always with these disorders is that people are suffering, symptoms are real, but it’s how people conceptualise what’s causing those symptoms that I think is a problem, and it’s also the perceptions. O’Sullivan on Freakonomics

There’s another super way for doctors on the yellow brick road to fame to convince people that something is true.

It’s based on unicorn-based medicine and quantum entanglement (irony) - you just have to keep repeating that it’s real.

The people are real, the symptoms are real, the suffering is real, even you, the doctor are a real doctor - not an imaginary one.

Phew, I hear you say. Glad we got that one sorted. So, you still don’t have to give any proof or even a theory as to how Long Covid and all these other conditions are psychosomatic?

Nope.

You see, the trick is that you misdirect by saying the symptoms are real, the suffering is real, but what you don’t say is that the disease isn’t real. The problem is the perception not pathology baby! But that’s the joy of being a psychosocial reductionist - you can ignore the biology!

The irony is that it isn’t the patient, labelled or unlabelled, that is somatising. The fiction of our real symptoms being influenced by our minds only exists in the psyche of O’Sullivan et al.

But isn’t psychosomatic a label and also a diagnosis?

(O shit! - SS)

A lot more people seem to have ADHD these days, which was barely around when I was at school. And millions now endure long Covid, a disease with a bucket of symptoms that did not exist at all five years ago. Adam Rutherford (we honestly expected better Adam!)

Another good one, and even bastion scientists like Rutherford (who actually had Long Covid) fall for this. Is you only have to say, back in my day no one had ADHD. Ahh, so no labels mean these illnesses have no reality. And now just trigger-happy doctors are imagining them into existence!

But I thought you said they were real?

Ummmmm?!?

Mind and Body

For any other fame aspiring Garner’s or O’Sullivan’s, there’s another trope one can’t miss out on. Just keep stating tit bits about the mind and body. It makes you sound holistic and woolly and caring.

Is there anything specific about the mind and body I need to say, I hear you ask?!

No, not at all! You just have to keep repeating yourself and dropping in the odd mind-body connection, or even interface to sound more psychonaut.

So, I don’t have to do any tricky philosophy of mind? Or any science proving the interface or showing where the mind is, or what it is?

No! This is the great thing - if anyone questions you, you just have to frown a bit and cast them as uncaring, nasty people that don’t care about mental health.

Genius!

Come play my game, I'll test ya Psychosomatic addict.

It’s worth noting the meaning of the word psychosomatic. No, it isn't Breathe by The Prodigy, but it is a very good song. Psycho refers to the mind, somatic to the body. A counter argument to criticism of the theory is often that it’s “physical and real”. But soma is the body. It’s been as real and physical since our real and physical wombs were wondering around our body. It doesn’t mean it’s correct - and it’s a pretty low flippin bar for validity. Flapjacks are real and physical but it doesn't mean they are causing or curing Long Covid.

It’s interesting that O’Sullivan is keen to resurrect the term. As the term biopsychosocial (note body, mind rehash) is often used as an alternative, due to the toxicity of psychosomatic.

Although dear reader, one warning sign is watch who is telling you this guff? Is it a psychiatrist or neurologist?

In modern times, these titles do give a modicum of epistemic authority. But it is worth noting the two disciplines were combined until the late 19th/early 20th century. The boundaries were fuzzy at the time of Charcot and Freud and their thinking (and bias) is still present.

It does seem, though, that real people in these real fields are particularly susceptible to proposing theories without proof and the bright lights of fame these beliefs offer.

The Dazzling Lights

What isn’t easy to ignore is that many doctors telling us that diagnosis is bad because it turns us into patients, is that quite a few seem to be on a fame gambit.

In an age of celebrity, it is wise to be skeptical of anyone who is on their soapbox of glory. This even applies to real doctors.

Its arch proponent is Paul Garner, who has done thousands (no, that’s not an underestimate) of media appearances about how he used his superhero mental powers to cure himself of Long Covid. It’s no surprise to see him in O’Sullivan’s book:

I suddenly believed I would recover completely. I stopped reading about illness and discussing symptoms. I spent time seeking joy. Paul Garner

He’s such a phenomenon it really should be called Garner’s Law: when a scientist can’t stop courting media with their saviour complex telling ALL about their miraculous mind-body recovery.

The point is the media thrives on these stories (and they are fiction) - there’s the new, the cutting edge, the pioneering misunderstood doctor who is compassionate and caring. It’s a shame it’s fantasy.

The problem is it’s a self-fulfilling prophecy. The more attention, the more media junkets, the more literary festivals, the more you are likely to believe your own yarn. Especially as you’ve already devalued anyone questioning your belief-based medicine as rigid fundamentalists.

