Listen to this episode and find out more about the topics therein at theallusionist.org/hypochondria.
This is the Allusionist, in which I, Helen Zaltzman, tenderly mop language’s brow.
This episode is about health anxiety, so content note: there’s a lot of discussion about health anxiety. And there are mentions of cancer, doctors and hospitals - but not detailed accounts of medical conditions or treatments.
18 April 2024, there’s a space-themed Allusionist live show in the planetarium at the H.R. Macmillan Space Centre in Vancouver, Canada, and it’ll be really fun - possibly a one-off, unless you have a planetarium you want some language-related entertainment to happen in? I’m open! I’ve linked to tickets at theallusionist.org/events, and they include a whole evening of space-related amusement and edutainment.
On with the show.
HZ: What does hypochondria mean? I suppose - what does it mean to you now?
CAROLINE CRAMPTON: I think to me now, it's come to mean a particular state of anxiety I experience that is related to health generally - specifically, though, bodily sensation. I associate it very strongly with, “I feel something, it doesn't feel right; it must be X, it must be Y” - that escalating train of anxiety. What it means in a more neutral dictionary definition way: I think the OED calls it “The persistent and unwarranted fear that one has a serious illness. Very much though mental condition that you experience around feelings to do with your health.”
My name is Caroline Crampton and I'm the author of A Body Made of Glass: A History of Hypochondria.
HZ: The word hypochondria has had a pretty big shift in meaning over its lifespan, since it originated as a word for a physical problem in the region of the body known as the hypochondrium.
CAROLINE CRAMPTON: Hypochondria, the word, is made up of two Greek words: the first one is ὑπό, which just means ‘under’, it's a preposition, and χόνδρος, which was the word for the cartilage of the sternum, so like the bit in the middle of your chest and under your ribs. And so the two together are really just a geographical term, hypochondria, hypochondros, it referred to the area of your body roughly where your liver and your spleen is. At the very beginning in Hippocrates in the 5th century BC and all that, the hypochondrium is just those places in the body, and hypochondria is any problem felt in those parts or thought to originate from the stuff in those parts.
HZ: It's interesting because a lot of psychological stress is felt in the body and in the midriff.
CAROLINE CRAMPTON: This was something I got very preoccupied by when I was working on this, that so much of how we conceptualize pain and sensation now is so old that we still talk about having a gut feeling about something, or we talk about having butterflies in the stomach when you're excited. We think of emotions with that part of the body.
HZ: Do you know if people were writing about this using other terms before 'hypochondria' came to mean this? Was this a particularly common thing to talk about?
CAROLINE CRAMPTON: Not especially, and that's why it was quite hard to research because there's not really a term that you can look for. There are various hints in Babylonian medical history, in Egyptian medical history, in Roman Republic history from Cicero, that people did experience this kind of anxiety or grief that expressed itself in bodily sensation in a way that doctors or healers of the time were not able to say, "Aha, we identify this as well known condition x." And Cicero uses this word, this Latin word, 'aegritudo': it's a word for sickness, or an instance of sickness; but it also has a supplementary meaning of grief. It meant to the Stoic philosophers - and Cicero's using it in that context - to have grief around your sickness. Which I interpret as meaning there being a very strong mental component to your thoughts about this sickness. And I think that's an early example that the mind-body tension exists in hypochondria basically the entire time that it exists.
And then what happens over the course of about 2,000 years is that the word translates from meaning this condition of the body to meaning what we now understand it to mean, completely of the mind conditions that aren't, quote, 'real', but that your mind has invented for your body to experience.
HZ: When did that shift happen and why?
CAROLINE CRAMPTON: It was very hard to pin down exactly when it happened, but my best guess is the late 17th/early 18th century. And before that though we have got this condition called ‘melancholy’, which is part of humoral theory.
HZ: Humoral theory is the idea that the body contains four fluids - blood, phlegm, yellow bile and black bile - that when imbalanced caused problems, physical and mental - a state called dyscrasia, the Greek for "bad mixture".
CAROLINE CRAMPTON: If you were ill, everything was about getting back to that sense of balance, whether that was because you were too cold and you needed to be made warmer, and so you needed to eat sort of warming foods, or you were too dry and you need to be wetter, like, so everything was And it's exactly the same in Chinese medicine and various Arabic schools of thought and Ayurveda in India: lots of different medical traditions from different parts of the world all have these same focus on balance.
