A Condition of Doubt: The Meanings of Hypochondria by Catherine Belling (review)

In A Condition of Doubt: The Meanings of Hypochondria, Catherine Belling examines hypochondria not as a problem of anxious patients, but, provocatively, as a condition inherent in contemporary medicine. Belling, a scholar of literature and medical humanities, unpacks the acts of interpreting bodies, diseases, patients, and their stories that constitute the practice of medicine and that reveal its integration in biology, culture, and language. Belling's study counters medicine's positivist habits of interpretation that hypochondria, she claims, especially places in doubt. She replaces such interpretations with unexpected readings of the hypochondriac's story and turns the unstable sign of hypochondria into a "diagnostic test for pathology . . . in medicine's stories" (74).

One prevailing story concerns medicine's presumed diagnostic acumen. Aided by technologies that appear to make bodies increasingly more transparent, modern medicine seems to offer the possibility of omniscience to those who practice it and those who entrust their well-being to it. Ironically, Belling discovers, the hypochondriac is the patient who most assiduously shares the physician's belief in the possibility of "benevolent medical omniscience" (10). Why else do these patients repeatedly return to doctor's offices? Yet the hypochondriac's insistence that he or she harbors an illness that eludes confirmation only incites the doctor to doubt the patient's story. Belling notices that the doctor's doubt and the anger it frequently ignites indicate less about the veracity or rationality of the patient than about the doctor's reluctance to acknowledge "the epistemological fragility of a medicine that sees itself as primarily a science" (40).

Rather than regarding hypochondriacs as unreliable narrators, Belling finds that they speak difficult truths. They are correct, for instance, in assuming that something potentially threatening is lurking (a word Belling repeats) in their bodies. In Belling's unsparing description: "we contain blood, and we end in death and the horror of the corpse" (5). Hypochondriacs seem more attuned than others to the "inescapable experience of embodiment" (60) and less able to sustain the fiction of invulnerability. The hypochondriac's credible narrative of vulnerability casts doubt on contemporary medicine's attempts to deny death and to define health as the absence of disease. Living in what Belling calls "a medicalizing society" (14)—one in which public health messages regularly subject us to the medical gaze and encourage vigilance for early detection of disease processes, we all participate to some degree in hypochondria's narrative. Furthermore, we live longer, sometimes for decades, with illnesses and injuries that killed previous generations. Given these conditions, the hypochondriac's vigilance is not unreasonable and being declared completely free of disease is not credible. Perhaps, Belling's argument continues, what merits doubt is the story that biomedical science, hegemonic in contemporary Western culture, is the most trustworthy "way of knowing any particular living body as it is inhabited and experienced by an individual patient" (30).

In Belling's reading then, hypochondria is not simply a condition within a person. Nor is it, she reminds us, somatization, an emotional or psychological state that manifests as a physical response or a symptom. Nor is it malingering, in which a healthy person feigns illness. Rather, hypochondria is a condition of embodiment, medicine, culture, and language: the four analytic categories that organize her discussion. The condition comes into being "in the gaps between the patients' subjective experience and medicine's demands for objective evidence" (32) and is therefore susceptible to misreading. Countering reductive understandings of hypochondria, Catherine Belling's important book calls for attentive, complex readings that are alert to the ironies that operate within these gaps and that unsettle oppositional and hierarchical structures implicit in medicine, among them doubt/ certainty, culture/biology, patient/physician, sick/well, imagined/real, subject/object. The figure of the hypochondriac and the meanings of hypochondria make evident what's at stake—for clinical medicine and also for how we live—in reading with attention to such complexities.

Belling offers seventeenth-century playwright Molière...