The Hypochondriac's Guide to Life. and Death. (5 page)

Sara was a woman of heroic gloom.
Anguish oozed from her tortured womb.
O Stygian depths, O life you accursed vip'rous crutch!
(That's what all her poems sound like, pretty much.)

Sara was a lifelong melancholic. She felt she had “weak veins” and particularly feared a stroke. Once, in 1928, after a particularly bouncy cab ride in Central Park, she became certain she must have suffered a life-threatening blood clot, or possibly a spinal injury. Her back and neck ached. At her insistence, she was hospitalized, but X-rays revealed no fractures. Masseuses, osteopaths, and neurologists were summoned. “I know what blows on the head mean,” Sara wrote to a friend. “Rheumatism often develops from an injury of this sort, and it seems to have attacked me practically all over” She hired a nurse for round-the-clock care.

But that was only a preamble. Sara Teasdale entered the Hypochondria Hall of Fame one day in 1933 when a small blood vessel burst in her hand, creating a purpled, spidery bruise.

Sara panicked. She decided this was the first sign of the massive embolism she had been expecting all her life. She knew all about what a stroke could do. She had researched it ceaselessly. She was not about to endure the indignity of it, or subject her loved ones to a lifetime of caring for a dull-eyed vegetable. And so she grimly took to her bath.

That is where her nurse found her the next day. The coroner concluded that her health had been fine, apart from the massive dose of sleeping pills that had killed her—and a small, harmless black-and-blue mark on her hand.

So there you have it, hypochondriacs.

Not only is your disease chronic, it can be fatal.

You've welcome.

1
I made this last one up. That is why it is important to read footnotes.

2
What kind of a name is Bysshe? What is
that
all about? Most people with idiotic middle names simply don't use them. How many of us, for example, know that Abraham Lincoln's middle name was Thptsk?

3
This is, to my knowledge, the first time Dick Cavett and Marcel Proust have appeared together in the same sentence.

The Mind of the Hypochondriac

The hypochondriac stands up
one day and feels a little dizzy. This is an ordinary sensation; it happens to all of us, a mild circulatory disturbance. But the hypochondriac is now instantly alert. He can't recall ever noticing this before. He is no expert, but it seems to have multiple implications. Logic tells him it might involve the heart, the lungs, or even the brain.

But he does not panic. The hypochondriac knows he is a hypochondriac. In a sense, this is his greatest comfort. Behind the certitude that he is deathly ill is a sneaking suspicion that it is all in his head. So he just tucks this moment into the back of his mind. Alas, that is the part of the brain that most bedevils the hypochondriac. It is where the mischief is born.

He starts casually monitoring himself. Testing. Lying on his back and then suddenly bounding to his feet, like a Whack-a-Mole. There is the dizziness again! Maybe he looks dizziness up in a home medical guide. He has sixteen of them.

Under “dizziness” there are many subheadings.

Subheading: “… in heart disease.”

Subheading: “… in cerebral arteriopathy.”

Subheading: “… in polycythemia rubra vera.”

The list is as long as a mortician's face.

The hypochondriac cannot help hut notice the entry right after “dizziness”—“dyspnea” which
also
has “… in heart disease” under it.

Just out of curiosity, he flips to the section on “dyspnea” and it turns out to mean “breathlessness.”

There is no immediate connection between these two conditions beyond the accident of their proximity on the page, but this is of no consequence to the hypochondriac. See, he
has
noticed dyspnea. He seems to get out of breath more easily of late. All other possible causes—aging, smoking, a sedentary lifestyle—do not at this moment occur to him. So he begins to watch himself, to
notice
things. He will climb a hill he goes up every day and realize he is somewhat out of breath. Has he felt this way before? The next time, he will follow a young woman up the hill, matching her step for step, and then, at the top, he will compare his breathing rate to hers. This will require him to carefully observe the heaving of her chest. But for some reason, she keeps walking away from him.

Does he smell bad? Is he perspiring excessively?

