Hypochondria, the ghost at medicine’s feast.

Hypochondria, the ghost at medicine's feast. Belling, Catherine. The Lancet, Volume 404, Issue 10454, 742 - 743

This fantastic article by Catherine Belling was published recently in *The Lancet*, and I believe it’s a powerful piece that dives deep into the complexities of modern medicine. It is a response to Dr. Shapiro’s article in The Journal of the American Medical Association, which was published back in 1998. Belling begins with an example: an ambiguous lesion on a scan. No one can determine if it is just scar tissue or a tumor. She compares this to the ancient Greek oracles, where a riddle would be handed out, and the priest had to interpret the riddle and apply it to the scenario being asked about. While the days of oracles are behind us, the principle remains the same.

“Science cannot always provide doctors and patients with the consistent and certain truths conventionally expected of it.” Modern medicine, fortunately or unfortunately, can still be cryptic, often leaving doctors feeling anxious.

Belling then shares her own experiences as a doctor, facing patients with what was traditionally called ‘hypochondria.’ She describes this as a diagnosis that arises when both the doctor and patient must confront the ambiguity and uncertainty of modern medicine. Personally, I can reflect on family members who have experienced this phenomenon—mystery illnesses that succumb to the limitations of our science. This often led to mistrust of physicians and medicine when reassurance (or psychiatric diagnosis) was not accepted. Interestingly, the same person went on to work in the medical field themselves!

However, these scenarios can also be seen as opportunities. They offer a chance to recognize the patient's own sense of illness, shaped by past experiences, culture, psychiatry, and the doctor-patient relationship itself.

Hypochondriasis has now been renamed illness anxiety disorder or somatic symptom disorder—more modern and descriptive ways of understanding a situation that has been a part of anthropology for centuries. Unfortunately, it is often misunderstood as people being “not really sick,” perhaps even selfish. The article also references A Body Made of Glass by Caroline Crampton. Though I haven’t read this book myself, it details the personal experience of living with illness anxiety. After being diagnosed with lymphoma, Crampton’s psychiatric illness took over due to her initial unawareness of the diagnosis. Her illness anxiety is now lifelong, accompanied by her doctors' ongoing vigilance. The book traces the history of this illness, from Freud’s theories to the possibility that even Charles Darwin experienced something similar.

Belling asserts that hypochondria is rooted in the realities of medicine itself, as applying science to individuals is inherently difficult due to the myriad variables involved. Hypochondria often emerges in someone with some form of pathology—at least in the beginning—rather than being the performance of illness in someone entirely healthy. Drawing the line between disease and health is incredibly challenging.

In conclusion, people with this condition constantly remind doctors of the ambiguity and limitations of medicine—something that doctors may perceive as a flaw in themselves, especially when their identity is so intertwined with their medical practice. It is, therefore, crucial that we embrace and celebrate those who experience this condition, rather than being haunted by their truths.