“Dick is a little concerned about catching cold,” the producer informed me with the determinedly cheerful expression of a mom assuring a neighbor that little Jason’s consumption of sidewalk pigeon shit is perfectly normal.
In terms of risk taking, however, Dick Cavett is a bomb-squad demolition expert compared with Marcel Proust.3 The nihilistic French novelist was so afraid of catching cold that he became a lifelong recluse, spending all his time in a bedroom with walls lined in cork to muffle the insalubrious sounds of civilization. When called upon to serve as best man at his brother’s wedding, Proust forced himself to go, but only after fortifying himself with three overcoats and several mufflers, and padding his chest and collar with layers of cotton. He was so immobilized that he could not sit down and had to stand in the aisle during the service.
The Greatest Hypochondriac of All Time, however, was the American poet Sara Teasdale.
Sara was a woman of heroic gloom.
Anguish oozed from her tortured womb.
O Stygian depths, O life you accursed vip’rous crutch!
(That’s what all her poems sound like, pretty much.)
Sara was a lifelong melancholic. She felt she had “weak veins” and particularly feared a stroke. Once, in 1928, after a particularly bouncy cab ride in Central Park, she became certain she must have suffered a life-threatening blood clot, or possibly a spinal injury. Her back and neck ached. At her insistence, she was hospitalized, but X-rays revealed no fractures. Masseuses, osteopaths, and neurologists were summoned. “I know what blows on the head mean,” Sara wrote to a friend. “Rheumatism often develops from an injury of this sort, and it seems to have attacked me practically all over” She hired a nurse for round-the-clock care.
But that was only a preamble. Sara Teasdale entered the Hypochondria Hall of Fame one day in 1933 when a small blood vessel burst in her hand, creating a purpled, spidery bruise.
Sara panicked. She decided this was the first sign of the massive embolism she had been expecting all her life. She knew all about what a stroke could do. She had researched it ceaselessly. She was not about to endure the indignity of it, or subject her loved ones to a lifetime of caring for a dull-eyed vegetable. And so she grimly took to her bath.
That is where her nurse found her the next day. The coroner concluded that her health had been fine, apart from the massive dose of sleeping pills that had killed her—and a small, harmless black-and-blue mark on her hand.
So there you have it, hypochondriacs.
Not only is your disease chronic, it can be fatal.
You’ve welcome.
1 I made this last one up. That is why it is important to read footnotes.
2 What kind of a name is Bysshe? What is that all about? Most people with idiotic middle names simply don’t use them. How many of us, for example, know that Abraham Lincoln’s middle name was Thptsk?
3 This is, to my knowledge, the first time Dick Cavett and Marcel Proust have appeared together in the same sentence.
The Mind of the Hypochondriac
The hypochondriac stands up one day and feels a little dizzy. This is an ordinary sensation; it happens to all of us, a mild circulatory disturbance. But the hypochondriac is now instantly alert. He can’t recall ever noticing this before. He is no expert, but it seems to have multiple implications. Logic tells him it might involve the heart, the lungs, or even the brain.
But he does not panic. The hypochondriac knows he is a hypochondriac. In a sense, this is his greatest comfort. Behind the certitude that he is deathly ill is a sneaking suspicion that it is all in his head. So he just tucks this moment into the back of his mind. Alas, that is the part of the brain that most bedevils the hypochondriac. It is where the mischief is born.
He starts casually monitoring himself. Testing. Lying on his back and then suddenly bounding to his feet, like a Whack-a-Mole. There is the dizziness again! Maybe he looks dizziness up in a home medical guide. He has sixteen of them.
Under “dizziness” there are many subheadings.
Subheading: “… in heart disease.”
Subheading: “… in cerebral arteriopathy.”
Subheading: “… in polycythemia rubra vera.”
The list is as long as a mortician’s face.
The hypochondriac cannot help hut notice the entry right after “dizziness”—“dyspnea” which also has “… in heart disease” under it.
Just out of curiosity, he flips to the section on “dyspnea” and it turns out to mean “breathlessness.”
