Drugbaron Blog

September 23, 2013 no comments

On the origins of hypochondria

DrugBaron suffers from a condition for which there are no approved drugs.  At times it can be a debilitating condition, with obscure causes.  Like many psychological illnesses, sufferers are often dismissed as slightly crazy, suffering from something that (to a non-sufferer) appears to have no basis in reality.  DrugBaron suffers from a (relatively mild) case of hypochondria.

Where does this notion that every mild ache or pain might be the harbinger of something particularly nasty, or even fatal, come from?

A little introspection revealed three plausible risk factors.  And given that a fair proportion of DrugBaron’s readership is likely to share more than the average number of these putative predispositions, it will be interesting to see if you, gentle reader, recognize any of these feelings.

The first and most obvious risk factor for a healthcare blogger is involvement in the multi-billion dollar healthcare industry.  Knowledge of every kind of poorly-treated disease in the universe is just grist to the mill of the hypochondriac.  Its difficult to worry about the onset of myasthenia gravis if you think it’s a village in rural Dorset.

Next, there is the matter of parentally-induced self-confidence.  Through childhood, and young adulthood, that turned out to be a sovereign salve – belief in yourself, and your opinions, is an important contributor to success in most endeavours.  DrugBaron has never been easy to knock off course by doubters, and while listening to others (properly) is undoubtedly important, so too is the ability to sustain your vision if you hear only ill-articulated doubts rather than cogent counter-arguments.

But supreme self-confidence has downsides too.  If not carefully managed and controlled it can make you rather unpopular.  Charismatic leaders may have no doubt they are right, but they deliver that confidence in a palatable way.  In the current context, though, self-confidence can make you rather more introspective – some may say ‘self-obsessed’.  Placing a high intrinsic value on yourself (not in comparison to your fellow man, but in absolute terms), then, becomes the second risk factor for hypochondria.  There is a fear your mission in the world, whatever that is, may be prematurely terminated by ill-health or death – a fear that those without a mission don’t encounter every day.

The third risk factor may also be the strongest: an entrepreneurial spirit.  At first glance, its hard to see the link between entrepreneurship and hypochondria.  But looking at the component characteristics that lead to entrepreneurial behavior reveals a surprising association.  Entrepreneurs believe they can change the world.

DrugBaron’s favorite definition of an entrepreneur is someone who can make something happen despite not controlling the resources necessary to do so

Entrepreneurs, therefore, believe there is nothing they cannot change, nothing they cannot make happen.  But, particularly as you reach middle age, there is a creeping realization that health and lifespan lie largely beyond control.  Dusty Egyptian mummies are the earthly remnants of once-great Kings who believed in their god-like powers.

In the 21st Century, we like to believe that we control our own destiny: don’t smoke tobacco, drink alcohol in moderation if at all, exercise regularly and eat a healthy diet and you will be immune from all ills.  Such beliefs drive middle-aged men (in particular), and entrepreneurial types especially, into punishing daily gym routines.

But do they work? Unfortunately, DrugBaron thinks their impact, while non-zero, has been substantially overplayed by an industry that wants to sell you health interventions.  For sure, cross-sectional studies show that people who do all these things live longer and healthier – but interventional studies, the true measure of the impact of adopting such a lifestyle, show a much smaller (and in many cases negligible) benefit.

Just as religion only “works” if you truly believe in it, in the same way DrugBaron is robbed of his feeling of control.  If you don’t really believe these interventions deliver health and longer lifespan, then the only viable alternative is to believe that things are mostly random, and anything is possible.

Things are mostly random, that is, apart from genetics.

You cannot escape the destiny that is encoded for you in your chromosomes.  Cross-sectional studies may over-estimate the impact of environmental exposures on health, but genetics studies accurately quantify the contribution of your ancestry – and its substantial.  For DrugBaron, whose father died from coronary heart disease at the age of fifty-five, the potency of genetics and impotency of environmental intervention is a frightening double-whammy.

All three risk factors clearly interact: a knowledge of the relative impact of genetics and interventions re-enforces the unique lack of control an entrepreneur may feel when it comes to matters of health.

All this matters because hypochondria is the psychological equivalent of metabolism’s “futile cycle”.  It achieves nothing, but drains energy and focus that could and should be put to more productive uses.

Hopefully, while there is no pharmaceutical cure, if there is any truth to the view that rational analysis of the problem is the first step to healing many psychiatric conditions, and that self-expression is cathartic, then writing this article may have done more than just inform the curious.  It may have helped the author, and any readers who recognize themselves at least partially in this description, imprison if not truly conquer these particular demons.

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