A reader’s synopsis

In this ground-breaking and highly original book Joanna Wildy, a cranial osteopath with over 30 years of hands-on clinical and teaching experience, asks why society is buckling under a tsunami of mental health problems, despite a century of scientific advances. The central problem she argues, is that the dominant model of diagnosis, with its fondness of labelling rooted in the DSM-5 Manual of Mental Disorders, conflates symptoms with causes and takes minimal interest in locating the specific origin of each individual mental health problem. Without a clear location of the root cause (or dimension of causes) of a person’s distress, patients cannot be directed towards a therapeutic approach which is going to be safe, relevant and effective.  At best this leaves millions of people suffering with chronic mental health issues, with all the personal, social and economic consequences this involves. At worst (as we learn in the tragic case of her patient Peter) it can lead to suicide.

Using the simple and effective image of a stack of Russian Dolls Joanna Wildy sets out an intricate map representing six dimensions at which mental health issues may arise, from the level of genetically inherited molecular building blocks, up through increasingly complex systems to the levels of the whole human being and of society itself. A label such as ‘depression’ merely describes a collection of symptoms, she explains, not their specific causes. These symptoms may originate ‘top down’ (for example from environmental stresses such as dysfunctional family dynamics or poor housing, or wider collective threats such as war or ecological collapse) or ‘bottom-up’ (for example from a compromised neuroendrocrine system leading to hormone imbalance, or a head injury that has altered the vital membrane that houses the brain itself).

This brings us to the seminal core of Wildy’s book which is her fascinating account of the fundamental role played in mental health by the sensitive, endlessly adaptive and protective membrane, the ‘dura mater’, that houses the brain within the skull and encloses the spinal cord. Seduced by the extraordinary discoveries concerning the neurobiology of the brain itself that have resulted from advances in brain-imaging technology, the membrane has been largely unrecognised in diagnosis across the board. Yet this most intimate of environments is key to facilitating adaptation to physical traumas to the head, ranging from orthodontic treatment and childhood falls, to sports injuries and more serious accidents. These impacts are rarely taken into account in the initial case history enquiry and are not readily observable through MRI and other scanning techniques.

Wildy explains that when placed under excessive strain, the membrane becomes fatigued and distorted, placing pressure on parts of the brain that can cause a wide range of mood disorders and psychological symptoms. The good news is that in many of these cases, a cranial osteopath with the right training can use ‘palpation’ to relieve the strain and restore membrane functioning, resulting in clear improvements in mental wellbeing.  At its simplest, palpation means using a sense of touch to perceive something which can’t be seen (Wildy compares it to the art of listening to a Mozart concerto). It requires the practitioner to learn to feel at a very deep level.

Joanna Wildy’s book is essential reading for the full range of therapeutic practitioners concerned with mental health, including psychiatrists, neurologists, psychologists, psychotherapists and counsellors, physiotherapists and osteopaths. It offers all of us a salutary reminder that there is no cure-all approach. Right at the heart of ethical practice lies the need to be clear concerning the scope of any specific competence and training. Only by placing our own specialism within the bigger picture can we respect the subtleties and skills of other practitioners and truly understand the specific application, range and limits of our own field of expertise. Reading Joanna Wildy’s book I have come away with an enormous respect for the years of compassionate, intelligent and sensitive enquiry that have refined a practice of diagnosis and hands-on treatment that has clearly saved lives and rescued many others from a lifetime of misunderstood suffering.

Susan Holliday is a psychotherapist and author of Hidden Wonders of the Human Heart: How to See Through your Sorrow (Matador, September 2021)