I’ve found that the most joyous moments in life are those ones when you try to put the milk back in the microwave, or tuck the cereal box into the freezer, or the times when you start to brush your teeth only to spit out the bitter taste of face soap. The leftover short-circuiting from our good old Cro-Magnon days always put a smile on my face, humbling little reminders of our true half-witted animal selves.
Other than those fleeting moments of droll humility, however, it’s mostly sad, sad sailing, a steady beam-reach towards the mysterious dark edge of existence. I’m talking about death. The thin film of dust that collects on our hoarded belongings serves as daily reminder of our ephemeral cells.
Of course, I’m not entirely serious. There are other bright spots: my Sunday march across town to meet friends for soul food and football, my significant other falling asleep in the nook of my chest, a smile from a stranger on the bus, a good joke.
But it’s easier to see the good things in life when the sun has reemerged on the dry side of a passing front. In the last year, I’ve seen a lot of fronts—slow moving ones with big, heavy raindrops.
Not long ago, I became the first person in history to self-diagnose and beat brain, colon, and lung cancer in the span of a few months. Cancer is much less formidable when it’s only a figment of your imagination and not an actual malignancy of the body. But it is formidable, real or imagined. You see, I have health anxiety, a condition whereby the line between good health and imminent doom—real cancer and fake cancer—is perpetually blurred.
I’m not the first image to materialize when a stereotype-prone brain is cued with the words “health anxiety,” or “hypochondria,” as the affliction is more frequently called. That picture would likely include a separated but not yet divorced empty nester with graying hair, neurotic mannerisms, and a wonderful kugel casserole recipe.
I’ve yet to marry or father sons. My hair, though retreating ever so slightly from the advancing flanks of my furrowed brow, remains brown. My fidgeting is mostly unnoticeable. And though I love Mel Brooks, Saul Bellow, and smoked fish, I’ve never seen, smelled, or tasted the Orthodox noodle.
My health anxiety evolved out of my troubles with generalized anxiety disorder, often called GAD for short. I just call it anxiety—which can prove problematic when discussing said problems with friends and acquaintances.
“Oh, I know, I know, Sunday anxiety is the worst,” they often say, attempting to empathize. If only. Sunday anxiety amounts to the mounting concerns over the workweek that lays ahead, homework undone, and/or errands unaccomplished. What a relief it would be to have my anxiety attach itself to tangible difficulties—to have my fears anchored to real problems. Then, I might be able to reel them in, untie the knot, and cast off the weight of panic and self-doubt for good. Alas, it is rarely the case.
What a lot of people don’t seem to understand about anxiety is that it—at least in my experience—is rarely tangible. Anxiety arrives in a multitude of ways for a multitude of people. But there are constancies from case to case. I gather that for those who truly suffer from generalized anxiety, worries materialize separate from knowable, definable problems.
This is not to say that real problems don’t exist, only that several confounding layers of the subconscious lie between the problem (or problems) and the anxiety, the symptoms of worry. Certainly, real problems almost always lurk beneath our troubles. But for GAD sufferers, correctly drawing connections between said worry and perceived problem(s) can be a mystery too tough for our riddled minds, let alone an overworked psychiatrist.
Think of it like this. Most basic physical ailments suffered in the minutiae of daily life feature fairly obvious sequences of cause and affect. I stubbed my toe, and fuck, now it hurts. Routine psychological and emotional developments are also easy to follow. I’ve got a test tomorrow, and I’m real nervous about it. Suffer one of these instances and your average adult not only knows what happened and why, he or she probably knows exactly what to do about it—apply salve and put a bandage on it, or study harder and take some deep breaths.
But for the angst-prone like me, bouts of anxiety seem to arrive at random, attended by no obvious problems or solutions. “Are there any developments that have you worried?” a doc or shrink might ask, trying to help me locate the source of an uptick in GAD symptoms. Well, I’m about to lose my job, I’m worried I can’t crack it as a writer, I’m woefully behind on my student loan payments, I don’t have health insurance, and I feel existentially frozen, I might say—naming only the most apparent of my conscious concerns. But the kicker is—and as I always tell the doctor or (on the rare occasion that I can afford) a shrink—all these doubts were present three weeks ago, and I was doing fine then!
Another way to explain it is that the chief concern for anxiety sufferers is always their anxiety. Curled up in the fetal position on my couch staring into the pillows as I struggle in a psychological quicksand pit of worry and self-pity—as I listen to my heart race and feel my stomach shrink in fear—I’m not fretting over what I’m going to do in two weeks when my job is over and the paychecks stop coming, I’m wondering how and why the hell I fell into this swirling hell hole of emotion and thinking where is the goddam rope to climb out of this place.
In other words, my Sunday anxiety is my anxiety over my anxiety—except it comes on Mondays, Tuesday, Wednesdays, Thursdays, Fridays, and Saturdays, too.
