I’ve been trying to decide which of my encounters with doctors, the ones from the early days of my illness, was the most mortifying, the most frustrating, the most burdened with assumptions about young women and their bodies and brains. But I can’t seem to be able to do it. Not because there were so many, too many to choose from—there were—but because I know I wasn’t thinking like this at the time, that I was so new to sickness and, more importantly, to medicine, that I still assumed it was unfailing and perfectly rational, that if I answered all the questions and did everything the doctors told me, we would uncover what was wrong, then they would treat it, and then it would go away. I’d go back to how things were before, pick back up from where I’d left off, before this brief interruption to my normal life. What I’m saying is: it took me years to get this angry.
Instead, I keep circling back to an encounter I’ve written about before, one that I can’t quite let go of, in part, I think, because the memory isn’t mine. I know the context: it was my second, maybe third, appointment with a gastroenterologist, in his shiny office tower overlooking the train station at Miranda, and tucked in between brown-bricked shopfronts and run-down apartments with patchy gardens of prickly natives. We were discussing a battery of test results that had all come back negative—I’d been collecting negative test results for almost a year by this stage, and couldn’t help but meet each one with a weird mixture of frustration and relief: relief that I didn’t have whichever particular awful condition each procedure tested for, and frustration that yet again I didn’t have an answer. I can’t remember his face, or his voice, or what was on his desk, I can’t remember the specifics of what he said. But my mother was with me at this appointment—I can’t have been older than just 18—and in her retelling of it, the doctor finished his explanations, turned to her and asked, ‘Why is she doing this?’
In my mother’s retelling of this, she was furious, but I can’t remember feeling the heat of the moment until long after the moment had passed. And when she tells this story, she always replies, ‘She’s not doing anything, this is happening to her’—although I’m not sure if she said that at the time, or later in the car, or if it was one of those reactions that women leave unsaid, because we don’t want to cause a fuss or any offence. She’s not doing anything, this is happening to her: I didn’t know, at that stage, that I would have to keep insisting on this for years. Maybe that’s why I can’t stop thinking about it now.
Or maybe I can’t stop thinking about this because when my condition was finally diagnosed, months and months later, the doctor who did so—another gastroenterologist, to whom this first one had referred me when he’d realised he was stumped—said something remarkably similar: he looked me in the eye (even this was remarkable enough) and said, ‘You’re not crazy, and you’re not doing this on purpose.’
It was so important, by that stage, to hear those words. Not because I had been starting to believe that I was crazy, although this would have been entirely understandable, given how often I was stared down by specialists, how often they asked me, in ways they thought were cagey but were actually terribly clumsy, if I might possibly be vomiting on purpose, or if I was absolutely certain that I couldn’t be pregnant (I had, at the time, only slept with women, and even then, not for the best part of a year). Instead, it was important to hear those words because I was starting to believe that everyone around me thought me crazy—I could see it in the knowing, faintly disapproving look they’d give me when I returned to the table after rushing off to find a toilet, could hear it in their deliberately measured voices when they’d ask about my illness—and this itself was maddening.
I knew I wasn’t crazy, wasn’t doing this on purpose, but when that doctor said so too there was still something that fell away. Some weight of doubt, or of disbelief, or even of invalidation. Someone finally believed me, and more importantly, someone finally knew—and could name—what was happening to my body.
• • •
In the nineteenth century there was a disease called chlorosis, or green sickness, or the disease of virgins. Green sickness because it caused a pale, greenish complexion, alongside lassitude, sadness, shortness of breath, loss of appetite or the development of a ‘perverse’ appetite for dirt or stones (we call this appetite ‘pica’ now and classify it as a rare kind of eating disorder). The disease of virgins because it was caused by menstrual blood becoming trapped in the womb—presumably by the hymen—and turning toxic and poisonous in the young women—it was exclusively young women—who developed the disease.
