IIn the 14th century, King Charles VI of France suffered from a strange, but certainly not original, delusion. He believed that his body was made entirely of glass. Glass, a relatively new material, both fragile and transparent, captures the hypochondriac’s most acute fear – brittle vulnerability – with their greatest desire: deep-seated omniscience. This human desire to peer into our “fleshy vessel” was answered in the 20th century by medical technologies, including blood testing, microscopy, and imaging, which became widely available. Far from soothing the hypochondriacal itch, this intimate access—along with Google’s democratization of medical knowledge—has fueled health fears to new heights.
Caroline Crampton describes herself as a hypochondriac, but one with imposter syndrome because she previously had a serious ‘real’ illness. She thinks back to the naivety of her 17-year-old self, unaware of “the tennis ball-sized lump” above her left collarbone that was “already big enough to cast its own shadow.” Life-threatening diseases lurked in plain sight, painfully obvious in old photographs. More than a decade after radiotherapy, chemotherapy, a stem cell transplant, egg retrieval and a successfully managed recurrence of Hodgkin’s lymphoma, Crampton now sees tumors everywhere. The hypochondriac cancer survivor is, she suggests, tragicomic. A brush with malice should remind you what really matters; instead, Crampton feels trapped in the limbo between the “binaries of illness and health,” as he pokes at her body in the mirror.
With extensive experience in the world of the medically explained and the medically unexplained, Crampton is perfectly placed to write this fascinating and intelligent cultural history of health anxiety, steeped in the intensity of the feeling that hypochondria ignites, as well as the insight that it often rules out. She is curious whether hypochondria is still a popular term, despite its vagueness and stigmatizing edge. Doctors don’t want to give it up either (there was even a question about hypochondria in the Royal College of Psychiatrists membership exam this month). While the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5an international “bible” of psychiatric conditions, has updated its terminology to “somatic symptom disorder” and “illness anxiety disorder,” as messy reality overwhelms the seams of these diagnostic categories.
Hypochondriacs tend to have a specific concern – cancer, infertility, a resident parasite – and scan their bodies for evidence to support this belief, setting in motion the “falling dominoes of catastrophizing.” But hypochondriasis also overlaps with obsessive-compulsive disorder and conversion disorder (when stress or emotion manifests as pain, weakness, or similar symptoms that don’t fit into a pattern that can be easily explained). Crampton also experiences complex post-traumatic stress disorder from her years as a cancer patient, characterized by flashbacks, intrusive thoughts and hypervigilance. As she wades through these labels, her guiding question is, “Who gets to decide what is reasonable fear and what is unreasonable?” – is exactly the right question.
A body made of glass does not claim that hypochondria has any redeeming benefit, unlike previous books on the subject. Brian Dillons Tormented Hope (2009) argued that health anxiety shares a root with creative genius. Crampton intersperses parts of her memoir with historical research and the lives of famous patients similar to Dillon, including Charles Darwin, Glenn Gould, Philip Larkin, Molière, Marcel Proust and John Donne, but instead of using these as evidence of the artistic silver lining of hypochondria, finds solace in the eloquence with which they address their health problems. Crampton takes us back to the origins of hypochondria – probably first mentioned by Hippocrates and previously visible as a concept in Egyptian texts.
Etymologically ‘below the breastbone’, hypochondria used to be firmly rooted in the body. Humorous medicine labeled the condition as an imbalance in black bile, which then became linked to the ‘wandering womb’ of hysteria, followed by the more ethereal ‘vapours’ in the 17th century and nerves in the 19th century. The body disappeared from view when hypochondria was reconceptualized as a disease of the mind. For more than a hundred years, hypochondria has been the staple of psychiatry, while it remains a lucrative target for quacks and charlatans.
How concerned the public is encouraged to be concerned about their health depends on the historical moment. Written for five years, A body made of glass is a Covid-19 book of sorts, bearing the hallmark of a time when illness became everyone’s concern and the stigma of health anxiety waned (in fact, Crampton found relative peace and camaraderie during the pandemic, joining her habits of self-monitoring). It’s staggering to think of how many ways the human body can malfunction; it’s a wonder it’s going well. In a way, hypochondria makes perfect sense. We’re all going to die. For the hypochondriac, most of us are just too easily lulled into a state where we forget this.
Despite doctors being let down in various ways, Crampton has the grace to empathize with the challenge of caring for patients with hypochondria. Doctors may feel pressured to either double down in a position of unearned assurance that nothing is wrong, or to investigate too much. Faced with the task of assessing potentially fatal or life-limiting diseases, doctors – especially in a rationed healthcare system such as the NHS – cannot scan, biopsy and operate on demand. An important consideration that Crampton slips over is the iatrogenic and collateral damage that can result from the pursuit of ‘incidentalomas’ – accidental findings that so often turn out to be benign.
Crampton rejects the convention that stories of illness must end with tragedy or healing. She explains how antidepressants, EMDR (eye motion desensitization and reprocessing) therapy, and cognitive behavioral therapy can help some people live with health anxiety, but are not magic solutions. She avoids the pitfall of false reassurance, however attractive to people with hypochondria, and sets an example. Historically, doctors have been wrong far more often than right, and have been especially willing to hear marginalized and minority voices.
A body made of glass reinforced my belief that physicians would do well to share doubts with their patients and become allies in uncertainty rather than antagonists. Both people in the doctor’s office seek confirmation about what is going on, but must face the disturbing truth that there is so much about our bodies we still don’t know.
Kate Womersley is a doctor and academic specializing in psychiatry. Her work at Imperial College London focuses on sex and gender equality in biomedical research