Transcript: Why does the mind create real symptoms in the absence of disease?

Dr. Suzanne O'Sullivan

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Suzanne O’Sullivan

Hi. My name is Suzanne O’Sullivan. I’m a consultant neurologist at the National Hospital for Neurology in London. And this is my Garden talk.

Sophie Adelman

Suzanne is an NHS consultant neurologist with expertise in epilepsy and functional neurological disorders. And in addition to her day job as a clinician, she has written several bestselling books on psychosomatic illnesses, including It’s All in Your Head, Brainstorm and recently, The Sleeping Beauties, which delves deeper into psycho social illnesses. Now, today, Suzanne is going to give us insight into why psychosomatic or phantom illnesses occur.

Suzanne, it’s wonderful to have you here today. Welcome.

Suzanne O’Sullivan

Thanks for having me

Sophie Adelman

Now, before I hand over to you. I wanted to understand from you. Why, in addition to your clinical work, did you start writing about psychosomatic illnesses in the first place?

Suzanne O’Sullivan

Yeah. I mean, it really was something that arose out of necessity. Really? I’m a very clinically trained doctor. I’m a neurologist. I’m a neurophysiologist. I spent a lot of time working with patients within those specialties. And yet when I qualified as a consultant and I had to take responsibility for patients, I found that you know, I was encountering huge numbers of people with psychosomatic disorders.

And every time I told them the diagnosis, they were shocked. And each time I was sort of reliving this experience of people not being familiar with this particular medical problem that I knew to be so common. So really, that sort of drove me to want to kind of raise public awareness about this issue.

Sophie Adelman

Well, I’m sure you’re gonna be able to do that today, and I’m so looking forward to hearing your talk. And so with that, I’d like to hand over to Suzanne O’Sullivan for her Garden talk on Why does the mind create real symptoms in the absence of disease?

Suzanne O’Sullivan

Okay, so over the next 30 minutes, I hope to change the way you think about how the mind and body interact to produce psychosomatic illness.

And I’m going to do that by telling you two stories of people who I think really had negative experiences of the old fashioned views that medicine sometimes brings to these disorders. And I hope to sort of wonder how things could have been handled differently for these people for a better outcome. So I’m going to start by telling you the story of one of my patients. Her name is Tara, and I met her when she was 32 years old, so Tara was accustomed to being well, and one day she bent over and got a searing back pain.

She never had a pain as bad as this before she went directly to her GP. He suggested that it was probably a muscular pain, gave her painkillers and referred to a physiotherapist, which is fairly standard treatment for that sort of problem. Unfortunately, it really wasn’t very effective for Tara. She did the prescribed exercises, but she wasn’t getting better. The pain continued. She went back to her. GP was referred to an orthopaedic surgeon who referred to as for a scan, which sort of Ouattara felt like a relief because she felt like she was being taken seriously.

But then, when she got the scan result, she found that she was more confused than relieved because she was told that the scan showed a slipped disc at the bottom of her spine. But then she was told that the doctors didn’t think that Zip Disc was important to her back pain and that still, she had a musculoskeletal problem and still she had to go back to the physiotherapist. So she felt a little disillusioned by this because, as you can imagine, she’d been through this process. She felt like she was going back to the beginning again, but she did what she was told.

She continued with the exercises, but she found that she was just beginning to decline into disability. She noticed that the pain extended into her legs. She began to notice that a sensation in her legs was altered. Her legs didn’t feel normal. The next thing she noticed that was that her legs felt weak, and gradually she noticed she was having difficulty walking. So, obviously concerned about this kind of downhill trajectory, she saw a second doctor. She saw a third doctor. She had a second scan.

She had a third scan, and each time she was given the same story, which was that she had a musculoskeletal back pain, that this was common and that it would be improved eventually with physiotherapy. And essentially, she shouldn’t worry. But clearly, as her ability to walk declined, she was extremely worried. It wasn’t until she got to the state that she could barely walk and needed a wheelchair for short journeys that someone said to her that actually, they thought her decline into disability was psychosomatic.

Now you can imagine she was absolutely flabbergasted by this suggestion. She couldn’t kind of even contemplate How could the mind produce paralysed legs? She was dubious about the diagnosis, but still she wanted to do what she has been asked to do by the doctors. So she went to see a psychologist meeting. The psychologist left her even more flabbergasted, quite honestly, because she found then she was being asked questions about her childhood. She was asked about her marriage. She was asked questions about the state of her mental health.

