0:04

This is The Illusionist, in which

0:06

I, Helen Zaltzman, tenderly mop languages

0:08

brow. This episode

0:10

is about health anxiety, so content

0:13

note, there's a lot of discussion

0:15

about health anxiety. And

0:17

there are mentions of cancer, doctors

0:19

and hospitals, but not detailed accounts

0:21

of medical conditions or treatments. But

0:25

on the 18th of April 2024,

0:27

there is a space themed Illusionist

0:29

live show in the planetarium at

0:31

the HR Macmillan Space Centre in

0:34

Vancouver, Canada. It'll be really

0:36

fun. Possibly a one off.

0:38

Unless you have a planetarium, you want some language

0:40

related entertainment to happen in. I'm

0:42

open. I've linked to

0:44

tickets at theillusionist.org/events and they

0:46

include a whole evening of

0:49

space related amusement and edutainment.

0:51

On with the show. What

1:00

does hypochondria mean? Like,

1:02

what does it mean? I suppose what does it mean to you now? I

1:06

think to me now it's come to mean

1:08

a particular

1:10

state of anxiety I

1:12

experience that is related to

1:16

health generally, specifically though

1:18

bodily sensation. I

1:21

associate it very strongly with I feel

1:23

something. It doesn't feel right. It

1:26

must be it must be X. It must

1:28

be Y that escalating train of

1:30

anxiety. What it means

1:33

in a more neutral dictionary definition

1:36

way. I think the OAD calls

1:38

it the persistent and unwarranted

1:40

fear that one has a serious

1:43

illness. Very much though a

1:45

mental condition that you experience

1:47

around feelings to do with your

1:49

health. My name is

1:51

Caroline Crampton and I'm the author of A

1:53

Body Made of Glass, a history of hypochondria.

1:57

The word hypochondria has had a pretty big

1:59

shift in meaning. over its lifespan since

2:01

it originated as a word for a physical

2:03

problem in the region of the body, then

2:06

known as the hypochondrium. Hypochondria,

2:09

the word, is made up

2:11

of two Greek words. The

2:13

first one is hukou, which

2:15

just means under, so preposition,

2:17

and kondross, which was the

2:19

word for the cartilage of the sternum, so

2:21

like the bit in the middle of your

2:24

chest and sort of under your ribs. And

2:26

so the two together are really just

2:29

a geographical term, hypochondria,

2:31

hukou, kondross. It referred to the

2:33

area of your body roughly where

2:35

your liver and your spleen

2:37

is. At the very

2:39

beginning in Hippocrates in the 5th

2:41

century BC and all that, the

2:44

hypochondrium is just those

2:46

places in the body, and

2:49

hypochondria is any

2:51

problem felt in those

2:53

parts or thought to originate from the

2:55

stuff in those parts. It's

2:58

interesting because a lot of psychological

3:01

stresses felt in the body and in

3:03

the midriff. Yeah, this is something

3:05

I got very preoccupied by

3:07

when I was working on this, that

3:10

so much of how we conceptualize

3:12

pain and sensation now is so old

3:15

that we still talk about having

3:17

a gut feeling about something,

3:20

or we talk about having butterflies

3:22

in the stomach when you're excited, that we

3:25

think of emotions with that part of

3:27

the body. Do you know if people

3:29

were writing about this using other

3:31

terms before hypochondria came to mean this?

3:33

Was this like a particularly common thing

3:35

to talk about? Not

3:38

especially, and that's why it was quite hard

3:40

to research because there's not really a term

3:42

that you can look for. There

3:44

are various hints in Babylonian

3:48

medical history, in Egyptian medical

3:50

history, in Roman

3:52

Republic history from Cicero, that

3:55

people did experience this kind of

3:57

anxiety or grief that

4:00

existed. expressed itself in bodily sensation

4:02

in a way that doctors or

4:04

healers of the time were not

4:07

able to say, aha, we identify

4:09

this as well-known condition X.

4:12

And Cicero uses this word, this Latin

4:14

word agritudo. It's

4:16

a word for sickness or an instance

4:19

of sickness, but it also

4:21

has a supplementary meaning of grief.

4:24

It meant to the Stoic philosophers

4:26

and Cicero's using it in that

4:28

context to have grief around your

4:30

sickness, which I interpret as meaning

4:33

there being a very strong mental

4:35

component to your

4:37

thoughts about this sickness. And I think

4:39

that's an early example of a

4:42

mind-body tension that

4:45

exists in the hypochondria, basically

4:47

the entire time that it exists. And

4:50

then what happens over the course of about 2000 years

4:53

is that the

4:55

word translates from

4:57

meaning this condition of the

4:59

body to meaning what we now understand it

5:01

to mean completely of the mind, conditions that

5:04

aren't quite real, that your

5:07

mind has invented for your body to

5:09

experience. When did that shift happen

5:11

and why? It was very

5:13

hard to pin down exactly when it

5:15

happened, but my best guess is the late

5:18

17th, early 18th century.

5:21

And before that, though, we have

5:24

got this condition called melancholy, which

5:26

is part of humoral theory. Humoral

5:29

theory is the idea that the

5:31

body contains four fluids, blood, phlegm,

5:34

yerobile and blackbile, that when imbalanced

5:36

caused problems, physical and mental, a

5:38

state called iscrazia, a Greek for

5:41

bad mixture. If you were ill,

5:43

everything was about getting back to

5:45

that sense of balance, whether that was

5:48

because you were too cold and you needed

5:50

to be made warmer. And so you needed

5:52

to eat sort of warming foods or

5:55

you were too dry and you need to

5:57

be wetter. And it's exactly the same in

5:59

Chinese medicine and various Arabic. schools of thought

6:01

and Ayurveda in India, like lots of different

6:03

medical traditions from different parts of the world

6:06

all have these same focus on balance. The

6:09

Four Humans have come up quite a few times in this

6:11

show because they do appear in our vocabularies a

6:13

lot. I get into it

6:15

a bit in the bonus 2016 episode

6:17

about character-related words that came from humoral

6:20

theory like sanguine and temperament

6:22

while another is melancholy. It is

6:25

derived from the Greek for black bile.