Why, yes, he is! His hands feel clammy, suddenly.

Back to the books. He looks up sweating. It can be a symptom of leukemia and encephalitis and a whole bunch of things he has never heard of: pyonephrosis, acromegaly, Graves's disease, hypoglycemia. Now he is nearly insane with worry. He goes to a doctor. The doctor listens to his heart, takes his blood pressure, and pronounces him fine!

And he
is
fine. Now he feels great! As he is leaving the doctor's office, though, he will notice a slight stitch in his side …

The fact is, most people are concerned about their health. But when does that concern cross the line from prudence to obsession? What is it that distinguishes the ordinary person from the hypochondriac?

In less enlightened times, the answer seemed easy. Hypochondriacs were thought of as whining, self-absorbed cowards. In the popular conception, they waddled around in bathrobes with ice packs on their heads and thermometers in their mouths. Doctors treated them as though they were feebleminded.

This should not be surprising. Through history, medicine has always been guilty of perpetrating hurtful, inaccurate stereotypes. For example, medical science used to categorize homosexuality as a psychiatric disorder caused by domineering mothers; its so-called “symptoms” were preening, mincing, flouncing, bitching, consumption of Midori watermelon liqueur, etc. Nowadays we recognize that homosexuality is a normal condition, caused by failed liberal social policies.

Similarly, we now know that hypochondria afflicts all types of people. And though we still do not know its causes or its cure, we have come a long way toward defining just who the hypochondriac is. There are no reliable clinical tests for hypochondria, but some emergency room doctors have devised their own screening procedure, known, delicately, as “a positive review of symptoms.” The hypochondriac will tend to answer yes to any question, so long as it is delivered with appropriate gravity. The two best-known screening tests: “Does your stool glow in the dark?” and “Do your teeth itch?”
1
Dr. Martin Wolfe, a Washington, D.C., specialist in parasitic diseases, deals occasionally with people who complain of bugs crawling out of their skin. Sometimes, bugs
do
crawl out of the skin, of course. Dr. Wolfe's screening question: “Did it have a mustache?”

The hypochondriac does not “imagine” pain, the way the ordinary person might fantasize, say, about blasting the homer that wins the World Series or getting that job she always dreamed about, or writing a fraudulent medical book that becomes a runaway bestseller, making him so wealthy he never has to work again and can buy sport utility vehicles and throw them away after using them once, like disposable razors. No, the hypochondriac actually
feels
his pain. The mechanics of how this happens remain a mystery, but the fact that it happens is indisputable.

This is not as peculiar as it seems. The human brain is an
amazing organ capable of astonishing feats. Doctors have long noted the existence of a phenomenon known as the “placebo effect”: When illnesses of all types are treated with sugar pills, and the patients are told they are getting medicine, as many as 35 percent get cured anyway. The implications of this are astounding. It means that either

1. Sugar is a tragically underutilized medical resource;
   or,
   

2. Doctors are swine. Because what about the 65 percent of patients who
   don't
   get cured?
   

Imagine the scene in the consulting room: “Well, Mr. Farquhar, I have good news and bad news. The bad news is that the canker sore on your lip didn't respond to medication and has migrated to your groin, where it has progressed to a particularly nasty case of thrombotic thrombocytopenic purpura. The good news is, the medication you didn't respond to was … a Domino demi-lump! Ha ha ha h—
(Sound of stethoscope inserted into nostril.)”

The point is, if the brain can relieve pain, surely it can create it.

My own extensive research into hypochondria suggests that the hypochondriac fits a basic personality pattern that might best be illustrated through the use of a Venn diagram, an extremely scientific visual aid utilized, for some reason, in the sixth grade and never again. Venn diagrams examine the relationships between groups of people via simple geometric comparisons.

For example,
Fig. 1
represents a general population breakdown.

Fig. 1

Get the idea? OK, now let's look at hypochondriacs (
Fig. 2
).

Fig. 2

This is a helpful, but still inadequate, profile.
Fig. 3
completes the picture.