The Text-Book of the Principles and Practices of Nursing (third edition, 1938) prescribes, for the treatment of a persistent cough, heroin. Lessons in Physiology and Hygiene, a medical text published in 1895, observes that the size of one’s brain is directly proportional to one’s intelligence and then dryly notes, without further comment, that women have smaller brains than men.
In the 1875 Nashville Journal of Medicine, a Dr. Bowling advises that persons permanently refrain from eating any fruits or vegetables. They can be deadly, he says, citing several rather thin case studies, including this one: “One of the most beautiful and accomplished young ladies in the city ate two or three pickles, and died.”
It was after reading some of these books that I entered the hospital for some minor outpatient surgery. There, I entrusted myself to an excellent doctor of my acquaintance, one of the very best physicians and surgeons of modern practice. He gave me a marshmallow enema.
Just kidding! That would have been ridiculous! We have come a long way since then. No, the doctor stabbed me in the side with a gigantic needle and yanked out a little plug of flesh, just to see what it was made of.
I was not at all concerned.
Why should I be?
He assured me this was One of the Most Approved Remedies and Methods of Treatment Known to Advanced Practitioners.
I am certain that a hundred years from now, it will not look at all foolish.
1 Have you ever read the vaunted Hippocratic oath? It is loony. It begins by swearing allegiance to “all the gods and goddesses.” Then it promises to revere the person who taught you medicine and support him financially. Then it says abortion sucks. Only then does it get down to business, saying you should not be greedy, should cause no injury, should respect your patient’s privacy, and should not sleep with her.
2 Actually, his hearing was never much to begin with; when I was a lad, I would frequently make some innocuous statement at the dinner table-say, “I got a B on my final”—and find out weeks later that my father believed I’d said I had gotten beer on my vagina, but was too polite to inquire further.
3 Medical quackery has a long and storied history. When King Charles II of England suffered a minor stroke in 1685, the finest medical minds of the time were summoned to the royal bedchambers. First, to rid the king’s body of all poisons, they drained him of a quart of blood. Then they further desiccated him with emetics and enemas. Over the next few days they shaved the king’s scalp and singed it with hot irons. They crammed sneezing powder in his nose and let him blast out his few remaining drops of liquid. They slathered his body with sticky hot plasters, and then, when they hardened, ripped them off; by this time, Charles was doubtless too weak to scream. The monarch was sinking rapidly. But the doctors were on top of it. They were giants of their profession. They drilled holes in his head, to drain off the bad humors and a few more pints of blood. Alas, it was no use. Five days after the treatment began, the king breathed his last, effusively thanking his physicians for their heroic efforts to save him.
Man. Woman. Birth. Death. Infirmity.
You would think that as medicine has become more sophisticated, the incidence of hypochondria would diminish. It hasn’t. By all accounts, it is increasing.
There are three reasons. The first is medical insurance. To understand the insidious impact of medical insurance on hypochondria, it would be helpful to imagine life before medical insurance. Imagine you were a Jewish peasant in Russia in 1903. If you felt sick, you trudged twelve miles to the doctor. His fee would be a goat. Which means not only did you have to walk the twelve miles from your shtetl to his shtetl, but you had to schlep the goat. On the way, Cossacks on horseback would harass you and make fun of your beard, and they might even take your goat.
Everything about this system discouraged hypochondria. You would do your best to convince yourself that your symptoms, whatever they were, were negligible and that medical attention was unnecessary. Or you attempted to treat yourself. You would try some random nostrum, say, taking a sitz bath in molasses and chicken hearts. And because most ailments eventually resolve themselves anyway, your symptoms would eventually disappear and you would conclude that whatever you did had worked.1 All over Russia, people would be curing themselves by drinking monkey urine or yodeling with beetles in their mouths. Yes, they were nincompoops, but they were not hypochondriacs. Behind the whole system was the fact that getting medical attention was difficult and costly. Now your doctor is a few minutes away. Your only fee is a $5 “copayment,” which is so puny doctors don’t even keep it; it goes into a plastic cup near the reception desk, for gum and panty hose.
