HEALTH HORIZONS : PSYCHOLOGY : Sinking Feeling : Confessions of an Almost-Hypochondriac
There it was. Unmistakably, undeniably, indisputably--a new symptom.
I had my wife check it out to make sure I wasn’t crazy, guiding her hand to the spot near the base of my right breast. She felt it too. A lump. A lump in my male breast.
“It’s probably nothing,” she said. “But you better get it checked.”
“I know,” I said.
I also knew, in the manic recesses of my consciousness, that the prognosis was bleak.
I develop a fatal illness every two years. I’ve been doing it for three decades now.
The first time involved another lump, this one under the armpit. Though barely a teen-ager then, I’d heard what could happen to those lymph glands. A first sign of Hodgkin’s disease. Time and again I felt under my arm and there is was, the lump.
“That’s your muscle,” the doctor told me. “A normal bulge in your muscle.”
“Are you sure?”
“Yes.”
A reprieve.
But only for so long. . . . Until I noticed those floating squiggles in the eye, undoubtedly a reflection of something twisted in the brain; a pulse that skipped a beat, a sign not of young love, I was sure, but a failing heart; or the case of what looked like boils that turned out to be, well, boils. “Calm down, man, relax,” Dr. Fitzhugh told me in Atlanta on that occasion.
But how could I? My body was rife with symptoms.
It wasn’t until my mid-20s that I understood the condition and realized, much to my relief, that I was not a hypochondriac. Medical experts define that-- hypochondriasis is their formal name--as an abnormal and unfounded anxiety about health. That wasn’t me. I suffered, I concluded, from NORMAL unfounded anxiety about health.
A normo-chondriac is what I am.
It may sound like a fine line, but it’s an important one. There are poor souls with something called Munchausen’s syndrome who will fasten a tourniquet around their leg to make it swell, then talk their way into the hospital. The hysteria of true hypochondriacs is such that they can wander from doctor to doctor, refusing to believe the blood tests that tell them they’re not going to die, at least not in the next week.
The normo-chondriac may wind up in the emergency room once or twice in a lifetime, maybe even overnight for observation. But he will not dispute CAT scans that find he is OK, especially after getting the bill. To the contrary, the normo-chondriac relishes the idea that the problem is in his or her head, so to speak. It beats the alternative.
The liberating realization that I wasn’t a loon came when I saw many friends go through the same thing. There was a fine Southern woman, for instance, a former cheerleader, who announced one day, “Ah have dots! Ah have dots!”
She was looking at tiny splotches on the skin of her arms, convinced they were exploding blood vessels. Leukemia, obviously.
Her doctor did a simple test to put her at ease. He unplugged a lamp and tied the cord around her bicep: If arteries were exploding in there, they’d be able to see it happening under that pressure. “You’re OK,” he reassured her.
For weeks after that, she’d take a lamp cord at home and wrap it around her arm. Sometimes she’d swear she saw new, ominous blotches. “Ah do have dots,” she insisted--until her mind drifted, a month later, to other concerns.
Another friend, a magazine editor, rushed to the emergency room, convinced he was having a heart attack. Dr. Ellen Reitz, a USC Medical School psychiatrist who specializes in psychosomatic conditions, notes that men frequently get anxious about their hearts, particularly as they reach their 50s and “see their friends dropping off.” That doesn’t sound unreasonable. But this guy was, what, 27?
My wife fixes on those tiny bumps that pop up behind the ear, inconsequential fatty deposits. “Another tumor,” she says, envisioning herself as the lead in “Love Story.”
The worst case I’ve seen is a doctor himself, a fellow who almost weekly fixates on some lump, bump or belch in his body. He’ll go into a swoon if he’s an hour overdue for lunch and his tummy starts gurgling. “When was the last time you had a brain tumor?” I asked him recently. “Not for 2 1/2 years,” he replied after some thought. That was about the time he’d felt faint one evening and, convinced his ticker was going, admitted himself to the hospital. To everyone’s surprise he emerged with a diagnosis: mitral valve prolapse, a minor defect that can produce leakage in the left side of the heart. So you never know.
What brings on such episodes? The dot-woman’s mother was in the final stages of a crippling illness. The editor handled a story about the latest “mystery illness.” The doctor friend, a dermatologist, daily sees bumps that aren’t figments of someone’s imagination. And it didn’t take Dr. Freud to speculate that my own normo-chondria wasn’t helped by a string of serious illnesses that afflicted others in my family.
Indeed, my mother had waited too long to have a lump checked. And even as I was driving to the internist to have mine examined, my father was going back in the hospital. In one moment of dark imagining, I saw myself sharing a hospital room with him, our beds side by side. I saw us reaching out, holding each others’ hands . . .
While there may be very personal reasons for obsessing on symptoms--real or imagined--there are broader forces at work as well, according to medical experts who have studied the phenomenon.
To some degree, we normo-chondriacs are products of our society’s increasing understanding of once mysterious diseases, along with very public campaigns “to get people to pay more attention to their bodies,” in the words of Dr. Thomas Garrick, an associate professor of psychiatry at UCLA. Who hasn’t seen the 10 WARNING SIGNS of this-or-that disease? How many thousands of people now have visions of the AIDS virus lurking in their tissue, fearing it was passed to them during liaisons entered into before they’d even heard of that modern plague? And what goes on in the minds of young girls, drilled now in the symptoms of breast cancer in seventh-grade health classes? “They certainly attune you to all the myriad ways in which you can get wiped out,” Garrick noted. “It is frightening,”
Such knowledge gives us an easy way to manifest “normal depression, anxiety and stress,” he said, explaining: “If you feel your life is falling apart, it’s very common for you to feel your body is falling apart.”