6:29

Melancholy is very associated with the liver.

6:31

That's where black bile is thought to

6:34

originate, be stored. It's very associated

6:36

with the abdomen and with digestive

6:38

complaints as well, also part of

6:41

that hypochondriac region. So

6:43

melancholy and the hypochondrium become

6:45

very associated. But as

6:48

early as about I think

6:50

in about the fifth century you start seeing

6:52

records of people talking about melancholy having

6:55

this mental component that

6:57

an excess of black bile can

6:59

make somebody very sluggish, can make them

7:01

depressed, can make them very listless about

7:03

life. And so melancholy

7:06

is kind of always understood to

7:08

be something experienced in the mind

7:10

as well as in the body. And

7:12

so what you get from about the

7:15

early 17th century through to the

7:18

18th is this gradual

7:20

transition where the mental symptoms become

7:22

more and more important to melancholy

7:24

and hypochondria and the

7:26

physical ones are referred to less and

7:29

less until I suppose in the

7:31

sort of 1720 1750s

7:33

you've got people just talking

7:36

about hypochondria and they just

7:38

mean these undetectable melancholic

7:41

feelings that no

7:43

medical doctor can explain. And

7:46

definitely by about the 1750s hypochondria

7:48

is entirely

7:50

a mental condition. Hypochondria

7:53

had some things in common not only

7:55

with melancholy but also hysteria,

7:57

a word documented from the end of the century.

8:00

early 17th century, coined

8:02

from the Greek word for uterus and

8:05

meaning nervous ailments caused by that

8:07

organ. It has this

8:09

very long and complicated literature to do

8:11

with wanderings of the womb,

8:13

this idea that the womb could

8:15

move around the body and

8:18

cause different problems. There are some

8:20

amazing ancient Egyptian texts about how

8:22

everything from dental problems to headaches,

8:25

problems in the legs, could all

8:27

be explained by wanderings of the

8:29

womb or terrors of the womb.

8:32

They had all these stock phrases

8:35

that they used for it. And so hysteria

8:37

comes up through history very

8:40

much as a female organ-based

8:42

complaint. It also starts to

8:45

acquire mental symptoms.

8:48

There's this alternative word for hysteria that gets

8:50

used in the 15th and 16th century where

8:53

they call it the suffocation of the mother. The

8:56

idea being that the womb could actually get

8:58

into the chest and throat and

9:00

cause shortness of breath and palpitations through

9:03

all symptoms that we now very much

9:05

associate with anxiety. But at the time

9:07

they thought this organ was literally sort

9:09

of sitting on someone's chest. So it

9:12

has its whole separate very gendered,

9:14

very female orientated history. And

9:17

then right at the point when

9:19

hypochondria is in this flux between

9:21

is it just a body condition

9:23

or disease rooted in the hypochondrium

9:25

or is it something mental. One

9:28

explanation that people start offering is

9:31

that we know that hysteria causes these mental

9:33

and physical symptoms in women. What if hypochondria

9:35

is the same thing but for men? Because

9:39

they're still very committed to

9:41

the womb as the organ

9:43

causing hysteria, it doesn't

9:45

quite work for male bodies to have the same

9:47

thing. So they have to call it hypochondria.

9:51

But yeah, so you do have this period where they

9:53

kind of cross over these two histories and

9:55

for not very long, maybe 50 years

9:58

or so, people are confused. contemplating the

10:00

idea that maybe they could be two

10:02

sides to the same coin and then

10:05

hypochondria moves into this purely mental realm.

10:07

Hysteria does the same but retains

10:09

all of its gendered baggage. What

10:12

treatments if any were being offered

10:14

for hypochondria? The official

10:18

treatments were pretty vague and tended

10:21

to fall into the general category of what

10:23

you might call rest cure. Opinions

10:26

seem to be divided. Some people thought

10:28

that it could be caused by too

10:30

rich a diet. Other

10:33

people thought not rich a diet

10:35

enough was the problem. This is

10:37

also where you start getting class entering

10:39

the conversation. This quite famous 18th century

10:41

doctor called George Chaine for instance, he

10:44

was very convinced that hypochondria

10:47

was a disease of the English upper

10:49

classes. He published a book called The

10:51

English Malady, which was all

10:53

about this. So he thought it was

10:55

the idle rich with

10:58

too much money, too much rich food, eating

11:00

too much meat, not getting enough exercise, not

11:02

enough honest toil. That was

11:05

what caused this. But then at

11:07

the same time doctors, you know at hospitals

11:09

there was one in Edinburgh that kept very

11:11

good records for instance and they

11:13

start getting ordinary working-class people

11:15

turning up with this same

11:18

problem and in their case

11:21

theories emerged like well, they're not eating enough

11:23

meat. Their diet is so poor they're mainly

11:25

subsisting through the winter on potatoes and oats.

11:28

If only they could eat a better diet,

11:30

more protein and so on, then they wouldn't

11:32

have these conditions. So the

11:34

treatments kind of come from two different directions.

11:38

So not especially helpful and as

11:40

a result you get people turning

11:42

to unofficial remedies.

11:45

Quack remedies, traveling

11:47

pharmacists and apothecaries who claim

11:49

to have invented the perfect

11:51

remedy for everything including hypochondria.

11:53

This is a big moment

11:55

for panaceas. This

11:58

one cordial fix everything

12:00

that's wrong with you. Cordial, another

12:02

word with a body organ etymology,

12:05

it was an adjective meaning heart related.

