Me, my brain and hypochondria: is fear of illness a problem or a curious blessing?

I have a tendency to assume the worst.

For instance, as I walked through Chicago recently, a small droplet of melted snow fell from the roof of the School of the Art Institute and, as though guided there by fate, landed directly in my mouth.

My response was immediate panic. I had recently heard of a man in Chicago who died suddenly of a bacterial illness, and within minutes I had convinced myself I was headed for the same fate: I was dying, quickly. I didn’t know how or when it would begin, but I was certain of it. Every ache and pain confirmed this: a cough, a stomach pain, a slight headache. These were all proof of something very wrong.

If this sounds unreasonable, it’s because it is. I knew this, even in the midst of my panic. And yet, I could think of nothing else except the disease I was certain had begun to grow inside of my body.

I checked myself for fever. I replayed possible scenarios I had read about in medical journals and news articles. I ran through a catalogue of possible diseases, calculating which might be most likely.

I died that day, in my imagination, a hundred times.

Beyond ‘something of germophobe’

For as long as I can remember, I have suffered from an acute form of hypochondria. I fear rare diseases such as necrotizing fasciitis, rabies, MRSA, Guillain-Barré Syndrome, and Creutzfeldt-Jakob. I fear every imaginable form of cancer. I fear neurological disorders such as multiple sclerosis and amyotrophic lateral sclerosis with such ferocity and determination that I have given myself the symptoms: my muscles twitch, my limbs tingle and I feel weak. I fear becoming a prisoner of my own body, of slowly losing control, but the truth is that I already have lost it.

Most of those close to me do not know about my hypochondria. They do not know how many times I have visited doctors, certain I have been sentenced to death when they ignore my concerns. I might make a joke about being “something of a germophobe”, but few know that I wash my hands roughly 30 times a day and meticulously disinfect every scrape or cut.

Ironically, all this cleaning has destroyed my skin. My hands are dried and cracked, offering even more entryways for bacteria. This is what being a hypochondriac is: a cycle that I am constantly trying to overcome, a feedback loop in which the fear of being sick creates a need for corrective behavior that in turn creates new fears.

I read through medical studies and abstracts – often in secret – and carefully examine the epidemiology of every disease or condition to calculate my odds to steady my pounding heart. Occasionally, I find relief in the beautiful precision of statistical probability.

As Don DeLillo wrote: “The power of numbers is never more evident than when we use them to speculate on the time of our dying.” This power never lasts, however.

Ask a therapist or neurobiologist?

I am well aware that my fears fly in the face of basic logic, but despite being able to recognize this I can not let them go. The question is: why? How is it possible to at once realize the absurdity of my thinking and remain so wholly consumed by it, to believe it nevertheless?

The answer to this question depends on who you ask.

A therapist might tell me that because I have had a remarkable amount of illness and death in my life – my father, stepmother, grandfather, aunt, and several classmates and teachers have all succumbed to untimely deaths – I have developed an understandably acute reaction to it. Lots of people get sick and lose loved ones, however, and only a fraction go on to develop a condition like hypochondria. Many live on, immune to the doubts and fears that spread in my imagination like a fungus. And while my own experiences with death are always there, nudging along my doubt, this does not mean they are causing it.

Maybe, then, it’s not my past. Maybe, as a neurobiologist feeding me into an fMRI might tell me, it’s something in my brain. The circuitry is off. Chemicals are out of balance. Depression and anxiety are prevalent in my family, so maybe I have inherited it. I am hardwired to be a hypochondriac. It’s in my genes. But are we anxious because it’s truly in our genes, or simply because we have all grown up together, as anxious people, people traumatized by death?

Or maybe I’m looking in the wrong place. Maybe, as my colleagues in critical theory might tell me, my anxiety stems from a broader source: a culture obsessed with “good health”, one bombarded with representations of illness and death. After all, a vast majority of my knowledge is fed through sensational news reporting, through tragic narratives of lives lost too soon. My sister is the one who first introduced me to necrotizing fasciitis, mentioning it one day without realizing it would become a cause of many restless nights, waking to a pain in my arm I was certain was the beginning – that was how it began for one survivor, according to a website I visited, a pain that “felt similar to a muscle strain after working out too hard”.

