“If you feel it is real, then it is”: Caroline Crampton on hypochondria

Recently, while interviewing a doctor, Caroline Crampton — journalist, podcaster, and editor-in-chief of The Browser — shocked her source by using the word “hypochondria.” He was relieved when she clarified (“or health anxiety”), telling her: “I’m so glad you said ‘health anxiety.’ I just hate to use that other word.”

“That other word” once referred not to a psychological condition or a set of beliefs, but to a literal place, roughly the upper abdomen. Over centuries, the term mutated. Today, “hypochondria” does not refer to anything so solid and practical as a bodily region. Instead, it prompts associations of nerves and hysteria, of the worried well obsessing over their perfect health. 

In A Body Made of Glass: A Cultural History of Hypochondria, Crampton traces the slippery contours of the condition, combining medical and social history, literary commentary, and her personal experience of surviving cancer as a teenager only to become preoccupied with illness now in her thirties. It’s a meandering, beautifully written chronicle that goes from poet John Donne to social media quackery; The New York Times calls it “a magical, trippy experience, with a whiff of Alice in Wonderland nibbling the magic mushroom.”

Crampton spoke with journalist Angela Chen about the publishing process, the language of hypochondria, how the condition shifts with culture, and more. This interview has been edited for clarity.

This is for The Browser, after all, so I assume that many readers are interested in reading and craft and the process of researching and publishing this book. First off, did researching and writing the book make your hypochondria worse by immersing you in it? 

It was really bad and then it became a lot better. There was definitely a period when I had to psych myself up to do any of the research, particularly anything that felt remotely close to my own experiences. It was probably the most advanced procrastination I’ve done in my life. And then it inevitably had to be done and by the time I got to the end and turned it in, I actually felt, just as a consequence of exposure, quite differently about it. I felt like I could read anything or do anything at that point and what had happened was that I’d learned so much that I didn’t know about how the human body worked. 

You know when you go in a magnificent building — a cathedral or concert hall, something really beautiful and elaborate that’s been constructed and it’s the product of so many brilliant minds and work — you have the really intense feeling of awe? That’s how I feel now whenever I think about my own body, how it is even to be here, and how it even exists. All of these amazing accidents had to take place for it to exist and that feeling has diluted my fear of it in some ways. 

“Hypochondria” is such a broad topic. Books have been written about it before, books will be written about it again. How did you find the borders of your book and figure out what you would and wouldn’t cover? 

It troubled me for a very long time. I got to a certain stage of research in which I felt quite mad and like everything was hypochondria. I remember going through a succession of TV shows during the pandemic and when I started to find hypochondria in random Marvel series I thought, “no, this has gone too far, you really need to rein it in.”

When we got to the stage where you have to confirm the title and the subtitle because they need to start uploading metadata, I was really puzzling over the subtitle and I thought “oh, the really important word here is “a.” It’s a history of hypochondria, not the history of hypochondria. And realizing that was very liberating. The borders were my attention and interest and what seemed to cohere. There have been a few occasions where people have said, “I can’t believe you didn’t write about Elizabeth Barrett Browning” or whoever and the reason is, that doesn’t interest me very much. 

Once you found the contours, how did you figure out the structure and how to combine the personal and researched elements? 

The thing that I need to know in order to be able to start writing is: what is the throughline, what is the “journey.” In my first book, that was quite easy because it was literally a journey, it was a book about the river and it moves from the source of the river to the very end of the estuary. 

With this book there was not an obvious journey. I was not going to travel somewhere or live through something. I had an idea that I would structure it like an illness — the beginning would be that you’re coming down with it, then diagnosis, treatment, convalescence, and cure — but I don’t know how I ever would have written it. Also, I really didn’t want this to be a cancer memoir and after discussion with publishers, I did agree that this “illness” structure basically structured it like a cancer memoir. 

It was actually my editor at Granta who said, what if it’s a biography of an illness? She cited two really great books as examples — The Noonday Demon and The Emperor of All Maladies — and then I thought of this as a biography of hypochondria and I thought, oh, that’s what it was. 

“Hypochondria” seems like an old-fashioned, almost euphemistic term compared to “health anxiety,” but you made the decision not to use any of the replacement words. Why’s that? 

Crampton: Broadly, I would say that medical professionals — people who deal with anxiety on a professional level — don’t like using the word “hypochondria.” When you ask them why, they refer back to the intense stigma that word carries and there’s interesting stuff in the scholarly literature of researchers trying out different terms and openly acknowledging that they don’t want to say “hypochondriasis” because it carries this baggage of not believing people. It has doubt packaged into it as a word, and they’re looking for a term that’s neutral. 

While I really applaud that as a sentiment, I think what often happens is that the replacement term just comes to mean the same thing, so “health anxiety” is rapidly acquiring the same baggage and it risks being vague. The words were meant to be synonyms, but I’ve had a few conversations with people who might say “I wouldn’t say I have hypochondria, I have health anxiety,” as if there are degrees where hypochondria is really bad and health anxiety not as bad. 

I have two main reasons for sticking with the word. First, I like it. It carries lots of bias and trauma within it — what words don’t, honestly?— and I think it’s interesting to have all that still on show, rather than hidden away with a new word. And it’s just what people understand. 

