Webstore The Infinite Mind West 47th Street If I Get Out Alive State of Mind: 2004 Voices of an Illness
Contribute Where to hear The Infinite Mind Chat board Awards and Honors Jobs Newsletter Staff About Contact
Lichtenstein Creative Media Creating Media that Matters
One Broadway 14th Floor Cambridge, MA 02142 617-682-3700 Fax: 617-682-3710 LCM@LCMedia.com
HYPOCHONDRIA
Week of December 1, 2004
It's the butt of jokes and the bane of the medical community, but hypochondria is a real illness, and people with it suffer real pain. We'll explore everything from the history of the disorder to the latest treatments. Guests include: Dr. Arthur Barsky, a professor of psychiatry at Harvard Medical School and the director of psychosomatic research at Brigham and Women's Hospital in Boston; Carla Cantor, the author of "Phantom Illness: Recognizing, Understanding, and Overcoming Hypochondria"; Dr. Susan Baur, the author of "Hypochondria: Woeful Imaginings"; and Gene Weingarten, a humor columnist for The Washington Post and the author of "The Hypochondriac's Guide to Life. And Death."Dr. Fred Goodwin begins with an essay in which he describes how normal health anxiety -- which he, himself, felt recently when he found a strange-looking mole -- differs from hypochondria. Once the dermatologist's tests came back negative, Dr. Goodwin stopped worrying. A person with hypochondria cannot be reassured -- he or she will continue to obsess. But, he says, this reaction should not be dismissed as "all in the head." Hypochondria is, itself, a real illness, and people with it are in real pain. As our guests discuss, there are even effective treatments. However, given the nature of the current healthcare system, the disorder still often goes undetected, and patients are not able to access proper care.
Then, Dr. Goodwin interviews Dr. Arthur Barsky, a professor of psychiatry at Harvard Medical School and the director of psychosomatic research at Brigham and Women's Hospital in Boston, and Carla Cantor, the author of Phantom Illness: Recognizing, Understanding, and
Overcoming Hypochondria, which she wrote with psychiatrist Brian Fallon.
Carla Cantor begins by describing her own hypochondria. In her case, there was a precipitating event -- when she was a teenager, she was driving a car during an accident in which one of her friends was killed. After that, she became very preoccupied with her health and thoughts of death. Her health anxieties came in waves. She describes one of the worst episodes, shortly after college, when she became convinced she had lupus. The idea totally consumed her. All she thought about, she says, was dying and lupus and being sick for the rest of her life, and she could not be reassured by doctors.
Dr Barsky says that Ms. Cantor's story sounds familiar, although not everyone with hypochondria has such a traumatic preceding event. For some it can be the onset of a depression, or a medical illness, or something seemingly benign. He gives the example of a man whose father died of a heart attack at 46 becoming obsessed with fears of dying after his 46th birthday. He says what is very characteristic in Ms. Cantor's description is the hypochondriac's fear that something terrible will happen and he or she will die.
Dr. Barsky explains that hypochondria is not like malingering, in which a patient feigns illness. People with hypochondria really feel the stiffness or pain or weakness they describe, and they truly believe they are dying. He says the current theory is that these people are extraordinarily sensitive, and they focus intensely on mild symptoms or normal bodily sensations. By focusing on their symptoms, they make them more intense, and so they end up feeling even worse. He says another hallmark of hypochondria is the inability to be reassured. People with hypochondria will often go from doctor to doctor, not believing their tests are really negative. Doctors natural inclination to conduct tests and try to rule out dire possibilities can, in fact, end up solidifying hypochondriacs' fears that their problems really are medical. He says we don't know how many people there are in the general population with hypochondria, but they seem to make up 4 or 5% of the medical population.
In response to a caller who asks about the link between hypochondria and OCD (obsessive-compulsive disorder), Dr. Barsky says that there is a lot of overlap between hypochondria and other psychiatric disorders. At one end of the spectrum, some hypochondria does look a lot like OCD (in these cases, people may know there physical symptoms are probably minor, but they remain obsessed with getting a diagnosis). More commonly, people with hypochondria have an underlying depression or panic disorder.
They then discuss treatment. Until very recently, hypochondria tended to be dismissed as untreatable, but that is changing. When there is an underlying disorder -- and even, in some cases when there is not -- SSRIs (selective serotonin reuptake inhibitors) can be very effective. Doctors are also developing cognitive-behavioral therapies that are proving effective for many patients. These involve training patients to view their symptoms in a different. less-threatening way. Ms. Cantor says that through medication and therapy, she feels "cured" of her hypochondria.
