The Case for Hypochondria

“The able and the disabled aren’t two different kinds of people but the same people at different times,” the journalist Tom Scocca wrote in a recent article in New York magazine. Whoever has health one day can be deprived of it the next. Scocca was writing at the time about stunning changes to his own health. Sickness, even when easily or quickly healed, brings with it suffering or pain; prolonged illness stirs up uncertainty, loss, and grief. One can so easily cross from the realm of the healthy and able-bodied into that of the sick and impaired. And what goes on inside the body, despite modern imaging and lab tests, is inevitably shrouded and opaque, hidden under our skin and within our cells. Our bodies remind us that there is so much we do not know: what an ache or a tickle or a lump means, whether it is benign or dangerous, an inevitable change over the course of a long life or a menacing omen of something much worse.

So it makes sense to worry about our health. It’s part of the human condition to take notice of the body, to track twinges of discomfort or a new tingle of numbness. “Hypochondria has been called ‘the ancient malady,’” writes Caroline Crampton in her lyrical new book, A Body Made of Glass: A Cultural History of Hypochondria. “For as long as humans have had an understanding of health, there has been anxiety about it”—especially when that understanding is subject to superstition and misconception.

What happens with that worry—what behaviors develop, how much it hampers or deforms us, how it relates to our symptoms and our interpretation of them—is where things get tricky. If doctors tell us there is nothing wrong with us, but we persist in our anxiety, are we acting pathologically? Or are we experiencing something as yet unknown, at the edge of medical knowledge? Is hypochondria a somatic condition—a form of mental illness, an experience of the mind expressed in the body—or is it rooted in physical experience? Is it a diffuse anxiety about health, fear of contracting communicable disease, or the conviction that an illness is already present? Is it a form of obsessive compulsion? What is hypochondria’s relationship to diagnosed illness, anyway? Is it always an unhinged departure from what’s happening in the body, or is it sometimes a reasonable response to the uncertainty of corporeal experience?

Crampton’s book, a cultural history prompted by personal experience, grapples with all of these questions. She follows the concept of hypochondria from antiquity to the present, tracking the definition throughout history as medicine and our cultural understanding of illness have evolved. Those shifts make the term hard to truly define: “Hypochondria is as slippery and elusive a term as the condition it tries to encompass,” she writes. It has also proved harmful, weaponized to undermine patient credibility, especially for those who present hard-to-diagnose illnesses. A burgeoning genre of literary nonfiction, from Scocca’s essay to Porochista Khakpour’s Sick to Meghan O’Rourke’s The Invisible Kingdom, documents and validates illnesses that do not always show up in lab tests, that present with unexplained pain, or that affect multiple body systems—conditions such as endometriosis, chronic fatigue, or long Covid. Because many of those illnesses disproportionately affect women, hypochondria, when mixed with other historical biases, can be another source of inequity.

Crampton acknowledges that sufferers of illness have long worked to avoid the term. Yet she proposes a use for hypochondria. A diagnosis of hypochondria, she argues, can offer consolation: “If this is ‘just hypochondria,’ my health is safe from other threats, for now,” she writes. Crampton includes herself in this community of sufferers, finding comfort in a shared experience with others. Even so, Crampton cannot shake the term free from the aspersions it inevitably casts. Is the sense of relief or camaraderie that hypochondria bestows enough to offset its risks?

Hypochondria has accumulated definitions over millennia that have never quite been erased or supplanted. As Crampton lays out, hypochondria ranges from certainty that serious illness lurks even when symptoms are mild to circumstances where discomfort is evident but cannot be explained. It can be a defense mechanism, a response to stress, a personality trait, a leaky gut, an inexplicable headache, a temperament susceptible to quack remedies, a collective delusion, or a habit of consulting Dr. Google. It can be, as a student of Freud’s, Isidor Sadger, wrote, “the state of being in love with one’s own illness.”

The knowledge that others have wrestled with the same anxieties over generations reassures Crampton. Hypochondria “feels rooted in a history and a tradition that connect sufferers stretching back over 2,000 years. It offers companionship while in the grip of a fear that can be completely isolating. It provides edges to a feeling of uncertainty that, in bad moments, can feel like it stretches on forever.” As she points out, a person living on a small Greek island in the fifth century BCE could use the term “hypochondria” in conversation with a doctor and be understood, just as she can today, even if the words would be received differently. That this concept persists “feels consequential,” Crampton writes. “It tells us something about the unaltering essence of what it is to be alive, sick and afraid.”

