Recently Dr Suzanne O’Sullivan joined Maudsley Learning Podcast, By the Thinking Mind Podcast. Their goal is “to help educate the general public, as well as healthcare practitioners, with more nuanced conversations about mental health.“
The introduction posted with the recording of the interview is “Dr. Suzanne O’Sullivan is a neurologist specializing in psychosomatic medicine. O’Sullivan gained recognition for her expertise in diagnosing and treating epilepsy and in improving services for people who suffer with functional neurological disorders. She is the author of three books: It’s all in your head: True stories of imaginary illness, Brainstorm: The Detective Stories from the World of Neurology and The Sleeping Beauties and Other Stories of Mystery Illness.”
At the time Dr O’Sullivan published her book ‘It’s All in Your Head: True Stories of Imaginary Illness’ there was understandably a backlash from the FND community given the title of the book. She later republished the book with an amended title to ‘It’s all in your head: Stories from the frontline of psychosomatic illness’. In 2016 the book was awarded the £30,000 Wellcome prize.
Last week we were approached by The Thinking Mind Podcast for feedback on this interview. We have responded with a statement explaining our misgivings about Dr O’Sullivan’s work and why we do not agree with her position on FND. You can read it below.
Thank you again for contacting FND Action, and for giving us the opportunity to be able to comment on Suzanne O’Sullivan’s work as we have had concerns for some time about the detrimental impact it is having on FND patients. Our position on her work is as follows.
While we don’t doubt Dr O’Sullivan’s good intentions, and applaud her calls for greater compassion for people suffering from Functional Neurological Disorder, we do not agree with her view on the aetiology of the condition. We also have concerns that she propagates an outdated viewpoint that is not in line with the latest research developments in FND.
We have summarised our main points here-
Dr O’Sullivan appears to present a purely psychosocial or largely ‘Freudian’ interpretation of FND. However most of the leading edge researchers, such as Stone, Carson, Edwards, Perez et al, now view FND from a ‘non-dualistic’ framework. In so far as there is an acknowledgement that disorders of the brain and nervous system cannot be split into simplistic ‘physical versus psychological’ or ‘organic versus non organic’ categories of the kind Dr O’Sullivan promotes. The consensus is that FND is now viewed as a ‘brain network disorder’. fMRI brain imaging scans from recent years have shown disruptions to the normal function of brain networks in FND patients, including areas such as the amygdala, insular cortex and temporo parietal junction. Recent studies have also shown disruptions to grey and white matter volumes in the brains of FND patients suggesting the condition does in fact have underlying neurobiology.
The latest treatment approaches involve viewing FND as an ‘error of predictive processing’ in the brain based on Bayesian hierarchical models. In the podcast interview Dr O’Sullivan presents what sounds like a very simplistic interpretation of ‘predictive processing’. Her position appears to be that FND is caused by ‘incorrect illness beliefs’ and attentional processes, and that these are the primary driver of the illness. However she does not address the complex problem of how to define the term ‘belief’ within a Bayesian hierarchical framework. From our experience the majority of FND patients have found that even when the ‘incorrect illness belief’ is discarded, the underlying ‘predictive error’ and brain network dysfunction still remains. So while addressing illness beliefs can certainly be helpful as a component of treating FND, Dr O’Sullivan’s assertion that they are the primary cause of the illness is in our view simplistic and in many cases incorrect.
Dr O’Sullivan appears to believe the majority of FND patients are converting psychological trauma into physical symptoms, however studies have shown there are a large proportion of FND patients who do not have any significant preceding psychological trauma. While we acknowledge that for some patients addressing psychological trauma can be very helpful as one component of a wider bio/psycho/social approach, we are again unable to agree with Dr O’Sullivan’s one sided and in many ways outdated ‘Freudian’ viewpoint on this issue. Simplistic causation models are not helpful when considering there are a range of patient subsets within FND.
Dr O’Sullivan also appears to take the position that viewing FND through a neurobiological framework is the incorrect approach as it reinforces the patient’s belief in the permanence of the condition. We firmly disagree and feel statements of this kind are in many ways extremely unhelpful and potentially damaging. Our view is that research into brain networks and the neurobiological underpinnings of FND have been key to developing effective treatments within a larger bio/psycho/social framework. Furthermore we view these as absolutely essential in attempting to fully understand the aetiology of this complex condition, and in order to develop much needed new and innovative treatments.
Our understanding is that Dr O’Sullivan is an expert in epilepsy and is not an active specialist FND researcher. She also has had little or no interaction with the FND community or the major charities. She does not back up any of her assertions with citations to research papers, and many of her views on FND are extremely outdated and contradict the latest scientific research. For this reason, in our view she is not best placed to be a spokesperson for the condition. For a genuinely expert viewpoint on FND we would recommend contacting one of the leading researchers such as Professor Jon Stone of Edinburgh university or Professor Mark Edwards of Kings college London.
In the spirit of good-natured scientific debate, and to present a wider ‘non dualistic’ view of FND, If you would be interested in interviewing a representative from FND Action on your podcast to discuss these issues we would be very happy to provide one. We greatly appreciate you contacting us and thank you for your interest in the condition. For a summary of the latest research developments in FND we have included a link to our guidance for medical professionals here – Information and guidance for medical professionals