From her perspective, she had injured her back, and now she had weakness in her legs, and none of this seemed relevant. So she abandoned this sort of conventional medical route, and she went around looking for a neurologist who could explain this better to her, and that was how she came to my door. Now I’m gonna leave Tora story at that moment at a cliffhanger, which I will be coming back to, and I’m going to move on to the second story, which occurred a few years after Torahs and thousands of miles away in Havana, Cuba.

So in December 2016 in Havana, a US diplomat based in the American Embassy in Havana woke in the middle of the night here, a piercing sound at the same time that they heard the sound. They experienced extreme discomfort in their ear. They felt dizzy. They felt sick. The sound went away. The symptoms didn’t. The next day, that diplomat broke up, and they felt very unsteady and extremely unwell. Now, we don’t know many details of this person, except what we do know is that they were versed in sort of that sort of subterfuge used by foreign agencies against US diplomatic staff.

And they believed that this sound was possibly part of an attack. Now, this was, you know, it sounds a little bit odd, but it was actually perfectly reasonable thought because the U. S. Embassy in Cuba had been closed for many years, it had recently reopened. There was a reason for us diplomats to believe there could be under surveillance, so it was a perfectly reasonable thought for that person to have. But it was the beginning of a rumour that US diplomats based in the embassy in Havana were being attacked by a sound or a sonic weapon.

What happened over the course of the next eight months was that 17 people said that they heard very unusual sounds, followed by a constellation of unusual symptoms such as headache and dizziness. Now you can imagine the State Department, you know, went into uproar over this. There was huge investigations. Some of those investigations were medical, so the people went, underwent intensive testing, first in Havana. Then they were evacuated to Miami, where they were further tested. Everything came back as completely clear.

At the same time, the CIA, CIA, the FBI, we’re looking for evidence of some sort of covert attack. But that search came up equally fruitless. Now, the concept that these diplomats were actually suffering from a psychosomatic illness wasn’t raised until about a year into this outbreak, and it wasn’t raised by the diplomats own doctors. About 10 months into the phenomenon, the information about the attacks was released to the public, along with some medical details and also statements from the doctors and descriptions of what was happening to the people.

That was when external experts in the form of doctors and scientists started saying, Well, this all sounds a bit impossible to me. The biggest sticking point was that sound doesn’t damage the brain. So the concept that allowed sound could cause the symptoms these people were describing was really impossible in neurological terms. What’s more, all of the extensive medical testing that had been done on these people had all come up clear. Well, I mean, you can imagine that just like Tara, these people must have been absolutely flabbergasted to have this sort of psychosomatic diagnosis thrust on them.

Now these people’s identities were protected because they were classified because of their position. But their doctors came forward and made statements for them. And what the doctor said was, these people are really sick. These people are not acting. These people are not pretending. These people are not avoiding work. This problem could not be psychosomatic, and they continued to look for alternative causes and in particular for a sonic weapon. And I’ll let you know what came what came of that story a little bit later.

So what really happened to both Tara and to these diplomats is that they both were given a psychosomatic diagnosis in different forms. So the people in Havana, we’re told that they had mass hysteria, which are contagious. Symptoms spread through fear and anxiety. And Tara was told she had a psychosomatic disorder caused by stress. They rejected that diagnosis. Now I’m a full time NHS neurologist. I see these problems all the time, and I know that it’s very, very hard diagnosis to take. And I also 100% understand why it’s a hard diagnosis to take.

You know, imagine that you were in a wheelchair or having seizures, that you were blind or you had memory disturbance and you went to a neurologist and you thought that neurologist was going to give you a diagnosis of epilepsy or multiple sclerosis. And they turned around to you and said, Well, I actually think that this is more of a psychological problem. I think many people would be confused by that, And yet this is an incredibly common phenomenon. It is both common and commonly misunderstood.

So what is a psychosomatic disorder? Well, a psychosomatic disorder is the experience of real, and I emphasise the word real, real physical disability that arises and cannot be explained by disease and arises through the interplay between psychological mechanisms, behaviour and brain physiology. Now you can sort of see just in that description how hard it is for people to take on board what’s happening to them, because it’s very hard to put together psychological processes with physical disability.

But I’m going to come to that, Um, but I think what also makes the diagnosis incredibly hard for people to accept is that this diagnosis is absolutely weighted down by negative connotations drawn from history. And I think it’s also weighted down by considerable amount of ignorant opinion, which is levelled at people who suffer in this way. So let’s touch a little bit on the history, so psychosomatic disorders would once have been known as hysteria. Hysteria is drawn from the Greek word for womb, so it was once believed that the womb could wander around the body, and wherever it went, it could potentially cause symptoms.

