It is difficult to be diagnosed as a hypochondriac. Though “hypochondriasis” remains in the World Health Organization’s International Classification of Diseases (ICD-11), it was removed from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) more than a decade ago, when it was replaced with the diagnoses of “somatic symptom disorder” and “illness anxiety disorder.” According to the most recent manual, the DSM-5-TR, those formerly considered hypochondriacs are either unduly distraught by the presence of real physical symptoms or else needlessly afraid of developing an illness they simply don’t have.
And yet, the many meanings of hypochondria persist. “The hypochondriac is well known, anecdotally, to all of us,” notes Brian Dillon, not as a clinical diagnosis but “as a character type.”1 Those who identify as or are accused of being hypochondriacs have long been derided as foolish, self-indulgent, overly sensitive, and, more recently, too online. The hypochondriac can be a source of frustration for healthcare professionals and loved ones alike. This may be because, as scholar Catherine Belling puts it, “hypochondria stubbornly refuses to have anything more at its core than questions.”2
But as governments across the globe fail to address—and indeed exacerbate—myriad health crises, there is good reason to question the limits of both medical knowledge and available care. In “The Health of Us,” composed in 2009, the poet Claudia Rankine writes:
if justice was how love showed itself in public then love
was defined by access to care when someone anyone
thought that cough that burned the chest
was probably nothing but who knew …3
In a poem about the promises and possibilities of universal healthcare, the speaker does not bemoan hypochondria as a waste of shared resources. Rather, Rankine suggests that the body’s ambiguities are all the more reason why care should be available to “someone anyone” in the throes of such uncertainty.
More than a decade later, the literature of hypochondria wrestles with how politics shapes both medical information and healthcare. Recently, two books on hypochondria by English writers have traced its long cultural history, turning to figures ranging from John Donne to George Costanza. Both Caroline Crampton’s A Body Made of Glass: A Cultural History of Hypochondria and Will Rees’s Hypochondria recount stories of health anxiety to illustrate Belling’s claim that hypochondria mobilizes questions about the limits of biomedical knowledge and discourse. Meanwhile, Spanish writer Marta Sanz’s autofiction narrative of ambiguous chronic pain, My Clavicle: And Other Massive Misalignments, translated by Katie King, expands the hypochondriac’s concerns to other realms of 21st-century life. What, she asks, does it cost to be ill amid economic crises?
Taken together, these new works present hypochondria as at once a personal and a global phenomenon. As such, they offer illness narratives that are less accounts of sickness itself than reckonings with medicine’s limitations.
Today, health anxiety is characterized largely by the patient’s relationship with healthcare. The hypochondriac is at once suspicious of medical authority and eager for it to advance, as when Rees fantasizes about “a scan that would light up every region of my body” and offer “complete and perfect knowledge.” If, as Belling argues, hypochondria is at its core a “condition of doubt,” then its primary task is to throw into question each new development in biomedical understandings of human health. As Crampton puts it, “our fears keep pace with our knowledge”—and that knowledge is always politically circumscribed.
Taken together, these new works present hypochondria as at once a personal and a global phenomenon. As such, they offer illness narratives that are less accounts of sickness itself than reckonings with medicine’s limitations.
While both A Body Made of Glass and Hypochondria situate their authors’ health anxiety within a long tradition, they also portray hypochondria as a condition entirely contingent on one’s historical moment. They each detail, for instance, the early understanding of hypochondria as a specific physical malady (its etymological origins lie in the Greek hupo, or “under,” and khondros, which refers to the cartilage of the sternum). They show, too, how in the 19th century, hypochondria was increasingly seen as a nervous condition. It became associated with men largely through its differentiation from the feminized condition of hysteria, and both were seen as distinctly white, middle-class diagnoses. Notably, both Crampton and Rees penned their books at the beginning of the COVID-19 pandemic, a period that prompted new anxieties about illness. As cultural histories of hypochondria, then, both books highlight the term’s malleability and use it as a window onto shifting medical and scientific beliefs.
Many patients seeking care have good reason to doubt medical knowledge. Race, gender, and class significantly impact healthcare providers’ perceptions of their patients’ credibility.4 Furthermore, as part of what Rees describes as medical research’s “circular logic,” conditions disproportionately affecting already marginalized groups tend to receive less research funding, which in turn positions those patients’ complaints as outside the boundaries of medical understanding.
Even when medical knowledge accounts for a patient’s physical experience, uneven access to care often exacerbates health inequities. Because both Crampton and Rees live in the United Kingdom, their contact with medicine occurs within the context of the UK’s National Health Service (NHS). Both note the NHS’s limitations: for Crampton, its bureaucracy; for Rees, its privatization. But they also hold up the United States’ for-profit healthcare system as a foil for their own. The US, Rees notes, is “a country where certain members of the worried well can enjoy limitless choice while window-shopping for ailments at the same time that millions of the un- or under-insured can barely afford a blood test.” Crampton, too, points out that Hispanic, Indigenous, and Black Americans are disproportionately likely to find themselves among the 27 million without health insurance.
As both writers make clear, many patients bring economic fears to the clinic. Recalling a prolonged period of concerns about his health that involved a series of time-consuming appointments, Rees notes that these “recent absences had been expensive” due to his lack of paid sick leave. Imagining the experiences of Americans and others navigating extensive medical bills, Crampton remarks, “The performance anxiety that I feel in trying to accurately represent my symptoms and experiences to a doctor would be amplified many times over with so much money at stake.” In other words, she describes a kind of healthcare anxiety, in which financial stressors amplify existing fears about physical health.
