The rhythms of this ritual are deeply ingrained. Lean forward, closer to the mirror, bracing hips against the sink. Old bruises accepting the hard angles. One hand to pull my shirt away from my left collarbone. The other to poke and prod the shadow I saw there.
It’s very bright in the deserted bathroom at work. The overhead strip lighting bounces off the walls, the tiled floor, the gleaming white of the sink and toilet. In the mirror, the room behind me is blanched out of sight. All that is in focus is my own pale face and pinpricked pupils. Blotchy redness is rising out of my collar and climbing up my throat. Turning my head slightly, I avoid catching my own eye in the reflection.
You are allowed to think it. I can hear you thinking it. I am a hypochondriac. Or, at least, I worry that I am, which really amounts to the same thing.
Hypochondria is, according to the Oxford English Dictionary, “a mental condition characterised by the persistent and unwarranted belief or fear that one has a serious illness”. I, like a lot of other people today, frequently worry there is something wrong with me that medicine has yet to detect. In part, this is a consequence of a shift in how we experience health in the modern era, not merely as an absence of illness or symptoms, but as something always to be hacked and improved.
Ready access to the internet, too, makes us all instant experts in the most esoteric of complaints the moment a symptom is felt, while the mass trauma of the Covid-19 pandemic encouraged us to scrutinise our bodies for any possibility of infection. In short, it has never been easier to find ways and means to escalate our passing worries into full-blown health anxiety.
And that’s what I am experiencing here. My gaze drops to the 2in of skin on my neck to the left of my Adam’s apple. This is the part of my body that most often flares into quivering sensation, and thus the part I know best. I could reconstruct it perfectly through touch alone, my fingertips following the baseline of the long-healed scar that snakes along parallel with my collarbone and the squashy dips between the tendons running down my neck. I usually avoid thinking about this part of me, because it carries bad memories and difficult associations. But now, I want to see it, to scrutinise it as if through a microscope.
I have done this before. Many times, in fact. I know the pattern, but I am still stuck in it. On bad days, when I’m tired and slow and distracted, I will turn my head to avoid someone’s gaze and feel it. The sensation of something soft and yet hard at the same time catching on the usually smooth mechanism of my pivoting neck. A feeling at once horribly familiar and completely alien. It’s like going downstairs in the dark and miscounting so that your foot connects suddenly with the floor when it was expecting to keep on passing downwards through the clear air to another step. A sudden jolt and an electric pulse ripping through the stomach. An intruder is detected.
Tumours have a certain texture, I’ve learned – a hard kernel moored deep inside with a slippery casing that can move over muscle and under skin. When I found one in this part of my neck before, I could roll it between my fingers. It danced across the sinews as I moved my head. It made a clicking sound I could hear with my tongue.
It has been more than a decade since I was considered a cancer patient. The Hodgkin’s lymphoma that I was diagnosed with at 17 was eradicated over the next few years by a combination of chemotherapy, radiotherapy and a stem-cell transplant. I don’t even have follow-up appointments or precautionary scans any more. As far as my doctors and my health records are concerned, my body and my life are cancer-free.
But I am not free. I am here, in front of this mirror, staring at this glassy, reflected version of me, quietly weeping and poking myself in the neck hard enough to leave marks. Long after I was told the cancer was gone for good, I am still looking for evidence of a lump, a bulge of flesh that shouldn’t be pushing its way out of my neck and yet, somehow, is. Except I can’t put it that clearly in my own mind – all there is inside my head as I search is blistering static and a dogged whisper of it can’t be it can’t be. I am forever arguing with myself, a sing-song, meaningless wrangle that is all too familiar. You know it’s not real, but this time it might be real.
Hypochondria is as slippery and elusive a term as the condition it tries to encompass. It dwells in contradictions: a perceived disease of the body that exists only in the mind. Within its shifting boundaries, the tangible and the intangible can change places and then change back again. It intersects with medicine, but is the antithesis of the certainty science attempts to provide. Hypochondria only has questions, never answers.
And it is on the rise. A 2020 study of health anxiety in students over the past 30 years found that rates had increased from 8.67% in 1985 to 15.22% in 2017. In part, this remarkable growth is attributed to the internet and the ready availability of information with which to self-diagnose. Living through the pandemic has been linked to an increase in hypochondria, too, as has attending medical outpatient clinics. One research project found that rates of health anxiety in a hospital’s clinics increased from 14.9% to 19.9% within five years. Most concerning of all, perhaps, is the data that shows high levels of anxiety about health can raise the risk of contracting heart disease by up to 70%. Worrying about being ill can, in fact, make you ill, it would seem.
