If you were to look up the word “hypochondria” in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), you would no longer find it as a diagnosis. In 2013, “hypochondriasis” was replaced by alternatives such as “illness anxiety” and “somatic symptom disorder,” categories meant to neutralize a fraught term. Within the medical community, the change signaled recognition of the harm the hypochondriacal label causes patients by implying their condition is not real. The reclassification, however, fails to acknowledge that some patients may be ill with something for which we do not yet have a name. When the DSM is treated as an ultimate authority, there is a risk of diagnostic complacency in complex cases that fall outside its neat categories and criteria.
Diagnostic failure in modern healthcare was magnified during the recent pandemic, when millions whose symptoms lingered long after a Covid infection found themselves dismissed by physicians as paranoid. Again and again, illness anxiety was used to explain away a condition doctors did not understand. Patients across history have endured this particular form of medical judgment that simultaneously denies them care.
When Caroline Crampton’s A Body Made of Glass: A Cultural History of Hypochondria appeared on the heels of the Covid-19 pandemic, it was hailed as a “timely intervention.” “Since the pandemic,” the Los Angeles Review of Books observed, “hypochondria has become something of a cultural mode.” We’re all paranoid about health now, most early reviews agreed—but without exploring the complexities of who is sick and who may be anxious, and who decides the difference.
“We live in an era of mounting health worries,” Meghan O’Rourke wrote for The Atlantic. “Intensive vigilance about our health has become the norm.” In Crampton’s view, this attention to health stems from the fact that “we know too much.” Access to technology and scientific advances in medicine allow for hyper-awareness, and therefore hyper-vigilance, of the body. O’Rourke writes that “There is a darker and dangerous side to all this knowledge: the idea that learning about a particular illness can make you believe you have said illness.” In other words, the power of suggestion—and ready access to Google—has made hypochondriacs of us all.
But if we learned anything from the recent pandemic, it’s that medical knowledge is never omniscient or complete. Conditions like long Covid revealed a gap between patients’ self-knowledge and medical authorities’ categories for legitimate disease. Our systems of care rely on shared definitions, yet definitions, as the DSM makes apparent, change. A history of hypochondria has the potential to explore the consequences of cultural moments when science falls behind patient experience, and could point us to a better way to care for those whose conditions might lie outside of current understanding. A Body Made of Glass does not rise to this potential.
The word “hypochondria” can be traced to Hippocrates’ time, Crampton notes, when it was considered a physical malady—in Greek, “hypochondria” means “under” (hypo) “the sternum” (khondros). This characterization persisted through the Middle Ages, when the word became associated with the abdomen. In the seventeenth century, the meaning shifted to an imbalance of the vapors in the body, resulting, it was believed, in a melancholy disposition. It wasn’t until 1822, when Jean-Pierre Falret published De l’Hypochondrie et du suicide, that hypochondria was accepted as a mental condition. In her introduction, Crampton adheres to this understanding of the term as “a perceived disease of the body that exists only in the mind,” setting up a false dichotomy between mind and body that haunts the rest of the book.
Hippocrates, of course, also passed down the dictum “first do no harm,” a phrase that might provide a firmer foundation for a system of care than whole textbooks of diagnostic criteria. Crampton reminds us of this charge—an oath medical students still pledge today—but, in perpetuating a term that has been used across centuries to undermine patient testimony, her revival of hypochondria fails to honor the dictum.
“I like the word ‘hypochondria,’” Crampton writes, advocating for its return. “I cannot abandon it.” This loyalty to a problematic label might be explained by the author’s health history, documented in the book, which includes, when she was eighteen, the return of the Hodgkin’s lymphoma she’d been cured of the year before, leading to long-term anxiety about her health and fear that the illness might recur. As a self-proclaimed hypochondriac, Crampton is eager to welcome others into the fold, and her cultural history embraces a broad range of cases across time. The word “hypochondria,” she writes, helps her feel connected to “fellow sufferers stretching back over 2,000 years.” Yet there is a profound difference between claiming hypochondria for oneself and assuming the identity for others.
In her quest to elucidate health anxiety, Crampton is most successful when writing about her own. Recounting her medical trauma and its subsequent anxieties, she immerses the reader in the experience of living each day with the possibility of disease. However, unlike many of the health histories documented in the book, Crampton’s anxieties are honored by her physicians; as a cancer survivor, she acknowledges the privilege of never being doubted by doctors. The shadow side of medicine appears when a condition is instead poorly understood or invisible to a lab test: the complaint that appears unjustified, easy to discount as imagined, unreal.
A Body Made of Glass applies the term “hypochondria” to historical figures who lived with the label in their lifetime, despite the fact that today we have the ability to better understand their conditions. In many of these cases, science wasn’t advanced enough to make the diagnosis, and, in an impulse that continues in medicine today, when doctors were faced with an unknown condition, they tended to blame the patient. Many of Crampton’s “fellow sufferers” languished under the stigma of hypochondria—a story of suffering this cultural history does not adequately address.
