Views & Reviews Between the lines

Help for hypochondriacks

BMJ 2007; 334 doi: (Published 05 April 2007) Cite this as: BMJ 2007;334:751
  1. Theodore Dalrymple, writer and retired doctor

    Every month for nearly six years, James Boswell wrote an essay for the London Magazine under the name of The Hypochondriack. By hypochondriack, Boswell meant not the man who is consumed by fear of illnesses he does not have but the one who suffers from melancholy, spleen, or the vapours. He hoped to ward off his own tendency to this condition, or these conditions, by his literary exertions.

    Inauspiciously, perhaps, his first essay in the series was dated November, and he quotes a French novel that starts with the line (one wants to read on), “In the gloomy month of November, when the people of England begin to hang and drown themselves . . .”

    If Boswell were writing his essays today, I suppose it would be as The Depressive, and he would long ago have been put on antidepressants. In Number XXXIX, he describes the hypochondriack's symptoms: “His opinion of himself is low and desponding. His temporary dejection makes his faculties seem quite feeble. His fancy roves over the variety of characters whom he knows in the world … and they seem all better than his own. He regrets his ever having attempted distinction and excellence in any way, because the effect of his former exertions now serves only to make his insignificance more vexing to him. Nor has he any prospect of more agreeable days when he looks forward. There is a cloud as far as he can perceive, and he supposes it will be charged with thicker vapour, the longer it continues. He is distracted between indolence and shame . . . He acts like a slave, not animated by inclination, but goaded by fear.”

    Boswell proposes two remedies to the hypochondriac: cognitive behavioural therapy, and psychopharmacology.

    The therapy is religious belief: “By religion, the Hypochondriack will have his mind fixed upon one invariable object of veneration, will have his troubled thoughts calmed by the consideration that he is here in a state of trial, that to contribute his part in carrying out the plan of providence in this state of being is his duty, and that his sufferings however severe will be found beneficial to him in the other world.”

    The psychopharmacological remedy Boswell proposes is drink: “To be sure we know that an excess in wine which alone can move a thick melancholy, will probably make us worse when its violent operation has ceased, so that it is in general better to bear the mental malady with firmness. Yet I am not so sure but when the black distress has been of long continuance, it may be allowable to try by way of a desperate remedy, as poisons are sometimes given in medicine, what a joyous shock will produce. To have the mind fairly disengaged from its baneful foe, even for a little while, is of essential consequence. For it may then exert its latent vigour, and . . . be able to get the better of what pressed it down before in abject submission.”

    And then come immortal words, in direct opposition to the health and safety view of human existence, which are more salient today than when they were written: “But we are not to consider the world as an immense hospital: and whenever we see a company with wine circulating amongst them, to think that they are patients swallowing a necessary potion.”

    Risk factors can seriously damage your peace of mind.

    And then come immortal words, in direct opposition to the health and safety view of human existence: “But we are not to consider the world as an immense hospital”

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