In the twenty-first century, this disease is thought to have been anaemia, caused by a lack of iron in the diet.
• • •
When I had that conversation with that doctor, when he finally found for me a diagnosis, it was 2003. When I talk about the diagnosis, even now, I mostly don’t name the condition, because so few people—medical and lay alike—have heard of it that the words are almost meaningless in any practical sense. And because this too is complicated by the fact that the important word, the rumination of rumination syndrome, is shared with a psychological symptom of anxiety: rumination as obsessive and circular thinking over one idea or event—and this is by far its more common usage. But my kind of rumination is derived from the physical, rather than the mental, sense of ‘chewing over’, that which is done by ruminant animals, such as cows and sheep and camels, which bring up food from one part of their stomach so they can chew the cud, before reswallowing it for further digestion. (The joke I’d always make: it’s like what cows do, but instead of a second stomach, I have a toilet bowl.)
That conversation, you’re not crazy and you’re not doing this on purpose, and that diagnosis, came in 2003. Ten years later, in 2013, rumination syndrome was added to the fifth and newest edition of the DSM, the Diagnostic and Statistical Manual of Mental Disorders, the thick and textbook-ugly index of mental illness and disorders, developed by the American Psychiatric Association, and widely considered the authority in the field. Ten years after I was diagnosed, that is, my illness was suddenly recategorised: it was no longer a disease of the body, but one of the brain, just as 40 years earlier (in the DSM-2) my sexuality had been reclassified, from a pathology and a perversion and a thing that needed fixing, to a normal part of human diversity and experience.
• • •
A 1972 gynaecology textbook, with the definitive-sounding title Gynecology and Obstetrics: Current Diagnosis and Treatment, claimed that nausea experienced during pregnancy ‘may indicate resentment, ambivalence and inadequacy in women ill-prepared for motherhood’.
Current estimates show that up to 88 per cent of women experience nausea—morning sickness—during pregnancy. (I also don’t know a single person, woman or man alike, who has been anything but ill-prepared for parenthood.)
In the 1960s and 1970s, excessive pain in labour (as determined by a male doctor, of course) was also considered a symptom of ambivalence about, or incomplete acceptance of, the mother’s ‘feminine role’, as were miscarriage or premature delivery, and pre-eclampsia.
• • •
Reclassifications, redefinition, diagnostic shifts: these happen in medicine all the time, of course they do, because scientific knowledge is always growing and changing, always uncovering new things and re-evaluating what came before. They happen when new imaging technologies are developed, allowing scientists to see inside the body and its tissues in greater detail, or with a greater ability to differentiate between structures and cells. They happen when new fields open out, alongside discoveries of germs, microbiomes, DNA.
But they also happen because the society that medicine exists in changes too, and as this happens there are shifts in our ideas about what is disorderly or unruly, what needs treatment and what needs acceptance, what is delineated and described in medical terms. It’s great that this happens—that we no longer pathologise any sexuality that isn’t exclusively hetero, or believe that young women can be poisoned if they wait too long to marry—but it doesn’t reconcile easily with our popular understanding of medicine, and of science—as entirely rational, systematic, empirical.
At least, this is how I thought of medicine—rational, systematic, empirical—before I became ill. Before it took more than a year and a half to find a diagnosis, only to be told that it couldn’t be treated, before that diagnosis then drifted, before I encountered uncertainties and bold assertions, as well as some truly awful assumptions. Before I realised I was an outlier and an ambiguity, and didn’t fit neatly in any of the existing medical frameworks—before I realised that this meant that doctors didn’t really know what to do with me.
