hypochondria is a condition in which a person believes that he or she is ill when no objective signs of illness can be observed. It has an obsessive as well as a delusional component. Sufferers from hypochondria, or, to use the clinical term,
hypochondriasis, remain convinced that they are ill despite reassurances, and often present themselves to their doctors over a long period of time as suffering from a series of different symptoms and diseases. The onset of hypochondria is frequently in the 30s in men and 40s in women. Those in sedentary occupations are notoriously liable to it, and, whilst medical students usually suffer only a transient bout of hypochondria, some doctors remain hypochondriacal throughout their career. Depression and alcoholism exacerbate the condition.
Originally hypochondria meant an illness of the organs lying immediately under the ribs and on each side of the stomach: the liver, gall bladder, and spleen. By the sixteenth century hypochondria had become an aspect of
melancholy and was associated especially with the humour of black bile and with the spleen, the organ that was supposed to clear black bile from the body. A variety of somatic and psychological states were subsumed under hypochondria, and its modern sense was prominent. As Robert Burton pointed out in the
Anatomy of Melancholy (1621), the belief in imaginary illness was an important aspect of melancholy; he wrote that the imagination could produce real illness, to the extent that fear of plague might lead to actual plague and death. In the next century George Cheyne in his
The English Malady (1733), or the ‘spleen’, wrote that the vapours and hysterical and hypochondriacal disorders (the last two had overlapping meanings) were characteristic of the English upper and middle classes, and were brought on by the nation's prosperity and peculiar climate. However, even though hypochondria was a fashionable disorder in the eighteenth century, it had a strong stigma attached to it, and this has continued up to the present day.
Hypochondria today lies in the domain of psychology and psychiatry. It is a label that is largely unproblematic to everyone except the sufferer. But in some instances it has been used to hide medical ignorance. In the nineteenth century many sufferers from
multiple sclerosis were diagnosed as hypochondriacal, and it was not until the discovery of signs such as Babinski's sign, in which an abnormal reflex of the great toe is elicited, that objective evidence supported what in the early stages of the disease are often subjective sensations such as paraesthesia (sometimes described as ‘pins and needles’). It is possible that another instance of blaming the patient for medicine's lack of knowledge is
chronic fatigue syndrome, which at present has few physical signs associated with it. The dispute between those clinicians who seek to give it organic causes and the psychologists who view it as a mix of depression and hypochondria is evidence that the diagnosis of hypochondria is not always unproblematic.
A. Wear