12:08

It used to be used like cardiac

12:10

is used now, and

12:12

a cordial was a medicinal drink to

12:14

stimulate the heart and restore warmth to

12:16

the body if that was the humoral

12:18

imbalance that needed to be corrected. One

12:21

of my absolute favourite bits of quackery that I

12:23

found for the book was about

12:25

this quack doctor called Samuel Solomon, who

12:28

had this thing called the cordial balm

12:30

of Gilead. He wrote a

12:32

whole book justifying its existence and

12:34

he tried to model it on

12:36

scientific texts. So

12:38

although it had absolutely no evidence to

12:40

it, he tried to construct the evidence

12:42

for it. And he even

12:44

included in that book something about how

12:47

most medications can't do

12:49

anything for hypochondria, but

12:51

mine can. So

12:54

he was simultaneously acknowledging

12:56

that most remedies

12:58

will not alleviate your hypochondria while

13:00

also monetising the hypochondriacs

13:03

in his own favour. Ingenious

13:05

in a certain way. Yes, and it's

13:07

really interesting that as medicine

13:10

evolves and becomes better, science becomes

13:12

more exact, the quackery evolves

13:14

alongside it. So by the time you get

13:17

into the 19th century and

13:19

into the early 20th century, the quack stuff

13:21

all becomes very specific. So no one would

13:23

expect to be able to take one cordial

13:26

and fix everything. Everyone has an

13:28

entire medicine cabinet full of different

13:31

remedies because you need one for your gout,

13:33

one for your warts, one for

13:35

your headaches. Also that is a more lucrative

13:37

way to take advantage of people's hypochondria if you have to

13:39

buy lots of things, not just one. Absolutely.

13:41

Like it feels hard to separate hypochondria

13:44

from money. Yes,

13:47

I think that's absolutely right. I think hypochondria

13:49

is inextricably linked to money and to commerce

13:51

and to capitalism. Yeah, when you see that

13:53

in the modern day

13:55

wellness industry, because there's a lot more

13:58

stuff you can sell to people for all the things that are in the industry. don't

14:00

have them, the ones they do have. Yes, and

14:02

it's so interesting to me the way that

14:04

we seem to have reverted a little bit

14:07

with wellness back to things that are

14:10

supposed to fix everything. Wellness is kind

14:12

of an ingenious term because everyone could

14:14

be more well. Yes. The healthy and

14:16

the unwell. Yes, that is fascinating because

14:19

I think for a very long time

14:21

people thought of health as

14:23

just the absence of illness. So,

14:25

you know, I don't currently have

14:28

any festering wounds or lingering complaints,

14:30

therefore I'm healthy. Wellness

14:33

takes it up a notch. Yeah, you haven't

14:35

got any festering wounds or lingering diseases, but

14:37

you could feel better, right? No

14:39

one feels perfect all the time,

14:42

but wellness encourages us to think

14:44

that we could. Betterness is just

14:46

a purchase away. Exactly, yeah, and

14:48

it's entirely commodified that you can

14:50

buy it, that sensation. My

14:54

dad, until he reached his

14:56

sixties, I never knew him

14:58

to be ill. Not so much as

15:01

even a cult, but wow

15:03

did he pursue a lot of flim-flam

15:05

remedies for his non-existent ailments. The pinnacle

15:09

was he used to go to see

15:11

a man who claimed to be able

15:13

to remove his so-called junk jeans using

15:16

a pendulum. I don't think that's the

15:18

thing that can happen, Dad, we said, but he's

15:20

written a book. Anyone can write a book,

15:22

Dad, and never mind. I think he was

15:25

just looking for a cure for his discontentment

15:27

with his life. Yeah, I

15:29

think that's quite common. I think there is

15:31

quite a lot of people having a

15:33

feeling of discomfort, dissatisfaction,

15:36

a kind of emotional malaise, and

15:38

they go looking for a pill or a potion

15:40

that can fix it, even though there's

15:42

no such thing. And in some

15:45

cases it might actually make them feel worse. We

15:47

just really love the idea of that simplicity, like

15:49

I have this feeling, I'll drink this thing, and

15:52

I'll feel better. And the relationship

15:54

between hypochondria and quackery really gets

15:56

underway at the same time as

15:58

consumerism becomes a little bit more of a struggle. thing when

16:00

you reach a point in, certainly

16:02

in Europe, where people are no

16:04

longer expecting that they

16:07

will manufacture all of their own

16:09

household goods. It only really

16:11

starts coming up once you get

16:13

the idea of prescribing, once

16:16

you start getting into 14th, 15th century, that

16:19

the idea of you can

16:21

just take this thing and it will fix

16:23

you. So you've had this change from

16:27

physical to hypochondria being understood to be

16:29

mental. You've also had the end

16:31

of humoral theory which required different

16:33

explanations for hypochondria. And

16:36

then you also have the rise of psychoanalysis

16:38

in the 19th century which didn't seem

16:40

to really engage with hypochondria very

16:42

well. No. And my best theory

16:44

as to why that is, is

16:46

because it's too open-ended, it's

16:49

too vague and it's too

16:51

difficult to solve. I think

16:53

psychoanalysis was interested in narratives

16:56

that had a beginning, middle and

16:58

end. Looking back to the

17:00

past for childhood trauma that linked to things

17:02

that were happening now. Start with your

17:04

mother, end with your penis. Exactly, yeah.

