10—
Occupational Hypochondria

Becoming a "hypochondriac" may be an occupational hazard for those who are in process of becoming medical experts.
—Paul Atkinson
"Becoming a Hypochondriac"

All creative writers are hypochondriacs, since those of them who do not worry about the state of their bodies are certain to worry about the state of their minds.
—Harold Nicholson
"The Health of Authors"

Certain activities, such as doctoring, performing, and arguing with God, expose their devotees to disturbing ideas not the least of which is the unsettling reminder that "all flesh is grass." As was the case with military men, part of the predisposition toward hypochondria experienced by doctors, musicians, painters, and the like comes from social circumstance and part from pressures inherent in the occupation itself. The latter can be as obvious as a doctor's intimate association with death and disease or as subtle as the relationship between action and self-disclosure.

Starting with medical students, it is a commonplace to say that many of them briefly become hypochondriacal, if not during their first-year anatomy laboratories when they anxiously confront their first patient, a cadaver, then a year or so later in response to the vivid teaching technique of making hospital rounds. In their third year medical students are abruptly surrounded by illness. There are apprehensive patients, embarrassing examinations, and painful open lesions to deal with daily. The students cannot help but be amazed by the number and kinds of things that can go wrong with the human body. Quite naturally many develop a sense of personal vulnerability, and as Paul Atkinson described in his account of making rounds with medical students, "as we heard more and more case histories, and as patients recounted the insidious onset and development of grave illness, so we came to take our own continuing good health less and less for granted."^[1]

Most of the students in Atkinson's acquaintance soon began to diagnose the symptoms of daily stress in themselves, their professors, and their fellow students as signs of fatal illness. Many took their own first cases of imagined ankylosing spondylitis and brain tumor to a doctor and were hurt by his casual dismissal of both their problem and their diagnosis. With experience, however, the same students learned to tolerate their symptoms for longer periods before consulting a doctor. In theory at least, their growing realization that healthy bodies produce vast arrays of temporary and inexplicable symptoms that are amplified during periods of anxiety allowed them to survive attacks of ear-ringing and indigestion. The commonness of unimportant symptoms would be further underscored when they entered private practice and began treating the less acutely ill. If current medical autobiographies can be trusted, the hypochondria so common in medical school is left behind. It reappears, if at all, only as anecdote.

Studies of the mental health of doctors do not entirely agree. (See Ford for a review.)^[2] Physicians, investigators note, are under considerable occupational pressure and suffer more

psychiatric illness than the general population. Although their psychiatric problems largely fall into two categories, depressions and addictions, hypochondriacal fears are also prevalent.

Studies suggest that physicians adopt one of two rather extreme stances vis-à-vis disease. The majority come to consider themselves invulnerable. A minority fear the most dangerous or unusual diseases that their patients present to them and often seek to control this painfully sophisticated form of hypochondria with self-prescribed drugs. "I would be an absolute cripple if I had even the normal amount of suggestibility," said a Cape Cod physician, Dr. Virginia Biddle, when asked if she feared contracting her patients' diseases.^[3] "No, no, no. I go in the opposite direction. I have to believe it can't happen to me."

Many of her colleagues say essentially the same thing. E. Langdon Burwell, for example, began having trouble speaking and even seeing when he was a young doctor doing his military service in the Azores.^[4] One morning his legs gave way beneath him as he tried to get out of bed and he fell flat on the floor. "Even then I did not make a diagnosis," he recalls with mild surprise, "and by that time I was seeing double." Fortunately a pediatrician recognized the onset of a dangerous form of polio and began treatment immediately.

And does a doctor learn from so dramatic an illustration that he is the last person to suspect his own illness and therefore should have periodic checkups with another doctor? Rarely, according to Burwell, who even now has a physical examination once every ten years, which is when his life insurance policy absolutely requires one. The recent death of one of Burwell's colleagues from advanced prostate cancer did not send many local doctors rushing to the doctor.

