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Monday 8 June 2015

Tom Sutcliffe does not challenge the Malingerers' Charter being promulgated by Dr Suzanne O'Sullivan cos he is afraid of feminazis

http://www.theguardian.com/books/2015/jun/07/all-in-your-head-review-o-sullivan-suzanne-osullivan

http://www.bbc.co.uk/programmes/b05xd449

Tom Sutcliffe:

"Suzanne O'Sulivan, I wonder what you feel about this. There is an interesting test case and it arises in Thomas Browne. Morgellon's disease was a disease he was writing about in the 17th century. It disappears for centuries then reappears because somebody finds out about it and puts it on Internet. All of a sudden you have campaign groups, you have research enterprises for a disease which probably doesn't exist."

Suzanne O'Sullivan:

"I don't think the Internet has been so much of a problem for doctors as such, I think it is a problem for patients and people. [Patients are people, you silly woman!] People have always had an array of symptoms they are worried about and they have never had such a resource to give them such a lengthy list of diagnoses before. Most people who read the Internet and interpret their own symptoms based on the Internet do poorly because they lack the medical knowledge. In general when doctors are faced with what patients bring to them they are able to put their minds at ease. The public has the problem that until they see the doctor they have a lot to worry about. You don't need the media to pick up epidemics raised from anxiety. In the 1990s there was a huge outbreak of people believing they had candiasis for example and to a certain degree it came from publications in newspapers and the media. So even before the Internet, this was an issue."

Tom Sutcliffe:

"This is the subject of your book It's All In Your Head, subtitled True Stories of Imaginary Illnesses. Your absolutely central point is that the idea of saying that an illness is not real is just wrong and that all diseases are real, or all illnesses are real but not always by disease. Could you just expand on that."

Suzanne O'Sullivan:

"To make the distinction between what is disease and what is illness: I would define disease as something patho-physiological that is affecting your body whereas your illness is your perception of how you feel and these two things are distinctly different. I could have a disease and I might suffer from epilepsy which is a brain disease but if my epilepsy is under control I might not be ill at all. On the other hand, the patients I am dealing with in my book are people who have no disease - so there is nothing patho-physiological to find that we are aware of."
[In other words, Dr O'Sullivan is saying 'You are sick if you say you are.' Time to buy shares in manufacturers of medical certificates, woo hoo!]

Tom Sutcliffe:

"Nothing detectable."

Suzanne O'Sullivan:

"Nothing detectable, but they are suffering illness. Now a lot of people perceive this to be 'If you don't find disease, that person isn't suffering' and the point that I want to make is that illness is something that someone feels and you can't tell them otherwise. [Why the bloody hell not?] And the illness comes from psychological reasons is every bit as real, every bit as disabling and every bit as significant as illness that is due to disease. Many of the patients I see [Are they mostly neurotic women, Dr O'Sullivan? Go on, you can tell us!] feel dismissed when told they don't have disease and the point is that if you have a stomach pain or a chest pain or weakness of your leg that is psychologically or you behaviourally driven it is every bit as significant and disabling as any other sort of disability."

Tom Sutlcilffe:

"Where does that resistance arise? You are very candid yourself about how long it took you to overcome your own clinical suspicions about this. Does medical training militate against a sympathetic understanding?"

Suzanne O'Sullivan:

"I think there is a lot to do in medical schools and as junior doctors to help doctors to properly appreciate the suffering of these [neurotic and mostly female] patients. The problem is that people who have disabilities that arise for psychological reasons go and see medical doctors, so doctors who have training in physical disease probably have only a smattering of training in how to deal with psychological disorders therefore don't always know exactly what to do when they encounter them. It was difficulty for me because there was a lot of inconsistencies. For example, I talk about a woman the book called "Yvonne" who had profound blindness we couldn't find any physical disease to explain it."

Tom Sutcliffe:

"It was triggered by an accident at work when she accidentally got some cleaning fluid in her eyes."

Suzanne O'Sullivan:

"Precisely. So there was a trigger for it, but there was no physical explanation for it and many of her tests were inconsistent with blindness. My personal struggle with Yvonne is that I saw her quite regularly during her hospital stay and I always felt she was looking directly at me. She was behaving like a sighted person while having the personal experience of being profoundly blind. When you're a medical student or a junior doctor and you have never encountered something like that before [ie malingering and/or psychosomatic illnesses being suffered by neurotic female patients], it is hard for you to accept that this person who is meeting your eye is genuinely blind, so it has been a journey for me."

