Wes, Rachel, Liz, Suzanne and an all-in-the Head Conspiracy Theory

David Black on the usefulness of popular publishing phenomena such as Suzanne O’Sullivan to our current rulers: “O’Sullivan’s basic premise would seem to be that people aren’t so much ill, as imagining they are ill thanks to maladaptive cognitions which really shouldn’t be encouraged. This is of course music to the ears of Wes Streeting, Liz Kendall, and Rachel Reeves in their bid to cut down on the numbers of benefit claimants, though it must be extremely annoying, not to say terrifying, for those bedbound by post-viral brain fog, chronic pain, muscle weakness, and severe fatigue.”

Is it just your scrivener, or might there sometimes be grounds for suspecting that not all coincidences are as coincidental as they seem? While it’s important not to fall down the rabbit hole, there is always a place for healthy doubt. As Arthur C. Clarke used to say, regarding his utter disdain for astrology ‘I’m a Sagittarius, and we’re skeptical.’ As a fellow Sagittarian, I fully concur.

Item. Chancellor Rachel Reeves has, as expected, announced a number of swingeing reductions to the welfare budget in her Spring statement, including an additional £500 million at the last minute after the Office of Budget Responsibility questioned the sums. ‘250,000 people will face relative poverty’ rang out The Guardian, while the BBC lamented ‘3 million families to be hit by welfare cuts.’ Labour backbenchers looked even more troubled than usual. One imagines Messrs Attlee and Bevan are currently spinning in their respective graves.

Item. Is it just a passing coincidence that on March 18th, the very day that Department for Work and Pensions minister Liz Kendall was addressing the House on the need for those cut backs to welfare expenditure, a celebrity neurologist by the name of Suzanne O’Sullivan just happened to be launching her book The Age of Diagnosis with the able assistance of the BBC. 

Conspiracy? What a silly idea – for one thing, Dr O’Sullivan, whose creative writing degree has enabled her to mine her theories of psychosomatic disorders to a remarkable extent, signed her contract with Hodder in the spring of 2023, at which point Rachel the Reiver was but a Chancellor in waiting while Liz the axe lady was a mere shadow minister for social care under opposition leader Sir Keir Starmer. 

On the other hand the underlying theme of Dr O’Sullivan’s book is a perfect fit for the new welfare slashing culture, her premise being that with all this over-diagnosing and over-medicalising the problem may not be so much the underlying ailment as the label our doctors attach to it. Long Covid, which she asserts ‘started with a hashtag’ is thus disparaged – a view not far removed from that of Canadian psychiatrist Jeremy Devine, who declared in a 2021 Wall Street Journal op-ed that long Covid was ‘the invention of vocal patient activist groups’ rather than the direct outcome of a viral infection sweeping through the global population, including many working in the health sector. 

It is, like Chronic Fatigue Syndrome, Fibromyalgia, and Post-Viral malaise, just another of those mystery medical illnesses which our medical authorities can’t explain, so not an illness at all, you see. The fact that thanks to the dominance of psychiatry’s biopsychosocial tendency UK medical schools have avoided teaching and researching these ‘unexplained illnesses’ for decades is apparently of little account. 

This variant of an old song from Suzanne O’Sullivan has served her remarkably well. Her previous award-winning bestsellers include It’s all in the Head; Stories from the Frontline of Psychosomatic Illness (2015) Brainstorm; Detective Stories from the World of Neurology (2018) The Sleeping Beauties; And Other Stories of Mystery Illness (2021)

One reader notably unimpressed by O’Sullivan’s 2015 All in the Head effort was the author of the acclaimed novel, The State of Me (Harper Collins, 2008). Nasim Marie Jaffry developed Chronic Fatigue Syndrome in 1982 during a Coxsackie B virus outbreak in Scotland. She was treated by, among others, consultant neurologist Professor Peter Behan, who had little time for the ‘talk-the-talk nonsense’ of certain pontificating psychiatrists and O’Sullivanesque neurologists.  

On the whole, Ms Jaffry found herself being gaslit by those who were trying to persuade her that her post-viral illness was – guess what? – all in her head! She vented her fury in her blog, Velo-gubbed.

‘The (ever more desperate) psychiatric lobby is always hiding behind you, waiting to jump out and squeeze the very soul out of you – we have been treated to a work called It’s All in your Head; True Stories of Imaginary Illness by a daft neurologist called Suzanne O’Sullivan, who apparently googled and then wrote her ridiculous chapter on false illness belief. She seems wholly unperturbed about spreading medical misinformation. I can confirm, however that it is certainly not groundbreaking, more a dreary recycling of the biopsychosocial narrative. If Suzanne were not so dangerous, she would be a hoot. She is taking the piss.

