The Unusual History of Hypochondria

IMG_8949Last weekend we moved house. (Which I had never really done before in this way, needing to move lock stock and barrel from one place to the next and having to be OUT of one place by Tuesday and IN to the new place and the landlady coming to do an inspection and needing everything to be PERFECT for her return. It was high up on the list of the Most Stressful Things I Have Ever Done. Not to be recommended.) In the course of this I ended up sorting through piles of books that I had evidently put aside at one moment, intending to read later or bring with me to Dublin, and then completely forgotten about.

And one of them was one that I had found when I was looking through another old forgotten pile of books entirely – that belonging to my grandfather, who in life was a semi-obsessive collector of books, newspapers, and music. After he died I was allowed to use as many of his books as I liked that might come in handy in my degree – and he did indeed have so many books of Old English, poetry, drama and a host of other things that were of enormous help.

This was different. It was a reprint of a pamphlet that had first appeared in 1766, written by John Hill (whom I’d never heard of before in my life) – called Hypochondriasis: A Practical Treatise.

I’d picked it up, curious to know what it contained. Nowadays a Hypochondriac is epitomised by that wonderful Woody Allen character in Hannah and Her Sisters (not to mention a few other Woody Allen characters in other films) – the anxiety-ridden man, often quite comic, who inspects his face with a microscope each day looking for New and Unknown Spots, he who gets an unusually severe cold and believes he has the lethal form of Swine Flu and is going to die, who has a strange pain in his hand one day and spends the next day googling possible deadly diseases of which the pain might be a symptom. (For some reason in popular culture it mostly appears to be the man who is imagined as the hypochondriac. I have no idea why; perhaps men not having to go through the unpleasantness of menstruation and childbirth feel left out and need to exaggerate their own pains somehow.)

My first thought was that this was an appropriate book for my grandfather of all people to have owned – he could rival Woody Allen in some aspects of his own anxiety – it is well known in our family that after accidentally swallowing the stone of a plum he leapt up from the table, his face stricken with fright and cried out “I’ve swallowed the stone! Girls, I’ve swallowed the stone! It’ll pierce my heart – my lungs – my liver!”

Moving on.

Nowadays hypochondriacs tend to be more a comic figure than the sufferers of a genuine illness. But here was this quite old and seemingly very well-respected Practical Treatise, if you don’t mind, outlining the history, the causes, the symptoms and, fascinatingly, a comprehensively outlined proposed cure for what the author calls “a real, and sad disease.” In fact his very first statement in the pamphlet is to insist that “to call the Hypochondrisis a fanciful malady, is ignorant and cruel.”

And he goes on to say a great deal that is mad, more that is misguided, much that is dated, but all very interesting.IMG_8950

The man himself, John Hill, says the introduction to the little booklet, was an “eccentric English scientist, physician, apothecary, and hack writer.” This sounds to my modern ears like a quite dizzying array of various professions – after all even being “eccentric” was, then, almost a whole occupation in itself. But in those days it would not have been uncommon to excel in a range of areas and interests. The poet John Donne was also one of the most well read men of his day in not only literature but science and mathematics. The genius mathematician Isaac Newton saw no conflict between his revolutionary innovations in empirical maths and astrology, and his equally sincere efforts to find the Elixir of Life.

By contrast with this level of eccentricity, John Hill is really quite tame. It’s a curiosity of reading his treatise that it is quite difficult to separate out what are the results of his own idiosyncrasies, from the weirdness that simply belonged to the medical profession at the time. His definition of “Hypochondria” seems a cocktail of what we would now call depression and what we now call heart disease.

“It is an obstruction of the spleen by thickened and distempered blood; extending itself often to the liver, and other parts.” In the course of the disease “innumerable ills follow its advancing steps, till life itself grows burthensome.”

While its cause seems to resemble what we call high cholesterol (a word which, by the way, is derived from “choler” – anger – it being thought even still that angry people are more likely to suffer from high cholesterol and heart attacks) – its Signs and Symptoms, according to Hill, are more like that of depression: “Lowness of Spirits”… “Wild thoughts; a sense of fullness, weight and oppression in the body; an appetite without digestion.” … “Pulse low, weak, unequal, palpitations of the heart” – so far, relatively normal I should think – but at this point he appears to get a little carried away: the symptoms go on worsening, if untreated, he warns; they will be beset by “a continual teazing cough, harness of the belly, a costive habit,” and – he’s on a roll now – “the lips turn pale, the eyes lose their rightness, the white grows as it were more greenish, the whole body becomes yellow, tawny, greenish, and at length of that deep and dusky hue, to which men of swift imagination have given the name of blackness.”

O dear. It appears that ethnic minorities are universally in the final stages of this Dire Disease.

“Thus,” Hill concludes in this section of the pamphlet, the patient “will in time be worn out, and led miserably, though slowly, to the grave.” Equally deadly is the effect of treating it “too hastily” – in this case too “the consequence is, equally, a sudden and miserable death.”IMG_8946

At the same time as Hill is enumerating the various aspects of what now appears to be actually a completely fictional illness, he seems bent on making his readers feel slightly guilty if they have yet to suffer from it. For the sufferers of The Hyp, as it came to be known, are led to it by their best qualities, for, says Hill, “The finer spirits are wasted by the labour of the brain.”

“Greatness of mind, and steady virtue, determined resolution, and manly firmness, when put into action and intent up on their object, all also lead to it: perhaps whatever tends to the enobling of the soul has equal share in bringing on this weakness of the body.”

Its sufferers are summed up as “the learned and wise, the virtuous and the valiant.”

In short, if you’re not suffering from the Hyp, you are most likely quite a useless individual.

Things becomes even stranger when Hill gets to the part where he begins to talk about the possible aggravators of the disease, and the way to cure it. This is a mixture of the bizarre and the surprisingly sensible. He advises against bleeding in most cases, and instead concentrates on the “Rules of Life for Hypochondriac Persons.” These seem mostly rather sensible, and in line with what is generally advised for people with depression or high cholesterol – “Air and exercise, as they are the best preservers of health, and greatest assistants in the cure of all long continued diseases, will have their full effect in this,” he begins, before adding the surely nonsensical recommendation that Hypochondriacs should avoid high ground: “the air he breathes should be temperate, not exposed to the utmost violences of heat and cold, and the swift changes from one to the other; which are most felt on those high grounds.”

Being outdoors in nature is in general highly recommended – and with this I am absolutely in agreement with Hill, although I might not go quite as far as he does in saying there is not “a stone that lies before his foot, but may afford instruction and amusement.”

His thoughts on diet, too, seem broadly familiar – not to modern western medicine, but surprisingly similar to the Ayurvedic diet recommendations, particularly those for balancing Vata dosha, (which I have personally always found quite intriguing, and weirdly intuitive – this is a very good information page on it, in case you are curious.) “Acids,” he says, “must be avoided carefully,” advising that the diet should be “at all times of a kind loosening and gently stimulating; light but not acrid.” Boiled vegetables are good but raw vegetables bad. He spends a long time examining exactly the right kind of drink that should be taken – apparently for some reason (he doesn’t say what) “Malt liquor carefully chosen is certainly the best drink.” Finally he urges, in line with another Ayurvedic principle, that routine is important in nursing the depressed and ill back to health, that “the patient attend regularly to his hours of eating.” For, he says, “We have to do with men for the most part whose soul is the great object of their regard; but let them not forget that they have a body.”

Which last line, at least, certainly seems a good general principle to keep in mind.

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