Is it health anxiety?

Odd as it may sound – for the pandemic played strange tricks on our experience of time – it has been more than five years since the World Health Organization (WHO) declared Covid-19 a Public Health Emergency of International Concern. Unsurprisingly, given legitimate fears of the virus and its potentially long-term consequences, the following years saw increased anxiety around disease and protecting our bodies, and a general increase in mental health disorders. WHO reported a whopping 25 per cent rise in rates of anxiety and depression worldwide in 2020 alone.

The pandemic years reminded us that anxiety can be adaptive – that is, it can lead to appropriate and positive responses to danger. Evolutionary theory suggests that, in the history of human development, anxiety was naturally selected as a useful trait for an individual to possess. A 2022 study by Mike J. Crawford and colleagues found that fear of Covid-19 resulted in people better adhering to public health measures aimed at containing the spread of the virus. But for some people, the authors noted, this anxiety became excessive and maladaptive, negatively affecting their mental health and impeding their social functioning. These effects, a 2024 study by Lara K. Autenrieth and colleagues suggests, may have had long-term consequences on people’s health anxiety post-pandemic.

But there is also a third category of people, who are usually less discussed: those who were already anxious about their health pre-pandemic. As two new books explore, for the so-called “hypochondriacs”, the worldwide proliferation of health anxiety during Covid-19 brought with it an unexpected comfort. “We were no longer the outliers,” journalist Caroline Crampton writes in A Body Made of Glass: A History of Hypochondria, for “that boundary between what is reasonable, justifiable fear and what is hypochondria had suddenly moved. Suddenly, we were normal.” After all, as writer Will Rees notes in Hypochondria, a world where everybody worries about illness and disinfects their hands and various surfaces multiple times a day very much looks like a world where everybody is a hypochondriac.

Both Crampton and Rees know hypochondria intimately; their books are grounded in memoiristic accounts of how the condition has shaped their lives. Going beyond the personal, both Hypochondria and A Body Made of Glass also suggest that hypochondria is, in Crampton’s words, the “marquee condition of our age”, something that the pandemic brought to everyone’s attention.

The history of hypochondria

When I type “hypochondria” in to my search engine, many of the results it regurgitates are about “health anxiety”. As Crampton and Rees make clear in their books, the history of hypochondria is meandering, while the words we use to talk about it are still slippery and in flux. Indeed, the term “hypochondria” is no longer widely accepted by the medical establishment, steeped as it is in centuries of stigma.

The memory of the word is kept alive in WHO’s 2019 International Classification of Diseases (ICD-11) through its featuring of “hypochondriasis”, where the suffix “-asis” affords the old word the more official aura of a medical condition. But the American Psychiatric Association (APA) has entirely done away with it. In 2013, the APA removed “hypochondriasis” from its Diagnostic and Statistical Manual (DSM-5) – the handbook used worldwide for diagnosing and treating mental disorders – replacing the term with two separate diagnoses, “somatic symptom disorder” and “illness anxiety disorder”. Both denote excessive anxieties and worries around health and illness, but the former is characterised by the presence of physical symptoms, albeit medically unexplained, while the latter by the absence of these symptoms. However, many medical professionals are dissatisfied with what they see as two overlapping and confusing diagnoses, instead preferring “health anxiety”.

Rees and Crampton, though, stick with “hypochondria”. This is because they are interested in tracing the condition’s medical, intellectual and literary history from antiquity to the present day, which they do in erudite and compelling detail, shedding light on the hypochondriacal tendencies of many famous figures, from Molière to Marcel Proust and from Franz Kafka to Virginia Woolf. As Crampton avows, there is something comforting about a word that connects sufferers across centuries and even millennia. To her, the old term “hypochondria” “offers companionship while in the grip of a fear that can be completely isolating”.

While today we tend to think about hypochondria as a psychological condition, something that is entirely in one’s head, through Rees’s and Crampton’s books we discover how the word’s etymology very much has to do with the physical body – specifically, the abdominal region, which was known as hypochondrium, from “hypo-” (below) and “-chondrium” (the cartilage of the ribs). The history of how our understanding of hypochondria moved from this bodily location to the mind is one of the most fascinating aspects of both Hypochondria and A Body Made of Glass.

