Hull, England, United Kingdom
|Figure 1: Cover of Hypochondriasis. A practical treatise by John Hill. Source|
In words, as fashions, the same rule will hold;
Alike fantastic, if too new, or old:
Be not the first by whom the new are tried,
Nor yet the last to lay the old aside.
– Alexander Pope
The changing use and meaning of words are the daily bread of dictionary compilers. Long ago the ever-changing idiomatic use of language was observed by the Athenian historian Thucydides (c.460-c.404 BC) in The Peloponnesian War:
Words had to change their ordinary meaning and to take that which is now given them. Irrational daring came to be considered the courage of a loyal supporter; prudent hesitation, specious cowardice; moderation was held to be a cloak for unmanliness . . .
When the meaning of a word changes, it usually reflects a contemporaneous change of context, ideas, social values, and implications, or it may be a clever linguistic device. It was the playwright Dennis Potter who wittily noted that “the trouble with words is that you never know whose mouth they’ve been in.” For instance, the words—silly, naughty, nice, awesome, egregious, pretty—like hundreds of words—have drastically changed their meaning with time.
Today television, magazines, and social media are almost obsessed by new objects of change: mental heath issues, stress (post-traumatic and otherwise), and depression of various categories. These labels are arbitrary but have largely replaced neurosis, anxiety states, nervousness, and neurasthenia commonly used in earlier centuries, though undoubtedly, they represented the same human symptoms and condition. Mental illness was not so called until in 1788, then defined as a serious abnormality in a person’s thinking or behavior . . . a psychiatric illness. This too has changed its social acceptability and is now “somewhat dated, and sometimes avoided as being potentially offensive” (OED). Absurdly, it appears that the newer pleonastic phrase Mental Health Issues is preferable. Traumatic experiences and stress are widely broadcasted without reference to Hans Selye’s use of stress to represent the effects of anything (physical or psychological) that seriously threatens homeostasis.1 Even the word neurosis is no longer used as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Its meaning remains but its social and medical acceptability have changed.
Although hypochondriasis has been replaced by “Illness Anxiety Disorder” in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as recently as July 2010 The Independent observed, “One in ten patients attending hospital has health anxiety disorder—the new name for hypochondria.”
How does something literally meaning “under the cartilage (ribs)” relate to these “nervous” symptoms? The answer can be traced to the 1500s. Hypochondriasis was then believed to be an organic, physical illness related to disease of the liver and spleen under the rib cage (hypochondrium), with generation of malevolent black bile and vapors. The word derives from Late Latin hypochondria, from Greek hypokhondria from hypo– “under” + khondros cartilage (the ribs). In post-classical Latin, Hypocondry Melancholy was referred to the spleen. Attributing the malady (which he understood was real, not imaginary) to obstruction of the spleen and liver, Sir John Hill MD stated in his book: (Fig 1):
To call the Hypochondriaſis a fanciful malady, is ignorant and cruel. It is a real, and a ſad diſeaſe: an obſtruction of the ſpleen by thickened and diſtempered blood; extending itſelf often to the liver, and other parts; and unhappily is in England very frequent: phyſick ſcarce knows one more fertile in ill; or more difficult of cure.2
The great Thomas Sydenham in a letter to Dr. William Cole of Worcester in 1681 systematically detailed the many and diverse bodily symptoms3 as the same phenomenon—hypochondria in men and hysteria in women—a state of anguish and despair:
“This Disease, most frequently occurs of all chronic diseases: one half, of all chronic diseases;” this he estimates “as one sixth of all human maladies . . . women, except for those who lead a hardy and robust life, are rarely quite free from it; Those men who lead a sedentary or studious life are subject to the same complaint; in their case it is indeed called Hypochondria; but this disease is as like Hysteria as one egg is like another . . . ‘Moreover, the Sick is oppressed by a dreadful Anguish of Mind, and wholly despairs of Recovery;”4
The sense of hypochondria as an “unfounded belief that one is sick” seems to begin in the 1790s with William Cullen, professor of physic in the University of Edinburgh. His description is lucid, though his conclusion is perhaps critical:
A languor, listlessness, or want of resolution and activity, with respect to all undertakings; a disposition to seriousness, sadness, and timidity; as to all future events, an apprehension of the worst or most unhappy state of them; and, therefore, often upon slight grounds an apprehension of great evil. Such persons are particularly attentive to the state of their own health, to every the smallest change of feeling in their bodies; and from any unusual sensation, perhaps of the slightest kind, they apprehend great danger, and even death itself. In respect to these feelings and fears, there is commonly the most obstinate belief and persuasion.5
To Cullen, the clinical definition of hypochondria included physical symptoms and pains as well as mental apprehension.