The second reason hypochondria is on the rise is the proliferation of scientific studies. It used to be that major achievements in medicine were made by solitary eccentrics like Louis Pasteur, puttering around in their basement laboratories, discovering that bread mold could cure syphilis. Their medical tools were a ball peen hammer, six worms, and spit. These days, things are much more complicated. Scientists work in teams, sponsored by universities, funded by gigantic grants. In order to justify their time and keep their sponsors happy, they must periodically issue reports, however obvious their conclusions may be. A study I just read actually concluded that small thin women tend to live longer than big fat women. (Next: BAD TO BE EATEN BY WILD DOGS, EXPERTS SAY.)
The official house organ of study-promulgating is the Journal of the American Medical Association, a highly respected medical periodical that gets quoted whatever it says, because it is so respected. I have never visited the offices of the Journal of the American Medical Association, but I suspect it is two guys named Murray and Ed, who sit around smoking cigars, playing practical jokes on each other, and inventing alarming facts. “Let’s put it out that laboratory rats are seventy percent more likely to develop esophageal cancer if spanked continually,” Murray says. “No, wait,” says Ed. “If spanked continually while being fed a diet of Ovaltine and Snickers.”
No one questions these studies, however preposterous they seem. I am looking at the results of a medical study recently reported by The Washington Post. Ordinarily, The Washington Post is pretty careful. If someone contended that President Chester Alan Arthur had actually been a donkey named Salvatore, you can bet the editors would demand a second source. But when a scientific study says something, newspapers instantly accept it because it is so darned scientific. This study I am looking at, solemnly reported by The Washington Post and other great newspapers, concludes that heart attacks might be prevented by diligent tooth flossing.
The media are the last and most important reason for the persistence of hypochondria in America. They’ll print anything.
The New York Times recently reported that a cure for cancer was just around the corner, in the form of a new drug that can shrink tumors by cutting off their blood supply. Everyone went nuts. CURE FOR CANCER JUST AROUND CORNER, the newspapers said. Medical stocks soared! Poets rhapsodized! Dying millionaires offered researchers tens of millions of dollars to become human guinea pigs! It turns out the headlines were ccurate in every way except for certain words: “Cure” “Cancer,” “Just,” “Around,” and “Corner.”
For one thing, so far the cure only works on mice. For another, the drug in question is partly synthesized from mouse urine, and at this point it takes two hundred quarts of mouse urine to extract a millionth of an ounce of the drug, which means you would basically have to force-feed a thousand mice a thousand gallons of Gatorade over a thousand years to get enough medicine to shrink a single hemorrhoid.
By the time all this qualifying data came out, however, the media had lost interest in CANCER CURE, moving on to yet another Big Medical Story, namely, KILLER ERECTIONS. Men who took Viagra, the new potency pill, were reported to be dying like germs in a jar of Listerine. Follow-up stories revealed, however, that these victims tended to be seventy-five-year-old guys who—suddenly invigorated after twenty years of sexual somnolence—bounded briskly out of bed and into the saddle.
Presumably, they died of heart attacks, or of old-lady-style hairpins briskly inserted between the third and fourth rib.
The press also insists on reporting news of horrifying new diseases and shocking medical errors, terrifying the hypochondriac. Some of these so-called medical mistakes are, of course, exaggerated. For example, I am at this moment looking at an Associated Press story about how the parents of a five-year-old girl are suing a doctor in Texas who was supposed to perform an appendectomy on their daughter but instead removed one of her fallopian tubes. Sure, it looks bad for the doctor, but I think we must give him the benefit of the doubt. Perhaps he was unfamiliar with anatomy, and when he asked, “What is that?” and a nurse said, “A fallopian tube,” he panicked and cut it off. I sure would. A fallopian tube does not sound like a good thing.
