Today I received a call from my son while he was at school: he was feeling ill and wanted to come home. We went through the usual to-ing and fro-ing with the gatekeepers at school reception and my own maternal gatekeeper (‘is he really ill enough to stay off school?’) before he was allowed to make his way home and back to bed. I don’t know whether he has a virus, is exhausted after a period of exams or just wants to retreat from the world on cold November day. Whatever the origin of his need to be under his duvet, luckily for him I’m feeling more than usually receptive to whatever it is he’s suffering from. I’ve just read It’s all in your head: stories from the frontline of psychosomatic illness by consultant neurologist Dr Suzanne O’Sullivan. The book weaves together case histories of patients she’s met in her neurology clinic with a history of attitudes towards illness which show themselves in the body but originate in the mind. Seizures, paralysis, blindness and chronic pain are presented to O’Sullivan by people who have exhausted all other medical routes, looking for a source and therefore a cure for their suffering. With great compassion, she emphasises that these people are not faking or malingering, that the symptoms are real but their cause is not organic disease.
The cases that O’Sullivan writes about are rare and severe, but the broader context (of the relationship between mind and body, physical and psychological illness, biological and emotional distress) is relevant to all of us. As a counsellor, a mother and, well, a human, I am often trying to find the meaning in and appropriate response to bodily symptoms. With my children, my home triage system goes something like: level 1, cuddle; level 2, paracetamol and duvet; level 3, attempt to make GP appointment and negotiate with gatekeepers even fiercer than the school’s (‘is it an emergency?’; ); level 4, a trip to accident and emergency, where the guilt of taking up scarce resources can bring on momentary relief when a child’s swollen wrist is indeed broken and we haven’t wasted anyone’s time (the relief doesn’t last – I am not suffering from Munchausen’s by proxy!). I have at times been perplexed when a GP has sent me and a feverish but otherwise well child away from the surgery with a prescription for antibiotics, with an instruction not to use it ‘unless things don’t improve in a few days.’ I see now that this was a response to the fear in my eyes, a dual reassurance that things will be okay but that if they’re not, there’s back up. I don’t suppose GPs have a lot of time to manage the emotional nuance required to convey all of that so a prescription is shorthand. (It’s a shame about the antibiotic resistance which ensues from this form of kindness.)
My counselling clients are adults and make their own decisions about when to seek medical intervention, but we routinely talk about the physicality of emotions (the tight throat, the churning stomach, the shortness of breath); indeed, being able to locate a feeling in the body can help us to ground and connect with emotions that otherwise roam around inscrutably. Where things become more complex is when the situations described in O’Sullivan’s book are reversed; when does the distress that clients bring to counselling need to be treated medically? When do the fatigue, the aching limbs, the racing heart, the upset stomach (which can all be symptoms of emotional and psychological distress) require medical investigation to rule out disease? When do symptoms which have an emotional and psychological source require medical intervention?
I will always support a client’s decision, made with a GP or psychiatrist, to take anti-depressants or other medication which helps to keep them feeling well alongside counselling. But I wish the attitude shown by Dr O’Sullivan,that symptoms have stories, some of which need sensitive and careful reading, could be more widely supported by our health service. I hear of fantastic GPs and other medical professionals who make the most of the time available to them to listen to their patients with curiosity and empathy. I worry, however, that even the most empathic of the profession are so squeezed for time that often a prescription has to stand in for human connection and all that it can heal.
I’d better check on my son and hope that we’re not at level 3…