The meaning continued to evolve so that by 1816 the sense had narrowed to a sense of “depression or melancholy without real cause.”
|Figure 2: “Worried Sick” comic by Doug Savage. From Savage Chickens. May 2006. Source.|
As these old medical ideas faded during the nineteenth century, the word hypochondria almost vanished from medical use but remained in popular use, often with an implied skepticism. To the layman it was the apprehension of ill health, without sufficient cause (OED). It came to mean a mental disorder, often considered a neurosis, characterized by a preoccupation with or the persistent unwarranted belief or fear of a serious illness, typically accompanied by over-interpretation of physiological changes.
Hypochondriasis also unkindly attracted a degree of scorn or jest (Fig 2).
It became a term of criticism and derision so that in The Devil’s Dictionary we find:
Some heaps of trash upon a vacant lot
Where long the village rubbish had been shot
Displayed a sign among the stuff and stumps —
“Hypochondriasis.” It meant The Dumps.
Bogul S. Purvy (pen name of Ambrose Bierce (1842-1914?))
The word hypochondria and of course its symptoms still linger, so that in November 1955 The Times noted, “The fantastic array of purges, nerve sedatives, tonics . . . processed this, irradiated that, and impregnated the other shows that hypochondria is widespread.”
Many new terms have emerged. Though the meaning of anxiety has changed little, compound forms are common: anxiety disorder, anxiety hysteria, anxiety neurosis, anxiety state, health anxiety, and anxiety complex; perhaps an example of what linguists call semantic satiation.
The medical language iconoclast might wonder whether the all-pervasive, fashionable, and politically correct mental health issues constitute an illness; it is not always easy to decide. Many so-called nervous symptoms, fears, anxieties, and mood changes simply mirror reasonable feelings and appropriate reactions caused by a variety of commonplace, unhappy, unfortunate experiences. An inevitable accompaniment of life, they are not illnesses or diseases and most people cope well with them,6 and importantly are thereby strengthened and acquire greater self-confidence. It is when symptoms are disproportionate, excessive, persistent, and impair the quality of living that they become illnesses that need medical help.
Although the words we use evolve continually, it should be reiterated that the disorders they portray sometimes carry unfair social stigmata of fault, weakness, or insanity. It is however, not easy to deny that this flood of new trendy terms rarely improves existing nomenclature and carries essentially the same meaning. Sat around large conference tables, well provided with refreshment, their inventors often merely flounder in their quest for definition, then drown it beneath a tempest of imprecise words.
- Selye H. The Stress of Life. New York: McGraw-Hill; 1956.
- Hill J. Hypochondriasis. A practical treatise on the nature and cure of that disorder; commonly called the hyp and hypo. London, 1766.
- Pearce JMS. Sydenham on Hysteria. Eur Neurol 2016;76:175-181.
- Pechey John [MD]. The whole works of that excellent practical physician, Dr. Thomas Sydenham. 8th ed’n: Corrected from the Original Latin, London: Printed for J. Darby for M Poulson, and sold by A. Bettesworth and F. Clay. MDCCXXII (1722).
- Cullen W. First Lines of the Practice of Physic. Edinburgh, 1791.
- Schneiderman N, Ironson G, Siegel SD. Stress and health: psychological, behavioral, and biological determinants. Annu Rev Clin Psychol. 2005; 1:607-628.
JMS PEARCE is a retired neurologist and author with a particular interest in the history of science and medicine.