- The Sleeping Beauties and Other Stories of Mystery Illness, by Suzanne O'Sullivan. Picador, $34.99.
This book examines psychosomatic disorders in a number of different countries, ranging from refugee children in Sweden to adults in Kazakhstan. Along the way, Suzanne O'Sullivan, a neurologist, delves into the ways that body and mind work together, and how social factors are involved in illness. She also investigates what is "normal", as the definition changes over time, and differs culturally. The resulting book is gripping, sometimes even disturbing, and will stay with the reader for a long time.
The title refers to refugee children from certain ethnic groups in Sweden, who seem to have resigned from "active participation in the world". They are not unconscious, but in a state of acute withdrawal. (That sounds almost intentional; this is not the case.) O'Sullivan emphasises how the plight of these children with "resignation syndrome" can only be understood by incorporating an examination of the social circumstances in which the illness manifests itself. The description of the author's examination of two children suffering from the illness takes the reader into the home of the afflicted girls, alongside the girls' parents and usual helpers. I felt almost uneasy about being given so many details of this visit; it is certainly a powerful and vivid section of the book. "Resignation syndrome" is now also seen in Nauru, where the conditions are "much, much worse" than those experienced in Sweden.
Kazakhstan's independence meant that previously privileged workers in a remote, formerly Soviet town based around a uranium mine, found their relatively fortunate lifestyle evaporate. However, it was not until some time later that those who refused to leave their homes to be moved to flats in another town, began to suffer from what referred to as "sleeping sickness". (The symptoms were actually much more varied than that term implies.) Because of this illness, the affected people were indeed moved away from the town that some remembered as "Paradise", for medical treatment, thus achieving what had been resisted by the residents previously. O'Sullivan argues that the illness suffered cannot be reduced to the effects of simple "stress", as some of the press suggested. At the same time, there was a widespread suspicion among the sufferers that they had been poisoned, an explanation that was preferred to any psychological factor. Lack of trust in the authorities and doctors fed into this belief. The author examines how biological explanations for illness are seen as more "real" in many different locales.
The book also includes the outbreak of a mysterious illness among US staff at the embassy in Cuba. Here, the fact that the sufferers were educated officials, and often male, meant the response was quite different from when young girls suffer what is still called "hysteria" by some. The press and medical authorities seemed very anxious to find a "real" cause for the outbreak of illness as opposed to a psycho-social one, searching for nefarious weapons trained on the diplomats by the Cubans. (There are still regular articles appearing about a possible physical cause for the illness, which has now also manifested itself in China.) The author also looks at "grisi siknis" that occurs in Miskito people in Nicaragua, and the effects on the heart of emotional or physical shock in a condition called Takotsubo cardiomyopathy, among other issues.
In later sections of the book, the author examines how the push to name new ailments (whether psychological or physical), and the emphasis on more and more tests being carried out on individuals to identify possible illness, has an effect on people who might once have not been seen as abnormal at all. A young woman called Sienna "had been taught to medicalise every bodily change and, once that pattern was set in her brain, she struggled to escape it". The effects on this individual's life have been profound.
The subjectivity of many medical classifications and diagnoses is unknown to most patients. The author brings up various revisions of the Diagnostic and Statistical Manual of Mental Disorders, and it seems that "the trend is towards broadening categories with new definitions and subcategories". (There are notable exceptions; homosexuality ceased to be considered a mental illness in the 1970s.) The cultural background of those writing this influential manual can not be ignored. O'Sullivan examines how economic and prestige factors play a part in the expansion of both psychological and physical tests, and new definitions.
Some of the concepts introduced are quite difficult, but the effort required to understand is certainly worthwhile. O'Sullivan is to be commended for taking on some big issues about illness, the divisions drawn between mind and body, and what is seen as normal. She brings a wealth of research and experience together for us all.
- Penelope Cottier writes poetry as PS Cottier.