WebMD and Google feeding obsession

Access to websites like WebMD and others pulled up in Google searches have probably contributed to the rise in illness-related anxiety – take as an example, this graph showing the spike in ALS-related searches coinciding with the bucket challenge – but are they really the cause of our growing obsession with health? Is it even possible to locate a single “cause”?

To speak of a cause is to understand mental illness in a particular way – namely, as something that can be treated. But medical knowledge is constantly changing, which means the criteria for how we determine the cause of mental illness are constantly changing as well.

In the 17th and 18th centuries, for instance, doctors considered hypochondria a form of hysteria or madness, one that arose from an imbalance of humors or nerves.

Beginning in the late 19th century, the classic Freudian model of neurosis made mental illness a byproduct of instinctual drives, situating hypochondria within a struggle between the demands of one’s sexual life and larger sociocultural forces of repression. In the mid-20th century, however, Freud’s speculative theories began falling out of favor and were replaced by the biological model of psychiatry that still dominates today, one that largely understands mental illness to arise from some mixture of neurochemistry, genetics, and environmental influence.

I mention this not to make the rather obvious point that things change with time, but because the ways in which doctors understand mental illness determines how these illnesses are treated. Being diagnosed with hypochondria in the 18th century meant something very different than it means today. It wasn’t uncommon, at that time, for hypochondriacs – along with hysterics and melancholics – to be committed to asylums, their insistence that “something is wrong” interpreted as proof of their insanity. In the beginning of the 20th century, hypochondria would have been treated with intensive psychoanalysis, a tradition now reserved largely for academic study (or, like me, those individuals inclined to think it actually works).

Today, treatment for hypochondria or “illness anxiety” is varied. While some studies have shown limited success treating hypochondria with SSRIs, the same class of drugs used to treat anxiety and depression, the results have otherwise been inconclusive. Most commonly, treatment consists of some form of Cognitive Behavioral Therapy (CBT), with the ultimate aim of reconceptualizing illness and the particular ideas the patient has concerning it. In CBT, essentially, one learns to either reimagine the significance of illness or discover ways of “correcting” patterns of unhealthy behavior.

No quick fix

The question I often find myself asking, however, is if it’s something we really even need to correct. Why is my fear of illness a problem? Many would say it’s because it causes me distress, that it is excessive, but how do we determine what amount of worry is too much and what amount is normal? Sure, some days I do less work, and some days I truly do agonize over my fears, but who ever said we are supposed to feel happy all the time? Death and illness are a fundamental part of the human experience, as are reactions to them like fear, anxiety and sadness.

People do suffer greatly from mental illness, and in no way am I suggesting we ignore or diminish their pain. My point is that, much like methods of treatment, how we determine what is healthy and what is not varies over time and across cultures, and this is something that often gets lost in a world looking for a quick fix.

This is one thing hypochondria has taught me: there is not always a cause with an easy solution. Sometimes things just hurt for no clear reason. On my more anxious days, this fact haunts me in ways I would wish upon no one. I find myself prisoner to my imagination, and would likely accept any method of treatment offered.

On better days, however, I see hypochondria as a curious blessing. My often absurd refusal to accept that I am healthy has forced me to consider things I would have never considered, to remain uncertain.

There is a great moment in Woody Allen’s Hannah and Her Sisters when Mickey, convinced the ringing in his ears is proof he has a brain tumor, asks Gail, “Do you hear a ringing sound?” At that moment, the phone is ringing, and Gail responds, emphatically, “Yeah! Yeah I hear it.” This misunderstanding is a classic comedic trope, but it also reveals something crucial about hypochondria, and mental illness generally. It relies upon a false dichotomy – either the ringing is caused by something in Mickey’s brain or by the phone – and to pick one is to in some way disregard the other.

Mental illness is incredibly complex. Maybe it has nothing to do with our brains, or our genes, or the culture – or maybe it does. Maybe it is all of these things, together, and by looking for the easy solution we are missing the point. To truly treat mental illness, we need look at them all, and remain uncertain.