We Are Never Well, nor Can Be So

Helena Aeberli ponders Caroline Crampton’s “A Body Made of Glass: A Cultural History of Hypochondria.”

By Helena AeberliMarch 11, 2025

• Cultural Studies

• Science & Technology

RECENTLY, I CAME ACROSS an unusual anecdote in a 17th-century medical compendium. A patient presents to her doctors convinced that she has swallowed a snake that lives on inside her belly, ravaging her fragile state of health. She is prescribed an emetic, then an established means of purging illness from the body. While the patient is busy throwing up, her sympathetic physician slips a hidden snake into her vomit. Convinced she has purged the snake and thus become freed from the anxiety quite literally eating her up inside, the patient miraculously recovers.

I recounted this story, which originated in antiquity yet crops up throughout premodern medical texts, to several hypochondriacs in my family who—among other neuroses—refuse to eat unfilleted fish for fear of swallowing the bones. People had suffered like this for centuries, I pointed out, and they could be cured, albeit through a combination of sleight of hand and good bedside manner. They weren’t convinced. And I understood; after all, as a child I had convinced myself that eating sunflower seeds would cause flowers to sprout in my stomach. If WebMD offered a user tracking service, I’d surely be in the top one percent of visitors.

So would Caroline Crampton, a self-professed hypochondriac who begins her new book, A Body Made of Glass: A Cultural History of Hypochondria, with another condition well known to early modern doctors: the glass delusion. In his famous medical text The Anatomy of Melancholy (1621), the scholar Robert Burton, who also recounts the story of the snake swallower, describes people who feel “that they are all glass, and therefore will suffer no man to come near them, that they are all cork, as light as feathers, others as heavy as lead.” Earlier sufferers had believed themselves transformed into pottery, but it was glass that exerted the most imaginative power for medieval and early modern people. While the reasons for this may have been partly material, tied to glass’s commercial visibility and status as a novel good from the 14th century onwards, its delicacy, fragility, and brittle nature held immense symbolic potential for those preoccupied with the feebleness of their mortal bodies. A fear of contact, breakage, and disintegration characterized the delusion, as in its most famous case, the 14th-century French monarch Charles VI, who refused all touch and ordered his clothing reinforced with iron to prevent his glass body shattering. The glass delusion may have been a peculiarly premodern ailment, but Crampton suggests that its anxieties and imagery remain with us today in the form of hypochondria.

Crampton is intimately acquainted with the vulnerability of the body and the equally imperfect medical systems that observe, diagnose, and cure it. For Crampton, who survived two rounds of cancer at a young age, a justified concern for the state of her health escalated into a debilitating obsession and the conviction that every minor ailment signaled the potential for total bodily collapse. Her personal history is woven throughout A Body Made of Glass, the writing of which coincided with the COVID-19 pandemic; during that period, anxiety and depression surged by 25 percent worldwide, while people who were already hypochondriacs felt suddenly affirmed, like “we were no longer the outliers,” as Crampton puts it. It’s a timely intervention. Since the pandemic, hypochondria has become something of a cultural mode, from the anti-vax conspiracists looking forward to RFK Jr.’s tenure as US health and human services secretary to the noisy minority of pro-lockdown advocates, peddling fear-mongering rhetoric and expensive face masks. The increasingly hysterical tone of wellness culture, with its panics about seed oils and ultra-processed food, can be seen as a kind of consumer-oriented hypochondria that promises to unlock one’s inner well-being through a series of products, treatments, and interventions. While not all of us are consumed by this “silly, dramatic, terrifying, disturbing, bewildering, contradictory” condition, hypochondria is everyone’s business, and it’s big business too. As Crampton suggests, it’s time to take it all a bit more seriously.

Glass provides a clear metaphor for the body in other ways. Both professional medical interactions and popular knowledge about health and wellness grant us more information about our physical interiors, the processes and functions that power our bodies and sometimes go wrong. As Crampton memorably describes it, this increased access to information transforms our bodies “from opaque meat sacks into transparent, comprehensible glass figures.” Medical knowledge is empowering, as activists are fond of reminding us—think of the seminal feminist publication Our Bodies, Ourselves (1970), which enabled women to understand their bodies and better navigate the healthcare system, with a particular eye to reproductive health. Yet this knowledge has a darker side, suggested by the popular—and in my experience entirely accurate—image of the hypochondriac hunched over their laptop, tumbling down a digital rabbit hole of dark diagnoses to explain the slightest out-of-sorts sensation—a condition termed “cyberchondria.” “I need to understand a disease before I can be scared of it,” writes Crampton, acknowledging that learning about a new condition can provide a way of structuring her experiences and giving them meaning, even if this ultimately fuels her anxious obsession. It is the vulnerable, hypervisible nature of the glass body that is the preoccupation of the hypochondriac.

