Yvonne, she was told, had been stacking the fridgesin a supermarket when a colleague had accidentallysprayed a fine mist of window cleaner in her face. She tried to wash her eyes, left work andwent to bed early, hoping they would feel less sore the next day. But when she woke up, hervision was worse – everything was so blurry she struggled to read the time on the clock.Twenty-four hours later, she could not tell night from day.
O’Sullivan’s colleagues assumed Yvonne was faking it, perhaps for some kind of lawsuit. “There’ll be no Oscar for that performance,” one muttered
Except after six months of examinations, doctors could find nothing wrong with Yvonne’s eyes.She was eventually admitted to the neurology unit where O’Sullivan was working. During theobservations, Yvonne’s eyes would flicker between her husband and the doctors; as theconsultant moved an ophthalmoscope close to her eyes, she blinked. It certainly seemed like hereyes were responding to her surroundings, yet she continued to claim that she was envelopedin an impenetrable darkness.
O’Sullivan’s colleagues assumed she was faking it, perhaps for some kind of lawsuit. “There’llbe no Oscar for that performance,” one muttered after they had left the ward. O’Sullivanherself was unconvinced. “I liked Yvonne. I felt sorry for her. But I did not believe she wasblind,” she writes in her new book It’s All in Your Head, recently shortlisted for the WellcomeBook Prize.
奥沙利文的同事们认为伊冯是装病，以便于进行诉讼。“这种表演不会得奥斯卡奖，”一个员工嘟囔着。奥沙利文自己不服气。“我喜欢伊冯。我为她感到难过。但我不相信她的眼睛瞎了，”她在她的新书《一切都源于你的想象》中写到，该书最近入围了英国惠康图书奖(Wellcome Book Prize)。
Now she knows better. At the Royal London Hospital she has become an expert in“psychosomatic” illnesses. She has treated people who are paralysed from the waist down, orwho have such severe cramp in their fingers that their hand has become little more than aclaw; one woman could not even empty her bladder without a medical catheter. Yet whendoctors look, they can find no physiological cause – suggesting the problem originates in themind, not the body.
现在她对这种情况有了更深的了解。在伦敦皇家医院(Royal London Hospital)，她已经成为了一个“心身疾病”的专家。她治疗那些下半身瘫痪，或有严重抽筋症状的手指，他们的手已成为一个爪子形状;一个女人甚至没有医用导管就无法排尿。对于这些症状，医生却无法找到任何生理病因，这表明问题源于头脑，而不是身体。
In this light, it’s perfectly possible that Yvonne really wasn’t conscious of what she was seeing– somehow, her unconscious mind was discarding the information before she became aware ofit.
Keen to know more, I spoke to O’Sullivan about her career and her recent book detailing theseremarkable case studies.
Although O’Sullivan had seen patients like Yvonne from the very beginning of her career, theinterest intensified once she started specialising in epilepsy. Patients would often come to hersuffering from debilitating seizures that left them writhing around on the floor, limbs flailing,helpless, yet when they came in to the hospital for neurological tests, they showed none of thesignature brain activity of epilepsy; they were “psychogenic” seizures. “It became obvious noone is talking about these problems that are consistently common, but which are getting noattention in medical journals or medical conferences,” she says. “This is a very neglected area.”
That silence brings stigma, meaning that most patients end up feeling insulted by thediagnosis. “Their first reaction is ‘you think I’m doing it on purpose’ or ‘you think it’s not real’or ‘I could stop it if wanted’,” O’Sullivan says. “There’s this perception that there is a degree ofwilfulness”.
If you find their symptoms hard to believe, consider the many profound ways that youremotions already move your body. O’Sullivan points out that every time we cry, or laugh, orshake with anger, if we feel so sad that it is hard to lift ourselves from our bed, or queasy withnausea after we hear of a friend’s food poisoning, then we are experiencing psychosomaticphenomena first-hand. In fact, up to 30% of people visiting their family doctor or GP (and 50%of women seeing their gynaecologist) are enduring symptoms that cannot be explained with aphysical cause – suggesting they may be psychosomatic in origin. The difference is that formost of us those feelings pass and we can return to our normal lives, but for O’Sullivan’spatients they are exaggerated and chronic, lasting months, years, even a lifetime.