HZ: The four humors have come up quite a few times in this show, because they do appear in our vocabularies a lot. I get into it a bit in the Bonus 2016 episode, about character-related words that came from humoral theory, like 'sanguine', and temperament. Well, another is 'melancholy'; it is derived from the Greek for black bile.
CAROLINE CRAMPTON: And melancholy is very associated with the liver. That's where black bile is thought to originate, be stored. it's very associated with the abdomen and with digestive complaints as well, also part of that hypochondriac region, and so melancholy and the hypochondrium become very associated. But as early as about, I think in about the fifth century, you start seeing records of people talking about melancholy having this mental component, that an excess of black bile can make somebody very sluggish, can make them depressed, can make them very listless about life.
And so melancholy is kind of always understood to be something experienced in the mind as well as in the body. And so what you get from about the early 17th century through to the 18th is this gradual transition where the mental symptoms become more and more important to melancholy and hypochondria, and the physical ones are referred to less and less, until in about, I suppose, the 1720s, 1750s, you've got people just talking about hypochondria and they just mean these undetectable melancholic feelings that no medical doctor can explain. And definitely by about the 1750s, hypochondria is entirely a mental condition.
HZ: Hypochondria had some things in common not only with melancholy, but also 'hysteria', a word documented from the early 17th century, coined from the Greek word for 'uterus' and meaning nervous ailments caused by that organ.
CAROLINE CRAMPTON: It has this very long and complicated literature to do with wanderings of the womb, this idea that the womb could move around the body and cause different problems. There are some amazing ancient Egyptian texts about how everything from dental problems to headaches, to problems in the legs, could all be explained by wanderings of the womb or terrors of the womb. They had all these stock phrases that they used for it. And so hysteria comes up through history very much as a female organ based complaint. It also starts to acquire sort of mental symptoms. There's this alternative word for hysteria that gets used in the 15th and 16th century where they call it "the suffocation of the mother", the idea being that the womb could actually get into the chest and throat and cause shortness of breath and palpitations - which are all symptoms that we now very much associate with anxiety, but at the time they thought this organ was literally sort of sitting on someone's chest. So it has its whole separate very gendered, very female-orientated history.
And then right at the point when hypochondria is in this flux between "Is it just a body organic condition, a disease rooted in the hypochondrium, or is it something mental?" one explanation that people start offering is that "We know that hysteria causes these mental and physical symptoms in women. What if hypochondria is the same thing but for men?” Because they're still very committed to the womb as the organ causing hysteria, it doesn't quite work for male bodies to have the same thing, so they have to call it ‘hypochondria’.
But yeah, so you do have this period where they kind of cross over, these two histories: their paths cross. And for not for very long, maybe 50 years or so, people are contemplating the idea that maybe they could be sort of two sides to the same coin. And then hypochondria moves into this purely mental realm. Hysteria does the same, but retains all of its gendered baggage.
HZ: What treatments, if any, were being offered for hypochondria?
CAROLINE CRAMPTON: The official treatments were pretty vague and tended to fall into the general category of what you might call ‘rest cure’. Opinions seem to be divided. Some people thought that it could be caused by too rich a diet. Other people thought not rich a diet enough was the problem. This is also where you start getting class entering the conversation: this quite famous 18th century doctor called George Cheyne, for instance, he was very convinced that hypochondria was a disease of the English upper classes. He published a book called The English Malady, which was all about this. So he thought it was the idle rich, with too much money, too much rich food, eating too much meat, not getting enough exercise, not enough honest toil: that was what caused this.
But then at the same time, doctors at hospitals - there was one in Edinburgh that kept very good records for instance - and they start getting ordinary working class people turning up with this same problem. And in their case, theories emerge like, "Well, they're not eating enough meat, their diet is so poor they're mainly subsisting through the winter on potatoes and oats. If only they could eat a better diet, more protein and so on, then they wouldn't have these conditions."
So the treatments kind of come from two different directions. So, not especially helpful. And as a result, you get people turning to unofficial remedies, quack remedies, traveling pharmacists and apothecaries who claim to have invented the perfect remedy for everything, including hypochondria. This is a big moment for quack remedies that are specifically panaceas that are about curing everything: this one cordial will fix everything that's wrong with you.