Turning to doctors who exhibit the opposite reaction and are chronically afraid of illness, many model their diseases on the infirmities of their most desperate patients. "I suffered extremely in the Symptomatic Fever, by violent Headaches, great Sicknesses and Sinking," wrote Dr. George Cheyne describing his own case in the early 1700s. "And lately having had two full-

bodied Patients, who had died of Mortifications from that Distemper, I was much frightened at mine."^[5]

Like his former patients, full-bodied Cheyne, who weighed over four hundred pounds and "exhibited in his immense hulk most of the diseases in which he specialized,"^[6] had thick, darkcolored blood. He bled himseft—as he had bled his patients—and "found one continued impenetrable Mass of Glew ."^[7] He was reduced to the last degree of misery.

As his brethren still do today, Cheyne tried to drive off his vague and ever-changing symptoms first with overwork and then with drugs. Finally he reached "a perpetual Anxiety and Inquietude, [with] no Sleep or Appetite . . . a constant Colick, and an ill Taste and Savour in my Mouth and Stomach . . . , a melancholy Fright and Pannick, where my Reason was of no use to me: So that I could scarce bear the Sight of my Patients or Acquaintances . . . , and yet could not bear being a Moment alone, every Instant expecting the Loss of my Faculties or Life. . . . In fine, I had recourse to Opiates."^[8] Cheyne knew these were "slow Poison." Nevertheless, he was in such torment that he took them and in the ever-increasing doses he knew were necessary for relief.

All this time, I attended . . . the Business of my Profession . . . , but in such a wretched, dying Condition as was evident to all that saw me. I had many and different Contradictory Advices from my Friends and Acquaintances.^[9]

In the main, the advice given Cheyne was to go to London and consult the best doctors he could find. For months he delayed, finding himself in the same awkward position that doctors anxious about their health do today. On the one hand, if a doctor is as sick as he believes himself to be, he is reluctant to go to a doctor and have his worst fears confirmed. On the other hand, if no illness is found, or much less than he tells his doctor to expect, he may feel reassured but also ashamed, for he will be revealed

within the medical community as a hypochondriac. He may hesitate further, knowing that because he will not be asked to pay for his care, his visits cut into the time his doctor would normally spend with paying patients.

Cheyne finally went to London and, having "promised to be passive," did for a time follow the prescriptions of six doctors, although not without modifying their suggestions. He put himself on a vegetarian diet—a regime thought by John Bull Englishman to be fit only for effeminate Italians—and in spite of his doctor's advice to return gradually to the customary meats, puddings, and gravies, Cheyne stuck to his seeds and milk. He recovered slowly and after several years proclaimed himself in perfect health with "as much Activity and Cheerfulness, with the full, free and perfect Use of my Faculties . . . , and of going about the Business of my Profession . . . , as I was ever capable of in my best Days."^[10] "I am myself come to that Time of Life when Hopes and Fears ought to be contracted into a very narrow Compass," he wrote later. "I have done my best, and pursu'd in my own Case the same Rules I have given to Others, and have at present, I thank God, inward Peace, Health and Freedom of Spirits."^[11]

Styles of self-revelation have changed since Cheyne appended "The Author's Case" to his famous book on the spleen, vapors, lowness of spirits, and hypochondriacal and hysterical distempers, and it is rare now for a doctor to make himself the subject of a treatise on hypochondria. That far less charming literary form, the sociological study, with its touching lust for quantification, has replaced Cheyne's confessions, but modern articles still indicate that some doctors are prone to hypochondria.

In The Emotional Health of Physicians , J. C. Duffy and E. M. Litin describe ten specialists who, diagnosed as suffering from "depressive reactions," all interpreted their problems as physical illness.^[12] It could be argued that none was a hypochondriac and that all were depressed instead, but the case histories of the pathologist who thought he had cardiac symptoms, the surgeon who spent months worrying about a cut on his finger that other doctors said was healed, and so on certainly suggest that

these doctors were expressing their troubles in terms of physical disabilities.^[13] "The physician fears a psychiatric diagnosis," the authors concluded, "and with some justification."^[14]

This seems true of a group of forty-seven doctors in another study whose methods of coping with emotional distress were compared to those of a carefully matched group of laypersons.