So you could you can really see how explanations like this ground this disorder in the bodies of women, when the reality is that this is a disorder that can affect both men and women. But if you still have these sort of attitudes going around, then a male U. S diplomat in Havana is more likely to be resistant of the diagnosis, But also male doctors are less likely to offer the diagnosis. Two male patients also partially perpetuating that myth. That this is a female only condition is some of Freud’s work, So Freud wrote extensively about this.

He had male patients amongst his group, but he wrote about his female patients. But probably the biggest prevailing attitudes that came from Freud came from his theories about how these disorders developed. So in 18 95 he published one of the most influential books that have ever been written on this subject. And it’s called Studies in Hysteria, in which he described patients who had psychosomatic phenomena. And he theorised in that book that a person suffers a severe psychological trauma, that they bury that psychological trauma in their unconscious, and that then the pain of that is converted into physical symptoms.

So the physical symptoms are sparing them the psychological suffering. And then he further theorised that if you could trace the physical symptoms back to the point of psychological trauma, that you could potentially have catharsis that the symptoms would melt away. He very much associated psychosomatic symptoms with histories of childhood trauma and abuse in particular, but other forms of psychological trauma. Also. Now these ideas have been so prevailing that for lots of doctors, and I would say, for the general public to this is the only form of explanation that they have for psychosomatic disorders.

The associate all psychosomatic disorders with psychological traumas with childhood abuse. And that leads to people into situations that Torah found herself in, where she’s been asked to see a psychologist. And she’s been asked about her marriage and her childhood questions that felt irrelevant to her. Now the U. S. Diplomats, on the other hand, were diagnosed with mass hysteria. And there is a disorder that is even more weighted down by history because history is absolutely littered with bizarre outbreaks of mass hysteria, laughing at epidemics and dancing epidemics and worst probably of all, are the witch hunts of the 17th century.

Now, if you don’t believe that these historical associations sort of still wait down people with psychosomatic disorders, let me tell you an anecdote of something that happened in 2000 and 11 in upstate New York. So in a town called LeRoi in upstate New York in 2000 and 11, a group of school girls, all in the same high school, develop sort of tick disorders so ticks like you would see in Tourette’s syndrome that then evolved into seizures. And when this came to the attention of the general media, one newspaper wrote about these young women in women in 2000 and 11 under the heading The Witches of LeRoi.

But probably even worse than the connotations that come from these kind of historical associations with psychosomatic disorders is the sort of ignorant attitudes that I would say go along with this diagnosis. So what did the doctors looking after the American diplomats say about what was happening to them? They said, Our patients are not acting. They’re not pretending they’re not faking. They are really ill. What they were essentially doing was mistaking a psychosomatic disorder for malingering.

And these are two distinctly different problems. So malingering is when you pretend to be ill, usually for something like financial gain, to get out of work or to get money or compensation. So malingering is not an illness. It’s an illegal behaviour. A psychosomatic disorder is an unconscious process. And for doctors to sort of 21st century senior doctors to be still, mixing up these two things is really, really problematic for patients. Because, let’s face it, what was Tara most worried about? She was worried that people would think she was pretending to be sick.

And what are the diplomats most worried about? That people are pretending that will say they’re pretending to be sick? And I don’t want to sort of just label the diplomats doctors as entirely, you know, the at fault here and and the only doctors who feel this way. I think it’s prevalent among many doctors, and I would say that at certain points in my career, I was culpable, too, You know, now I teach medical students, and when we’re talking about these disorders are often very preoccupied with this sort of question of whether or not the person’s symptoms are real or not.

These symptoms are always real. That’s the wrong preoccupation. They should be worried about what story what narrative led them to this situation. But I can’t blame these medical students because I was exactly the same medical students are not taught enough about these disorders, and when they encounter them in clinical practise, as a junior doctor, you know, we don’t really know what to do or how to approach them. And I can certainly remember that when I was a junior doctor when I met somebody like Torre and examine them on the examination couch, and they couldn’t move at all.

I would. Then when I was writing my notes up at the desk, you know, I’d be keeping a sort of sly eye on the patient to see what they did when they were putting their shoes on to see what they did when they were transferring from the couch to the wheelchair. And, you know, in a sense, I was trying to catch them out. I was looking to see if there was a sort of little twitch of movement that was there in those sort of moments when they thought they weren’t being observed compared to when I was observing them.

And if I saw a tiny movement, you know, I read so much into it, I believe that they knew all along that they could move, and that was never the right conclusion and there’s a rich history of doctors moving walking sticks away from their patients to see if they will move towards them. So I think you know the diplomats experience is happening all over the world in much smaller ways. So basically, I think that this is a disorder which is absolutely rife with kind of misunderstanding, negative connotations, historical associations.

I don’t know any other medical disorder that still sort of is holding on to beliefs that are 100 years old or even 300 years old. So that brings me, hopefully to something slightly more positive, which is we are now in the 21st century. So how can we, with all the knowledge we have now conceptualised these problems in a different way? Before I begin doing that? I do want to say that I don’t dismiss Freud’s idea. I think that certainly there are people who develop psychosomatic problems because of psychological trauma.

I think that’s absolutely relevant and important. Point is, that’s not the only way these disorders develop. There’s multiple mechanisms and these people develop disabilities for different reasons. So if we just say that everybody has this one mechanism, which is stress induced, then we’re doing a disservice to the other people who’s medical disorder is quite distinct. Okay, so before I move on to how these develop, we need to understand how the brain processes information, because we need to understand that so we can see how it can go wrong.

So I’m going to talk about three different important features of our processing. The first is called top down Processing. Okay, so the brain doesn’t just record information like a recording device. What it does is it. Both kind of fills in blanks, and it manipulates information as it enters. So, for example, you know you’re not going to see every object from every angle all the time. But when you see it from different angles at different times, your brain has to quickly recognise it, even though it’s never seen that angle before.

Or you’re going to see lots of different kinds of handwriting, for example, and you may never see the same handwriting twice amongst lots of different people. But you have to be able to boil that down to some sort of understanding, so your brain doesn’t sort of just taking information as it is. It’s sort of manipulates it to fit with the pattern it recognises, and that’s how we interpret things. So it’s called top down processing. And it means that as the information enters, your brain is processing from above by comparing to experience that we get through learning.

So we have kind of prior expectations coded in our brain, which are drawn from experience, and we use those prayers to make sense of a world that is full of information. So, for example, you’re crossing the road and out of the corner of your eye you see a car coming. Your brain’s got a moment to say. That’s how far away that car is. That’s how quick that car is going. It fills in the blanks to make that very rapid assessment for you, so you know whether you’re safe or not. So it’s filling in the blanks in that situation, but it doesn’t just fill in blanks.

Top down processing also manipulates the information that you see. So I think everybody must have had the experience where they’re reproof reading something very something important. Their dissertation, an essay, whatever it is and you proof, read it 20 times and 20 times you miss a very obvious type O. And it’s not until you hand it to the next person in the chain that they point out the typing error to you. Well, what’s happened there is that your brain has corrected the mistake. So what your brain is doing is it’s looking to make the best sense out of what you’re reading, and it’s showing you what you expect to see rather than what is literally there.

So some people say that what we’re seeing around us, we all see something different, and what we’re actually seeing is a controlled hallucination created by our brains. So I’m going to come back to that. But now I’m going to move on to another important brain process, which is filtering So our environments are absolutely chock a block with signals. So we’ve got all sorts of sensory signals, things to hear, things to see, things that are touching us, and there’s so much sensory information in our environments that we couldn’t possibly be able to process it all and still function.

We still would be so overwhelmed. So what our brain does, is it? It philtres out all of the extraneous information, anything that’s not necessary. So I, you know, just at this moment I thought about traffic noise and I heard a car outside my apartment, but I didn’t hear that noise until I thought about it. Or the feel of the chair under my underneath me. You know, all of those sensations are unnecessary to me, so my brain is filtering them out. But at the same time, for example, this sort of filtering process allows you prioritise a noise like a child crying so that you can hear that noise above all of the less important noises.

So filtering is there to allow us to focus on things, to keep us safe and so that we won’t become overwhelmed by all the sensory information. The third process I wanted to talk to you about is just bodily noise. So what I’ve said is that we’ve got all of this kind of external noise in our environment that’s available to be heard and seen and felt, but we don’t hear or see or feel it. We’ve got just as much internal noise. So all day long your body is changing. If I stand up, my heart rate goes up.

If I eat some food, my bowels start moving. So I’ve got all of these kind of changes happening in my body. But I’ve spent a lifetime learning to ignore those changes and to know that those are normal things that happened to me. Um, so I absolutely don’t notice them, and nobody notices them. But they’re going to be important in a moment when I talk about how we develop psychosomatic illness. So these are the unconscious processes that keep us safe, that make us efficient and help us make sense of a confusing world.

But there’s two important things about them, and one is that they’re unconsciously generated. And the second is that they are absolutely fallible. So, like everything in our bodies, they go wrong. So a person, you know, hair you can have too much air. You can have too little hair. So similarly, these sort of unconscious process designed to keep us safe. They go wrong sometimes. So, you know, we’re basically we’re judging the world, according predictions, but our predictions could be wrong. Or perhaps we’re filtering out the right the wrong things, and we’re failing to philtre out the things that we should be filtering out and that can alter our experience of our bodies and our experience of the world.

And two particular things really disrupt these unconscious processes. And those two things are, firstly attention and secondly expectations. So let’s talk about attention for a second. So anything that draws your attention to your body will affect that filtering process. So all of those, all of that bodily white noise that I talked about is available for you to notice. And if for some reason you’re given them reason to search your body for symptoms, you will start noticing it. And the minute you notice it, if you judge it to be abnormal, it becomes a symptom.

And one, once you call it a symptom, you’re on the hunt for disease. So, for example, you know, Covid is a good example. If I were not vaccinated and if I was in a room with someone who I later learned to have covid, you know it would be automatic that I would start looking for evidence that I had a high temperature searching my body for evidence of shortness of breath or change in smell. And once you start searching for symptoms, you find them Similarly, if I injured a limb that might direct my attention to my limb and might start making me notice sensations in my limb that I never noticed before, So attention changes how your body feels, but it also changes the mechanics of movement.

It also changes how you move. So, for example, most of us walk. If you’ve never had a difficulty walking, you just walk without thinking about it. It’s just something we do because we’ve learned how to do it, and it’s embedded in our muscle memory’s. But then now imagine how differently you walk. If you’re walking somewhere like a cliff path, for example, you know it immediately sort of makes you more aware of what you’re doing, and ironically, it makes that movement less fluid. So once those sort of automatic processes leave the unconscious and enter the conscious, they actually become less efficient.

I often think a good example of this is with kind of elite sports people. So in elite footballers, only a percentage of elite footballers are actually able to take penalties because that sort of scrutiny of the crowd the moment affects the accuracy of something they could actually do quite well at other times, so attention affects both how our body feels and how our body moves. Then we come to expectations. So I’ve said already that you know, our brain uses prior expectations to make sense of the world.

But of course you know expectations. They don’t have to be right. So how does the brain deal with an expectation if it gets, it’s making its best guess. But maybe it’s guess is wrong. It’s got two potential ways that it can handle. That dilemma, one is that it adjusts the expectations to fit with the new information. Or the second thing it can do is it can adjust the experience of this incoming signal to fit with the expectation. So let me just explain that. So imagine you touch a radiator. You’re expecting that radiator to be cold.

The radiator is hot. There’s always that kind of moment before you take your hand away. And in that moment it’s your brain saying OK, you know, the my prior expectation was wrong. What am I going to do? I’m going to adjust that expectation. Okay, the radiators hot. Take your hand away and what’s happened there is you’ve adjusted the expectation you’ve learned something new for the future. Sometimes radiators are hot when they look like they’re cold. But there’s another way that the brain could have handled that situation, and that is that it could actually have held onto its prediction.

So if a prediction is particularly strong, it can be hard to change. If an expectation is strong, it’s hard to change. So I think a good example of this is someone with a needle phobia. So if someone is terrified of needles and they’re terrified of the pain associated with needles, they can often experience pain even before the needle has pierced their skin. So what’s happening there is that the prediction that the needle will be painful is so strong and so sort of rigid and unable to change that it has overwhelmed the nervous system to produce the experience of pain in the absence of the painful stimuli.

And what we have to doubly remember about all of this is that it’s all happening at an unconscious level. So we’d love to think that we’re able to sort of control how these unconscious processes work. But, you know, if I could control these unconscious processes. I wouldn’t constantly be sending sort of manuscripts to my publisher that have multiple typing errors. Despite multiple read throughs, I wouldn’t be constantly listening to the news and missing the same segment that I’ve been listening out for over and over.

I wouldn’t spill food on my clothes, but unfortunately, these unconscious processes we don’t get to choose what’s filtered necessarily. We don’t necessarily get to choose what enters our consciousness and what stays in our unconscious, and that makes these processes valuable and outside of our control. And it’s that fallibility that can lead to psychosomatic illness. So let’s come back to Tara and the diplomats with these kind of unconscious processes in mind and consider what might have happened to them.

So Tara was not used to being unwell. It was a new experience for her. She also found that her back pain was just so severe. It was difficult for her to accept that it was sort of normal back pain per se that it was just as the doctors kept telling her a muscle strain. She felt that there was something more serious than that going on, and that drew her attention to her body in a way that attention would never. She gave her body the kind of attention she would never have given her body. And then she started noticing the white noise.

And then she learned of the slipped disc that created a very rich visual imagery inside her brain, in which she imagined this disc pressing on her nerves and that drew her attention to her legs that altered her sensory experience of her legs. That then altered the movement, and this was a cumulative process because she changed the way she walked to accommodate the pain. And then that changed the way her legs felt. And then she had to change her walking again. So it was a kind of a looping process that began with simple back pain and progressed into chronic disability.

So, really, Tara was quite right that the back pain was at the heart of all of this. And there was no need for sort of deep, deep, psychological kind of understanding of her background, since it was the back pain and the attention she paid to her body, which was the problem all along. Let’s think about the diplomats. So what happened to them? is that someone gave them a very strong expectation. So it was perfectly reasonable for people living in Havana who worked for the U. S. Embassy to think that they might be under attack.

You know, there was tonnes of precedents for Russian operatives breaking into embassy staff’s houses, moving things around just to unnerve them. Loads of precedent for surveillance. It was reasonable for these people to think that they could be potentially under attack. And then what happened to them? Well, they got called into offices by the highest authorities in the US and told that they were under attack from a sonic weapon and they should listen out for sounds. And they should, if they heard a sound that was unfamiliar, that they should hide behind walls to protect themselves.

Then they were told to examine their bodies for signs that they might have already been attacked. They were called repeated meetings, and as this progressed, they were even told that if they felt perfectly well, they should still go to the doctor just in case they have been attacked. So essentially they were being ordered to examine this sort of stimulus rich environment for noises and Of course they found noises, and then they were being ordered to examine this sort of stimulus rich environment of their own bodies for noises.

And they found those two and that gradually sent them on a trajectory to disability and similarly to the Tora. This was a cumulative process, because what happens when you’re in that situation is that all of your stress pathways are activated. What happens when your stress pathways are activated? Your heart rate goes up, your blood pressure goes up. So now you’ve got even more bodily noise to worry about. So this is a sort of a looping process. Every stage feeds into the next stage, making things worse.

So I think it was true to say the Torah and the diplomats had a psychosomatic phenomenon happening to them in the sense that there was a problem between the interplay of the cognitive psychological mechanisms and their brain physiology. But they didn’t have a psychosomatic disorder in the sense of that Freudian, stress induced kind of abuse dependent model. They didn’t have a psychosomatic disorder in terms of the malingering, as there as the doctors diplomats suggested, and I think that if they had been sort of allowed to understand what was happening to their body differently.

It really could have changed the trajectory of their illness. So for Tara, I explained what happened to her in terms she that I felt that she could relate to, which was that the pain had changed the way she thought about her body. The pain had changed the way she used her body, and that had been a cumulative thing. I addressed the fear that prevented her from moving. I referred her back to the physiotherapist, but with a different approach. What she needed really was to relearn the automatic process of walking, and she did that with sort of novel approaches.

She started to learn to walk to music because that returned the sort of rhythm of her walking got it back into her muscle memory. And she also used distraction techniques so that she didn’t pay so much attention to small sensory changes in her legs, and through that, with gradual physiotherapy, she made a full recovery. The story is not so. The outcome of the story rather is not quite so positive for the diplomats. Their doctors continue to conflate psychosomatic with malingering which really pushes people into a position of having to reject the psychosomatic diagnosis.

They’ve never been offered a palatable way of understanding the sort of interaction between psychological mechanisms and body physiology. So they have been forced to reject the diagnosis and continue to look for the sonic weapon. So bad has that situation become that Havana syndrome has defied its name and is now moving to embassies all over the world. So there are hundreds of people in U. S. Embassies throughout the world who are now being struck by Havana syndrome in the belief that they have been attacked by a sonic weapon.

Finally, what what does this matter to all of us? Because clearly were unlikely to be targeted by a sonic weapon. And most people will not end up as disabled as Tara. But what I would remind you is that these kind of disorders in less severe forms represent about 30% of all visits to a doctor. So there may very well be many people either listening now or known to people who are listening now who have medical symptoms that are simply not being explained by medical tests and or in the position that Tara and the diplomats were in, where they are constantly going for tests and being told they’re normal and really not making any progress.