There is no immediate connection between these two conditions beyond the accident of their proximity on the page, but this is of no consequence to the hypochondriac. See, he has noticed dyspnea. He seems to get out of breath more easily of late. All other possible causes—aging, smoking, a sedentary lifestyle—do not at this moment occur to him. So he begins to watch himself, to notice things. He will climb a hill he goes up every day and realize he is somewhat out of breath. Has he felt this way before? The next time, he will follow a young woman up the hill, matching her step for step, and then, at the top, he will compare his breathing rate to hers. This will require him to carefully observe the heaving of her chest. But for some reason, she keeps walking away from him.
Does he smell bad? Is he perspiring excessively?
Why, yes, he is! His hands feel clammy, suddenly.
Back to the books. He looks up sweating. It can be a symptom of leukemia and encephalitis and a whole bunch of things he has never heard of: pyonephrosis, acromegaly, Graves’s disease, hypoglycemia. Now he is nearly insane with worry. He goes to a doctor. The doctor listens to his heart, takes his blood pressure, and pronounces him fine!
And he is fine. Now he feels great! As he is leaving the doctor’s office, though, he will notice a slight stitch in his side …
The fact is, most people are concerned about their health. But when does that concern cross the line from prudence to obsession? What is it that distinguishes the ordinary person from the hypochondriac?
In less enlightened times, the answer seemed easy. Hypochondriacs were thought of as whining, self-absorbed cowards. In the popular conception, they waddled around in bathrobes with ice packs on their heads and thermometers in their mouths. Doctors treated them as though they were feebleminded.
This should not be surprising. Through history, medicine has always been guilty of perpetrating hurtful, inaccurate stereotypes. For example, medical science used to categorize homosexuality as a psychiatric disorder caused by domineering mothers; its so-called “symptoms” were preening, mincing, flouncing, bitching, consumption of Midori watermelon liqueur, etc. Nowadays we recognize that homosexuality is a normal condition, caused by failed liberal social policies.
Similarly, we now know that hypochondria afflicts all types of people. And though we still do not know its causes or its cure, we have come a long way toward defining just who the hypochondriac is. There are no reliable clinical tests for hypochondria, but some emergency room doctors have devised their own screening procedure, known, delicately, as “a positive review of symptoms.” The hypochondriac will tend to answer yes to any question, so long as it is delivered with appropriate gravity. The two best-known screening tests: “Does your stool glow in the dark?” and “Do your teeth itch?”1 Dr. Martin Wolfe, a Washington, D.C., specialist in parasitic diseases, deals occasionally with people who complain of bugs crawling out of their skin. Sometimes, bugs do crawl out of the skin, of course. Dr. Wolfe’s screening question: “Did it have a mustache?”
The hypochondriac does not “imagine” pain, the way the ordinary person might fantasize, say, about blasting the homer that wins the World Series or getting that job she always dreamed about, or writing a fraudulent medical book that becomes a runaway bestseller, making him so wealthy he never has to work again and can buy sport utility vehicles and throw them away after using them once, like disposable razors. No, the hypochondriac actually feels his pain. The mechanics of how this happens remain a myste
ry, but the fact that it happens is indisputable.
This is not as peculiar as it seems. The human brain is an amazing organ capable of astonishing feats. Doctors have long noted the existence of a phenomenon known as the “placebo effect”: When illnesses of all types are treated with sugar pills, and the patients are told they are getting medicine, as many as 35 percent get cured anyway. The implications of this are astounding. It means that either
Sugar is a tragically underutilized medical resource; or,
Doctors are swine. Because what about the 65 percent of patients who don’t get cured?
Imagine the scene in the consulting room: “Well, Mr. Farquhar, I have good news and bad news. The bad news is that the canker sore on your lip didn’t respond to medication and has migrated to your groin, where it has progressed to a particularly nasty case of thrombotic thrombocytopenic purpura. The good news is, the medication you didn’t respond to was … a Domino demi-lump! Ha ha ha h—(Sound of stethoscope inserted into nostril.)”