At times of adult life crises, hypochondriasis and turning against the self . . . were seen twice as often among the physician sample as among controls. . . . During interviews nonphysicians frequently repressed critically painful events in their lives. In contrast, physicians told us in detail about their medical symptoms.^[15]

And yet, the authors of this study go on to note, few of these anxious physicians had consulted other doctors. "It was as if . . . the physician said 'There is a lot wrong with me, but I will not inconvenience anyone else."^[16]

If this is typical behavior for a hypochondriacal physician—and the modern doctors cited believe it is—then the vast majority might be trying to treat themselves and will never come to the attention of other doctors or therapists. If reduced to the last degree of misery and unable to function, many might seek treatment for and be classified as drug abusers or alcoholics.

"Tenth month, 1753. Morose on trifles," wrote Dr. Rutty, an Irish physician who experienced every addiction and obsession in spite of himself.^[17]

Second month, 1754. Weak and fretful.
Third month. The pipe enslaves.
Twelfth month. An hypochondriack . . . , wind and indigestion.
Fifth month. O my doggedness.
Ninth month. An overdose of whiskey.

Sixth month, 1756. Feasted a little piggishly.
Second month, 1757. Snappish on fasting. 27th—Avant, Satan! the Lord is strengthening and promoting my progress.

A second place to look for a greater-than-normal concentration of hypochondria is in the performing arts. Dancers, singers, actors, and musicians—all rely far more than most on the full functioning of their bodies. Their concerns for the health of leg muscles, vocal chords, or hands can become so intense that they seem hypochondriacal, but it is difficult to tell if their preoccupations are realistic in view of the risks that physical disabilities pose to their social, emotional, and financial well-being.

The attention that the famous tenor Enrico Caruso gave to his vocal chords seems an example of realistic if not ordinary concern. Caruso rose every morning at 8:00 A.M. and began a long and complicated routine. Wrapped in an enormous white robe, he swept into his steamy bathroom and for half an hour lay in a scented tub while an inhalator added moisture to the already hazy atmosphere. He never sang in the bathroom. Next he moved to his dressing room and, after setting a mirror against a window, opened his mouth as wide as he could and examined his vocal chords with a dentist's mirror. If they looked at all irritated, he would paint them with a special solution procured from his personal laryngologist. After this daily examination Caruso proceeded into his living room and while his barber shaved him, his accompanist played whatever score the tenor was working on. Caruso followed the music silently. By late morning—bathed, examined, shaved, and dressed—he was finally ready to sing.

At times, however, the attention that performing artists and serious athletes lavish on parts of their bodies exceed the bounds of common sense, and their preoccupations weave back and forth across the boundaries of hypochondria. Frequently an approaching performance produces bizarre rituals and examinations as the musicians or hurdlers suffer the anxious anticipation that precedes many forms of acting. Like doctors, performers are

initiating a string of irreversible actions and reactions. Their performance cannot be taken back. A play, a ballet, a concert—all are gestures of self-disclosure that will inevitably be followed by responses, which in turn will act upon the performer. "To do and to suffer are like opposite sides of the same coin," wrote Hannah Arendt.^[18]

Nonperforming artists—painters, sculptors, writers, and composers—also work within the realm of "authentic perplexities." Although their statements may be retouched or rewritten many times, these too are acts of self-disclosure. When released into the public domain, the works initiate response (one of the worst is silence), and these reactions cannot help but heighten an author's self-awareness.