I returned to see the doctor who gave me my diagnosis, at the advice of a psychiatrist, just after the change in its classification occurred. This timing was coincidence: by that stage, I knew I also had anorexia, and was struggling to treat it because the rumination meant that I kept vomiting when I tried to eat the things that made me frightened. The psychiatrist I’d been assigned to in the local public hospital thought it might be worth revisiting this doctor, in case medical knowledge had moved on in the decade since my diagnosis, and new treatments were now available—‘Ten years’, he said, ‘can be a long time in medicine’ (and it’s only now that I appreciate just how true this is). This time, I sat in front of the doctor, who didn’t remember me at first, and explained how trying to manage my rumination had led me into an eating disorder, and he replied, ‘Well, the difference is academic.’
This time, he was saying, you are crazy, and you are doing this on purpose.
• • •
In the 1960s the ‘typical patient’ with endometriosis was said to be overanxious, intelligent, egocentric and perfectionistic, and these characteristics were implicated in the development of the disease. A 2003 study found that women reporting infertility to their doctors received a diagnosis of endometriosis in half the time of those reporting severe and even crippling period pain.
Some doctors still consider chronic fatigue syndrome to be an illness caused by an inability to deal with the constant speed, pressure and restlessness of modern life—the same conditions that were said to cause neurasthenia, a ‘disorder of capitalist modernity’ thought to fray the nerves of women living in the newly mechanised, early-industrial late nineteenth century. One neurologist blamed neurasthenia on overstimulation caused by ‘sensational newspapers, the steam engine and the telegraph’.
• • •
I only recently discovered that the changed status of rumination syndrome isn’t as complete as I was told, by any doctor or specialist in the intervening years. Rumination syndrome is still listed, that is, in the International Statistical Classification of Diseases and Related Health Problems (the ICD)—which is essentially the physical-illness counterpart of the DSM, for diseases of the body rather than the mind. Or rather: the ICD is the manual upon which the DSM was modelled, in no small part as an attempt to prove the legitimacy and solidity of mental illnesses and psychiatric practice alike. The DSM, that is, adopted the conventions and metaphors that existed for physical illnesses to delineate and describe the kind of illnesses that psychiatrists were dealing with, as if this were the only way to make them intelligible. But it’s troubling to me that there are two books, two distinct sets of listings for two categories of illnesses that aren’t always neatly discrete. And what it means here is that my illness exists, officially, in two different spheres, or in both simultaneously, or even somewhere somehow nebulous and in-between.
In the ICD, rumination is considered a ‘disease of the digestive system’ and a ‘functional gastrointestinal disorder’—but it’s also accompanied by the caveat that the condition cannot be considered to exist in a patient who also has anorexia or bulimia nervosa.
This too I consider ridiculous—because rumination causes such frequent spontaneous and unintended vomiting, because it meant that I was throwing up within minutes of finishing almost all of my meals, because it’s uncomfortable and embarrassing and still occasionally terrifying, I don’t see how anyone with this condition could end up with anything other than a difficult relationship with food. To me, and for me, anorexia is a consequence of rumination syndrome, and definitely not a cause.
But the thing that unites both classifications of rumination syndrome is the idea that the condition is ‘functional’. It’s a strange word, functional. In medical terms, it means that the illness is ‘inorganic’, or unrelated to any ascertainable physical abnormality. Some physicians call conditions like this ‘medically unexplained’, because the technology that we have so far can’t determine a definite cause. There is one medical test for rumination, whereby a monitor is inserted through the nose and throat to sit at the top of the stomach, and measure the muscular tics and spasms there that cause the vomiting. When I had this test, incidentally, I threw the monitor up—or as the doctor so much more elegantly put it, I was ‘unable to tolerate the procedure’. But all this monitor can determine, if it does stay in place for a full day, is that the muscles are behaving inappropriately—there’s still no way of understanding what the mechanism is that makes this happen. And so the dysfunction—these last few years at least—has been determined to be functional. Which is really just a cagey way of saying, this woman is hysterical.
• • •
In the nineteenth century, migraines were said to especially affect women with excitable brains, acute senses, a nervous temperament and a vivid imagination. A gastroenterologist in that same century claimed that migraines were suffered by women who were ‘either psychopathic, or else … over-working or worrying or fretting, or otherwise using [their] brain incorrectly’. Also blamed were ‘marital infelicity’, sexual maladjustment or thinking about divorce.
