Psychosomatics 50:430-431, July-August 2009
doi: 10.1176/appi.psy.50.4.430
© 2009 Academy of Psychosomatic Medicine
Well Enough Alone: A Cultural History of My Hypochondria
By Jennifer Traig, Ph.D., New York, Riverhead, 2008, 272 pages, ISBN-10: 1594489912, $23.95
Craigan Usher, M.D.
As psychiatrists, we often find ourselves maintaining a delicate balance when confronted with popular media portrayals of mental illness that are intended to be funny. Although we appreciate that humor can help patients (and their psychiatrists) cope, there is much to be offended about, with ignorant, insensitive, inaccurate, stereotype-reinforcing portrayals abounding. Jennifer Traig’s Well Enough Alone: A Cultural History of My Hypochondria offers plenty of opportunities to wrestle with this dialectic. There is plenty to laugh at (the book is a spectacular pun-fest), and, overall, there is much to recommend this book to patients struggling to find humor in their hypochondriacal concerns and to physicians in need of a breather. Still, there is also some cringe-worthy material.
Traig is a clever, gifted writer, whose work has appeared in The New York Times and in the literary magazine The Believer. Well Enough Alone is the follow-up to her popular book Devil in the Details, which detailed her teenage struggles with religious preoccupation, anorexia, and obsessive-compulsive disorder (OCD). Intimately familiar with the overlap between OCD and hypochondria, Traig opens Well Enough Alone by linking the two: "With OCD, I worry about the electrical outlet, and with hypochondria, I worry about the mole, but the exercise is the same—an endless lap around a circuit I can’t break (p 13)." She goes on to note that OCD and hypochondria have been shown to have genetic links, but jokingly offers that "it’s become more common for transmission (of hypochondria) to occur through the internet." Here, she introduces the term "cyberchondriac" and notes how pervasive subclinical forms of the disorder are in an age where we can easily access on-line medical information with which we can (often mis)diagnose ourselves and loved ones with hideous maladies.
In Chapter 2, the author offers a brief pseudo-history of hypochondriasis. I use the term "pseudo" because Traig often blends accurate historical data with humor, such that facts become blurred. An example comes when Traig writes about Freud. She notes that the father of psychoanalysis speculated that hypochondria was "caused by the body directing its sexual impulses back at itself." "He’s right, in a sense," Traig asserts, "because the hypochondriac does ‘screw’ (she uses a different term) himself, wasting his time and energies on symptoms that amount to naught (p 26)."
The chapters that follow, a blend of personal history and wry comedy, feel more earnest and provide the heart of the book. In them, Traig not only details how hypochondriasis affected her life, with frequent visits to the ER and physician’s office, but also how somatic preoccupation affected her decisions around getting necessary medical treatments. Traig writes, for example: "In the Bible, you get the disease you deserve, a sty for an eye. Skin diseases tend to be punishment for the sins that should leave you shamefaced (p 180)." Hence, she reports hesitating before going to the dermatologist, worried that he "would look at my face and instantly know...I’d been behaving shamefully." Although Traig doesn’t announce this point, the chapters at the heart of this book also offer insight into obsessive-compulsive behavior—as she constantly writes about "doing and undoing," "building and taking apart," in an endless cycle. This is revealed in her writing style, where she gives information that is heartfelt and daringly self-revealing, then takes away the severity by use of wit and humor.
You will recall I wrote earlier that there was much to recommend this book to patients eager to look at the lighter side of hypochondriasis. Indeed, it is inspiring to see the ways in which Traig tackles her fears of disease with a successful counterphobic response, working in a gastroenterology office by day and writing by night. Furthermore, it may prove refreshing and hopeful to patients suffering somatic preoccupation/hypochondriasis to read about suffering relieved by psychiatric treatment. Traig writes: "It’s true that SSRIs don’t work for everyone, but I got lucky. Prozac cured the irritable bowel syndrome, as well as the brain cancer, kidney failure, diabetes, and gout"—worries about which had plagued the author for two decades.
This also may be a refreshing read for physicians; offering a chance for us to laugh at ourselves. Writing of doctors’ "famously illegible penmanship," she notes: "I’m not sure it’s worse than anyone else’s, but the stakes are certainly higher. When the difference between R EAR and REAR is whether your ointment goes into your right ear or your rectum, you hope the writing is clear."
Although Traig’s book is funny and often endearingly honest, for some readers there are parts that I anticipate will fall offensively flat. One example occurs in the opening chapter when, writing of the hypochondriac, Traig asks what’s the point of treating someone "who (isn’t) even crazy in a fun way? At least with paranoid schizophrenics, you get good stories." Despite this concern, I encourage those seeking a pun-packed, compelling memoir about OCD and hypochondriasis not to leave this book well enough alone.
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FOOTNOTES
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Dr. Usher is Assistant Professor of Child and Adolescent Psychiatry, Oregon Health and Science University, Portland OR.
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