To contact Dr. Barsky, please write to: Dr. Arthur Barsky, Brigham and Women's Hospital, Department of Psychiatry, 75 Francis Street, Boston, MA 02115. Or visit http://www.harvard.edu/.
To contact Carla Cantor, please write to: Carla J. Cantor, Associate Editor, Rutgers Focus, Department of University Relations, Rutgers, The State University of New Jersey, 101 Somerset Street, New Brunswick, NJ 08901-1281.
After a short break, Dr. Goodwin interviews clinical psychologist and writer Dr. Susan Baur. She's the author of several books, including Hypochondria: Woeful Imaginings. They discuss the history of the disorder, from the first mention we know of it, about 2000 years ago, to now. Originally, "hypochondria" was an anatomical description, referring to a part of the abdomen. Our current definition of hypochondria dates back to Galen in the second century AD. Galen described it as a digestive disorder associated with melancholia (which was a medical condition caused by an abundance of the humor black bile) and marked by a fear of illness. Over the centuries, there have been changes in the perception of the disorder. For example, during the Renaissance, hypochondria became associated with "superior" people -- artists and other creative types. Dr. Baur then gives example of famous hypochondriacs, including Robert Burton, James Boswell, and Charles Darwin. She says in the early 1800s, a French physician was the first to classify hypochondria as a mental disorder, which gave it a pejorative connotation. Then, less than 100 years later, Freud rejected it as "unanalyzable" because it had a physical basis. At the same time, medical doctors -- now cognizant of germ theory -- rejected it as untreatable because there were no germs involved. As a result, hypochondria dropped out of medical registers until the 1970s when it was added to the DSM-II (the Diagnostic and Statistical Manual of Mental Disorders) as a somatoform disorder.
To contact Dr. Baur, please visit www.susanbaur.com or write to susanbaur@aol.com.
To order Hypochondria: Woeful Imaginings, click here.
Next up, The Infinite Mind's Devorah Klahr reports on the stress hypochondria can put on a marriage. She begins with David and Melissa Woycechowsky. When they were married three months, Mrs. Woycechowsky became convinced she had multiple sclerosis. Mr. Woycechowsky says, "She would say over and over again 'I think I'm going to die.' That would be the first thing she'd say and that would also be how she'd close up whatever she had talked about. That was pretty much all she'd talk about." Dr. Charles Ford, professor of psychiatry at The University of Alabama in Birmingham and author of a book about hypochondria, recommends that, in situations like these, the spouse offers reassurance but also expresses how he or she feels, so as not to become resentful.Hypochondria is no joke. It's a serious disorder that can have debilitating effects. But, as the old saying goes, laughter can be the best medicine. So next, The Infinite Mind's Marit Haahr interviews Gene Weingarten, a humor columnist for The Washington Post and the author of The Hypochondriac's Guide to Life. And Death. He's no scientist - but he offers personal insight into the mind of the hypochondriac.
He says he was a "dedicated hypochondriac," and he explains that, "the truly skillful hypochondriac obsesses only over those things that can prove fatal after a long and debilitating illness." He, himself, went through different phases, as he puts it -- a brain tumor phase, a "groinal" phase, etc. His book offers examples of all kinds of things that seem harmless but could be signs of impending doom -- hiccups and itching, to name just two.
Mr. Weingarten offers a cure for hypochondria, one that worked for him. He contracted a fatal disease -- hepatitis C. He does not recommend this, but he says he no longer obsesses over minor health worries. Happily, his hepatitis C now seems to be cured, as well, and his hypochondria has not returned.
To contact Mr. Weingarten, please write to: Mr. Gene Weingarten, Columnist, The Washington Post, 1150 15th Street, N.W., Washington, D.C. 20071. Or visit: http://www.washpost.com/.
To order The Hypochondriac's Guide to Life. And Death, click here.
Finally, commentator John Hockenberry takes on current health reporting. He says, "...I worry that our whole approach to human health is an invitation to constant worry. The media speak of every study of cancer causing agents. There are endless discussions of lumps and lesions and their causes. None of it is reassuring. To the point that obsessing may be a normal response."
- Marit Haahr
· Back to the The Infinite Mind Index
(c) 2004 Lichtenstein Creative Media, Inc.
