Straight to the point

It’s been a difficult week for those with illness anxiety disorder — the group formerly known as hypochondriacs. Primed to react with a jolt of unpleasant adrenalin to any health-related headline, the already troubled sufferers were this week brought the worst news imaginable as The Guardian sounded “the link between hypochondria and early death”. A Swedish study has found that, apparently, “people with what is now called illness anxiety disorder may die earlier than others”.  As one commentator acutely put it: “It’s not enough just to have worries — now you have to worry about your worries.”

Pity the poor Guardian-reader; now faced, alongside all his other heavy psychological burdens, with the prospect of health anxiety spiralling in an uncontrollable loop, recursively feeding off his last set of worries about worries about worries until he keels over from sheer mental exhaustion. And the rest of the newspapers’ health pages this week won’t have helped much. Even as an early test for Alzheimer’s was being greeted with much fanfare, it was also emphasised that the latest drugs are still relatively powerless to reduce the disease’s terrible ravages once diagnosed: bad news for anyone who tends to panic when they lose their reading glasses or forget a word. And there were also unpleasant tidings for fans of ZOE, the wildly popular private programme designed to improve digestive health. One Times report this week suggested that ZOE’s focus on gut health is distracting people from more pressing problems like high blood pressure and cholesterol. Ironically, it also suggested that engagement with the programme is likely to increase health anxiety — bad news indeed for nervous ZOE users who subscribe to both the Times and Guardian.

As it happens, someone in my house has been a ZOE user for the past few weeks, so I’ve had an inside view of the process, as it were. And I can certainly see how it might encourage neurosis. For two weeks, you stick a needle in your arm and temporarily turn yourself into a cyborg, able to check your blood sugar at any point in the day by waving your smartphone somewhere near your armpit. Meanwhile, in a move perhaps secretly designed to revive the fortunes of the Royal Mail now that we’ve all stopped writing letters to one another, you are also instructed to send your faecal matter off in the post. Back comes a chart arraying your personal gut bacteria types, each cosily personified by use of a familiar first name. “Jesse”, “Bethan”, “Polly”, “Somesh” and “Priya” are good bacteria, while among the bad bacteria, there seems a strangely high preponderance of Scandinavian and Eastern European names, including “Sven”, “Slawek” and “Lars”. The goal is to decolonise your gut, quite literally. It’s not hard to imagine that perfectionist types, already susceptible to taking purity metaphors too far in their personal lives, will become obsessed.

I speak of all this relatively empathically, as a former member of the hypochondriac community. Though free from it now, at earlier times in my life health anxiety has been a torment, made no less unbearable by the knowledge that I was very probably imagining things. My first perceived encounter with the grim reaper was at university, when — sitting trembling in a doctor’s surgery I’d hastily found in the yellow pages — I stammered out my tragic tale to a bored looking medic. About two months earlier, I reported, I’d found a worrying lump on one side of my neck. Later, about two days before the present appointment, I’d discovered another symmetrical lump on the other side. The doctor reached forward and prodded the lumps. “These?” he asked. I nodded solemnly.  A diagnosis was issued: “They are bones holding up your skull.” The relief was intense, as was my embarrassed resolution never to get into such a ridiculous state again. But both were ultimately short-lived.

It’s easy to laugh at hypochondriacs — I do, at my past self — and, if you are one, it’s easy to blame yourself, too. For me, shame was a crucial component of the distress, which lent to an agonising stand-off where I couldn’t bring myself to see a doctor to put an end to the worrying, at least momentarily, for fear of medical disapproval or even ridicule that would come with reassurance. And, actually, the real story is how widespread and debilitating health anxiety is these days, though sufferers are often too ashamed to talk about it; and how newspapers and even the medical profession itself contribute to feeding the beast to bank the clicks.

On one hand, there is the ludicrous boom-or-bust pattern of health reporting. First comes the hope: pouncing with great fanfare on some new piece of research or technology, emphasising its promise to improve some dreaded physical outcome (Ozempic, anyone?). Then, sooner or later, the more sceptical debunkers arrive, suggesting that the original breakthrough was not all it was cracked up to be. Most of us lack the expertise to assess either claim, optimistic or pessimistic, and so are at the mercy of whatever our individual psyches would have us believe. But the more (dis)information that circulates about the relation of behavioural choices to health, or about the range of diagnostic tests or prophylactics newly available, the more everyday decisions can seem freighted with potentially devastating consequences, and the heavier the guilty responsibility if you get things “wrong”.

And then there is the media’s approach to hypochondria itself; an approach apparently also shared by many doctors. This, as already indicated, is effectively to pathologise the problem as a psychological disorder that, if possible, should be managed or treated — whether through CBT, antidepressants, being “kind to yourself’, or better educating yourself about differential diagnosis, as one Telegraph article suggests. It’s not that these are all bad ideas, necessarily, but more that the initial medicalised framing of the issue hinders rather than helps. The report about ZOE this week exemplifies the paradox: telling us all to worry more, not less, about things like cholesterol and blood pressure, but equally not to worry too much about any of it, as that too would be unhealthy. But while many of us can respond all too readily to a medical cue to be vigilant about something in particular, we cannot mentally stand down on command so easily. Speaking as a person with well-established hypochondriac tendencies, where these get framed as a form of health disorder, the mere existence of them becomes yet one more problem to haunt your thoughts.

And it’s not just the media’s fault, nor even the internet’s generally. In GPs’ waiting rooms around the country, campaign posters exhort you to stay on the alert for even small physical changes, and to alert a doctor as soon as any sinister ones appear — while also failing to say how to distinguish sinister from benign. The general aim of public-health campaigns seems to be not just to scare people, but also to moralise vaguely about non-compliance. Conscientious or suggestible types can easily start feeling as though it is an ethical duty to do regular breast scans, mole checks, and other close bodily readings, and that you have somehow failed if you don’t. I have no doubt, in this time of lengthening waiting lists, that surgeries are full of people with concerns that otherwise would not have occurred to them, had they not been artificially prompted. People with real illnesses are the main losers.

You haven’t failed morally if you miss something terrible, though. I’m not exactly sure what contributed to my own emergence from body-checking hell, but properly accepting that serious illness would never be my “fault”, no matter what the circumstances or lifestyle choices supposedly behind it, was definitely one aspect. Facing the inevitability of death was another; and stopping reading The Guardian, probably a third. I now steer clear of health reporting generally, knowing that, by its very nature, it can only ever increase confusion and not alleviate it. And in general, I try not to think about health anxiety as a medical problem at all, rather viewing it as a relatively normal by-product of strong attachment to life, with all of its known unknowns. When it comes to worrying about worrying about illnesses, probably the last person you should trust is a health professional.

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Source: UnHerd Read the original article here: https://unherd.com/