Welcome to Medical Histories, a series that brings you curious stories from the history of medicine. In this first instalment, we look at the apparent epidemic of “hypochondriac disease” in the early modern period.
Lots of common and country folk, of both sexes, come to me very frequently seeking advice and cures for murmurings and motions, continual and extraordinary, persuading themselves most stubbornly that they have accidentally swallowed the spawn of frogs or other beasts in drinking water, from which, in their bodies, those beasts have thereafter hatched and been nourished … Since I have to agree with them, whether I like it or not, in deference to their most fixed melancholic impressions, I prescribe either vomitives or cathartic medicines, and I expel these imaginary beasts with their melancholy feces, not without ample incantations, to the great relief of the sick.
This passage comes from a seventeenth-century medical treatise, The Hypochondriac Microcosm, by Munich physician, Malachias Geiger. Like so many medics during the early modern period, Geiger was preoccupied by an apparent epidemic of “hypochondriac disease” that had been sweeping Europe since the late Renaissance.
But hypochondriac disease in this period was not exhausted by the sort of imaginary illness described above by Geiger. For early modern writers, afflictions of the “hypochondria” were just that – real sickness caused by disorders of the organs “below” (hypo-) the “cartilage of the ribs” (chondria).
Disorders of digestion could give rise, via the transmission of noxious vapours through the body, to respiratory and cardiac problems, and in the case of “hypochondriac melancholy”, to severe psychological anguish and delusions.
Sufferers harboured unreal beliefs – one was made of glass; another had turned into a bird; one was a king, the pope, or the most brilliant or irresistible man alive. It’s difficult to credit such sensational “symptoms”, especially when they are attributed so widely and to anonymous individuals.
But we can point to at least one historical, self-convinced victim of the malady, the Dutchman Caspar Barlaeus (1584-1688). A famous poet, theologian and physician, Barlaeus seems to have come to believe that he was made of butter, and drowned himself in a well.
Interestingly, such extreme derangements of the imagination (the image-processing faculty in the brain) were not usually thought to affect the reason. The healthy reason, if you like, was merely working with faulty perceptions. But there was also a recognition that such delusions, which would be classified by modern psychiatrists variously as “psychotic” or “somatoform”, were closely connected with the emotions, or “passions of the soul”.
Reviewing Barlaeus’s case, an eighteenth-century Dutch physician, Gerard Nicolaas Heerkens, concluded that the poor man had come unstuck because of a well-founded anxiety about religious persecution; not, as one of Heerkens’s fellow physicians claimed, because of the long-term ill-effects of the sedentary academic life!
The connection between mental health and lifestyle, including diet, exercise, social and sexual intercourse, was certainly no invention of modern medicine. But what, if any, are the lessons for modern psychiatric theory and practice of the experience and diagnosis of early modern hypochondriac disease?
Modern “hypochondriasis” according to both the current diagnostic “bibles” for mental disorders – the DSM-IV-TR and ICD-10 – requires patients to show chronic anxiety that they have one or more specific diseases, such as cancer or multiple sclerosis; be hyper-vigilant about bodily symptoms; and have been doctor shopping.
Early modern hypochondria sufferers were also anxious about their health and notoriously dissatisfied with their doctors. The difference between now and then is that they and their doctors “knew” and named the malady from which they suffered – it was hypochondriac disease, and it was serious.
Bodily suffering is not necessary in modern day “hypochondriasis”, but the gastrointestinal problems mandated by the DSM-IV for modern “somatisation disorder” (patients seem to experience real physiological problems and distress) were hypochondriac problems par excellence in the early modern period. Indeed, most early modern patients would be classified by modern psychiatrists as “somatizers”, sufferers from a different kind of “somatoform” disorder.
Needless to say, dark religious scruples leading to self-castration, motor and neurological problems, the sense that one’s bed is crawling with snakes and other such symptoms would not appear anywhere near the modern DSM and ICD definitions of “hypochondriasis”. My research collaborator, a neurologist and psychiatrist, informs me that he often sees in his practice patients with delusions of being infested with parasites who are, nonetheless, not especially anxious about their health. They are thus not hypochondriacs as defined by the DSM.
Histories of illnesses like hypochondriac disease leave one wondering whether modern psychiatry has really de-cluttered the diagnostic house or merely rearranged the furniture. There is certainly nothing in modern definitions of illness in the ICD or DSM that speaks to the aetiology of the sufferings (let’s not call them symptoms) associated with these “disorders”, let alone guarantees better treatment of patients.
In the seventeenth century the typical hypochondriac (usually a man) would have grizzled about his guts, been fearful, sad and perhaps even delusional. He would have turned to his physician for both physical and psychological care, not just a quick prescription.
A label of “melancholy hypochondriac” would be just the beginning of a course of multi-pronged, no doubt often misguided, attempts to alleviate his suffering – bodily, emotional and even spiritual. For his doctors, the baffling hypochondriac illness was never “all in the mind”, let alone reducible to a neat checklist.
The messy work of tracing the long conceptual history of “mental” disorders is probably not to the taste of busy modern psychiatrists. But scientists should, after all, be in the business of evidence, not bibles.
This is part one of Medical Histories – click on the links below to read the other articles: