On 16 March, as Wes Streeting was being interviewed by Laura Kuenssberg, the neurologist Suzanne O’Sullivan was mentioned with her view that too many people are over-diagnosed in terms of mental health and learning disabilities. Streeting generally agreed, saying “too many people were being written off”. The dropping of O’Sullivan’s name was no accident, as her book on the subject of ‘overdiagnosis’ was published two days later. In The Age of Diagnosis: Sickness, health and why medicine has gone too far, O’Sullivan argues that a lot of the cases she encounters or has examined were psychosomatic – including long Covid.
She suggests that we should be aware and wary of ‘diagnosis creep’: the gradual expansion of diagnostic criteria.
Suzanne O’Sullivan: selling the overdiagnosis myth to lay the groundwork for benefit cuts
For this book, long Covid is just one of the conditions O’Sullivan decided to examine. Other topics include Autism, ADHD, cancer, Huntington’s Disease, depression, mental health, and hypermobile Ehlers-Danlos syndrome (hEDS).
As a neurologist, it’s clear she’s rummaging into other specialities, something ‘Darcie’ – a patient – pointed out to her, saying:
You’re not an EDS doctor and you’re not a PoTS doctor, so you have no right to look into these.
But O’Sullivan did feel she had the right to examine these topics for the book.
This ‘psychosomatic’ mantra and talk of ‘overdiagnosis’ is a divisive issue. For certain politicians and sections of the media it can also be highly seductive.
This was a concern expressed by readers. One said:
It was clear this (book) isn’t about following the evidence, its ideological.
For the government, it could give justification for its harsh cuts to Personal Independence Payment (PIP). These are cuts directed at learning disabled people and those living with mental health issues.
It could also have an impact on NHS services for these groups with Baroness Claire Fox calling for a review of the ‘problems’ of overdiagnosis. She said this review should look at the impact on NHS resources of overdiagnosis of those with mental health problems, ADHD, and those on the Autistic spectrum.
A controversial medical circle of ‘overdiagnosis’ clinicians – notably over long Covid
In medical circles, O’Sullivan is not alone in making such ‘overdiagnosis’ claims, but she’s not in the majority with her belief that so many of the conditions she covered in her book are potentially because of overdiagnosis, misdiagnosis, or over-screening.
But being somewhat of an ‘outsider’ doesn’t deter her, because along with others in her bubble of ‘free-speech, non-believers’, they promote and quote each other.
So, in the chapter ‘The Age of Diagnosis’ on ADHD, Depression, and Neurodiversity O’Sullivan used the ‘trauma not illness’ arguments made by psychologist Lucy Johnstone.
Likewise, in the chapter I am looking at here on long Covid, she used the comments of the highly controversial doctor Paul Garner, who has claimed he recovered from Covid through graded exercise activity.
According to the World Health Organization (WHO), Covid-19 can lead to serious long-term effects, known as post Covid-19 condition (PCC). This is referred to by the patient-preferred term, long Covid.
Long Covid is characterised by a range of symptoms which usually start within three months of the initial Covid-19 infection. It can affect a person’s ability to do day-to-day activities and hinder their ability to participate in society.
With so many people affected by long Covid, there has been a controversial debate from some commentators like O’Sullivan, who in The Age of Diagnosis said:
Long Covid behaves just as psychosomatic illnesses do.
This claim has been rejected by those with long Covid. Exasperated, one person said:
Has the author not read any of the thousands of research papers that identify microclots, lung damage, immune system malfunction? The psychosomatic take is beyond offensive.
Long Covid: O’Sullivan’s dangerous misdiagnosis beliefs
O’Sullivan is not new to being controversial. A previous book from 2015 entitled: It’s all in Your Head: stories from the frontline of psychosomatic illness caused much ire amongst those living with ME/CFS, another condition she believes is psychosomatic.
With ME/CFS having many of the features of long Covid, it’s hardly a surprise she’s also repeating the message here for most patients.
Why not all patients? That’s because O’Sullivan concedes some people do have persistent symptoms. She separates all long Covid patients into four groups.
The first group are those who were hospitalised with Covid. She thinks this group could indeed have persistent symptoms following hospital treatment.
The second group are those who have these symptoms after being infected with Covid. Some of these patients she believes could have some sort of post-viral infection.
The third group, rather than long Covid, she believes their symptoms may be a misdiagnosis, not helped by the lack of face-to-face GP appointments.
But it’s the fourth group, where she thinks the majority of long Covid patients are with long Covid having a psychosomatic cause.
O’Sullivan’s reasons for this include it being a patient who first discovered the link between her symptoms and Covid. Also, she points to the number of symptoms now attributed to long Covid.
But her main two arguments involve the demographic and mental health.
O’Sullivan’s book is ideological opinion, not evidenced fact
In terms of the demographic O’Sullivan suggests those with long Covid are different than those who were ventilated and/or died from Covid, who were more likely to be older, and men.
In response, there are studies showing younger adults and adolescents suffer more neurological long Covid symptoms that adults over 65. So, the demographic is different, because long Covid is different, hitting a younger demographic.
Her second argument is that studies showing factors like anxiety, depression, and even loneliness may play a role, and as such, O’Sullivan thinks this may make long Covid psychosomatic.
But the question is: does living with a chronic condition such as long Covid cause the secondary problems with mental health or vice versa?
Professor Carolyn Chew-Graham, who was the first in the UK to publish on long Covid said:
I don’t think the authors opinions follow from the research. NICE is very clear that anxiety and depression are more likely to be consequences of long Covid than causes.
And psychiatrist Dr Linda Gask says:
When you have pre-existing anxiety or depression you always feel worse in your mood when you are physically unwell, especially with a viral illness. Post-viral depression is common. People who have long Covid may be more likely to be lonely, that doesn’t mean loneliness is the cause of it.
With suggestions of overdiagnosis, misdiagnosis, and even a tendency to over-screen for conditions, this book not only undermines those who are suffering from long-term chronic illnesses, but could be used as justification to cut funding and benefits. It should be taken as how it reads, ideological rather than anything else.
Featured image via the Canary