They really are disabled. They are more disabled than most people with a physical disease
She emphasises that the psychological origin does not make the blindness, fatigue, seizuresor paralysis any less debilitating. “They really are disabled. They are more disabled than mostpeople with a physical disease.”
Consider Camilla, a lawyer in London, who had been diagnosed with epilepsy before O’Sullivanmanaged to show that it was psychogenic. She described how humiliating she found theseizures; how people try to help by sitting on her to stop her limbs from flailing about, andstick their fingers down her throat to stop her choking; one man knelt beside her, asking if shewas OK, before stealing her mobile phone. “But do you know what happens all the time? Peoplevideo me on their mobile phones and walk away laughing,” she told O’Sullivan. The more youknow about these patients, the harder it is to believe that anyone would deliberately exposethemselves to this humiliation.
O’Sullivan has nevertheless met a few fakers, such as Judith, who claimed to be sufferingseizures as the side-effect of chemotherapy for leukaemia years before. Hoping to get to thebottom of the story, O’Sullivan called her into a hospital ward, where a video camera could filma seizure when or if it occurred. Sure enough, at 9:15 in the evening, a nurse found Judith lyingon the floor unconscious, falling so hard that she had apparently fractured her hand. WhenO’Sullivan played back the video, however, she saw there had been no seizure at all. Judith hadsimply raised her hand and hit it hard against the wall four times, before lying down gently onthe floor, pulling down a plate with her to attract the nurse. Indeed, looking at the medicalrecords, it became clear that Judith had never suffered from leukaemia, either.
What kind of mental torment would make someone invent an illness?
Although such patients with “factitious” illnesses may add to the stigma of people like Camillaor Yvonne, O’Sullivan still feels compassion for these people. After all, what kind of mentaltorment would make someone behave in this way? Even if Judith hadn’t suffered fromleukaemia, perhaps she had witnessed it in someone else – an experience she found difficult toprocess in any other way? “Factitious illness is one of most serious disorders I know,” O’Sullivansays.
There is currently precious little research on the best way to treat psychosomatic illness, butshe tends to refer her patients to psychiatrists or to a cognitive behavioural therapist (CBT)who might be able to unknot the distress or trauma that is leading to the illness.
目前很少有人研究治疗心身疾病的最好方式，但奥沙利文常常建议她的病人去看精神科医生或进行认知行为治疗(cognitive behavioural therapist)。这种疗法或许可以解开致病痛苦或心灵创伤。
And there are some real success stories. Not all cases can be pinned to a specific event, butCamilla realised that her seizures may have been linked to the death of her young son, settingher on the path to recovery. Yvonne, meanwhile, seemed to have been struggling to juggle thestresses of work, children, and an overbearing husband, and as she learned to cope with thoseupsets, her sight slowly returned.
Patients with paralysis or muscle spasms can also respond well to physiotherapy. “They needto learn how to use their legs again,” O’Sullivan says. It’s often an uphill struggle; particularlywith seizures, relapse is common. “We have to give ongoing support and reassurance.”
One of O’Sullivan’s biggest concerns is the rate of misdiagnosis – doctors overlooking thepsychological origin of these illnesses, instead prescribing the patients drugs, or evenadmitting them for harmful surgery. She says this may come from the doctors’ fear; somehow,it seems more serious missing a physical cause of an illness than a psychological cause – yetthe damage can be just as great.
“The people who have been told they have epilepsy – they will be put on a toxic medication forat least a couple of years, before they accept it’s not going to work.” Over that time, thecondition has become a part of the patients’ life – they’ve told their friends, families, andemployer, making it much harder to accept the new diagnosis. “You become wedded to itthrough your own belief and the doctor’s belief,” O’Sullivan says. “You are getting treatmentyou don’t need for a disease you don’t have, and you are deprived of the treatment you do need– you’re not referred for CBT, a physiotherapist or a psychiatrist.”
Perhaps inspired by meeting Yvonne at the start of her career, she would like to raiseawareness of psychosomatic illnesses at the earliest stages of a doctor’s training. “My feeling isthat it needs to start at medical school-level,” she says. “I must have encountered thesepatients thousands of times but I have no recollection of being told how I should help them.”
For the time being, she hopes that her book will at least spark that conversation; so far, shehas already found that a small number of patients are becoming more accepting of thediagnosis, and are less afraid of the stigma attached to it. “I have my fingers crossed that itwill be a talking point, that people will feel less ashamed.”