Tom Sutcliffe:

"You tell a very striking story when you are leaving at one point, and she's going out of hospital and going home again and she hands over to you a hand-drawn card and it is perfectly coloured in and perfectly drawn and you say 'But you are blind, how did you do it?' and she said 'Well, I felt the colours' or 'I felt the pencil marks.' Now you make the very important point that it is not proof of fraud but proof of sincerity because nobody faking it would do such a thing. [Really? Now they will all be doing this to get a few days away from their horrible families and their horrible cleaning jobs.]

Suzanne O'Sullivan:

"Well, that 's the journey I have come on and I've realised over time and looked at the behaviour of the people I deal with. Someone who is pretending to be paralysed, someone who is pretending to be blind doesn't present themselves repeatedly to specialists and to hospitals asking to be investigated. [Really? Why not, if they are really determined and know there are lots of stupid female bleeding heart doctors who just love displaying their compassion at the expense of the NHS?] They behave in a covert way and I think it is in the way that people seek explanations for their physical symptoms speaks volumes about their innocence and behaviour. [sic]"

 [What did Hitler about big lies and little lies, do you know, Dr O'Sullivan?]

" .. in the big lie there is always a certain force of credibility; because the broad masses of a nation are always more easily corrupted in the deeper strata of their emotional nature than consciously or voluntarily; and thus in the primitive simplicity of their minds they more readily fall victims to the big lie than the small lie, since they themselves often tell small lies in little matters but would be ashamed to resort to large-scale falsehoods. It would never come into their heads to fabricate colossal untruths, and they would not believe that others could have the impudence to distort the truth so infamously. Even though the facts which prove this to be so may be brought clearly to their minds, they will still doubt and waver and will continue to think that there may be some other explanation. For the grossly impudent lie always leaves traces behind it, even after it has been nailed down, a fact which is known to all expert liars in this world and to all who conspire together in the art of lying." 

Tom Sutcliffe:

"The denial is very fierce, isn't it, for example ME. This is a contested disease. People who suffer from ME feel absolutely despairing that it is not acknowledged as a physical disease. The doctors who are treating them can't find a physical cause, or that's disputed as well. Do you understand why they feel so dogged about it?

[It does not appear that Tom Sutcliffe has even heard of invalidism, but I have. Perhaps I should have been conducting the interview myself.]

http://press.uchicago.edu/ucp/books/book/chicago/I/bo3638987.html

Nineteenth-century Britain did not invent chronic illness, but its social climate allowed hundreds of men and women, from intellectuals to factory workers, to assume the identity of "invalid." Whether they suffered from a temporary condition or an incurable disease, many wrote about their experiences, leaving behind an astonishingly rich and varied record of disability in Victorian Britain.

Using an array of primary sources, Maria Frawley here constructs a cultural history of invalidism. She describes the ways that Evangelicalism, industrialization, and changing patterns of doctor/patient relationships all converged to allow a culture of invalidism to flourish, and explores what it meant for a person to be designated—or to deem oneself—an invalid. Highlighting how different types of invalids developed distinct rhetorical strategies, her absorbing account reveals that, contrary to popular belief, many of the period's most prominent and prolific invalids were men, while many women found invalidism an unexpected opportunity for authority.

In uncovering the wide range of cultural and social responses to notions of incapacity, Frawley sheds light on our own historical moment, similarly fraught with equally complicated attitudes toward mental and physical disorder.
Suzanne O'Sullivan:

"I absolutely understand and say who can blame them, because society is very judgemental of people who suffer psychologically in general and in particular physical disability and fatigue is particularly looked down upon. [Well, we have all heard for malingering, even if you haven't, Dr O'Sullivan!] For example, if we were here [We already are, Dr O'Sullivan!] and we have two patients here and one was paralysed due to a road traffic accident and one was paralysed for psychological reasons. We would regard those people as quite different or perhaps not everyone in this room, but a lot of them would regard them differently. Now it is true that one has a better chance of getting better. One is amenable to treatment and one is less amenable to treatment, but until they receive that treatment they are equally paralysed, they are equally disabled, and yet one will be less the focus of research, less the focus of receiving our resources and the things like Disability Allowances whatever will be less available to them but they are both paralysed. The issue is that a lot of society don't really believe that both of them are paralysed. My point is that they are." 

So she wants more funding, more politicisation of medical training and more indoctrinating of doctors with her bleeding heart crap while the NHS haemorrhages cash on lost causes. If people are sick in the head stigmatise them so they shut up, suppress their symptoms, stop being attention-seeking nuisances. Let doctors stop diverting precious resources to them when they are genuinely sick people around, unless the malingerers and invalids can go private.




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