Crampton is candid about the way hypochondria has affected her life, including these dilemmas inherent in the condition. The hypervisibility of her body post–cancer treatment, and her ease of access to doctors and online medical information, proves both a blessing and a curse. Paying intimate attention to the minutiae of her body might provide the key to unlocking the secret of her health, much as it helped catch the resurgence of her tumor as a young woman, but it might just be making her sicker. And that sickness isn’t just “all in the head”: one of the most eye-opening sections of the book suggests a physiological link between health anxiety, real illness, and even mortality, due to the mysterious power of the “nocebo” effect, a kind of anti-placebo where negative suggestions cause corresponding physical effects. One 2016 study showed that patients suffering disproportionate levels of anxiety about the prospect of heart disease were in fact 73 percent more likely to develop the condition over a 10-year period than a control group. Which is, of course, more fuel for anxiety.

Hypochondria is a frustrating and ill-defined condition, as those of us who have experienced it know. Sometimes a little health anxiety is rational and appropriate, as in the case of the early pandemic—recent research suggests that concern for health likely emerged as an evolutionary advantage to protect the species—yet for the hypochondriac, it can easily spiral out of control, becoming all-consuming and detrimental to the health it seeks to protect. I once refused to visit my partner, who was suffering from a minor cold, because I’d convinced myself that he had COVID-19, only to find myself struck down by a different cold at home the following day. It was this incident that came to mind as I read Crampton’s account of the “Appointment in Samarra,” an ancient Mesopotamian tale retold by W. Somerset Maugham in the 1930s, in which a servant encounters Death in the marketplace and flees on his master’s horse to nearby Samarra. When his master meets Death that evening, he asks him why he threatened his servant, but Death only expresses surprise: “I was astonished to see him in Baghdad, for I had an appointment with him tonight in Samarra.” As Crampton reads the fable, “there is no escaping our ultimate fate, and attempting to do so only results in a lot of wasted energy.” Sickness and death are always waiting. They constitute an inevitable if uncomfortable part of being human—one that the hypochondriac is both constantly aware of and constantly struggling to confront.

Perhaps that’s why health anxiety has such a long cultural history. As soon as we become aware of our bodies, their physical fragility and ultimate mortality, we become aware of what could so easily go wrong. This anxiety is shaped by context and medical understanding, taking different forms in different cultures and eras. While Renaissance writers such as Burton and John Donne invoked the flux and flow of humors within the body to explain hypochondria as a type of melancholy caused by an excess of black bile generated in the spleen, hypochondria became, during the 18th century, a nervous disorder, part of the class of complaints physician George Cheyne labeled the “English Malady” for their epidemic prevalence. In this period, hypochondria was a rarefied, elite disease, tied to civilization, leisure, and luxury, which only lost its associated glamour once it began to affect substantial numbers of the poor and laboring classes. Meanwhile, theories of its origin abounded, often dragged along by cutting-edge medical developments and debates, such as those surrounding hysteria in the 18th century and PTSD in the 20th and 21st.

According to Crampton, hypochondria has shifted across this long history from a purely physical ailment to a purely mental illness, though it may be regaining a somatic basis with new studies into the relationship between mind and body, particularly in the field of trauma research. This is perhaps too straightforward a narrative, generated by a focus on the word “hypochondrium,” which once referred to a part of the abdomen. Even when unexplained diseases were thought to arise from this physiological area, they were understood to incorporate significant mental, emotional, and spiritual effects. Introduced at the very end of the book, the image of a pendulum swinging between mind and body is an unnecessarily neat summing-up uncharacteristic of the complex picture Crampton has painted throughout, one of a “slippery and elusive” condition. As she acknowledges elsewhere, what she is describing is not the linear story of a single disease but a collection of disparate conditions with some connection to the term “hypochondria” or its modern understanding as a kind of health anxiety. Her decision to apply the term to a motley crew of writers and worriers, from Donne to Sigmund Freud, touches on the thorny issue of retrospective diagnosis—the question of whether we can impose modern conclusions onto figures whose voices exist only in textual remnants, and who expressed their medical concerns in sometimes very different contexts to our own.