But back to my health anxiety. Spawned from my perpetually depleted serotonin levels, my hypochondriacal episodes arrive as a combination of generalized anxiety and more acute fears about actual physical symptoms.
The Diagnostic and Statistical Manual of Mental Disorders (DSM), the Oxford Dictionary of neurosis and bible of psychology, defines hypochondriasis as an affliction whereby a patient worries incessantly over their health, strongly suspecting or even sincerely believing they suffer from one or more serious, perhaps life-threatening diseases. Minor symptoms and/or physical anomalies confirm their suspicions and fuel anxieties about their imagined problems.
This is more or less how it is for me. Because my descent into the rotten realities of GAD began as a series of panic attacks disguised as fainting spells and heart attacks, I was particularly predisposed to confuse anxiety and sickness.
Connections between anxiety and physical problems are common but poorly understood in the medical literature—perhaps because we’ve compartmentalized our doctors into neat little sub-categories and specialty areas, leaving that spacious overlap of the physical and mental unattended to. Or perhaps because the brain is so damn confusing, coil upon coil of brain cells, synapses tied in Gordian knots firing off a Morse code that scientists are still years away from understanding.
My hypochondria haunts me as some sort of hellish offspring of generalized anxiety and acute worry over specific physical maladies—an anxiety simultaneously unhinged from reality and directly attached to bodily woes. A misconception that many have about hypochondria is that those afflicted are suffering from make-believe symptoms. But while the conclusions hypochondriacs draw from their symptoms may be a fantastical invention of the imagination, the symptoms are very much real.
Last year, I suffered several months of painful irritable bowel symptoms and a near constant burning sensation in the lower right quadrant of my abdomen. I became sick with worry, convinced I had colon cancer. A colonoscopy and a clean bill of health from a GI specialist eventually helped me shrug off these concerns, but not before I wasted weeks trapped in my apartment writhing in psychological agony, able to eat little more than pineapple and pretending to care about the NBA in order to distract myself from inner turmoil.
Not long after I’d escaped the dark clouds of colon cancer, an x-ray at a checkup alerted the doctors to a small node on my right lung. The doctor assured me that it was nothing to worry about, that it was nothing more more than a bit of scarring leftover from a childhood bout of pneumonia, but suggested I get it checked-on in a couple months just to make sure it was stable. Nothing to worry about, my ass! For two weeks, I suffered intense acid reflux symptoms and a fiery sensation shot up the length of my trachea every time I took a deep breath. I began feeling twangs in my lower back and soreness in my shoulders—symptoms I’d read were the first signs of lung cancer. Only a follow-up MRI and an all-clear from my internist relieved my anxieties.
When you suffer from health anxiety, you become especially adept at honing in on strange new sensations. You never know when a new feeling might set the hypochondriacal wheels in motion—turn a sensation into a full-blown medical symptom, help you add up the clues and finally uncover the truth of your nearing expiration—so you have to keep your focus at all times.
Several months after I’d dismissed my lung cancer concerns, a stress headache caught my attention. In the days that followed, it waxed and waned but never fully subsided. Soon cranial nerve endings were firing off in small circles, resulting in intense concentrations of pain—like a giant scorpion performing a Stone Cold Stunner on the apex of my skull. The only logical explanation was a golf-ball-sized tumor growing inside my head.
Since this final episode, which occurred over the span of a couple weeks on either side of Thanksgiving, I have been relatively healthy. Good health allows one to reflect on darker times. And that’s what I’ve done. As a result, I’ve gathered up a few tidy, if not important, truths.
For one, health anxiety and general anxiety are more alike than they are dissimilar. They are both full of ironies.
For both generalized anxiety and health anxiety, the task of understanding and sorting out the frayed disconnect between mind and body remains the crux of the problem. For this reason, I take a bit of issue with DSM’s definition of hypochondria. Certainly some patients may simply excessively worry about their suspected fate, while others sincerely believe their health-related delusions. But, for me, the difference is negligible. Even during the lowest points of my struggles with hypochondria, if I’d been given the opportunity to wager on my health, I would have placed my life savings on the truth that I was just fine. That is to say, the person that knows their oversized worries are ridiculous and the person who truly believes they are doomed are likely suffering in similar amounts—at least in the short term. The mental demons that compel us to these dark places are mostly unconcerned with facts.
Now is a good time to acknowledge the caveat to all that’s been said. Engaging with your delusions is not unproductive. It’s just very, very hard, and the benefits are often slow to arrive. When I say that the connection between real problems and psychological pain is blurred and near non-existent, I’m speaking from the perspective of someone in the midst of a drawn-out spell of anxiety. It doesn’t mean a connection doesn’t exist, and it doesn’t mean confronting that connection is a futile effort—only that it seems like a futile effort in the midst of a panic attack, in the midst of paralyzing fear.
