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Listening to Hypochondria

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Lee Gardon enrolled in Fallon’s leg of the study, conducted under the rubric of the Somatic Disorder and Heightened Illness Concern Research Program at Columbia University Medical Center, in November 2006. By then, Gardon was worried not only about his health but about his marriage as well. He didn’t have much hope for the study, but he had come to a dead end pursuing medical explanations for his illness, and he had to demonstrate to his wife that he was earnestly trying to get better.

Gardon’s skepticism about the study soon began to ease. He was grateful that Fallon’s staff referred to his condition as “heightened illness concern” rather than as hypochondria, a label he found demeaning. During his intake, he responded to a lengthy, detailed survey, and it seemed to him that the kinds of questions it asked—how often he checked himself for symptoms, how focused he was on bodily sensations—reflected an uncanny understanding of his thought process. (Indeed, it turned out that Gardon, who had been a track star in his youth, had been drilled to develop what he called a “hypersensitivity to my body.”) The tone of the questions seemed, Gardon thought, to show some compassion for his ordeals. A psychiatrist administered a physical exam to rule out the possibility of undiagnosed medical conditions. “It was 100 percent different from my other visits to doctors,” he says. “It was very comforting. Apparently, they knew what they were doing.”

Gardon began doing some independent research about hypochondria and was struck by how many risk factors he had for developing the disorder. As many as 70 percent of hypochondriacs are also depressive, and since Gardon’s childhood, in Soviet-dominated Czechoslovakia, he had been described as “melancholic.” Some research has cited a genetic component in hypochondria, and Gardon could recall that his grandfather, with whom he loved to hike in the woods, would carry medication with him on these outings out of fear of having a heart attack. Gardon grew aware, too, that stress could precipitate both physical ailments and a hypochondriacal state of alarm, and his life had featured a litany of hardships: a dramatic and life-threatening escape from Czechoslovakia to Italy, via Hungary and Yugoslavia, in which he ultimately evaded capture by sailing a windsurfer across the Adriatic; two years living in an Italian refugee camp; and the difficulties of arriving alone in the U.S., in 1986, unable to speak English and constantly fearful for his survival. “You have to work long hours and stay healthy if you don’t want to starve,” he says of the experience, “and nobody cares how you feel.”

Indeed, it turned out that the saga of Gardon’s medical woes, which had made him feel so poorly understood, was a casebook study in hypochondria. Constantly fatigued, Gardon had at one point become dependent on stimulants, consuming more than 25 double espressos daily for a long stretch. Anxiety attacks had followed, during which Gardon would be convinced he was having a heart attack. On numerous occasions, he summoned ambulances for himself. Despite tests showing that he had outstanding cardiac health, he worried about his heart so intensely that he installed a GPS unit in his car to map the location of hospitals along his driving routes and avoided crossing bridges and tunnels in case he was stricken while caught in traffic. In time, his health fears had begun to spread. Hearing of an acquaintance’s stroke, he was convinced he was at risk. He feared bone cancer and fibromyalgia. Even the common cold would be a problem—congested, he would grow panicked that his airways were clamping shut.

Gardon was assigned by Fallon’s staff to the group of subjects who would receive both medication and therapy. He was anxious about taking Prozac, given his suspicions of conventional medicine and his concerns about toxins. Still, after years of being regarded as a problem patient, he was now, at Columbia, a model subject, and he complied fully and enthusiastically with the requirements of the study. Each week he headed to the New York State Psychiatric Institute, looming above the Hudson in Morningside Heights, to visit his assigned psychiatrist, with whom he discussed at length his response to the medication. He also had a dozen sessions of cognitive behavioral therapy. In the first session, he was taught deep-breathing techniques that he found effective in short-circuiting panic. He was tutored in common-sense strategies for contending with hypochondriacal thinking, like distracting himself from worry by watching TV or exercising, and placing constraints on his Internet research, and challenging catastrophic thinking with factual information about the likelihood of having a serious disease. Within about a month of starting the study, Gardon felt his hypochondria begin to evaporate. He credited Prozac with the change. After years of believing that he was the victim of a plethora of dire illnesses, Gardon decided, instead, that his principal malady was an easily treated neurochemical imbalance. Gardon had always been in search of a diagnosis, and this one provided him with a powerful explanatory tool for coping with his fluctuating states of mind and body. “It was a revelation,” he says.

It’s not, however, as though Gardon believed he was cured. It will be some years before the results of Fallon and Barsky’s study are published, and for now it remains unclear how long-lasting the effectiveness of either medication or therapy is likely to be. Gardon knows that. And he knows himself well enough to remain ever fearful of the return of crippling anxiety. In March, six months after he wound down his participation in the study, he had surgery to repair a torn rotator cuff. A month later, his arm in a sling, he was paying close attention to how the shoulder was healing. “That’s a habit I can’t break,” he says. His progress was slower than he would have liked, but he claimed not to be unduly worried. Most important, his marriage was much more stable, even if, as Laura, observed, “once the hypochondria improved, there were other issues to deal with, too.” Laura was inclined to attribute Gardon’s hypochondria to the emotional traumas of his past, and those scars had not been made to vanish under the influence of Prozac. Not long ago, Laura says, as the spring allergy season got under way, Gardon woke in the middle of the night in a state of alarm, and repeated a familiar refrain: “I think my throat is closing.”

“I didn’t even stir,” Laura recalls. “In the past, he might have called an ambulance. But this time he just got up and went into the other room. I don’t know what he did out there, but he must have calmed himself down, because the next thing I knew he was back in bed, next to me, sleeping.”


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