"[Mental] disease prevails most among those whose minds are most excited by hazardous speculations and by works of imagination and taste," wrote Amariah Brigham, medical superintendent of the State Lunatic Asylum in Utica, New York. "The registers of the Bicêtre [an asylum] in France, show that the insane of the educated classes consist chiefly of priests, painters, sculptors, poets, and musicians."^[19]

The first comprehensive study of occupational hazards was made a century before Brigham's time by Bernardino Ramazzini. In 1700 he published De Morbis Artificum , or Diseases of Workers , which included both physical problems, such as hernias among trumpet players, and mental ones. ("Those who hold appointments at the court of princes . . . head the list of hypochondriacs.") Ramazzini was aware that the occupation of painter, scholar, judge, or sculptor posed a double or even triple threat to tranquility. "To begin with, nearly all learned men . . . suffer the drawbacks of a sedentary life. . . . As a general rule [they] suffer from weak stomachs."^[20] The perspicacious Ramazzini noted that in addition to this imbalance between mental and physical activity, the excitement of ideas, combined with the need to please, led to hypochondria and other forms of distress.

Ramazzini could have used the life of the Florentine painter Jacopo Pontormo to illustrate the hazards of painting.

Pontormo was born in 1494 and orphaned as a small child. At the age of eleven he was apprenticed and over the next seven or eight years painted in the workshops of such great painters as Leonardo da Vinci and Piero di Cosimo. Pontormo's first important work was a fresco of the figures of Faith and Charity executed in honor of Pope Leo X.

That work . . . was of such a kind, and so beautiful, what with the novelty of the manner, the sweetness in the heads of those two women, and the loveliness of the graceful and lifelike children with the Charity . . . , that one is not able to praise them enough.^[21]

As Pontormo's reputation rose and the demand for his work increased, the painter became increasingly solitary and eccentric. At the slightest outbreak of the plague in Florence he fled to the country even if this meant interrupting his work for months at a time.

He was so afraid of death that he could not bear to hear it mentioned, and he fled from the sight of corpses. He never went to festivals or to any place where people gathered, so as not to be caught in the crowd; and he was solitary beyond belief.^[22]

During the last years of his life, when he was working on frescoes for the chapel of San Lorenzo, he kept a diary in which he recorded day by day, or even hour by hour, his concerns for work and health.

March, 1555: Wednesday I did the rest of the putto and had to stoop uncomfortably all day, so that on Thursday I had a pain in my kidneys; and on Friday, apart from the pain, I was illdisposed and did not feel well and had no supper that night; and on the morning that was the 29th day I did the hand and

half the arm of that large figure and the knee and that part of the leg on which rests his hand. That was on the said Friday, and the said evening I did not sup. And had no food until Saturday night when I ate 10 oz. of bread and two eggs and a salad of borage flowers. Sunday the 31st I had lunch in the house of Daniello, fish and capon; and in the evening I had no meal and on Monday morning I was distracted by pains in my body. I got up and then, owing to wind and cold, I returned to bed and stayed there until 6 o'cl. and all day long I felt unwell, yet in the evening I supped a little on boiled meat with beets and butter; and I remained thus not knowing what was the matter with me. I think my returning to bed must have harmed me, yet now, at 4 o'cl. in the morning I seem to feel much better.^[23]

Pontormo, who died a year later at the age of sixy-five, lived during a period when the artist-as-craftsman and artist-as-workshop-member was being replaced by the image of the artist as an inspired individual. Thus singled out as the lone worker who took personal responsibility for the success or failure of his projects, the artist joined the ranks of other individual "actors" and was prone to their characteristic pressures and distress. In addition, the old ideas of the allegiance between genius and insanity were being revived during the Renaissance and became so widely accepted that the public actually expected painters and writers to have certain peculiarities. As time went on, circumstance deprived other artists of the protection of anonymity and they too felt singled out—torn between the excitement of their ideas and the desire, or financial need, to please.

By the nineteenth century the picture of the high-strung intellectual given to chronic indigestion and deep anxieties over health applied to scholars and men of letters as well as to painters and poets. Not only did Lord Byron "roll in agony through long assaults of acute dyspepsia" but Percy Bysshe Shelley catch imagined elephantiasis from seeing a lady with swollen legs, and Alfred Lord Tennyson become convinced that he would be bald, blind, and dead by fifty, but scientists and scholars began to re-

cite the same tedious litany of morbid symptoms. Of the dozens upon dozens of famous lives that could serve as examples, Charles Darwin's is one of the clearest illustrations of the anxious hazards that await a person working in the realm of ideas. Even before the publication of The Origin of Species , Darwin suffered—in the culturally accepted manner of his day—from his anticipation of the violent response he knew his work must elicit.

