There’s Even A Word For It: Hypochondria
Somewhere along the line, someone noticed that when patients go to the doctor with specific complaints, many times they can be diagnosed easily and treated effectively. On the other hand, when patients go to the doctor with a long list of generalized complaints, it is often more difficult to ascertain the diagnosis and to find a suitable treatment. So it may have been incorrectly concluded that the patients with the more generalized complaints were healthy, having no physical problems, since the level of medical technology available at the time was unable to provide a reasonable explanation for the patients’ complaints.
This may be what has led to the sentiment that when patients go to the doctor with a few well-circumscribed complaints they are sane, good people with a medical problem. When patients go to the doctor with a long list of non-specific, generalized complaints, they are more likely to be thought of as fakers, hypochondriacs or a little bit odd. As a matter of fact, I was taught this rule of thumb in medical school. I remember our class being taught that if a patient came in with a hand-written list of complaints, that red flags should go up in our minds as an alert that these patients might have a large hysterical or psychosomatic component to their complaints. The reasoning offered was, that if they had to write the complaints down, then they must not be very significant (if they couldn’t remember them without notes), or that they were probably fishing for attention.
I remember having had a hard time understanding that reasoning then, and I continue to struggle with it now. Especially when I consider that it is possible that patients can have a large multitude of complaints, some of which may come and go at different periods of time. It seems understandable to me that under the pressure of being asked point blank by a doctor what he is complaining of, that the patient might have a hard time remembering all the complaints. And it is understandable how patients would want to write their complaints down to ensure that their money is well spent on the time they have with the doctor and so that they do not leave some of their questions unanswered. This circumstance is so pervasive in the medical profession that there is even a word for it: Hypochondriasis. A hypochondriac is a person affected with hypochondriasis. The definition of a hypochondriac out of Dorland’s Medical Dictionary is: “A person who has an unhealthy apprehension about one’s health, with numerous and varying symptoms that cannot be attributed to organic disease.” But just because a person’s complaints cannot be attributed to organic disease with available medical technology does not necessarily mean that they are not due to organic disease, nor does that necessarily make the person’s apprehension about his health neurotic. And just because a patient has numerous and varying symptoms does not necessarily mean that they are not due to organic disease.
This sentiment has also helped the word, “hypochondriac,” to take on a derogatory nature. Patients I know are aware of this sentiment because many times they will comment to me, as they sheepishly rehearse their physical complaints, that they hope that I don’t think they are a hypochondriac. It is clear from their comments that they are aware that people who notice and complain of a large number of symptoms are often thought of as complainers with no real problem. In fact, there is nothing unexpected or unusual about a patient having a larger number of generalized complaints when he has a medical problem that is affecting a more fundamental level of the body’s organization. Indeed, it would be more surprising if there weren’t a large number of related complaints. It’s understandable, then, why patients are often reluctant to recount all of their aches, pains, symptoms, and complaints to their physicians. Many times a patient will only volunteer one symptom or maybe two, usually pointing out those that are the most bothersome. It is interesting that if a doctor asks the patient the right questions, he may find that the patient suffers from quite a few more complaints.
What is strange is that since the first time a patient went to the doctor and died from severely decreased thyroid system function caused by severe hypo-thyroidism, it has been well known that patients with DTSF suffer from a large number of generalized complaints. Since then, doctors don’t discount the possibility that a patient with numerous generalized complaints might be suffering from DTSF- until the blood tests come back. Many times a Wilson’s Temperature Syndrome sufferer’s complaints can be so characteristic of DTSF that a doctor will run thyroid blood testing, being certain that he will find evidence on thyroid blood tests that the patient is suffering from severe hypothyroidism. However, when there is no evidence found on the thyroid hormone blood tests that the patient is suffering from DTSF, the patient may be told that he has no medical problem and he may be thought of in a derogatory light.
What is surprising is how much doctors sometimes seem to think our still fledgling understanding of the human body to be complete and exhaustive. One minute, the doctor can easily recognize the patient’s severe and debilitating symptoms of Multiple Enzyme Dysfunction as being a classic presentation of DTSF in need of immediate treatment. The next minute, when the blood tests come back normal, the doctor may think that the patient’s large number of generalized complaints can’t possibly be related and that they are all in his mind. The doctor may make this “about face” all on the basis of a set of thyroid hormone concentrations measured in the patient’s blood (which can’t possibly be conclusive).
When the thyroid hormone blood tests come back abnormal, indicating that the patient is suffering from the symptoms of DTSF due to a pituitary or thyroid gland problem, then the symptoms appear to the doctor as being anything but vague and unrelated. When the thyroid hormone tests are low, no one is shocked at all if the patient is fatigued, suffering from fluid retention, depression, dry skin, dry hair, decreased memory/ concentration, abnormal throat/swallowing sensations, numbness or tingling of the hands, inappropriate weight gain, irregular periods, and infertility. No one would be shocked that the huge number of generalized complaints could possibly be all related to one another and could all be caused by the same single problem, because it is well known that one cause of DTSF namely hypothyroidism can cause all of the symptoms discussed.