HZ: ‘Cordial’: another word with a body organ etymology. It was an adjective meaning 'heart-related', it used to be used like 'cardiac' is now; and a cordial was a medicinal drink to stimulate the heart and restore warmth to the body, if that was the humoral imbalance that needed to be corrected.
CAROLINE CRAMPTON: One of my absolute favourite bits of quackery that I found for the book was about this quack doctor called Samuel Solomon, who had this thing called the Cordial Balm of Gilead. He wrote a whole book justifying its existence, and he tried to model it on scientific texts. So although it had absolutely no evidence to it, he tried to construct the evidence for it. And he even included in that book something about how “most medications can't do anything for hypochondria, but mine can.” So he was simultaneously acknowledging that most remedies will not alleviate your hypochondria, while also monetizing hypochondriacs in his own favour.
HZ: Ingenious, in a certain way.
CAROLINE CRAMPTON: Yes. And it's really interesting that as medicine evolves and becomes better, science becomes more exact, the quackery evolves alongside it. So by the time you get into the 19th century and into the early 20th century, the quack stuff all becomes very specific, so no one would expect to be able to take one cordial and fix everything. Everyone has an entire medicine cabinet full of different remedies, because you need one for your gout, one for your warts, one for your headaches.
HZ: Also, that is a more lucrative way to take advantage of people's hypochondria, if you have to buy lots of things, not just one.
CAROLINE CRAMPTON: Absolutely.
HZ: It feels hard to separate hypochondria from money.
CAROLINE CRAMPTON: Yes, I think that's absolutely right. I think hypochondria is inextricably linked to money and to commerce and to capitalism.
HZ: Yeah, you see that in the modern day wellness industry, because there's a lot more stuff you can sell to people for all the things they don't have than the ones they do have.
CAROLINE CRAMPTON: Yes and it's so interesting to me the way that we seem to have reverted a little bit with wellness but back to things that are supposed to fix everything.
HZ: 'Wellness' is kind of an ingenious term, because everyone could be more well, the healthy and the unwell.
CAROLINE CRAMPTON: Yes, that is fascinating, because I think for a very long time, people thought of health as just the absence of illness - you know, "I don't currently have any festering wounds or lingering complaints therefore, I'm healthy." Wellness takes it up a notch: "Yeah, you haven't got any festering wounds or lingering diseases, but you could feel better, right?" No one feels perfectly perfect all the time, but wellness encourages us to think that we could.
HZ: Betterness is just a purchase away!
CAROLINE CRAMPTON: Exactly, yeah, and it's entirely commodified that you can buy it, that sensation.
HZ: My dad, until he reached his 60s, I never knew him to be ill, not even so much as a cold, but wow did he pursue a lot of flimflam remedies for his non-existent ailments. The pinnacle was that he used to go to see man who claimed to be able to remove his so-called ‘junk genes’, using a pendulum. “I don’t think that’s a thing that can happen, dad,” we said. “But he’s written a book!” “Anyone can write a book, dad” - never mind. I think he was just looking for a cure for his discontent with his life.
CAROLINE CRAMPTON: Yeah, I think that's quite common. I think there is quite a lot of people having a feeling of discomfort, dissatisfaction, a kind of emotional malaise, and they go looking for a pill or a potion that can fix it, even though there's no such thing, and in some cases it might actually make them feel worse. But we just really love the idea of that simplicity, like, “I have this feeling, I'll drink this thing, then I'll feel better.”
And the relationship between hypochondria and quackery really gets underway at the same time as consumerism becomes a thing, when you reach a point, certainly in Europe, where people are no longer expecting that they will manufacture all of their own household goods. It only really starts coming up once you get the idea of prescribing; once you start getting into the 14th, 15th century, the idea of you can just take this thing and it will fix you.
HZ: So you've had this change from physical to hypochondria being understood to be mental. You've also had the end of humoral theory, which required different explanations for hypochondria. And then you also have the rise of psychoanalysis in the 19th century, which didn't seem to really engage with hypochondria very well.
CAROLINE CRAMPTON: No, and my best theory as to why that is, is because it's too open ended; it's too vague and it's too difficult to solve. I think psychoanalysis was interested in narratives that had a beginning, middle and end; you know, looking back to the past for childhood trauma that linked to things that were happening now.
HZ: Start with your mother, end with your penis.
