This is one of the larger contradictions O’Sullivan describes. Many, or most, of these patients will ardently deny the presence of any stress or trauma that might have brought on their symptoms. But 20 years of practice have shown her how much real suffering can be accompanied by so little evidence of organic disease. As a medical student she was tempted to laugh at the “worried well”, the transparent hypochondriacs and shameless malingerers who any doctor meets regularly. O’Sullivan, born and educated in Ireland, is a consultant neurologist at the Royal London Hospital. But such “imaginary” ailments remain vastly misunderstood by physicians and patients alike – not to mention the family, friends and colleagues whose attitudes to the hapless somatiser may be ruinously enabling or painfully dismissive. The more serious somatic disorders have been recognised since the time of Galen, who around 150 AD wrote of a woman whose racing pulse “points to a troubled mind”. The tremors only stopped when I taught myself to locate the fear instead in the pit of my stomach my guts might now be in flitters, but at least I made a less puzzling or comic interlocutor.Īs Suzanne O’Sullivan points out in her rich and wise study of psychosomatic illness, we have all been there or thereabouts, converting our emotional turmoil (and even elation) into physical symptoms of greater or lesser gravity.

As a nervous young thing in my 20s I suffered from an alarming case of the shakes – proper bobblehead-doll stuff, hard to hide – whenever I was faced with an even mildly fraught encounter: academic, romantic or bureaucratic.

Imaginary by Jamie Sullivan