Still, these are aberrations. Bad medical news is not happening with greater frequency than in yesteryear. It is just that the press is far better at finding and reporting it. Let’s say in 1841 a cholera epidemic wiped out half of Montana. The event would be covered six weeks later, as news trickled in. Journalism in that era was a lot more genteel. Information was disseminated only reluctantly, gradually, in manageable little bursts of increasing gravity, the way one might deliver bad news to an elderly aunt with a weak heart:
* * *
NEWS OF THE TERRITORIES
A Distressing Affair
CHOLERA OUTBREAK
MANY SERIOUS INDISPOSITIONS REPORTED
Fig Poultices Applied
OUR CO-RESPONDENT’S EYEWITNESS ACCOUNTS
20,000 Dead
It is reliably reported by cable from, our Co-respondent in. the Northwestern Territorial Provinces, that contrary to more sanguine reports published elsewhere, the most Unfortunate Event has occurred of a medical nature. Horses were not affected. As could best be confirmed by presstime …
* * *
And so forth.
Hypochondriacs of earlier years did not even read these stories. In fact, no one read these stories. People bought newspapers for the ads, many of which featured products like Dr. Von Otherwise’s Patented Lip Balm and Heart Tonic, which promised a cure for Neuralgia, The Vapors, Constipation, Dropsy, Quinsy, Pustulating Bronchitis, and Vomitacious Catarrh.
Nowadays, however, both medicine and the media are better. Hypochondriacs have much more to obsess over.
On June 23, 1997, for example, the American media and the American medical establishment conspired to perpetrate the greatest assault ever on hypochondriacs. On that day, the American Diabetes Association officially announced—and the media dutifully reported—that it had lowered the blood glucose levels necessary to diagnose a person as having diabetes. Overnight, they created a serious health problem for tens of thousands of people who had not had a health problem the day before. Every endocrinologist in America immediately purchased a second yacht.
Here’s a recent newspaper story reporting the final days of convicted Virginia cop killer Roy Bruce Smith. Mr. Smith requested a last meal consisting of a glass of Welch’s grape juice, one-eighth level teaspoon of Epsom salts, and unleavened bread made with olive oil. He had been eating nothing else for months. His lawyer disclosed that Mr. Smith believed many of the world’s health problems, including cancer and diabetes, are caused by soy, and that to counter any ill effects, people should eat more foods containing magnesium, including Epsom salts and Rolaids. Mr. Smith spent the last month of his life bargaining with his cell mates for Rolaids. His biggest regret, he told his lawyer, was that he could not get this information out to the world. Also, he had figured out a way to achieve cold fusion. This secret, too, died with him. He was executed by a lethal injection of soy sauce.2
Now that all this information has been published in an actual book, I predict hypochondriacs all over the country will start gobbling Rolaids.
Not that that will save them from flesh-eating bacteria.
Remember flesh-eating bacteria? They entered the public consciousness a few years ago, more or less the way the AIDS virus enters the human body: right up the wazoo. Some doctor somewhere in some reputable medical journal reported that there was a microorganism that digests protein, and if it gets into an open wound it will, ahem, consume flesh. Pretty soon the responsible media got onto this story, quoting experts, prudently cautioning against panic, noting dispassionately that there was a germ out there that could, under certain conditions, EAT YOUR FACE OFF.
Instantly this reached the supermarket tabloids, in particular one supermarket tabloid called the Weekly World News, and that pretty much was the ball game. The Weekly World News makes the National Enquirer look like Kant’s Critique of Pure Reason. As I recall, the Weekly World News promptly informed America that a CANNIBAL MICROBE was ON THE RAMPAGE, turning ordinary humans into
BLOBS OF GOO.
I do not mean to disparage the Weekly World News. The Weekly World News is a fabulous newspaper. I say that as a knowledgeable journalist who has worked at several major American newspapers. Not one of them was cool enough to report a cure for cancer but put it on page 27, under a story about a man who eats cockroaches.
Once the tabloids got hold of the flesh-eating-bacteria story, hypochondriacs began to appear in their doctors’ offices whimpering and pointing with horror at their zits.
