Hypochondria : Part 1

Why Worry?
by George Lincoln Walton, M.D.

(Page 7 of 20)

Il marche, dort, mange et boit comme tous les autres; mais cela n'empeche pas qu'il soit fort malade.

MOLIERE: Le Malade imaginaire.

The victim of hypochondria may present the picture of health, or may have some real ill regarding which he is unduly anxious. His consultation with a physician is likely to be preceded by letters explaining his exact condition, naming his various consultants and describing the various remedies he has taken. At the time of his visit notes are consulted, lest some detail be omitted. In his description anatomical terms abound; thus, he has pain in his lungs, heart, or kidney, not in his chest or back. Demonstration by the physician of the soundness of these organs is met by argument, at which the hypochondriac is generally adept.

The suggestion that the hypochondriac devotes undue attention to his own condition is met by him with indignant denial. Proposals that he should exercise, travel, engage in games, or otherwise occupy himself, fall on deaf ears, but he is always ready to try a new drug. If a medicine is found with whose ingredients the patient is not already familiar, its use is likely to produce a beneficial effect for a few days, after which the old complaint returns.

The case has come to my attention of a young man who, for fear of taking cold, remains in bed, with the windows of the room tightly closed and a fire constantly burning. He has allowed his hair to grow until it reaches his waist, he is covered with several blankets, wears underclothing under his nightshirt, and refuses to extend his wrist from under the bed-clothes to have his pulse taken.

Such faulty mental habits in minor degree are common. There are those who will not drink from a bottle without first inspecting its mouth for flakes of glass; some will not smoke a cigar which has been touched by another since leaving the factory; some will not shake hands if it can possibly be avoided; another pads his clothing lest he injure himself in falling. Many decline to share the occupations and pleasures of others through fear of possible wet feet, drafts of air, exhaustion, or other calamity. Such tendencies, though falling short of hypochondria, pave the way for it, and, in any event, gradually narrow the sphere of usefulness and pleasure.

No part of the body is exempt from the fears of the hypochondriac, but he is prone to centre his attention upon the obscure and inaccessible organs. The anecdote is told of a physician who had a patient of this type - a robust woman who was never without a long list of ailments. The last time she sent for the doctor, he lost patience with her. As she was telling him how she was suffering from rheumatism, sore throat, nervous indigestion, heart-burn, pains in the back of the head, and what not, he interrupted her:

"Ah," he said in an admiring tone, "what splendid health you must have in order to be able to stand all these complaints!"

The phobias are so closely allied to hypochondria that it will not be out of place to discuss them here. A phobia is an insistent and engrossing fear, without adequate cause as judged by ordinary standards. Familiar instances are fear of open places (agoraphobia), fear of closed places (claustrophobia), and fear of contamination (mysophobia).

The sufferer from agoraphobia cannot bring himself to cross alone an open field or square. The sufferer from claustrophobia will invent any excuse to avoid an elevator or the theatre. When a certain lady was asked if she disliked to go to the theatre or church, she answered, "Not at all, but of course I like to have one foot in the aisle; I suppose everyone does that."

The victim of mysophobia will wash the hands after touching any object, and will, so far as possible, avoid touching objects which he thinks may possibly convey infection. Some use tissue paper to turn the door-knob, some extract coins from the pocket-book with pincers. I have seen a lady in a public conveyance carefully open a piece of paper containing her fare, pour the money into the conductor's hand, carefully fold up the paper so that she should not touch the inside, and afterwards drop it from the tips of her fingers into a rubbish barrel.

The case of a nurse who was dominated by fear of infection has come to my attention. If her handkerchief touched the table it was discarded. She became very adept at moving objects about with her elbows, was finally reduced to helplessness and had to be cared for by others.

Unreasoning fear of one or another mode of conveyance is not rare. It is said that Rossini found it impossible to travel by rail, and that the attempt of a friend to accustom him to it resulted in an attack of faintness (Lombroso).

The sufferer himself realizes, in such cases, that there is no reason in his fear - he knows he can undergo greater dangers with equanimity. Even doubting folly finds no answer to the question why should this danger be shunned and that accepted. The nearest approach to an answer is "I can't," which really means "I haven't."

The origin of the phobia is not always clear, but given the necessary susceptibility, circumstances doubtless dictate the direction the phobia shall take. A startling personal experience, or even reading or hearing of such an experience may start the fear which the insistent thought finally moulds into a fixed habit.