Hypochondriasis (Gr. under, andcartilage), a disease generally classed among neuroses, characterized by derangement of various organic functions, and accompanied by an habitual sadness, often bordering on despair, and a disposition to exaggerate every trifling symptom into a sign of dangerous malady; probably so called because it was formerly attributed to disorder of the spleen, an organ situated in the left hypochondrium. It occurs principally in persons of melancholic temperament, and in those whose moral and intellectual faculties have received high and unnatural development; it is said to be common in proportion to the elevation of the human mind and to the progress of civilization. Men of letters, overtasked students and men of business, and those whose naturally delicate constitutions and ardent imaginative minds have been abnormally stimulated, are the most frequent subjects of hypochondria; but it may arise at any age and in the strongest persons after profound grief or other moral emotion, whether of love, hope, jealousy, or fear, debilitating excesses of any kind, the suppression of any habitual discharge, a sudden change of habits of life, or unceasing devotion to any philanthropic, political, or intellectual pursuit.
The symptoms are as various as its causes and the constitutions of men; there is not a part of the body which may not be the subject of the hypochondriac's complaint; the senses are ordinarily very acute, and the sight, hearing, smell, taste, and touch are preternaturally excitable, and the sources of great real or imaginary suffering from the slightest causes; there is almost always digestive disturbance, which enters largely into the explanation of the causes; without fever or local lesion, the sensibility is exalted, with flatulence, nausea, spasms, palpitations, illusions of the senses, aches and pains simulating most diseases, fear of trifling dangers, exaggeration of all the moral sentiments, extreme instability of conduct, and anxiety in regard to the health. The head is full of painful sensations, as fugitive as passing clouds, agonizing at one moment and forgotten the next; sleep is disturbed and unrefreshing, and the waking hours rendered miserable by imaginary troubles. Expressing complete disgust with life, the sufferers yet run to the physician with an account of every fugitive pain, and consider themselves neglected if not listened to, and insulted if their ailments be called imaginary. Both sexes suffer from hypochondria, and the female specially in the reproductive system.
Though in the beginning the disorder may have been wholly in the digestive organs, and that only of a functional and curable character, by constant and morbid attention to these and other fancied ailments real and organic disease may be produced, and a return to health be impossible. It is generally slow in coming on and of long duration, and is not incompatible with long life; if the digestion be tolerably good, the prognosis is favorable, as such persons are apt to observe most rigidly the ordinary rules of hygiene; in some impressionable but resolute natures, it degenerates into a settled melancholy, which a slight cause may convert into temporary insanity and suicidal mania. It cannot be said to have any special organic lesions, though in severe and fatal cases there have been found various alterations of the digestive, circulating, and nervous systems. There are two opinions as to the nature and seat of hypochondria: one is that it is an irritation of the nervous system which presides over the digestive organs, with or without gastro-intestinal inflammation; and the other that it is a cerebral neurosis, a kind of melancholy, as proved by the constancy of the cerebral symptoms and the efficacy of moral methods of treatment.
Some modify the latter opinion by tracing it to a disturbance of the intellectual powers, which acts upon and impedes the functions of all the organs by concentrating the whole nervous energy in turn upon each system, organic lesions following upon the neurosis and displaying the morbid symptoms peculiar to each. As a general rule the disease is of far less moment than the formidable array of symptoms, the complaints of the patient, and the expression of suffering would indicate; sometimes deceitful, and their feelings misinterpreted both by themselves and the physician, irritable, suspicious, and versatile, hypochondriacs are exceedingly troublesome and unsatisfactory patients. Children of hypochondriac parents, if they show any signs of uncommon nervous susceptibility, should be educated in a manner calculated to diminish the preponderance of the nervous element, and to increase the physical strength, as by avoiding excess of study and all excitement, cultivating the generous sentiments, and by gymnastic exercises; in this way the ranks of hypochondriacs would be much lessened.
Attention to the causes, when these can be ascertained, and their removal as far as possible, the observance of hygienic rules adapted to circumstances and constitutions, avoidance of excess in eating and drinking, and perhaps an occasional laxative or a tonic course, are probably all that can be done in the way of treatment. But in order to be of any benefit to his patient, the physician must secure his confidence, and accustom him to the belief that his affection is understood, his feelings appreciated, his sufferings commiserated, and his complaints attentively listened to; having inspired this confidence, it is not difficult to lead even the most confirmed hypochondriac to change his stereotyped way of regarding men and things, to interest him in new enterprises and modes of thought, and by judicious management to put him in the way of a return to health by following the dictates of his own feelings and common sense.