17:07

Or looking into dreams. Looking

17:09

for parallels everywhere. And I think hypochondria

17:11

is just too amorphous. It's

17:13

not susceptible to analysis in

17:16

that sense. You see

17:18

various attempts from Freud for instance

17:21

over his career to try and fit

17:23

it into his paradigm. So at certain

17:25

points he's thinking, is it a kind

17:27

of narcissism? Is hypochondria sick,

17:30

self-love? Is it a

17:32

manifestation of self-obsession? Is it too much

17:34

ego? But he never really comes to

17:36

any firm conclusion and he tends to

17:38

just brush it under the carpet a

17:40

bit really. Which is interesting in its

17:42

own right I think. It demonstrates quite

17:44

how fashion driven a lot of illness

17:47

is. Hypochondria become extremely fashionable

17:49

in the 18th century and then

17:52

I think fashion changed in the

17:54

19th century and early 20th century

17:56

psychoanalysis is much more popular and

17:58

it just doesn't really fit. and

18:00

so it falls away. Why was

18:02

the hypochondria a fashion? I

18:04

think hypochondria's status as a

18:07

fashionable illness links back to

18:09

the idea of it being something that

18:11

the upper classes experienced, that it was

18:13

a disease of luxury. Only

18:15

people who had the time and means

18:18

to imagine themselves ill and indulge in all

18:20

of the behaviours that followed from that, only

18:23

rich people could do that. And therefore

18:25

it became aspirational in the same

18:28

way that a fancy carriage or a big

18:30

house or a particular kind of

18:32

clothing was aspirational. That if you

18:34

were working or middle class and

18:36

you aspired to a kind of

18:38

aristocratic life of the upper crust,

18:40

then you aspired to their kind

18:42

of illnesses as well. Musculoskeletal

18:46

illnesses that were common

18:48

among working people that

18:51

you might get if you're a bricklayer

18:53

or a wagonier or something

18:55

like that. Whereas having something

18:57

with no clear cause and effect, with

18:59

no visible, you can't see a joint

19:01

that's popped out or a bone that's

19:04

broken, it's just a feeling. And you

19:06

treat it by lying around

19:08

on a couch and fanning yourself and calling for the

19:10

doctor and telling everyone about it. You

19:12

can absolutely see which one you'd prefer to have.

19:15

And therefore, as a signifier of wealth

19:17

and of class and of being able

19:19

to have leisure, hypochondria

19:22

becomes fashionable and sought

19:24

after in that way. Something Caroline

19:26

wrote about in her book that I found

19:28

particularly striking was how hypochondria

19:30

could be a power move

19:32

for some characters in literature.

19:35

Several examples appear in Jane Austen's

19:37

novels. Yeah, this is one of

19:39

my favorite parts of its whole history,

19:41

I think. Jane Austen had

19:44

a lot of hypochondria in her

19:46

own family, mostly through her mother,

19:48

who seems to have wielded

19:50

it as a kind of manipulative

19:53

weapon in amongst her relatives.

19:55

So she was always having them change

19:58

their plans or accommodate. her. So

20:00

they go on a journey, mother's too

20:02

ill with her hypochondria to sit in

20:04

normal carriage, we have to carry her

20:06

in a litter on a feather bed.

20:08

It seems to be a way of

20:10

basically getting attention from those around her.

20:13

At least that's how it is perceived by

20:15

Jane and her siblings and so on in

20:17

their surviving letters. And that's

20:19

how she uses it in her novels as

20:21

well. I don't think there's a single Jane

20:23

Austen novel that doesn't have at least one

20:25

hypochondriac in it. Her final

20:28

novel, Sanditon, that she left unfinished at her

20:30

death is entirely about hypochondria. It's

20:32

about the setting up of a new smart

20:35

town full of doctors and hypochondriacs. I

20:38

think my favourite one is Mrs

20:40

Bennett in Pride and Prejudice. Her

20:42

nerves! She suffers greatly with

20:44

her nerves. And so must everybody else.

20:47

Exactly. She uses her

20:49

nerves to try and communicate her

20:51

unhappiness to other people. So she's

20:54

constantly nagging her husband and saying, you pay

20:56

no attention to my poor nerves, you have

20:58

no regard for them. She says the same

21:00

thing to her daughters. I think what she's

21:02

really saying is, you don't consider my feelings.

21:05

You don't consider me when you're making decisions.

21:07

You don't make me a part of your

21:09

lives in the way that I would like.

21:11

But of course, rather than just saying

21:13

that, instead, she has to make

21:16

this big performance about her

21:18

nerves. Same thing when her daughter elopes and

21:21

disappears and they don't know where she is.

21:23

She takes to her bed with her nerves

21:25

because that's how she expresses grief and concern

21:27

and anxiety, I suppose. In

21:29

Emma, Frank Churchill, who is

21:32

this roaring young buck, handsome

21:34

guy that Emma and everyone else

21:36

fancies, he has this aunt who

21:39

he is financially dependent upon, who

21:41

is always a bit sick

21:44

and she will occasionally just summon

21:46

him. And she will

21:48

use her illness as the means of getting

21:50

him to jump when she shouts, essentially. And

21:53

so he has to disrupt his life and go and wait upon

21:55

her. And I would

21:57

definitely interpret that as she's using

21:59

it. using it as a form of control. Just the

22:01

money isn't enough, the money doesn't keep him by her

22:04

side. So she has to add in

22:06

this extra element of, oh I'm dying, I'm dying. There's

22:08

something very poignant about it because it's all

22:10

about unmet needs of some kind, but

22:13

expressed in a way that is going to keep

22:15

them unmet. Yes, especially if you're

22:17

most familiar with Austin from film

22:19

and TV adaptations. You're

22:21

often encouraged in those things

22:24

to see hypochondriac characters as

22:26

ridiculous and silly and not

22:28

at all rational. But when you read the

22:30

books and you really think about it, they

22:32

are, I think, mostly just expressing

22:35

some quite sincere emotions but maybe in

22:37

a bit of a warped and controlling

22:39

way. So hypochondria was kind

22:41

of fashionable but also annoying

22:43

and stigmatised at the same time? Yes,

22:46

I think so. The way I would think of

22:48

it is fashionable from a distance but annoying up

22:50

close. So

22:52

what happened then to the term in the 20th century?

