“This minute I was well, and am ill, this minute.” The pain arrives slowly, like a Polaroid sharpening into view, but the fear comes suddenly: a channel switched, a cloud sped across the sun. It’s June 1989, I recently turned 20, and I am supposed to be studying for first-year exams in English, at University College Dublin. Instead, I’m letting a morning’s MTV binge slide into the afternoon and paying keen attention to the fingers of my right hand, which have begun to ache. In the days that follow – though I only half believe it’s happening – stiffness spreads to my wrist and elbow, to the other arm, to my hips and knees. I start hobbling, and hunch over on the bus on my way to university. I will have to repeat some exams, but my affliction will have vanished by midsummer, walked off one hot day in St Stephen’s Green.
Most of my life, from early adolescence onwards, has been punctuated by these episodes, more or less alarming, depending on my symptoms and the disease I have decided is expressed there. Fretful interludes have remained secret, never spoken about to parents, friends or professionals. Others have been, or felt, dramatic: the shock of a sudden lump, rash or pain must be taken to a GP, then to specialists, only to be quickly dismissed, or dissolved in the weeks-long agony of appointments and results. Still others have lingered for months or even years, dragging at daily life, relationships, career prospects.
At a certain point I saw the pattern, spoke about it, wrote about it, even became a kind of lay expert on hypochondria. And still it persisted, despite, or because of, my never being seriously ill, or spending a night in hospital. (Measles, mumps and flu aside, the worst that’s happened to me was a florid allergic reaction to penicillin.) I am happy to judge myself a “hypochondriac”, even if I’d hesitate to use the word about anyone else. “Health anxiety” is the more respectable, and NHS-preferred, term, which surely describes how many of us have felt since the spring of 2020. Early in the pandemic, I hit my head hard on the corner of a kitchen cupboard, and for a moment, as the blood flowed, I pictured an emergency room, stitches, almost certain Covid infection. I quickly got a hold of myself, but began to worry that my anxiety was about to get out of hand.
What had spooked me in the summer of 1989 and caused my joints, or my mind, to seize up? I was afraid it was my turn. Four summers before, my mother had died aged 50, from a complex case of scleroderma: an autoimmune disease with many painful, debilitating and disfiguring effects. As a child, I’d got used to my mother’s bouts of major depression, her failure to appear some mornings at breakfast, the periodic hospitalisations (for electroconvulsive therapy, a fact I didn’t know until a decade ago), a cupboard stocked with Valium or Mogadon. And then, when I was about 10, her more visible suffering. A darkly glamorous woman, she hid her hard, mottled and excruciating skin under polo necks and leather gloves. But the illness was at work internally. One day, when I was 15, she cried out that she’d be better off dead. Months later, she was gone: in a small fraction of cases, scleroderma will cause cirrhosis of the liver. By my mid-teens, I had internalised that this was what adulthood entailed, at least for my family: you grew up, you got sick, you died. Before your time.
When I was 20, the family doctor said the pains in my joints might have been caused by a recent virus. Later, I was quite sure they’d been conjured out of pre-exam fear and avoidance. They were also the belated expression of a horror that had been there all through adolescence. From 12 to at least 18, I had a minor but shaming case of psoriasis, mostly of the scalp (diagnosed by nobody except the hairdresser who lived next door). One night my mother mentioned that while she was in hospital, despite her own suffering, her heart went out to a psoriatic patient in the next bed: her torments of itching, the coal-tar baths, her swollen, immovable joints. Without telling a soul, I concluded this was my future. I watched Dennis Potter’s The Singing Detective in admiration and panic, read interviews with the writer about his own psoriatic arthritis, wondered if I would have the willpower to work through such a life. For years I used to walk the streets, terrified some physician or nurse would spot me and my incipient condition, and in their gaze I’d meet the damning certainty of diagnosis.
Almost a year after my half-imagined rheumatic episode in 1989, my father, 61 and recently retired, was going for a walk after mass when he dropped down dead of a heart attack. Anxiety, grief and irresponsibility all contend in the mind of the newly orphaned almost-adult. A sense of absolute fatality and freedom. Also shame, as always. I rushed to spend what money my father had left behind on late nights and a protracted, half-botched PhD at Trinity College. Grand ambitions and a tendency to sabotage them: a not unusual combination, as I now remind myself when talking to troubled students. I was also embracing a new health crisis every few months. Alone in the library, I convinced myself that some growing discomfort was in fact testicular cancer. I thought I found a lump, and believed it would kill me, but waited weeks before blurting it all to a girlfriend. A year (and no cancer) later, a friend marched me to the medical centre at Trinity when I complained of chest pains. Again – nothing. My friends noticed what I’d failed to see, and one night – tough but drunken love – sat me down to say they could bear my whingeing no longer. Yes, of course, they said, it was all obviously to do with what had happened to me.
I never made the connection between my parents’ deaths and my addiction to fear and false alarm. Only in my late 20s, in the aftermath of a period of depression, during which I had dreamed about discovering my mother’s bones wrapped in warm bedsheets in the bottom of her chest of drawers, did I notice my body-panic fits had become rarer, and divine the link with my parents and my childhood. Later I wrote my first book, In The Dark Room, about my family, and in it described my own hypochondria, which prompted a second book, Tormented Hope, on the cultural and medical history of health anxiety. I liked to say that it took a decade, two books and a nervous breakdown, but it seemed I had been cured of hypochondria. I even imagined myself able to face any real future illness with wisdom and serenity.
