June 11, 2008 at 11:03 AM ET
"For each ailment that doctors cure with medications (as I am told they do occasionally succeed in doing) they produce 10 others in healthy individuals by inoculating them with that pathogenic agent 1000 times more virulent than all the microbes - -the idea that they are ill."?
-- Marcel Proust, “The Guermantes Way”
Dr. Billy Goldberg:
This quote came to mind after a particularly grueling weekend in the ER. You see, I am just getting over a brief yet vicious bout of nosophobia. Nosophobia refers to a morbid fear of contracting a disease. In my case, I was terrified of about 37 different ailments that might strike me or one of my family members down. It didn’t help that when I got home from the hospital I had to spend an hour convincing my sister that she didn’t have thyroid disease, liver failure or metastatic cervical cancer. My sister and I both share a genetic predisposition towards worrying that isn’t exactly helped by my practice of medicine.Surprisingly, most doctors aren’t hypochondriacs. But medical students often go through a phase of thinking they have everything they learn about in school. I can recall sitting in a genetics lecture with a pregnant friend and watching her cringe and rub her belly as we learned about every horrendous ailment that might affect her unborn child. This condition has been called "medical student's disease," "hypochondriasis of medical students" – and best of all, "medical studentitis."
Some studies suggest that as many as 80 percent of med students suffer from unfounded fears of illness. The prevalence of true psychiatric hypochondriasis among regular folks has been estimated to be as high as 10.7 percent. This number strikes me as low, probably because it doesn’t include people like me who have occasional episodes of hyponchondriacal thought.
Most medical students recover from their “medical studentitis” and join the legions of doctors who ignore their own medical illnesses and scoff at their patients who have unfounded fears. Unfortunately, I am prone to relapse. Where does all this leave me? I have no idea, but I sure would like to forget my sister’s fears, that 5-year-old who came into the ER with newly diagnosed leukemia and that funny lump that I have on my own leg.
Hypochondria is a Möbius strip to me. I can’t tell where it begins or ends, or, conceptually, what’s the inside and what’s the outside of it. So, it produces a kind of vertigo. Or maybe I just think I have vertigo.
Isn’t there a profound truth to thinking that we’re sick all the time? The reality is that once we’ve outlived our prime procreative days, we begin to inexorably degrade. Our very bodies become constant reminders of our own mortality.
Isn’t hypochondria, actually and paradoxically, an illness in and of itself? It’s included in the category of somatoform disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the reference handbook used by clinicians to guide the diagnosis of mental disorders. Some experts argue that hypochondriasis shares many features with obsessive-compulsive disorder or panic disorder and would be more appropriately classified with the anxiety disorders.
So, thinking you’re sick when you’re not is … sick. Hmm.
Our society’s ingrained hostility to hypochondriacs clearly demonstrates how arbitrary cultural judgments can be. Certain delusions are more disreputable than others. We denigrate hypochondria – the delusion of being ill when one is well. But we laud sick people who think they’re well – it’s evidence of a brave and gritty optimism. Stupid people who maintain the delusion that they are smart tend to be intolerable. But smart people who insist that they are stupid display wonderful humility and charm. And even in the pecking order of bogus invalids, hypochondriacs rank above the malingerers, who knowingly feign illness or other incapacities in order to avoid work.
As a child, I was elaborately schooled in the fine art of hypochondria. Hypochondria was to my family what skiing or folk-dancing was to other families – a traditional pastime that stretched back for generations. Dinner conversation inevitably turned to someone’s bloody sputum or lumpy testicle. It was like a never-ending borscht-belt production of Munchausen syndrome (the epic Wagnerian version of hypochondria).
Here are some of the conditions, diseases and tumors I’ve thought I’ve had just over the past two months: oligodendroglioma, arrhythmia, bladder cancer, skin cancer, cirrhosis of the liver, syphilis, Crimean-Congo hemorrhagic fever, Creutzfeldt-Jakob disease, anaphylactic shock from dust-mite allergies, some teratological malformation of the alveolar ridge, and bronchiolitis obliterans (Popcorn Worker’s Lung Disease).
The consummate achievement in the art of hypochondria goes considerably beyond merely thinking that you’re sick. The ultimate form of hypochondria is thinking you’re dead. A person who thinks he’s dead, but consents to a sort of feigned life is to be enormously admired.
Here we can see how this ultimate hypochondria can be a profound expression of bushido – the traditional code of the Japanese samurai.
This is how Yamamoto Tsunetomo, a 17th-century samurai retainer of the Nabeshima Clan, described the proper attitude of a warrior: "Every day without fail one should consider himself as dead. There is a saying of the elders that goes, 'Step from under the eaves and you're a dead man. Leave the gate and the enemy is waiting.’ This is not a matter of being careful. It is to consider oneself as dead beforehand."
Now there’s an eminently healthy attitude, if I ever heard one.