We learn that the first time the word “hypochondria” appeared – in the Hippocratic Corpus, attributed to the founder of western medicine, Hippocrates of Kos – it simply identified a disease of the abdomen, connected to an excess of black bile. Black bile was one of the four humors that constituted the body in the Hippocratic tradition, which dominated western medicine well into the 19th century. According to humoral theory, health consisted in the balance between these humors, which mapped onto different personalities. As the Ancient Greek words for “black bile” (melaina chole) suggest, this humor was connected with what became known as a melancholic temperament.

The association between hypochondria and melancholia proved enduring, as did the one between hypochondria and gastrointestinal complaints. As we read in Rees’s book, many hypochondriacs throughout the centuries, such as Charles Darwin, kept detailed records of their melancholia flatuosa, what we would now call flatulence. And, Crampton notes, digestion and stomach issues – both in terms of symptoms and as sites of fears – recur in those who suffer from health anxiety even today, reminding us of hypochondria’s ancient, and largely forgotten, abdominal roots.

As humoral theory was slowly dismantled and new theories of the human body began to emerge in its wake, so our understanding of hypochondria evolved. By the Victorian age, the condition was firmly associated with the mind. Hypochondria became “the intellectual’s condition”, as Rees puts it, the product of overactive brains that paid too much attention to everything, including their bodies. And, as hypochondria morphed into a condition of the mind, the figure of the hypochondriac came to be intertwined with class and gender hierarchies. Nervous ailments like hypochondria and melancholia were seen as almost aspirational maladies for the lower classes, fashionable diseases that were symbols of status and refinement.

Hypochondria was also framed in the Victorian age as a male condition – the counterpart of hysteria, which was regarded as a female malady given the belief that it was caused by a wandering womb (just as with hypochondria and melancholia, the etymology of the word “hysteria” – from hystera, uterus – is revealing). This distinction between hypochondria and hysteria, Rees argues, was a product of gendered stereotypes that saw the mind as male and superior and the body as female and inferior.

While the association of hypochondria with a certain gender or class may seem like a quirky historical fact, it remains a live issue today. As Crampton illustrates in detail, the health concerns of women, non-white people, and other marginalised communities are more likely to be dismissed by the medical establishment, and the diagnosis of health anxiety often works to entrench this dismissal further. This is confirmed by Rees, who reports that half of the people who are eventually diagnosed with autoimmune disorders, which mainly affect women and are typically under-researched, are initially labelled as hypochondriacs (or, these days, sufferers of “somatic symptom disorder” or “illness anxiety disorder”). This makes research into these disorders even less likely to be funded, creating a vicious circle.

How to deal with doubt

But hypochondria doesn’t just invite us to consider issues of prejudice and privilege that are still intrinsic to medicine today. Instead, the condition foregrounds a truly unsettling idea: while “the illusion of certainty is vital to the smooth operation of modern medicine”, Crampton writes, “there is no such thing as certainty when it comes to our health, nor will there ever be.” Hypochondria, after all, evolves as medicine evolves, suggesting that no medical knowledge of the body is ever final. Indeed, as Rees maintains, hypochondria “is a diagnosis that puts into question how certain we can ever be about any diagnosis – including, needless to say, a diagnosis of hypochondria”.

This is not to say that the authors of Hypochondria and A Body Made of Glass propound anything even remotely close to medical scepticism. Far from it: for both Crampton and Rees, medicine is always about the best available option at the time. But through complementary explorations of hypochondria’s history, both authors come to the conclusion that what defines the condition is the experience of doubt.

Hypochondria forces us to face a question we work very hard to ignore: to what extent can we ever be fully sure of our health? The answer is, of course, not much; hence the hypochondriac’s fundamental doubt, as well as their repeated, but ultimately always failing, attempts at banishing this doubt. The condition throws medical knowledge and science into question, along with the neat stories we try to construct about our lives, our health, and illness. And no matter the time period, there is money to be made off the desire for certainty and reassurance. In the past, it was the so-called quacks who profited from our health anxieties. Their name, we read in Crampton’s book, signals how, before the advent of the printing press, quacks needed to be noisy in order to sell their remedies. Today, it’s the turn of the wellness industry, with its influencers, supplements and devices. Rees convincingly writes about the rise of self-tracking wearables as gadgets that sell us the illusory fantasy of being able to fill in, once and for all, gaps in our self-knowledge, illuminating every aspect of our body and making it fully transparent and knowable to us.

