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The Sleeping Beauties
Suzanne O'Sullivan's THE SLEEPING BEAUTIES, an exploration of different aspects of psychosomatic disorders, mass hysteria, culture bound syndromes (a set of symptoms that exist only within a particular society), using as its starting point a particular case of more than 400 migrant children in Sweden who have fallen into a "waking coma", to Dan Frank at Pantheon, in a pre-empt.
336 pages, Hardcover
First published April 1, 2021
About the author
Suzanne O'Sullivan
6 books108 followersSuzanne O'Sullivan is an Irish neurologist working in Britain who is the winner of the 2016 Wellcome Book Prize. She won for her first book, It's All in Your Head: True Stories of Imaginary Illness, published by Chatto & Windus in 2015. The book also won the Royal Society of Biology General Book Prize.
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Displaying 1 - 30 of 263 reviews
June 23, 2021
It started off with a mystery disease I had read about. the very strange 'resignation syndrome' limited to the daughters of illegal immigrants into Sweden. The girls fell into comas that lasted years and emerged from them when their families were granted permission to stay. They really were comatose although their brain scans showed normal, waking brains. Very strange. This used to be called hysteria, 'it's all in the mind', 'a psychosomatic disorder', 'conversion disorder' and now, FND, functional neurological disorder. However, I ended up skimming the last part of the chapter as it was long and didn't hold my interest at all.
But I started the next chapter with enthusiasm. It was the same. Started off ok and then I drifted off, couldn't remember what I'd read, skimmed.... This happened the whole book. It's All in Your Head was about the same subject but much more interesting. I think that was because that was about individuals with their disorders, and this book was about groups of people who had various FNDs that were geographically limited.
I read two previous books by Suzanne O'Sullivan, It's All in Your Head (4 star) and, the other day, Brainstorm: Detective Stories From the World of Neurology which was wonderful, a top 5 star about epilepsy, so I couldn't wait to read this but it didn't work for me. The detective work of trying to find out what caused these syndromes in various parts of the world didn't interest me at all. The book was not for me, but I think I was just the wrong reader, I think a lot of people might find it fascinating.
But I started the next chapter with enthusiasm. It was the same. Started off ok and then I drifted off, couldn't remember what I'd read, skimmed.... This happened the whole book. It's All in Your Head was about the same subject but much more interesting. I think that was because that was about individuals with their disorders, and this book was about groups of people who had various FNDs that were geographically limited.
I read two previous books by Suzanne O'Sullivan, It's All in Your Head (4 star) and, the other day, Brainstorm: Detective Stories From the World of Neurology which was wonderful, a top 5 star about epilepsy, so I couldn't wait to read this but it didn't work for me. The detective work of trying to find out what caused these syndromes in various parts of the world didn't interest me at all. The book was not for me, but I think I was just the wrong reader, I think a lot of people might find it fascinating.
October 11, 2022
3.5 stars
Dr. Suzanne O'Sullivan is an Irish neurologist who wrote the prize-winning book 'It's All in Your Head: True Stories of Imaginary Illness.' This book follows in the same vein, discussing illnesses that seem to have no somatic cause.
Dr. Suzanne O'Sullivan
*****
The placebo effect occurs when a sick person receives a 'fake treatment' (like a sugar pill) and feels better anyway. It seems the mind can convince the body a fake treatment is the real thing.
The opposite is true as well. A person can exhibit ailments caused by their mind. Symptoms might include paralysis, blindness, headache, dizziness, coma, tremor, skin rashes, breathlessness, chest pain, palpitations, bladder problems, diarrhea, stomach cramps, or any other symptoms or disability one can imagine. This type of illness has been given many names over the years, including hysteria, conversion disorder, psychosomatic disorder, and functional neurological disorder (FND).
O'Sullivan observes that many people wrongly consider psychosomatic symptoms 'less real' than other medical problems She writes, "I struggle to see where this underestimation comes from....That the body is the mouthpiece of the mind seems self-evident to me, but I have the sense that not everybody feels the connection between bodily changes and the contents of their thoughts. So when a child becomes catatonic in the context of stresses....people are amazed and perplexed."
O'Sullivan became interested in childhood catatonia when she read a 2017 article about a 9-year-old girl in Sweden called Sophie. Sophie can't move, communicate, eat, or even open her eyes.....though medical tests show nothing wrong. Moreover, Sophie isn't unique. Other young girls in Sweden have fallen into similar catatonic states, suffering from a condition called 'resignation syndrome.'
A girl with resignation syndrome
The common factor among the resignation syndrome victims seems to be the fact that their families are asylum seekers. Sophie's family escaped persecution in Russia, and other catatonic girls belong to ethnic minorities like the Yazidi or the Uyghurs, who are oppressed in their home countries. If asylum isn't granted, the families will be deported.
Asylum seeking is a years-long process, and the families can feel like they're on trial....like they're being interrogated rather than listened to. O'Sullivan writes, "The asylum system seeks to find the mistakes that disprove an applicant's case, rather than looking for the evidence to prove it." O'Sullivan believes the children faced with possible deportation are under strain, and this induces the symptoms of resignation syndrome. Moreover, when granted residency the children usually wake up, albeit very very slowly.
Unfortunately many people look at psychosomatic symptoms as being 'fake' and untreatable. A physician called Dr. Olssen took O'Sullivan to visit two Yazidi sisters in Sweden - Nola (10) and Helan (11) - both of whom suffer from resignation syndrome.
Nola and Helan have resignation syndrome
O'Sullivan writes, "Dr. Olssen welcomed me because I was a neurologist. She hoped that I could find a [brain-related] explanation....that I would interpret the clinical signs and legitimize the girls' suffering and convince someone to help them. That Nola had been lying in bed for a year and a half without eating or moving had not been deemed impressive enough to get her the help she needed."
Oddly enough, though asylum seekers are found all over the world, resignation syndrome seems confined to Sweden, and affects only certain ethnic groups. O'Sullivan speculates the syndrome is not a biological or psychological illness in the Western sense, but rather a sociocultural phenomenon.
O'Sullivan goes on to write about additional sociocultural/psychosomatic illnesses, which manifest differently in diverse places and varying ethnic groups.
*****
The Miskito people indigenous to Nicaragua have outbreaks of a condition called grisi siknis, which appears as irrational behavior and hallucinations. Victims have been seen to have convulsions, foam at the mouth, rip off their clothes, run manically, hyperventilate, and break and eat glass. Miskito people don't believe grisi siknis is psychosomatic, but say it's caused by a spirit or demon that (usually) appears as a man.
Girl showing symptoms of grisi siknis
Boy showing symptoms of grisi siknis
*****
In the Kazakhstani cities of Krasnogorsk and Kalachi, many residents experienced a mystery illness that drove them from their homes. One victim, named Tamara, got sick at a community party. She tells O'Sullivan that she started to feel strange, light-headed and sleepy and had to leave the party early. Tamara then went home, went to bed, and didn't get up for a few days. Tamara recovered, but never went back to feeling as healthy as she had been before she fell asleep. Tamara was not an isolated case, and many people in the region experienced similar symptoms.
Kazakhstani woman with mystery sleeping sickness
*****
In 2016, an illness called Havana syndrome originated among Western diplomats in Cuba. American and Canadian State Department employees developed symptoms such as headache, earache, hearing impairment, dizziness, tinnitus, unsteadiness, visual disturbance, memory problems, difficulty concentrating and fatigue.
A woman with Havana Syndrome being examined by medical personnel
Most of the victims reported hearing a strange noise before their symptoms started, and speculation began that they had been subjected to a sound energy or sonic attack. The FBI and CIA looked high and low for traces of a sound weapon, but found none. Later, new victims appeared in China, and more recently in Serbia and India. Physicians aren't able to explain the sickness, and it appears to be a functional neurological disorder.
No sonic weapons were found
*****
In La Cansona, a region of Colombia, schoolgirls got caught up in a health crisis that began in 2014. The phenomenon began in a high school, when a group of girls - all in the same class - collapsed. Some just fell to the floor in a faint and some had convulsions. The condition spread quickly, and within a day, girls in several other classes got sick.
High school class in Colombia
By 2019, it was estimated that, out of 120,000 people in the area, as many as 1,000 girls had fallen ill. The villagers attributed the illness to an HPV vaccine administered years before, but doctors dismissed this as a cause.
*****
High school girls in Le Roy, a town in upstate New York, developed neurological symptoms in 2011. The manifestation began with a teenager name Katie Krautwurst, who woke from a nap to find she had developed involuntary movements and verbal outbursts reminiscent of Tourette's syndrome. Katie twitched and writhed and let out involuntary shouts. Katie's best friend Thera got sick next, and the disorder soon spread to other teenagers. Some victims had convulsions, others couldn't walk. Katie and Thera ultimately needed wheelchairs when the muscle jerks became so violent that they caused them to fall. Doctors could find no somatic cause and the girls were diagnosed with conversion disorder.
Katie Krautwurst was one of the first girls to develop neurological symptoms
A similar phenomenon occurred in Guyana in 2013, where the local people attributed the illness to 'Granny', the spirit of an old woman who lives in a cave.
*****
O'Sullivan discusses all these illnesses in detail, emphasizing that medical tests NEVER demonstrate a somatic cause and patients ALWAYS resist the idea they have a psychosomatic disorder.
O'Sullivan also goes on to discuss Western medicine vs. native remedies; attitudes of doctors to functional neurological disorders; the social stigma associated with having a 'fake' illness; the fact that psychosomatic disorders are attributed more often to females than males; her belief that people with psychosomatic disorders would improve with the correct treatment; the effect of the media on conversion disorders; the effect of culture and tradition on psychosomatic disorders; patients she's treated; and more.