We still don’t understand entirely what causes migraines, but have evidence that imbalances in brain chemicals—especially in serotonin, which regulates pain in the nervous system—are involved, as well as changes in the brainstem and the trigeminal nerve.
• • •
Of course, no-one, in medicine at least, uses the term ‘hysterical’ any more. It’s still attached, in common usage, to women who are too emotional, too opinionated, too political, too much—indeed, to the kinds of women who may very well have been given this diagnosis during its heyday in the nineteenth century, who are somehow still considered societally uncouth, but doctors, at least, have moved on. Instead, conditions such as rumination syndrome are referred to, variously, as somatisation (from the Greek soma, for body, implying a kind of embodiment of unknown forces), as conversion (as in the body converting psychic pain into something physical), or as psychogenesis, generated in the mind. But the idea behind all of these labels is the same, that it’s impossible for the patient consciously to express their emotional suffering, so the body finds a way to do it for them. Somatisation is the body rebelling against repressed trauma, at best, or the patient unconsciously crying out for attention and care (for what doctors call ‘secondary gain’) at worst. Which is not to say that the patient has any control over the symptoms, or awareness or suspicion that they’re anything other than purely physical. It is not to say that the symptoms are not real.
Somatisation is an idea that permeates our culture, if not always explicitly—I’ve lost track of how many novels I’ve read where the protagonist suffers an illness that operates as a metaphor for who they really are or what they secretly desire—a literal broken heart standing in for a figurative one, say, or an itchy rash that expresses an existential discomfort. Susan Sontag, in her famous Illness as Metaphor, points out that these kinds of analogies (she calls them ‘fantasies’) are more likely to become attached to diseases that are poorly understood—that because medicine can’t ascribe them a meaning, cultural forces step in instead to make them sensible, intelligible. Sontag also writes that ‘psychologising seems to provide control over the experiences and events—like grave illnesses—over which people have in fact little or no control’. If we understand an illness as psychological, that is, it is no longer unexplained, no longer mysterious in its manner of attack. It is no longer something that could happen to you or me.
But doctors are divided about whether or not somatisation actually exists—Chloë Atkins writes that ‘an ambivalence’ has emerged in the medical literature around the disorder since the 1960s; and systematic reviews suggest that an average of 8.4 per cent of people diagnosed with somatisation later have their symptoms explained by other medical conditions within five years (few reviews check back in after more time has passed). In this same period, too, almost one-third of the study participants who die do so by their own hand. I can’t help but think: how awful it is to have your suffering disbelieved.
It’s also worth noting that many people with rare diseases have to wait longer than five years to receive a diagnosis, especially if their condition has vague and changing symptoms (such as fatigue or muscle pain) as many autoimmune or chronic conditions do. Some people wait decades. Women, on average, wait much longer than men.
One more thing about somatisation: it is almost exclusively a diagnosis given to women. There’s a part of me that wishes it were still called hysteria, because at least the gendered and cultural assumptions that underpin that word are transparent, in a way that the newer words are not.
• • •
An old mnemonic to help doctors remember the seven main symptoms reported by somatising patients—Shortness of breath, Dysmenorrhea (painful periods), Burning sensations, Lump in the throat, Amnesia, Vomiting, and Pain in the extremities—advised that Somatisation Disorder Besets Ladies And Vexes Physicians.
• • •
The problem here is that once your illness is deemed psychogenic, the way the medical system treats you changes. Because your illness is suddenly all in your head, your symptoms are something you are making up, or even worse, deliberately making happen. Because your illness is suddenly all in your head, your concern about your symptoms is ‘excessive’ (I always think: come back to me after you’ve been vomiting every day for three months straight and tell me if your concern is excessive). You’re wasting the time and resources of doctors who could be helping people who are properly, legitimately ill. You place, as researchers put it, ‘a disproportionate burden on health services’. Any doctor who pays your symptoms any heed is ‘acquiescing’ to your delusion. You just need to snap out of it.
