Hypochondriasis

Hypochondriasis (synonyms—“the spleen,” “the vapours”), a medical term (from τὸ ὑποχόνδριον, τὰ ὑποχόνδρια, the soft part of the body immediately under the χόνδρος or cartilage of the breast-bone) given by the ancients, and indeed by physicians down to the time of William Cullen, to diseases or derangements of one or more of the abdominal viscera. Cullen (Clinical Lectures, 1777) classified it amongst nervous diseases, and Jean Pierre Falret (1794-1870) more fully described it as a morbid condition of the nervous system characterized by depression of feeling and false beliefs as to an impaired state of the health. The subjects of hypochondriasis are for the most part members of families in which hereditary predisposition to degradation of the nervous system is strong, or those who have suffered from morbid influences affecting this system during the earlier years of life. It may be dependent on depressing disease affecting the general system, but under such circumstances it is generally so complicated with the symptoms of hysteria as to render differentiation difficult (see Hysteria). Hypochondriasis is often handed down from one generation to another in its individual form, but it is also not unfrequently to be met with in an individual as the sole manifestation in him of a family tendency to insanity. In its most common form it is manifested by simple false belief as to the state of the health, the intellect being otherwise unaffected. We may instance the “vapourish” woman or the “splenetic” as terms society has applied to its milder manifestations. Such persons are constantly asserting a weak state of health although no palpable cause can be discovered. In its more definite phases pain or uneasy sensations are referred by the patient to some particular region, generally the abdomen, the heart or the head. That these are subjective is apparent from the fact that the general health is good: all the functions of the various systems are duly performed; the patient eats and sleeps well; and, when any circumstance temporarily overrides the false belief, he is happy and comfortable. No appeal to the reason is of any avail, and the hypochondriac idea so dominates his existence as to render him unable to perform the ordinary duties of life. In its most aggravated form hypochondriasis amounts to actual insanity, delusions arising as to the existence of living creatures in the intestines or brain, or to the effect that the body is materially changed; e.g. into glass, wood, &c. The symptoms of this condition may be remittent; they may even disappear for years, and only return on the advent of some exciting cause. Suicide is occasionally committed in order to escape from the constant misery. Recovery can only be looked for by placing the patient under such morally hygienic conditions as may help to turn his mind to other matters. (See also Neuropathology.)

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