So it seems strange that a person can present with the exact same symptoms, having an even more classic and severe presentation of DTSF than a patient with blood test-documented hypothyroidism, and the possibility of DTSF is not even entertained, just because no other causes of DTSF have been well described up until now.
It is interesting that the greater our understanding and technology has grown over the years, the fewer and fewer cases of “hypochondria” that are found. More and more illness can be attributed to organic disease, leaving fewer and fewer people in the hypochondria waste basket. I am almost convinced that there is no such thing as hypochondria in the derogatory sense. There is just imperfect medical understanding and technology. I’m not saying that our feelings, thoughts, actions, and physical health are completely out of our hands. I know that the choices that we make in terms of attitudes, diligence, tolerance, etc., do have a tremendous bearing on ourselves, other people, and the things around us. But that might be getting into spiritual questions which are also difficult to measure.
I have gained my perspective on hypochondria from my unusual vantage point of having seen thousands of people, many of which have been told over the years (often not in a nice way) by some of the most highly trained doctors in the world that there is definitely nothing wrong with them. I have often seen their symptoms improve quickly and dramatically, if not completely, with proper thyroid hormone therapy, and with their complaints often staying resolved even after treatment has been discontinued. So needless to say, it can be quite an eye-opener when a patient who has been suffering for years with a characteristic set of complaints ever since the death of their spouse; and has gone through every test and treatment imaginable over the years with little or no success; has their symptoms and complaints corrected sometimes within two weeks with proper thyroid hormone therapy; and has their symptoms stay corrected even after treatment has been discontinued. A very large number of such situations has a way of changing one’s point of view.
I don’t believe that people go to the doctor for recreation. I think that they can find more use for their entertainment dollar and I don’t think they really do enjoy playing the sick role solely for the sake of attention and special considerations from those around them. I really do know that there may be a few people that suffer from such a psychological disturbance only because I know that probably whatever can go wrong does go wrong; and because I know that people are so varied that if a certain psychological disturbance can be imagined, then it probably does exist somewhere someplace. But if I was led to believe in medical school that five to ten percent of people who go to the doctor really do not have a physical ailment and have their problems all “in their head,” then I now think that if such a situation does exist, it is extremely rare, being perhaps less than one in ten thousand.
One of the experiences that has helped my perspective change on this matter involved a particular woman. I remember one lecture in medical school when we were briefed regarding what attributes to look for in a patient, that when present, would increase the probability of that patient’s symptoms having a mental origin. The patient’s initials were S.F. As I have discussed with S.F. herself, if anyone fit the bill for being a “hypochondriac” she did. She was disheveled, and preoccupied with her personal belongings, continually making sure that her comb was in her purse, that her purse was on her lap, and that she knew where her sunglasses and keys were, to the extent that these issues seemed to be the most pressing things on her mind. She had difficulty in maintaining her train of thought, and remembering all of her complaints and all of the points that she wanted to discuss. Overall she behaved rather inappropriately, making the other people in the waiting room and the staff little uncomfortable. So if there was ever a time when I believed a patient’s symptoms were all in his or her head, this would be it.
The only nagging problem was that the patient’s symptoms were classic for DTSF, and the clinical picture and presentation of those symptoms were classic for Wilson’s Temperature Syndrome. They came on after a major stress, worsened with a subsequent stress together in a group, etc. Knowing that, at the time, the classic presentation of Wilson’s Temperature Syndrome wasn’t exactly common knowledge, I felt that there was no way that this patient could make up on her own such a classic description of a typical case. So I suspected that the patient may have indeed been suffering from DTSF, and she was started carefully on proper thyroid hormone treatment.
The staff and I will never forget the unbelievable change that came over S.F. within a few short weeks of treatment. She became coherent, appropriate, lucid, and as normal as the day is long. Prior to treatment she had lost several jobs in succession because of the simple mistakes she would make, and she was unable to hold down a job and remain gainfully employed. After treatment, she was able to easily obtain and maintain employment for which she dressed neatly and professionally. She was glad to once again consider herself a contributing member of society, which was especially important for her since she was divorced and needed to provide for herself and be of some support to her adult children. I’ll never forget how shocked and amazed I was at the clarity, organization, and eloquence of the appreciation letter she wrote to me. It was just incredible that this letter could have been written by the same person that I had first met. S.F. would agree to this characterization of herself since she was able to see the obvious changes also. She was aware also of her inappropriate functioning and behavior prior to treatment.
In countless other cases, I have seen patients who had previously been labeled “hypochondriacs” enjoy complete resolution of their symptoms with proper thyroid hormone therapy. These experiences have been real eye-openers for me because I have been able to see what our current medical technology labels as being “normal” sometimes isn’t even close to being normal at all. I have also been able to see just what can be easily corrected in a predictable way, in a short period of time, with proper treatment. Is it not possible that there may be some common and treatable medical problems that we are not yet even aware exist? (Almost like not seeing the forest for the trees).
