‘A Body Made of Glass – A Cultural History of Hypochondria’ by Caroline Crampton

Kerry Greenan is a GP Partner at Bromley-by-Bow Health Partnership, Tower Hamlets ICB Clinical Lead for Population Health and Neighbourhoods incl. Homelessness and the Secretary for the European Young Family Doctors’ Movement. She is on LinkedIn.

I came across this book in a slightly roundabout way: as someone who is an avid reader but usually in the pursuit of escapism from the day job, I don’t often choose to read medically-themed books in my free time. Author Caroline Crampton is the host of the popular golden-age crime fiction podcast ‘Shedunnit’ (a great example of the type of escapism which many people find therapeutic). However, her reference to writing this book in the context of her own battle with hypochondria (a term she prefers over the more contemporary health anxiety or illness anxiety disorder) and the historical aspects intrigued me. Listening to her familiar voice in the audiobook felt almost like a podcast spinoff.

Crampton gives a detailed history of the history of the term ‘hypochondria’ and the evolution of the terminology, going back as far as the four humours theory of Ancient Greece to current diagnostic criteria given by the DSM-5. There are some examples from history, whether they were labelled as such or not at the time (and in some cases where although this was the implied diagnosis at the time, later medical advances have provided retrospective diagnostic clarity, further feeding into doubts that something is being missed, that there is an explanation for symptoms always just beyond reach). Many of these historical depictions are reflected in the literature of the time, which in turns shapes attitudes towards those suffering from the condition: think of Pride and Prejudice’s Mrs. Bennett forever complaining of her nerves, and the scorn she is treated with by almost all the other characters in the novel.

This journey through history is interspersed with some vivid and emotive descriptions of Crampton’s own complex lived experience: diagnosed with Hodgkin’s lymphoma in her teens, and relapsing in her early 20s, it is easy to see how the lines between recommended self-surveillance for recurrence and hypervigilance can blur and lead to the development of such anxiety. I’m sure as GPs we can all conjure up similar examples of patients, often frequent presenters with physical symptoms and a medical history which raises the threshold of concern for both patient and clinician. At one point, Crampton expresses that she almost wishes she was taken less seriously by doctors, recognising that given her previous diagnosis, her presentations often result in multiple, sometimes invasive, investigations which further drive the cycle of anxiety. It is managing this doubt and uncertainty that is one of the most difficult skills for primary care physicians: the balance between premature reassurance and over-investigation is often a delicate one, and one which I believe is best navigated together between doctor and patient with honesty. There are no easy answers here.

Another facet of hypochondria as illness which is explored here is the influence of the health services available, and the idea of who has the ‘luxury’ to be a hypochondriac. Crampton is from the UK and so has the benefit of free access to the NHS, and reflects on the benefits and pitfalls of this, and how different her experiences may have been had she been living in a country where she had to pay for healthcare or claim for cover via insurance. The rise of ‘cyberchondria’ driven by ease of access to health information of varying quality is also an example of this, and one which continues to increase anxiety exponentially thanks to the ever-present algorithms designed to keep people reading rather provide reassurance. There is also recognition of her own privilege, that as a middle class white woman, her concerns are likely to be given more credence than perhaps someone of a minority background, although perhaps less so were she a man (the association of hysteria and hypochondria as female and male illnesses respectively at certain points in history are illustrative of this).

‘A Body Made of Glass’ is a beautifully written and informative book, part memoir, part history of medicine and part literary analysis. We often acknowledge that our mind’s interpretation of own health and bodily symptoms is shaped by a complex mix of our own previous experiences of life events including illness, interactions with health professionals and others. However, this book illustrates the additional impact of centuries of changing health attitudes and beliefs in society. The impossibility of absolute certainty is something we must learn to sit with as clinicians. The true skill is in helping our patients to navigate this as well.

Featured book: Caroline Crampton, A Body Made of Glass – A Cultural History of Hypochondria, Granta Books; 1st edition (11 April 2024), 336 pages, ISBN 978-1783789054, Hardback, £16.99

Featured Photo by Anh Tuan To on Unsplash