We may mock them, but their terror of death and sickness can be a debilitating condition in itself. Brian Dillon unravels the tortuous connections between real and imagined illness through the lives of some of the afflicted
Tuesday, 8 September 2009
Hypochondria is an ancient name for a malady that is always distressingly novel and varied. In anatomical terms the hypochondrium is the portion of the body just below the ribs; in classical medicine, "hypochondria" was a general term for diseases (mostly of the digestion) that troubled that region. But the illness gradually lost its organic meaning and came to denote a purely psychological state. When we use the term today – generally with pejorative intent – it's to describe a tenacious fear of illness, or the mistaken conviction that one is unwell. Hypochondria, for patient and physician alike, is the shadow – often as troubling or frustrating – of real disease.
Why should some of us so misread the messages we receive from our bodies, or inflate in our minds the real health risks we face, that we become debilitated by fear and delusion? Why, when presented with strong evidence to the contrary, do hypochondriacs persist with their concerns, fretfully returning to the same symptoms or embellishing their bodies with new imaginary horrors?
Historically, the illness – for it was, and still is, a disorder in itself – was obscurely related to other popular diagnoses such as hysteria, melancholia and neurasthenia. In the wake of Freud, however, hypochondria seemed merely to mask more deeply-seated neuroses. But a diagnosis of "hypochondriasis" or (in its more contemporary variant) "health anxiety" is once again a common one, and this venerable distemper is now thought to exist on a continuum with other modes of modern worry such as obsessive-compulsive disorder and body dysmorphic disorder.
We can begin to discern the tremulous profile of the modern hypochondriac in medical treatises of the 17th century. For Robert Burton, whose Anatomy of Melancholy (1621) is a colourful compendium of mental and physical ailments, the symptoms of "windy hypochondriacal melancholy" included stomach pain, flatulence, cold sweats, tinnitus and vertigo; accompanied by fear, sorrow and delusions. But the precise cause eluded Burton, and it was not until the early 18th century that writers such as Richard Blackmore began to point to "a tender and delicate constitution of the nervous system" as a likely origin.
For the Victorians, the disease combined fear, misery and an organic disorder that arose, as it had for the Greeks, from the stomach. Among the more common treatments for hypochondria was hydrotherapy, the water cure that involved drenching the patient daily to bring about a crisis or turning-point. Dr James Manby Gully, prime exponent of the treatment in Malvern, proudly advertised his success in banishing "the fiend of hypochondria". Charles Darwin is Gully's most prominent patient, but many Victorian notables had recourse to the same cure.
@Getty
In his enthusiasm for the water cure and the professional uses to which he put his indisposition, Darwin seems his century's most-accomplished hypochondriac
Among the oddities of hypochondria's history is the fact that it has been thought primarily to afflict men. So entrenched was this idea in the 18th century that it was possible to call the stomach "the male womb": the origin of the disease, just as the uterus was said to be in cases of hysteria. By the mid-19th century, women such as Charlotte Brontë could also self-diagnose a disease that in its symptoms was perhaps close to what we would today call depression.
It's a phenomenon well known to Florence Nightingale, whose polemical treatise Cassandra is an obvious precursor to Virginia Woolf's better-known essay, A Room of One's Own. Nightingale inveighs against the constraints under which women live; expected always to be engaged in social or domestic activities, their only sanctuary is the sickbed, physical illness the only excuse for not fulfilling wifely or daughterly duty.
Nightingale did not think of herself as a hypochondriac, but in her bedridden industry she resembles a writer well informed about current medical theories regarding hypochondria at the end of the 19th century. Marcel Proust's father was a leading figure in medical hygiene and lectured on epidemiology, neurology and neurasthenia. His son was aware of the psychological origins conjectured for those disorders, and probably knew the theory of the "common sense" – the sense that sensed the other senses at work – supposed to have gone awry in hypochondria.
This latter theory – that hypochondriacs are too well attuned to bodily sensation and mistake normal feelings for morbid ones – was overtaken by Freud's conviction that hypochondria masked another neurosis: melancholia, narcissism, even homosexuality. Hypochondria ceased to be an attractive diagnosis and pointed instead to culpable repression. In famous cases such as the pianist Glenn Gould or Andy Warhol, the problem seems to be a reluctance to engage with the real world.
In recent decades, that fear has been characterised as an anxiety disorder: a pattern of would-be controlling responses (just like OCD) that can be broken with cognitive-behavioural therapy. But whether or not we have found the definitive cure for hypochondria, the history of the disease suggests that the fundamental doubts it raises – about what it means to be ill, or well, or just to be human – will not easily be assuaged.
'Tormented Hope: Nine Hypochondriac Lives' by Brian Dillon (Penguin, £18.99). To order this book for the special price of £17.09, with free P&P, go to Independentbooksdirect.co.uk or phone 0870 0798897. The author will chair a discussion of the medical and cultural history of health anxiety at Tate Britain on 18 September. Tickets: tate.org.uk, 020 7887 8888
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