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Hypochondriasis, now called illness anxiety disorder (IAD), is characterized by excessive worry about a serious illness. This persists despite appropriate medical evaluation and reassurances. Individuals suffering from this disorder tend to interpret normal or minor bodily sensations as severe disease symptoms. A slight cough could imply lung disease; a headache might suggest a brain tumor or minor chest pain might be seen as a heart attack.

What sets hypochondriasis apart from merely being cautious about one’s health? The answer lies in the severity of the worry and its impact on everyday life. An individual with hypochondriasis lives with constant, debilitating fear; it is not a fleeting concern. As IAD progresses, it becomes a lens through which they see their life, leading to significant distress and impaired functioning.

Historical perspective

Greek physician Hippocrates (c. 460–370 BC) first used the term “hypochondria,” referring to the anatomical area below the ribs that houses vital organs. The liver was considered the most important organ in the body, the source of the body’s natural heat, and the organ that made blood the most vital humor. The spleen was associated with black bile–the root of the word “melancholy” (melas – black, khole – bile). He theorized excess black bile led to melancholic symptoms, including sleep and appetite disturbances, restlessness, irritability, and a despondent state of mind, somewhat akin to our modern understanding of depression. Hippocrates and his followers connected mental and physical health. This laid the groundwork for later developments in psychosomatic medicine and conditions like hypochondriasis.

In the modern era, hypochondriasis was added to the list of neuroses Freud conceptualized as resulting from unresolved conflicts between unconscious desires and societal constraints. The symptoms served as symbolic expressions of these underlying conflicts.

In the last several years, clinicians recognized the variability of health anxiety and introduced two related diagnoses: Somatic Symptom Disorder (SSD) and Illness Anxiety Disorder (IAD). SSD involves distressing somatic symptoms and excessive thoughts and behaviors related to them. Illness Anxiety Disorder centers around excessive worry about having a serious illness despite minimal or no medical evidence supporting the belief. Diagnostic criteria emphasize preoccupation with illness, anxiety about health, excessive health-related behaviors (e.g., frequent medical consultations), and significant impairment in functioning.

Fear of death

Existential fear of death revolves around the fundamental awareness of mortality and our uncertain existence. Realizing life is finite and that we inevitably face death becomes intertwined with excessive preoccupation with physical health. Consistent worry about developing a severe illness seemingly confirmed by minor bodily sensations is taken as signs of imminent doom leading to cycles of dread and excessive reassurance-seeking behaviors. By focusing excessively on health concerns, individuals attempt to gain a sense of control over their mortality. They believe they can delay or prevent their demise if they detect and address any potential health issue. Fear of the unknown, losing autonomy and control over one’s body, and the desire to preserve one’s identity, relationships, and plans can drive us into IAD.

Psychodynamics

Jung believed every psychological symptom was the psyche’s best attempt to address an underlying problem, given all the inner and outer factors. Viewed from that perspective, intense fear of having an undiagnosed disease might arise from numerous unconscious dynamics.

In the early 20^th century, hypochondriasis was placed in the general category of Neurosis, which meant it was a condition of the nerves rather than a physical illness. As Freud refined his theories, it came to mean an intense inner conflict between instincts and internalized societal rules. When this created enough tension to interfere with functional neurological processes, it generated a variety of symptoms.

Jung initially accepted this theory of repression and, over time, added his discoveries. He writes:

“…tendencies [instincts] that are merely repressed are usually of a somewhat doubtful character. They are not so much antisocial as unconventional and socially awkward. The reason why we repress them is equally doubtful. Some people repress them from sheer cowardice, others from conventional morality, and others again for reasons of respectability. Repression is a sort of half-conscious and half-hearted letting go of things, a dropping of hot cakes or a reviling of grapes which hang too high, or a looking the other way in order not to become conscious of one’s desires. Freud discovered that repression is one of the main mechanisms in the making of a neurosis. Suppression amounts to a conscious moral choice, but repression is a rather immoral “penchant” for getting rid of disagreeable decisions. Suppression may cause worry, conflict and suffering, but it never causes a neurosis. Neurosis is always a substitute for legitimate suffering.” CG Jung, CW 11, Para 130

Identifying deeper conflicts that surface as ‘fear of undiagnosed illness’ is a journey of self-discovery, confrontation, and integration.

Symbolic Attitude

Misdirected fears are expressions of Psyche, who speaks in metaphor and image. The impulse to discover the secret illness that eludes outer examination is a call to descend into our inner landscape. We must become cartographers of our psychic bodies and map their terrain. Over time we may discover where our life force is flowing and the purpose of its redirection.