Hypochondria is an old, old word, but it has not always signified what it means today. It was formed out of two terms for parts of the body: hupo meaning “under” and khondros denoting the cartilage of the sternum in the original Greek. Initially, it was an anatomical term, a name for an area of the abdomen that might experience injury or disease. For instance: Hippocrates, writing in the fifth-century BCE, recorded that a patient was experiencing pain in the right “hypochondrium” after giving birth.
Gradually, over the next 2,000 years or so, the term “hypochondria” became more than just a way to describe the issues arising from a particular area of the body. Thanks to the theory of the four humours and the strong connection between the liver (located in the hypochondrium), the black bile humour and a kind of persistent mental and physical distress known as melancholy, hypochondria acquired an additional association with what we would today call anxiety. Physical symptoms like heart palpitations, fatigue, digestive trouble and more were all linked with the general malaise and anguish that Robert Burton catalogued so vividly in 1621’s The Anatomy of Melancholy.
Then in the subsequent centuries, the connection to the “hypochondrium” area of the abdomen dwindled and faded, leaving hypochondria to denote just the mental suffering and the sensation of having physical symptoms that can’t be confirmed or identified. The hypochondriac became a figure of fun, a laughing stock – someone to mock because they have a too-intense obsession with bodily functions and believe in things that aren’t really there. It’s in part because of this stigma that the NHS now prefers the term “health anxiety” to describe the condition.
Precise figures on how much the rising rates of hypochondria are costing the NHS are hard to come by, because there is no universal definition of the condition that allows for consistent data collection. There are clues, though, that our constant monitoring of symptoms and potential illnesses impacts healthcare provision. A survey of GPs in 2013 revealed that 97% had prescribed placebos like sugar pills or saline injections at least once in their careers, and a Danish study found that people with severe illness anxiety used between 41% and 78% more healthcare over a five-year period than those with a lower level of concern.
For those with pre-existing conditions, the question of whether or not to seek treatment is forever fraught. My fears about my health are persistent and at times intrusive, but they are not necessarily unwarranted. I have been diagnosed with cancer once already and had it recur the following year to the surprise of the experts treating me. Perhaps it is not unreasonable or irrational, then, to worry that either that same cancer or the effects of the powerfully harmful treatments I received for it could still be lingering in my body, causing mischief.
The more I have thought about this, though, the more I am unsure that this deceptively simple classification of health concerns as “warranted” or “unwarranted” is accurate. I think we can all identify something in our past to use as a justification for anxiety, whether it be a past illness, a family history of a condition, a genetic test result, an environmental factor or some other trauma. Humans are built to tell stories and find meaning in them, to make connections between seemingly disparate events and symptoms. The perfectly healthy hypochondriac, who has absolutely no cause for any concern whatsoever and yet is still racked with anxiety about symptoms that science cannot detect, seems to me to be more of a theoretical figure than someone who exists in the real world.
As with everything about hypochondria, even determining who is suffering from it is a question mired in uncertainty and subjectivity. I think my own anxieties about my health began as a natural consequence of my experiences with cancer. During treatment and monitoring, I was even encouraged by my doctors to pay close attention to changes in how my body felt, in case I could pick up an early warning sign of a new symptom or treatment side-effect. Over time this bodily hypervigilance morphed into something else. Perhaps it is reasonable for me still to be morbidly afraid of potential lumps in my lymph nodes, but that has nothing to do with the occasions when I have been convinced I have post-concussion syndrome, multiple sclerosis or polycystic ovarian syndrome. It is as though that original, justified, fear mutated and spread throughout my body. Everything became its target.
When I’m in the grip of a hypochondriac episode, standing in front of the mirror poking my imaginary lump, all the images in my mind are about fairytale malevolence, of poisonous yet invisible roses creeping through my flesh to bind my life with their thorny tangles. My mind races, sketching in scenes from a possible future: delivering the bad news to my family and friends, navigating the peculiarly modern dilemma of deciding how much of a highly personal tragedy to share with strangers on the internet, dealing with financial problems when I can no longer work.
Once the panic has ebbed again, these images fade, too, only to flash before my eyes again the next time I feel like a bit too much hair has come out in the shower or I’ve got pins and needles in my big toes. Over time, I have become quite efficient at tuning the panic in and out, and then re-emerging into the world as if nothing has happened. Sometimes I can go from definitely dying to rude health inside half an hour.
This time, I’m almost there. I haven’t found anything definite and the panic ebbs ever so slightly. The tears have dried up and a strange bubble of mirth bursts in my throat as I turn on the tap so I can splash my streaky face. My little chuckle echoes in the empty bathroom, the first sound I’ve made since I entered. All of the roaring I could hear was inside my head, as was the lump that I could feel but not see.
A Body Made of Glass: A History of Hypochondria by Caroline Crampton is published by Granta (£16.99). Buy a copy for £14.44 at guardianbookshop.com
