The best books on Hypochondria

Thanks for selecting these five books on hypochondria—it’s an intriguing mix of fiction, memoir, and a script for a play. But, first, could you talk us through what hypochondria is, exactly, and how it has been interpreted by health professionals?

The dictionary definition of hypochondria today is something like ‘a mental condition characterized by the persistent and unwarranted belief or fear that one has a serious illness.’ It’s generally understood to mean the intense anxiety some people experience about their health, sometimes associated with symptoms that medicine can’t detect or diagnose. But in medical practice it’s now deemed an obsolete word, with some organisations like the World Health Organisation preferring to use ‘health anxiety’ to describe this phenomenon, while the DSM-5 (the ‘bible of psychiatry’ in the US) has split it into two official conditions: ‘somatic symptom disorder’ and ‘illness anxiety disorder.’

It’s a hard term to pin down: most lay people that you mention it to will have a working understanding of what it is, either based on themselves or someone they know, but creating objective criteria for identification and diagnosis has been something medicine has struggled with for decades.

Until very recently, there has also been substantial stigma associated with the word hypochondria—it was used both from within medicine and outside to dismiss or diminish people’s health concerns, especially those from already-marginalised groups. Part of the reason medicine has now shifted to using phrases like ‘health anxiety’ instead is to do away with this previous baggage when discussing the condition.

What about your own hypochondria, how did it develop? Your experiences form one strand of your new book, A Body Made of Glass: A History of Hypochondria.

It all had its origins in being diagnosed with cancer when I was 17. I had no idea that I was ill, or that there was a tennis-ball sized tumour visible in my neck—you can see it in old photos of me from that time, but it had grown so slowly that I hadn’t noticed it. Even after going through years of treatment and finally being declared cured, I could never quite shake the anxiety that this could happen again, that a serious illness could be taking over my body without my knowing. As I got further away from being an active cancer patient, this hypervigiliance and constant awareness of every little ache and twinge turned into health anxiety. It was confusing and complicated, though. Because I had been diagnosed with a ‘real’ major illness, my concerns were often treated as justified, at least initially. It took quite a while for me to even realise that the thought patterns I was stuck in were consistent with hypochondria. So often, the figure of the hypochondriac in popular culture is a perfectly healthy person who is convinced they are sick, rather than someone with a legitimate medical reason to be afraid.

Well maybe that brings us to the first text that you’ve chosen to recommend: Molière’s Le malade imaginaire, available in English as The Imaginary Invalid. It’s a three-act play dating from 1673. Tell us more.

Molière struggled with his health for several years before he wrote this play — he had a terrible cough and difficulty breathing, especially in the damp, smoky Parisian winters. In this play, he wrote the central role of Argan, the ‘imaginary invalid’ of the title, for himself. Argan is frustrating and cantankerous, always trying different doctors and treatments and then abandoning them when they don’t bring him relief. This was obviously something Molière had personal experience of, and he had written plays satirising the medical profession before: 1665’s L’Amour médecin, for instance, features five doctors who were based on real-life Parisian physicians, each with their own idiosyncrasy mercilessly satirised by the playwright.

Le malade imaginaire is meant to be a comedy, so there’s plenty of bodily humour and farcical action as Argan’s frivolous second wife tries to secure her inheritance. There’s also a romantic sub-plot, as Argan tries to marry his daughter off to a doctor so that he will always have a free medical attendant in the family. The play ends in the kind of musical dance interlude that was traditional in late 17th century drama, with Argan getting himself “certified” as a doctor because there is no one more qualified to practice medicine than a hypochondriac and no disease will dare kill off a doctor.

“A few hours before Molière died, he had convinced an entire theatre that he was perfectly fine”

Although a comedy, this play has come to have a tragic resonance for me, because it was Molière’s last play. During the fourth ever performance, Molière was taken ill while acting onstage as Argan, racked with terrible coughs. He managed to pass it off as part of the character, but after the play was over he collapsed and had to be carried in a litter to a colleague’s lodgings nearby. He died there a few hours later, choking on his own blood. Just a few hours before, he had convinced an entire theatre’s worth of people that he was perfectly fine, just a hypochondriac. I think this is an extreme example of how a lot of people with health anxiety feel all the time: it’s just hypochondria until something serious shows itself, by which time it’s too late.

Your next book recommendation is Jane Austen‘s Sanditon, her unfinished satirical novel. How does hypochondria drive the story?

Sanditon was begun in early 1817 and left unfinished when she died in July of that year. She completed eleven chapters, though, which give us a fair idea of the book’s plot and themes. A carriage accident at the start introduces the protagonist Charlotte Heywood to a Mr and Mrs Parker, who are from a seaside town called Sanditon. Until recently, this place was a small fishing village, but with the investment of Mr Parker and others, it is quickly being transformed into a fashionable watering place, full of invalids and hypochondriacs who have come to stay there for the ‘cure’ offered by the fresh sea air and various local quacks. Once the Parkers are recovered, they invite Charlotte to return home with them to experience Sanditon for herself, where she finds a community of quarrelling, selfish people obsessed with their own health.

It’s much more bitingly satirical than Austen’s previous fiction, I think, and it’s truly a shame that we will never know how she intended to develop the ideas further. It’s also fascinating to think about how the book’s subject matter intersects with her own life. Austen’s mother, Cassandra Leigh Austen, was well-known in the family as a hypochondriac, so the author was writing Sanditon from personal experience. And at the time when she started writing it, Jane herself was already unwell with the illness that would, six months later, take her life. As Austen biographer Claire Tomalin puts it: “What other fatally ill writer has embarked on a savage attack on hypochondria?” It’s a remarkable piece of fiction for a dying woman to write.

