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Lecturer discusses hypochondria’s role in narrative medicine

Individual perceptions of illness require physicians to adopt creative and sympathetic approaches

Medical care is often based on the way patients describe their afflictions to doctors. But people with hypochondria — a condition in which patients are plagued with anxiety about perceived medical afflictions — present a distinctive challenge because the stories they tell about their own health are often unreliable.

The illness narrative of a hypochondriac doesn’t follow the typical linear narrative of other medical stories related by patients, said Catherine Belling, associate professor in medical humanities and bioethics at Northwestern University’s Feinberg School of Medicine and author of “A Condition of Doubt: The Meanings of Hypochondria,” during a lecture Wednesday night in Pembroke Hall. Part of the Creative Medicine Series, the talk “Plotless Stories and Poor Historians: Hypochondria’s Challenge to Illness Narrative” focused on the broader issue of storytelling in medicine, but honed in on the specific challenges that hypochondriacs present to clinicians.

In narrative medicine, illness is considered a “subjective experience” and refers to the way each patient personally experiences and manages illness, Belling said.

Narrative medicine goes beyond the diagnosis and helps physicians understand the meaning of patients’ descriptions of their illnesses in order to determine what is best for each individual, said Jay Baruch, associate professor of emergency medicine and founder of the Creative Medicine Series.

“Before you can respond to patients with diagnosis or treatment, you must first understand their story,” Baruch said.

“It requires a different set of skills, more creative skills,” he added.

Belling began the lecture by explaining the three plots that illnesses often follow: acute, progressive and chronic. The narrative of hypochondria, Belling said, takes on a fourth plot called the “recursive.” In the hypochondriac’s experience of illness — a condition in which the patient repeatedly perceives medical afflictions affecting them — the story “contains itself,” Belling said.

Hypochondriacs’ stories never begin, which means they also never end, she added. The patients are unable to forget about the possibility of future disease, all the while “looking ironically on the past false start.”

In most cases, the patient’s narration functions as a source of data for the medical provider, Belling said. The patient’s narrative is most helpful to the clinician if it is “clear, internally-consistent, logical, and not fictional,” she said. The hypochondriac’s illness narrative defies this set of criteria, but the story that the hypochondriac believes to be true, “remains significant and continues to be a meaningful story,” she added.

Understanding a patient’s story can change the course doctors follow in diagnosis and treatment, Baruch said. The patient’s story prompts doctors to ask a different set of questions, which can result in better medical care, Baruch said.

Focusing solely on diagnosis may lead to certain errors, Baruch said.

“We’re focused on outcomes nowadays, but we have to see that in medicine patients are all different and come with complex stories,” Baruch said. “You have to understand it all to understand the illness,” he said.

Relying on the patient’s story can be difficult when dealing with hypochondria, because the story is often unreliable. But listening to a hypochondriac’s story is a more beneficial approach than dismissal of the story entirely, Belling said.

In treating hypochondria, “making the symptoms go away actually makes things worse, because now you’ve dropped the clues,” Belling said.

Treating a hypochondriac’s current symptoms alone is merely scratching the surface of their condition. But trying to understand the symptoms’ future implications in the context of the hypochondriac’s life — “that’s the real story,” Belling said.

Emma Barrett ’15 said the lecture was “particularly interesting” to her because she hopes to become a doctor. Barrett attended the lecture as part of the “Medical Humanities: Critical Perspectives on Illness, Healing, and Culture” course, which requires students to write their own illness narratives.

As part of the Creative Medicine Series, the lecture corresponds with a broader movement to prepare future physicians to be creative in medical care, Baruch said.

“There are a growing amount of people from different disciplines looking at the role of creativity and how to apply that to medicine in order to meet the challenges of a world that is in transformation.”



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