The word “hypochondria”, I discovered in my research, denotes the region of the abdomen directly below the ribcage; Hippocrates, for example, refers to a woman suffering “in her right hypochondrium”. Hypochondria was actually a physical disorder chiefly affecting the digestive system. In The Anatomy Of Melancholy (1621), Robert Burton lists the symptoms of “windy hypochondriacal melancholy”, which include “sharp belchings, fulsome crudities, heat in the bowels, wind and rumbling in the guts, vehement gripings, pain in the belly”. Already, in the 17th century, hypochondriacs are also patients with overactive imaginations, invented ailments. In the 18th century, a neurological element is added: the hypochondriac appears more sensitive, physically but also emotionally, than others. Slowly, “hypochondria” began to signal an affliction that is very like contemporary descriptions of health anxiety, but also at times closer to what nowadays we would call depression.
By the middle of the 20th century, hypochondria had become a comic personality type, as in certain of Woody Allen’s characters, or the germophobia of Donald Trump. “Hypochondria” now pointed to a species of bodily or medical delusion. Doubled delusion, in fact: the hypochondriac thinks he or she is ill, but also imagines health as a state of the body in which nothing ever happens. The fact that, according to the NHS website, you may be diagnosed by your GP with health anxiety and referred for cognitive behavioural therapy does not mean it’s an easy diagnosis to face up to. One can know a lot about the subject and still feel judged.
Despite the reclusive productivity of Marcel Proust or Andy Warhol’s horror of other people’s illnesses and neglect of his own, I wanted to reject the idea there was some inherent affinity between creativity and hypochondria. Except perhaps a negative one: I had to admit, cured or not, that I had a habit, when meant to be finishing a book or other big writing project, of distracting myself with some new anxiety: a nagging cough, an enlarging mole. (Appointment with a deadpan Australian dermatologist: “The good news is you don’t have cancer; the bad news – you’re middle aged.”) But for a time – late 30s, early 40s – such interruptions were easy enough to weather. Until they were not. A period of depression, the end of a long relationship, the joys and insecurities of a new life, another book to finish: perhaps it had all conspired to start a fresh cycle of dread, collapse, relief, dread again.
It’s the spring of 2017. My partner is thousands of miles away visiting her parents, and I’m alone in my flat in the final phase of a book that is long overdue. I’ve had a cough for several months, on and off, and now I’ve begun to feel something in my throat. Googling my symptoms makes this worse, of course, but in fact the images summoned to the mind are much the same as in the pre-internet crises of youth. A faint suspicion, intermittent and then regular fits of self-scrutiny, self-diagnosis, and lucid moments of self-reproach. A self circling itself, spiralling into the worst visions of decline, including (frequently in my case) suicide as the only logical end. Hours, days, weeks may pass like this. “Rumination”, “catastrophising” – it’s possible to know very well the signs and the terminology, and still, as you go down, see no escape.
My “throat cancer” was the first in a new round of worries culminating, thanks to a few minor eruptions of the skin, in the absolute conviction that aged 50 (for how could I outlive her?) I’d acquired the disease that killed my mother. And at the same time there arrived a new, desperate need for reassurance, such as I’d never known even as an anxious child. “But you think it’s OK – it’s nothing?” “Yes, I do.” My partner spent far too much time trying to coax me back from “the dark place”. At times we might put the neediness, now added to my fears, down to other things – worrying about money, about writing – but there was surely something else at work, deeper rooted and not quite reached either by self-knowledge or the support of therapists who’d dealt with my depression. An intractable sense of inexorable fate. I’ve lost count of the times my partner has had to say: “You are not your mother!”
In her 2016 book It’s All In Your Head: True Stories Of Imaginary Illness, the neurologist Suzanne O’Sullivan describes patients who present not only with crippling anxieties about this or that disease, but real symptoms of apparently unreal illness. As O’Sullivan points out, we live in a time when it’s widely accepted that emotional stress may have physical effects, so why is it hard to see there is a backstory?
When I was younger, my fears tended to be traceable, at least in retrospect, to my parents’ illnesses; nowadays, these are joined by the potential ailments of a middle-aged male ex-smoker. The past no longer matters; I have been summarily deposited in this frail present that opens only on to a dreadful future. “Life will have been so short,” Jacques Derrida, one of my hypochondriac heroes, used to say, projecting himself into a future past. Afterwards, when the test results are in, or appointments cancelled because my symptoms have disappeared and I’ve realised my folly, when life has got in the way of fearing for my life – then, of course, I can look back and see just how repetitive and absurd the story of my hypochondria has been.
I had been thinking about – that is, putting off – the prospect of professional help for a while when the pandemic arrived. That spring day when I hit my head was the last time I felt afraid of Covid. I do not mean I’ve been reckless; quite the contrary. But I have been entirely calm in the face of tests and quarantines and recent self-isolation. Curiously enough, contagious illness has never been a part of my hypochondriac repertoire.
The distractions of the pandemic have not magicked away other worries. The throat thing again – it is certainly reflux, as a number of doctors have told me – and another eruption of my fear of scleroderma. But these have been relatively short-lived, or spirited away by escaping, with long walks and bike rides, the shut-in round of working from home. Mostly now when I think about illness and anxiety, I’m thinking about other people. The sick, vulnerable people, the solitary. Those who have had reason greatly to fear the virus, and those who perhaps do not, but whose pre-pandemic health anxiety has not abated like my own. I think about the creative writing students I met online in the spring while teaching a class on illness and nonfiction. Students who write with profundity and lightness about the anxious wonder of being embodied, and one of whom, much less than half my age, tells me he thinks all the time about the future failings of his body. I hope he can stop worrying, but he’s also, of course, quite right – life will have been so short.