Anxiety about health has always existed, but the form it takes mirrors in fascinating fashion the preoccupations and peculiarities of each era. Crampton traces how hypochondria evolved alongside medicine and our knowledge of the body. It began as a mysterious ailment of the abdomen at a time when medicine understood the body as a grid of discrete anatomical regions, two of which, corresponding to the liver and the spleen, were called “the hypochondrium.” Then it was thought to be an illness caused by an imbalance in the four “humors,” viscous substances the proportions of which influenced everything from a person’s temperament to their predilection for certain aches and pains. Later, it was considered a product of “vapors,” gaseous “agents of mysterious malignity” released by various organs that addled the mind and undermined “bodily control.” All of these theories pointed to substances within the body, impossible to definitively detect, as sources of discomfort or illness.

Sometimes hypochondria took on metaphoric, almost poetic form: In the second century CE, hypochondriacs worried that the body, if jostled, would break into fragments, like earthenware pottery; by the late thirteenth century, people moved on to comparing the body to glass, when that material became more common. Fears evolved, from a terror of being “extremely smashable” to one where the body was transparent, our insides visible and exposed, or immaterial and unreal. (One modern sufferer of a “full-blown glass delusion” explained his worry to his doctor by pointing to a window: “That’s me. I’m there, and I’m not there.”) Historically, such sufferers were usually classified not as hypochondriacs, per se, but as manic or melancholic.

Already by the second century, hypochondria was a disease defined by a combination of physical symptoms and a mental propensity toward depression and anxiety. That hypochondria, hysteria, and nervous disorders were, at different points in history, all terms for essentially the same thing, tells us some-thing about our feelings on the mysteries of the body—and that the most opaque mysteries (those of the abdomen, the uterus, and the mind, respectively) tend to be perceived as the most threatening.

A Body Made of Glass details how hypochondria became a vessel that contained the fears and preoccupations of different milieus. Hypochondria shifts shape, from the French King Charles VI, who in the fourteenth century believed himself made entirely of glass, to John Donne, whose poetry dwelled on the possibility that illness “demolishes all,” to Molière, who likely had undiagnosed tuberculosis and often ridiculed in his comedies the doctors who failed to cure him. Immanuel Kant, a self-described hypochondriac, embodied the Enlightenment’s total devotion to reason in his belief that the ailment was a symptom of the mind’s inability to master the body; his response was to devote himself to a rigorous regimen of exercise, work, and diet that would subvert the weakness of the body to the superiority of the mind. Charles Darwin, who suffered his whole life from physical ailments that doctors were never able to explain (it was likely lactose intolerance), developed similarly strict habits to fend off “paralyzing fear of the unknown,” Crampton writes. Marcel Proust experienced allergies and asthma so severe that he adopted elaborate procedures to shield himself from irritants, forgoing heat in his rooms (smoke from fires triggered attacks) and eating little (he feared the effect of cooking smells). His father, an epidemiologist, believed his asthma was a form of hysteria or nervous disorder. (Given hypochondria’s association with hysteria, I was pleased that Crampton selected so many men as her historical examples; then again, they were the people most likely to leave a written record of their maladies.) In all cases, personality became distorted in response to symptoms and the fear they precipitated: Proust’s “life gradually shrank to his own four walls and then to his bed”; in Darwin’s case, “a routine meant to prevent the attacks that interfere with life becomes the stuff of life itself.”

Crampton seeks out these stories to identify “fellow travelers,” as she puts it, but in each of these examples, how was the notion of hypochondria helpful to the sufferer? Some dwelled on illness because it had indeed shattered their lives (Donne lost his father, three sisters, a brother, a stepfather, four children, and his wife in untimely fashion), and expressing fear of illness gave voice to a defining part of his life, while others, like Molière, who engaged medical professionals to no avail, may have dramatized the experience to balance his anxiety with levity. Others, like Kant, used the term to regain a sense of control over the body. Later, Freud’s preoccupation with the unconscious mind established the idea that health problems were either physical or mental, but that one could indeed influence the other. Hypochondria, in these instances, is not pure pathology but serves a purpose: It expresses our fundamental mortality, or a theory of mind or body.

The idea of hypochondria remains intriguing today, Crampton argues, as a means to reconsider our modern division of mind and body. A discussion of hypochondria forces us to consider how connected or distinct the two are, and how anyone can really tell. Crampton informs us, for instance, that a blend of cognitive behavioral therapy and SSRIs is one of the most effective treatments for hypochondria, proof, she writes, that “treating the mind helps to treat the body.” As we process the fact that some aspects of mental illness are organic to the body, and that our mental state has an impact on the body, might we begin to have more sympathy for hypochondriacs?