22:55

In the 20th century, the

22:58

term kind of undergoes this process

23:00

of stigmatisation really. It becomes, especially

23:02

in the wake of the First

23:04

World War where you have a

23:06

lot of people returning from the

23:09

trenches with shell shock and chronic

23:11

fatigue syndrome and similar, you

23:13

suddenly have a lot of this so-called

23:16

invisible illness where it can't be

23:18

plotted and charted and tabulated

23:21

by medicine. Demonstrably,

23:23

people are suffering

23:26

and so hypochondria, it

23:29

gets thrown around as this derogatory

23:31

term, proper ones are invented like

23:33

shell shock and so on. This

23:35

really intense amount of stigma gets

23:38

attached to the word hypochondria through

23:40

the 20th century, even to the

23:42

point where in medical papers,

23:44

the late 20th century, 21st century, people

23:46

start trying to give it new names

23:48

just because the word hypochondria is so

23:50

tainted that it doesn't feel like you

23:52

can use it at all in a

23:54

medical context. So some alternatives that

23:57

get proposed. One is valetudin disorder.

24:00

What? Very odd. From the Greek

24:02

word valetudo meaning the state of

24:04

health. That one didn't catch on. But

24:07

the one that really does and that

24:10

you see used now in papers by

24:12

the World Health Organization is health anxiety.

24:15

This is now the contemporary term for

24:17

what you might once have called hypochondria.

24:20

Is it different, do you think? I

24:22

read an awful lot of medical

24:25

literature about this trying to discover and

24:27

ultimately I would conclude no. I don't

24:29

think it is different. I

24:31

think health anxiety has always been

24:33

expressed in modern terms. It

24:36

coexists with modern medicine quite

24:38

comfortably. It fits in with

24:40

other mental health diagnoses that

24:42

a doctor now might be looking at. And

24:45

it doesn't come with all of this

24:47

complicated baggage about black bile and melancholy

24:49

and people in the second century

24:51

thinking they were made of pottery. It doesn't come

24:54

with any of that stuff. And therefore I think

24:56

it's much easier to use.

24:59

We're also just quite comfortable now with the

25:01

term anxiety. Most people

25:03

know what that means. So just giving it a

25:05

qualifier that locates it in a specific realm of

25:07

your life makes total sense. But no,

25:09

I don't think there are any characteristics

25:12

of health anxiety that aren't also present

25:14

in hypochondria. But I do

25:16

think that if you were to go

25:18

into a doctor's surgery and

25:20

say I'm worried I've got hypochondria, you

25:23

could reasonably expect to be treated one way. And

25:25

if you went in and said I'm worried I've

25:27

got health anxiety, you might be treated

25:29

another way. And so I'm

25:31

not sure that hypochondria is necessarily a

25:34

practical term that will result in you

25:36

getting good treatment at a

25:38

clinical level. So

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28:03

now back to talking about hypochondria with

28:05

Caroline Crumpton. As

28:11

well as tracing the medical and cultural

28:13

history of hypochondria, Caroline's book recounts how

28:15

she had cancer in her late teens

28:17

and how that does influence her own

28:19

relationship with the concept of hypochondria in

28:22

adulthood. One

28:24

of the really challenging things about

28:26

hypochondria is that it is always

28:28

somewhat justifiable because inevitably

28:32

something is gonna kill us. Yeah,

28:34

so this is something that I grappled

28:37

with quite early on in the process of writing the

28:39

book because a lot of the theoretical

28:42

material I'd read about hypochondria

28:46

very much positioned it in

28:48

this binary situation that either someone

28:51

has, quote, real illness,

28:54

i.e. illness that you can detect with a scan

28:56

or a blood test or some

28:59

other diagnostic tool, or it's

29:02

all in their head and it's made up. And those

29:04

are the only two ways it can be. But

29:07

just personally, I

29:09

feel like I'm pretty much constantly

29:11

experiencing some combination of the

29:13

two. And I think the

29:15

idea that there is unwarranted

29:18

fear, I don't

29:20

think there is any such thing as unwarranted fear, to

29:23

be honest. I encountered as well

29:25

the idea a lot of the hypochondriac as

29:28

a theoretical figure as someone

29:30

who only has these

29:32

imaginary illnesses and

29:35

these fears with no basis. Whereas

29:37

I think almost everyone, or

29:40

everyone, let's say everyone, could find a

29:42

reason for their fear. And it might

29:44

be something as very direct

29:46

as I had cancer before,

29:49

so maybe I have cancer again, that's

29:51

not unreasonable. Or it might be a bit more

29:53

remote, my aunt had this particular

29:55

kind of cancer and I'm worried that I

29:58

now have it too, again. not

30:00

unwarranted, we know all about genetic

30:02

predispositions towards particular conditions, or it

30:04

might be something like, I

30:07

think I'm getting asthma and I live in

30:09

an area with really bad air pollution. Again,

30:12

not unwarranted, totally logical, totally

30:14

reasonable, very direct connection between

30:17

those things. So I think you

30:19

can find a justification for almost any fear

30:22

that you might have. What's

30:24

the role of labels

30:26

like hypochondria in

30:29

medical professionals, maybe

30:32

not making diagnoses, either because they

30:34

can't, because it's too difficult

30:36

to ascertain what is wrong, or

30:38

because they are not listening

30:41

to the patients or believing them, or

30:43

they're overlooking symptoms? This is

30:45

a serious and persistent problem, the

30:47

idea that a doctor might dismiss

30:50

something as just hypochondria,

30:53

when in fact either someone has

30:55

got an organic disease

30:58

that they're just not detecting. In the course

31:00

of writing the book, I interviewed one person

31:02

who has now been diagnosed

31:04

with multiple sclerosis, who in her early

31:06

attempts to approach doctors was

31:09

dismissed as just imagining it.

