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18 June 2008

What's Wrong With My Body?

Surajit Dasgupta
(Click on the headline for details of cognitive behaviour therapy for hypochondriasis by the Journal of the American Medical Association)
The reproduction of this article in this blog has been provoked by a frequent topic of discussion at this writer's workplace: health profiles of the respective speakers. It amuses me, hailing as I do from a small town where I grew up leading a carefree and yet disease-free life, as to why the people living in big cities are often unduly worried about their health

Asukh: This film by Rituparno Ghosh showed how the mere thought of a disease can wreck a family
(Published first in The Pioneer on 1 October 2007)
Ever since The Pioneer published the story, "Indian woman stripped of her job for wearing nose stud in UK" (September 19), I have been trying to eat with my nose and figure out how it could possibly affect my hygiene and that of the people whose company I keep.

Jokes apart, what raises hackles is that the firm Eurest, while trying to justify the sacking of Amrit Lalji, stated that "jewellery can harbour bacteria, create a hazard when working with machinery and find its way into food..." So was a nose-studded Lalji, if not eating, cooking or serving food with her nose, handling machinery with that organ of her body? Howsoever funny this may sound, it is a very valid scientific question.

And the question is a pointer to a psychological disorder called hypochondriasis, a preoccupying fear of having, or acquiring from others, serious diseases. It happens to two classes of people: One, who are not able to engage themselves enough in constructive work and, two, amateurs in medical science.

The first class of people while idling around indulge in various useless thoughts, one of which is a compulsive niggling notion that something must be wrong in their body. It is, therefore, a major problem in those regions of the world where unemployment is a widespread phenomenon: Erstwhile socialist countries in Europe, a major part of Latin America and the State of West Bengal in India.

But hypochondria does not spare the prosperous people either. There, the victims are casual students of medical science. While being initiated into physiology, these amateurs read about various diseases and tend to take the reverse route to analyse their health. That is, they first read the symptoms, then recall their environment and physiological history, tally the third with the second and the first, and infer, wrongly, that one of the diseases mentioned in the books must have afflicted them. It is this reason that turns many Americans, Britons and Germans hypochondriacs.

As consumer awareness is high in these countries, and medical service falls in the ambit of consumer rights, lay citizens are given an elementary idea of various common diseases, their causes, symptoms and treatments. While this makes some people health conscious, others turn hypersensitive to possibilities of ailments. Employer Eurest, which sacked Lalji, probably suffers from this category of the psychological disorder.

But out of the two kinds of hypochondriacs, Bengalis are the worst hit. For them, it is a vicious circle where the first reason (decades of recession in West Bengal) augments the second (health consciousness). It is a rare phenomenon to come across a Bengali from the State -- probashi or non-residents are a breed apart -- who does not complain of ambol (indigestion). If the listener is unlucky enough to be caught unawares by a Bengali hypochondriac, a larger health bulletin will follow, and a gamut of gastro-enterological ailments will be listed.

Regular visits to the local physician, right from his childhood, gives a Bengali a fair idea of names of a plethora of diseases and drugs. This, rather than keeping him alert of impending health crises, keeps him preoccupied with a phobia of diseases. He is obsessed with bodily functions and interprets normal sensations (heart beats, sweating, bowel movements, etc) or minor abnormalities (a runny nose, a small sore, slightly swollen lymph nodes, etc) as symptoms of serious medical conditions.

A similar social condition makes Americans and Britons suffer despite their much better economies. Unlike in India, in the US and the UK, physicians' prescriptions are like packaged products. The recommended doses are legibly typewritten and pasted on the lid of a box containing the medicines. The other labels on the cuboidal box include the patient's medical history and side effects, if any, of the prescribed drugs.

A regular study of such medical kits turns the patient into a quack who thinks he can now afford to treat himself as and when he falls ill in future. Last week, a survey by food diagnostic company YorkTest found that of 12 million Britons who claimed to be food intolerant, less than a quarter had been formally diagnosed; 39 per cent of those polled believe it is trendy to declare themselves food intolerant.

The report suggests that the Brits have deceived themselves into becoming a nation of hypochondriacs with at least three million having wrongly convinced themselves that they are sufferers.

Hypochondria can be treated, but it takes time. And the tendency to have exaggerated health anxiety may not vanish completely. The patient should be first made to acknowledge the fact that he has anxiety, and not a serious physical disease. Then is the need to reduce his anxiety.

Hypochondria is often triggered by a major life event. For example, parents who have a single child after the mother had had several miscarriages, or the first one or two babies died, may rush to the doctor to get the surviving child checked even if he has an innocuous common cold.

Cognitive-behavioural treatment combined with medication, if needed, is perhaps the best approach. First, the patient explains his symptoms and the doctor makes an evaluation whether he has been examined well enough. Of course, the healers should not discuss whether the patient has his symptoms (pain, nausea, numbness, etc) or not, which are always subjective, and hence 'accepted'.

However, interpretation of the symptoms should be accurate. A hypochondriac believes something serious must have happened to him. He cannot imagine that his 'symptoms' can be caused by, say, anxiety.

During the treatment, the patient registers what he thinks when he notices his 'symptoms'. Hypochondriacs choose the most serious, but often least probable, explanation: Headache is not migraine or stress but brain tumour; chest pain is not caused by tense muscles but is a serious heart attack! They may believe, "It is normal to feel okay; that does not mean I'm fine... doctors may mis-diagnose even cancer!" So, the healers must first win their trust. Behavioural (checking the body less) and cognitive work (registering situations, thoughts, feelings and behaviour) therapies follow.

Are you a hypochondriac? Test for yourself. Below is a list of questions about your health. For each one, circle the number indicating how much this is true for you: 1. not at all, 2. a little bit, 3. moderately, 4. quite a bit, 5. a great deal.

  • Do you worry a lot about your health?
  • Do you think there is something seriously wrong with your body?
  • Is it hard for you to forget about yourself and think about other things?
  • If you feel ill and someone tells you that you are fine, does it annoy you?
  • Are you often aware of various things happening in your body?
  • Are you bothered by aches and pains?
  • Are you afraid of illness?
  • Do you worry about your health more than most people?
  • Do you get the feeling that people are not taking your illnesses seriously enough?
  • Is it hard for you to believe the doctor when he/ she tells you there is nothing for you to worry about?
  • Do you often worry about the possibility that you have a serious illness?
  • If a disease is brought to your attention (through the radio, TV, newspapers, or someone you know), do you worry about getting it yourself?
  • Do you find that you are bothered by may different symptoms?
  • Do you often have the symptoms of a very serious disease?

You arrive at what is known as the "Whiteley Index score", found by summing the responses to each question. The higher the score the more hypochondriacal you are. There is no set cut-off score, but healthy people without health anxiety generally have a score of 21 ± 7 (14 to 28). Patients with hypochondria are found to have a score of 44 ± 11 (32 to 55). If your score is high, you must seek professional help. Notice that if you are depressed, you might get a high score, and your hypochondriacal ideas might be secondary to your depression. The same is true if you have a specific or general anxiety disorder. In both instances, you must talk to your doctor.

The writer is a mathematician and linguist, now a corporate communicator and has been a journalist, a teacher and marketing manager (in reverse chronological order) in his previous vocations

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Surajit Dasgupta treats no individual, organisation or institution as a holy cow.