The Sleeping Beauties

July 15, 2021
A neurologist investigates psychogenic disorders, characterized by complex, holistic sets of symptoms that take root in a particular culture and time. Psychosomatic suffering--"real physical symptoms that are disabling, but which are not due to disease and are understood to have a psychological or behavioural cause"--is no longer considered purely hysterical, framed in Freudian interpretation, or dismissed as simply mysterious. O'Sullivan, a London-based Irish neurologist, marches straight into this deep, strange pocket of experience. A pleasing storyteller, she puts to good use her neurological background while melding it with a closely observed appreciation of environmental, social, and cultural elements in the dissociative process. She introduces a variety of psychosomatic disturbances, beginning with resignation syndrome in Sweden, "a disorder that exclusively affects children of asylum-seeking families," rendering them in a sleeplike state that is indecipherable with today's instrumentation. Sadly, explanations "come with the inevitable need to apportion blame, passing judgement on the child and...family." The author also investigates the aggressive hallucinations experienced by members of the Miskitos peoples of Nicaragua, a foreboding sleeping sickness in Kazakhstan, and many more. All lead the author to the idea of "a cultural concept of distress," with the body intimately involved in cognition, responding to the environment, the specific circumstances of the moment "and the socially constructed ways of responding to illness." O'Sullivan keenly explains illness templates that are coded in our brains by our sociocultural environment, so that "when you look for symptoms, you find them." As the author connects dot after dot, she discusses the role of induced illnesses as a language of distress, in which the members of a specific community understand symptoms as metaphors of personal suffering or a way of exteriorizing a conflict. Doctors, she writes, "still struggle to appreciate the magnitude and reality of the interaction between mind, body, and the environment." A fascinating view of mind that mingles culture with biology, creating a richly embroidered, albeit difficult, world.

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September 1, 2021

Neurologist O'Sullivan (It's All in Your Head) takes readers on a gripping international journey documenting outbreaks of psychosomatic illnesses (once called mass hysteria, now called functional neurological disorder or FND). In Sweden, young asylum seekers with resignation syndrome spend their days in a comatose state. In the mountains of Colombia, schoolgirls experience fainting spells and convulsions. "Every medical problem is a combination of the biological, the psychological and the social," O'Sullivan explains. She explores a number of case studies, aiming to uncover how external factors meet with brain function to create disabling symptoms. Psychosomatic illnesses often carry stigma, and patients are sometimes accused of faking their symptoms; as a result, FND sufferers and their families generally resist such the diagnosis. O'Sullivan argues that it is precisely because FND is more common in women and young girls that it is stigmatized or dismissed, although the symptoms are real and debilitating. Her book proposes that physicians should look beyond basic diagnoses, to the environmental factors and social context that may contribute to patients' illnesses. VERDICT O'Sullivan has written a medical page-turner that makes a compelling argument for a holistic approach to health care.--Ragan O'Malley, Saint Ann's Sch., Brooklyn

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Starred review from August 1, 2021
Much of doctoring involves detective work. Clues gleaned from the story the patient tells, a physical examination, and results of medical testing are puzzled together to form a diagnosis. Neurologist O'Sullivan vigorously examines several outbreaks of enigmatic sickness occurring around the world and identifies them as mass psychogenic illnesses. She convincingly explains how psychological, cultural, and social factors give rise to symptoms and can produce disability. She provides a powerful perspective of functional neurological disorders. O'Sullivan warns readers not to underestimate these conditions nor devalue their legitimacy. The "Sleeping Beauties" of the title refers to hundreds of children (most from families seeking asylum) in Sweden who cannot be awakened and require feeding tubes. They appear to be unconscious, but their brain-wave tracings are fine. The condition is dubbed "resignation syndrome." Elsewhere, more than a hundred people in neighboring towns in Kazakhstan behave strangely and develop a kind of sleeping sickness. Schoolgirls in Colombia suddenly begin fainting. Miskito people in Nicaragua suffer from an illness manifested by visual hallucinations and convulsions. Diplomats in Cuba are afflicted with hearing problems, dizziness, and headaches (Havana syndrome). Teens in New York develop Tourette-like tics. This is a startling and empathetic investigation into the power of the mind, the contagiousness of fear, and the consequences of hopelessness.

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