Caroline Crampton is a writer and reviewer who covers a wide variety of subjects for the Guardian, the Spectator, the Mail On Sunday, and other publications. Her first book, The Way to the Sea, was published by Granta in 2019. She appears regularly as a critic on BBC Radio 4. She lives in Merseyside, England.
Author photo by Jamie Drew
In A Body Made of Glass: A Cultural History of Hypochondria (Ecco, Harper Collins, 2024), author Caroline Crampton combines what she refers to as a cultural history of hypochondria with a memoir of her experiences with anxiety disorder, allowing the history of it to inform her life and vice versa. Lest readers think they have nothing to learn about their own lives from a study of hypochondria, especially if they’ve never experienced it before, Crampton, a writer and critic who lives in England, reminds them that hypochondria has much to teach them about health. She goes even further by connecting the disease to gender and the mind-body divide.
Part of what makes this autobiographical-biography work so well is Crampton’s particular experience with hypochondria. Rather than structure the book as a linear history, she divides it into various subjects as she combines and contrasts the historical thinking about it with her experiences. For example, in one chapter titled “Sharp Belchings and Windy Melancholy,” she draws on the metaphysical poet John Donne and Oxford scholar and author Robert Burton, known for his encyclopedic book, The Anatomy of Melancholy, published in 1621, to relate the historical ideas about melancholy and how the four humors (blood, yellow bile, black bile, and phlegm) were thought to guide health and disease. She then connects those and other historical figures and writings to the larger question of ‘Is this normal?’ where she draws on moments in her life to bring an amusing dark humor to the subject. We as readers are made to consider certain pertinent questions, such as when exactly does the focus on one’s health turn into obsession—and what along the way crosses the line? She relates a moment, for example, when she answers a question she has via telemedicine that makes the person entering the information into the system believe she’s hemorrhaging, not menstruating.
Her own personal concerns about health are well-founded. When Crampton was a teenager, she was diagnosed with cancer, which then returned a couple of years later. That development raises the question of what counts as hypochondria. Now that the disease has returned, she remains vigilant, checking to make sure there are no further signs of that disease. Such attention makes perfect sense. As she writes early in the work:
“I have been diagnosed with cancer once already and had it recur to the surprise of the experts treating me. Perhaps it is not unreasonable or irrational, then, to worry that either that same cancer or the effects of the powerfully harmful treatments I received for it could still be lingering in my body causing mischief.”
However, it’s not much of a step from being watchful and observing her health overall to worrying about sensations that may or may not be present at all. The medical establishment even encourages such behavior, given how focused the messaging is on self-examinations and being aware of our bodies.
Still, that laser focus on the body —be it healthy or at risk — can result in hypochondria, defined in Merriam-Webster as “excessive concern about one's health especially when accompanied by imagined physical ailments.” Crampton develops her analysis of the healthcare system by talking about the technology that enables healthcare professionals to catch diseases and ailments more rapidly than in the past. Doctors and hospitals encourage patients to have tests run in order to find problems while they’re still treatable. Cancer is one such disease, which makes Crampton’s case fit well with the argument she’s making. Crampton points out that for those with insurance, such a problem becomes magnified. She’s in the UK, so tests or procedures are completely covered, but she points out that the privilege of those with first-class insurance in the U.S., are in a similar situation, easily agreeing to any and all tests for no or low-cost.
So it makes sense to be hypervigilant, at least until people cross some vague line that leads them into hypochondria.
The difficulty of establishing that line makes treating hypochondria even more challenging. She draws from the DSM-V to explore the shifting language around the disorder, showing how it has moved from a physical ailment (early physicians believed it was a problem stemming from the abdomen, as the term originally meant “below the sternum”) to a mental one. Thus, doctors and healthcare professionals now have to begin by focusing on physical concerns. After exhausting the tests and procedures, clinicians then recommend the patient to mental health professionals for treatment. The challenge is to do so without treating the patients as if their concerns don’t matter.
