These days it’s difficult not to be ill. In fact, it’s impossible to be well. Few of us do not have, or at least indulge in, risk factors for catastrophic illness. My doctor is constantly badgering me (by computer-generated letter) to be screened for one or all of them, thereby to destroy my peace of mind if not to delay my demise. For risk-factor medicine, a meal is a medical procedure. Just as John Stuart Mill thought that matter was the permanent possibility of sensation, so doctors are inclined to think of people as the permanent possibility of illness — or accident. In the long run, of course, they are right.
Surely there must be a condition known as health? But the World Health Organisation defines health as not merely the absence of disease, but complete — yes, complete — physical, psychological and social wellbeing. According to the WHO, then, there’s not a healthy man alive and never has been, at any rate not since prelapsarian times.
Between perfectionist notions of health and risk-factor medicine, it is surprising that we are not more hypochondriacal than we are. But even hypochondriacs are ill. They have the condition known to the Diagnostic and Statistical Manual of the American Psychiatric Association (Fifth Edition) as Illness Anxiety Disorder. The World Health Organisation’s International Classification of Diseases (Tenth Edition) describes hypochondriasis as follows:
The essential feature is a persistent preoccupation with the possibility of having one or more serious and progressive physical disorders. Patients manifest persistent somatic complaints or a persistent preoccupation with their physical appearance. Normal or commonplace sensations and appearances are often interpreted by patients as abnormal and distressing, and attention is usually focused upon only one or two organs or systems of the body.
This gives rise to the possibility of meta-hypochondriasis, for a patient might start to worry whether his worries about his health constituted illness anxiety disorder, thus starting an infinite regress of diagnosis. Nor need the sufferer from this disorder actually be well, in the sense of having nothing wrong. All that is necessary is that his concerns be deemed excessive or disproportionate by his doctor. But, as the great physician and researcher into high blood pressure Sir George Pickering once said, a minor operation is an operation performed on someone else. An unreasonable worry, for most of us, is a worry experienced by someone else.
There is no doubt that hypochondriacs are boring; you fear to ask them how they are in case they should tell you. But one cannot help but suspect that their excessive concern with the state of their health is a defence against something worse, an existential fear that life has no meaning beyond itself, and that therefore the achievement of health, the avoidance of illness, is the highest goal possible.
Certainly, our obsession with health, safety and security (which have replaced faith, hope and charity as virtues) is not proportional, except possibly inversely, to risk or threat. The hypochondriac is not assuaged by statistics that show that his generation is the healthiest that has ever lived, or that death does not lurk in every food and every product and every situation. In the absence of a transcendent purpose in life, staving off death becomes all-important. Hypochondriasis, then, is in part a religious or philosophical problem.
Few people are completely immune from the temptation to hypochondriasis, and a friend of a friend of mine, Mr Mark Wickham, former art master at Marlborough, developed an original and effective technique to combat it. Having reached the age at which minor aches and pains were to be expected, he found himself enumerating them to a friend of his who, having reached the same age, was likewise liable to such aches and pains. They decided that on meeting each of them should have five uninterrupted minutes of ‘organ recital’. Once it was over, the subject was forbidden; and they found to their surprise that their litanies of woe sounded ridiculous even to themselves. They started to laugh at their ailments, and felt much better for it.
This technique confirmed what I had long suspected: that it is far more important for people to be able to lose themselves that to find themselves. The ability to distance themselves from their own twinges and morbid thoughts is precisely what hypochondriacs lack.
To observe, but also to observe yourself observing: that is the trick. Once, when being mildly beaten by a Balkan policeman with a truncheon, I managed to think about how I was going to describe it, and I found thinking about it a considerable relief. There comes a point, of course, when such detachment is impossible: but by definition, almost, hypochondriacs have not yet reached that point. As Lord Bacon said, ‘It is a poor centre of a man’s actions, himself… That which maketh the effect more pernicious is that all proportion is lost.’