CAROLINE CRAMPTON: Exactly, yeah. Or looking into dreams. Looking for parallels everywhere. And I think hypochondria is just too amorphous. It's not susceptible to analysis in that sense. You see various attempts from Freud, for instance, over his career to try and fit it into his paradigm. So at certain points he's thinking, “Is it a kind of narcissism? Is hypochondria sick self-love? Is it a manifestation of self obsession. Is it too much ego?” But he never really comes to any firm conclusion, and he tends to just brush it under the carpet a bit, really. Which is interesting in its own right, I think; it demonstrates quite how fashion-driven a lot of illness is. Hypochondria had become extremely fashionable in the 18th century, and then, I think, fashion changed in the 19th century. And early 20th century psychoanalysis is much more popular. And it just doesn't really fit. And so it falls away.
HZ: Why was hypochondria a fashion?
CAROLINE CRAMPTON: I think hypochondria's status as a fashionable illness links back to the idea of it being something that the upper classes experienced, that it was a disease of luxury. Only people who had the time and means to imagine themselves ill and indulge in all of the behaviours that followed from that: only rich people could do that.
And therefore it became aspirational, in the same way that a fancy carriage or a big house or a particular kind of clothing was aspirational, that if you were working- or middle-class and you aspired to the kind of aristocratic life of the upper crust, then you aspired to their kind of illnesses as well. Musculoskeletal illnesses that were common among working people, that you might get if you're a bricklayer or a wagoneer or something like that, whereas having something with no clear cause and effect, with no visible - you can't see a joint that's popped out or a bone that's broken - it's just a feeling and you treat it b lying around on a couch and fanning yourself and calling for the doctor and telling everyone about it: you can absolutely see how which one you'd prefer to have. And therefore, as a signifier of wealth and of class and of being able to have leisure, hypochondria becomes fashionable and sought after in that way.
HZ: Something Caroline wrote about in her book that I found particularly striking was how hypochondria was a power move for some characters in literature. Several examples appear in Jane Austen's novels.
CAROLINE CRAMPTON: Yeah, this is one of my favourite parts of its whole history, I think. Jane Austen had a lot of hypochondria in her own family, mostly through her mother, who seems to have wielded it as a kind of manipulative weapon in amongst her relatives. So she was always having them change their plans or accommodate her. They go on a journey: “Mother's too ill with her hypochondria to sit in a normal carriage, we have to carry her in a litter on a feather bed.” It seems to be a way of basically getting attention from those around her - or at least that's how it is perceived by Jane and her siblings and so on in their surviving letters - and that's how she uses it in her novels as well. I don't think there's a single Jane Austen novel that doesn't have at least one hypochondriac in it. Her final novel, Sanditon, that she left unfinished at her death, is entirely about hypochondria. It's about the setting up of a new spa town full of doctors and hypochondriacs. But I think my favourite one is Mrs. Bennett in Pride and Prejudice.
HZ: Her nerves!
CAROLINE CRAMPTON: She suffers greatly with her nerves -
HZ: - And so must everybody else.
CAROLINE CRAMPTON: Exactly, she uses her nerves to try and communicate her unhappiness to other people. So she's constantly nagging her husband and saying, "You pay no attention to my poor nerves. You have no regard for them." She says the same thing to her daughters. I think what she's really saying is "You don't consider my feelings. You don't consider me when you're making decisions. You don't make me a part of your lives in the way that I would like." But of course, rather than just saying that, she has to make this big performance about her nerves. Same thing when her daughter elopes and disappears and they don't know where she is, she takes to her bed with her nerves because that's how she expresses grief and concern and anxiety, I suppose.
In Emma, Frank Churchill - who is this roaring young buck, handsome guy that Emma and everyone else fancies - he has this aunt who he is financially dependent upon, who is always a bit sick, and she will occasionally just summon him, and she will use her illness as the means of getting him to jump when she shouts, essentially, and so he has to disrupt his life and go and wait upon her. And I would definitely interpret that as she's using it as a form of control. Just the money isn't enough; the money doesn't keep him by her side. So she has to add in this extra element of, "Oh, I'm dying. I'm dying!"
HZ: There's something very poignant about it because it's all about unmet needs of some kind, but expressed in a way that is going to keep them unmet.