To add a little perspective, let me point out that if doctors cannot tell a hundred patients out of a hundred exactly what’s wrong with them, exactly the cause, and exactly how to fix it so that it goes away a hundred times out of a hundred, then doctors don’t yet know everything there is to know about the human body. For if they did, they would always be correcting the problems rather than sometimes just treating the symptoms.
With the specialization and fragmentation of medicine, there is now more focus on specific symptoms, and the diagnosis and treatment of these symptoms. It is interesting how much of medical treatment is symptomatic. For there are many things in medicine for which the underlying cause cannot yet be determined. So, doctors are forced to resort to treating the symptoms while not being able to ascertain fully the underlying cause.
Blood pressure medicine, for example, is used to control high blood pressure. But if it could be easily determined what is causing a patient’s high blood pressure, and if the underlying problem could be corrected, then there would not be a need for symptomatic control with blood pressure medicine. Likewise, if a patient had a tendency for developing ulcers because of increased acid secretion in the stomach, and if the underlying cause could be found and corrected, then the patient would not need to take antacid medicine.
One measure of how well a treatment addresses the underlying problem rather than just the symptoms, is how well the symptoms remain corrected after the treatment has been discontinued. So our medical understanding and technology is not yet complete and there is still a long, long way to go.
Wilson’s Temperature Syndrome is easily diagnosed and treated (since there are few things in medicine in which it is easier to do so). It is fortunate that the sickness of sufferers will no longer be overlooked and that they will no longer be subjected to the prejudices and criticisms that are often placed on those who are unfortunate enough to suffer from conditions that medical science does not yet understand.
Working with patients that suffer from Wilson’s Temperature Syndrome has been an extremely humbling experience for me, because I now realize that, just maybe, we don’t know everything there is to know. It won’t be a problem for Wilson’s Temperature Syndrome sufferers any longer, but for the sake of all those who are unfortunate enough to suffer from physical abnormalities that are not yet fully understood and recognized by the field of medicine, I hope that we, as doctors, can be open-minded and honest enough to say, “I don’t know what’s wrong with you, but maybe someone else does or maybe someday someone else will.”
Patients don’t want excuses; they don’t want to be patronized; they don’t want smooth talk; they want to get better. I don’t want Wilson’s Temperature Syndrome patients and people suffering from as yet undetermined maladies to be given excuses either, I also want them to get better. When the going gets tough its good for the tough to get going, especially if they can. But sometimes the blind can’t see, the lame can’t walk, etc. There are some people who have physical conditions that hinder them from functioning as well as they would like to. It is sometimes a little easier for us to be empathetic towards those whose hindrances are more obvious to us, like, for instance, a man who walks with a seeing eye dog and carries a white cane with red tip. But we must remember that just because we can’t easily detect a person’s hindrance, such as a chemical imbalance causing depression or premenstrual syndrome, doesn’t mean that they don’t have one. So if all of medicine, with all of its tests and understanding and knowledge, cannot always detect a person’s physical abnormalities, then certainly we cannot, as passers-by, always tell what a person’s hindrances are.
I don’t want to spend a lot of time on it, but I think there is a point that deserves mentioning. With such a clear description of Wilson’s Temperature Syndrome (including a predictable and reproducible response to treatment), will there be those who would resist it? Yes. There is opposition in all things and there are very few things that doctors can agree on. Medicine, for some of the reasons that we have discussed, can be a little slow to change. There is a great deal of tradition and a tendency to do things the way they have always been done. But things can’t be done any better unless they are done differently. It’s gratifying, though, how quickly people are recognizing Wilson’s Temperature Syndrome for what it is.
Doctors disagree with one another for all kinds of reasons (some of them noble, and others not so noble). It is good that doctors question one another, working through one another’s thought processes and conclusions. This helps to provide a more balanced set of thinking. But some doctors may find it easier to say that certain information is wrong, than to say, “I don’t know about this yet, even though I am a doctor and I would like to think of myself as being up on the latest developments in medicine.” Or the doctor may feel that certain information is wrong because “I have not learned it or been made aware of it through my sources.” But we have already seen that no source can present to a physician in one lifetime the entire “haystack” of available medical information. Neither can any source necessarily best analyze which “needles in the haystack” are the most important and which it should emphasize to physicians. In addition, “needles” are being added every day.
One might say that some of the symptoms related to Multiple Enzyme Dysfunction are psychological, in that the existence of these symptoms and their resolution are all in the patient’s head. Some might tend to think so since there is no way of measuring directly the thyroid hormone influence at the level of the cells. But what about when patients’ classic low thyroid symptoms get better when thyroid medicine normalizes their temperatures, and their symptoms remain improved even after they wean off the treatment (regardless of what their blood tests show)?