New book tries to explain the roots of hypochondria

What do Andy Warhol, Howard Hughes and Woody Allen have in common with Chicago drive-time disc jockey Roe Conn?

They all are — or were — hypochondriacs. But they're not alone. Due to our increased access to medical information, we are becoming a nation of hypochondriacs, said Catherine Belling, author of the new book, "A Condition of Doubt: The Meanings of Hypochondria."

Belling's interest in hypochondria stems from the "constant tension," she said, "between the doctor who says he knows your body and the patient who says, 'I know it better.'"

A native of South Africa, Belling lives in Chicago, where she spends her spare time reading medical thrillers.

To learn more about hypochondriacs, the Tribune caught up with Belling at Northwestern University Feinberg School of Medicine, where she is an assistant professor of medical humanities and bioethics.

Q: What's the origin of the word "hypochondria"?

A: Until the early 18th century, it meant a physical disease caused by imbalances in the region that was below your rib cage. In his 1621 "Anatomy of Melancholy," Robert Burton blames it for everything from "too much spittle" to "rumbling in the guts."

Dictionaries still retain the term "hypochondrium" as an anatomical term but now we define "hypochondria" as a person's recurrent fear that he has a serious disease or is about to get one. It's different from "malingering," which is pretending to be sick.

In the 1960s, we started to see more distrust of doctors overall. A Time magazine article encouraged readers to question their doctors. Horror films reflected the change in attitude. Before the '60s, they had monsters that died in the end. After that era, horror films became more open-ended; science no longer had all the answers.

Q: "Fear" is the operative word?

A: There are five elements that define the hypochondriac, and fear is one of them. The others are doubt (he doubts the doctor), embodiment (his body contains diseases he can't see), information (he's informed) and narrative.

I have a Ph.D. in English, so narrative is what intrigues me. Every suspicion of disease is a story. Doctors are trained to see the symptoms, give a diagnosis and treat the illness. With the hypochondriac, there is no diagnosis, so he's messing with the plot.

Q: How have the Internet and the media affected hypochondria?

A: We're bombarded with ads that tell us that we'd better get that mammogram and better try that new drug. We can't help worrying about being sick. There's a lot of pressure on us to fix ourselves.

There's a fine line between being a diligent health citizen and being a hypochondriac. They both have access to the same journals the doctors read and they both do their research. But the hypochondriac exposes medicine's limitations. We now know of diseases and conditions that used to be considered aches and pains.

Q: Tell me about your "Jaws" metaphor.

A: To me, the hypochondriac is like the woman swimming in the "Jaws" movie poster. The shark (the disease) is down there somewhere but she can't see it. Originally, I was going to call my book "Swimming in the Dark."

Q: Is hypochondria a mental disease?

A: The current edition of psychiatry's DSM ("Diagnostic and Statistical Manual of Mental Disorders") lists "hypochondriasis" as a "psychiatric disorder." Treatment can include cognitive-behavioral therapy or anti-depressants. But people with extreme hypochondria are a minority.

But one study showed there's a physiological difference, that hypochondriacs are actually more sensitive to body sensations. They notice heart palpitations, for example, that you and I may not.

Q: When did the hypochondriac become an object of ridicule?

A: In 1673, the French satire, "The Hypochondriac" gave us the idea of the hypochondriac being the back-seat driver and a comic figure. Ironically, at the end of the play, he becomes a doctor. This was perhaps the first time the illness called hypochondria and the behaviors of constantly worrying about being sick and demanding medical attention came to be connected in such an explicit way.

Now, sitcoms and movies have fictional funny hypochondriacs like George on "Seinfeld." We laugh at them, and they laugh at themselves.

We hear hypochondriac jokes. My favorite: "He's such a hypochondriac, he can even read his doctor's handwriting."

Q: How do doctors view hypochondriacs?

A: It's interesting that many first-year medical students get "medical student disease," believing they have the diseases they're learning about. But during their clinical years, they become "doctor," not "patient," and disassociate themselves from their bodies.

Then many doctors resent hypochondriacs because they expose medicine's vulnerabilities and they continue to question them.

Q: What's the upside of hypochondria?

A: They remind doctors that they don't have all the answers. Not every disease or condition can be diagnosed or treated. Doctors shouldn't feel threatened when they can't give a diagnosis.

The opposite of hypochondria is complacency. Hypochondriacs believe in medicine. They know something can be done.

At some point, we all do get sick and die. Doctors don't always know why. You know those people with the tombstones that say "I Told You I Was Sick"? They were right.

"A Condition of Doubt: The Meanings of Hypochondria" is published by Oxford University Press.

Copyright © 2014, Los Angeles Times
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