CAROLINE CRAMPTON: Yes, I think, especially if you're most familiar with Austen from film and TV adaptations, you're often encouraged in those things to see hypochondriac characters as ridiculous and silly and not at all rational. But when you read the books and you really think about it, they are, I think, mostly just expressing some quite sincere emotions, but maybe in a bit of a warped and controlling way.
HZ: So hypochondria was kind of fashionable but also annoying and stigmatized at the same time.
CAROLINE CRAMPTON: Yes, I think so. The way I would think of it is fashionable from a distance, but annoying up close.
HZ: So what happened then to the term in the 20th century?
CAROLINE CRAMPTON: In the 20th century, the term kind of undergoes this process of stigmatization, really. It becomes, especially in the wake of the First World War, where you have a lot of people returning from the trenches with shell shock and chronic fatigue syndrome and similar, you suddenly have a lot of this so-called 'invisible illness' where it can't be plotted and charted and tabulated by medicine, but demonstrably, people are suffering. And so hypochondria, it gets thrown around as this derogatory term. ‘proper’ ones are invented, like 'shell shock' and so on.
This really intense amount of stigma gets attached to the word 'hypochondria' through the 20th century, even to the point where, in medical papers in the late 20th century, 21st century, people start trying to give it new names, just because the word 'hypochondria' is so tainted that it doesn't feel like you can use it at all in a medical context. So some alternatives get proposed, one is 'valetudin disorder'.
HZ: What?
CAROLINE CRAMPTON: Very odd.
HZ: From the Greek word 'valetudo', meaning "the state of health."
CAROLINE CRAMPTON: That one didn't catch on. But the one that really does, and that you see used now in papers by the World Health Organization, is 'health anxiety'. This is now the contemporary term for what you want, what you might once have called hypochondria.
HZ: Is it different, do you think?
CAROLINE CRAMPTON: I read an awful lot of medical literature about this, trying to discover. And ultimately I would conclude, no, I don't think it is different. I think health anxiety has always been expressed in modern terms. It coexists with modern medicine quite comfortably; it fits in with other mental health diagnoses that a doctor now might be looking at; and it doesn't come with all of this complicated baggage about black bile and melancholy and people in the second century thinking they were made of pottery. It doesn't come with any of that stuff, and therefore I think it's much easier to use. We're also just quite comfortable now with the term 'anxiety'. Most people know what that means. So giving it a qualifier that locates it in a specific realm of your life makes, makes total sense. But no, I don't think there are any characteristics of health anxiety that aren't also present in hypochondria.
But I do think that if you were to go into a doctor's surgery and say, "I'm worried I've got hypochondria," you could reasonably expect to be treated one way, and if you went in and said, "I'm worried I've got health anxiety," you might be treated another way. And so I'm not sure that 'hypochondria' is necessarily a practical term that will result in you getting good treatment at a clinical level.
HZ: As well as tracing the medical and cultural history of hypochondria, Caroline's book recounts how she had cancer in her late teens, and how that has influenced her own relationship with the concept of hypochondria in adulthood. One of the really challenging things about hypochondria is that it is always somewhat justifiable, because inevitably, something is going to kills us.
CAROLINE CRAMPTON: Yeah, so this is something that I grappled with quite early on in the process of writing the book, because a lot of the theoretical material that I'd read about hypochondria very much positioned it in this binary situation that either someone has, quote, real illness, i.e. illness that you can detect with a scan or a blood test or some other diagnostic tool, or "It's all in their head and it's made up," and those are the only two ways it can be. But, just personally, I feel like I'm pretty much constantly experiencing some combination of the two. And I think the idea that there is unwarranted fear: I don't think there is any such thing as unwarranted fear, to be honest.
I encountered as well the idea a lot of the hypochondriac as a theoretical figure as someone who only has these imaginary illnesses and these fears with no basis. Whereas, I think almost everyone - or everyone, let's say everyone - could find a reason for their fear. And it might be something as very direct as, "I had cancer before so maybe I have cancer again" - that's not unreasonable. Or it might be a bit more remote like "my aunt had this particular kind of cancer, and I'm worried that I now have it too." Again, not unwarranted. We know all about genetic predispositions towards particular conditions. Or it might be something like, "I think I'm getting asthma and I live in an area with really bad air pollution." Again, not unwarranted; totally logical, totally reasonable, very direct connection between those things. So I think you can find a justification for almost any fear that you might have.