Crampton turns first to one of the most well-known of literature’s so-called hypochondriacs: Marcel Proust. Like her, Proust received an early diagnosis. His first asthmatic episode, while walking with his family at the age of nine, was so violent his physician father believed he was going to die. But there was no cure for Proust’s condition, nor did it go away. Medicine was not advanced enough to have adequate treatment or even a valid form of evaluation. The assumption that the prolific author’s health concerns were unwarranted is outdated, belonging to an era that believed asthma to be a condition of the nerves. In 1904 a Parisian specialist told Proust his condition was a “nervous habit” and recommended he “unlearn” it.
Proust, of course, could not unlearn his asthma. Instead, the sick man was forced to take extreme measures to care for himself, living in a cork-lined bedroom and keeping car windows up on spring drives to avoid life-threatening scenarios. Crampton reads these behaviors as complicating and prolonging his illness, until it became an inseparable part of his personality. “In a case like this,” she writes, “the original sickness, the fear of its recurrence, the steps taken to treat it, and the personality of the patient all meld into one living, coughing, suffering being.” This view suggests anxiety was in large part to blame for his condition, rather than admitting the reality of a dangerous disease and the regrettable lack of treatment. Like Proust, many living with chronic illness today are compelled to take care into their own hands through patient communities and online research—an additional burden on the sick.
Not only was Proust aware of the absurdity of his situation, he wrote about it in his novel In Search of Lost Time through Aunt Léonie, a character based on his aunt Élisabeth Amiot, who, people assumed, performed her illness. The sick woman’s bedridden behavior was justified when surgery revealed a cancerous tumor. She did not survive the operation. “And everyone agreed at last that she had really been ill, for she died,” Proust’s biographer George Painter sums up her short life.
Too often these characters, real or imagined, are justified only in their demise. Molière passed away after collapsing on stage while playing an ailing patient he’d written as self-parody in Le Malade imaginaire. John Donne, who appears in Crampton’s text as “a peculiarly hypochondriacal writer,” probably had typhus. The poet Philip Larkin, after worrying that he had a deadly cancer and that his throat might become blocked, was eventually diagnosed with an esophageal cancer that killed him. “The hardest part of Larkin’s hypochondria to grapple with is that he was, in several ways, proved correct in his fears,” writes Crampton. If Larkin’s worries had been accepted from the beginning as legitimate concerns, there would be nothing difficult about his situation. It was Larkin’s doctors’—and the author’s—impulse to impose hypochondria that made it hard, and of course, fatal for Larkin. What if he had simply been believed?
When writing about Donne, Crampton acknowledges that “not everybody agrees that Donne’s evident and lifelong preoccupation with all the ways in which a human body can malfunction is evidence of a hypochondriacal mind.” The critic Elaine Scarry declared Donne’s response was justified—“not only intelligible but inevitable”—considering the context of his life, which consisted of great trauma, loss, and disease. “In such a situation, is it not reasonable to be afraid?” Crampton asks rhetorically, “and to experience those fears not just in the mind but in the body too?” Ultimately, she decides that the fervor of Donne’s fear is unfounded because it “does not indicate a measured response to early modern death rates.” The suggestion that he experienced his fears in his body insinuates his illness was a manifestation of anxiety, rather than a disease with a biological origin that resulted in that anxiety.
This pattern repeats throughout the cultural history of hypochondria: a patient’s complaint is assumed to be “all in their head,” or, worse, a character flaw, a twist in the development of their personality: they are eccentric, narcissistic, hyperbolic, and their fixation on health is the cause of their illness, or perpetuates it. Because they are not believed, no treatment is offered, and the patient continues to suffer, not only from their original ailment, but also from the denigration of others’ disbelief.
But if we choose to read these case histories instead through the lens of belief, suddenly the patients’ behavior—from talking about their pain to managing it—is justified. It’s our tendency to doubt the sick that makes them appear paranoid. If you do not believe severe, untreated asthma is a real and life-threatening concern, Proust’s self-care practices might appear obsessive. But if you start from a position of credulity, the narrative shifts: now the precautions make perfect, rational, even tragic sense, especially considering the ill person was left on his own to take measures essential to his survival. When an illness is taken seriously, it’s not difficult to understand why a person would take any means possible to avoid aggravating or prolonging a painful and chronic condition.
“It is almost impossible, except for those who watched his daily life, to realise how essential to his well-being was the regular routine,” Francis Darwin observed of his father’s carefully managed days, “and with what pain and difficulty anything beyond it was attempted.” Crampton notes that Darwin’s symptoms, which included “debilitating headaches, violent heart palpitations, severe gastric upsets, [and] bouts of vomiting,” at times took on “a definite physical form, so that at least some of them are verifiable by observation,” including a disfiguring eczema that made him unrecognizable to friends. Yet because “no doctor was ever able to diagnose the underlying cause for these disparate conditions,” the author joins the medical community at the time in discounting Darwin’s ailments by attributing them to his own concern about his health. “Darwin’s illness was connected to the anxiety he experienced when he had to deviate from his self-imposed, strict routine of work and rest,” she writes, asserting that “over time, the condition and the supposed cure became indistinguishable.”