31:12

There's lots and lots of stories like that, and

31:14

there are lots of factors that might make a

31:18

doctor more likely to dismiss you as

31:21

just hypochondriac, to do with

31:23

your race, your body, your

31:25

accent, your level of education, all kinds

31:28

of things. There's also a

31:31

prejudice that can emerge

31:33

against people who are seen to

31:35

be overusing medical treatment, this idea

31:37

of the so-called worried well, people

31:40

who are fine, but are always

31:42

coming in to just get things

31:44

checked. I think

31:46

there's a predisposition to think that those

31:48

people must just be making

31:51

it up and draining

31:53

resources from other people, and

31:55

lots of negative associations with that.

31:58

It's an unpleasant and oppressive

32:01

label that doesn't have productive

32:03

outcomes. Where it gets

32:05

a bit more complicated and blurry

32:08

is if something

32:10

is quote just hypochondria. I

32:13

don't think that means that people should

32:15

be dismissed. I think it's

32:17

very possible that their hypochondria

32:20

is an expression of

32:22

something going on with them that requires

32:24

attention. It might be not a physical

32:26

health condition but it may well be

32:29

a mental health condition. And

32:31

there have been attempts to codify that.

32:34

Hypochondria isn't in the DSM-5,

32:37

the Diagnostics and Statistics manual,

32:39

which is the so-called Bible

32:41

of Psychiatry. They got rid

32:43

of it for this edition and instead

32:46

they have two different disorders,

32:48

one called somatic symptom disorder

32:50

and one called illness anxiety

32:52

disorder. The main difference between the

32:54

two is that somatic symptom disorder is where

32:57

someone feels physical symptoms

32:59

that can't be explained and

33:02

illness anxiety disorder is where there are no symptoms

33:04

but the person has a really heightened

33:07

level of anxiety about illness. There

33:09

are not extensive but there are

33:12

treatments, there are protocols that can

33:14

be prescribed for these things.

33:16

They mainly focus in two areas. One

33:19

is antidepressants, SSRIs. Some

33:22

studies have shown them to be relatively

33:24

effective for some people in alleviating

33:26

hypochondria or illness anxiety and the

33:28

other is cognitive behavioral therapy. You

33:32

can therefore diagnose and treat it

33:35

in a way that you would anything else. So

33:37

I think that's the attempt by the medical

33:39

field to be productive rather than

33:41

have it be we've got hypochondria on one side

33:44

and then all real illnesses

33:46

on the other, getting rid

33:48

of the idea that there's any kind

33:50

of hierarchy of realness is

33:53

important. And also acknowledging that the

33:55

brain is terrifyingly

33:57

powerful. It seems like

34:00

a very fine balance to

34:02

strike between not

34:04

seeming dismissive of a hypochondriac's

34:06

concerns whilst not amplifying them.

34:09

And that is the absolute impossibility, I

34:12

think, of practicing medicine. I really do have great

34:14

empathy for anyone who's trying to do it, because

34:16

I don't think there is good

34:19

guidance on this, because how could

34:21

there be? I think they're just having

34:23

to feel it out in the moment every

34:25

time and try and judge for themselves, you

34:28

know, is this a person where actually it would

34:32

put their mind at rest if I did all the tests

34:35

and showed them that the tests are negative? Or

34:37

is this someone where if I send them for

34:39

a load of tests, they're going to interpret that

34:41

as me thinking it's really serious? And I'm better

34:43

off just telling them that they're fine and not

34:46

to worry. I

34:48

don't take my health anxieties to any

34:50

medical personnel. I just let them

34:52

bubble and fester privately. I know

34:55

exactly where they stem from. Long-term

34:57

listeners might recall that in 2018,

35:00

a sore throat escalated into a

35:02

rogue ailment that landed me in

35:04

the ICU after emergency surgery, and

35:07

I ended up spending three and a half weeks in hospital.

35:10

The doctors were quite excited because I was a

35:12

bit of a medical mystery to them. And

35:14

let me tell you, being a

35:17

medical mystery sucks. I

35:20

don't usually aspire to being

35:22

boring, but being boring medically

35:24

is my ideal state. Anyway,

35:27

I recovered. I've had no medical

35:29

bother since then. The rogue ailment

35:31

is unlikely to recur, and there

35:33

were probably no long-term physical impacts

35:35

except for my splendid neck scar,

35:38

and a little extra vocal growliness

35:40

when I'm tired. What? Mentally?

35:43

Because some things so serious arose from

35:45

something as common as a sore throat.

35:48

Every time I have the slightest hint of one

35:50

now, my brain immediately goes

35:52

into emergency mode, mentally preparing for

35:55

another spell in the ICU. Yes,

35:57

I do think there's a lot to unpack

36:00

in relation to the ICU. to trauma, a

36:02

part of hypochondria now can be related to

36:04

trauma in your past. Which is

36:06

kind of contrary to that classical definition

36:08

of hypochondria as only about

36:11

imaginary things, because if

36:13

it's dealing with real trauma events

36:15

that definitely occurred, then

36:17

it's not imaginary, is it? Right.