HZ: What's the role of labels like hypochondria in medical professionals maybe not making diagnoses either because they can't, because it's too difficult to ascertain what is wrong, or because they are not trained listening to the patients or believing them, or they're overlooking symptoms?
CAROLINE CRAMPTON: Tis is a serious and persistent problem, the idea that a doctor might dismiss something as “just hypochondria”, when, in fact, either someone has got an organic disease that they're just not detecting. In the course of writing the book, I interviewed one person who has now been diagnosed with multiple sclerosis, who, in her early attempts to approach doctors, was dismissed as just imagining it. There's lots and lots of stories like that. And there are lots of factors that might make a doctor more likely to dismiss you as just a hypochondriac, to do with your race, your body, your accent, your level of education, all kinds of things.
There's also generally a prejudice that can emerge against people who are seen to be overusing medical treatment. This idea of the so-called "worried well", people who are fine but are always coming in to just get things checked: I think there's a predisposition to think that those people must just be making it up, and draining resources from other people, and lots of negative associations with that. It's an unpleasant and oppressive label that doesn't have productive outcomes.
Where it gets a bit more complicated and blurry is if something is, quote, "just" hypochondria, I don't think that means that people should be dismissed. I think it's very possible that their hypochondria is an expression of something going on with them that requires attention. It might be not a physical health condition, but it may well be a mental health condition. And there have been attempts to kind of codify that.
Hypochondria isn't in the DSM-5, the Diagnostics and Statistics Manual, which is the so-called Bible of Psychiatry. They got rid of it for this edition, and instead they have two different disorders, one called Somatic Symptom Disorder and one's called Illness Anxiety Disorder. The main difference between the two is that Somatic Symptom Disorder is where someone feels physical symptoms that can't be explained, and Illness Anxiety Disorder is where there are no symptoms, but the person has a really heightened level of anxiety about illness.
There are, not extensive, but there are treatments, there are protocols that can be prescribed for these things. They mainly focus in two areas: one is antidepressants, SSRIs; some studies have shown them to be it's relatively effective for some people in alleviating hypochondria or illness anxiety. And the other is cognitive behavioural therapy. So you can therefore diagnose and treat it in a way that you would anything else. So I think that's the the attempt by the medical field to be productive, rather than have it be, "we've got hypochondria on one side and then all real illnesses on the other." Getting rid of the idea that there's any kind of hierarchy of realness is important. And also acknowledging that the brain is terrifyingly powerful.
HZ: It seems like a very fine balance to strike between not seeming dismissive of a hypochondriac's concerns whilst not amplifying them.
CAROLINE CRAMPTON: And that is the absolute impossibility, I think, of practicing medicine. I really do have great empathy for anyone who's trying to do it, because I don't think there is good guidance on this, because how could there be? I think they're just having to feel it out in the moment every time and try and judge for themselves, you know, "Is this a person where actually it would put their mind at rest if I did all the tests and showed them that the tests are negative, or is this someone where if I send them for a load of tests think they're gonna interpret that as me thinking it's really serious and I'm better off just telling them that they're fine and not to worry?"
HZ: I don't take my health anxieties to any medical personnel, I just let them bubble and fester. I know exactly where they stem from: longterm listeners might recall that in 2018, a sore throat escalated into a rogue ailment landed me in the ICU after emergency surgery, and I ended up spending three and a half weeks in hospital. The doctors were quite excited because I was a bit of a medical mystery to them, and let me tell you, being a medical mystery suuuuucks! I don't usually aspire to being boring, but being boring medically is my ideal state. Anyway, I recovered, I've had no medical bother since then, the rogue ailment is unlikely to recur and there are probably no longterm physical impacts except for my splendid neck scar and a little extra vocal growliness when I'm tired. But, mentally? Because something so serious arose from something as common as a sore throat, every time I have the slightest hint of one now, my brain immediately goes into emergency mode, mentally preparing for another spell in the ICU.
CAROLINE CRAMPTON: Yes, I do think there's a lot to unpack in relation to trauma. Part of hypochondria now can be related to trauma in your past. Which is kind of contrary to that classical definition of hypochondria as only about imaginary things. Because if it's dealing with real trauma, events that definitely occurred, then it's not imaginary, is it?
HZ: Right. I mean you definitely had that cancer. There seems to be a lot of proof.