Charles Darwin was raised in Shrewsbury, England, by a strict father, described by one relative as "a very considerable tyrant," and a mother who died when Charles was only eight. Even more than most upper-middle-class Victorians, Charles learned to respect the authority of God, Queen, and father and to direct any rebellious thoughts down his own throat. Like many of his contemporaries, he never learned to handle the conflicts and confusions of disobedience.

Following the wishes of his father, who was a doctor, Charles enrolled in medical school at the University of Edinburgh but did not enjoy it. After witnessing "two bad operations, one on a child . . . [which] fairly haunted me for many a long year,"^[24] he changed without great enthusiasm to a program of geology and natural history. As a student he already suffered from the gastrointestinal complaints that would plague him all his life and also complained of problems with his hand and lip. It was not until he took the adventurous step of embarking on an around-the-world voyage on the Beagle (against his father's better judgment), however, that his serious complaints began. He wrote many years later:

These two months at Plymouth [waiting for the ship to sail] were the most miserable which I have ever spent. I was out of spirits at the thought of leaving all my family and friends for so long a time, and the weather seemed to me so inexpressibly gloomy. I was also troubled with palpitations and pain about the heart, and like many a young ignorant man, especially one with a smattering of medical knowledge, was convinced that I had

heart disease. I did not consult any doctor, as I fully expected to hear the verdict that I was not fit for the voyage, and I was resolved to go at all hazards.^[25]

Once safely embarked on the Beagle , Charles did not complain much about his health, though he did suffer terribly from seasickness. Upon his return his health remained good until he married. Then, about the time that his patient wife (and cousin), Emma, became pregnant, Charles's health deteriorated and was rarely restored to what most persons would consider normal for the rest of his seventy-three years. Although he used his father as his doctor until the latter died, he did not get the sympathy he craved from the elder Darwin. "I told him of my dreadful numbness in my finger ends," he wrote Emma, "and all the sympathy I could get was 'Yes-yes-exactly-tut-tut, neuralgic, exactly, yes, yes!!"^[26] But from Emma it was different. "Without you when I feel sick I feel most desolate. . . . I do so long to be . . . under your protection for then I feel safe."^[27]

After three years of marriage and a second pregnancy, which "knocked me up almost as much as it did Emma," the Darwins moved to the country, where Charles's delicate health would not be taxed by social obligations. As was mentioned before in connection with the privileges of illness, Emma's "whole day was planned to suit him, to be ready for reading aloud to him, to go his walks with him, and to be constantly at hand to alleviate his daily discomforts."^[28] Gradually she came to plan his rest cures and vacations, monitor the number of his guests, and even determine the length of his conversations with visiting scientists.

But it was not a simple desire for privilege and pampering or even an aversion to social gatherings that had Charles retching over his washbasin night after night or lying awake feeling "so much afraid though my reason was laughing & told me there was nothing." As he worked on the quantities of data gathered on the Beagle , he began sketching a broad hypothesis that would make sense of information that, if viewed traditionally, seemed difficult

to fit together. To his first confidant, the botanist Joseph Hooker, he admitted that he was engaged "in a very presumptuous work, and I know no one individual who would not say a very foolish one. . . . At last gleams of light have come, and I am almost convinced (quite contrary to the opinion I started with) that species are not (it is like confessing a murder) immutable. . . . I think I have found out (here's presumption!) the simple way by which species become exquisitely adapted to various ends. You will now groan, and think to yourself, 'on what a man have I been wasting my time and writing to.' I should, five years ago, have thought so [too]."^[29]

With as much sorrow as conviction, Charles Darwin inched his way toward a position that put him painfully at odds with people whose professional feelings he feared to offend and whose personal affection he trembled to lose. Darwin, who so hated arguments that it made him sick to think about them, realized that his theory of natural selection would be vehemently rejected by many. And Darwin, who so wanted to please his wife by being a Christian of unwavering faith, knew he was basing his life's work on a natural process so "clumsy, wasteful, blundering, low and cruel" that it could not possibly be an expression of God's will.