She states that this argument is going to upset people, because her ‘truth’ is questioning their dearly held ideas about themselves, which they are intent on defending against the evidence. Dr Elke Hausmann

Cheap as Chips

Yes, this article has been on the flippant, sardonic side in an attempt to laugh at the ridiculous and not re-traumatise ourselves.

But there are very real consequences to narratives such as O’ Sullivan’s. And she’s not the first. We’ve seen Garner, Wessely, Santhouse, Sharpe and others on this gravy train of overdiagnosis and psychosomatic medicine.

There is an irony for many interested in a biopsychosocial explanation of symptoms. The reality is that there are social determinants of health, but you very rarely hear them calling for an end to poverty, healthy social housing, universal basic income. They aren’t raging socialists. Maybe because medicine is a traditional conservative bastion?

If anything, this form of medicine (if one can call it medicine as they don’t want us to be labelled as patients) is that it enables a pulling back of the State. Less diagnosis means less healthcare and less expenditure. It means fewer benefits and a withholding of support.

O’Sullivan is popular, not because she’s real, or compassionate or humanistic, but because her theories are cheap. One doesn’t even have to prove them - which is even more convenient.

It allows medicine and the State to paper over the cracks. To push back against the patient and years if not decades of advocacy efforts to have stigmatised, ignored conditions like ADHD, Autism and Long Covid recognised, and that means labelled.

If anything, there is an underdiagnosis problem. This isn’t a fancy. One can see this in medical literature (which O’ Sullivan doesn't seem connected or interested in). We know ME, Long Covid and ADHD are under diagnosed. If she doesn’t believe the evidence, she obviously hasn’t sat down and listened to the thousands of stories of parents trying and failing to get an ADHD or autism diagnosis in a system that is under-funded and a nightmare to navigate.

The Age of Diagnosis covers so many topics that have been troubling me but which I hadn’t been able to resolve myself. It slices through the confusion and the contradictions that have tied me in knots - both as a parent and as a clinician - with grace, elegance and compassion. Chris van Tulleken

We also expected better from you Dr Chris! Note: if you’re ever troubled about labelling your kids as being neurodiverse - don’t - diagnosis and labels matters.

O’ Sullivan is convenient. I’m sure she thinks she’s noble and esteemed as she ventures into the literary world - who can resist the kudos of being an author?! But the rub for her is she’s being used as much as she’s castigating the unwell.

At this time when Labour is aiming to decimate benefits in a Tory fuelled orgy of disability cuts, O’Sullivan is a handy tool to justify austerity and cruelty. She is a means to add to the rhetoric of pandemic denialism, in order to avoid responsibility and expenditure in supporting and explaining one of the largest mass disabling events in history.

Not getting your social security is more physical than psychosomatic Long Covid - and has devastating real-life consequences.

All that Glitters is not Gold

O’Sullivan isn’t the only one who likes and listens to stories. The ability to listen and care as a doctor without a grounding in evidence-based medicine doesn’t make one heroic. It makes one a fantasist and not the Tolkienesque type.

Stories and fairy tales are full of warnings about discrimination and wisdom, of not being deceived by the pretty, easy bauble. It would be an idea if Suzanne widened her reading and not just cherry picked the stories that validated her beliefs. And they are beliefs, because she has no evidence.

The Casket Scene by Lucien Besche

If Suzanne decided to come listen to our story, we would sit her down with a nice cup of tea and carefully explain that all that glitters is not gold. That Portia, in the Merchant of Venice, has to offer three caskets to her suitors and choosing the one that “gilded tombs to worms enfold, had you been as wise as bold!” is not the path to wisdom.

What ‘The Age of Diagnosis’ tells us is not that Long Covid is psychosomatic, but the thrall that this idea still has in medicine. If Rutherford, Van Tulleken, Santhouse and a large cohort of the BACME and Long Covid clinical ecosystem give space, belief and credence to these theories, we are in a big pile of poo. As however much they care, the iatrogenic harm perpetuated is real. Misdiagnosis can have a devastating effect on mental health and damages trust in the healthcare system - for some permanently.

If you are interested in what stories have to tell us about the dangers of psychosomatic ‘medicine’ please see our Miranda post (much the same applies)…

Just in case you hadn’t guessed we are a real organisation, with real people with real symptoms, we also really care. The difference is that we follow the (vast swathes of science) that show Long Covid in based in pathophysiology not loneliness or some other grift that is unprovable. If you’d like to support our work then please do subscribe!