I was able to shake off my suspicions of a swelling brain tumor and escape my headaches without the assistance of any sort of conclusive medical tests because I slowly but surely convinced myself there was nothing to worry about. The kicker is: I always knew there was nothing to worry about. But as I’ve tried to explain, the fiendish subconscious is not easily reasoned with.
This brings us back to the small truth mentioned above: anxiety is full of ironies. The missing link between our worry and our source of worry is both our undoing and our salvation, our way out. The symptoms of health anxiety are both real and imagined.
As you may have heard, anxiety is on the rise. One of the reasons why, experts proffer, is that our culture has grown increasingly hostile to the disposition required for successfully dealing with anxiety. Instead of accepting our ups and downs with patience and grace, we are encouraged to vilify bad feelings, to squash, to ignore, to run away from our negativity. We’re told we can have it all, and that it all can be good. Our news feeds constantly remind us that there are only nine steps or three tricks or 15 new ways of thinking standing between our abiding happiness and our pitiful selves. Look good, live healthy, and be happy, the mommy bloggers and New Age gurus insist. It’s easy!
This theory speaks to me and to what I’ve long recognized as one of humanity’s most enduring flaws—our insistence on seeing things in black and white and avoiding nuance and contradiction. The same cultural and psychological forces that propel us to straight ticket voting at the ballet box—implore us to lump people into restrictive categories, to pledge allegiance to ideologies, to the othering of people and ideas that complicate our own—also stunt our ability to effectively take on and tackle our anxieties.
This is also true of how we understand and talk about anxiety and psychological disorders as a society. We seem unwilling to accept that mental troubles arrive in a variety of forms and to varying degrees. We expect our crazies to be obviously so, not walking anonymously among us. Our depressed are locked away in their rooms or bedridden in institutions, we assume. And if the mentally corrupt aren’t secluded away in shame, struggling through treatment programs, then they are spouting lunacy on a street corner, or they are slaving over the next great American novel or screenplay, their psychological pain the burden of Great Art. As a writer of moderate success and a nominally accomplished student of human nature, I’ve tried to revel in contradiction—embrace my own as well as our collective ironies. But even I have fallen pray to the Romanticisms of the tormented artist, attempting to justify my mental anguish as some higher calling. If I’m going to suffer, I think, at least let it be for a purpose, for art.
Hemingway and Fitzgerald suffered through bouts of anxiety. Darwin was a hypochondriac. As was James Boswell, Charlotte Brontë, and Marcel Proust. Ever since the Greeks first began discussing the condition some two thousand years ago, thinkers have been drawing connections between genius and melancholy. The philosopher David Hume even called hypochondria the “disease of the learned.” Of course for every tormented artist, there are dozens and dozens of harrowed souls walking about without Pulitzers or Pushcarts or even unfinished manuscripts. I imagine most troubled writers and painters know this. I imagine Fitzgerald knew this. But I also imagine that occasionally, they humored themselves with the thought that they’re suffering was special. Even the myth of the suffering artist does not employ itself simply. Even as Samuel Johnson, who suffered from a variety of anxieties—some of them health-related—dismissed such romanticized notions of anxiety, he consoled himself with the idea that mental anguish was the price of his intellect.
Alas, when things fall apart, they rarely fall into to neat little categories. When things falls apart, they shatter on the floor, our semblance of things scattered in all directions. Art and anxiety broken and confused along with the rest of it.
It is, however, understandable that humans would shy away from the haunting expanses of gray area that exists between the polar absolutes. It’s a scary and uncertain void, much more intimidating and far less comforting than the black-and-white mode of interpretation. Of course, going too far in the opposite direction is also dangerous. Wallowing in doubt can lead to an existential disinterest, a disposition that acts as a fertile breeding ground for debilitating anxiety. Embracing contradiction should not become an ideology in itself but should be a way to temper our certainties, a way to grow comfortable with our afflicted selves, and a way to make peace with our complicated realities.
It’s this acceptance of our internal ironies that allows me to detach myself from the brain that instructs me to pour orange juice on my cornflakes, to take a step back and laugh at the same stupid thing inside my head that compels me to anxiousness.
This task is not easy. If it were, we wouldn’t be so haunted by psychological maladies, by groupthink and narrow mindedness. But one of the best ways to trick the brain into embracing nuance is through story. Humans have been employing narrative to reveal and engage with the complexities of human nature since the beginning of time. It’s the reason why so many of us are moved to the Sisyphean task of writing. It’s the reason I’ve tried to make some sense of my own experiences here on these pages. So tell stories. Read stories. Ones that do more than distract. Ones that challenge your perspective. If I do. If you do. If we do. I think we’ll find that sail into the unknown will become a little less sad, a little less uneasy, and a little more joyous.