This shocking indelicacy is in marked contrast to the sort of fawning, salivating reviews Dr Sullivan is accustomed to receiving. The Guardian’s Tim Adams hailed It’s all in the Head as ‘excellent’ in an article-cum-product endorsement (with reader discount). Further praise came from The Times’ David Aaronovitch, who described it as ‘honest, fascinating, and necessary’ having previously distinguished himself as a hardline ME/CFS sceptic, despite his lack of expertise in the subject.

Its all in the Head, a triumph of marketing, achieved strong home and overseas sales. Energetically promoted around the book festivals, the author’s radio airtime included a Start the Week billing and a Jim Alkilili Life Scientific special. The final cherry on the cake was the 2016 Wellcome Book Prize which came with a £30,000 premium. They love the hubris, these populist clinicians.

On her current theme of over-diagnosis Dr O’Sullivan is, up to a point, onto something. The diagnostic manuals produced by the American Psychiatric Association are overblown gothic horrors which some might suspect are just whipping up the billable hours for a profession which is out of control, though I gather they make excellent doorstops.  

O’Sullivan’s basic premise would seem to be that people aren’t so much ill, as imagining they are ill thanks to maladaptive cognitions which really shouldn’t be encouraged. This is of course music to the ears of Wes Streeting, Liz Kendall, and Rachel Reeves in their bid to cut down on the numbers of benefit claimants, though it must be extremely annoying, not to say terrifying, for those bedbound by post-viral brain fog, chronic pain, muscle weakness, and severe fatigue.

They know they’re not making it up, especially those nurses and doctors laid low by long covid after months of tending the sick and dying. So, too, do a number of our less hidebound MPs, like Debbie Abrahams and John McDonnell, who has suggested that the number suffering from ME/CFS is likely to be over a million, rather than the much quoted statistic of 250,000 – 300,000. Unfortunately, parliament lost a number of exceptional advocates for that same cause, including former health minister Sajid Javid, and the SNP’s Carol Monaghan.

The Kendall-Reeves conundrum is that targeting the working age sick and disabled is a gamble  which could – and given the precedents, probably will – go wrong. The Institute of Fiscal Studies has described it as, at best, a ‘coin toss’ with ‘at least a 50-50 chance’ she’ll be forced to abandon her fiscal rules and put up taxes in her autumn budget. The black swans, from Trump’s tariffs to a continuing Ukraine war, are already casting shadows over the UK economy. The last thing the UK needs at the moment is a public health crisis rooted in the deepening poverty of some of the most vulnerable people in our society. 

PSYCHO POLITICS; DIAGNOSING LABOUR’S DISSOCIATIVE DISORDER

Sometimes ya just gorra laugh, as Cilla used to say. At other times it’s not so funny.  Department of Witchcraft and Punishment (whoops, sorry, Work and Pensions) sachem Liz Kendall and business secretary Jonathan Reynolds have commissioned a ‘Keep Britain Working’ review from Sir Charlie Mayfield, ex-boss of the John Lewis Partnership, a firm which is reportedly laying-off around 11,000 of it 74,000 shop floor ‘partners’ and has closed around 16 of its stores. Wherever all these new jobs for the working-age sick and disabled are going to be magicked up from, it’s not going to be the retail sector, obviously. So why did they hire this particular expert?

It’s an old Blairite ruse, as it turns out. Indeed The Guardian’s Owen Jones writes of ‘Groundhog Day.’ Almost 20 years ago a target driven system of quotas and ‘statistical norms’ was devised by Labour adviser David Freud and ‘happiness tsar’ Lord Layard. This decreed that the numbers of benefit claimants should be strictly limited. On the basis of no evidence whatsoever, Freud, a city banker with a £2m London townhouse, an 8 bedroom Kent mansion, and a peerage on the way, concluded that two thirds of sick incapacity benefit recipients could be re-classified as ‘fit to work’ – possibly for as little as £2 per hour. 

In 2008 Lord Layard, an economist, came up with the Improving Access to Psychological Therapies initiative (IAPT). A later NHS England report Investment in Mental Health; announced that the IAPT programme could ‘generate savings in excess of £300 million by March 2015 through reductions in healthcare usage and Exchequer savings through helping 75,000 people move off welfare benefits.’ It was anticipated that ‘by the end of 2016/17 a net financial benefit of £4640 million is expected as the provision and utilisation of accessible evidence-led therapies increases.’ 