Austen also famously poked fun at Mrs Bennett’s ‘nerves’ in Pride and Prejudice. How was hypochondria understood at that time?

Pride and Prejudice was first published in 1813, which is right at the point when lots of competing theories about how the mind and the body interact are being debated by the scientific community. William Harvey’s work on the circulation of the blood had inspired other ideas about what might be flowing around the human body, and thoughts ranged from a kind of ‘vapour’ that moved around inside us, to mysterious ‘animals spirits,’ to fibres or ‘nerves’ that delivered information to the brain.

“Mrs Bennet’s nerves represent much more than just the emotional disregulation of a silly woman”

Hypochondria was also right the point here of transitioning from being considered wholly a condition of the body—the ‘hypochondrium’ was a term for an area of the upper abdomen and ‘hypochondria’ was disease experienced there—into being a problem felt in the mind, as we know it today. Less than a decade after Austen’s novel appeared, the French doctor Jean-Pierre Falret published a pivotal book that declared hypochondria to be an entirely mental condition. “Moral and intellectual causes are, without contradiction, the most usual causes of hypochondria,” he wrote.

All of which is to say, Mrs Bennet’s nerves represent much more than just the emotional disregulation of a silly woman. The palpitations and flutterings and faintness she experiences in moments of great emotion or distress are actually a major point of medical debate at the time, as well as being crucial to a greater understanding of how the human body works.

Your next recommendation is Deborah Levy’s Hot Milk, which portrays a very complicated mother-daughter relationship riven with health anxieties. Could you talk us through it?

Hot Milk is about Rose, who has confusing and debilitating health problems, and her daughter Sofia, who finds her mother exasperating but seems perpetually tied to her, and even sometimes experiences apparent sympathy pains for her. The novel sees them travel to a peculiar clinic in Spain, where Rose is supposedly going to be cured of the cause-less paralysis that has confined her to a wheelchair by a strange man named Gómez. The novel is a dense, literary exploration of Sofia’s interior life, but it also provides some fascinating and tragic insights into the plight of the hypochondriac. For instance: Rose has remortgaged her house in order to be able to pay the 25,000 euro fee to attend the clinic. Given that she has no diagnosis, this seems exceptionally steep, but it is representative of the desperate lengths people will go to get relief when no other answers are forthcoming.

Rose is portrayed as deeply suspicious. It seems she does not, ultimately, want to be cured. Do you think this is common among hypochondriacs? Or is that an unsympathetic reading of a complicated situation?

I do think that hypochondria can be part of, or even mask, other psychological or mental issues. Something the comedian Marc Maron says in his standup comes to mind: “My father was a doctor, which means I was a hypochondriac. How else are you going to get their attention?” For him, his hypochondria was connected to his issues in his relationship with his father and it was part of how he asserted himself. Jane Austen’s mother seems to have used her fluctuating health problems to keep her family constantly surrounding her, fussing over her and moulding their lives to fit hers. It can be a means of exerting control, which I think is what the character of Rose wants from it. It can even be compared to factitious disorder imposed on another, what was previously called Munchausen syndrome by proxy, in which a caregiver will deliberately neglect their charge or make them sick so as to be able to seek medical assistance and receive attention.

But in its simplest form, I think hypochondria is a very internal and individual condition, not necessarily defined by its reception by others. And every hypochondriac I have ever spoken to has expressed the desire never to think these thoughts again. For myself, if I could flick a switch and never worry about my health again, I would.

Your next book is Daniel Paul Schreber’s Memoirs of My Nervous Illness, an account of his mental collapse in the 1880s which has been republished by the New York Review of Books as part of their ‘Classics’ series. What can we take from it today?

Before his illness and incarceration in various mental institutions, Schreber trained as a lawyer and worked as a judge. The clarity and specificity of his descriptions in this book are remarkable: one modern reviewer called it “a textbook of psychiatry from the viewpoint of the patient,” and I think that sums it up well. Both Freud and Jung were compelled by Schreber’s case and analysed it extensively, and the new NYRB edition has only brought more interested people to the text. I think what I take from it, above all, is that the patient’s voice matters: we still read this book in part because of how unusual it is to hear from the person actually experiencing the delusions rather than those trying to treat them.

Your final choice is Alice James’ diaries. Perhaps you’d introduce us to her first, before giving us a sense of how the diaries illuminate the subject of hypochondria.

Alice James was the younger sister of both the novelist Henry James and the psychologist William James. She experienced ill health for most of her life, mostly dismissed as hysteria, before dying at the age of 43 from breast cancer. She began keeping a diary in 1889, when she was already in her 40s and existing in a state of near-constant invalidism. Like Schreber’s Memoirs, her writing is valuable both because it comes from the patient’s perspective, and because it was written in real-time rather than with hindsight. Alice shows us how frustratingly non-linear her condition is; periods of chronic but manageable weakness are punctuated by seemingly random acute attacks that render her bed-bound and, at times, unable to walk. Always, she has to contend with the shadow of insanity or ‘mental feebleness’ that hangs over her—because doctors are unable to fix a physical diagnosis for her many symptoms, there is always this lingering possibility that it was all a result of her malfunctioning mind. This is very frustrating for Alice, and for the reader, who finds themself in the peculiar position of actually rooting for her to be diagnosed with a serious illness just so everyone will stop assuming that she is crazy.

Finally—do you have any words of advice as to how one might support friends or family members suffering from hypochondria or health anxiety?

Two things come to mind. The first is: don’t try and talk them out of it. Bracing injunctions that “you probably imagined it” have always just made me feel worse, because I don’t feel believed. The second is: focus on distraction and misdirection. Without denying that the anxiety is there, try and pull the hypochondriac into other enjoyable activities that will keep their mind occupied. Once they are fully engaged, they may well forgot all about the disease that was killing them just a few hours ago.