1—
Being a Hypochondriac
This afternoon, by taking too much physic, I felt myself very ill. I was weak. I shivered, and I had flashes of heat. I began to be apprehensive that I was taking a nervous fever. . . . I was quite sunk. I looked with a degree of horror upon death.
—James Boswell's
London Journal 1763
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In August 1763 The generally vivacious but now distressingly subdued young Scot, James Boswell, glided slowly into the Dutch city of Utrecht on a canal boat. A week earlier he had set off from London "with a kind of gloom upon my mind" to study law at the famous University of Utrecht. Now, a month before his classes began, he arrived—a complete stranger. Boswell and his baggage were taken to a hotel that stood near the city's cathedral. Its bell tower looked back upon a cloister, and from there a somber row of saints and gargoyles gazed impassively at the university buildings next door.
"I was shown up to a high bedroom with old furniture," wrote Boswell to one of his friends the next day. "At every hour the bells of the great tower played a dreary psalm tune. A deep melancholy seized upon me. I groaned with the idea of living all
winter in so shocking a place. . . . I was worse and worse the next day. All the horrid ideas you can imagine, recurred upon me. . . . I sunk quite into despair. I thought that at length the time was come that I should grow mad. . . . I went out to the streets, and even in public could not refrain from groaning and weeping bitterly."[1]
Boswell was plunging into what he later called his most severe hypochondria. Thoughts of disease, madness, failure, ridicule, and death "in all the various ways in which it has been observed" trampled through his mind and he was powerless to repulse them. On that Sunday morning in August he tried touring the historic city on foot but saw nothing. He searched for someone to talk to but found only an unsympathetic clerk at the English-speaking Calvinist church. Boswell walked faster. His thoughts kept pace, and soon the flushed and perspiring young man was running frantically down the narrow cobbled alleys, across public squares, and along quiet canals, sobbing without restraint.
Boswell dreaded spending another night in Utrecht; the cathedral bells reminded him of frightening Calvinist sermons he had heard as a child, and he knew from personal experience that "night is universally the season of terror." But as evening fell he forced himself into his chamber, determined to leave Utrecht the next day and to spend the hours until dawn writing to his friends. At noon the following day he reboarded a canal boat and, at approximately three miles per hour, "fled" to Rotterdam. There he sought shelter in the home of a recent and somewhat surprised acquaintance.
Thoroughly demoralized, Boswell was not easy to comfort. A lot depended on his winter sojourn in Holland, for although his career as a lawyer was already assured, the ten-month stay in Utrecht was haft of an important bargain he had struck with his stern and generally uncompromising father. The two had agreed that if the younger Boswell studied civil law and learned French, his father would give him a grand tour of Europe. The twenty-three-year-old Boswell saw this extensive holiday as a major step toward the reputation he desired as a worldly gentleman and a
"Great Man," so he was prepared to study hard. Besides, in earnestly applying himself he had hopes of changing from a rakish, somewhat rebellious youth inclined to plumpness and other expressions of self-indulgence into a man of inner strength, outward calm, and regular habit. Yet after thirty-six hours alone in Utrecht, he had repacked his bags and written his friends begging them to meet him, write him, pardon him, and, above all, help him .
"The pain which this affair will give my worthy father shocks me in the most severe degree," he wrote William Johnson Temple. "O Temple! all my resolutions of attaining a consistent character are blown to the winds. All my hopes of being a man of respect are gone."[2]
Boswell was in a state of profound irresolution. Should he retreat to London or return to Utrecht? Should he seek a physician or try to hide his distress? Could he fight his fears and "think them down," or was he preordained to suffer?
His moods fluctuated wildly. "Let not this dreadful affair affect you too much. There is no real harm done," he added at the end of a letter to Temple, fearing he had painted too grim a picture of his wretchedness. Then, at the very end, he tacked on, "O dear! I am very ill."[3]
Boswell had long known that the streak of hypochondriac passion ran through his family, and that streak, he believed, consisted of a physical disorder combined with a morbidly overwrought imagination. He knew it had not passed him by. "My grandfather had it in a very strong degree," he would frequently say to explain his own black moods, and he described his mother as having been "an extremely delicate girl, very hypochondriac."[4] His younger brother John struggled with insanity all his adult life.
As a child Boswell was timid. He was afraid of ghosts and especially of being left alone in the dark. By the age of twelve he had contracted a "nervous ailment" that required treatment at a spa. His first real attack of hypochondria occurred when he was about seventeen, and throughout his life "the black foe" pe-
riodically attacked him, though not always with equal force or frequency.
When Boswell was in London preparing for his forthcoming trip to Holland by soaking up all "the delicate felicity" the city had to offer, he met the famous literary figure and fellow sufferer, Samuel Johnson. Boswell was immediately attracted to the gruffly eccentric, honest, and articulate Johnson and went out of his way to meet him several times. Almost on the eve of his departure for Utrecht, Boswell got up the courage to confess his torments. He told the much older Johnson of his long periods of lassitude when nothing seemed worth doing or striving for and his terror of illness. At times, he explained, he feared a nervous fever or an "almost madness" and at other times he became morbidly preoccupied with venereal disease or other purely physical disorders. He had, for example, contracted gonorrhea that winter and for weeks afterward was afraid that it would recur and eventually kill him.
"Upon my coming home, I felt myself not so well," he had written in his journal in February. "I dreaded the worst and went to bed. . . . I lay in direful apprehension that my testicle . . . was again swelled. I dreamt that Douglas [a surgeon] stood by me and said, 'This is a damned difficult case.' I got up today still in terror."[5]
To Boswell's relief, Johnson understood this kind of suffering and said that he himself "had been greatly distressed with it."
He advised me to have constant occupation of mind, to take a great deal of exercise, and to live moderately; especially to shun drinking at night. . . . It gave me great relief to talk of my disorder with Mr. Johnson; and when I discovered that he himself was subject to it, I felt that strange satisfaction which human nature feels at the idea of participating distress with others; and the greater person our fellow sufferer is, so much the more good does it do us.[6]
Johnson's intellectual and moral support was a great help
to Boswell, and the famous author of the Dictionary and of so many fine essays even made the day-long trip to Harwich with his new young friend when it was time for Boswell to take the packet boat to Holland.
But when Boswell actually found himself in Holland, among persons who spoke languages he had not yet learned, Johnson's powerful friendship was too far away to comfort him. As he toured through the flat Dutch countryside, Boswell compulsively examined his problem from a dozen different angles, explained it a dozen different ways, and constructed as many unmanageable solutions. In spite of these spasms of convoluted reasoning, he gradually came around to a fairly obvious conclusion: idleness and solitude were no good for him. If he could keep immensely busy, he might survive Utrecht.
In early autumn, therefore, when classes got under way, Boswell set up housekeeping near Cathedral Square. Each morning he arose about 6:30 A.M. and, arming himself against lone-liness, wrote out an intricate memorandum. Each began with an evaluation of his previous day's work (or, rather, behavior), then listed objectives for the day at hand. "Read Latin 7 to 8, write French from 8 to 9," begins a typical timetable. "Breakfast from 9 to 10, Latin again from 10 to 11; 11 to 12 get shaved and dressed, 12 to 1 Trotz's lecture, 1 to 3 walk and dine, 3 to 4 French Master . . ."[7] and so on until 10 P.M., at which time he began working on his private journal, writing to friends and doing whatever light reading his remaining strength allowed. The evaluations that proceeded from these relentless schedules gradually changed in tone as the term wore on. Anxious nagging gave way to expressions of cautious approval and finally of astonished delight.
"You was a little irregular yesterday," he wrote of himself in his characteristic style, "but it was but for one day." "You did charmingly yesterday." "You read an immensity of Greek. . . . It was a dismal day and you eat too much wild duck, so was a little gloomy. However, you said not a word of it, nor have you said a word of it near these three months."[8]
But if Boswell hoped that his hypochondria was not a real recurring malady—and he sometimes did—he was dismally reminded of his susceptibility when he returned to Utrecht after the Christmas holidays. He had kept himself in check for three months and was tired of the routine. Moreover it was winter and the weather was dreary beyond all description. More and more of his memoranda were critical.
