06:22am Monday 18 November 2019

We've Become a Nation of Hypochondriacs

By Marla Paul

CHICAGO — We have become a nation of hypochondriacs, says a Northwestern Medicine professor in a new book that explores our ratcheting anxiety about our bodies and health.  

“We are constantly being bombarded with messages telling us we might really be sick even though we have no symptoms,” says Catherine Belling, assistant professor of medical humanities and bioethics at Northwestern University Feinberg School of Medicine. “We’d better have that mammogram or genetic screening or check ourselves for symptoms of a disease we read about in a drug company ad. With the Internet, we are more informed patients than ever before, but we’re often also worried.”

“People are encouraged to think like hypochondriacs to be good public health citizens, but the emotional cost is high,” Belling adds. “You are supposed to worry about being sick, even if you don’t feel sick.”

In her new book, “A Condition of Doubt: The Meanings of Hypochondria (Oxford University Press),” Belling explores the mixed messages that make us worried, and also ashamed of worrying, and reveals why hypochondriacs are physicians’ least favorite patients. 

Doctors don’t like hypochondriacs, Belling says, because their concerns mirror physicians’ own anxieties about the uncertainty of medicine and the fact that we all eventually get sick and die.

“These patients can undermine medicine’s own self-confidence,” Belling says. “Hypochondriacs challenge the doctor’s ability to tell them they are fine. They stir up all the insecurities that learning to be a doctor forces you to set aside. Once you are a doctor you have to be decisive, you have to make decisions when you are not 100 percent certain.”

Clinical hypochondriasis is a recognized psychiatric disorder. Patients with vague complaints keep going back to the doctor hoping to discover what’s really wrong with them.

But contemporary hypochondria should be seen less as a mental illness in individual patients and more of a rational — if maladaptive — condition emerging from gaps between doctors’ and patients’ expectations of contemporary Western medicine, Belling contends.

Belling says more humanities training in medical education will enable physicians to become more tolerant of uncertainty and the unknown. This training also will give them the tools to communicate with patients who demand, ‘How do you know?’

And patients have to stop expecting omniscience from doctors and medicine and learn to live with a more laissez-faire attitude. The hypochondriac knows everyone will die eventually, and she may even have cancer that hasn’t been diagnosed yet. 

“But deluding yourself is necessary,” argues Belling. “Being slightly irrational may be more adaptive. We need to tell ourselves everything is going to be fine.”

Marla Paul is the health sciences editor. Contact her at marla-paul@northwestern.edu

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