I can’t resist quoting Morrissey on hypochondria and the mind-body connection. His musings on the topic are apt, and appropriately elusive and unequivocal. In the Smiths’ song “Still Ill,” he warbles:
“I decreed today that life is simply taking and not giving/ England is mine, it owes me a living… Does the body rule the mind or does the mind rule the body? I really don’t know… Am I still ill?”
Morrissey’s unanswered, unanswerable queries about the links between body and mind, depression (and other psychic maladies) and physical illness, are an essential aspect of modern medical and psychological inquiries. And a particularly fascinating, pervasive and little-understood (although amply postulated) intersection between the mind and body is that set of anxieties colloquially referred to as “hypochondria.”
Definitions and Descriptions
The term “hypochondrium” makes its earliest appearence in the writings of Hippocrates, where it is used to describe an anatomical region below the ribs. In the second century A.D., Galen of Pergamon, an influential physician, used the term to refer to a series of digestive and abdominal disorders. Additional connotations evolved over a period of centuries. In the 1600s, “hypochondria” was used to describe a melancholic disorder that was also characterized by indigestion and vague pains, and the disease acquired a certain chic. Its attendant physical and emotional sensitivity was associated with exceptional intellectual and artistic abilities, and, rather more subtly, with the upper classes.
Though hypochondria has become a more proletarian—and more widespread—malady, it has no shortage of distinguished sufferers. Notorious hypochondriacs include Samuel Johnson, Alfred Lord Tennyson, Charles Darwin, Florence Nightingale, poet Sarah Teasdale, and Howard Hughes.
In the nineteenth century, the definition of hypochondria narrowed; the term began to be used to refer specifically to an excessive fear of illness. Today this association remains, though there is a distinction between colloquial and medical or psychological usage. Referring to someone with health anxieties of varying severity as a hypochondriac is common, but the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) defines hypochondriasis as the preoccupation with fear of, or the belief that one has, a serious disease, based on the misinterpretation of physical symptoms.
According to DSM-IV, hypochondriasis is both long-lasting and significantly disruptive: the manual defines the disorder as a preoccupation with disease that lasts for six months or longer and causes impaired functioning at work or school and in social situations. Persons may be afflicted only by hypochondriasis (referred to as primary hypochondriasis) or by additional psychiatric disorders, like depression, general anxiety, obsessive compulsive disorder and panic disorders.
Easthampton psychotherapist Manfred Melcher described the psychic and somatic overlap which has long confounded health professionals and lay people: “Given the strong mind/body connection,” he said, “teasing apart physical and emotional symptoms is difficult at best and often requires on-going assessment. … Respect must always be given to potential medical issues/concerns.”
Melcher noted that many sufferers of generalized anxiety disorder have “notable, sometimes obsessive, health concerns as well.” His findings are not unusual according to a 2006 estimate that hypochondria occurs in an estimated .8 percent to 3 percent of the population in America; another recent study reported that as much as 6 percent of the population might suffer from the disorder.
Causal Factors
Theories about causes of hypochondria and health anxieties are disparate and diverse. Formative childhood experiences (especially early childhood hospitalization and surgery), the untimely or unexpected death of a peer, the presence of a chronically ill or hypochondriac family member, all are thought to increase an individual’s risk of suffering from severe health anxieties. Susan Baur, psychologist and author of the comprehensive study “Hypochondria: Woeful Imaginings,” also makes a persuasive (though largely inferential) case about chronic hypochondriacs’ use of their disease phobias to exert control over other members of their households.
But what about a lay person’s health anxieties—those not severe or long-lasting enough to merit diagnosis as “acute” hypochondriasis? Popular, plausible theories about the media’s impact on individuals’ perceptions of their health abound. A 2005 article in the APA’s Monitor on Psychology cites a study claiming that “the more a society promotes healthy lifestyles, the more people worry about their health and the sicker they feel;” the point is supported by contrasting the frequency of self-reported illness in the poorest state in India with that in the United States. And an article in the Washington Post titled “The Irony of Fear” noted that many of the most-reported diseases affect very small population swaths and actually result in relatively few deaths.
The article emphasized that the life spans of Americans have increased by 60 percent in the last century: “We live…largely disease-controlled lives. And yet, we worry more than ever.” Excessive, often conflicted or inconclusive studies about health and disease are amply publicized in every magazine on the newsstand, and publications and advertisements also encourage patients to be pro-active, insistent and informed with regard to their medical care.
Then, of course, there are innumerable anecdotal stories about health—and terrifying diseases—published online. The authors and publishers of such articles may mean well, but for a portion of the population they can do more harm than good. In fact, a catchy term has been devised for those who read about diseases obsessively on the Internet: cyberchondriacs. A Boston-based psychotherapist who has done extensive work with hypochondriacs, Dr. Arthur Barsky, encourages those with hypochondriac leanings to help manage their anxiety by avoiding what might be termed “yellow health journalism.”
A third predominant theory about the origins of hypochondria or severe but short-lived health anxieties attributes those problems, unsurprisingly, to stress. In “Woeful Imaginings” Baur offers the case study of a young woman who had recently left home to study abroad. At some point, she began to channel the loneliness and anxiety caused by her displacement into fears about throat cancer.
Manfred Melcher echoed Baur (and numerous other experts) on the relationship between external stress factors and health anxieties. Melcher noted the timeliness of my queries as we corresponded between Christmas and New Year’s: “Major holidays are a notable time of increased psychosomatic complaints and are predictable periods of increased help-seeking behaviors. The relation [of health anxieties] to stress is clear in such circumstances… the holidays are associated with family and therefore bring forth dynamics or the memories of events that may be painful, grief-filled, traumatizing or simply stressful. … For individuals with strained family relations, the holiday season activates issues that simply can’t be suppressed. Often the body becomes the ‘expressive voice’ of the mind or soul.”
The Good – and Bad – News
Robert Lowell, that notoriously pathological poet, wrote memorably in a lost-love poem called “Obit” that “in the end, every hypochondriac is his own prophet.” Lowell’s wry pragmatism (or fatalism) about health anxieties has its share of truth; however, as noted before, alarmist headlines about health are consistently inflammatory and incendiary. Longevity in America is very high.
If health anxieties do become worryingly acute and disruptive, individuals have recourse. Though empirical studies about patients’ response to hypochondria treatment are not abundant, certain findings are promising. Cognitive-behavioral therapy is a relatively effective method of treating obsessive thoughts of disease. Education about psychosomatic ailments has proven to lessen stress for some of those anxious about health, particularly children. Relaxation techniques may be helpful for some individuals. And preliminary studies have shown that antidepressants have some efficacy in treating health anxieties as well. Psychotherapy may help individuals understand underlying issues that contribute to their expressions of stress.
But don’t trust me—trust the experts. If you’re constantly wondering about illness or experiencing worrying symptoms, take Manfred Melcher’s advice: consult “a licensed, well-trained professional” for help navigating “the abundance of data…[and] the mental health system.”