Not surprisingly, this challenge affects patients who present as female or come from marginalized groups, more than any other demographic. In fact, when discussing the history, Crampton points out that there was once a divide between hysteria and hypochondria, with the former a diagnosis for women and the latter for men. Given that hypochondria was considered a physical problem, physicians would use that terminology for men, as they had a “true” ailment. Hysteria, on the other hand, was in women’s minds, so it was one more way for male doctors to dismiss women’s concerns. Along the same lines, healthcare professionals still dismiss reports from members of marginalized groups at a much higher rate than they do for white males. Thus, they can use hypochondria as a way of ignoring physical illnesses, telling their patients it’s “all in their minds,” as opposed to treating the physical manifestations or recommending help for their hypochondria.
These problems have led some professionals to recommend a change in terminology altogether, especially to avoid stigmatizing those with hypochondria, especially for those demographics traditionally challenged by the healthcare industry. One of the most popular phrases now is “health anxiety,” which conveys the belief the problem is more related to mental health than physical ailments, while also removing the stigma that hypochondria is not a real problem. However, that diminishes the term from its long history and connection to the body. Crampton wants to keep some of that connection, concerned that changing the terminology would further the mind-body divide that happens in conversations around the disease. The problem is that hypochondria does manifest itself in the body in clear and specific ways; removing that reality could suggest that doctors should see it as just a mental issue.
One way Crampton connects hypochondria to health overall is through her conversations about narratives we craft for ourselves. In A Body Made of Glass: A Cultural History of Hypochondria, she points out that most people—those who don’t suffer from hypochondria—have a story about their health, which is that they’re largely healthy. When something happens, whether it’s a cold or flu, or something as major as a gall bladder being removed, cancer or a heart attack, they believe by going to the doctor or hospital, the problem will be resolved, and then they’re healthy yet again. Of course, that narrative is flawed, as health concerns can linger, whether it’s high cholesterol or a knee that gives us trouble every other month. More importantly, though, the part of the narrative people don’t focus on is that one of these ailments may ultimately kill them. They believe the beginning, middle and end of the story is they are healthy, they get sick, then they get better. The true narrative, Crampton reminds readers, is that we are born, we live for a certain amount of time, then we die.
In the final analysis, Crampton’s story is less of a narrative, she admits, which is a problem for hypochondriacs, in general—being able to have that beginning, middle and end of an illness narrative is the false hope we often seek when confronted with health concerns. After discussing Virginia Woolf’s complaints about being able to clearly communicate her illness to others, Crampton reflects, “The problem that I think she had, and that I have too, is not so much of word selection but of narrative veracity. It is impossible to condense every sensation and symptom into a believable account that someone else can understand.”
Crampton ultimately accepts this lack of a clear narrative in her life. By the end of A Body Made of Glass: A Cultural History of Hypochondria , she’s not better, as there really is no getting better for her, in the way we typically think of it. She has found ways of managing her hypochondria, but it still flares up, and some ways of dealing with it are better than others. She also knows that her cancer could come back, or she could develop something else that would lead to an earlier death. Her hypochondria helps her recognize her mortality, and it’s a reminder for her and us, as readers, that we use healthcare to deny our mortality and death rather than to face it. Her story might not have a clear ending, but in exploring hypochondria, she helps readers see their story better because of what she has experienced and the research she has done.—Kevin Brown
Kevin Brown
Kevin Brown (he/him) teaches high school English in Nashville. He has published three books of poetry: Liturgical Calendar: Poems (Wipf and Stock); A Lexicon of Lost Words (winner of the Violet Reed Haas Prize for Poetry, Snake Nation Press); and Exit Lines (Plain View Press). He also has a memoir, Another Way: Finding Faith, Then Finding It Again, and a book of scholarship, They Love to Tell the Stories: Five Contemporary Novelists Take on the Gospels. Find out more about him and his work on X-Twitter at @kevinbrownwrite or on kevinbrownwrites.com