Mind Moves:'Be careful about reading health books," warned Mark Twain, "you might die of a misprint." He had a point. It can be dangerous for some people to read health books. For perusal of signs and symptoms of illness may convince even the most casual reader that potentially they have any number of previously unheard of fatal illnesses. A little knowledge is the clichéd dangerous thing.
But what about the non-casual reader of health manuals? What about the person morbidly preoccupied with illness who is monitoring every internal twinge and external twitch for signs of imminent illness? What about those who trawl the internet for information that will confirm what they believe their doctors have missed: the serious disorder underlying their innocent symptoms. And what about those people described as hypochondriacs who despite repeated reassurance from their GPs and regardless of undergoing exhaustive medical tests, remain convinced that their end is nigh? What can be done for them?
Groundless intense anxiety about one's health, known as hypochondriasis, is a source of real distress for sufferers. It is too often dismissed as the delusion of the healthy, the attention seeking of the manipulative, the fanaticism of the self-absorbed, or the whining of those who are too weak to get on with life like everyone else.
As a consequence, little sympathy is extended to those who suffer from hypochondriasis. They are often believed to fake illness in order to elicit sympathy. Their body language makes others uneasy, anxious and irritated. People become tired and bored at having to endlessly listen and reassure. Like many people who are most in need of listening to, those suffering from hypochondriasis often end up feeling isolated, alone and unheard.
Hypochondriasis involves intrusive thoughts about illness. Anxiety cannot be satisfied until family, friends and physicians have been consulted for reassurance. But reassurance is fleeting, for upon leaving the doctor's surgery, the hypochondriac thinks of a symptom not described to the doctor that might have been significant, an ache that was not emphasised, or a new warning sign that might herald a new disease. Then there are the bacteria that may have been contracted in the surgery, or contagious diseases acquired from others waiting to see the doctor. In its most severe form, hypochondriasis is a round of worry from which there is little reprieve.
Hypochondriasis is what is called a "somatoform" disorder, as it involves physical complaints about non-evidential physical symptoms. In its most dramatic form, a kind of hysterical paralysis in a limb may occur. Alternatively, numerous evolving problems, such as stomach upset, dizziness or pain, will be reported. To the sufferer they are real. To the investigator, no physical cause can be found. Unless the psychological nature of the problem is identified quickly, unnecessary medical procedures may be undertaken - surgery occurs twice as often in this group.
It is not surprising that hypochondriacs become depressed. But what is less often understood is the degree to which depression may evoke the pessimistic approach to health in the first place. Besides, depression and anxiety produce so many physical symptoms of their own that as the body feels out of control, so too does thinking about it. Sometimes hypochondriasis is part of what is know as an obsessive compulsive disorder, where intrusive thoughts accompanied by compulsive behaviours, such as wiping door knobs to avoid infection, converge into a round of misery, fear of contamination, distressing physical symptoms and the depression that is inevitable when things seem out of control.
The internet adds a new dimension to hypochondriasis with cyberchondria: the term for those who research medical conditions on the internet and then believe they have them. Most psychology students will admit that, in their undergraduate years, they secretly regarded themselves as having most of the psychological conditions they encountered and med students have the challenge of keeping health concerns in perspective.
Our relationship with illness is multifaceted. Body and mind are not separate. How can one know if stress has preceded or succeeded a physical illness? Illness can cause depression. Depression can trigger illness. For the sufferer it is inconsequential: all induce fear.
Hypochondriasis is along a complex continuum of anxiety, and justice cannot be done to the condition with these few words. But we might remember that hypochondriasis, as opposed to "creaking door" complaining, is neither faked nor manipulative. It is a real, if irrational fear about health and death. However unfounded the fear may be, one must have compassion for those who live under its shadow and believe themselves to be in the shade of terminal diagnoses about which nobody seems to care. The comedian Spike Milligan, a man who spoke courageously and publicly during his lifetime about the psychological challenges that influenced his life, left a legacy for those of us who will not listen to fear. On his gravestone his epitaph reads: "I told you I was ill."
Marie Murray is director of the student counselling services in UCD. Her most recent book is Living Our Times, published by Gill and Macmillan.