Friday 24 October 2008

A Hypochondriac Nation

A Battle in Print essay from the Battle of Ideas 2008

Our health is a national pastime, though it has little to do with whether we are ill. According to reports last year, every fourth GP appointment is taken by someone who has nothing wrong with them. We want to be scanned, screened and palpated for early signs of disease. We want diagnoses of vague symptoms and special diets to follow. Our list of agents to avoid grows with every ‘cancer link’ story and food scare. And when we think we have failed, we have to purge, detoxify and self-medicate.

But why? I spend my working day pointing out the lack of evidence for many health claims. In fact, much health anxiety seems to be based on dubious medical assertions, overstated research findings or misleading ideas about our bodies and disease.

A few weeks ago, a fellow commuter told me that he is ‘on tablets’ because of ‘neighbour trouble’ (disputes about parking). This was in the week that BBC Woman’s Hour discussed doubtful science in the medical treatment of naughty children and an article about nutrition for a good sex life landed on my desk. Having just emerged from a row about the pseudo-scientific ‘Brain Gym’ being used to improve the mental performance of primary school children, I couldn’t help but ask why we experience so many things as medical in the first place.

There’s an understandable inclination to blame health-related industries, for encouraging us to buy our loved ones a full body scan for Christmas (presumably to tell them how much we’d rather they didn’t pop their clogs right now), or for promoting vitamins to improve children’s academic performance, or for generally exaggerating our risk of ills and our need for pills. Carl Elliot’s account of how the desire to be ‘better than well’ has been cultivated in 21st Century America is a discomfiting account of this medicalisation of consumer culture, from aggressive marketing campaigns for anti-depressants to the promotion of self-fulfilment through cosmetic surgery. But his account also makes you wonder whether commercial messages are really the top and bottom of it all. While the marketing of health to the hypochondriac nation has certainly been innovative, Elliot sees our responsiveness to it as emerging from a ‘radically individualistic society’ in which ‘meaning is increasingly found in private rather than public life’ (2003: 140-141). Our bodies and lifestyles have become the objects of our need for fulfilment or liberation. Advertising and popular writing about health is responding to what we seek as much as it is suggestive.

Perhaps then, as some columnists and commentators have implied, it’s just that we should toughen up and stop seeking all this quasi-medical attention. We are told that the expectation of good health has made us neurotic. We aren’t as robust as sixty years ago when we might have felt awkward queuing to see the doctor about our food intolerance ‘results’ behind someone who had had his legs blown off. We are now a nation obsessed with our bowels and bumpy bits, indulging in the guilty pleasure of a meat-feast pizza then seeking penance with the cholesterol kit. But why should it follow that a healthier population must be more obsessed with health?

Health, it seems, is the currency in which we transact many parts of our lives.  And that is not our fault. From the Prime Minister’s pledge to screen apparently healthy men (for possible indicators of kidney disease, heart disease, aneurysm and stroke) to local authority-sponsored supplements for improving pupils’ performance, so many agencies now minister in very specific ways to our health. Policies and budgets must be expressed in ‘health impacts’.  Employers, schools, individuals – all are being asked about their ‘strategies’ to improve health. Good politicians worry about your health. Good employers worry about your health. Good schools worry about your childrens’ health. Shouldn’t you be worried too?

In case you are not, there is a growing appetite in public health and in medical marketing for what is called ‘effective use of fear’ . There are certain kinds of stories used in advertising testimonials and public health campaigns that have become very familiar and reinforce the dangers of lack of awareness and the need for body vigilance. We hear about the man who pursued his feeling that something wasn’t right and proved the complacent doctors wrong; we hear about the city high flier who thought her lifestyle was ‘normal’ and then turned out to have liver disease. These are apocryphal stories that warn us we should probably be doing more to be well. In some cases the threat of health responsibility is very explicit: if we have gone about our lives without making healthy choices and with few check-ups, we are being warned not to expect to use the resources of the health service or a health insurance company to put it right.

So it’s not surprising, with so many of our social interactions now having a medical component, from the employer’s health challenge to advice to parents on helping teenagers with exam stress, that there is plenty of room for quackery and poorly founded advice (Though, I confess I am surprised by the sheer hubris of some who put themselves forward to ‘doctor’ us, as individuals or as a nation, with no medical training!). It is also not surprising that questionable medical beliefs abound and people reach for the doctor, the online health check or the product to ‘boost your immune system’. We fear being negligent. We must keep our bodies working, like some delicate piece of apparatus that we have been left in control of and for which we might have to show due diligence should anything, ever, go wrong. While for some healthy people anxiety about health can set them on an even more anxious or destructive journey of undergoing tests or self-medicating through diets and supplements, most of us are just left with a vaguer sense that our lives are in need of some medical attention. This is what has been described as ‘empowerment’. But anxiety makes us gullible and I’m afraid it looks to me an awful lot more like dependency. 

Elliot, Carl 2003. Better than well: American medicine meets the American dream, WW Norton, New York

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