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Dr Suzanne O'Sullivan, consultant neurologist at the Queen Square National Hospital for Neurology and Neurosurgery in London, is the author of this intriguing and important book, which has been shortlisted for the Wellcome Book Prize 2016. Her case histories read rather like another book of case histories more familiar to psychoanalysts and psychotherapists published 120 years ago - Freud and Breuer's Studies in Hysteria. O'Sullivan writes about the many patients in her practice who suffer from various forms of hysteria, within which term we might today include medically unexplained symptoms (MUS), psychosomatic disorders, functional disorders, dissociative seizures or conversion disorder.
‘It's all in your head’ - a familiar and dismissive remark when someone is thought to be imagining things. The words ‘true’ and ‘imaginary’ in the subtitle face the reader with a contradiction. The author writes of her experiences as a neurologist with patients referred for various, often dramatic, symptoms such as blindness, paralysis, seizures, chronic fatigue, intense pain, Munchausen syndrome. My reading of the title is that what is ‘true’ refers to the reality of painful symptoms her patients are undergoing, while the ‘imaginary’ refers to how their symptoms are interpreted by the doctor and others. Following the barrage of medical tests which inevitably and rightly precede and follow the initial appointment with the consultant neurologist, the patients described by O'Sullivan are the ones whose test results come back ‘normal’. No organic cause found. She writes about symptoms which have no apparent or identifiable physical or neurological cause or disease. She writes about the patients who still suffer from these symptoms and who come to her for help, or at the very least a medical diagnosis.
What I find tantalizing is that the author's account of her involvement with each patient seems to end where psychotherapy might begin. Like Freud, O'Sullivan writes with a mixture of cur