Head First

 

As frequently happens these days, I was alerted to this book by Susan Green and immediately ordered it in at the library. Head First is subtitled A Psychiatrist's Stories of Mind and Body, which is a very accurate description. Having worked for years as a physician in hospitals before becoming a psychiatrist, Alistair Santhouse is in a good position to assess how mind and body intertwine. I was struck by his observation that we often seek medical explanations of physical -- I was going to say symptoms, but that in itself implies a larger Something Wrong -- sensations might be a better word, perhaps? when sometimes there is no physical explanation, or the true culprit is a state of mind rather than a disease. 

Santhouse's account of the spiral of ever more tests and scans producing diminishing returns, perhaps ruling out one explanation, but not settling on a definite cause, reminded me of Atal Gawande's Being Mortal, where he described how treatments can also spiral endlessly while producing less benefit each time. It seems it's easy to become trapped in the medical cycle, whether at the stage of diagnosis or treatment, but so difficult to extract oneself.

Santhouse's stories of individual patients are fascinating and often moving, and they don't all have happy endings. He is especially insightful when he criticises the shortcomings of the hospital system -- overworked staff, a loss of team spirit, a lack of care and empathy for staff that trickles down to patients. There is even a final chapter reflecting on Covid. A thoughtful, wise and intriguing read.