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ลำดับตอนที่ #91 : Imaginary illnesses
Soon
after Suzanne O’Sullivan had left medical school in Dublin, she met a patient
named Yvonne, whose mysterious illness appeared to bear little relation to any of her previous
studies.
Yvonne,
she was told, had been stacking
the fridges in a
supermarket when a colleague had accidentally sprayed a fine mist of window cleaner in her face. She tried to
wash her eyes, left work and went to bed early, hoping they would feel less sore the next day. But
when she woke up, her vision 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.
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 the observations, Yvonne’s eyes would flicker
between her husband and the doctors; as the consultant moved an ophthalmoscope
close to her eyes, she blinked. It certainly seemed like her eyes were
responding to her surroundings, yet she continued to claim that she was enveloped in an impenetrable darkness.
O’Sullivan’s
colleagues assumed she was faking it, perhaps for some kind of lawsuit. “There’ll be no
Oscar for that performance,” one muttered after they had left the ward. O’Sullivan herself was unconvinced. “I liked
Yvonne. I felt sorry for her. But I did not believe she was blind,” she writes
in her new book It’s All in Your Head, recently shortlisted for theWellcome 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, or who have
such severe cramp in
their fingers that their hand has become little more than a claw; one woman
could not even empty her bladder
without a medical catheter.
Yet when doctors look, they can find no physiological cause – suggesting the
problem originates in the mind, not the body.
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 of it.
Keen
to know more, I spoke to O’Sullivan about her career and her recent book
detailing these remarkable case studies.
Although
O’Sullivan had seen patients like Yvonne from the very beginning of her career,
the interest intensified once she started specialising in epilepsy. Patients would
often come to her suffering 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 the signature brain activity of epilepsy; they were “psychogenic” seizures.
“It became obvious no one is talking about these problems that are consistently common, but
which are getting no attention 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 the diagnosis. “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 of wilfulness”.
If
you find their symptoms hard to believe, consider the many ways that your
emotions already move your body in profound ways. O’Sullivan points out that every time we cry, or
laugh, or shake with anger, if we feel so sad that it is hard to lift ourselves
from our bed, or queasy
with nausea after we hear of a friend’s food poisoning, then we are
experiencing psychosomatic phenomena 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 a physical
cause – suggesting they may be psychosomatic in origin. The difference is that
for most of us those feelings pass and we can return to our normal lives, but
for O’Sullivan’s patients they are exaggerated and chronic, lasting months,
years, even a lifetime.
She
emphasises that the psychological origin does not make the blindness, fatigue, seizures or
paralysis any less debilitating.
“They really are disabled. They are more disabled than most people with a
physical disease.”
Consider
Camilla, a lawyer in London, who had been diagnosed with epilepsy before
O’Sullivan managed to show that it was psychogenic. She described how
humiliating she found the seizures; how people try to help by sitting on her to
stop her limbs from
flailing about, and
stick their fingers down her throat to stop her choking; one man knelt beside her, asking if she
was OK, before stealing her mobile phone. “But do you know what happens all the
time? People video me on their mobile phones and walk away laughing,” she told
O’Sullivan. The more you know about these patients, the harder it is to believe
that anyone would deliberately
expose themselves to this humiliation.
O’Sullivan
has nevertheless met a few fakers, such as Judith, who claimed to be suffering
seizures as the side-effect of chemotherapy for leukaemia years before. Hoping
to get to the bottom of the story, O’Sullivan called her into a hospital ward,
where a video camera could film a seizure when or if it occurred. Sure enough,
at 9:15 in the evening, a nurse found Judith lying on the floor unconscious,
falling so hard that she had apparently fractured her hand. When O’Sullivan played back
the video, however, she saw there had been no seizure at all. Judith had simply
raised her hand and hit it hard against the wall four times, before lying down
gently on the floor, pulling down a plate with her to attract the nurse. Indeed, looking at the
medical records, it became clear that Judith had never suffered from leukaemia,
either.
Although
such patients with “factitious”
illnesses may add to the stigma of people like Camilla or Yvonne, O’Sullivan
still feels compassion
for these people. After all, what kind of mental torment would make someone behave in this way?
Even if Judith hadn’t suffered from leukaemia, perhaps she had witnessed it in
someone else – an experience she found difficult to process in any other way?
“Factitious illness is one of most serious disorders I know,” O’Sullivan says.
There
is currently precious little research on the best way to treat psychosomatic
illness, but she 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.
And
there are some real success stories. Not all cases can be pinned to a specific
event, but Camilla realised that her seizures may have been linked to the death
of her young son, setting her on the path to recovery. Yvonne, meanwhile,
seemed to have been struggling to juggle the stresses of work, children, and an overbearing
husband, and as she learned to cope with those upsets, her sight slowly
returned.