Jung discusses an example of this process in CW volume 7. He was consulted by a highly successful American entrepreneur who chose to retire at an early age. Previously, “he had lived entirely for his business and concentrated all his energies on it with incredible intensity and one-sidedness.” Despite purchasing a huge estate and settling into a life of pleasures, he began to brood “over peculiar, vague sensations in his body, and a few weeks more sufficed to plunge him into a state of extreme hypochondria.” As Jung followed his fantasies in analysis, the telos of the process was revealed, “…the ultimate goal was to drive him back, as it were, into his own body, after he had lived since his youth only in his head.” Though the ego had directed its attention to infantile pleasures, a deeper intelligence had a different priority. Jung cautioned, “Psychic energy is a very fastidious thing which insists on fulfillment of its own conditions. However much energy may be present, we cannot make it serviceable until we have succeeded in finding the right gradient.” The fantasies, dreams, and synchronicities that proceed from our suffering can reveal the purpose of our symptoms.

Fear of illness disrupts our energy flow. It sets us on a journey to find a suitable new direction for our life force. This often reveals the unconscious opposite of our previous priorities that demands attention. If that is fully explored, our irrational fears can dissipate.

If we follow, Psyche may reveal any number of fantasies hidden under the dread of an undiagnosed disease.

The fear of illness may arise due to an intense longing for attention and empathy, often manifesting as a craving for caregiving and nurturance. This can be addressed through a realistic vision where genuine, reciprocated relationships provide care and attention without the necessity of illness as a trigger. Such relationships foster an emotionally fulfilling social network.

At times, hypochondria springs from the quest for a unique identity or sense of purpose, using the perceived illness as a distinguishing factor. A healthier alternative lies in life where significance is found in personal achievements, interests, or talents, fostering an identity not reliant on health status.

Illness anxiety disorder may stem from a desire to evade confronting unpleasant emotions, conflicts, or responsibilities. In response, we can imagine an environment where we possess the tools and emotional strength to tackle challenges directly, eliminating the need to seek refuge in perceived illness.

Internal drive to avoid perceived failure and pursue perfection can fuel the fear of illness. Embracing a balanced perspective on success and failure becomes a constructive attitude, acknowledging the normality of faltering and reducing dependence on illness as a scapegoat.

Isolation avoidance can also drive hypochondriasis, leading to a constant yearning for care and attention. Developing independent skills and confidence becomes a healthier narrative, enabling contentment in solitude without fearing being forgotten.

Self-punishment due to perceived past wrongdoings or personal shortcomings can manifest as illness anxiety disorder. Relief involves achieving self-forgiveness and recognizing that everyone makes mistakes, eliminating the need to manifest suffering through perceived illness.

Dread of illness may arise from a need to feel special or unique, using the perceived illness as a standout factor. Recognizing our unique qualities and skills that make us special beyond health status creates a healthier sense of self.

Hidden desires to express dissatisfaction or exert control over others can drive hypochondria. An ideal scenario involves open and respectful communication of needs and cultivating healthier relationships free from manipulation through illness.

Unmet needs for nurturance and dependence can manifest as a terror of illness. Establishing mutual, caring relationships fulfills the need for nurturance without resorting to illness to elicit care.

A need for certainty or predictability amidst chaos may underlie illness anxiety disorder. Developing coping strategies to navigate uncertainties and lead a balanced life becomes the ideal position, eliminating dependence on illness for stability.

The myriad psychic conflicts that give rise to Illness Anxiety Disorder can seem daunting. But we might rally if we understand our exaggerated fears are serving to push us away from deeper truths. By relaxing into the fantasies that arise when panic grabs us, they might lead to unexpected insights. If we can ask, Why is Psyche leading me here, a new meaning may emerge, offering us a thread to tug and unravel our misdirected dread.

HERE’S THE DREAM WE ANALYZE:

“I’m inside my 7-year-old nephew’s classroom with him during a school day. He has a lot of excess energy, and his teacher is frustrated with him disrupting her lesson. I feel I should do something to help, but I am unsure what to do. I’m caught between understanding where the teacher is coming from and wanting to validate my nephew’s needs. The teacher asks me to take him out of the classroom, which I do. I take him outside. I plan to validate and comfort him, but as he runs outside, he suddenly turns into a bird, what looks like a brown hawk, and starts flying above the ground. There’s a sense of ecstatic joy about him. Another bird moving very fast flies past him and clips his wing as he flies. He falls to the ground, and I rush over to help. He’s ok, but his wing is wounded. I wake up.”