It seems fair to say that grisi siknis was named before doctors worried too much about the niceties of political correctness. This disease mainly afflicts teenage girls on Nicaragua’s Mosquito Coast. Symptoms vary, but it often begins with a hallucination, a visitation from a terrifying man in a hat — sometimes described as the Devil. Next come the convulsions, the tremors, the superhuman strength that means many from the village have to hold the girl down.
The symptoms are real. The cause, the Miskito people believe, are demons. It is, writes Suzanne O’Sullivan, a “biological disorder induced by something spiritual”.
And the name? Grisi siknis is a Miskito term that has its roots in two English words: “crazy” and “sickness”. From a Western perspective it’s hard not to first feel slightly shocked by it, then to feel, guiltily, it’s a little apt. The illness in these girls came in through their minds.
And yet, would we use similar terms to describe teenage girls who claim to get ill en masse — as they do — after receiving the HPV vaccine? Or the children of asylum seekers who fall asleep — as happened in Sweden — for years while their parents’ claims are considered?
Would we — and here’s where O’Sullivan’s book starts to get a little controversial — apply it to the members of the US embassy in Havana who are convinced that the Cubans have been attacking them with a sonic weapon? Or even — and this is where O’Sullivan, a neurologist, gets a lot controversial — to boys diagnosed with milder forms of ADHD?
These days we have another name for the various crazy sicknesses that afflict humans. We call them functional neurological disorders or, more commonly, psychosomatic illnesses.
A Bitter Pill to Swallow
No one, not doctors, not O’Sullivan and most definitely not patients, is overly happy with that label. Psychosomatic means “mind” and “body”. It is about what happens when a malfunction in one loops back into a malfunction in the other.
Humans have problems with psychosomatic illness. There is the harmful idea people have that patients should just “snap out of it”, and, perhaps, a view among patients that they are in some way morally negligent for not being able to. This has long beset psychiatric illness, although society is getting more understanding.
There is, though, a deeper problem with these kinds of psychosomatic illnesses. It’s that the vector is thought itself. It is the idea of the disease that causes the disease. The medical system, O’Sullivan argues, can be the cause as much as the cure.
The first case of what is known as resignation syndrome was recorded in the early 2000s, although it may have been around for longer. In Sweden, the children of asylum seekers began to fall asleep — and they didn’t wake up for months and years. They resigned from life.
Nola, a Yazidi from Syria, was one of them. She had been asleep for 18 months when O’Sullivan visited, entering the twilight of her room to see the ten-year-old lying in “a pink dress and black and white harlequin tights … She looked serene, like the princess who had eaten the poisoned apple”, O’Sullivan writes. “As Nola’s hand lolled over the side of the bed, the dog nudged it with his nose, but she didn’t respond.” Recently, her sister had joined her.
These children, and hundreds of other sleepers in the surrounding area, have been scanned, prodded and jabbed. They have been case studies in medical journals and front pages in newspapers. They should not be, according to conventional medicine, ill. There is no biological explanation for their predicament. Yet they are also, according to any reasonable definition, very ill indeed. The only sign of Nola’s struggle was her rigid cheek muscles, her teeth clenched shut.
No ten-year-old, no matter how determined, fakes sleep for years. Something is badly wrong with these children and you can no more blame their brains for acting in this way when exposed to the peculiar pressures of their lives than you could blame their lungs for reacting when exposed to Covid. Equally, you can no more expect them to pull themselves together than you could expect someone on a ventilator in ICU to do so.
And yet, it seems, the only reason they are ill is that they knew of others who are ill. This isn’t a disease of ethnically Swedish people. It isn’t a disease of stress — though that is almost certainly a cause. It isn’t even (until its fame spread) a disease of asylum seekers.
It is a disease that affects a particular group of people (asylum seekers) in a particular geographical area (Sweden) and it does so precisely because people believe that it affects a particular group of people in a particular geographical area. They “searched their bodies”, says O’Sullivan, “and played out the story predicted for them”. As with a subatomic particle, the act of seeing the illness, of naming it, brings it into existence.
A Mind of Its Own
O’Sullivan’s beautifully written book interweaves the stories of those afflicted in this way around the world, in a travelogue of illness that is ultimately a travelogue of our own irrational, suggestible minds. She does not spare those of us in the West who might claim to have transcended such suggestibility.
“Psychosomatic symptoms have a social life that moves with the times,” she says. “The recent exponential rise in the reporting of food intolerances comes in large part from modern folklore.” The French, meanwhile, have a disease unique to their medical literature, called “heavy legs”.
She talks about her own patients, including a young woman called Siena who was diagnosed in her teens with a fainting condition, who then spent the next ten years picking up “so many chronic medical problems, all without proven pathology, that she will never be able to live in the world normally”. In a world where patients demand diagnoses and doctors want to pretend to omniscience “the accumulation of new and expanded medical categories is a collusion between doctor and patient”, she writes.
This is why she worries about conditions such as ADHD. She does not dispute attention deficit hyperactivity disorder is real, but “my concern is about the long-term harm to those children in the grey zone of the diagnosis… The child may identify with the label and fulfil the prophecy associated with it.”
Although she writes with compassion, O’Sullivan’s book will anger many, not least, I suspect, its subjects. Almost all of those she visits reject the idea that their disease is psychosomatic. In all cases there are competing explanations, albeit some that involve demons. There are many too who are chronically sick in Britain today who will see in her writing veiled accusations toward their conditions — implications that they too are, in some sense, suffering from diseases created by their minds.
What is most profoundly unsettling about O’Sullivan’s book though is the realization of just how sick your own mind can make you. The brain can create and maintain a real, crippling illness from which it is unable to extricate itself. And there are few good answers for curing it.
Modern medicine can treat the brain and it can treat the body. But when the act of treating is part of the feedback loop that causes the pathology, when it provides the validation, refutation, the theater of illness, what do you do? What if diagnosing spreads the contagion? What if reading this book does?
Doctors have tried their best, but resignation syndrome has only one known cure: a successful asylum application. Grisi siknis too has been treated with epilepsy drugs and benzodiazepines, to no avail. The only intervention with proven results is a shaman, a ritualistic process with all the symbolic power in its own context of gaining Swedish nationality in another.
It is a measure of how effective O’Sullivan is at describing the dilemmas and difficulties of treating psychosomatic conditions that, by the end, a visit to a witch doctor begins to feel like the most sensible medical intervention in the book.
Tom Whipple covers science for The Times of London