36:20

I mean, you definitely had that cancer. Seems

36:23

to be a lot of proof. Definitely had the cancer. Definitely

36:26

had, you know, the horrible

36:28

IVF procedures that resulted from

36:30

the cancer treatment, you know,

36:33

all of the things that were giving

36:35

me these really intense flashbacks and periods

36:37

of anxiety definitely happened. There's medical records to

36:39

prove it. This is why I

36:41

got so confused for

36:43

a long time about hypochondria, I think,

36:46

because I felt like by the

36:49

pure classic traditional definition of it,

36:51

I would not be a hypochondriac,

36:54

because I have a

36:56

complicated medical history full of a lot

36:59

of serious conditions that

37:01

therefore surely me feeling anxious about any

37:04

kind of illness now, it doesn't

37:06

come out of nowhere. Yeah. And

37:08

I guess you don't know which warning signs

37:10

are going to be significant unless you pay

37:12

attention to all the warning signs just in

37:14

case. Exactly. Yes. So

37:17

that's also something that is

37:19

really common with hypochondria is

37:22

what they call hypervigilance or

37:24

hypersensitivity and body scanning.

37:26

So constantly checking in with your body

37:29

to see how is everything? Do

37:31

we feel okay? Is everything as it should

37:33

be? Or are we feeling some new sensation

37:35

that shouldn't be there? You

37:37

immediately jump to the

37:40

worst possible explanation or

37:43

not even an explanation, just a, this has

37:45

to be really, really serious because it doesn't

37:47

feel normal. So hypervigilance is a really common

37:50

and acknowledged part of health anxiety. I

37:52

feel like I and lots

37:55

and lots of other people who've gone through

37:57

serious health situations with a lot of medical

37:59

intervention. that you basically get trained

38:01

to be hypervigilant. They encourage it, they

38:03

ask you to do it. Doctors are

38:05

constantly at the end of every appointment

38:07

saying, well, you know, if you feel

38:10

anything that feels off, don't hesitate

38:12

to get in touch straight away. Because

38:15

that could be the difference between

38:17

catching something early and not catching it

38:19

early enough and all this sort of

38:21

thing. But then when you're released

38:23

out into the wild or told you're no

38:25

longer a patient anymore, you don't have cancer,

38:28

it's really hard to switch off the hypervigilance.

38:31

Especially if like me, you're the kind

38:33

of person that does really well with

38:35

rules and procedures and, you know, likes

38:37

to feel like she's doing a good

38:40

job. You

38:42

can't then be like, okay, so all these authority figures

38:44

told me that this was the right way to behave.

38:46

And now I'm just supposed to stop. Yeah,

38:49

it doesn't make sense to me. Yeah, so

38:52

you're trying to seek certainty in a

38:54

morass of uncertainty. I

38:56

think that is what hypochondria is

38:59

at its most deep

39:02

level. There's a really good book

39:04

called Hypochondria, a condition of doubt.

39:06

And I think that's a really great

39:08

summation of it that hypochondria is

39:10

just the constant question mark at the end

39:13

of the sentence. Like could it maybe? Yes.

39:16

And it's also complicated by the

39:18

fact that I don't think especially when

39:21

it comes to human bodies

39:23

and medicine, I don't really think there is

39:25

such a thing as certainty. The

39:27

certainty thing, I think, worryingly is

39:30

a part of like why I feel nostalgia for when

39:32

I was the most ill I was in my

39:34

life, because there was no doubt about where

39:36

I was supposed to be, and what my obligations

39:39

were. And they were very simple in

39:41

certain ways. And when I

39:43

think about that time, what I can think

39:45

about are the positive emotions and not the

39:47

extreme discomfort and boredom and fear

39:49

that I felt and the disgustingness of

39:51

it all. It feels very

39:54

messed up to be like nostalgic for

39:56

being in hospital. But no, I know exactly

39:58

what you mean though. And there is something very

40:00

comforting in having a higher power

40:03

essentially say, no, this is what

40:05

you have to do to stay alive. Now

40:08

do it, which we don't really

40:10

have in everyday life. We

40:12

don't have that kind of absolute

40:14

knowledge of what we're supposed to do

40:16

to stay alive. No continual

40:18

guessing and that's exhausting. But

40:21

more exhausting when you're thinking about all the things that could go

40:23

wrong and haven't yet. Yes,

40:26

I think it's just a very

40:28

advanced fear of mortality. The

40:31

same way that everyone,

40:33

if they choose to think about it, has

40:37

to grapple with the finiteness of their life.

40:39

I think hypochondriacs are just doing that at

40:41

a really high level, really

40:43

hard all the time. And having

40:47

learned more about the

40:49

extreme limitedness of our time

40:52

on Earth, I

40:54

feel a bit released actually from

40:57

that constant grind of anxiety.

40:59

Because I feel like even if I

41:02

don't spend all this time researching

41:04

brain tumors or skin conditions or whatever my

41:07

current fixation of choice is, I

41:09

am still going to die at some point that I

41:11

don't know. So maybe I could not.

41:15

Do you still use the word? Do you use the word about

41:17

yourself? What do you favour? I

41:19

like hypochondria and I would use it

41:22

about myself. But

41:24

that's because I've spent all these years

41:26

reading about its history and learning about

41:29

it. And I have great affection

41:31

for it. I actually think it's a good

41:33

word. I think it's a useful word because

41:35

it contains all of

41:37

that historical information. And

41:39

I also like the fact that you can expand

41:41

it to include yourself and lots of other people

41:44

all through history who all have this and all

41:46

call themselves that. I think it's quite

41:48

a nice community in that way. Do

41:51

you have any advice for

41:53

hypochondriacs out there? I

41:58

only have really grim advice. about

42:01

how you will die anyway. Yeah.

42:04

Weeee! That's ultimately where I've

42:06

landed on the whole thing. Is

42:09

that, yeah, remember that you

42:11

will die. And that you

42:14

get to choose what you do before then. And

42:17

maybe you don't want it

42:19

to be this. You don't

42:21

want to spend it consumed with medical

42:24

information. But no, I don't really

42:26

have advice. I had a really funny, well, funny

42:28

to me conversation when I was in the process,

42:30

right at the beginning of pitching the book, one

42:33

of the meetings I went to with a

42:35

publisher. They were all very

42:37

positive, like, yeah, we love this idea. It's really,

42:40

really great. But one question, would

42:42

you be open to changing the ending?