The book is interesting and I liked the parts about O'Sullivan's travels; her interactions with people she met; victims she saw; foods she tried (like Colombian buñuelos (cheese donuts) and Kazakhstani mayonnaise soup); and more.
Buñuelos
Mayonnaise soup
On the downside, the narrative is somewhat repetitive and disjointed. Still, this is a fascinating subject and the book would probably appeal to readers interested in functional neurological disorders.
Thanks to Netgalley, Suzanne O'Sullivan, and Pantheon Books for a copy of the book.
You can follow my reviews at https://reviewsbybarbsaffer.blogspot.com
May 15, 2021
Great audiobook! I find O’Sullivan’s work fascinating and appreciate what she is trying to achieve with regards to our perspective of psychosomatic illnesses.
September 5, 2021
Dr O'Sullivan discusses a plethora of mass functional illnesses, including resignation syndrome from Sweden, Havana syndrome, and several more individual cases.
This was a really interesting read about a subject I did not know too much about. The author did a good job of scouting interesting cases, some more well-known than others. She discusses the background, the disease itself, and what social factors may have caused them.
She also talks about the field of functional illnesses more generally in a clear and engaging manner. I appreciated that we got to go along on her investigation beside her, sharing in her changing thoughts and opinions as she learned more about the illnesses.
I did sometimes find her tone slightly unsympathetic toward the patients, which bothered me, but I think this added veracity to the account. Ultimately I found this an informative, interesting read.
Disclaimer: I received an ARC of this book from NetGalley. This is my honest and voluntary review.
This was a really interesting read about a subject I did not know too much about. The author did a good job of scouting interesting cases, some more well-known than others. She discusses the background, the disease itself, and what social factors may have caused them.
She also talks about the field of functional illnesses more generally in a clear and engaging manner. I appreciated that we got to go along on her investigation beside her, sharing in her changing thoughts and opinions as she learned more about the illnesses.
I did sometimes find her tone slightly unsympathetic toward the patients, which bothered me, but I think this added veracity to the account. Ultimately I found this an informative, interesting read.
Disclaimer: I received an ARC of this book from NetGalley. This is my honest and voluntary review.
December 21, 2021
3.5 stars
I found this book utterly fascinating and compelling to read, though after letting it settle a bit I do think it has its issues.
As a neurologist, Suzanne O’Sullivan has treated many people with “functional” illnesses—in other words, people with real symptoms, but ones without a pathology that can be objectively measured. Just as at times we can somehow make ourselves healthier without medication (see: the many varieties of the placebo effect, from sugar pills to faith healing to basically every bizarre cure in Quackery), illness can also come from a psychological cause, without the patient’s being consciously aware of it. I think most people know this on some level—that stress, for instance, can cause headaches, stomachaches, vomiting, even heart problems—but what may come as a surprise is that symptoms can get much worse, including seizures and what appears to be paralysis or a coma, with no physical cause. What’s more, these illnesses can be contagious. Dr. O’Sullivan’s primary focus in this book is investigating incidents of mass psychogenic illness and culture-bound syndromes.
And the stories are wild and fascinating. The book begins with the saddest stories, of children from asylum-seeking families in Sweden who succumb to “resignation syndrome”: they gradually withdraw from the world, stop playing, eating, and ultimately even opening their eyes, which can last for months or years. Brain scans, however, show nothing unusual, even when the kids are admitted to the hospital in an apparent coma: to a machine they appear to go through normal cycles of sleeping and waking. Their illness seems to be triggered by hopelessness and fear of deportation from what’s often the only home they’ve known, and some children have recovered once their families were granted asylum. It does not happen to native-born Swedish children, nor (until very recently, when it spread to a couple of refugee camps) to asylum seekers in other countries.
Then there are the Miskito people of Nicaragua, whose young people sometimes experience bouts of grisi siknis (a phonetic pronunciation of “crazy sickness”), in which they have seizures and try to run away; going to a hospital often makes them worse, but home remedies and shamanism are effective. The Miskito only experience this in their homelands, while outsiders never get it. It’s a culture-bound syndrome well-known to them and perhaps serving a social function.
Some of the other episodes sound more like the traditional “mass hysteria,” in which a large number of schoolchildren begin fainting or seizing at once. O’Sullivan focuses mostly on severe events of this type that don’t end with a single incident: there are the groups of girls in Colombia and New York who continued to be ill for some time after, and the townspeople from a once-idyllic, now dying mining town in Kazakhstan who experience bouts of sleeping sickness. O’Sullivan also sees a psychogenic cause in the large number of American diplomats in Cuba who suddenly became ill, believing themselves assaulted by some unknown weapon.
These are all great stories, O’Sullivan’s writing highly readable, and I devoured the book and was fascinated by it, appreciating her thoughtful analysis, empathy for those involved, and the diversity of cultures included. It taught me a lot about an issue I’d never thought much about before, although perhaps I should have, having been recently startled by the number of people experiencing side effects in COVID vaccine trials…. after getting the placebo.
While it makes for accessible writing though, I have doubts about O’Sullivan’s choice to focus the book around her own journeys to learn more about these illnesses, and not to cite any references. In some cases (Kazakhstan, Colombia), traveling to their countries allows her to speak to people currently or previously suffering from the illnesses in question, which is great. She also supplements with a couple of powerful stories from her own medical practice. In Sweden though, she visits children suffering from resignation syndrome but isn’t their doctor and only hears accounts from those who have recovered secondhand. She visits a Miskito community in Texas, and talks to people who have witnessed grisi siknis but no one who’s actually had it. The Cuba and New York stories seem to come entirely from media reports, while a great story from Guyana she gets only from an anthropologist. Obviously most science and psychology books are not written from firsthand experience, nor should they be, but it’s a bit odd when the book does focus so much on her firsthand experience and again, cites no sources.
Meanwhile, I found O’Sullivan’s analysis and arguments very interesting and relevant, though they also left me with questions. One of her major points is that psychogenic illnesses are not “mystery illnesses,” as often portrayed in the press, where doctors are reported as “stumped” or “baffled” when in fact they are not, they’ve made a diagnosis and the journalist simply doesn’t view it as legitimate. But I wanted to know more about the mechanisms by which these illnesses occur and how they’re treated. There seem to be some telltale signs: tests show no abnormalities; alternate theories of causation are not biologically possible (as in the case of the Colombian girls, whose families insisted they were having an HPV vaccine reaction…. all at once, a solid month after getting the vaccine; or the diplomats who believed they were injured by a “sonic weapon” when audible sound does not damage the brain and their brain scans showed nothing wrong; or the woman who believed a slipped disc in her lower back had paralyzed her arm). And, in cases of mass psychogenic illness, the symptoms often evolve as new people experience them in new ways.
That said, a psychogenic diagnosis does seem to come through process of elimination, and we don’t know everything about the human body; it seems possible that some illnesses understood as psychogenic today might later be discovered to have some other cause. O’Sullivan shows here how people tend to reject the psychogenic diagnosis—often because they equate it with faking or because their communities denigrate them for it—and this can be a real problem, preventing them from believing in their own recovery. She makes a strong case for the public’s need to understand psychogenic illnesses better and treat them more sensitively. At times she seemed to be downplaying psychological causes, pointing out that everyone has stress and that mass incidents are really triggered by something in the community or just a fluke of circumstance—and yes, reducing stigma is important, and the last thing anyone needs is to have their personal traumas bandied about and then their symptoms dismissed for it. But it did feel as if O’Sullivan were working so hard to combat stigma that she didn’t fully address the underlying psychological causes of at least some of these illnesses. After all, just because stress and trauma are common doesn’t mean that some people, in some circumstances, can’t have very unusual reactions.
The final chapter takes the book in a totally different direction, with concerns about over-medicalization. Essentially, O’Sullivan asks, “what is western culture’s culture-bound syndrome?” (there are a few in the traditional sense, like “heavy legs” in France), and answers, “well, all kinds of things,” pointing to the proliferation of diagnoses with no known pathology, “diseases” that are largely just ways of being that are inconvenient in the modern era (I highly doubt hunter-gatherers suffered from ADHD), and the way many people feel the need for a diagnosis to be heard by others or feel validated in themselves. All interesting and important points, though perhaps only tangentially related to the rest of the book.
Overall then, definitely a book I enjoyed and one that gave me a lot to think about, though in some ways it left me wanting more. It seems like a great starting point on an important topic.
I found this book utterly fascinating and compelling to read, though after letting it settle a bit I do think it has its issues.
As a neurologist, Suzanne O’Sullivan has treated many people with “functional” illnesses—in other words, people with real symptoms, but ones without a pathology that can be objectively measured. Just as at times we can somehow make ourselves healthier without medication (see: the many varieties of the placebo effect, from sugar pills to faith healing to basically every bizarre cure in Quackery), illness can also come from a psychological cause, without the patient’s being consciously aware of it. I think most people know this on some level—that stress, for instance, can cause headaches, stomachaches, vomiting, even heart problems—but what may come as a surprise is that symptoms can get much worse, including seizures and what appears to be paralysis or a coma, with no physical cause. What’s more, these illnesses can be contagious. Dr. O’Sullivan’s primary focus in this book is investigating incidents of mass psychogenic illness and culture-bound syndromes.
And the stories are wild and fascinating. The book begins with the saddest stories, of children from asylum-seeking families in Sweden who succumb to “resignation syndrome”: they gradually withdraw from the world, stop playing, eating, and ultimately even opening their eyes, which can last for months or years. Brain scans, however, show nothing unusual, even when the kids are admitted to the hospital in an apparent coma: to a machine they appear to go through normal cycles of sleeping and waking. Their illness seems to be triggered by hopelessness and fear of deportation from what’s often the only home they’ve known, and some children have recovered once their families were granted asylum. It does not happen to native-born Swedish children, nor (until very recently, when it spread to a couple of refugee camps) to asylum seekers in other countries.
Then there are the Miskito people of Nicaragua, whose young people sometimes experience bouts of grisi siknis (a phonetic pronunciation of “crazy sickness”), in which they have seizures and try to run away; going to a hospital often makes them worse, but home remedies and shamanism are effective. The Miskito only experience this in their homelands, while outsiders never get it. It’s a culture-bound syndrome well-known to them and perhaps serving a social function.
Some of the other episodes sound more like the traditional “mass hysteria,” in which a large number of schoolchildren begin fainting or seizing at once. O’Sullivan focuses mostly on severe events of this type that don’t end with a single incident: there are the groups of girls in Colombia and New York who continued to be ill for some time after, and the townspeople from a once-idyllic, now dying mining town in Kazakhstan who experience bouts of sleeping sickness. O’Sullivan also sees a psychogenic cause in the large number of American diplomats in Cuba who suddenly became ill, believing themselves assaulted by some unknown weapon.
These are all great stories, O’Sullivan’s writing highly readable, and I devoured the book and was fascinated by it, appreciating her thoughtful analysis, empathy for those involved, and the diversity of cultures included. It taught me a lot about an issue I’d never thought much about before, although perhaps I should have, having been recently startled by the number of people experiencing side effects in COVID vaccine trials…. after getting the placebo.
While it makes for accessible writing though, I have doubts about O’Sullivan’s choice to focus the book around her own journeys to learn more about these illnesses, and not to cite any references. In some cases (Kazakhstan, Colombia), traveling to their countries allows her to speak to people currently or previously suffering from the illnesses in question, which is great. She also supplements with a couple of powerful stories from her own medical practice. In Sweden though, she visits children suffering from resignation syndrome but isn’t their doctor and only hears accounts from those who have recovered secondhand. She visits a Miskito community in Texas, and talks to people who have witnessed grisi siknis but no one who’s actually had it. The Cuba and New York stories seem to come entirely from media reports, while a great story from Guyana she gets only from an anthropologist. Obviously most science and psychology books are not written from firsthand experience, nor should they be, but it’s a bit odd when the book does focus so much on her firsthand experience and again, cites no sources.
Meanwhile, I found O’Sullivan’s analysis and arguments very interesting and relevant, though they also left me with questions. One of her major points is that psychogenic illnesses are not “mystery illnesses,” as often portrayed in the press, where doctors are reported as “stumped” or “baffled” when in fact they are not, they’ve made a diagnosis and the journalist simply doesn’t view it as legitimate. But I wanted to know more about the mechanisms by which these illnesses occur and how they’re treated. There seem to be some telltale signs: tests show no abnormalities; alternate theories of causation are not biologically possible (as in the case of the Colombian girls, whose families insisted they were having an HPV vaccine reaction…. all at once, a solid month after getting the vaccine; or the diplomats who believed they were injured by a “sonic weapon” when audible sound does not damage the brain and their brain scans showed nothing wrong; or the woman who believed a slipped disc in her lower back had paralyzed her arm). And, in cases of mass psychogenic illness, the symptoms often evolve as new people experience them in new ways.
That said, a psychogenic diagnosis does seem to come through process of elimination, and we don’t know everything about the human body; it seems possible that some illnesses understood as psychogenic today might later be discovered to have some other cause. O’Sullivan shows here how people tend to reject the psychogenic diagnosis—often because they equate it with faking or because their communities denigrate them for it—and this can be a real problem, preventing them from believing in their own recovery. She makes a strong case for the public’s need to understand psychogenic illnesses better and treat them more sensitively. At times she seemed to be downplaying psychological causes, pointing out that everyone has stress and that mass incidents are really triggered by something in the community or just a fluke of circumstance—and yes, reducing stigma is important, and the last thing anyone needs is to have their personal traumas bandied about and then their symptoms dismissed for it. But it did feel as if O’Sullivan were working so hard to combat stigma that she didn’t fully address the underlying psychological causes of at least some of these illnesses. After all, just because stress and trauma are common doesn’t mean that some people, in some circumstances, can’t have very unusual reactions.
The final chapter takes the book in a totally different direction, with concerns about over-medicalization. Essentially, O’Sullivan asks, “what is western culture’s culture-bound syndrome?” (there are a few in the traditional sense, like “heavy legs” in France), and answers, “well, all kinds of things,” pointing to the proliferation of diagnoses with no known pathology, “diseases” that are largely just ways of being that are inconvenient in the modern era (I highly doubt hunter-gatherers suffered from ADHD), and the way many people feel the need for a diagnosis to be heard by others or feel validated in themselves. All interesting and important points, though perhaps only tangentially related to the rest of the book.
Overall then, definitely a book I enjoyed and one that gave me a lot to think about, though in some ways it left me wanting more. It seems like a great starting point on an important topic.
May 31, 2022
Very interesting, learnt a lot!
July 3, 2021
Early in her book on outbreaks of mass psychosomatic illness around the world, neurologist Suzanne O’Sullivan observes that “disease impresses people; illness with no evidence of disease does not. Psychological illness, psychosomatic and functional symptoms [that is, symptoms which indicate problems with how the nervous system is working] are the least respected of medical problems.” She proceeds to look at cases in various countries, including Sweden, Kazakhstan, the Miskito Coast of Central America, Columbia, (the US embassy in) Cuba, Guyana, and small-town USA. Many of these cases involve children and teenage girls, and most involve people on the periphery of the dominant culture: ethnic minorities and groups suspicious of the government or caught between two worlds, the traditional and the modern.
Drawing mostly on anthropology, social psychology, and philosophy, the author makes a strong case for the ways in which society and culture shape illness and the means by which extreme symptoms, which can’t be attributed to physical pathology, communicate important messages about conflicts within a group or culture. O’Sullivan says mass hysteria/conversion disorder/psychosomatic or neurological disorder—the phenomenon goes by a variety of interchangeable names—are as “real” as disease in which there is discernible abnormality in the body. She rightly rejects Cartesian mind-body dualism, pointing out that “mind” is a function of the brain, that it too is created from biology and is “not an intangible independent entity.” However, she does not explain how the minds/brains of groups of people actually create illness—that is, how problems with the functioning of their nervous systems cause mass hysteria. There is vague, unsatisfying mention of neural circuitry and of patients paying too much attention to the “white noise” of their bodies, misinterpreting that noise, perseverating on symptoms observed and reinforcing their misinterpretations. It is not clear how all this ties in with the mass events that O’Sullivan is interested in. Noticeably lacking is a discussion of the mechanisms of social contagion. Also absent are footnotes and sources.
While I found The Sleeping Beauties an interesting and stimulating read, it was not a wholly satisfying one. Thank you to Net Galley and the publisher for providing me with a digital ARC.
Drawing mostly on anthropology, social psychology, and philosophy, the author makes a strong case for the ways in which society and culture shape illness and the means by which extreme symptoms, which can’t be attributed to physical pathology, communicate important messages about conflicts within a group or culture. O’Sullivan says mass hysteria/conversion disorder/psychosomatic or neurological disorder—the phenomenon goes by a variety of interchangeable names—are as “real” as disease in which there is discernible abnormality in the body. She rightly rejects Cartesian mind-body dualism, pointing out that “mind” is a function of the brain, that it too is created from biology and is “not an intangible independent entity.” However, she does not explain how the minds/brains of groups of people actually create illness—that is, how problems with the functioning of their nervous systems cause mass hysteria. There is vague, unsatisfying mention of neural circuitry and of patients paying too much attention to the “white noise” of their bodies, misinterpreting that noise, perseverating on symptoms observed and reinforcing their misinterpretations. It is not clear how all this ties in with the mass events that O’Sullivan is interested in. Noticeably lacking is a discussion of the mechanisms of social contagion. Also absent are footnotes and sources.
While I found The Sleeping Beauties an interesting and stimulating read, it was not a wholly satisfying one. Thank you to Net Galley and the publisher for providing me with a digital ARC.
April 23, 2021
An interesting look at psychosomatic disorders, or functional neurological disorders as they can be called. O'Sullivan interviews sufferers and their families from Sweden, Colombia, Kazakhstan and elsewhere about their wide-ranging and curious symptoms from sleeping to tics, faints, and many more. I was also really interested in O'Sullivan's ideas about how and why Western medicine over-diagnoses and over-treats. (It was a shame that the publisher - I presume - chose to market the book as about 'mystery illnesses', which is exactly what O'Sullivan spends a lot of the book saying they're not.)
January 19, 2022
A little bit too repetitive of the first book, which, In my opinion, is better.
After eagerly awaiting the release of this follow up, I can’t help but feel a little disappointed.
After eagerly awaiting the release of this follow up, I can’t help but feel a little disappointed.
May 9, 2022
** Thanks so much to NetGalley, Suzanne O'Sullivan, and Knopf Doubleday Publishing Group for this ARC **
The Sleeping Beauties: And Other Stories of Mystery Illness by Suzanne O'Sullivan was a fascinating look at psychosomatic/functional disorders through the lens of a physician who treats them. I especially enjoyed the reflection on the role of diagnosis in creating a self-fulfilling process and the ways in which functional disorders form in reinforcing feedback loops. The process reminded me very much of Panic Disorder, in which a person notices a physical experience, identifies it as a precursor of panic, tries to eliminate this physical experience, and in doing so re-ups their anxiety until they are panicking. As a therapist, I think a lot about the role of diagnosis in both pathologizing normal experiences and allowing for access to care. The medicalization of mental health has required formal diagnosis of illness for a person to access services, and I wonder frequently about whether or not the giving of a diagnosis to a person on the more ambiguous side of diagnostic criteria results in harm for our clients. I have been thinking about this a lot with the addition of Prolonged Grief Disorder to the DSM. As a grief counselor, I am grateful that this opens up services to more people, while also being concerned about the effect that this has on our understanding of what is often normal bereavement.
Overall, this was a fascinating book that really made me think. My main complaint was that the level of knowledge that O'Sullivan was able to have about the cases discussed varied significantly, through no fault of her own. This just meant that some chapters were interesting stories about her own lived experience having met with people with functional disorders, while others were her postulating on cases she did not have first-hand experience with. As a result, some chapters were more or less interesting.
4 stars - I really liked it
The Sleeping Beauties: And Other Stories of Mystery Illness by Suzanne O'Sullivan was a fascinating look at psychosomatic/functional disorders through the lens of a physician who treats them. I especially enjoyed the reflection on the role of diagnosis in creating a self-fulfilling process and the ways in which functional disorders form in reinforcing feedback loops. The process reminded me very much of Panic Disorder, in which a person notices a physical experience, identifies it as a precursor of panic, tries to eliminate this physical experience, and in doing so re-ups their anxiety until they are panicking. As a therapist, I think a lot about the role of diagnosis in both pathologizing normal experiences and allowing for access to care. The medicalization of mental health has required formal diagnosis of illness for a person to access services, and I wonder frequently about whether or not the giving of a diagnosis to a person on the more ambiguous side of diagnostic criteria results in harm for our clients. I have been thinking about this a lot with the addition of Prolonged Grief Disorder to the DSM. As a grief counselor, I am grateful that this opens up services to more people, while also being concerned about the effect that this has on our understanding of what is often normal bereavement.
Overall, this was a fascinating book that really made me think. My main complaint was that the level of knowledge that O'Sullivan was able to have about the cases discussed varied significantly, through no fault of her own. This just meant that some chapters were interesting stories about her own lived experience having met with people with functional disorders, while others were her postulating on cases she did not have first-hand experience with. As a result, some chapters were more or less interesting.
4 stars - I really liked it
October 10, 2021
3.5⭐️
July 15, 2021
Thank you to NetGalley for providing me with an advanced reading copy of this compassionate book that treats patients suffering from functional neurological disorders with respect. Dr. O'Sullivan emphasizes from the opening pages that the symptoms and suffering of people (frequently young women) with what have been called psychosomatic disorders are real, even if they are not pathological.
Through a set of case studies of her own patients and patients and families from Sweden, Kazakhstan, Nicaragua, Colombia, and the United States, O'Sullivan describes how mass psychogenic illnesses--mass hysteria--have complex causes. These patients are not "fakers" buttheir maladies can't be understood through a search for pathogens and pathology, but through complex socio-cultural examination.
Through a set of case studies of her own patients and patients and families from Sweden, Kazakhstan, Nicaragua, Colombia, and the United States, O'Sullivan describes how mass psychogenic illnesses--mass hysteria--have complex causes. These patients are not "fakers" buttheir maladies can't be understood through a search for pathogens and pathology, but through complex socio-cultural examination.
April 30, 2021
O’Sullivan is a consultant at the National Hospital for Neurology and Neurosurgery. She won the Wellcome Book Prize for It’s All in Your Head, and The Sleeping Beauties picks up on that earlier book’s theme of psychosomatic illness – with the key difference being that this one travels around the world to investigate outbreaks of mass hysteria or sickness that have arisen in particular cultural contexts. An important thing to bear in mind is that O’Sullivan and other doctors in her field are not dismissing these illnesses as “fake”; they acknowledge that they are real and meaningful, yet there is clear evidence that they are not physical in origin – brain tests come back normal – but psychological with bodily manifestations.
The case that gives the book its title appeared in Sweden in 2017. Child asylum seekers who had experienced trauma in their home country were falling into a catatonic state. O’Sullivan visited the home of sisters Nola and Helan, part of the Yazidi ethnic minority group from Iraq and Syria. The link between them and the other children affected was that they were all now threatened with deportation: Their hopelessness had taken on physical form, giving the illness the name resignation syndrome. “Predictive coding” meant their bodies did as they expected them to. She describes it as “a very effective culturally agreed means of expressing distress.”
In Texas, the author meets Miskito people from Nicaragua who combat the convulsions and hallucinations of “grisi siknis” in their community with herbs and prayers; shamans are of more use in this circumstance than antiepileptic drugs. A sleeping sickness tore through two neighbouring towns of Kazakhstan between 2010 and 2015, affecting nearly half of the population. As with the refugee children in Sweden, it was a stress response to being forced to move away – though people argued they were being poisoned by a local uranium mine. There is often a specific external factor that is blamed in these situations, as when mass hysteria and seizures among Colombian schoolgirls were attributed to the HPV vaccine.
This book was released on the 1st of April, and at times I felt I was the victim of an elaborate April Fool’s joke: the cases are just so bizarre, and we’re used to rooting out a physical cause. But she makes clear that, in a biopsychosocial understanding (as also discussed in Pain by Abdul-Ghaaliq Lalkhen), these illnesses are serving “a vital purpose” – just psychological and cultural. The first three chapters are the strongest; the book feels repetitive and somewhat aimless thereafter, especially in Chapter 4, which hops between different historical outbreaks of psychosomatic illness, like among the Hmong (cf. Anne Fadiman’s The Spirit Catches You and You Fall Down), and other patients she treated for functional disorders. The later example of “Havana syndrome” doesn’t add enough to warrant its inclusion.
Still, O’Sullivan does well to combine her interviews and travels into compelling mini-narratives. Her writing has really come on in leaps and bounds since her first book, which I found clunky. However, much my favourite of her three works is Brainstorm, about epilepsy and other seizure disorders of various origins.
Originally published on my blog, Bookish Beck.
The case that gives the book its title appeared in Sweden in 2017. Child asylum seekers who had experienced trauma in their home country were falling into a catatonic state. O’Sullivan visited the home of sisters Nola and Helan, part of the Yazidi ethnic minority group from Iraq and Syria. The link between them and the other children affected was that they were all now threatened with deportation: Their hopelessness had taken on physical form, giving the illness the name resignation syndrome. “Predictive coding” meant their bodies did as they expected them to. She describes it as “a very effective culturally agreed means of expressing distress.”
In Texas, the author meets Miskito people from Nicaragua who combat the convulsions and hallucinations of “grisi siknis” in their community with herbs and prayers; shamans are of more use in this circumstance than antiepileptic drugs. A sleeping sickness tore through two neighbouring towns of Kazakhstan between 2010 and 2015, affecting nearly half of the population. As with the refugee children in Sweden, it was a stress response to being forced to move away – though people argued they were being poisoned by a local uranium mine. There is often a specific external factor that is blamed in these situations, as when mass hysteria and seizures among Colombian schoolgirls were attributed to the HPV vaccine.
This book was released on the 1st of April, and at times I felt I was the victim of an elaborate April Fool’s joke: the cases are just so bizarre, and we’re used to rooting out a physical cause. But she makes clear that, in a biopsychosocial understanding (as also discussed in Pain by Abdul-Ghaaliq Lalkhen), these illnesses are serving “a vital purpose” – just psychological and cultural. The first three chapters are the strongest; the book feels repetitive and somewhat aimless thereafter, especially in Chapter 4, which hops between different historical outbreaks of psychosomatic illness, like among the Hmong (cf. Anne Fadiman’s The Spirit Catches You and You Fall Down), and other patients she treated for functional disorders. The later example of “Havana syndrome” doesn’t add enough to warrant its inclusion.
Still, O’Sullivan does well to combine her interviews and travels into compelling mini-narratives. Her writing has really come on in leaps and bounds since her first book, which I found clunky. However, much my favourite of her three works is Brainstorm, about epilepsy and other seizure disorders of various origins.
Originally published on my blog, Bookish Beck.
August 13, 2021
My attention was caught when I read a review of this book in The Times. The subject of psychosomatic illness has long been of fascination to me largely due to my having worked for many years as a GP in the National Health Service.
Doctor O’Sullivan brings both scholarship and wisdom into her writing. Her insistence that functional illnesses should be regarded in the context of the cultures in which they originate and that cultures themselves have much to do with their origins and evolution is spot on. Attempting to define them purely as psychological/biological phenomena does little to understand, help and support those who suffer from them.
Addressing these issues requires courage. The subject is the source of not a little contention within the medical profession and the patients that doctors purport to serve. I found myself wondering if this might be the reason why no consideration is given in the book to such conditions as myalgic encephalitis (ME) and fibromyalgia. While the author might not think of these as primarily functional disorders, she must be aware that a great many doctors do hold this view and as a consequence there are a great many patients who, holding fast to the notion that their illness has a physical and not a psychological cause, are in conflict with those that care for them.
I am sure that many who read this book will, like me, be doctors. I think they would have valued the view of an acknowledged expert such as Doctor O’Sullivan on these conditions that present to them regularly in the consulting room.
Doctor O’Sullivan brings both scholarship and wisdom into her writing. Her insistence that functional illnesses should be regarded in the context of the cultures in which they originate and that cultures themselves have much to do with their origins and evolution is spot on. Attempting to define them purely as psychological/biological phenomena does little to understand, help and support those who suffer from them.
Addressing these issues requires courage. The subject is the source of not a little contention within the medical profession and the patients that doctors purport to serve. I found myself wondering if this might be the reason why no consideration is given in the book to such conditions as myalgic encephalitis (ME) and fibromyalgia. While the author might not think of these as primarily functional disorders, she must be aware that a great many doctors do hold this view and as a consequence there are a great many patients who, holding fast to the notion that their illness has a physical and not a psychological cause, are in conflict with those that care for them.
I am sure that many who read this book will, like me, be doctors. I think they would have valued the view of an acknowledged expert such as Doctor O’Sullivan on these conditions that present to them regularly in the consulting room.
February 3, 2022
really helpful for understandig how psychosomatic illness works
“Despite the ubiquitous nature of these disorders, many people still doubt them, considering them somehow less ‘real’ than other sorts of medical problems. I admit, I struggle to see where this underestimation comes from. I am aware of all the ways in which my own body speaks for me, often unbidden. My posture changes with my mood. Poorly controlled facial expressions inadvertently reveal my opinion to others, even when I don’t intend it. It doesn’t seem a stretch, therefore, to suggest this embodiment of a person’s inner world has the potential to extend into illness. That the body is the mouthpiece of the mind seems self-evident to me, but I have the sense that not everybody feels the connection between bodily changes and the contents of their thoughts as vividly as I do. So, when a child becomes catatonic in the context of stresses of the most extreme sort, people are amazed and perplexed.”
“So, if the DSM-V does not specifically name any culturally defined disorders that originate in English-speaking, industrialized, Western communities, does that mean we don’t have culturally shaped illness? Are we so open about our suffering that we have no need of metaphors?”
“Despite the ubiquitous nature of these disorders, many people still doubt them, considering them somehow less ‘real’ than other sorts of medical problems. I admit, I struggle to see where this underestimation comes from. I am aware of all the ways in which my own body speaks for me, often unbidden. My posture changes with my mood. Poorly controlled facial expressions inadvertently reveal my opinion to others, even when I don’t intend it. It doesn’t seem a stretch, therefore, to suggest this embodiment of a person’s inner world has the potential to extend into illness. That the body is the mouthpiece of the mind seems self-evident to me, but I have the sense that not everybody feels the connection between bodily changes and the contents of their thoughts as vividly as I do. So, when a child becomes catatonic in the context of stresses of the most extreme sort, people are amazed and perplexed.”
“So, if the DSM-V does not specifically name any culturally defined disorders that originate in English-speaking, industrialized, Western communities, does that mean we don’t have culturally shaped illness? Are we so open about our suffering that we have no need of metaphors?”
May 7, 2022
Overall, this is a fascinating and meaningful book. However sometimes I would get so irritated at the authorial voice that I had to put the book down and do other things until I could separate from my irritation and focus on the book's good parts. I'm... pretty hard to alienate as a reader (at least for contemporary nonfiction), so that was frustrating.
August 5, 2021
I find the author's work fascinating and her previous 2 books were excellent. This one is also thorough and insightful, but I found it much more repetitive and less enjoyable to read. It has a point to make and makes it, but it does so in quite a laboured way.
June 28, 2021
How much hold does the mind have over the body? What is the impact of culture on our physical health? In The Sleeping Beauties, Dr. Suzanne O’Sullivan looks at several different types of ‘mystery illness’, where people fall ill with no medical explanation, some which occur in groups and some which are individual cases to determine the role of the mind and culture on our physical health.
In The Sleeping Beauties, Dr. O’Sullivan covers the following cases:
- Resignation Syndrome, which primarily affects refugee children in Sweden, where children lose their will to do anything and sleep for years
- The Grisi Siknis in Miskito Community, which is sometimes called a folk illness and is treated by non-modern medical methods
- A sleeping sickness that affected over a hundred people in two towns in Kazakhstan
- US employees in Havana who were suspected to be the victims of a terrorist ‘super sonic’ attack
- A group of schoolgirls in Colombia who are fighting the label of “mass hysteria” (they blamed a vaccine)
- Another group of schoolgirls in Le Roy who also fought the label of mass hysteria (they blamed possible environmental pollution)
- A few people who were are convinced that their doctors have not properly diagnosed their illnesses – such as a lady who had a slipped disc but ended up unable to walk.
Each case has its nuances, but overall, what I took away from this book was that: the mind and our environment have a lot more (subconscious) control over the body than we realise. If we’re primed to notice certain pains, or if we’re taught to look for physical diagnosis for illnesses, we may end up reinforcing a cycle where we expect our bodies to fail us, our bodies fail, and we expect more physical failure. Environments and emotions can be catching too – what could start as an overreaction to a physical cause can lead to a group of people feeling ill. The way that authorities react to the physical symptoms can have an impact on it too.
I also thought that the differentiation between illness and disease was interesting. I always thought that the words were synonyms, but according to the book:
“The seventeenth-century physician Thomas Sydenham, sometimes referred to as the English Hippocrates, said that a disease was something waiting to be found out, which existed independent of the observer. It is a cancer that grows and makes itself known, rendering the person sick whether the doctor defines it as a disease or not. Illness is another matter. It is a perception of how one feels and does not need to be associated with a disease – i.e. it does not need an objective pathology to exist. Illness is defined by the person who has it and the doctor who gives it a name and as such will be an inherently cultural phenomenon.”
Another very interesting point that Dr O’Sullivan pointed out was the connection between sexism and the label ‘mass hysteria’. As the cases of the schoolgirls in Colombia and Le Roy show, “mass hysteria is a magnified version of all that is wrong in the way we perceive and discuss psychosomatic and functional disorders. Stereotypically, the condition is rejected as a diagnosis for men and caricatured for young women.”
Overall, I found this to be a very illuminating book that gave me a new perspective on our health; I now wonder how many of the vaccine side-effects reported are really a side-effect and how many are side-effects that we feel because we’ve been primed to feel it. I’d recommend this book if you’re interested in learning more about the mind-culture-body connection.
This review was first posted at Eustea Reads
In The Sleeping Beauties, Dr. O’Sullivan covers the following cases:
- Resignation Syndrome, which primarily affects refugee children in Sweden, where children lose their will to do anything and sleep for years
- The Grisi Siknis in Miskito Community, which is sometimes called a folk illness and is treated by non-modern medical methods
- A sleeping sickness that affected over a hundred people in two towns in Kazakhstan
- US employees in Havana who were suspected to be the victims of a terrorist ‘super sonic’ attack
- A group of schoolgirls in Colombia who are fighting the label of “mass hysteria” (they blamed a vaccine)
- Another group of schoolgirls in Le Roy who also fought the label of mass hysteria (they blamed possible environmental pollution)
- A few people who were are convinced that their doctors have not properly diagnosed their illnesses – such as a lady who had a slipped disc but ended up unable to walk.
Each case has its nuances, but overall, what I took away from this book was that: the mind and our environment have a lot more (subconscious) control over the body than we realise. If we’re primed to notice certain pains, or if we’re taught to look for physical diagnosis for illnesses, we may end up reinforcing a cycle where we expect our bodies to fail us, our bodies fail, and we expect more physical failure. Environments and emotions can be catching too – what could start as an overreaction to a physical cause can lead to a group of people feeling ill. The way that authorities react to the physical symptoms can have an impact on it too.
I also thought that the differentiation between illness and disease was interesting. I always thought that the words were synonyms, but according to the book:
“The seventeenth-century physician Thomas Sydenham, sometimes referred to as the English Hippocrates, said that a disease was something waiting to be found out, which existed independent of the observer. It is a cancer that grows and makes itself known, rendering the person sick whether the doctor defines it as a disease or not. Illness is another matter. It is a perception of how one feels and does not need to be associated with a disease – i.e. it does not need an objective pathology to exist. Illness is defined by the person who has it and the doctor who gives it a name and as such will be an inherently cultural phenomenon.”
Another very interesting point that Dr O’Sullivan pointed out was the connection between sexism and the label ‘mass hysteria’. As the cases of the schoolgirls in Colombia and Le Roy show, “mass hysteria is a magnified version of all that is wrong in the way we perceive and discuss psychosomatic and functional disorders. Stereotypically, the condition is rejected as a diagnosis for men and caricatured for young women.”
Overall, I found this to be a very illuminating book that gave me a new perspective on our health; I now wonder how many of the vaccine side-effects reported are really a side-effect and how many are side-effects that we feel because we’ve been primed to feel it. I’d recommend this book if you’re interested in learning more about the mind-culture-body connection.
This review was first posted at Eustea Reads
November 17, 2021
Written by a neurologist with tons of experience treating functional neurological and psychosomatic problems, this book is a fantastic read for those in health, mental health, and media/public interfacing fields, as well as those who have received (or whose loved ones have received) diagnoses of “conversion disorder”, psychosomatic disorder, FND or “psychogenic seizures” or been part of a “mass hysteria” experience. So glad that those other than mental health experts are beginning to understand that cultural, community, political, and financial influences can drive, shape, and create individual and group emotion, behavior, experiences, and suffering consistent with functional and psychosomatic problems.
August 5, 2023
In the past, people who were told they had psychosomatic illnesses have often been viewed as malingering, pretending to be ill, or seeking attention. The author of this book goes a long way toward destigmatizing what are now called functional illnesses, and this is a good thing. However, there are many illnesses where patients in the past were told they had a psychosomatic illness, only to later learn that their illnesses were in fact physical just not yet understood or explained – for example Lyme disease. The value in this book is helping patients and their friends and family to understand that Efendi is not shameful, nor can they control the symptoms with willpower. However, in some cases I think there's a fine line between looking at FND as a possible cause of illness and gaslighting patients who have real but poorly understood physically-based illnesses. Some people are still in denial that long Covid is a real illness and claim it's A neurological condition, but there are now tests that show physical causes for at least some of its symptoms.
January 14, 2024
3,5 - ogólnie uwielbiam czytać o różnych dziwnych "chorobach" mających podłoże neurologiczne, fascynujące jest to jakie rzeczy potrafi nasz mózg. Opisane tutaj przypadki były bardzo ciekawe i intrygujące, ale jednocześnie dość zbliżone do siebie, przez co dla mnie momentami było zbyt monotematycznie, aczkolwiek po tytule wnioskuję, że taki był zamysł książki - skupić się na jednym głównym problemie. Przez to miałam wrażenie, ze czasem czytam po raz enty o tym samym i bywałam nieco znudzona.
June 29, 2022
It took me a while to warm up to this book, but in the end it undeniably expanded my horizons, was very legible and very engaging, so hard to give it anything but 5 stars. I would recommend it to pretty much anyone, although I imagine many people may not be convinced even 300 pages in.
This book is about illnesses generated not from disease or even the mind, but rather from society. With the right combination of factors, something that starts out as one or a group of individuals getting sick, turns into a new endemic illness in a very tight population. For years to come, other individuals also get sick, with the symptoms slowly evolving as the story changes. Even as a psychologist, psychosomatic is usually the last diagnosis I would give, and still leave open the possibility of a medical condition we just don’t have the instruments for, but at about 90% into the book I realized the evidence was pretty compelling that this is a real thing.
First, these cases are very well studied, so any accusation of investigative negligence is nonsensical.
Second, there are biological limits to what psychosomatic symptoms can manifest, and crucially, they can manifest in ways that would be impossible for more “physical” diseases but would instead match a naïve intuition of how illness works. The cases presented by the author are very clearly ones in which there’s no other diagnostic contender, nor even the consistency which one would expect for a single disease. It is important to understand that these psychogenic symptoms not only reflect real suffering like any psychiatric condition, but they go beyond what is under conscious control. The most extreme example is “sleeping” for years on end for children with resignation syndrome, but there are always elements in every outbreak that you couldn’t “psych” yourself into experiencing, and this is exactly what makes it believable as a real disease and also so much harder to treat.
Third, just like with infectious diseases, context is an important indicator. With the exception of the first, and maybe a few similar cases after that, the only way this illness can spread is if the person already knows about it beforehand. Even in the case of resignation syndrome in migrant children, because of their necessary role as family translators, even young kids learn of the disease affecting their peers. So a common trajectory is one person gets sick for whatever reason, then a whole bunch of people get sick for a different reason but by coincidence with similar symptoms. Then individuals start to get those symptoms until soon a label has been given and a story told. In fact, the set of symptoms tends to evolve with time (like any story).
Fourth, the victim pool is not random. Every case the author presents was generated in a small community (even if co-existing within larger communities, but in practice isolated ) in which the individuals involved know each other or at least of each other. They often have little exchange with the outside world. It is more common in young people, and more common in girls, but not exclusively. Importantly, this is a group for which peer pressure can be quite strong. A key factor that rules out many alternative explanations is where the illness doesn’t take hold. If it only affects the girls of a school and not the boys, or the foreigners and not the locals, and you can exclude genetic effects, then there are not many other explanations left.
Fifth, there needs to be a clear (incorrect) culprit. The illness doesn’t take hold unless the community is collectively convinced about a cause. In some cases it’s an environmental toxin, others a vaccine, and of course evil spirits and curses. Whatever is considered an acceptable, crucially external, cause, rather than an internal or societal one, keeps the illness in the community.
Lastly, these occur when the community is under duress of some kind. Not necessarily “stress”, also a major life change that individuals aren’t ready to accept, or hopelessness, or any other form of “unhappiness”. It doesn’t even have to be in the individual suffering, but rather present in the community as a whole. Interestingly, when asked the patients are aware of these psychological/social issues but they don’t make link with their illness, even when sometimes the symptoms literally include crying uncontrollably. It may in fact be this inability to acknowledge one’s own discomfort, or society’s discomfort, that lets these illnesses manifest.
One problem I had a bit was the author’s subtle viewpoint of these illnesses reflecting a “purpose”. My first instinct was to immediately reject that as some form of determinism, but then thinking it through I realized it’s not completely out there as a hypothesis. Most signals our body gives really do have “a purpose”, like feeling hungry so you go eat. Physical symptoms during periods of distress might really have the evolved “purpose” of getting you to change behaviour in some way and acknowledge some problem. But, who knows.
A real problem I had with the book, but this is personal, is that she first tells all the stories, and then provides explanations, whereas I would have rather preferred a comprehensive description of the medical condition, followed by examples.
All in all though, a very worthwhile read.
This book is about illnesses generated not from disease or even the mind, but rather from society. With the right combination of factors, something that starts out as one or a group of individuals getting sick, turns into a new endemic illness in a very tight population. For years to come, other individuals also get sick, with the symptoms slowly evolving as the story changes. Even as a psychologist, psychosomatic is usually the last diagnosis I would give, and still leave open the possibility of a medical condition we just don’t have the instruments for, but at about 90% into the book I realized the evidence was pretty compelling that this is a real thing.
First, these cases are very well studied, so any accusation of investigative negligence is nonsensical.
Second, there are biological limits to what psychosomatic symptoms can manifest, and crucially, they can manifest in ways that would be impossible for more “physical” diseases but would instead match a naïve intuition of how illness works. The cases presented by the author are very clearly ones in which there’s no other diagnostic contender, nor even the consistency which one would expect for a single disease. It is important to understand that these psychogenic symptoms not only reflect real suffering like any psychiatric condition, but they go beyond what is under conscious control. The most extreme example is “sleeping” for years on end for children with resignation syndrome, but there are always elements in every outbreak that you couldn’t “psych” yourself into experiencing, and this is exactly what makes it believable as a real disease and also so much harder to treat.
Third, just like with infectious diseases, context is an important indicator. With the exception of the first, and maybe a few similar cases after that, the only way this illness can spread is if the person already knows about it beforehand. Even in the case of resignation syndrome in migrant children, because of their necessary role as family translators, even young kids learn of the disease affecting their peers. So a common trajectory is one person gets sick for whatever reason, then a whole bunch of people get sick for a different reason but by coincidence with similar symptoms. Then individuals start to get those symptoms until soon a label has been given and a story told. In fact, the set of symptoms tends to evolve with time (like any story).
Fourth, the victim pool is not random. Every case the author presents was generated in a small community (even if co-existing within larger communities, but in practice isolated ) in which the individuals involved know each other or at least of each other. They often have little exchange with the outside world. It is more common in young people, and more common in girls, but not exclusively. Importantly, this is a group for which peer pressure can be quite strong. A key factor that rules out many alternative explanations is where the illness doesn’t take hold. If it only affects the girls of a school and not the boys, or the foreigners and not the locals, and you can exclude genetic effects, then there are not many other explanations left.
Fifth, there needs to be a clear (incorrect) culprit. The illness doesn’t take hold unless the community is collectively convinced about a cause. In some cases it’s an environmental toxin, others a vaccine, and of course evil spirits and curses. Whatever is considered an acceptable, crucially external, cause, rather than an internal or societal one, keeps the illness in the community.
Lastly, these occur when the community is under duress of some kind. Not necessarily “stress”, also a major life change that individuals aren’t ready to accept, or hopelessness, or any other form of “unhappiness”. It doesn’t even have to be in the individual suffering, but rather present in the community as a whole. Interestingly, when asked the patients are aware of these psychological/social issues but they don’t make link with their illness, even when sometimes the symptoms literally include crying uncontrollably. It may in fact be this inability to acknowledge one’s own discomfort, or society’s discomfort, that lets these illnesses manifest.
One problem I had a bit was the author’s subtle viewpoint of these illnesses reflecting a “purpose”. My first instinct was to immediately reject that as some form of determinism, but then thinking it through I realized it’s not completely out there as a hypothesis. Most signals our body gives really do have “a purpose”, like feeling hungry so you go eat. Physical symptoms during periods of distress might really have the evolved “purpose” of getting you to change behaviour in some way and acknowledge some problem. But, who knows.
A real problem I had with the book, but this is personal, is that she first tells all the stories, and then provides explanations, whereas I would have rather preferred a comprehensive description of the medical condition, followed by examples.
All in all though, a very worthwhile read.
July 7, 2021
This was such an interesting read! A wonderful book written by a woman who is an expert in her field but is searching for further and better ways to help her patients and the medical field at large.
This book looks at several 'mystery' illnesses with a particular focus on the cultural and social context in which they occur. O'Sullivan is intent on trying to understand and get others to even consider that illness as we in the West understand it is not as cut and dried as we think it is. O'Sullivan here also questions her own practises as a neurologist and wonders whether the way that Western medicine treats many conditions (particularly those with a psychosomatic or now called 'functional' aspect) is doing more harm than good.
A wonderfully written captivating and easy to understand read that I found fascinating and would recommend to anyone interested in this area but particularly to those of a medical and/or psychological background.
This book looks at several 'mystery' illnesses with a particular focus on the cultural and social context in which they occur. O'Sullivan is intent on trying to understand and get others to even consider that illness as we in the West understand it is not as cut and dried as we think it is. O'Sullivan here also questions her own practises as a neurologist and wonders whether the way that Western medicine treats many conditions (particularly those with a psychosomatic or now called 'functional' aspect) is doing more harm than good.
A wonderfully written captivating and easy to understand read that I found fascinating and would recommend to anyone interested in this area but particularly to those of a medical and/or psychological background.
Read
March 28, 2024Kinda powered through this one to be honest. There was a lot of really interesting stories and science in here, but overall I found the book to be a bit repetitive (and a little bit stressful? idk.)
My favorite chapter I think was the final one, about how overdiagnosis of illnesses can create symptoms in otherwise healthy people (sort of creating a self fulfilling prophecy i guess).
My favorite chapter I think was the final one, about how overdiagnosis of illnesses can create symptoms in otherwise healthy people (sort of creating a self fulfilling prophecy i guess).
February 19, 2022
I got this book for my birthday, never heard about it before that, but I must admit... this book is great. Firstly, the issue this book is discussing is fairly underdiscussed, which is a shame to be honest. I learned so much, not necessarily new facts, but new ways to look at psychosomatic issues worldwide as well as western medicine and overdiagnosing in a way I had not thought about myself.. I highly recommend this book if one are interested in biology and psychology! Especially the distinguishing between brain illness and mental illnesses, history of psychosomatic illness and bias connected to the diagnosis, not just in the perspective of Western medicine, but worldwide. O'Sullivan is really breaking som barriers with this piece, highly recommended reading in 2022.
Read
April 12, 2024zmęczyła mnie trochę, mimo tego że była bbb ciekawa
May 2, 2021
This book is very clever in toeing a thin line between being a 'popular science' one and an academic monograph. It's very readable, you can generally get a grip on quite complex psychological issues, and – with the Fortean aspects to many of the cases here – you can read about strange medical goings-on, and what the author demands in the way of major changes before we can all understand them when they arise again. That said, the book is far from perfect, introducing a stumbling-block to my satisfaction I'll get to a bit later.
Those cases, then. We start with children of refugees and immigrants, who seem to have involuntarily gone on strike at the idea of being sent back. It's an incompletely understood syndrome, but our neurologist guide is fairly sure it can't be all blamed on something internal, with so many chances of parental influence and just the fact of past traumas all being potential causes. She says the whole environment must be an unmeasurable factor – and the fact all of these children are confined to their beds in Sweden and nowhere else is just one further intrigue.
Next we're in a Nicaraguan community in Texas, to chat with people who know first-hand of 'grisi siknis', something else that defies categorisation. Is it really a 'crazy sickness' brought on by the devil, and/or leprechauns, and/or incubi/succubi, or is there a firm medical cause – or is it a cultural thing whereby certain teenagers feel the need to act up to get attention and a kind of erotic kick? But why is it confined to one region? And how can a medically-trained person tally their experience to the evidence that only shamanic rituals and ideas can cure it?
A surprisingly good turn into travel writing takes us to a pair of villages in Kazakhstan, where a sleeping sickness had killed the places off, although here the writing not only balances travelogue with neuro-psychological science but also adds in something of the investigative, and the conclusion is something best for the reader to find and think about. But this chapter is where the issue I have with all this starts to really show itself. Each of the three cases here not only get discussed in turn, but what we learn with the second is reflected back on the first, and what feels new and definitive to the third gets applied to the previous pair, and so on.
Now, this is not as repetitive as you might expect it to be, but it forces a false, "watch me investigate this!" journalese on to things. Our author knows what she thinks is right and wrong about the issues with the Swedish girls of the title, and of course she has a solution for all the cases – she wouldn't be writing such a book about things if she didn't – but boy she's going to pad it out and leave every case hanging, deferring things as much as seemingly possible.
I liked the cases and what they have to say about our world, from the Colombian girls you might think ill due to the national history of violence – except the malady was in no way national – to embassy workers for the USA newly installed in Havana, and cases of media hysteria prolonging what was once called actual hysteria in up-state New York. Singular people are seen to blow their medical problems up so greatly in their own mind it easily transfers to paralysing degrees in their body. All this, the Fortean side, is wonderfully explained and diagnosed and re-categorised, and this is probably the best writing from the best author to so do. That definitive feel has still earnt this volume a high mark, as you'll have seen, but in lengthening the whole affair on the page greatly, and in prevaricating so often, I don't see either the layman or the academic really served as well as they should by such obfuscation.
Those cases, then. We start with children of refugees and immigrants, who seem to have involuntarily gone on strike at the idea of being sent back. It's an incompletely understood syndrome, but our neurologist guide is fairly sure it can't be all blamed on something internal, with so many chances of parental influence and just the fact of past traumas all being potential causes. She says the whole environment must be an unmeasurable factor – and the fact all of these children are confined to their beds in Sweden and nowhere else is just one further intrigue.
Next we're in a Nicaraguan community in Texas, to chat with people who know first-hand of 'grisi siknis', something else that defies categorisation. Is it really a 'crazy sickness' brought on by the devil, and/or leprechauns, and/or incubi/succubi, or is there a firm medical cause – or is it a cultural thing whereby certain teenagers feel the need to act up to get attention and a kind of erotic kick? But why is it confined to one region? And how can a medically-trained person tally their experience to the evidence that only shamanic rituals and ideas can cure it?
A surprisingly good turn into travel writing takes us to a pair of villages in Kazakhstan, where a sleeping sickness had killed the places off, although here the writing not only balances travelogue with neuro-psychological science but also adds in something of the investigative, and the conclusion is something best for the reader to find and think about. But this chapter is where the issue I have with all this starts to really show itself. Each of the three cases here not only get discussed in turn, but what we learn with the second is reflected back on the first, and what feels new and definitive to the third gets applied to the previous pair, and so on.
Now, this is not as repetitive as you might expect it to be, but it forces a false, "watch me investigate this!" journalese on to things. Our author knows what she thinks is right and wrong about the issues with the Swedish girls of the title, and of course she has a solution for all the cases – she wouldn't be writing such a book about things if she didn't – but boy she's going to pad it out and leave every case hanging, deferring things as much as seemingly possible.
I liked the cases and what they have to say about our world, from the Colombian girls you might think ill due to the national history of violence – except the malady was in no way national – to embassy workers for the USA newly installed in Havana, and cases of media hysteria prolonging what was once called actual hysteria in up-state New York. Singular people are seen to blow their medical problems up so greatly in their own mind it easily transfers to paralysing degrees in their body. All this, the Fortean side, is wonderfully explained and diagnosed and re-categorised, and this is probably the best writing from the best author to so do. That definitive feel has still earnt this volume a high mark, as you'll have seen, but in lengthening the whole affair on the page greatly, and in prevaricating so often, I don't see either the layman or the academic really served as well as they should by such obfuscation.
January 12, 2022
I have a mystery illness of my own. Over the last few years I have had several intermittent episodes of confusion which include a « black » spell during which I have no memory. On either side of that I am disoriented and fail the Mental Status Exam. Each time I go to the ER and each time all the tests come back negative: no stoke, no nothing. If I were to describe it—and generally there is a stressor though nothing extreme, it feels like I’ve blown a fuse. That’s a metaphor.
Turns out, according to the author (and Susan Sontag though I haven’t read her book Illness as Metaphor), that many illnesses are metaphors but not in the sense of faking, or ‘It’s all in your head.’ Rather they embody something about the sufferers relation to her world or experience. One example is « resignation syndrome », which effects immigrant children in Sweden awaiting resolution of their families’ asylum applications. These children fall asleep and don’t wake up. They have clinical signs and symptoms upon examination but attempts to diagnose them using the typical medical means of measurement and evaluation come up empty. There is nothing organically wrong with them but they embody the situation of exile and uncertainty. There is also what the author terms a ‘sociogenic’ source and the corresponding contagion. Thus, it’s not just one child but a group of them.
Another example the author explores is the so-called Havana Syndrome, experienced by US Embassy employees who experience debilitating symptoms brought on, so the speculation goes, by some environmental weapon deployed by the Cuban government. Such a weapon has not been identified and again no underlying biological process has been identified to account for the real suffering experienced by the victims.
O’Sullivan is clear and firm throughout all her examples that the illness and suffering of victims is real. It is not adequately described as psychosomatic, because that term minimizes the reality of the experience. She is also clear that western medicine medicalizes too much of personal experience. She notes that bodily sensations are a constant white noise in daily life that may be ignored or attended to. If attended to minutely, one may end up in the doctor’s office requesting a diagnosis, treatment, something to make it go away. Think of the dismissive terms for this: hypochondria, psychosomatic, attention-seeking, nerves, stress.
Toward the end of the book, O’Sullivan explores the over-diagnosis of some things—prediabetes, ADHD, Postural Orthostatic Tachycardia Syndrome (POTS). She talks about the issue of measurement scales and when, along those scales, a potential diagnosis becomes an actual disease requiring treatment.
One thing the author does not explore enough is (what I believe to be) society’s toxicity. Especially now of course, but is it any wonder if one feels sick all the time? Uncertainty preys upon everyone, some personalities are more vulnerable, some vulnerabilities are harder to tolerate, communities are attenuated, and society is hardly geared to make life easier. I always think of Bill Clinton’s formulation of « people who work hard and play by the rules ». But what about everyone else?
I have inadequately summarized the points raised in this book. It is complicated and O’Sullivan is working with mysteries, various cultures, and ideas that challenge assumptions and received knowledge. I think the book is well worth reading. I have quibbles with the clarity of the writing and I wish an index and a bibliography had been included, but I honor the courage of her explorations.
Turns out, according to the author (and Susan Sontag though I haven’t read her book Illness as Metaphor), that many illnesses are metaphors but not in the sense of faking, or ‘It’s all in your head.’ Rather they embody something about the sufferers relation to her world or experience. One example is « resignation syndrome », which effects immigrant children in Sweden awaiting resolution of their families’ asylum applications. These children fall asleep and don’t wake up. They have clinical signs and symptoms upon examination but attempts to diagnose them using the typical medical means of measurement and evaluation come up empty. There is nothing organically wrong with them but they embody the situation of exile and uncertainty. There is also what the author terms a ‘sociogenic’ source and the corresponding contagion. Thus, it’s not just one child but a group of them.
Another example the author explores is the so-called Havana Syndrome, experienced by US Embassy employees who experience debilitating symptoms brought on, so the speculation goes, by some environmental weapon deployed by the Cuban government. Such a weapon has not been identified and again no underlying biological process has been identified to account for the real suffering experienced by the victims.
O’Sullivan is clear and firm throughout all her examples that the illness and suffering of victims is real. It is not adequately described as psychosomatic, because that term minimizes the reality of the experience. She is also clear that western medicine medicalizes too much of personal experience. She notes that bodily sensations are a constant white noise in daily life that may be ignored or attended to. If attended to minutely, one may end up in the doctor’s office requesting a diagnosis, treatment, something to make it go away. Think of the dismissive terms for this: hypochondria, psychosomatic, attention-seeking, nerves, stress.
Toward the end of the book, O’Sullivan explores the over-diagnosis of some things—prediabetes, ADHD, Postural Orthostatic Tachycardia Syndrome (POTS). She talks about the issue of measurement scales and when, along those scales, a potential diagnosis becomes an actual disease requiring treatment.
One thing the author does not explore enough is (what I believe to be) society’s toxicity. Especially now of course, but is it any wonder if one feels sick all the time? Uncertainty preys upon everyone, some personalities are more vulnerable, some vulnerabilities are harder to tolerate, communities are attenuated, and society is hardly geared to make life easier. I always think of Bill Clinton’s formulation of « people who work hard and play by the rules ». But what about everyone else?
I have inadequately summarized the points raised in this book. It is complicated and O’Sullivan is working with mysteries, various cultures, and ideas that challenge assumptions and received knowledge. I think the book is well worth reading. I have quibbles with the clarity of the writing and I wish an index and a bibliography had been included, but I honor the courage of her explorations.
April 25, 2021
The Sleeping Beauties takes you around the world to a handful of seemingly disparate mystery illnesses. O’Sullivan draws links between them as all being examples of psychosomatic illnesses or functional neurological disorders that have symptoms that exist in the body as a result of activity in the brain and the influence of culture and environment.
In each case the communities have very different opinions about the causes of the illnesses, with the HPV vaccine, poisoning, sonic weapons and the devil being blamed in different cases. Each community, however, rejected the idea of psychosomatic disorders and conflated it with faking. O’Sullivan explains how FNDs are a “a result of physiological mechanisms” in the brain “that go awry to produce genuine physical symptoms and disability”. p323 in the epilogue is a really good summary of what they are and how they come about.
O’Sullivan suggests that FNDs have a purpose and can give people a voice. For example the refugee children in Sweden who have ‘resignation syndrome’ and sleep for months or years at a time, typically become ill after their asylum applications are rejected. The children are often the ones who open the letters and can translate the bad news to the family. Resignation syndrome has spread to an island off Australia called Nauru and Lesvos with the symptoms changing in each case. Perhaps this is a case of ‘embodying and enacting conflict is either more manageable or more practical than articulating it’.
O’Sullivan discusses the culture of patients going to a doctor to seek a diagnosis. There is a danger in labelling a disorder or disease as patients can embody the symptoms of the labels. A patient from her clinic is used to explain the negative psychological and behavioural effects of over diagnosis.
Psychosomatic disorders can be treated, ‘brains that have been programmed can be unprogrammed’. O’Sullivan notes that the response at community level can make the difference between recovery and descent into chronic illness. ‘The quality of a person’s experience is changed by others’ reactions to it’. The Miskito community in Nicaragua who experienced ‘grisni siknis’ (crazy sickness), which presented as convulsions, hallucinations and huge strength bought people together rather than isolating the victims. A local responding to a question about why people are affected by grisni siknis answers “I don’t know … but I think maybe the girls are weak and grisi siknis makes them strong.”
Overall, a really interesting read that made me consider the interconnectedness of health, medicine, the environment and culture.
In each case the communities have very different opinions about the causes of the illnesses, with the HPV vaccine, poisoning, sonic weapons and the devil being blamed in different cases. Each community, however, rejected the idea of psychosomatic disorders and conflated it with faking. O’Sullivan explains how FNDs are a “a result of physiological mechanisms” in the brain “that go awry to produce genuine physical symptoms and disability”. p323 in the epilogue is a really good summary of what they are and how they come about.
O’Sullivan suggests that FNDs have a purpose and can give people a voice. For example the refugee children in Sweden who have ‘resignation syndrome’ and sleep for months or years at a time, typically become ill after their asylum applications are rejected. The children are often the ones who open the letters and can translate the bad news to the family. Resignation syndrome has spread to an island off Australia called Nauru and Lesvos with the symptoms changing in each case. Perhaps this is a case of ‘embodying and enacting conflict is either more manageable or more practical than articulating it’.
O’Sullivan discusses the culture of patients going to a doctor to seek a diagnosis. There is a danger in labelling a disorder or disease as patients can embody the symptoms of the labels. A patient from her clinic is used to explain the negative psychological and behavioural effects of over diagnosis.
Psychosomatic disorders can be treated, ‘brains that have been programmed can be unprogrammed’. O’Sullivan notes that the response at community level can make the difference between recovery and descent into chronic illness. ‘The quality of a person’s experience is changed by others’ reactions to it’. The Miskito community in Nicaragua who experienced ‘grisni siknis’ (crazy sickness), which presented as convulsions, hallucinations and huge strength bought people together rather than isolating the victims. A local responding to a question about why people are affected by grisni siknis answers “I don’t know … but I think maybe the girls are weak and grisi siknis makes them strong.”
Overall, a really interesting read that made me consider the interconnectedness of health, medicine, the environment and culture.
January 3, 2022
Dr. Suzanne O’Sullivan is a London-based neurologist who focuses on “functional neurological disorders” in this book. These “functional” disorders are so named because there are no observable clinical findings that match the symptoms described by patients, so they are essentially diagnoses of exclusion. Dr. O’Sullivan takes great pains to explain that she and other clinicians aren’t saying that the symptoms are “all in one’s head,” but she mentions that these “functional” disorders are essentially psychosomatic illnesses. In this book, the author takes on several journeys around the world to highlight various cases of patients suffering from these functional neurological disorders, from young children undergoing asylum in Sweden suffering from “resignation syndrome” to diplomats and their families in Cuba suffering from “Havana syndrome.”
I gave this book the benefit of the doubt, but in the end found myself to be quite disappointed and list my thoughts below:
1. In some chapters, Dr. O’Sullivan examines the patients, but in others, she uses descriptions from others about their symptoms to make the case. Without actually conducting in-depth examinations, she is repeating (potentially flawed) information and is possibly adding credence to the fact that some of these are psychosomatic illnesses when there could be a non-psychological cause that has yet to be understood.
2. In one chapter, she tells the story of a young woman with symptoms remarkably similar to Long Covid: brain fog, problems with temperature and blood pressure regulation, joint pain, and fatigue. This was written before Covid-19, and Dr. O’Sullivan does what so many doctors before her had done: she dismisses the young woman and notes that she’s “normal” and is just — you guessed it — stressed out. After reading extensively about Long Covid, it is very likely that this young woman has a post-viral syndrome and went through dozens of doctors and years of being dismissed before being believed.
3. Dr. O’Sullivan takes great pains to explain that disease is culturally experienced, which, while there is truth to that, the symptoms of major pandemics such as Covid-19, SARS, and various influenza viruses have shown us that biological disease is disease and that the symptoms are pretty consistent. She tries to make the point that some diseases are just people experiencing a cultural event but this sounds like a way to dismiss patients real experiences of suffering by claiming their distress is imagined.
I would strongly recommend against reading this book. It is medical gaslighting at its worst.
I gave this book the benefit of the doubt, but in the end found myself to be quite disappointed and list my thoughts below:
1. In some chapters, Dr. O’Sullivan examines the patients, but in others, she uses descriptions from others about their symptoms to make the case. Without actually conducting in-depth examinations, she is repeating (potentially flawed) information and is possibly adding credence to the fact that some of these are psychosomatic illnesses when there could be a non-psychological cause that has yet to be understood.
2. In one chapter, she tells the story of a young woman with symptoms remarkably similar to Long Covid: brain fog, problems with temperature and blood pressure regulation, joint pain, and fatigue. This was written before Covid-19, and Dr. O’Sullivan does what so many doctors before her had done: she dismisses the young woman and notes that she’s “normal” and is just — you guessed it — stressed out. After reading extensively about Long Covid, it is very likely that this young woman has a post-viral syndrome and went through dozens of doctors and years of being dismissed before being believed.
3. Dr. O’Sullivan takes great pains to explain that disease is culturally experienced, which, while there is truth to that, the symptoms of major pandemics such as Covid-19, SARS, and various influenza viruses have shown us that biological disease is disease and that the symptoms are pretty consistent. She tries to make the point that some diseases are just people experiencing a cultural event but this sounds like a way to dismiss patients real experiences of suffering by claiming their distress is imagined.
I would strongly recommend against reading this book. It is medical gaslighting at its worst.
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