Darwin published On the Origin of Species by Means of Natural Selection in 1859 and with it broke the link between moral and natural sciences. Nature no longer had a moral lesson to teach. As expected, The Origin was violently attacked by the Church, but not in Darwin's presence. He was already doing penance. He was sick.

I am glad I was not at Oxford, for I should have been overwhelmed, with my stomach in its present state. . . . I would as soon have died as tried to answer the Bishop [Samuel Wilberforce] in such aft assembly.^[30]

As Darwin grew older he gradually gained insight into the part his illnesses had played in his personal economy. He had

learned from taking water cures that it was possible for him to "walk & eat like a hearty Christian" for the regime of long walks, simple food, and scrubs and showers "dulls one's brain splendidly. I have not thought about a single species of any kind since leaving home."^[31] Yet in another letter to his friend Joseph Hooker he admits that although his "head will stand no thought" without making him sick, "I would sooner be the wretched contemptible invalid, which I am, than live the life of an idle squire."^[32] "My abstract [The Origin of Species ] is the cause, I believe, of the main part of the ills to which my flesh is heir to."^[33]

In addition to realizing that his controversial theory of natural selection brought on a great deal of his physical distress, Darwin also began to see that the illnesses themselves had functioned as regulators. They had protected him from "the distractions of society and amusement" and, more important, from the very real possibility of mental collapse. "I know well that my head would have failed years ago had not my stomach saved me from a minute's over-work."^[34]

During the last decade of his life Darwin worked almost exclusively on plants, which he loved. Although his health was gradually undermined by heart disease, his vomiting and anxious insomnia largely ceased. His reputation as a scientist was secure, his personal relationships less demanding, his daily routine set beyond disruption. There were fewer threats and conflicts in his country life and far less anxiety to channel into his own stomach. Even the words he had underlined in his manuscript to remind himself that when a species has vanished the same form never reappears gave him less sorrow. With that knowledge, wrote Philip Appleman more than a century later, "we know we are mortal as mammoths, / we know the last lines of our poem."^[35]

Darwin was by no means alone in preferring illness to open conflict or in paying excessive attention to his health. For many of his contemporaries in literary as well as scientific circles, the quest for health in such a time of rapid change seemed a search for a physical, emotional, and moral unity that could replace the traditional faiths that were being so badly shaken. As is the case

today, an exaggerated concern for health was an acceptable avenue of retreat from a disheartening world both for some hypochondriacs who denied the problems of the larger world altogether and for persons such as Darwin, T. H. Huxley, Lytton Strachey, Robert Burns, Alfred Lord Tennyson, and so many others whose painfully honest dealings with their part of the world seemed to drive them toward a partial retreat.

In Darwin's case, as with the others mentioned, there has long been talk of "creative maladies," of the impetus that anxiety can lend to a career, and of the part that suffering plays in the getting of wisdom. But although hypochondria has been used as a synonym for excruciating sensitivity and is associated with the lives of such artists, writers, and composers as Molière, Voltaire, Jonathan Swift, Samuel Johnson, James Boswell, Immanuel Kant, Beethoven, the de Goncourt brothers, André Gide, and Sara Teasdale, these persons could hardly think or write during their severest bouts of hypochondria. All struggled against their disorder with the tremendous activities that made them famous.

Hypochondria might be something of an occupational hazard for doctors, performers, and intellectual rebels, and it might sometimes serve as a defense against or regulator of conflicts that could overwhelm, but it certainly does not seem to be a prerequisite of creativity.

"Disease is not the soil from which the best products of our culture spring."^[36]