This is the fantasy of a body made of glass, which gives Crampton’s book its title and which captures at once the hypochondriac’s wildest hopes (that is, complete bodily knowledge) and their deep-seated fears (the body’s intrinsic and inevitable vulnerability). The delusion of a body made of glass was widespread in the early modern age: some people felt like their entire body was made of glass; for others, it was just some of their limbs. What was at stake in all cases was the frightening prospect of shattering, which the people who suffered from the glass delusion tried to avert in ingenious ways, such as the Parisian glassmaker who would go everywhere with a cushion on his buttocks to prevent himself from breaking upon seating. As Crampton explains, early modern people were latching onto the symbolic properties of glass to express fears around the vulnerability of human bodies. But a glass body is also transparent and, therefore, fully knowable. That is why, Rees notes, in Cervantes’s 1613 novella The Glass Graduate, the protagonist’s glass delusion has its benefits, since the sufferer becomes incredibly knowledgeable and wise.

Cyberchondria and the dream of perfect knowledge

Today, we’re as close as we’ve ever been to realising the fantasy of a thoroughly transparent body, thanks to imaging techniques, scans, tests, as well as medical knowledge widely available at our fingertips. Yet, just like anything else that has been repressed, hypochondria is never too far away. The more we know about our bodies, the more anxious we appear to be. This apparent contradiction is not exactly unique to our time. Rees notes that, as early as the 19th century, physicians were worried that increased medical literacy amongst the masses would create a rise in hypochondria. However, there is no question that the internet – in Crampton’s words, “the most expansive and spacious playground that hypochondria has ever had” – is making matters worse.

One of the latest permutations of the old condition is what is now being called “cyberchondria”, which occurs in part as a result of searching for information online. It’s compounded by how algorithms work. The more we search for rare diagnoses or terminal conditions, the more we are likely to see these results fed back to us in future. Due to the nature of the internet, therefore, hypochondriacal fears risk turning into self-confirming beliefs.

Crampton reports of a strange and fascinating phenomenon that occurred as TikTok was expanding in popularity at the height of the Covid-19 pandemic. Young people began to develop tics en masse, and exposure to social media videos about Tourette’s syndrome, a condition characterised by motor and vocal tics, seems to have played a crucial role in producing this “pandemic within a pandemic”. Responding to concerns around health anxiety, WHO repeatedly emphasised the importance of “flattening the infodemic curve”, advising us to seek information about the virus from trusted sources only, and limit our consumption of news to once or twice a day. The rising rates of health anxiety at the time were undoubtedly exacerbated by the constant barrage of frightening headlines and online rabbit holes that were tempting to many of us, especially those with time to kill.

Hypochondria is the “dream of perfect knowledge”, Rees argues. But the condition also warns us of the drawbacks of this dream, for our knowledge of our bodies will never be complete, and pursuing it can keep us trapped in our phobias. I am reminded here of the tech entrepreneur and biohacker Bryan Johnson, whose quest to slow down his ageing has led him to ingest more than 100 pills a day, constantly monitor his body, and live what the vast majority of us would see as a very limiting life: dinner by 11am, bedtime by 8:30pm, no sunny vacations, always sleeping alone.

Rees’s book thus closes on something of which we would do well to remind ourselves in our health-anxious times: health isn’t found by excavating and tracking our every waking and sleeping moment. Instead, he writes, health is “encountered in those fleeting moments when ordinariness is experienced as a sort of miracle, when the background conditions that support life become manifest as a source of pleasure”. This is the lesson hypochondria has taught Rees. Whether or not you read his and Crampton’s excellent books, it’s an important takeaway for us all.

“A Body Made of Glass: A History of Hypochondria” by Caroline Crampton is published by Granta.

“Hypochondria” by Will Rees is published by Coach House.