It is more likely Darwin experienced symptoms, structured his days in ways that allowed him to live with them, and then became anxious about their return because the symptoms were painful and interfered with his work. The anxiety stems from, and is a consequence of, illness—the disease itself is not caused by anxiety. Anyone who has lived with a chronic condition that flares in response to exertion learns to change their habits so as not to trigger symptoms. What, in Crampton’s text, gets interpreted as paranoia are, in reality simply pain management skills.
Medical knowledge has progressed since it failed to accommodate Proust’s asthma or detect the nature of Darwin’s ailments. In the 1950s it was proposed that an insect that bit Darwin on his around-the-world journey was a carrier of the protozoan causing Chagas disease. In the nineties, a researcher diagnosed systemic lupus erythematosus, and in 2014, geneticists used two strands of Darwin’s beard to identify biomarkers for Crohn’s disease. A Body Made of Glass recognizes many “reputable journals” have attempted to analyze and apply “posthumous diagnostic treatment” to those assumed to have “hypochondriac tendencies.” Yet rather than analyzing these studies for a biological explanation for her subjects’ illnesses, Crampton concludes that “hypochondria only has questions, never answers, and that makes us perpetually uneasy.”
Our unease with uncertainty, however, should never be an excuse to assume hypochondria, a verdict that offers no more proof than the more legitimizing diagnoses these retrospective studies put forward. A Body Made of Glass is built on the belief there is a cogent body of knowledge of what constitutes disease and any sensation outside such diagnostic criteria qualifies the patient as a hypochondriac. This denies that medical knowledge is evolving. Crampton admits that scientific advancement is not perfect: “This is not how progress, or indeed humanity, works.” Yet her cultural history reinforces an age-old prejudice—the assumption that any experience outside the reach of medicine’s vast laboratory belongs to the realm of mental illness.
While Crampton makes the point that mental illness is “real, too,” her argument assumes someone’s physical complaint is purely psychological. Telling a patient “it’s all in your head, but that’s okay, that’s real too,” closes off the possibility of a correct diagnosis, on which the possibility of care, and even a cure, depends. Though well-intended, Crampton’s effort to legitimize mental illness reflects a stance that is used all too often to deny care to those seen as non-compliant, costly, and complicated. It’s easier to dismiss someone than to spend time and money on the care and research it would take to prove them right.
Mental health therapies built on the hypothesis that a physical condition is wholly psychological not only lead to wrong and sometimes harmful treatments, they can also cause the ill person anguish by downplaying their distress. This happens most often to those whose pain has not been heard across history. Crampton recognizes that “marginalized people—be they women, those who aren’t white, the disabled, the poor, the less educated—have long been considered by those in authority to be less reliable witnesses to their own symptoms and sensations.” Yet A Body Made of Glass champions cognitive therapies aimed at getting patients with chronic pain to stop “catastrophizing,” rather than addressing the physical causes of that pain with advocacy for funding, research, and treatment.
One retrospective study, which uses Proust’s well-documented symptoms to diagnose a vascular subtype of Ehlers-Danlos syndrome, ends on a cynical note. “Ironically, even if Proust were correctly diagnosed—after the years required by most patients with rare diseases to obtain correct diagnoses—he would not necessarily receive much better care today than he did in the early twentieth century,” Yellowlees Douglas admits in the journal Medical Hypotheses. Not only has science failed to advance as far as we’d like, neither have we learned to extend imagination across the borderline of its frontier to meet with empathy patients whose multisystemic and rare disorders we don’t understand. The hypochondriac label can seem a more palatable alternative than accepting their pain and medical responsibility. A critical history of hypochondria reveals a larger, social responsibility that our governing bodies have failed to address: Not only are chronic, multisystemic, and difficult-to-diagnose diseases real, but our medical system does not accord sufficient care to those who suffer them.
Yet without these complicated health histories, our medical record is incomplete, and people will continue to suffer undue harm within it. Reading the history of medicine through a lens of belief might magnify some difficult failures, but it could also point a way forward, allowing us to imagine a better way to care for each other. We might begin by believing what others tell us about their bodies. We might learn from the mistakes of the past, including those of the recent pandemic. We might invest in a system that approaches all patients’ health concerns with credence, time, and resources. In such a future, we would no longer need to fear another person’s health concern, or seek to undermine its legitimacy, because we could be assured that there was a system of care in place for them, and for us as well, when we, in turn, require it.
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A Body Made of Glass. By Caroline Crampton. New York: HarperCollins, 2025. 336 pp. $19.99.
