If you were hoping for Caroline Crampton’s book on hypochondria to provide some clarifying definition of the term, you may find yourself a little disappointed. It is through the exploration of the unanswerable that Crampton invites us into her inner world, where she remains haunted by the duality of being sick and well in each waking moment.
In Crampton’s view, hypochondria breeds on the “doubt inherent in modern medicine”. Since certainty is a condition that has always been irreconcilable with science and medicine, hypochondria has persisted, from its roots as a purely anatomical term in the fifth century BC — denoting the upper third of the abdomen — to the present day.
In one poetic attempt to encapsulate the essence of the condition, she describes it as “being homesick for the body that you are still in”. This description feels all the more poignant when Crampton reveals the origins of her own hypochondria: a diagnosis of Hodgkin’s lymphoma at 17 which, despite going into remission after a half-decade of invasive treatments, has left her hyper-conscious of “every twinge and scrape”.
In tying her own experience, as if by an invisible thread, to numerous intellectual giants and fictional characters across time, she offers us a rounder taste of her condition. She speaks of the magical thinking that permeated Joan Didion’s life in the wake of her husband’s death; the existential dread of Woody Allen’s parodied neurotic characters “forever trapped between the two possibilities” of health and terminal illness; the despair of Elizabethan poet John Donne facing his mortality during a relapsing fever; and the obsessiveness of Charles Darwin’s daily rituals aimed at controlling his fears about his degenerating body.
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Just as the condition itself is rife with contradictions, Crampton wastes no time exposing her own contradictory relationship with the condition. She oscillates between emphasising its utter absurdity — the reason it lends itself so effortlessly to cruel satire — and showing us her reverent appreciation of its deeper existential roots. At its core, she suggests that hypochondria is nothing more than the fear of death. She questions whether we should all fear death, suggesting that the blissful ignorance of health and a medically uninformed mind may derive from a comforting lie — that we will be alive tomorrow when such certainty is never guaranteed.
With the realisation that a tumour could grow silently for years, undetected, and the fact that she herself could have a solid mass in her neck without noticing, Crampton finds herself ruthlessly disenchanted with this illusion.
Her unflinching interrogation of hypochondria and its evolution leads to fascinating cultural observations, as when she highlights the striking similarities between the “quacks” of the past and those of contemporary society. Both exploit what she regards as the hypochondriac’s desperate yearning for certainty and explanatory narrative. This, in the eyes of Crampton, is precisely what modern quackery and the so-called wellness industry thrive on.
By implying that hypochondria is a driving force behind the modern wellness industry, Crampton risks stretching an already elusive concept to the brink of losing its meaning, potentially reducing it to a catch-all term for anxiety. However, any generous reader will probably be willing to forgive her tendency to blur the lines between hypochondria and poorly understood chronic illnesses, as well as her inadvertent reinforcement of the long-discredited divisions between “mind” and “body” given the depth and breadth of her thinking.
Her investigation reaches beyond her private experience and even beyond hypochondria as a shape-shifting, millenniums-old evolutionary phenomenon, delving into what hypochondria reveals about the evolution of scientific and medical thought at large.
Hypochondria has evolved throughout the millenniums from a purely physical, abdomen-rooted condition to a mental disorder. As research investigates the microbiota-gut-brain axis and seeks to identify and treat mental health conditions using biological markers, Crampton has the sense that “the body is returning”, possibly heralding a “return to the very beginning of hypochondria”.
“Haunted by the image of hypochondria as an enormous pendulum,” she questions our cultural understanding of scientific progress as a steady march towards some inevitable endpoint. In following the evolution of hypochondria through the different minds that attempted to elucidate it, Crampton shows that our medical advancement can paradoxically land us back near our original starting position. Somehow, the introduction of a new diagnostic name — ”illness symptom disorder” or “illness anxiety disorder” — along with the gravitas of the Diagnostic and Statistical Manual Fifth Edition (DSM-5), appears to shield us from the cyclical nature of progress.
Crampton starts and finishes the book as a hypochondriac. She gifts the reader with a glimpse of just how much she has had to battle her perfectionism to end without a neat narrative resolution, without “a moment of absolute catharsis”. In a manner that aptly captures the reality of hypochondria, she reveals that “a good ending ... has yet to arrive”.
