"How are you?’
Oh no, here we go again if it is not an arse it is an elbow, literally.
So you head off and leave Adrian to his moaning, OK it might seem a smite uncaring but you have heard it all before. From his indigestion, to the twinge in his left knee. One day a woman friend of mine snapped at him, ‘Look,’ she wagged her finger, ‘there’s something you must understand; “How are you?” is usually met by "Fine thank you, how are you? This is a common courtesy."
Adrian seething with a desire to disclose his imagined bodily malfunctions was denied his confessional.
When a hypochondriac asks ‘How are you?’ he really wants to know, what you think about how you are; his problem is that, before the conversation is over, he may well have developed your symptoms himself. Hypochondria is not – or not only – a form of self-indulgence. It is also a form of pathological empathy. "...yes, I have been sniffling a bit lately, have you been coughing as well...because I have this constant tickle in my throat...do you have that?"
For Freud hypochornica was merely ‘the state of being in love with one’s own illness’
You see for Adrian the minutest sign of bodily discomfort kicks off complex communication negotiations with the supposed state of his body and the reporting of this to the outside world.
Hilary Mantel writes rather brilliantly about this. 'For some of us, the question ‘Am I ill or well?’ is not at all straightforward, but contentious and guilt-ridden. I feel ill, but have I any right to the feeling? I feel ill, but has my feeling any organic basis? I feel ill, but who am I to say so? Someone else must decide (my doctor, my mother) whether the illness is real by other people’s standards, or only by mine. Is it a respectable illness? Does it stand up to scientific scrutiny? Or is it just one of my body’s weasel stratagems, to get attention, to get a rest, to avoid doing something it doesn’t want to do?
Some of us perceive our body as fundamentally dishonest, and illness as a scam it has thought up
It is the dismaying opaqueness of human flesh that drives us to anxiety and despair. What in God’s name is going on in there? Why are our bodies not made with hinged flaps or transparent panels, so that we can have a look? Why must we exist in perpetual uncertainty (only ended by death) as to whether we are well or ill?
The hypochondriac is not a healthy person with a delusion, so much as a person who is pre-ill; the anticipation creates the very condition he fears. A pattern of suspicion becomes a way of life
His supposed hypochroniacal condition exists on a continuum, with fraud at one end, delusion in the middle and medical incompetence at the end. His body is like a piece of luggage that he his did not pack himself. Of course many people are simply hyper-aware of bodily sensations, and so are driven continually to check in with themselves, examining visceral events as a man about to confess to a priest examines his conscience; like the believer scrutinising himself for sin, they expect to find something bad, perhaps something mortal. Oh God, what is that eruption on my skin it's cancer...I just know it is....better make an appointment with the doctor.
Forgiveness, and cure, are only ever partial and temporary; there will always be another lapse, some internal quaking or queasiness, some torsion or stricture, some lightness in the head or hammering of the pulse, some stiffness in the joint or trembling of the limb, or perhaps even an absence of sensation, a numbness, a deficit, a failure of the appetite. A state of abounding good health can in itself be a cause for suspicion. The migraineur just knows that a jaunty sense of well-being is likely to be the precursor to a splitting headache.
It is reasonable to think that those who are highly sensitive to the outer world, and who constantly interpret it, would be sensitive to the inner world too, and would seek to ascribe meaning to the body’s negotiations with itself
For some, illness is an enabler, the sickroom a stage. 'live plainly and keep busy, and you won’t have time to worry about your health.' This prescription is too simple, because those with health anxieties are among the busiest people on earth. The young Boswell, travelling in Holland, was prey to all sorts of debilitating symptoms: ‘Oh dear! I am very ill.’
Do procrastination and hypochondria often go together? Is hypochondria a creative mechanism employed by the perfectionist? Each crisis of illness is succeeded by a fresh start, which is what the perfectionist craves above all else. The body is purged, light; the page is blank.
But how much easier to develop a symptom, which would then magnetise attention. For some illness is something to do, a pastime.
The undiagnosed are like stateless persons, ejected from the office of one consultant, washed up at the doors of another specialty, booted out of a third clinic with question marks all over their notes; sometimes it is a relief, however hellish the final destination, to be granted leave to remain.
Many artists are hypochondriacs. The pianist Glenn Gould, at one stage in his life, took his blood pressure hourly; he tried to turn down the sensory excitements of the outside world, wearing grey and brown and eating arrowroot biscuits, reducing input to a minimum and aiming to live like his own ghost. Patted on the shoulder by an employee at Steinway, he felt the pat to be a blow, an assault which had ‘compressed or inflamed or whatever’ the nerves of his hand; he cancelled a European tour and filed a lawsuit.
Hypochondriacs contemplate their body's well being or not with a ‘strange combination of intensity and ignorance’
Philip is in Turkey he wipes himself after defecating. He notices the bright red blood on the paper. 'What is that oh my God, oh my Christ...fuck...I am dead..., my death warrant." He hares down the marbles steps. In the ornate dining room his wife's sit demurely with the two kids. He approaches her the intensity seething out of him. She has been down his alarmist road before. Wearily she looks at the paper, poor woman,yes that is blood. "I'm fucked." Calm down. On his return from the UK a visit to the doctor clears up the matter as an innocent case of piles.
And it wont be long before he has found something else about his health to be intense and ignorant about. Poor woman,the sad part is she loves him.
And yet, it is their own distress; it is self-generated and self-selected, not imposed by society; pain is private, when so much else is not. Perhaps only very simple people are not hypochondriacs at one time or another. For the intelligent and inquiring, a measure of hypochondria may be a necessary self-soothing. Anxiety about a specific symptom is more bearable and easier to rationalize than the diffuse ontological malaise that used to be known as spiritual despair