"You was sad and gloomy." "Yesterday you was lethargic and still hippish [a slang expression for hypochondriacal]. . . . Force activity and drive off this gloom."[9]
Boswell teetered on the verge of another collapse until early March, when he was pushed over the edge by the death of his illegitimate son, an infant he had never seen but was supporting. At first Boswell became lethargic and found it difficult to keep his mind on Latin and law. His thoughts fastened instead "upon all the evils that can happen to man," and in his dreams he again suffered "death in all the various ways in which it has been observed."[10] "How direful the thought of death is when one lies awake in the middle of the night,"[11] he wrote plaintively.
"Nobody but a sincere friend can listen to my complaints when opprest with melancholy," he confided to Temple, explaining further that the very thought of company now made him irritable and peevish. Cheerfulness had "the effect of an insult though unintentional."[12] He wanted friends who, if not hypochondriacs themselves, at least dreaded what he suffered. "It was old-womanish of you to complain so," he would scold himself when, by repeated miscalculations, he revealed his hypochondria to some cheerful, uncomprehending person. Nevertheless throughout March and April Boswell felt driven to demand solace and advice from almost everyone he encountered.
Five days after a particularly horrible night when "you awaked in great disorder, thinking you was dying and exclaiming, 'There's no more of it! Tis all over!' Horrid idea!"[13] Boswell overcame his squeamishness and summoned a physician to bleed him. He hoped that this would rid him of some of the poisons that he believed rose to his head nightly and caused such ghastly night-
mares. Besides, having tried "all the modes of cure" except medicine, it was time, he felt, to ask for professional help.
The bloodletting did not ease his apprehensions, however, and a month later Boswell visited the famous doctor, Jerome David Gaubius, who told him that although he had no choice but to tolerate his hypochondria for the present, he would outgrow it by the age of thirty. This cheered Boswell considerably (although the prognosis proved inaccurate), and faced with the delightful prospect of leaving Utrecht in June and gradually outgrowing his hypochondria, Boswell regained his spirits. Toward the end of his stay he wrote out a brave and "INVIOLABLE PLAN —to be read over frequently."
You believed that you had a real distemper [were mad]. On your first coming to Utrecht, you yielded to that idea. You endured severe torment. You was pitiful and wretched. You was in danger of utter ruin. This severe shock has proved of the highest advantage. Our friend Temple showed you that idleness was your sole disease. . . .
Remember that idleness renders you quite unhappy. That then your imagination broods over dreary ideas of its own forming, and you become contemptible and wretched.[14]
Bravely, naively, he added, "Let this be no more."
On a fine day in June Boswell swung into a coach and four and went clattering out of Utrecht. For the duration of his grand tour he was rarely troubled with a dreary or lumpish thought. It was one of "the clear seasons of his existence." Some ten years later, however, long after he was to have outgrown his hypochondria according to Dr. Gaubius, Boswell sank back into familiar apprehensions.
"It vexed me to find a return of that distemper of mind which formerly afflicted me so much. . . . But when the mind has been hurt by hypochondria, it is not soon quite easy again."[15]
Boswell was afflicted with hypochondria on and off for the rest of his life, though never so severely as in Utrecht. He be-
came fairly adept at reading or writing the malady out of his system, and between 1777 and 1783 (as a man in his late thirties and early forties) he passed along his experience and advice in a long series of essays called "The Hypochondriack." Seventy installments appeared anonymously in the London Magazine . He was writing, he said, not for the young and gay or for "the solid tranquil species of men," or again for "those whose minds are concentrated by the necessity of providing support for their lives." Rather, he said, "I write to people like myself . . . , who are arrived at the age of serious thinking; to beings whose existence is compounded of reasons and sentiments; who can judge rationally, yet feel keenly; who have an incessant wish for happiness, but find it difficult to have that wish gratified."[16]
"I snatch gratifications ," he had said of his own life, "but have no comfort ."[17]
Two centuries after Boswell struggled with fears of illness in Utrecht, the loneliness of solitary travel is still triggering bouts of hypochondria among the susceptible. The anxiety and misery seem scarcely to have changed, but the focus of concern is cancer or heart disease rather than "nervous fevers," and the stresses that impinge upon the sufferer have changed also. It may be well to look briefly at a modern hypochondriac's troubles, to transcribe Boswell's descriptions into a more modern idiom.
