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A Condition of Doubt
The Meanings of Hypochondria
Catherine Belling
288 pages
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235x156mm
978-0-19-989236-5
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Hardback
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28 June 2012
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- The book applies the methods of humanities scholarship, in particular narrative and literary theory, to the texts of medicine and psychiatry as well as to a wide range of popular culture accounts of hypochondria, both by hypochondriacs and by those who resent or make fun of them.
- Belling argues that, since the rise of bioethics (producing patient autonomy and informed consent) in the 1970s, patients have become postmodern, but medicine has remained largely modern. Hypochondria is a sign of the tension between these two paradigms.
- As Belling demonstrates, it is not irrational to be a hypochondriac: because we all die eventually, and most of us get sick first. But it is also not adaptive; we need to ignore some truths in order to function. This raises questions about the positivism and rationalism of science-based medicine, where a patient's resistance to reassurance is understood as irrational, as a sign of mental illness, and often as a threat to the physician.
The "hypochondriac" is a complicated figure, often treated with scorn and derision, resented for making excessive demands on attention and health care resources. Lacking credibility but needing to be taken seriously, the hypochondriac is most doctors' least favorite patient. Yet
people who suffer from hypochondria endure the anxiety of suspecting they are seriously ill, or are about to be, and having their suspicions and their suffering dismissed as baseless.
A Condition of Doubt seeks to change the way we think about hypochondria, and to use hypochondria to sharpen our thinking about health care. It claims that contemporary hypochondria should be understood less as mental illness in particular patients than as a rational if maladaptive condition emerging from gaps between doctors' and patients' expectations of contemporary Western medicine.
Medicine relies on objective evidence to verify the absence or presence of disease. The hypochondriac struggles to accept reassurance that no disease can be found. Examining
the tension between these two positions reveals insights into clinical reasoning and practice, into patients' (not just hypochondriacs') clinical experiences, and into our medicalizing culture's troubled understandings of health, illness, risk, and uncertainty.
The book's four parts examine hypochondria as a condition of biology; of medicine; of culture; and of narrative. Using a wealth of texts from the medical literature, published illness narratives, psychiatric diagnostics, online discussions, and popular culture, A Condition of Doubt is both an example of, and a case for, the place of serious humanities scholarship in understanding medicine and in understanding how medicine thinks about itself and trains its practitioners.
This book
argues that over the last half-century, patients have become postmodern but medicine has not, and claims that hypochondria-as a shared cultural condition-can be addressed by rethinking both patients' expectations of medical omniscience and physicians' need to meet such expectations. This means reconceptualizing hypochondria and, more broadly, reconceptualizing medicine's orientation toward the unknownReadership: The book is primarily analytical, and is intended to combine conceptual accessibility with rigorous close attention to texts. It is intended first for academic readers, primarily in the humanities, medical humanities, and bioethics (but also cultural studies, literature, life writing and auto/biography
studies, science and technology studies, psychology, disability studies, philosophy), for readers in academic medicine and medical education, and for educated general readers-including clinicians-who are interested in understanding more about medicine as a biocultural enterprise and about hypochondria as a particular aspect (and symptom) of that enterprise. It is intended, too, as an intervention in the currently expanding debate about medical education and the growing place of humanities in the curriculum.
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Catherine Belling, Assistant Professor of Medical Humanities and Bioethics, Feinberg School of Medicine, Northwestern University Born in South Africa, Catherine Belling came to the United States on a Fulbright grant to complete her PhD in English at Stony Brook University, New York, focusing on representations of medicine and the body in Renaissance drama. On graduating, she joined the medical school faculty at Stony Brook, as Associate Director of the Institute for Medicine in Contemporary Society, and in 2007 moved to Chicago to take up a position in the Medical Humanities and Bioethics program at Northwestern University's Feinberg School of Medicine in Chicago.
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Introduction: A Dubious Condition
PART I: A BIOLOGICAL CONDITION
Chapter 1: That Within: Biologies of Hypochondria
Chapter 2: Medicine's Ghost: The Unnatural History of an Unreliable Idea
Chapter 3: Swimming in the Dark: The Hypochondriac in the Body
PART II. A MEDICAL CONDITION
Chapter 4: Contested Authority: An Expert Patient Lectures the Physicians
Chapter 5: Hating Hypochondriacs: Stigma and Stereotype
Chapter 6: Dangerous Fearlessness: The Formation of Physicians
Part III. A CULTURAL CONDITION
Chapter 7: Be Informed: Medical Knowledge
Chapter 8. Be Responsible: Cautionary Tales
Chapter 9. Be Afraid: Horror Stories
PART FOUR: A NARRATIVE CONDITION
Chapter 10: How Can I Tell? Professing Hypochondria
Chapter 11: The Story that Won't Begin: Hypochondria's Narrative Structure
Chapter 12: Unreliable Historians: Hypochondria's Narrators
Conclusion
Bibliography
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The specification in this catalogue, including without limitation price, format, extent, number of illustrations, and month of publication, was as accurate as possible at the time the catalogue was compiled. Occasionally, due to the nature of some contractual restrictions, we are unable to ship a specific product to a particular territory. Jacket images are provisional and liable to change before publication.
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