CAROLINE CRAMPTON: Definitely had the cancer, definitely had the horrible IVF procedures that resulted from the cancer treatment, you know, all of the things that were giving me these really intense flashbacks and periods of anxiety definitely happened. There's medical records to prove it. This is why I got so confused for a long time about hypochondria, I think, because I felt like by the pure classic traditional definition of it, I would not be a hypochondriac, because I have a complicated medical history full of a lot of serious conditions that, therefore, surely, me feeling any kind of illness now is me feeling anxious about any kind of illness now: it doesn't come out of nowhere.
HZ: Yeah, and I guess you don't know which warning signs are going to be significant unless you pay attention to all the warning signs just in case.
CAROLINE CRAMPTON: Exactly, yes. So that's also something that is really common with hypochondria is what they call hypervigilance or hypersensitivity and body scanning. So constantly checking in with your body to see “how is everything? Do we feel okay? Is everything as it should be or are we feeling some new sensation that shouldn't be there?” You immediately jump to the worst possible explanation. Or, not even an explanation, just a, “This has to be really, really serious because it doesn't feel normal.”
So hypervigilance is a really common and acknowledged part of health anxiety. I feel like I and lots and lots of other people who've gone through serious health situations with a lot of medical intervention, that you basically get trained to be hypervigilant. They encourage it. They ask you to do it. Doctors are constantly at the end of every appointment saying, “Well, you know if you feel anything that feels off, don't hesitate to get in touch straight away,” because that could be the difference between catching something early and not catching it early enough, and all this sort of thing. But then when you're released out into the wild you're told, “You're no longer a patient anymore, you don't have cancer,” it's really hard to switch off the hypervigilance, especially if, like me, you're the kind of person that does really well with rules and procedures and likes to feel like she's doing a good job. You can't then be like, "Oh okay, so all these authority figures told me that this was the right way to behave and now I'm just supposed to stop?” It, yeah, doesn't make sense to me.
HZ: So you're trying to seek certainty in a morass of uncertainty.
CAROLINE CRAMPTON: I think that is what hypochondria is at its most deep level. There's a really good book called Hypochondria: A Condition of Doubt and I think that's a really great summation of it, that hypochondria is just the constant question mark at the end of the sentence, like, "Could it? Maybe?” Yes. And it's also complicated by the fact that I don't think, especially when it comes to human bodies and medicine, I don't really think there is such a thing as certainty.
HZ: The certainty thing, I think, worryingly is a part of like why I feel nostalgia for when I was the most ill I was in my life, because there was no doubt about where I was supposed to be, and what my obligations were, and they were very simple in certain ways. And when I think about that time, what I can think about are the positive emotions and not the extreme discomfort and boredom and fear that I felt, and the disgustingness of it all. It feels very messed up to be nostalgic for being in hospital.
CAROLINE CRAMPTON: But no, I know exactly what you mean though. And there is something very comforting in having a higher power essentially say, “No, this is what you have to do to stay alive, now do it.” Which we don't really have in everyday life. We don't have that kind of absolute knowledge of what we're supposed to do to stay alive.
HZ: No; it’s continual guessing and that's exhausting. But more exhausting when you're thinking about all the things that could go wrong and haven't yet.
CAROLINE CRAMPTON: Yes, I think it's just a very advanced fear of mortality, the same way that everyone, if they choose to think about it, has to grapple with the finiteness of their life. I think hypochondriacs are just doing that at a really high level, really hard, all the time. And having learned more about the extreme limitedness of our time on Earth, I feel a bit released actually from that constant grind of anxiety. Because I feel like even if I don't spend all this time researching brain tumours or skin conditions or whatever my current fixation of choice is, I am still going to die, at some point that I don't know. So maybe I could just…not.
HZ: Do you still use the word? Do you use the word about yourself? What do you favour?
CAROLINE CRAMPTON: I like ‘hypochondria’ and I would use it about myself, but that's because I've spent all these years reading about its history and learning about it, and I have great affection for it. I actually think it's a good word. I think it's a useful word because it contains all of that historical information. And I also like the fact that you can expand it to include yourself and lots of other people all through history who've all had this and all called themselves that. I think it's quite a nice community in that way.
HZ: Do you have any advice for hypochondriacs out there?
CAROLINE CRAMPTON: Um… Ha! I only have really grim advice about how you will die anyway.