Perhaps, then, the fear of illness is not so irrational, given both the realities of under-researched conditions and the prospect of not being able to access care without significant financial consequences. Although Crampton and Rees confess their affinity for the term “hypochondria” (even as it becomes clinically obsolete), their books invite a broader stance of uncertainty that transcends individual anxiety. Indeed, A Body Made of Glass and Hypochondria do more than defend the hypochondriacal position. They invite readers to ask questions of their own about the systems they rely on for care.
The hypochondriac’s uncertainty finds a new sense of urgency in Sanz’s autofiction narrative, My Clavicle. The first English translation of Sanz’s work, My Clavicle is a dizzying, fragmented book that centers on a mysterious pain plaguing an insistently self-contradicting narrator. The book opens with the narrator noting “the presence of a particular rib underneath my left breast. And, on that rib, I feel a bump like the head of a pin, or a literal bloodsucking tick, and suddenly I’m sure it’s the harbinger of a malignancy.” Notably, anatomical location of this first pain harkens back to hypochondria’s origins beneath (hupo) the sternum (khondros). However, much like the shifting status of the term “hypochondria” itself, the narrator’s pain moves and transforms over the course of the book, taking on manifold meanings and eventually making its way to her titular clavicle. Throughout the book, she is unable to decide whether she is a “an actual hypochondriac” or is having a rational response to the prospect of being ill in the 21st century.
Like Crampton and Rees, Sanz narrates ambiguous pain largely through a series of disappointing medical appointments. While the various specialists she encounters offer a range of theories for her pain, she observes that “no one mentions the word menopause,” though the narrator is in her late 40s. She makes clear, though, that such an explanation would offer little relief in the context of Spain’s underfunded Servicio Nacional de Salud. While, in typical hypochondriacal fashion, she craves medical expertise—“someone in a white lab coat” who can provide both “a name” and “a painkiller” for what ails her—she also recognizes the barriers to such interventions. “Sorry,” she ventriloquizes, briefly becoming the lab coat–wearing expert herself, “there’s no budget for that. Because its fucking natural, isn’t it?” For Sanz, the hypochondriac’s fantasy is not only of an all-seeing test, but also of changes to healthcare funding. She’s as concerned with the limits of medical knowledge as she is with the Spanish healthcare system’s failure to invest in understanding aging women’s bodies.
When she describes her current phase of life as “the age of mysterious ailments,” the narrator refers not only to the changes wrought by menopause but also to fears that include “ending up … broke.” When one healthcare provider asks what she’s afraid of, the narrator confesses, “Of being sick. Of not being able to work.” She is, she explains, “sick with fear that the world is collapsing and that my illness will keep me from paying the bills.” Pain, for Sanz’s narrator, is inextricable from financial precarity. She reckons, too, with the marketplace into which the ill are thrust. She imagines weighing her ambiguous pain on a “capitalist scale” to determine both its nature and what it might cost her. Predicting that she will become mired in either the labyrinth of modern healthcare or the behemoth wellness industry, she determines that there is little relief in diagnosis under capitalism.
Throughout My Clavicle, Sanz’s narrator wonders whether the ambiguously unwell are simply “self-absorbed” or rather are absorbed by the innumerable global crises that “have all entered our bloodstream.” She aligns herself with other Spanish women writers who “understand the uncertainty of our lives during a global recession and brutal government austerity, and … write about it because it pains us.” Sanz posits that this porous boundary between self and world can also be a site of dissent. When women confront the anxiety elicited by governmental harm and “resist by somatizing it, making it physical,” the disproportionate rates of ambiguous illness in women register as a symptom of patriarchy.
Furthermore, though she attributes both her ill health and her financial anxieties to her gender and age, Sanz also insists that “the economic crisis and the government’s austerity policy and its fallout have made us old before our time.” Toward the end of the book, she writes,
The belt tightening, benefits cuts, ridiculous government euphemisms, political profanities and angry outbursts, and personal income tax withholding and 21 percent VAT have all entered our bloodstream, like demonic bacteria, and are now, in fact, part of our platelet count and will cause the disease that, I swear to god, is going to kill us all.
As the Spanish government’s austerity measures spill out of the narrator like a litany of distressing symptoms, her supposed health anxiety becomes fully legible as concerns about vulnerability in the absence of care. Indeed, even as her insistently self-contradicting narrator draws readers into the uncertainty of living with an “imaginary illness,” Sanz underscores the very real political forces that make disease a prospect worth fearing.
Near the end of My Clavicle, Sanz’s narrator expresses her need “to name what’s happening to me and, with the name, feel that I’m part of something.” Clinical diagnoses can certainly provide this sense of community by likening a patient’s condition to that of others. Even the label “hypochondria,” in Crampton’s experience, “offers companionship while in the grip of a fear that can be completely isolating” because it “connects sufferers stretching back over 2,000 years.”
But there are also other kinds of collectivity that can aid the hypochondriac. “If health care were available to everyone,” writes historian Timothy Snyder in Our Malady: Lessons in Liberty from a Hospital Diary, “we would be not only healthier physically but also healthier mentally. Our lives would be less anxious and lonely because we would not be thinking that our survival depended on our relative economic and social position.”5 Indeed, by learning, as Rankine puts it in “The Health of Us,” “to see / our range of possibilities as a precious commodity,” we might invest in systems of care that place value on human life—with all of its attendant uncertainties.6 
This article was commissioned by Liz Bowen.