The fact that none of this worked doesn’t seem to have altered the ‘maladaptive cognitions’ of our new political elite, which still seems convinced that scapegoating the working age ill is the great panacea which will solve all our economic woes. In July 2024 newly appointed DWP minister Liz Kendall set up a ‘Labour Market Advisory Board’ under her ‘Pathways to Work’ programme. Every member of her eight-strong commission was an economist. There was no input at all from the public health sector, though the DWP did vaguely establish a ‘panel to consult disabled people’ through ‘stakeholder engagement forums.’ 

Even before its publication Dr O’Sullivan’s The Age of Diagnosis; Sickness, Health, and Why Medicine has gone too Far was being cited by health minister Streeting on Laura Kuenssberg’s Sunday show to back up his specious claim that the problem with the welfare budget was that too many people were being ‘over-diagnosed’ as sick and disabled. How very convenient, from a cost-cutting perspective.

Again, The Guardian pitches in with a fawning promo by Adam Rutherford who deems it ‘A doctor’s brilliant study of the dangers of overdiagnosis, from ADHD to long Covid’ and continues ‘modern life is making us sick, goes the ill-informed mantra. Thankfully, Suzanne O’Sullivan is here to help, and her voice deserves amplification.’ Really, Dr Rutherford?

Let us briefly triage the O’Sullivan hypothesis and its slightly creepy precedent the DWP funded Malingering and Illness Deception Conference held at Woodstock, near Oxford, in 2001. This event was staged to sell the notion that a great many welfare claimants had been seduced into the delusional belief that they were rendered ill by the easy availability of social welfare provision, thus the state should seek to discourage the ‘growing inclination to medicalize social deviance’ by those indulging in ‘deviousness and manipulativeness.’ 

One of the 39 delegates at this particular junket was psychiatrist Simon Wessely, credited with coining the phrase ‘the medicalization of malingering.’ His conference paper argued that;

” – the key stimulus [to malingering] was the introduction of progressive social legislation in Bismarckian Germany between 1880 and 1890, with the Workmen’s Compensation act of 1908 and the National Insurance Act of 1911 playing a similar role in the United Kingdom. This legislation appeared, to the medical profession at least, to allow financial rewards to malingering.”

The welfare state, in other words, was a morally corrupting force. The more you provide the sick with alms, the more you encourage them in their folly and wickedness. While the founder of ‘The Wessely School’ wasn’t quite suggesting laying the afflicted out on a hill to die, he wasn’t brimming over with compassion either. 

The spirit of Wessely’s anti-welfarist neo-liberal critique and it’s sub-text of forcing the ill back into work has now been usefully revived by Dr O’Sullivan almost quarter of a century later, just in time to serve as a handy adjunct to the government’s need to save Rachel’s blessed fiscal rules and slash Liz’s departmental budget. 

As an example of collaborative propaganda this one pumps on all cylinders. That Wes Streeting had been fed a line from O’Sullivan’s as yet unpublished book in support of Labour’s policy of bashing welfare claimants is a point worth noting. The BBC had obligingly chipped in with a Today interview with O’Sullivan plugging her forthcoming Book of the Week slot, transmitted over five days. She was also poised to make book festival celebrity appearances – Cambridge’s was already sold out. 

Like her fellow Trinity College alumna, Sally Rooney, the author of All in the Head and similar biopsychosocial diatribes is something of a manufactured phenomenon, though at least Ms Rooney only dishes up a mix of bourgeois Irish soft-porn and faux Marxism, where O’Sullivan peddles a harmful denialist pseudo-scientific doctrine which usefully provides ammunition for the present government’s policy of grinding the noses of the sick.

Diagnosing the government’s current dissociative identity disorder and the failure of cognitive communication between its neural upper echelons and its despairing synaptic backbenchers could be quite a challenge for the likes of Suzanne O’Sullivan, but one presentation is patently manifest.

Labour ministers and their advisers would seem to be congenitally incapable of distinguishing between the fiscal and the clinical. Why, otherwise, would Liz Kendall be appointing a commission of eight economists to sit in judgement on what is essentially a public health crisis? Why would Wes Streeting be rebranding his health ministry as ‘no longer simply a public services department – it is an economic growth department’ as he spouts ‘I want to end the begging bowl culture – I want to deliver the Treasury billions of pounds of economic growth’? And who on earth thought it might be a clever idea to hire a boss from the country’s beleaguered retail sector to come up with a ‘Keep Britain Working’ report? 

Cilla was right, it seems, though nobody’s laughing.

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