Crampton is frank that her interest in hypochondria is personal. She describes episodes of prodding her neck for lumps, Googling symptoms, or calling paramedics when her hair falls out in the draft of an open train window.

When Crampton reads the current diagnoses that encompass hypochondria in the American Psychiatric Association’s Diagnostic and Statistical Manual, she describes, with great poignancy, seeing herself reflected there—an experience that might resonate with many who have received a diagnosis for a long-existing burden. There is the initial prick of recognition, of discovering one is not alone in the world, of entering into kinship. It is “comforting, even exciting” to see her experience “inscribed with supreme authority in the pages of this highly influential text…. The list of likely symptoms matches up with me.”

Where things get tricky is that Crampton has very real and rational reasons for fearing disease. At 17, she was diagnosed with Hodgkin’s lymphoma. After months of treatment, she was told the cancer had been eradicated, but a lump in her neck the following year—one she had failed to notice—meant the disease had returned. She spent the next several years in treatment, including more chemotherapy, radiation, and a stem cell transplant. For years after, she was monitored for a return of the disease. But what began as her “responsible cancer survivor behavior” at some point “morphed into something else…. The worry itself had become the problem.”

Even if personal experience is the impetus for this exploration, it doesn’t drive it. A memoir this is not, at least not primarily, and Crampton is selective in her self-disclosure, sharing only discrete episodes from her personal history. The approach can be disorienting. Her experiences give emotional ballast and intimacy to an otherwise cerebral work, but we never get a full picture of what happened, when, or in what order; instead, we are offered fragments and glimpses, moments that Crampton isolates thematically. Even in an age of confessional writing and proliferating memoirs, she fears that writing about this part of herself opens herself to scrutiny and exploitation: “Some of you reading this now, whether friend, acquaintance or stranger, will probably think less of me in some private, secret way.” It’s a shame: The sections about herself are delicate and deft and full of insight.

Some of what Crampton divulges raises the question of whether the term hypochondria really applies to her at all. Crampton wonders this, too—repeatedly. “My fears about my health are persistent and at times intrusive, but they are not necessarily unwarranted,” she writes. “Perhaps it is not unreasonable or irrational, then, to worry.” And then: “Who gets to decide what is reasonable fear and what is unreasonable?” she asks. Also: “Diagnosable illness and hypochondria can coexist. One is not the antithesis of the other.” And again: “Am I a hypochondriac, or am I just a responsible patient?” Writing about her stem cell transplant, she recalls that the medical team who cared for her during her three-week isolation afterward was required to wake her every four hours to perform vital checks. “I no longer had any white blood cells that would organize a protective response to an invading infection or cause easily visible signs of a fightback like sweating or aches. Unless I was minutely monitored, by the time I physically felt that something was wrong with my responseless body, it would be too late to save me.” Such an experience seems formative of her hypervigilance—an essential part of her story. To have been so ill, especially at an age when the body is expected to be as hale as it will ever be—how could anyone escape such an experience without a lingering feeling that health is fragile, that catastrophe is around the corner?

Despite her own persistent doubts, Crampton chooses ultimately to cast the behaviors and emotions that linger after her illness as hypochondria, that is, as anxiety about illness that is not there. But what if, instead, she considered them a response to trauma? To be given such a grave diagnosis at 17, when independent adulthood is in sight but has not yet been attained; to have the sanctity and health of the body be snatched away when it is still settling into its adult form; to see one’s mother faint in shock, as Crampton does, at the news of her diagnosis—those are moments of trauma. She has indeed been taught by experience to doubt her body: “Why would I trust my body to heal itself unaided when, left to its own devices, it has previously developed tumors?”

Crampton treats historical figures and their health concerns with care and compassion. Yet, even with her complex understanding of the fragile nature of health, she grants herself far too little grace. For all her work to add context and nuance, hypochondria remains weighted with judgment. Where Scocca, O’Rourke, and others focus on the mystery of their hard-to-describe illnesses—the long diagnostic process, the emotional turmoil that uncertainty provokes, what that experience reveals about our medical system—Crampton prefers to give the entire experience one name. That she chooses the label at all tells us just how uncomfortable it can be to live with ambiguous health. “A name,” she writes, “is a powerful spell.”