Crampton preempts these questions, though, when she writes in her introduction that she offers “a history of hypochondria, not the history,” rejecting any “grisly chimera formed out of the dictionary and encyclopaedia.” Her approach is informed by medical history-taking, the account of an individual’s illness that is produced in the interactions between doctor and patient, and formed by their partial perspectives and subjectivities at a particular moment in time and space. This “living biography” is a compelling approach to medical history, one that acknowledges the tangled, multifarious nature of the past, and the interplay of similitude and difference when we come to assess the lives of those long dead. And it’s particularly fitting for a study of hypochondria, itself an unstable condition that problematizes our assumptions about the divide between mind and body, knowledge and ignorance, the concepts of medical authority and the idea of rationality itself.

Those who study illness have often drawn on the language of narrative and performance. Susan Sontag famously interrogated the metaphors that shape the way we think about disease, the sociologist Talcott Parsons described illness as a “sick role” conferring certain rights and obligations on the sufferer, and historians use the term “framing” to analyze how societies come to understand diseases through their social definitions. Narrative, performance, and storytelling are concerns for Crampton too, particularly the difficulty of making meaning out of hypochondria, which can itself be seen as a meaning-making exercise for anxious people desperate to understand the complexities of embodiment.

Many of her historical hypochondriacs are also writers, from Donne to Virginia Woolf to Marcel Proust, who struggled to express their experiences in their work. “[C]an there be worse sickness than to know / That we are never well, nor can be so?” pondered Donne in his gloomy poem “An Anatomy of the World” (1611). But hypochondria is a “plotless story, a deviation from the regular progression of an illness from stage to stage”; it goes against the straightforward hero’s journey we have come to expect from illness narratives today, one of diagnosis, treatment, and cure. This makes it hard to tell the story of hypochondria, Crampton repeatedly reminds us, both in terms of the individual sufferer and of the condition as a whole. You have to read history—your own and medicine’s—backward and sideways. At times, this means that A Body Made of Glass is a frustratingly circular read, filled with questions but few answers. Crampton rejects the idea of a cure for hypochondria, and the ease of a happy ending. But in doing so, she offers a thought-provoking conclusion.

In recent years, cultural or literary history plus memoir has become a popular form in writing about illness, from Anne Boyer’s The Undying: Pain, Vulnerability, Mortality, Medicine, Art, Time, Dreams, Data, Exhaustion, Cancer, and Care (2019) and Meghan O’Rourke’s The Invisible Kingdom: Reimagining Chronic Illness (2022) to Ione Gamble’s Poor Little Sick Girls (2022) and Jessica Hamel-Akré’s The Art of Not Eating: A Doubtful History of Appetite and Desire (2024). As a historian, I find this combination at times limiting, offering only a blurred view of history filtered through the lens of the memoirist’s own experiences. Here it mostly works well, perhaps because of the author’s explicit interest in narrative construction and her rejection of a single, authoritative story. You warm quickly to Crampton, who is present throughout the text, reaching out a reassuring hand to her fellow sufferers across time and space. She’s a generous companion, guiding readers through her subject with warmth and understanding. She has been there, she reassures us, hunched over her laptop googling her symptoms, booking needless GP appointments—she knows what it’s like.

Unlike the endless jokes and barbs about the hypochondriac in pop culture (“But if you cure my hypochondria I won’t have any hobbies” goes one New Yorker cartoon), Crampton doesn’t condescend or look down on her fellow sufferers, though she does acknowledge that the condition can be ridiculous, a source of farcical humor as well as strife. If at times she dips into platitudes, she’s just reflecting prevailing popular discourse, which doesn’t really know how to talk about hypochondria beyond bland reassurances of the “it’s all in your head” variety.

On the whole, though, A Body Made of Glass is very far from bland reassurance. Nuanced, kind, and compelling, it’s a long overdue treatment of a complex subject, one that is often dismissed or labeled as irrational but which sheds light on some of the most fundamental aspects of the human condition.