And once a doctor has determined that your illness is a subconscious expression of something you’ve repressed, there’s no way you can argue against this; because a psychogenic diagnosis is based on the absence of evidence, on the exclusion of everything that can be seen and tested and measured. And just as there’s no evidence that the illness is physical, there’s also no evidence that it isn’t—except for the word of a doctor who probably hasn’t interrogated the assumptions behind the diagnosis for himself (and, let’s face it, it’s usually a man). And if you don’t, or can’t, believe that doctor’s word—well, that’s because there’s something you’ve repressed.
An ancient parable of hysteria tells of a physician treating a man whose paralysis was thought to be psychogenic by asking a servant to run into the room screaming ‘Fire! Fire!’ The patient leapt up from his chair and jumped out the window to escape the danger, and was thereby, apparently, cured.
The first episode of the recent adaptation of The Adventures of Sherlock Holmes sees Martin Freeman’s Watson, an ex-soldier recently returned from Afghanistan, unable to walk without a cane, despite his (beautiful, female) therapist’s insistence that there’s nothing wrong with him physically. Unable, that is, until Sherlock shocks him into chasing after a suspected villain—and Watson runs, dropping his cane, athletic as can be. (‘I was proving a point,’ Holmes later says.)
The second time I tried to get treatment at a public hospital day program, I was told that I would only be admitted if I understood that I’d be thrown out of the program if I threw up, even once. Over the next four weeks, I sat silently at the table, holding my mouth closed and swallowing my own vomit (this is absolutely as disgusting as it sounds) and tearing up at the pain. The program director said, ‘See: it worked.’ I knew better, by then, than to contradict her.
This same director, during my first admission, had researched my condition and informed me that if I used diaphragmatic breathing—those long, slow breaths into the belly and the bottom of the lungs that are used by opera singers and yoga practitioners alike—I’d be unable to activate the same muscles that cause the vomiting and thereby learn to make them stop. I tried this. It helps sometimes, but very infrequently; it also causes me a lot of pain. I remember chasing up the study that this recommendation was based on at my university library—although I’ve been unable to find it more recently—and discovering that the trial had a sample size of five. The technique worked for three of them. But it was presented to me as uncontroversial, as proven medical fact.
In the years since, there have been more trials of diaphragmatic breathing for rumination syndrome, most of which involve fewer than 25 patients. One review suggests that the total number of patients enrolled in all of these trials together is fewer than one hundred; and the overall result seems to be that the technique leads to some improvement for 30 per cent of these participants, and a resolution of the problem for 56 per cent. That still leaves a lot of people for whom the treatment doesn’t work. But no-one ever mentions this.
A psychiatrist, barely three years ago: ‘What exactly is it in this world that you can’t stomach? What are you physically rejecting?’ This same man, when I told him that I don’t have any major traumas in my childhood, replied, ‘I’m sure we’ll find something.’ This same man, when I mentioned Illness as Metaphor, said, ‘I don’t know why you want to talk about that here.’ I’d thought that was obvious.
• • •
In the nineteenth century, people with epilepsy were considered insane, and their seizures were considered caused by debauchery, lust or poor morality. Before that, they were considered signs of demonic possession. In the 1970s, doctors considered epileptics to be impulsive, egocentric, overly religious or philosophical, and humourless, and to display ‘altered sexual interest’, whatever that might mean.
Epilepsy is now known to be a largely genetic condition, or it can also be caused by infections in, or trauma to, the brain. It is diagnosed through the use of an electro-encephalogram, a device that measures electrical currents in the brain, and which was invented in 1929.