And like the word, the condition itself is slippery. It has overlap with several different things: OCD is a big one, generalized anxiety disorder, body dysmorphia is something that has come up too. I did research on this relatively recent condition called orthorexia, which is a bout of extreme rule-following associated with wellness and contemporary health advice. So yes, I don’t think it is really possible to put clean borders about hypochondria or health anxiety. 

I was really interested in how your hypochondria was affected by your cultural context. Because you have access to the UK’s National Health Service and a history of cancer, all of your visits to the doctor were taken seriously. You were believed. How might your hypochondria have manifested differently in, say, the US where you might have to pay for every visit? 

So much. The fact that I can just make appointments without having to worry about finances is enormously impactful and it’s definitely made me into that “care seeking” type of hypochondriac rather than the “care avoidant” type. At the base level, if I didn’t have that I would either be in debt, I would be care avoidant, or both. I don’t think I wouldn’t have anxiety though.

Regarding insurance and health—on a family trip to South Africa a few years ago, I was wearing a smartwatch that tracks your step and heart rate. A family friend asked if I was on that insurance plan where you have to wear a fitness tracker. I’d never heard of it before but it turned out that there are plans that if you do a certain number of steps, your monthly premium is so much less. 

Meanwhile, I quite recently decided that I cannot wear those things anymore. I decided in the same way as a friend who’s recovered from an eating disorder and can never, ever look at calories. And I was thinking, if I were in a situation where my healthcare was predicated on something like that, I probably would have an OCD diagnosis. I think those tendencies would have flourished with more data like that to feed on.

A memorable incident in the book is when you start losing your hair and panic and call the NHS non-emergency hotline, and the other person asks if you’re bleeding. You say yes, because you’re on your period, but they were actually asking if you were haemorrhaging — and after that it’s so ridiculous to explain the hair thing that the absurdity kind of shocks you out of the panic. What role can humour have in dealing with or addressing hypochondria? 

There is already some quite good health anxiety material. The comedian Taylor Tomkinson has generalised anxiety disorder and has a bit where she talks about how there should be two emergency rooms, the actual one where you go when you’ve been shot and the one next to it where you have a bad feeling and you can’t figure out why but you have palpitations. 

So there are people doing interesting material about this, but I’m also undecided about hypochondria humour because I know I, personally, use humour to make other people feel okay and that they don’t need to worry about me. I use it as a way of deflecting. I observe myself doing this and I don’t like it but I don’t seem to be able to stop and I do wonder how the experience of hypochondria would be different if we were completely serious about how we felt. Health anxiety is often linked to the way people interact socially with others and some have guilt around having health anxiety and humour can be a way of not trying to be a burden. 

It’s like when you can tell you’re about to be bullied so you turn it into a joke. I’m inviting this laughter, but my true preference might be no laughter. But at least I can control this laughter. 

You write in the book about how the internet — of course, a relatively new development — affects hypochondria . How else might it affect the experience of hypochondria in the future? 

Yes, the ready availability of information has definitely changed hypochondria. I also think we are starting to conceive of health itself differently because of medical progress. It’s moving from being reactive to being preventative, with public health focusing on early detection and screenings and this idea of “there is absolutely no way you can tell you have this yet, but we’re able to use technology to find it.”

As it becomes possible to diagnose things earlier and earlier and detect them in small traces and biomarkers, you don’t have to wait to get a tumor anymore to know something’s wrong with you. And the possibility that we can diagnose disease when it's still only detectable on the molecular level can do strange things to the ways our minds process it. To the human eye, illness moves from being a mostly visible to a mostly invisible phenomenon.

I also think we have changed how we think about health, though I don’t fully have my head around this yet. The idea of being healthy is no longer something static, it’s now just a constant effort, always something we’re trying to be and never quite feeling like we are. Somebody who’s currently going through chemo would look at me and go “she’s perfectly healthy” but by comparison I don’t feel healthy because I have allergies, my back hurts because I don’t do the exercises the PT gives me, and so on. The wellness industry has effectively monetized this perfectionism when it comes to our state of being and it’s only going to get more pronounced. 

How did writing the book make you think about this condition differently? What new questions are you interested in now?

I think there is a fair amount about how past illness and other past traumas and family history of an illness can impact hypochondria, but I am now interested in questions of how your physical environment impacts it. What about if you live in a very polluted area and you have a lot of anxiety about your respiratory system, is that a justified anxiety given a lot of very good research into the link between air pollution and respiratory disease? Is this person being a hypochondriac, or appropriately concerned? 

But the big thing that has come from publishing it and talking to people and hearing from other people about hypochondria is: I am just very sure that I don’t believe in the idea that there is “real” illness and not-real illness anymore. If you feel it is real, then it is. I’m just not interested, if I ever was, in the attempt to decide, “well, this person’s chest pains are real because we’re having a heart attack and this person’s chest attacks aren’t because they’re only having a panic attack.” I think both are real chest pains happening for different reasons.

Five Articles In true Browser fashion, here are five articles that Crampton came across that informed A Body Made of Glass. 

• The Politics of Chronic Illness Memoirs (LitHub)
• You Know It’s a Placebo. So Why Does It Still Work? (Wired)
• Womb Up, America! (The Baffler)
• What I’ve Learned From Having Cancer Is Nothing (Slate)
• Hilary Mantel's Art Was Infused With Her Pain (The Atlantic)