A historical perspective
Hypochondria takes its name from anatomy. Hypo means below, and chondria refers to the area below the rib cage. In the Hippocratic tradition (Hippocrates, 460–370 BCE), diseases, including personality variations, were explained as an imbalance of the four bodily fluids: phlegm, yellow bile, black bile and blood: so-called humoral pathology. For a long time, hypochondria was considered to be the same as melancholia, which was believed to be caused by an excess of black bile. Even if this theory was scrapped a long time ago, the treatment was not dissimilar to present-day therapy as it focused on diet and physical exercise. It was not until the 18th century that hypochondria came to be described as a disease in terms that are similar to our current understanding.
It was not until the 18th century that hypochondria came to be described as a disease in terms that are similar to our current understanding
However, severe health anxiety is not a new concept. Crampton's book refers to 3000-year-old Egyptian papyrus scrolls that describe mysterious conditions – conditions that are not palpable to the touch like fractures, or visible to the eye like jaundice, weight loss or similar. The first written accounts of conditions resembling hypochondria appeared in Babylonia, present-day Iraq, in the second century BCE. These texts describe symptoms that could not be cured by normal medical interventions, which at the time tended to be exorcism of evil spirits or magic. The link between body and soul was key to philosophers like Plato (428–347 BCE), who believed there was a link between our digestive system and our emotions. Little did he know about today's research on microbes and the gut-brain axis! Plato viewed the soul as a wild animal chained to the liver.
The 17th century was a period of transition from an era of superstition to an era of reason. Book printing was introduced at this point, and there were worries that 'information overload' might explain the affliction, not dissimilar to today's theories about social media and googling. Robert Burton's work The Anatomy of Melancholy (published in 1621) was written at a time when melancholia covered a range of mental health conditions and disorders, such as anxiety, depression, grief, phobias, delusions etc., and these were accompanied by a variety of physical ailments due to the humoral imbalance, which was still a live tradition.
One of Burton's contemporaries was the physician William Harvey (1578–1657), who wrote about blood circulation. He explained the blood circulatory system in terms of hydraulics, with the heart acting as the pump. This was a departure from the old theory about bodily fluids, where blood was formed in the gut and then absorbed by other organs. Like most other people in the 17th century, he distinguished between body and soul. Harvey believed they were linked by nerves, and he described the nervous system in a way that is similar to today's descriptions. At the time, the uterus, hystera, was considered the seat of hysteria, while the liver and the spleen were associated with hypochondria. Gradually, hypochondria moved from the gut to the brain. Thomas Sydenham (1624–89), a physician known as 'the English Hippocrates', wrote what became the most widely used medical textbook for two centuries. He described hypochondria and hysteria as two similar disorders. While women would tend to develop hysteria, on account of having a uterus, men were more likely to develop hypochondria.
Views on hypochondria changed in the 18th century. It continued to be considered a physical disorder, but with a significant mental component. Hypochondria was described as a civilisation illness, an ailment that plagued the elite who by now had moved away from a simple lifestyle to a rich diet and sedentary living. In 1766, botanist Sir John Hill (1714–75) published his book Hypochondriasis. A practical treatise on the nature and cure of that disorder; commonly called The Hyp and Hypo. He was convinced that hypochondria was a physical affliction, which he personally suffered from, but he admitted that certain mental elements could aggravate the blockage in the spleen, which by now was the main hypothesis. Grief and love could both aggravate the symptoms, as could too much rest or excessive activity.
In the 19th century, hypochondria was considered a mental illness, not least thanks to the French psychiatrist Jean-Pierre Falret, who wrote the book De l`hypochondrie et du suicide. Here he describes many of the symptoms experienced by hypochondriacs, like excessive focus on the body, imaginary symptoms and a strong interest in medical texts and news. He explained to his patients what his predecessors did not know about the key significance of the brain to our symptoms.
As psychoanalysis developed towards the end of the 19th century, represented by Jean-Martin Charcot (1825–93) in France and William James (1842–1910) in the United States, attention focused on how past experiences could cause problems in the present. Charcot, who was a professor at the Salpêtrière Hospital in Paris, distinguished between hysteria, which he classified as a purely mental disorder, and hypochondria, which remained a confusing and indeterminate condition. Sigmund Freud (1856–1939), a student of Charcot, believed that hypochondria was a mental disorder with physical manifestations. However, he found no link to earlier traumas, and consequently psychoanalysis could not be used to treat hypochondria. Freud was also concerned with his own tendency toward hypochondria. He had palpitations and an irregular pulse, stabbing pains and a burning sensation. He consulted his friend Josef Breuer (1842–1925), who much to his annoyance treated him 'like a patient'. The doctor did not listen to him, only told him what he believed Freud wanted to hear, saw him too infrequently and never gave clear answers to questions. Freud stopped smoking cigars, but later wrote that he felt incredibly better after cocainisation of his left nostril. At the time, many believed that the nose was a microcosm of the body, and that cocaine deposited in the right place in the nose could cure diseases that affected other parts of the body.
In her book, Caroline Crampton describes how, during a school visit to Darwin's home, which is now a museum, she discovered that he had led an extremely rigid and structured life. He underwent hydrotherapy, which meant frequent baths and the consumption of set volumes of cold water at set times. He had to take a bath several times a day, and he was wary of things that were unfamiliar to him. He had many health complaints and kept an exact diary of his symptoms over a period of six years, The Diary of Health.
Catastrophising is not the core problem of hypochondria, but the fact that the answer is in the future, which is a closed book