How I learned to tame my hypochondria

Surrounded, growing up, by slightly health-hysterical women (“How are you?” I once asked an aunt over the phone. “I’m on a mobile IV,” was the reply), I never worried about my own health. There was simply no room anyway, because someone was always sicker. How I laughed at my friend Mark when, in his 20s, he thought he was dying from some dodgy bolognese. Even when I smoked and developed what would now be a Google-worthy search—a searing pain in my lungs—I just lay on a tennis ball and massaged the spot. It worked.

So when my, as I came to call it, “late-onset hypochondria” hit, in my 40s, I wasn’t ready for it. And I didn’t know how terrifying it could be. In its way, it is a disease. (Strictly speaking, hypochondria and health anxiety are two separate ailments with overlapping features.) The background to all of this was death—many of them. My cousin died, aged 51, her death shrouded in whispers and secrets; then a friend died, then another, then another. This last friend, Callie, had felt fine, gone to the doctor, and died two weeks later. All these friends had also been 51 when they died, and in my mind it seemed impossible to get over that age.

Then a family friend died, then my aunt, then my uncle. Through it all, I knew my father was sick too, on his own last flight, but he didn’t want to be defined by his illness, and so he wasn’t, and very few people knew it. The secrets and fears mixed together to make their own special kind of dynamite.

Somewhere in the middle of all this it started. The symptoms. They varied as did the “diagnoses”, but on one memorable day I had Parkinson’s, liver cancer and Paget’s disease (some members of my mother’s family have this) all at once. It was a Thursday and I was catatonic with fear. All I could think about was, how could I make it through school while receiving chemotherapy? How would I deal with the tremors and the tremors and the pain in my skull? I had two children, one still a baby, could I breastfeed her on chemo?

The cycle will always be the same. I would hear about someone getting sick, I would ask too many questions. I would develop the symptoms. I would be terrified and unable to tell anyone, let in light or perspective, nor any hope of safety. I couldn’t go to the doctor because Callie had been fine, gone to the doctor, and then she was dead. In my mind, I was convinced that if I could just avoid the diagnosis, I could avoid death. It was exhausting and terrifying. Eventually something would give way, I would be able to tell someone who would give me a reality check and I would have some breathing room, until the whole cycle started again. Of course, there were moments when I realized that these must be my thoughts, which were powerful but destructive. And the symptoms would disappear, until the next time.

Then, finally, one day my nipple started bleeding, a symptom so extreme that I knew my mind couldn’t be responsible. The redness of it all somehow made me notice it and back to my childhood home (for some reason this encouraged me) I couldn’t call my current GP but a removed one, my previous doctor who I had kept in touch with. I told him my symptoms. He hung up on the end of the phone as I rolled the net curtains in the bedroom between my finger and thumb, wondering how long I had left.

“I can’t tell you that you don’t have breast cancer,” he said very slowly, “but I can tell you that you need to see your GP and that you need to tell him about your health concerns.” Health anxiety? Not only did I not realize I had this, but I didn’t realize I could talk to my doctor about it.

Luckily my GP was brilliant. He listened and immediately put my mind at ease about some of the other ailments I was sure I had at the time and sent me off for tests on others, including on my chest (which was fine, it was a rash and cleared up , but I think of it as a godsend now). But, crucially, he also put me on the list for a course of CBT, cognitive behavioral therapy.

While I was waiting for CBT, my father died.

The body is a theater where we stage our inner conflicts

I was hesitant about CBT, but my therapist, Jill, was extraordinary and wonderful, and it was the perfect solution. After taking my history, Jill would challenge my belief that I was ill by asking for proof. I can still hear her voice now asking for hard evidence of my assumptions, and it’s a technique I still practice. So the pain in my leg = cancer would be broken down to: “It’s highly unlikely to be cancer, but if the pain continues, it makes sense to go to the doctor.” It sounds easy and takes a lot of time to really work, but it did for me. Reframing my worry, making myself realize that I had no hard evidence that I was sick, and reframing the worry helped me deal with it in small pieces. I also learned to tell trusted people around me what was going on so they could help ‘pop’ the worry (not advisable to tell another hypochondriac!)

Jill also got me to stop asking about people’s symptoms and taught me that it was OK to just say, “I’m sorry to hear that,” if I heard someone was sick/had died, without also asking for a full medical history , something I would then digest and embody. (The combination of the ability to Google any symptom with a constant conveyor belt of new diseases and variants served up to us at every news feed is a heady mix for those predisposed to health anxiety.)

Peter Tyrer, professor of community psychiatry at Imperial College London, has a special interest in health anxiety (it is called illness anxiety disorder in the USA and comes under the psychiatric classification of DSM-5) and has written several articles on the subject, one in British Medical Journal in 2016, who called it a “silent, disabling epidemic” reaching “epidemic proportions”. In a 2006 study carried out in certain specialist clinics in North Nottinghamshire (respiratory, gastroenterology, endocrinology), 12% had excessive health anxiety. Four years later, this had risen to 20% in the same clinics. Tyrer attributed this rise to “cyberchondria” and our addiction to Google. “People with health anxiety,” he wrote, “pay selective attention to the most serious explanation for their symptoms even though these may be very unusual.” There’s no point in telling those people they have a 1 in 1,000 chance of getting sick, he said, “it just convinces them that they’re actually the one person.”

Tyrer further explained to me that some people, like me, are evasive and body-conscious about medical insurance at all costs, and it is of course “impossible to know how many of these there are”. And then there are those who need almost constant reassurance from doctors, who, however, are not trained in mental health and therefore provide clinical test after test with a lack of resources without providing a long-term solution. It does not pull the problem out at its roots. Tyrer is a proponent of CBT to help with health anxiety.

I told the psychoanalyst Alessandra Lemma my story. Lemma is someone I have worked with before and I not only trusted her but valued her insight into how my brain works. “What I recognize,” she said, “is a kind of architecture of hypochondria and often an actual experience of illness either by yourself or someone you’re very close to. It’s very rare that health anxiety comes out of nowhere, and it’s the intersection of the encounter with vulnerability and mortality, plus it often comes out at a transition point in life, so you often get that with young people going to university, or people retiring, etc. For you, it was this terrible worry for your father, this proud, strong father who struggled with something that was outside of him, and when we are afraid of losing someone, we often identify with them and can take on physical symptoms.”

But why couldn’t I just think that I’m worried about my father? Why this big drama?

“Because,” Lemma expanded, “as a general way of thinking, the body and our relationship with it is a kind of theater, if you will, where we stage our inner conflicts and one of the main reasons why psychological conflicts arise. translated into bodily symptoms are when we don’t yet have the words or even a conscious acknowledgment of what it is that’s bothering us.”

Lemma explained that talking to someone—the doctor, a therapist, or a trusted friend—can help because you can begin to put those symptoms into words, which can then begin to dissolve the worry. For me it was like starting to let the light into the dark corners, but at first it was so hard to talk about what was going on because I had an irrational fear that as long as I didn’t say anything bad would happen. The hypochondria literally felt like a monster in my body that I had to appease by staying still.

It is now six years since I have been free from this and that long since I have been able to write about it. (And yes, I reached 51!) I am still vigilant and keep myself in check. As I was writing this, I looked up the symptoms of Paget’s disease and could immediately tell that I was turning the corner into a health anxiety street again. So I stopped reading.

Although the monster in me is mostly asleep now, it can reawaken when I’m anxious and need to feel in control. And one thing I’ve learned through all of this is that, perversely, worrying about dying is a strange way of trying to feel in control.

Conversations with Annalisa Barbieri, series 3, is out now (pod.link/1567190358)

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