Richard Webster argues that at least three of Freud’s five original hysteria patients—such was the size of his sample group—displayed symptoms that could be explained by epilepsy. Katharina’s pressure on the skull and hallucinations, Lucy R’s olfactory seizures (her attacks involved the smell of burnt pudding), Anna O’s lapses in consciousness, paralyses and emotional outbursts—all of these are symptoms of temporal lobe epilepsy. (Freud developed mouth cancer late in life, and one of his physicians, Wilhelm Reich, claimed that there was a logic in this disease attacking the organ responsible for Freud’s ‘beautiful’ speech, at the time when he had resigned, ‘given up hope’. The cancer, that is, he saw as metaphoric, as caused by emotion rather than chance.)
• • •
But here’s what I have to confess: there’s a part of me that still doubts. I know, for example, that the DSM cautions psychiatrists that patients with somatic illnesses can be very resistant to the idea of psychogenesis, because their symptoms are so real. I’ve read studies that try to understand how patients react to a psychogenic diagnosis, and how doctors should try to explain it (in a manner that acknowledges the symptoms, gives tangible explanations for them, and empowers patients to ‘manage problems themselves’), that claim that patients value their subjective experience over what they see as the ‘imperfect techniques’ of doctors, who cannot see and measure everything.
I know I’m not a scientist. I know I’m not a medical doctor, and I’m frustrated by the wider conversations that are happening in our society where people—politicians and wellness practitioners in particular—voice their distrust of experts in fields that are not their own, proclaiming that they don’t believe in climate change, for example, or think that sunscreen and gluten are toxic. There’s a part of me that’s terrified that this is what I’m doing here.
But then I think: the vast majority of the research that exists on rumination syndrome is case studies, which describe the experience of one individual patient, over a period that’s rarely longer than a few years. And I’ve been following my individual case now for 15 years, running countless experiments with this same sample size, and that has to count for something.
I know too that due to advances in technology, or just changes in medical culture, many illnesses that used to be considered hysterical—epilepsy, endometriosis, fibromyalgia, multiple sclerosis, irritable bowel, lupus, Crohn’s disease, migraine, cancers—have moved into the physical realm, just as more and more mental illnesses, including anorexia nervosa, are being discovered to have a strong genetic base. I know that many of these, like rumination syndrome, occur more frequently in women, and that medicine simply doesn’t know as much about women’s bodies as it does men’s, because, as Maya Dusenbery writes, women were excluded from participating in medical research until the 1970s, and even now make up an average of only 37 per cent of trial subjects. I know that women’s reports of pain are taken less seriously than men’s, that women are more likely in emergency rooms to be prescribed tranquilisers where a man would be administered something to relieve the pain, and I know too that the disparity is even worse for women of colour.
I know how easy and undramatic it was for rumination to be recategorised in 2013, and so I know that it’s possible, and maybe even feasible, it will one day shift out of the DSM, back into the physical realm. That medicine might come to understand a reason for my misfiring muscles, some physical and tangible evidence that exculpates the unconscious mind.
And it bothers me that I still feel I have to insist that the disease is purely physical, that I keep on trying to assert that it’s my body, not my brain, that first became unwell. It bothers me that it still feels so important to make this chronology clear, as if the fact of its physical precedent somehow proves that my mental illness is valid, undeserved, even inevitable, as if some part of me still believes that for people whose mental illnesses develop differently, none of these things are true. I don’t believe this. I still can’t let this go. I know that the mind and body are not entirely separate spheres, that I was suffering psychically when my physical illness developed, that coming to terms with both of these facts has been integral to my coming to terms with my anorexia.
But the problem is that I’ve been told that, and treated as if, my physical symptoms uncontroversially aren’t bodily, and that my illness as a whole is therefore completely invalid, when the reality is that we just don’t know. Medicine isn’t good at tolerating the limits of its knowledge, the ambiguous, the unknown. It operates by delineation, by building discrete categories, and struggles to accommodate anything that upsets these. This is a real problem, and it’s this that I’m frustrated with and finally so angry about.
