Tag Archives: neurology

One Station Away: Olaf Olafsson

“But the brain is a maze, made up of so many parts, so much that is mysterious.”

Icelandic author Olaf Olafsson’s novel,  One Station Away arrived at the end of an excellent reading year, and although the competition is tough, this incredibly rich, complex novel easily makes my best-of-year-list. This is the story of a British neurologist, a transplant to New York, whose complex relationships with the women in his life challenge his notions of perception and delusion.

One station away

Neurologist Magnus Colin Conyngham  works in Cold Harbor Connecticut, part of a team of doctors researching brain activity on patients in a vegetative state being kept alive on ventilators. The American team shares research with similar teams in Cambridge and France, and the three teams follow the same procedure: patients are placed in MRI scanners and asked to imagine playing tennis and then walking through their homes. Each of these mental activities light up different areas of the brain, so, in theory, doctors can communicate with vegetative, yet conscious, patients and with some simple training patients can give answers to yes/no questions.

If you think this is far-fetched, then check this out. 

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When the novel opens, Magnus is finding it hard to concentrate on his research which hasn’t been that successful, and his inability to concentrate can be explained by the sudden death of his Argentinean lover, dancer Malena, a warm and yet strangely remote woman. Magnus is sliding into an abyss when two things happen: his father, Vincent, asks Magnus to return to England for his mother’s 70th birthday, and a new patient arrives: a young, unidentified woman with significant head injuries who was left abandoned at the site of a horrendous motorcycle accident.

Magnus returns home reluctantly, and we gradually learn about his relationship with his parents. His mother Margaret, is a pianist, who, according to herself, and her devoted, single-minded husband, has been slighted and overlooked in her career. Magnus, who was the unwanted child of a neurotic, self-focused woman (according to his mother, he’s partly to blame for her failed career) has moved on from his parents and their pathological scene building of the thwarted monumental musical talent, but still, he finds it trying to be in their toxic, delusional company.  He worries that he has inherited his mother’s worse traits.

But the fact was, my mother had never fulfilled her potential, or rather, she had never received the recognition which she and Vincent felt she deserved. Many things, and people, were to blame, most notably the cliques controlling the world of classical music behind the scenes, who had systematically prevented her from enjoying the acclaim she was due. It was they who kept her from giving recitals in the most prestigious concert halls, they who wrote disparaging reviews about her in newspapers and magazines, although without being too harsh, for that might arouse suspicion, they who awarded grants to other pianists, not half as good as she, they who took every opportunity to push her side, knowing that she was indomitable and served no one but art, no matter who they were, what position they held or what the consequences might be. 

Magnus’s co-worker, Simone, who’s secretly in love with Magnus, has covered for him in the past, but now she’s very concerned about his behaviour. Magnus’s new patient sparks new life into this doctor who is beginning to question whether or not his research has any purpose, and soon he’s spending hours alone with this mystery  “Jane Doe.”

I sensed it the moment I saw her face. This wasn’t a suspicion or a hunch–it was an absolute certainty. The woman was conscious: she could hear me walking toward the bed, she could feel my presence. I was expecting her to open her eyes at any moment and speak to me. I imagined her voice echoing in my head, her accent when she asked where she was. I even saw her raise her hand and brush away the lock of hair that had fallen across her brow, before turning to me and smiling. 

One Station Away focuses on perceptions and delusions. Events occur which cause Magnus to question everything he thought was true. Is his mother extremely talented? Is she the victim of a thwarted career as she’s argued for decades? And if that’s true, shouldn’t she be treated with more compassion? Sometimes we manage to block out what is right under our noses, but, as the novel argues, we can also delude ourselves into believing what we want. MRIs reveal brain activity but how does that compare to the depths and intricacies of motivation? Olaf Olafsson explores this brilliantly in this incredible novel through Magnus’s relationship with the four women in his life: Malena, his patient, his mother, and Simone.  I cannot praise this book highly enough.

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Filed under Fiction, Olafsson Olaf

Is It All In Your Head?: True Stories of Imaginary Illness by Suzanne O’Sullivan, M.D.

It is not necessarily the greatest suffering that receives the greatest consideration and sympathy. Illness is not scored in that way. Deadly disease obviously scores higher than others. After that there is an unofficial ranking system for illness in which psychiatric disorders are the out-and-out losers. Psychiatric disorders manifesting as physical disease are at the very bottom of that pile. They’re the charlatans of illness. 