The point is, if the brain can relieve pain, surely it can create it.
My own extensive research into hypochondria suggests that the hypochondriac fits a basic personality pattern that might best be illustrated through the use of a Venn diagram, an extremely scientific visual aid utilized, for some reason, in the sixth grade and never again. Venn diagrams examine the relationships between groups of people via simple geometric comparisons.
For example, Fig. 1 represents a general population breakdown.
Fig. 1
Get the idea? OK, now let’s look at hypochondriacs (Fig. 2).
Fig. 2
This is a helpful, but still inadequate, profile. Fig. 3 completes the picture.
Fig. 3
1 Emergency rooms can be a crucible for hypochondria, and a carnival of misunderstandings. People who use emergency rooms for primary medical care tend not to be the most knowledgeable patients. In medical schools, emergency room stories are legion. One woman is said to have informed an admitting doctor her baby was having a relapse of “the smilin’ mighty Jesus.” Eventually, he figured it out: spinal meningitis. A Washington-area emergency medical technician reports that a patient told him her baby was on regular dosage of “peanut butter balls”—phenobarbital.
How Your Doctor Can Kill You
A doctors reputation is made by the number of eminent men who die under his care.
—GEORGE BERNARD SHAW
A number of doctors have studied hypochondria, but very few openly specialize in its treatment. The only one I could find through a global search of the Internet was a Dr. Ingvard Wilhelmsen in Bergen, Norway. Norwegians are apparently prone to hypochondria because Norway has a high standard of living, meaning that people have a great deal of leisure time in which to contemplate their lives, which are spent in a dank, hellish place that could depress a hyena. Norwegians have it so bad that when they flee Norway in search of a more hospitable clime, they often head for North Dakota.
In my relentless search for information, as a service to hypochondriacs, I telephoned Norway. I had many questions. I wished to pool my commonsense knowledge of the subject with Dr. Wilhelmsen’s professional expertise. Together, I hoped, we could bring a measure of solace to persons afflicted by this much maligned condition. This was my conversation, as reflected by my notes:
Me: Is Dr. Wilhelmsen in?
Norwegian Person: Va? Schlift wann kumm?
Me: Er, is the doctor in? DO YOU SPEAK ENGLISH?
Norwegian Person: Schmu? Isfaehrkt?
Me: OK, sorry. Never mind.
So, big shot Wilhelmsen proved no help at all.
This should not come as a surprise. Doctors are not always the most helpful people. The vaunted Hippocratic oath1 requires doctors to do no harm, hut medical texts are full of warnings about procedures that often go seriously awry. Some are minor. Some are not. For example, doctors treating you for hypernatremia, a serious electrolyte imbalance caused by dehydration, will sometimes accidentally overdose you on water and potassium. This creates a brain condition called central pontine myelinolysis, leaving you a quadriplegic, or a corpse.
Some years ago my father went to see a doctor for a routine physical exam. My father is a gentle, self-effacing man who does not wish to make a fuss or be a bother to others. He is the sort of man who, in a restaurant, will not ask for a translation prior to ordering a dish with a fancy French name. Then, rather than complain, he will consume it even though it appears to be rat fetuses in béchamel sauce.
A few hours after his medical exam, my father phoned me and reported that everything went well, and were the kids home from school yet, and he is dying. Now, my father is pretty old and his hearing isn’t what it used to be.2 I figured he had misheard the doctor. So I called the doctor.
The doctor gave me good news and bad news. The good news was that there was apparently nothing additionally wrong with my father’s hearing. The bad news was that my father had a heart condition so severe it was a wonder he was still walking around, of apparently sound mind, and unaware of his predicament. The doctor said my father would progress rapidly into a nearly catatonic state in which he would need round-the-clock nursing care, his mind slowly deteriorating into an unpredictable form of dementia typically leading to slack-jawed insensibility and, inevitably, death, which would come as a mercy.