• • •
What bothers me most about the idea of somatisation, I think, is that it is also built upon a terrible irony: it’s a diagnosis that tells women that we don’t believe their reports of suffering and pain precisely by insisting that their bodies are expressing the suffering and pain that they otherwise cannot. It’s a diagnosis that assumes that women should be quiet, that it should be hard for them to speak, that they should feel pressure not to make demands, not to cause a fuss, not to draw attention to themselves. That they should not want to articulate their pain.
I know I’ve struggled with this idea for years, that so much of my treatment, for the anorexia at least, has focused on accepting my own emotionality, on trying to take up space in the world rather than insisting on shrinking away. I know it still takes me two or three days to recognise that I am angry about an interaction or insult, that I still feel guilt long before I register any other emotion, that it can take me a full week before I muster up the courage to let someone know that they have hurt me. And I know that this is common too among my healthy women friends: I’ve caught one of them instinctively apologising when she bumped into a piece of furniture and barked her own shin. What I’m saying is: this idea has leaked into our own brains. (I don’t want to phrase this as ‘internalising’, because the word sounds too damn bodily, too eerily somatic.)
But this whole concept of somatisation would fall apart, and rapidly, if we started believing women. If we started trusting that women know their own bodies and minds as much as anyone else is ever able to, if we took care to remember the long, gendered history of medical ideas and practices and stopped assuming that we have moved beyond this into something objective, rational, systematic. If we accepted that when women speak, it is important to actually listen.
Because they’re not just being dramatic, or hysterical. •
Fiona Wright’s latest essay collection is The World Was Whole (Giramondo, 2018). Her book of essays Small Acts of Disappearance won the 2016 Kibble Award and the Queensland Premier’s Prize for nonfiction.
Chloë Atkins, My Imaginary Illness: A Journey into Uncertainty and Prejudice in Medical Diagnosis, Cornell University Press, 2010.
Maya Dusenbery, Doing Harm: The truth about how bad medicine and lazy science leave women dismissed, misdiagnosed, and sick, HarperCollins, 2018.
Barbara Ehrenreich and Deidre English, For Her Own Good: Two Centuries of the Experts’ Advice to Women, Anchor Books, 1978.
Magnus Halland, John Paldofino and Elizabeth Barba, ‘Diagnosis and Treatment of Rumination Syndrome’, Clinical Gastroenterology and Hepatology, vol. 16 (2018), pp. 1549–55.
M. Halland, G. Pathasarathy, A.E. Bharucha and D.A. Katzka, ‘Diagphramatic breathing for rumination syndrome: Efficacy and mechanisms of action’, Neurogastroentrology and Motility, vol. 28 (2016), pp. 384–91.
Mike McRae, Unwell: What Makes a Disease a Disease?, UQP, 2018.
Sarah Peters, Ian Stanley, Michael Rose and Peter Salmon, ‘Patients with medically unexplained symptoms: Sources of patients’ authority and implications for demands on medical care’, Social Science Medicine, vol. 46, nos 4–5 (1998), pp. 559–65.
Peter Salmon, Sarah Peters and Ian Stanley, ‘Patients’ perceptions of medical explanations for somatisation disorders: qualitative analysis’, British Medical Journal, vol. 318 (1999), pp. 372–6.
Elaine Showalter, Hystories: Hysterical Epidemics and Modern Culture, Columbia University Press, 1997.
Susan Sontag, Illness as Metaphor and AIDS and its Metaphors, Penguin, 2013.
John Stone, Roger Smyth, Alan Carson et al., ‘Systematic review of misdiagnosis of conversion symptoms and “hysteria”’, British Medical Journal, vol. 331 (2005), pp. 989–91.
Richard Webster, Hysteria: Medicine, Psychiatry and Misdiagnosis, 2007, book extract at <www.richardwebster.com>.