And what I say to those people is, just consider this alternative explanation because here is a common here is a treatable condition from which you can recover. And that might potentially end your own search for a personal sonic weapon or a personal slipped disc, and perhaps stop the downhill trajectory the Torah faced. Thank you,

Sophie Adelman

Suzanne. That was absolutely fascinating. Thank you so much for sharing all those amazing insights, and I’ve heard about Havana syndrome, but I hadn’t really dug into it.

So it’s really interesting to get your perspective as a as a as a doctor about why that exists and thank you for sharing all those great insights. I could see lots of questions have come up from our members, so I’m going to jump straight into those because we have so many to try and get through. The first question comes from James. Now James wants to know what do you think is needed to remove the stigma around psychosomatic illnesses within the public and the media?

Suzanne O’Sullivan

I absolutely think that we need to normalise these sort of, um, interactions between our mind and our body.

And we have to remove this association with the concept of stress and psychological distress because in little ways these sort of bodily changes affect us all at some point in our lives. Unfortunately, most of us don’t descend into disability. But if we could make people understand that this is part of the human condition, this is just an illness that arises because of a certain way that the body behaves and it could happen to any of us. I think that would really make a big difference. I think it’s really a question of normalising and making people realise they’re not alone because it’s an incredibly common condition.

Sophie Adelman

It’s so interesting. I hadn’t really thought about how often people have these kind of conditions, but it really makes a lot of sense. Once you start talking about the kinds of conditions that people have, I’m going to move on. To Laura’s question, Laura wants to know what are the most common triggers for a psychosomatic illness?

Suzanne O’Sullivan

So I wouldn’t say that there is a common trigger, but there are sort of patterns. So let’s say some psychosomatic conditions are triggered by illness and injury, so I deal a lot with seizures.

So this is quite an extreme for a form of psychosomatic disorder where people have what would have been called a hysterical seizure. We’re now called dissociative seizure. So it’s sort of trigger for that could be that somebody faints on the underground, and that’s a very frightening experience. And the next time you get on the underground you’re frightened. It will happen again, and it produces lots of bodily white noise, and that can be cumulative. So it may be that your disorder has been triggered by a sort of, you know, maybe an injury or an illness or a disease of some sort.

And then the psychosomatic thing follows the pattern of the original injury, illness or disease. Certainly there are some people again, you know, I’m trying to emphasise that these are not all stress related, but some are so It’s also important for us to realise that some of these can be triggered by significant psychological trauma and stresses in life.

Sophie Adelman

I know in your books you’ve talked a lot about these, um, mass Mass hysteria. Maybe they’re not the right word, but these sort of mass psychosomatic diseases, Psycho social diseases like ticks. Can you talk a little bit about those?

Suzanne O’Sullivan

Yeah. So I visited a town in upstate New York called Le Roy where in a school. Um, there was an outbreak of tic like disorders, so girls started twitching like Tourette’s syndrome, and that evolved into some sort of seizure disorder. Now these sort of outbreaks are just phenomenally common. They happen in high schools, particularly all the time, because young people are very impressionable. Young people’s brains are still developing and also kind of social groups for teenagers are really important.

So contagious physical symptoms through some kind of groups of teenagers in schools is super common. Fortunately, mostly when these things happen, they’re gone in a flash. However, they can be perpetuated if something is done to sort of exacerbate the situation. So the town that I visited in upstate New York, bizarrely enough, the kind of celebrity investigator Erin Brockovich got involved in this outbreak and attributed it to poison coming from a train cash several miles from the school. The minute you kind of pathologize these disorders rather than saying that they’re sort of a social phenomena passing through a school, and they’re gone very quickly.

If you pathologize as as it happened in this instance, then you can really perpetuate the symptoms by heightening people’s anxiety and heightening people’s searches for symptoms. So this phenomena of physical symptoms spreading through teenage groups is super common, and I think it’s happening a little on tiktok. Now I’ve heard that apparently tic like movements are happening spread through social media on tiktok. These are not worrying phenomena. They worrying when people pathologize them and medicalize them, and that’s when they can become chronic.

Sophie Adelman

That’s really interesting. That actually leads nicely onto Simon’s questions. So Simon wants to know once somebody is actually received a diagnosis for a psychosomatic illness and they accept it. Is that enough to start alleviating the symptoms? And does it actually help?

Suzanne O’Sullivan

I mean, it’s absolutely I mean, that’s such a great question. I’m so glad you asked, because basically, it is astonishing how quickly talking to someone about the diagnosis can actually help them. So I see people of seizures, and if you tell somebody in a way that they can understand why they’re having seizures for a psychosomatic reason that can actually stop the seizures on the spot, which is absolutely incredible.

