Flawed assumptions?

The June edition of The Psychologist reported on Suzanne O'Sullivan's It's All In Your Head: True Stories of Imaginary Illness winning the 2016 Wellcome Book Prize. Enticed by the promise of insights into the intriguing phenomenon of psychosomatic illness, I'd read the book soon after publication. I wasn't so much disappointed by it, as alarmed. Dr O'Sullivan's argument for the imaginary illness of her subtitle is based, unless I've completely misunderstood, on two fundamentally flawed assumptions.

The first is that being unable to identify any organic cause for physical symptoms means that the symptoms have no organic cause. It's a risky assumption. The history of medicine is replete with examples of elusive organic causes the existence of which was long denied – from Semmelweis's contagion theory to Helicobacter pylori.

The second flawed assumption relates to the relationship between body and mind. Joan Bakewell, chair of the Wellcome judges and quoted in the feature in The Psychologist, points out that the divide between the physical and the mental is being increasingly challenged. Indeed it is, but Dr O'Sullivan's challenge assumes that an entity called 'the mind' can exert a powerful influence over another entity called 'the body'. The nature of the body is well established. The mind, not so much. Even when discussing the brain–mind distinction Dr O'Sullivan talks of the brain and mind being 'interdependent on each other' without explaining what she means by 'the mind'.

Defining 'the mind' isn't straightforward. The Cartesian mind–body model has been challenged by such luminaries as Gilbert Ryle, Daniel Dennett and Antonio Damasio. John Bowlby in Attachment also tackles the knotty problem of 'emotion' and finds the term so unhelpful he avoids using it in the rest of his trilogy. Yet despite the concepts of 'mind' and 'emotion' being central to her thesis, Dr O'Sullivan uses the words liberally without reference to the debate.

It's perfectly possible, as the author suggests, that stress, anxiety and past trauma cause illness. But they can do that via the brain. One doesn't need to posit a construct such as 'the mind' to come up with hypotheses for potential organic causes. Nor does one need to appeal to Freud for an explanation as O'Sullivan does, claiming that 'the twenty-first century has brought no great advances to a better understanding of the mechanism for this disorder'. The disorder? Hysteria.

People who are experiencing seizures, paralysis or blindness, whatever the cause, have organic illness. The absence of an apparent organic cause does not make the illness imaginary. We just don't know what causes it. Suggesting it's 'the mind' simply opens a can of worms.

Sue Gerrard
Market Drayton
Shropshire