That was six years ago. My father has since celebrated his eighty-fourth birthday. He has won a national math-puzzle competition. He still does my taxes. He regularly beats me at poker, though he seems to lose fairly consistently to his grandchildren. He baby-sits for my dogs. I go to his place to watch football games because he lets me smoke cigars and swear. There is nothing wrong with his heart. Never was.
I do not mean to cast aspersions on the entire medical profession because of one bonehead’s mistake. The medical profession is and has always been peopled by caring professionals operating at the very pinnacle of human achievement, though it does give one pause that the official cause of death of Warren Harding, soberly pronounced by the finest attending physicians of the day, was “a fit of apoplexy.”
My point is that doctors tend to be profoundly sure of themselves, even when they have no idea what they are talking about.3
I used to blame the arrogance of medicine on modernity, on the technologies that have elevated the physician to the role of divine mechanic: Mr. Godwrench. In my thinking, doctors of earlier, simpler times were probably just fellas, humble dispensers of commonsense therapeutics, only a dram more sophisticated than the medieval barber-surgeon, painfully aware of the limitations of their science and of themselves.
That is what I thought until, recently, I happened upon a book published in 1902. The Cottage Physician, written by a consortium of “the best physicians and surgeons of modern practice,” was a popular home medical text offering sage advice on the prevention and treatment of disease. The most striking thing about this book is the authority with which it presumes to speak on medical matters large and small. Cautioning against placing yourself in the hands of charlatans, it promises “The Very Best and Most Approved Remedies and Methods of Treatment Known to Advanced Practitioners.”
To wit:
The diabetes sufferer is informed that his condition is of his own making, caused by sexual intercourse, by generally intemperate living, and by “copious evacuation of the bowels.” For treatment the licentious, poop-crazy scoundrel is advised to wear flannel clothing, to eat no vegetables, to vomit frequently, and to take suppositories carved from bars of soap.
A man’s hair loss may be arrested through the application of a pomade of lard and rum.
Difficulty in urinating requires a marshmallow enema.
Women, the book informs us, are mysterious creatures, so constitutionally inferior that they must be coddled throughout life. Fortunately, aside from pregnancy—a time when the practitioner must deal with a woman’s inexplicable, insatiable appetites for nonfoodstuffs such as clay, chalk, and charcoal—women’s medica
l problems are fairly simple, and easy to diagnose and treat. Almost everything that befalls them occurs because of their womb. Sometimes the womb “falls.” Sometimes it swells. Women are particularly susceptible to hysteria; it is caused by the womb. Doctors recommend that the victim of hysteria be treated in the following manner: Her hands should be bound to prevent her from injuring herself. A piece of steel, heated in boiling water for two minutes and wrapped in silk, should be passed down her spine. And last, an enema should be administered consisting of turpentine and stinkweed. During this procedure, it is essential that the woman be kept “tranquil.”
Tranquillity is also prescribed at other critical times, for men and women alike. “If within an hour or two of any violent mental emotion the impregnating act follows” the book cautions, “the offspring has that predominating trait throughout life.” The doctor-authors theorize that this explains how the villainous Aaron Burr could have been born to two parents of irreproachable character. At the instant of conception, they suggest, Mr. and/or Mrs. Burr must have somehow permitted their piety to slip, and entertained an impure thought.
Flipping through this wonderful book, one discovers that almost every ailment—rheumatism, cataracts, eczema, convulsions, sciatica—responds well to generous and sustained doses of laxatives. Cancerous tumors—thankfully confined mostly to persons of “scrofulous constitutions”—may be reliably eliminated by application of a poultice of warm milk and figs.
Proper nutrition is essential to good health; one must consume not only the egg but also the shell. Tetanus is cured by “pouring cold water on the head from a considerable height” and by turpentine enemas.
The discovery of this book set me on a journey to find others. It turns out almost every used-book store has one or two of them, and though they differ in content and philosophy, they are similar in the impressive medical pedigrees of their authors and in the certitude with which they deliver remedies. One of these, the Obstetrical Journal of Great Britain and Ireland (1873), reports favorable results from the treatment of constipation with arsenic.
The Hypochondriac's Guide to Life. and Death. Page 3