Health and the Rhetoric of Medicine

4. Hypochondria as a Rhetorical Disorder

74 Hypochondria as a Rhetorical Disorder 4 Hypochondria as a Rhetorical Disorder If primary headache is the headache that is of interest in itself, not as a symptom of meningitis or brain tumor, then, on analogy, hypochondria is a kind of primary suffering, a suffering in itself, more complete because it takes place at a heightened level of awareness. Indeed, reflection is what ties hypochondria of the eighteenth century to hypochondria of the twenty-first. In the late eighteenth century, James Boswell describes the suffering of the hypochondriac—himself. Boswell’s hypochondriac feels ill and is languid, but he suffers not only from his illness and his languor but also from his memory of a time before them; he suffers by comparison with his former state of activity. Yet he is more miserable for not being able to wish to return to his former happiness because he is certain he was deceived in it. Or he desires to be alone, and he despises himself for that desire. While hypochondria is not the same disorder now as it was in Boswell’s time—the historical variability of the disorder under hypochondria’s name is one of its most interesting features— hypochondria’s relentless, ruminative misery endures as its characteristic mode of suffering. Hypochondria is an irresistible topic for rhetorical study in health because it is essentially a rhetorical disorder. Contemporary hypochondriacs are people who have become persuaded in the absence of an organic precipitating cause that they are ill. Often, external agents who publicly advertise diseases and treatments have persuaded them that they are ill; in private, and often in the middle of the night, hypochondriacs have per- 75 Hypochondria as a Rhetorical Disorder suaded themselves. Hypochondriacs bear the burden, then, of persuading physicians and others (family members, for example) that they are in need of care. Only rhetorical resources are available to them for this purpose. Hypochondriacs make their case for disease with arguments more reliably left to blood or heartsounds or ultrasounds; the very complaints of the hypochondriac are challenges to belief, lacking demonstrable correlatives in the body. Hypochondriacs, furthermore, make demands on the rhetorical capacities of other people: Physicians, for example, try to persuade them that they are well. Overall, the hypochondriac’s interlocutors are unsuccessful ; if they were successful, the hypochondriacs in question would not officially be hypochondriacs (hypochondriacs are defined in part by their inability to be persuaded that they are well). Hypochondriacs, finally, inspire other patients to dissociate rhetorically from them. Persons with fibromyalgia , chronic fatigue syndrome, chemical sensitivity, and whiplash and others who understand themselves to be taken as suspect patients seek to persuade other people that they themselves are not hypochondriacs. So, its myriad persuasions make hypochondria a rhetorical disorder in its own right. Hypochondria is also a rhetorical disorder in relation to the culture in which it appears. As was noted in the chapter on migraine, discourse fills the space that certainty in medicine leaves unoccupied. Much about the medicine of a time and a place is revealed by that discourse . The hypochondriac inhabits a specific illness-discourse universe, but also medicine as a set of terms and practices gives at different times and places different accounts of its suspect patients in general and its hypochondriacal patients in particular. Hypochondria, in other words, is importantly kairotic. In 1912, British physician Frederick Parkes Weber wrote about female patients with a condition he called “hysterical malingering ” (a sort of irrepressible impersonation of an ill person). The “tendency to simulation and deception” was not surprising in these patients, for women, in Weber’s view, were bred for deception, an “exaggeration . . . of an instinct which is normally greater in women than in men, the greater prominence in woman of the tendency or instinct to deceive constituting a normal psychical sex character” (138). That is, in Britain, in 1912, a reputable physician might proffer a Darwinian, and thoroughly sexist, account of certain complex complaints, finding in the general discourse of the time (Weber was a great collector of newspaper clippings and a dutiful archivist) support for the thesis that hysterical malingering might be associated with a tertiary sex characteristic arising from the natural selection of wily women, their wiles compensating for their deficits in physical strength. And the trait might be weeded out by eugenics. 76 Hypochondria as a Rhetorical Disorder Hypochondriacs invite theories about themselves in part because they are, overall, medically anomalous.1...