Caroline Crampton’s cultural history of hypochondria begins with her own hunt for a tumor. She stares at her reflection in a bathroom mirror at work, fingers kneading her neck, searching for suspicious lumps. Tumors, she knows from experience, have “a certain texture … a hard kernel moored deep inside with a slippery casing that can move over muscle and under skin.”
Is Crampton a hypochondriac? Even using the word means taking a position in an ongoing debate. “I once used the word ‘hypochondria’ during a consultation with a doctor,” she recalls, “only to have him chuckle and pull a brand new medical dictionary off the shelf to show me that the term had now been deemed ‘obsolete’….”
Now the condition has been split in two, and hypochondria abandoned for “somatic symptom disorder” — which involves the experience of physical symptoms — and “illness anxiety disorder,” which is defined by excessive health-related behaviors and unreasonable concern about becoming ill. But Crampton has long identified with the label and still does, despite the doctor and his dictionary. She sees herself as sharing in a special kind of despair with an enormous community, among whom are many cultural luminaries: Marcel Proust, Virginia Woolf, John Keats, Molière, Darwin. Hypochondriacs all.
“I like the word hypochondria,” insists Crampton. “I cannot abandon it. It feels rooted in a history and a tradition that connect sufferers. … It offers companionship while in the grip of a fear that can be completely isolating. At times, it can even offer relief: if this is ‘just hypochondria,’ my health is safe from other threats, for now. A name is a powerful spell.” Crampton does an excellent job as a historian, telling surprising and dramatic stories about the figures listed — Molière’s death is a spectacular story of hypochondria vindicated — and many more with whom she feels a strong kinship.
Crampton does not defend a specific definition of hypochondria. Instead she moves from one definition to the next, exploring their strengths and weaknesses. In one of many striking passages that effectively blend philosophy of medicine and personal anecdote, Crampton describes her experience when COVID-19 took over the public consciousness. As cases started to rise, she and other hypochondriacs found it oddly calming. They adopted “extreme coping mechanisms,” like “unnecessarily cleaning the packaging of all our food with disinfectant.” But what made it different was everyone else was doing it too.
“Suddenly, we were normal,” writes Crampton. Everyone was a hypochondriac, and therefore no one was a hypochondriac, even the hypochondriacs. She quotes a psychiatrist, speaking 18 months into the pandemic: “Health anxiety in a situation like the one we’re living through is normal, appropriate, and expected.” What counts as excessive or irrational fear, observes Crampton, is subjective, and depends on one’s context and personal experience. Are her throat-kneading rituals irrational magical thinking, or are they the reasonable behavior of someone who was once diagnosed with cancer as a teenager, cancer which, once treated, recurred against the odds?
But Crampton isn’t making an argument for relativism about hypochondria. Clearly the word picks out an important type of human experience, an existential pain at the intersection of medicine and mortality. Crampton has experienced it regularly, the panic that demands endless anxious attention.
“When I experience an episode of severe anxiety about my health, I become an unreliable narrator of my own body,” she explains. “The fear makes me partial; I only pay attention to what fits my belief that I am sick.”
The book gives very serious consideration to the idea that hypochondria is, at least in part, a problem with the direction and intensity of one’s attention. Although anyone can be a hypochondriac, those who have experienced serious illness are far more likely to suffer from it. Their own unlikely brush with mortality shifts their attention to the precarious and uncertain nature of human health, a truth the rest of us can blithely keep repressed.
Misdirected attention can turn into delusion, as it did for King Charles VI, who, at 24, suffered a breakdown while on a military campaign and began babbling nonsense and attacking fellow soldiers. His courtiers managed to return him to Paris, where “his ravings coalesced around a specific fear. He could not bear to be touched, he said, because he was made of glass and could shatter on contact.”
Not all hypochondriacs suffer from glass body delusion, of course, but Crampton uses it as a metaphor that captures the experience of hypochondria: a sense of yourself as perilously delicate, excruciatingly fearful of the damage your body might suffer. In the face of this crisis, you’ll do anything to feel safe. Charles VI develops his own hypochondriacal rituals, reinforcing his clothes with iron rods and moving very cautiously. Nowadays we might Google our symptoms for hours, only to discover that we’ve been made more anxious — not unlike victims of so-called medical student syndrome, where students of medicine fear they have been struck ill by the sicknesses they are studying.
Although Crampton acknowledges that some researchers doubt the reality of medical student syndrome, one of the book’s central themes is that beliefs, like names, are powerful spells. In early 2021, there was an enormous spike in “functional tic-like behaviors.” The behavior was dubbed “TikTok tics,” and linked to the TikTok Tourette subculture of people describing health conditions. The spike was mostly girls, which was strange because Tourette’s is far more common in boys. Strange, but not so strange, since girls were more likely to watch “tic influencers on TikTok,” and a substantial majority of patients reported watching them.
The upshot of this story is not that we should go back to the days of stigma and silence about our suffering, be it physical, mental, or existential. To the contrary: Crampton believes our collective attitude toward those who suffer has improved dramatically. The tics are a sign of our progress, the anti-glass delusion, a better response to the shock of a pandemic and lockdowns. “Rather than wishing to be invisible, these sufferers are taking up space and insisting on recognition in a way that I find admirable. Why should they keep calm and carry on? Look at us, they seem to say. We are not OK, and neither are you.”
Some readers may be frustrated by the absence of clear definitions or concrete plans for improvement. Crampton’s various experiments with treatment are mixed. The most effective was “eye movement desensitization and reprocessing,” or EMDR, which involves recalling traumatic memories while tracking a shifting LED light back and forth with your eyes. “At the start,” Crampton writes, “it felt too close to a ritual to be scientific.” Nevertheless, she reassured herself that a substantial body of experts and a handful of studies seemed to show it worked.
But is there an incompatibility between ritual and science? In her discussion of cognitive behavioral therapy, Crampton compares the techniques of Stoic philosophers, who visualize their worst fears, to the contemporary practice of “negative visualization.” The book’s attention to names forces the reader to ask: So what is negative visualization? A “technique”? A “ritual”? A “spiritual exercise,” as Crampton refers to the methods of the philosophers? Or a “therapeutic technique,” which has the advantage of being covered by insurance?
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There’s no answer in the book, but that, in itself, is part of the answer. Hypochondria resists definitions, Crampton warns. It is a sickness of endless questions: Am I ill? How can I know? How can I protect myself? Am I being reasonable? Can I trust myself? “Some treatment programs for hypochondria begin by asking the sufferer if they are willing to be mortal,” writes Crampton. “What a question.”
It’s yet another that Crampton leaves unanswered, to the reader’s benefit. If hypochondria is a demand for certainty when none can be had, then A Body Made of Glass might be, to mix philosophy with science, a spiritual exercise that protects against illness anxiety. If you worry about your health, or worry about worrying about your health, it’s worth a read — just remember that books are not yet covered by insurance as therapeutic interventions.
Alan Levinovitz is a professor at James Madison University, who specializes in the intersection of philosophy, religion, and science. His most recent book is Natural: How Faith in Nature’s Goodness Leads to Harmful Fads, Unjust Laws, and Flawed Science.