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Listening to Hypochondria


Not surprisingly, Gardon and his wife, Laura, were not enjoying the honeymoon period they might have envisioned. Laura, a massage therapist and aesthetician, had begun to feel that Gardon was drawn to entertaining only the most calamitous scenarios about his health, and her patience with him eroded. She had had plenty of experience with health problems of her own; before meeting Gardon, she had been through two bouts with breast cancer. “I’d had treatments and surgeries,” she says. “I wasn’t happy about any of it at the time, but I dealt with it. It made no sense to me what Lee was going through. To be honest, I got disgusted with it. And then I just became indifferent to him.”

As the months of uncertainty wore on, Gardon withdrew into himself. He was barely functioning. He gave up exercise, took handfuls of tranquilizers to cope with his anxiety, and entered what he called a “zombified” state, unable to turn his mind from thoughts of MS. “I’d be sitting with him,” says Laura, “having a conversation, or watching TV, and suddenly it was as though he wasn’t there at all.”

Laura was beginning to question how long she could remain with Gardon. Then one morning, she picked up a copy of AM New York and spotted an advertisement for a medical-research study that was trying to recruit subjects. She could barely believe what she was seeing.

“Do people call you a hypochondriac?” the ad read.

Not long ago, Lee Gardon would likely have continued to bounce from doctor to doctor, languishing as a lost cause, becoming progressively more isolated and incapacitated by his illness—which, it turned out, was not MS, but rather the extreme, involuntary, unshakable preoccupation with disease that characterizes hypochondria. In this matter, at least, Gardon was lucky. It has long been recognized that hypochondria is neither uncommon nor inconsequential. Chronic worriers represent around 5 percent of patients in primary-care settings, at an estimated annual cost to the health-care system of at least $20 billion in unnecessary doctors’ visits and tests. (One of the few epidemiological studies to address hypochondria, conducted in a community in Vermont nearly 40 years ago, found a 16 percent incidence of hypochondriacal thought.) How to deal with hypochondria, though, has been a far murkier matter. The enduring stigma attached to it has inhibited research and has allowed those who care for (and live with) hypochondriacs to respond to them as though they were toddlers in the midst of tantrums: Ignore them, and after a while, they’ll get over it. Physicians have been known to refer to their hypochondriacal patients as “turkeys,” “crocks,” and gomers (“Get out of my emergency room”), and to pass them on to specialists for further evaluations as a way of getting rid of them. Now, however, after decades of neglect by the medical and psychiatric Establishment, hypochondria is undergoing a paradigm shift. Following the path blazed by such related conditions as depression, anxiety, and obsessive-compulsive disorder, hypochondria is coming to be seen not as a weakness of character or a sign of eccentricity (or, worse, the stuff of a Woody Allen movie) but as a complex phenomenon of neurochemistry, biology, and psychology. The change is anything but academic. It is serving to lend hypochondria a trace of legitimacy, which itself can bring comfort to those who suffer its miseries. And the new model of understanding the causes and processes of rampant illness-related fear has already led to newly effective therapies, and holds out the hope for still more.

Hypochondria has been around, in one conception or another, as long as the practice of medicine. Hippocrates coined the term. Hypo means “under” and khondros refers to the cartilage binding the ribs together; hence, for 2,500 years, the discomfort and malaise of hypochondria was presumed to be situated in the liver, gallbladder, spleen, digestive tract, or other soft abdominal organs from which emotion sprang. Through the nineteenth century, hypochondria was regarded as a sign of intelligence and refinement. James Boswell, who chronicled the minutiae of Samuel Johnson’s thought—including his persistent thoughts of illness—was himself floridly hypochondriacal and particularly concerned with venereal disease. Boswell became the literary muse of medical fretfulness, publishing a series of essays called “The Hypochondriack.” He would keep good literary company: Kant, Darwin, Tolstoy, Charlotte Brontë, Proust, William James, and Tennyson are usually cited on rosters of celebrity hypochondriacs. So is Hitler.

In modern times, hypochondria fell into low esteem and was considered beneath clinical regard; Freud threw up his hands, writing, “I have always felt the obscurity in the question of hypochondria to be a disgraceful gap in our work.” Ironically, its decline seemed to be a function of its comical reputation as a thinking person’s affliction—the furthest thing from an organic illness. Arthur Barsky, professor of psychiatry at Harvard Medical School and director of psychiatric research at Brigham and Women’s Hospital in Boston, admits that it can be a challenge to contest the popular view of hypochondria as a sport of high-strung, hyperbolic, navel-gazing attention-seekers. “Hypochondria is no fun,” he says. “But we’ve still got a long way to go before it’s regarded as a legitimate illness of the brain and not just material for jokes.”

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