In Is It All In Your Head? True Stories of Imaginary Illness, M.D. Suzanne O’Sullivan, whose specialties are neurology and clinical neuropathy, offers a casebook of patients who presented with powerful physical symptoms and yet in time various illness and diseases were systematically ruled out. This left these ill, debilitated people, technically speaking, or at least in the eyes of the doctors who treated them, with nothing wrong, no diagnoses.

Up to one-third of people seen in an average general neurology clinic have neurological symptoms that cannot be explained; in these people an emotional cause is often suspected. It is very difficult for a patient to be given the news that their physical illness may have a psychological cause. It is a difficult diagnosis to understand, let alone accept. And doctors can be reluctant to offer it up, partly for fear of angering their patients but also for fear of what they might have missed. Patients often find themselves trapped in a zone between worlds of medicine and psychiatry.

The book’s introduction builds a pathway to the case histories here, and I particularly loved the way the author pointed out that “modern society likes the idea that we can think ourselves better,” and while accepting that a “positive mental attitude” is invaluable, Suzanne O’Sullivan argues that “society has not fully woken up to the frequency with which people do the opposite–unconsciously think themselves ill.” The lead-in intro paves the way with commonly acknowledged physical symptoms caused by emotions or stress, and from this common point of acceptance, the author takes into her patient casebook.

 is-it-all-in-your-head

As for the case histories, there’s a range: Pauline, a 27-year-old woman with an extensive medical history, whose been ill since age 15. A general feeling of being “unwell” morphed into burning pain when passing urine. Then followed years of, how can I say this, being bounced around the medical community, being given vague diagnoses and even an unnecessary appendectomy. Finally after losing the use of her legs, Pauline ended up in a wheelchair. If you think this sounds bad, well just keep reading Pauline’s case; it’s truly appalling. I’m not going to blame the doctors here because if a person keeps complaining about pain & various other symptoms, the doctors are going to keep looking for causes (that’s their job,) and that, at the very least, led to even more complications for Pauline who ended up being kicked out of the hospital only to suffer seizures right before her release.

Wheelchair-bound Matthew is convinced that he has Multiple Sclerosis ( he can’t feel anything in his lower body, yet “despite the lifelessness of his legs the reflexes reacted as they should”) ; Shahina‘s problems began when someone accidentally steps on her hand. Yvonne becomes blind after a few drops of glass cleaning solution accidentally land in her eyes.  The treatment given her by the junior doctors and medical students is appalling, (“there’ll be no Oscars for that performance.”) Alice, I found perhaps the most interesting of the case histories, since her story started with breast cancer and from that moment on, the experience tapped into Alice’s subconscious mind. Camilla spent years with unacknowledged grief which manifested itself in other ways.

The most disturbing, controversial chapter concerns Rachel, who suffers from Chronic Fatigue symptom/ME and ends up in a locked psychiatric unit. Rachel seems to be the other end of the spectrum–someone who does indeed have something physically/clinically wrong with her even though Dr O’Sullivan argues that “psychological factors and behavioral issues, if they are not the entire cause, at the very least contribute in a significant way to prolonging the disability that occurs in chronic fatigue syndrome. Do I know that for sure? No, nobody does: but I am influenced by the lack of evidence for an organic disease. ME/CFS sufferers do not usually have any objective physical findings to explain their fatigue. They have been likened to those who had multiple sclerosis before that disease was properly understood.”  Fatigue (CFS) is a problem as it tends to gather up the label of malingering and that is so unfair. And on the subject of Rachel, just because a patient makes a big demonstration of being unable to do something doesn’t necessarily mean a thing. We all bring our characters to our illnesses and our diseases. Some of us suck it up and some of us don’t.

The chapters go back and forth from the case history under examination to other cases and also the history of various medical practices. This can be distracting, even though I can understand why the author took this approach. Some of the stories were tied up too neatly with a bow, but I suppose that is how the doctor’s casebook ends when the patient walks through (or wheels out of) the door for the last time and lands on someone else’s patient list. Ultimately this was an interesting read–even though I didn’t agree with the author about every issue.

In a matter of semantics, I had a bit of a problem with the book’s byline: True stories of Imaginary Illness as it implies, at least to this reader, that the patients in these pages ‘imagined’ their illnesses as in fabricated. But the whole point of the book is that these patients suffered very real physical symptoms as a result of psychological distress. They weren’t imagining anything.

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Filed under Non Fiction, O'Sullivan Suzanne