This, of course, was silly. Ordinary-looking pimples do not remotely resemble the skin eruptions created by flesh-eating bacteria.
Ordinary-looking pimples resemble the skin eruptions caused by a malignant tumor of the adrenal gland.
1 This illustrates a psychological phenomenon known as “superstitious behavior.” In one study, behavioral scientists placed a dozen pigeons in boxes and fed each bird pellets of food at completely random intervals, to see what would happen. After a few days, the pigeons were behaving bizarrely. One was hopping up and down on one foot; another was moving in circles with one wing raised; a third was incessantly scratching the wall, etc. The scientists eventually theorized that because there was no rhyme or reason to the feeding schedule, the birds had leaped to the conclusion that whatever they had just been doing immediately before they got a pellet—whatever random act—must have prompted the feeding. So they began doing that one thing more and more, and each time they were fed, it reinforced this belief. This is the only specific lesson I recall from four years as a psychology major in college.
2 Wouldn’t that have been great?
Hypochondria and Me
When I was twelve years old, my classmate Kenneth told ø øme that if your urine smelled funny after you ate asparagus it meant you had cancer of the larynx. This frightened me, even though I did not, technically, know where the larynx was. Kenneth said it was the “stomach bone.”
After worrying in silence for a week and probing gingerly for signs of an enlarged stomach bone, I finally screwed up my courage and asked my mom, who informed me that some people’s urine smells funny after they eat asparagus1 and that it doesn’t mean anything bad. So I owed Kenneth one. It proved easy. Kenneth was not a mental giant. I told him the Punic Wars were between the Phoenicians and “the Krauts,” and he wrote this on a test.
Revenge, it is said, is sweet. Mine had a sour undertaste, From that moment on, I sensed in myself something unhealthy. Many things unhealthy, in fact. It was the first tentative awakening of what was to become a lifelong engagement with hypochondria. For much of my life I was a hypochondriac, and now I am cured. Disclosure of the details of my cure will provide the spectacular denouement of this book, rewarding the loyal reader with soulshattering insights into the delicate nexus of the psychological, physiological, and spiritual roots of disease, not to mention an anecdote about unconscious people farting. But all that will come later. I will disclose this much right now: When chronic illnesses are cured, the cure often comes about incrementally, over time, without a single, dramatic, defining moment. But the cure for my hypochondria occurred on September 17, 1991, a Day That Will Live in Infirmity. It was shortly after ten o’clock2 in the m
orning. It was a Tuesday. It was raining. God wept. But I am getting several chapters ahead of myself.
When I was thirteen, I began going to the dentist all the time, complaining of tooth pain. This was partly hypochondria, but mostly it was substance abuse. My dentist, whom I will call Dr. Bliss, had a practice that, as far as I could tell, consisted primarily of dispensing nitrous oxide. He would give you nitrous oxide to clean your teeth. He would give you nitrous oxide when he examined your teeth. He would give you nitrous oxide when he was in the other room, working on someone else’s teeth. Dr. Bliss’s patients—men, women, kids, blue-haired grandmas—would sit in his waiting room fidgeting and eyeing each other guiltily, like crack addicts.
Nitrous oxide is called laughing gas, though I never understood why. It never made me laugh. It was like sex: waaaay too intense to make you laugh, but hardly unenjoyable. Each time I was under nitrous oxide I would attain some overwhelming philosophical revelation that disappeared the instant I came out of the anesthesia. At this critical juncture, I once ripped off the rubber mask, grabbed a pen from the doctor’s shirt pocket, and scribbled my insight onto my bib. This is what I wrote, in its entirety:
“I-N-GÜ”
In subsequent visits I honed this revelation, eventually determining that the meaning of life involved gerunds. But that is about as far as I got.3 Personally, I think Dr. Bliss was everything you could want in a dentist, except that by the time I was sixteen, my molars were made entirely of ferrous compounds.
The Hypochondriac's Guide to Life. and Death. Page 4