As any hypochondriac worth their salt knows, expert confirmation of one’s condition is not normally necessary and is even more rarely desirable. The certainty with which he or she can diagnose a fatal illness should be the envy of every clinician not least because it can be achieved without expert knowledge and in the face of all reason. More remarkable still is the capacity of the human organism to survive an unlimited number of inescapably terminal conditions and to still bounce back with its ability to defy common sense undiminished. Hypochondria is a widespread and uniquely strange response to the periodic (and usually minor) malfunctioning of the mind and body. As an exercise in imagination and creative extrapolation it is matchless amongst forms of thought and as a completely contrary activity it appears to have no purpose, rational or otherwise.
Its symptoms can be both tragic and hilarious, its consequences entertaining or crippling and in any manifestation, its origins are almost invariably obscure. To a dedicated hypochondriac, the convictions of imminent mortality that their condition generates can, in extremis, subsume all normal thought and activity and lead to a psychological paralysis whose reality is even more substantial than the condition of hypochondria itself.
One cannot but wonder what purpose this condition might serve: most psychological malfunctions appear to be enlarged and/or distorted forms of a “normal” process that is nominally designed to generate positive outcomes. Hypochondria goes far beyond being an exaggerated manifestation of concern for ones own health and wellbeing. One can see, for example, obsessive washing as a simply exaggerated extension of a healthy concern for hygiene but, in my argument, hypochondria can become so all-encompassing that it goes substantially beyond obsessive-compulsive conditions in its impact.
The dominant sensation is of fear, often not of the suspected ailment itself but of its possible consequences and those of the anticipated treatment, not to mention a more abstract sense of foreboding. One might extend this idea to suggest that hypochondria is a specific and focussed manifestation of a more generalised state of fear: rational fear is, after all, manifested in different ways by different people so why not so with irrational fear?
This begs the somewhat obvious question as to the origin of such generalised fear. In some cases, the source may be external – one thinks here of post-traumatic conditions – but, more usually, there is no apparent external source and we are forced to conclude that it is the output of an internal process. Once again, fear is the process outcome of a normal reaction to danger and, unsurprisingly, some experience it more than others. The over-production of fear could be seen as being analogous to an obsessive disorder: this, however, implies an almost mechanistic (and hence quite specific) process like the over-activity of an important gland. This explanation does not address the condition of chronic and pervasive non-specific fear that rides shotgun on the hypochondriac psyche. What is the source of this fear if it is not the product of a normal but distorted process?
Clinical psychologists will often seek answers to this kind of question through a reductionist approach that tries to identify (and subsequently treat) specific causes. Childhood trauma and other clinical conditions or external events may be blamed but this approach, though understandable, seems to me to be unduly simplistic. If I have a backache, I can take an aspirin and, with luck, the pain will go away. I have cured the symptom but not even begun to address the underlying causes of my pain. So too with fear: I have a sense of fear or foreboding that is not justified by circumstances so, logically, I look for its immediate source and apply a treatment designed to correct the anomaly. I may use psychoactive medication or I may enter a form of therapy designed to modify my responses.
Logically, these responses address the consequences of fear (its psychological and physical manifestations) but do not seek out its origins, let alone endeavour to confront them. This involves a more profound psychology altogether, one that goes far beyond the gamut of conventional practice as recommended by statutory regulating bodies such as the all-powerful National Institute for Clinical Excellence. The pain caused by my back problem may itself be a symptom of something else and to treat the pain alone may be an unduly simplistic response too. A competent doctor will always look beyond immediate symptoms and will consider possible underlying causes so why does clinical psychology, as it is practiced, stop so far short of a similar response? For example, conventional wisdom has it that sufferers from depression have incorrect responses to the world outside. They may have these by reason of neurochemical imbalance (in which case, have a course of Prozac) or by reason of inappropriate thinking (sign up for a course of cognitive behavioural therapy). Both these treatments seek to change the patient’s responses into conformity with the broadly accepted model for correct responses to the world at large and thereby devalue or even deny the reality of their experience. (I may think the outside world is shit because my responses to it are wrong or, just possibly, it may actually BE shit!).
In much the same way, we can consider fear in both its generalised form and in the specific form that is hypochondria. This is not to say that someone with an obsessive fear of, say, cancer must necessarily be suffering from it but it is a dreadful disease and fear is an entirely appropriate response. Few sufferers from serious diseases are able to confront their condition without fear and, for many this will be obsessive and overwhelming. The difference between the actual sufferer and the hypochondriac lies not in their common fear but in their objective clinical states. This is where hypochondria and fear diverge: a physical clinician can offer a range of diagnostic procedures that can confirm that there is or is not something of which to be fearful whereas the clinical psychologist cannot make any such offer.
One might extend this idea to suggest that hypochondria is a specific and focussed manifestation of a more generalised state of fear: rational fear is, after all, manifested in different ways by different people so why not so with irrational fear?
This begs the somewhat obvious question as to the origin of such generalised fear. In some cases, the source may be external – one thinks here of post-traumatic conditions – but, more usually, there is no apparent external source and we are forced to conclude that it is the output of an internal process. Once again, fear is the process outcome of a normal reaction to danger and, unsurprisingly, some experience it more than others. The over-production of fear could be seen as being analogous to an obsessive disorder: this, however, implies an almost mechanistic (and hence quite specific) process like the over-activity of an important gland. This explanation does not address the condition of chronic and pervasive non-specific fear that rides shotgun on the hypochondriac psyche. What is the source of this fear if it is not the product of a normal but distorted process
He never said it in so many words but I suspect that the pioneering analytical psychologist Carl Jung was aware of this critical shortcoming and sought a solution. In his work, he used himself as a subject and simply allowed his mind to go where it would, penetrating deep into that part of ourselves of which most of us are unaware most of the time. He found deeper layers of experience, archetypal figures and symbols to which we are all subject even though we are rarely aware of them. He also discovered a shared pool of existence below the level of day-to-day awareness which he christened the “collective unconscious” and reasoned that this lies below consciousness at a depth that varies from person to person. By this argument, a collectively held belief, response or other phenomenon can logically impact to a different extent upon different individuals. Hence, where the collective unconscious is in a state of fear, excitement, joy or whatever, there will be some individuals who will feel this state more readily and perhaps to a greater extent.
If, in a fearful age, this is the primary source of generalised fear, then existing treatments given to the individual can never do any more than paper over the cracks in a damaged psyche that is subject to incontinent leaking of toxins from the collective unconscious. Hypochondria may be just one such crack but more generalised fear is real in everyone and simply more dominant in some than in others. No amount of medication or behaviourist therapy can hope to address more than the superficial symptoms: the fundamental problem therefore lies not with the individual but with the world that we have collectively built and it is that that must change if we are all to be able to live without fear.