I mean, it doesn’t work for everybody, but it can have an instantaneous improvement. And for some people it can have at least a sustained improvement improvement for a few weeks. And I think, you know, just telling people about the diagnosis. Absolutely. It changes the attention they’re paying to their body. And again, I talked about how I used to watch patients who were paralysed and look for flickers of movement, and I’d sometimes see flickers of movement. And that’s because this disabilities are sustained by the amount of attention that you’re paying to your body.

And if you start paying less attention and you have less reason to worry or you’re in an unconscious moment, the paralysis is less complete. So absolutely just talking about the diagnosis, explaining it to someone in a way they can understand can actually be curative for a small number of people,

Sophie Adelman

Which which goes to back to your point about of de stigmatising as people then talk about it more, Miriam wants to know to what extent you would say that most diseases have a psychosomatic component and whether or not they can act as a catalyst, for example, in autoimmune diseases or in stress related diseases,

Suzanne O’Sullivan

I mean absolutely so. There’s different ways that this works. So it’s extremely common for someone who’s got an underlying disease to develop psychosomatic symptoms that are the same sort of symptoms that they would have from the disease. So I look after patients with epilepsy, and a proportion of epilepsy is not a psychosomatic. Illness is caused by unwanted electrical discharges in the brain, but people who have had epilepsy since childhood are at a higher risk of developing psychosomatic seizures later in life. So once your body becomes a kind of used to expressing distress in a particular way, you might find that you get a lot of psychosomatic symptoms even when your disease is actually quite stable.

I would also say that every disease is in some way kind of biological, psychological and social, so it doesn’t matter if you suffer with cancer that has psychological implications that are social implications. So we need to have a sort of better sort of bio psychosocial approach to all illnesses because every illness has an element of each of these just in different proportions.

Sophie Adelman

That’s really fascinating. I’m going to go to a question from Monica now. So she wants to know. Um, some medical conditions are labelled as functional and others as psychosomatic. What is the difference?

Suzanne O’Sullivan

Yeah, I mean, really, it’s just There’s a lot of arguments about terminology in this, um, in this field. So what if we take sort of seizures as an example? What were hysterical seizures became pseudo seizures became non epileptic, attacks became psychogenic, non epileptic attacks became dissociative seizures, and similarly, what was once psychosomatic in the neurological form has become a functional neurological disorder. And really, what all these name changes are doing is they’re trying to separate these disorders into their different types.

So rather than Tara being sort of accused of having a stress related illness related to something in her childhood which never existed, she might be diagnosed with the functional neurological disorder, meaning that her neurological system isn’t functioning properly. Psychosomatic doesn’t seem quite an accurate label for her, where someone in a similar situation to her, who suffered a significant psychological trauma psychosomatic, might be a more appropriate label for her. What these really are are sort of a graduation of labels as we try to tease apart these conditions and find less pejorative ways of talking about them and more accurate ways of representing them.

But really psychosomatic and functional disorder. You know, there are parts of the same thing.

Sophie Adelman

We’ve only got time for one more question. So we’re going to go to a question from John and he wants to know why is the brain designed to create these experiences that ultimately harm the individual? What’s the biological reason for it? Or do we know?

Suzanne O’Sullivan

Oh, yes. I mean, how how would you function if you didn’t have these unconscious processes? You would be overwhelmed by sensory signals. You wouldn’t be able to sort of if you had to think about walking every time you did it.

If you had to deliberately philtre out processes every day just to kind of focus on the thing you wanted, you know, you simply couldn’t function in the world. So the vast majority of time these things are doing something important. They’re keeping us safe. They’re keeping a sufficient. They’re allowing us to kind of negotiate a very unpredictable world and the vast majority of times they work brilliantly. But you know what? Everything in the body goes wrong, so it’s inevitable that even things that work fabulously in our favour are going to go wrong sometime.

Sophie Adelman

I would love to ask you so many more of the questions that we’ve got from our members. But thank you so much, Suzanne, for joining us here in In The Gardens Day. Brilliant speaker. And we’ve loved hearing all of your insights and thoughts on this topic.

The Unconscious Mind Collection

The unconscious mind is a vast unmapped territory of feelings, thoughts, urges and memories that sit just outside our awareness. Luckily, our intrepid Garden Fellows are at the forefront of exploring it, and they're taking you with them on the journey.

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