When Kate was eighteen and a student at Connecticut College for Women, she took the money she had saved since childhood and went to Europe. Having flown to England, she crossed the channel as Boswell had at Harwich. It was her intention to visit the Dutch university towns of Leiden, Nijmegen, and Utrecht before proceeding south into France, where she had been offered a job as a live-in baby-sitter. It was the first time Kate had been away from home without family or friends. She was traveling alone and loving it.
For a week Kate toured the Dutch countryside, walking everywhere, looking at everything, and except for the strain of trying to speak Dutch or French and the loneliness of eating din-
ner by herself each evening, she was pleased with her vacation. In June she traveled to a small town in the north of France and there, four blocks from a cobbled square with a broken fountain and an American tank, she took up residence with a family of ten. She was given a low-ceilinged room in the attic under the caves. A single small window looked down through the branches of an old chestnut tree onto a gravel courtyard below.
Kate congratulated herself on being part of "the real France." She spoke only French, ate only French food, and began dressing like local girls in sandals and dirndl skirts. She fit right in. Yet several weeks after her arrival she began to daydream more than usual—not about home but about falling in love. She was surprised when these fantasies turned into a terrible feeling of loneliness. Getting ready for bed one night, she began sobbing without reason. The next morning her throat felt slightly constricted, and because it tightened further during the day she assumed she had caught cold. That night she tied a T-shirt around her neck to keep warm. It was a useless gesture. She had a horrible nightmare of being lost in an enormous rotting carcass. It was a dream that had often terrified her as a child. By the end of the week the thought possessed her that she had cancer of the throat and was dying.
Like her throat, which now tightened so severely that her breath sometimes rasped, the whole world constricted around her. The chestnut tree that had extended gently moving branches toward her window now froze in place and became a rigid, incomprehensible pattern of brown and green. The children she watched all day became unreal too, and she quickly became short-tempered with them. Letters from her parents were meaningless and so were her mechanical replies. In fact the entire outside world was switched off, shut out, and Kate retreated into intense introspection.
Like Boswell, Kate picked and pried at her problem endlessly and in two contradictory ways. On the one hand, if her throat were really closing, she should rush home to her family and family doctor. She considered this option every time she felt
her neck, but she never acted on it. On the other hand, if her illness were really an admission of failure and a sign that she was too immature to be on her own, she should confront that issue. This she never did either. Boswell had been horrified at the thought of admitting his weakness to his worthy father, and Kate was unable to admit even to herself that her resources were not sufficient for the task at hand.
As the summer wore on the civil war in Kate's head intensified, and she became increasingly involved with her symptoms. She monitored them continuously, compared them to the sensations of the day before, and tried to force them into some meaningful pattern. She also began gaining weight at an alarming rate. Although at mealtimes she ate no more than two helpings of anything, she began to sneak food from the pantry when the children were napping and the cook was in town. Gingerbread and candies did not make her throat feel better, and getting too fat for her clothes did not make Kate feel better, but she seemed driven to eat by the same pressures that forced her to feel her neck and mull over her symptoms.
Several weeks later, on the allotted day of her return and not a moment earlier, Kate boarded a plane in Paris and flew home. Late that summer night her father drove her along the Connecticut River to the house where she had always lived. Her mother ran out the door to greet her, and as Kate smelled the familiar lavender cologne and felt her mother's embrace, her throat began to close instead of open. There was no protective circle to reenter, she realized with disheartening certainty. Even in her mother's arms she was still alone with her secret disease and alone to puzzle over the loss of innocence and security that accompanied her fearful acknowledgment of death.
As the American philosopher William James had written of his own crisis,
after this the universe was changed for me altogether. I awoke morning after morning with a horrible dread at the pit of my stomach, and with a sense of the insecurity of life that I never
knew before. . . . I remember wondering how other people could live, how I myself had ever lived, so unconscious of that pit of insecurity beneath the surface of life.[18]
For Kate, for Boswell, for William James, the sudden awareness of vulnerability, accompanied by dismal imaginings and an intense fear, was an experience that reverberated throughout their lives.
"When the mind has been hurt by hypochondria, it is not soon quite easy again," Boswell had written. This has not changed for centuries.