Medical and Health Documents

Writing with grace, humor, and an expert’s eye for revealing detail, Susan Baur illuminates the processes by which hypochondriacs come to adopt and maintain illness as a way of life.

Sample

“A Disease So Grievous, So Common”

That “Tedious and long protracted Disease, whose Symptoms are so violent and numerous that it is no easy Task either to enumerate or account for them,” has had a remarkably constant clinical picture for the past two thousand years. Few disorders have had so continual or so long a history as hypochondria. Although the disorder has been given a dozen auxiliary names and ten times that number of explanations, the “bad and peevish disease” has been a recognizable entity for at least two millennia. The earliest written descriptions of hypochondriacs who were much troubled with indigestion, vertigo, insomnia, and bad dreams were immediately recognizable to sixth-century Byzantine physicians, to seventeenth-century chroniclers of disease, and even to us.

As far as anyone knows, the word hypochondrium first appeared among the Hippocratic aphorisms relating to fevers: “If jaundice arise in a fever on the seventh, eleventh, or fourteenth day, it is good,” Hippocrates is supposed to have said some four hundred years before Christ, “unless the right hypochondrium be hard, in which case it is bad.” Used this way, hypochondrium is an anatomical term referring to a specific place in the body, namely hypo (under) and chondros (the cartilage of the ribs). Thus the right hypochondrium includes most of the liver and gall bladder and the left hypochondrium, the spleen. The stomach and the rest of the epigastric apparatus sit between them. It was not uncommon to hear of someone wounded in one or both of his hypochondria (plural), and even as late as the 1700s it was reported that Deacon Sam’ll Field of Massachusetts fought with the Indians and was shot clear through his right hypochondrium.

Although the word hypochondria persisted for centuries as an anatomical term, during the second century A.D. it took on its second and more popular meaning. At that time the influential physician Galen of Pergamon linked the term to a broad range of digestive disorders. Hypochondria’s other attributes—preoccupation with disease, inexplicable periods of anxiety, nightmares, and the rest—were gradually added over the next four hundred years, after which the clinical picture, or “presenting symptoms,” as doctors would say, changed very little. In contrast, the explanations for hypochondria remained pretty much as Galen had formulated them for about fifteen centuries and then changed with increasing frequency, as did medicine in general.

Throughout most of its history hypochondria was linked to melancholia, which, being one of the four directions a personality could tend toward, was a common temperamental type. In fact, during Hippocrates’ time the problems we now call mental illnesses were loosely ranged in two categories: mania for agitated disturbances and melancholia for tranquil, depressive forms. The latter were understood to be caused by an excess of black bile, and hence the name was derived from melas or melanos , meaning black, plus chole , gall or bile. When Galen coined terms such as morbus hypochondriacus in the first century A.D. , he was attempting to differentiate among a vast collection of melancholic complaints.

During the Middle Ages interest in hypochondria waned, as it did generally in many aspects of corporeal existence. As attention was focused on salvation and eternal life more than on the flesh, a fascinating kind of spiritual hypochondria flourished briefly. This religious hypochondria was called pusillanimata , or scrupulosity. The condition was characterized by morbid doubt as to the adequacy of one’s devotion and a terrible fear not of disease and death but of eternal damnation.

During the Renaissance, when Aristotelian and Platonic ideas were revived and the belief grew that only the melancholic were capable of inspiration and other forms of creative madness, the physical variety of hypochondria reappeared as part of the new stance. Among Italian artists of the 1500s, for example, there was a gradual movement away from an earlier image of the competent craftsman toward one of the eccentric and slightly mad artist.

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