HZ: Yeah. Wheeee!
CAROLINE CRAMPTON: That's ultimately where I've landed on the whole thing, is that, yeah, remember that you will die - and that you get to choose what you do before then, and maybe you don't want it to be this. You don't want to spend it consumed with medical information.
But no, I don't really have advice. I had a really funny - well, funny to me - conversation when I was in the process right at the beginning of pitching the book, one of the meetings that I went to with a publisher, they were all very positive, like, "Yeah, we love this idea. It's really, really great. But one question: would you be open to changing the ending? Would you be willing to end the book with helpful advice and tips for eradicating hypochondria and you could explain how you've defeated it and really bring the book to a happy ending in that way?" And I had to say to them that, "No, I'm sorry, I can't do that.” Because I don't have those answers. I don't really think anybody does." And I also wouldn't really describe myself as cured. I would describe myself as very much a hypochondriac in the present tense, just continuing to exist.
HZ: Well, the only cure is illness.
CAROLINE CRAMPTON: That's the thing. And there is this weird effect where if you are a hypochondriac, you can feel weirdly pleased to be given a very serious diagnosis because you do get that satisfaction of like, "I knew it! I knew there was something wrong with me. I knew I was right." And that can be very pleasurable, I'm not going to lie. Although you do then have to go, okay, I was right, and now I have to deal with this thing. Which is maybe less fun than the immediate reaction of feeling validated. But, nonetheless, just acknowledging that your continued existence is a marvel I think is the best thing that you can do.
HZ: Caroline Crampton makes Shedunnit podcast, about golden age detective fiction - I’m on a recent episode, you can hear it and all the other episodes, and join the Shedunnit book club, at shedunnitshow.com - and she is the author of the new book A Body Made Of Glass: A History of Hypochondria, which I read and immediately it became my primary topic of conversation with everyone I’ve spent time with since. So order A Body Made of Glass by Caroline Crampton.
It’s a big month for several of our podfriends. The amazing show Imaginary Advice just reached its 100th episode; you heard Ross Sutherland on this show a few years ago talking about Oulipo on the episode Trammels, and he kindly lent me some of his work to play you when my aforementioned throat ailment left me unable to make this podcast. Anyway, I make a little appearance on the centenary episode of Imaginary Advice, and the whole thing is a real treat. Also congratulations to Alumsionist Dan Pashman from the Sporkful podcast and our collaborative episode about apples, and a really early Allusionist about brunch; spot my voice on the Sporkful about Dan’s latest adventure in becoming a pasta baron, and he has a new pasta sauces cookbook out, called Anything’s Pastable. Yeah it’s a portmantNO, but the sauces are delicious. Oh and I make another tiny cameo in Switched on Pop asking about the choice of the brand Lexus in Beyonce’s song ‘Texas Hold’Em’. Podcasts, get yourself more podcasts!
And if you would like to ensure this podcast keeps going, you can donate to the show at theallusionist.org/donate and from just $2 per month, which not only means supporting this independent pod AND having fortnightly livestreams with me and my ever-expanding dictionary collection, but also spending time with your fellows in the Allusioverse Discord community, where we chat about our hopes and dreams, our fancy spoons, our latest reads. Join us: theallusionist.org/donate.
Your randomly selected word from the dictionary today is…
edaphic /r'dafik/ • adj. Ecology of, produced by, or influenced by the soil.
Try using ‘edaphic’ in an email today.
This episode was produced by me, Helen Zaltzman, on the unceded ancestral and traditional territory of the xʷməθkʷəy̓əm (Musqueam), Sḵwx̱wú7mesh (Squamish), and səlilwətaɬ (Tsleil-Waututh) Nations.
Editorial help and music were provided by Martin Austwick, of the podcasts Neutrino Watch and Song By Song, which just released its final episode examining every single song by Tom Waits. Hear it in the podplaces and at songbysongpodcast.com.
Our ad partner is Multitude. Ad spots are available on the show, so if you - yes you - have a product or thing to shift and would like me to talk winningly and affectionally about it to that end, contact Multitude at multitude.productions/ads.
Find @allusionistshow on the social networks. And you can hear or read every episode, find links to more information about the topics and people therein and other episodes that might be relevant, and see the full dictionary entries for the randomly selected words, and get tickets for events such as our planetarium show this April, all at the show’s forever home theallusionist.org.