42:44

Would you be willing to end the

42:46

book with helpful

42:49

advice and tips for eradicating

42:51

hypochondria? And you could explain how you've

42:53

defeated it. And really

42:56

bring the book to a happy

42:58

ending in that way. And I had to say

43:00

to them that, no, I'm sorry, I can't do

43:02

that. Because I don't have

43:04

those answers. I don't really think

43:06

anybody does. And

43:09

I also wouldn't really describe myself as

43:11

cured. I would describe myself as very

43:14

much a hypochondriac in the present tense,

43:16

just continuing to exist. Well, the

43:18

only cure is illness. That's the

43:20

thing. And there is this weird effect where

43:22

if you are a hypochondriac, you

43:25

can feel weirdly pleased to

43:28

be given a very serious diagnosis. Because

43:30

you do get that satisfaction of like, I knew it.

43:33

I knew there was something wrong with me. I knew

43:35

I was right. And that

43:37

can be very pleasurable. I'm not going to lie. Although

43:39

you do then have to go, okay, I

43:41

was right. And now I have to deal

43:43

with this thing, which is

43:45

maybe less fun than the immediate reaction

43:48

of feeling validated.

43:51

But nonetheless, acknowledging that your

43:53

continued existence is a marvel, I

43:57

think is the best thing that you can do. Caroline

44:01

Crampton makes She Done It

44:03

podcast about golden age detective

44:05

fiction. I'm on a recent episode, you

44:07

can hear it and all the other episodes, and join the

44:09

She Done It book club at

44:12

shedoneitshow.com. And she

44:14

is the author of the new book,

44:16

A Body Made of Glass, The History

44:18

of Hypochondria, which I read and immediately

44:21

it became my primary topic of conversation with everyone

44:23

I've spent time with since. So,

44:26

Order A Body Made of Glass by Caroline

44:28

Crampton. You

44:55

can set up custom email addresses, you can sell

44:57

courses, you can sell merch, you

44:59

can feature your writing, pictures, videos,

45:01

podcasts, you can do it all

45:03

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There's enough stuff to be worrying about, but

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thanks to Squarespace, all this is

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45:42

launch, to save 10% off your

45:44

first purchase of a website

45:46

or domain at squarespace.com/illusionist.

46:01

It is a big month for several of our pod friends!

46:03

The amazing show Imaginary Advice by Ross

46:05

Sutherland just reached its 100th episode. You

46:07

heard Ross on this show a few

46:10

years ago talking about Oolapoe on the

46:12

episode Tremors, and he kindly lent me

46:14

some of his work to play you when my aforementioned

46:16

throat ailment left me unable to make

46:19

this podcast. Anyway, I make

46:21

a little appearance on the centenary episode

46:23

of Imaginary Advice, and the whole thing

46:25

is a real treat. Also

46:28

congratulations to alumgenist Dan Pashman

46:30

from the Sporkful Podcast, and

46:32

our collaborative episodes about apples, and a

46:34

really early episode about brunch. You can

46:36

spot my voice on the Sporkful about

46:39

Dan's latest adventure in becoming a

46:41

pasta baron, and he

46:43

has a new pasta sauces cookbook

46:45

out called Anything's Pasta Bowl. Yeah,

46:48

it's a portmanteau, but the sauces are delicious.

46:51

Oh, and I make another tiny cameo in Switched

46:54

on Pop, asking about the choice of

46:56

the brand Lexus in Beyonce's song

46:58

Texas Hold'em. Podcast, get

47:00

yourself more podcasts! And

47:03

if you would like to ensure this podcast

47:05

keeps going, you can donate to the show

47:08

at the illusionist.org/donate, and from

47:10

just two American dollars per

47:12

month, you are not only supporting

47:15

this independent podcast, you are

47:17

also having fortnightly livestreams with me

47:19

and my ever expanding dictionary collection,

47:22

and spending time with your fellows in the

47:24

Illusionist Discord community, where we chat

47:26

about our hopes and fears, fancy

47:28

spoons, or our latest reads. Join

47:32

us at the illusionist.org/donate.

47:37

Your randomly selected word from the dictionary today

47:39

is... Edaphic.

47:46

Adjective. Ecology of, produced

47:49

by, or influenced by the

47:51

soil. Try using Edaphic

47:53

in an email today. This

47:56

episode was produced by me, Helen

47:58

Zoltzmann, in the NCB. the ancestral

48:00

and traditional territory of the Musqueam,

48:02

Squamish and Tsleil-Waututh Nations. Editorial

48:05

help and music were provided by Martin

48:07

Orstwick of the podcasts

48:09

Neutrino Watch and Song by Song,

48:12

which just released its final episode

48:15

after eight and a half years

48:17

of examining every single song by

48:19

Tom Waits. Hear it

48:21

in the pub places and

48:23

at songbysongpodcast.com. Ad

48:25

partner is Multitude. Ad spots are available

48:28

on the show, so if you, yeah

48:30

you, have a product or thing to shift and

48:32

would like me to talk winningly and affectionately

48:34

about it to that

48:36

end, contact Multitude at

48:38

multitudes.productions.com. Find Illusionist

48:41

Show on the social networks and

48:44

you can hear or read every episode.

48:46

Find links to more information about the topics and people

48:49

therein and other episodes of this show that

48:51

might be relevant and see

48:53

the full dictionary entries for the randomly

48:55

selected words and get tickets

48:57

for events such as our planetarium show

48:59

this April all at the show's forever home

49:02

theillusionist.org.