Complicating the phenomenon is the fact that anxiety can produce physiological reactions, including the release of hormones in the brain and body. “Your bowels don’t work the same way. . . . Your heart function doesn’t work the same,” Garrick said. “You may feel hotter or colder.” So you’re not merely imagining that “your body feels different.”
Garrick got a firsthand lesson in this mental game during his medical training, when he rotated through his hospital’s cardiac unit. It was a difficult time for a young doctor whose own father had died of heart disease: His first patient in the unit died. Then another intern had a heart attack. Then two members of the medical staff joined the casualty list. Then came new stress--a breakup with his girlfriend.
Soon after, Garrick felt telltale pains in his chest. Even after he underwent an EKG and examined the printout himself, he was convinced that it confirmed his worst suspicions . . . until another doctor set him straight: “I had indigestion,” he recalled.
Garrick’s experience is common among neophyte physicians. There’s even a name for it: medical students disease.
“Almost all medical school students become convinced at some point they have a serious disease,” said Charles V. Ford, a Birmingham, Ala., psychiatrist who wrote a book on “The Somatizing Disorders.” “One (reason) is that medical school is highly stressful (and) the person under stress is always expressing things bodily. That combined with the fact that the person has a whole new area of information about diseases and symptoms.”
Such experiences should sensitize doctors, in later years, to the possibility that many patients’ complaints may have emotional roots. But that’s not always the case, according to Ford. Many physicians today “are so technologically oriented,” he said, “it is almost impossible for them to think of a symptom as anything other than a concrete manifestation of a disease.”
The result? They order elaborate tests, drugs--and even perform surgery--in a vain effort to find or treat the “real” disease.
Such a practitioner may order a $900 MRI exam for a patient complaining of headaches, when empathetic questioning might uncover the fact that the man had a vicious fight with his wife the night before. Ford tries to tell his medical colleagues that “an MRI is not a very effective way to treat a marital fight.”
Of course, the hysteria of such patients can test the patience of doctors, families and friends. Norman Cousins, who made an industry of chronicling his psychological counterattack against cancer, bemoaned how we were becoming “a nation of weaklings and hypochondriacs,” a people taught to be fearful from early life of “invisible monsters called germs.”
Yet in this kinder and gentler age, medical experts now lean toward a milder term for the phenomenon: “somatosensory amplification.” We normo-chondriacs have a “heightened awareness of the senses,” as a study in the British Journal of Psychiatry put it. We may simply be listening too closely to our bodies.
That doesn’t sound all bad. After all, those 10 WARNING SIGNS are posted for a reason--not every symptom is a false alarm, unfortunately. One study found that between 24% and 40% of patients judged hypochondriacs eventually are found to have a real disease that explained their earlier symptoms.
The internist clearly was worried about my lump. “Most of these are harmless,” he explained. But he immediately called a specialist and set up a mammogram.
The appointment was two days off, so I had 48 hours to contemplate my doom. Part of me was pleased, in a strange way. I’d progressed over the years--the symptoms were real now. I wasn’t fixating on normal muscle bulges in the armpit. My prior episode also centered on a real symptom, a shooting, shock-like sensation from the neck down my left arm, all the way to the fingertips. Of course, it wasn’t the grapefruit-sized brain mass I’d feared--merely a pinched nerve in the jaw area, apparently caused by the way I sat in front of my computer.
And now the breast. My cover story--the one I told the internist--was that I’d just spotted the lump that week. I’d gotten hit my a tennis ball, hard, right in the chest. When I poked around the bruised area, I noticed it.
But as I awaited the mammogram, I wondered whether I was deceiving myself. Maybe I’d blown it this time, put myself into a true predicament. Maybe, just this once, I hadn’t obsessed on a symptom soon enough, succumbing instead to the opposite extreme--denial and neglect.
As soon as the thought came to me, I knew it was the truth. The lump had really been there a while. I’d just blocked it out, become like one of those people who hear a clunking in their car and respond by turning up the radio.
I suddenly recalled how I’d once felt a tenderness in the same area. I’d worried about it, sure, but chalked it up to muscle soreness, caused by that quirkly way I whip my arm across my body during my service motion.
Thus had I forgotten the most important duty of a mature normo-chondriac, the willingness to go to the doctor quickly. You risk the embarrassment of being told it’s all in the head, but at least you don’t stew in the juices of your worry--or risk ignoring a symptom that is no delusion.
I was sure that’s what I’d done. And I knew the consequence. I was a goner.
Such is the intensity of an episode. You go through an emotional dance of sorts, playing with many of the moods you read about--and see--in people for whom it isn’t a false alarm: the denial, panic, rage, resignation, the pondering of what’s important in life. Perhaps the episodes are preparation--if there can be any--for the real thing.
When my doctor related the results of the mammogram, he told me of another recent male patient who, it turned out, did have breast cancer. “It was very serious,” he said, not needing to give the outcome.
In my case, however, it was a “harmless fibrous” something-or-other. I didn’t really hear the rest. My mind had started to check out after the first two words, beginning to wander from the examining room even as he explained that I could live with this, no problem, or have it taken out “if it really bothers you.”
“No, I doesn’t bother me at all,” I said, shaking his hand and leaving with the diagnosis I wanted, another reprieve, at least for another two years, before there’d be a new lump in the night. . . .