Patients
with paralysis or muscle spasms
can also respond well to physiotherapy. “They need to learn how to use their
legs again,” O’Sullivan says. It’s often an uphill struggle; particularly with 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 the psychological origin of these illnesses, instead prescribing them
drugs, or even admitting 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 – yet the damage can be just as great.
“The
people who have been told they have epilepsy – they will be put on a toxic
medication for at least a couple of years, before they accept it’s not going to
work.” Over that time, the condition has become a part of the patients’ life –
they’ve told your friends, families, and employer, making it much harder to
accept the new diagnosis. “You become wedded to it through your own belief and the
doctor’s belief,” O’Sullivan says. “You are getting treatment you 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 raise
awareness of psychosomatic illnesses at the earliest stages of a doctor’s training.
“My feeling is that it needs to start at medical school-level,” she says. “I
must have encountered these patients 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, she has already found that a small number of patients are becoming more
accepting of the diagnosis, and are less afraid of the stigma attached to it.
“I have my fingers crossed that it will be a talking point, that people will
feel less ashamed.”
--
bear (v.) to hold or support something:
stack (v.) to arrange things
in an ordered pile:
mist (n.)
thin fog produced by very small drops of water collecting in the air just above an
area of ground or water:
sore (Adj.) painful and uncomfortable because of injury, infection,
or too much use:
enveloped (v.)
to cover or surround something completely:
impenetrable (Adj.)
impossible to
see through or go
through
impossible to
understand:
ward (n.)
one of the parts or large rooms into which a hospital is divided, usually with beds for patients:
shortlisted (n.)
a list of people who have been judged the most suitable for a job or prize, made from a longer list of people originallyconsidered,
and from which one person will be chosen
paralysed (Adj.) unable to move or act:
bladder (n.)
an organ like a bag inside the body of a person or animal, where urine is stored before it leaves the body:
catheter (n.)
a long, very thin tube used to take liquids out of the body
epilepsy (n.) a condition of the brain that causes a person to becomeunconscious for short periods or to move in a violent and uncontrolled way:
​โรลมบ้าหมู
debilitating (adj.) causing weakness:
seizures (n.)
a very sudden attack of an illness in
which someone becomes unconscious or
develops violent movements:
a sudden failure of
the heart:
the action of taking something by force or with legalauthority:
writhe (v.)
to make large twisting movements with
the body:
to experience a
very difficult or
unpleasant situationor
emotion,
such as extreme embarrassment:
limbs (n.)
an arm or leg of a person or animal:
flailing (v.)
(especially of arms and legs) to move energetically in an uncontrolled way:
consistently (Adv.)
in a way that does not vary:
stigma(n.)
a strong feeling of disapproval that most people in a society have about something, especially when this is unfair:
profound (Adj.)
felt or experienced very strongly or in an extreme way:
showing a clear and deep understanding of serious matters:
queasy (Adj.)
fatigue (n.) extreme tiredness
expose (v.)
to make public something bad or dishonest:
fractured (v.)
If something hard, such as a bone, fractures, or is
fractured, it breaks or cracks
to divide an organization or
society,
or (of an organization or
society)
to be divided:
factitious
(adj.)
artificial rather than natural:
compassion (n.)
a strong feeling of sympathy and sadness for the sufferingor bad luck of others and a wish to help them:
torment (n.)
great mental suffering and unhappiness, or great physicalpain:
cognitive
(adj.)
connected with thinking or conscious mental processes:
distress (n.)
a feeling of
extreme worry, sadness, or pain:
a situation in
which you are suffering or
are in great dangerand therefore in
urgent need
of help:
trauma (n.)
severe emotional shock and pain caused by an extremelyupsetting experience:
juggle (v.)
to throw several objects up into the air, and then catchand throw them up repeatedly so
that one or more stays in the air, usually in order to entertain people:
to succeed in
arranging your life so that you have
time to involve yourself
in two or more different activities or
groups of
people:
to change results or information recorded as numbers so that a situation seems to be better than it really
is:
spasms (n.)
an occasion when
a muscle suddenly becomes tighter in a way that
cannot be controlled:.
spasm of sth
a short period of something,
especially something
that cannot be controlled:
relapse (v.)
to become ill or start behaving badly again, after making an improvement:
wedded (adj.)
believing firmly in an idea or theory and unwilling to changethat belief:
deprived (adj.)
not having the things that are necessary for a pleasant life, such as enough money, food, or good living conditions:
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