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The Meaning of Hypochondriasis. Bella S. Van Bark. Sept. 26, 1951.
The object of this paper is to inquire into the motivating forces in the symptom-complex known as hypochondriasis. Most observers are well acquainted with the characteristics of the overt activity of the hypochondriacal individual: how he carefully scrutinizes and observes his body from moment to moment, how involved he becomes in a compulsive, detailed recital of his symptoms and how careful he is not to leave out any details. However, there is less clarity, in general, about the reasons for this compulsive, passionate, apparent “interest” in the body and its functions.
Hypochondriacal individuals have the following points in common: they are all severely neurotic, extremely alienated individuals who show an inordinate poverty of inner experiencing of psychic life. In addition, they are passive individuals who live almost entirely outside of themselves. In contrast to individuals described by Kelman as peripheral livers with great investment in anonymity, hypochondriacal individuals have been unsuccessful in satisfying this drive for anonymity in any way other than by this peculiarly anonymous but very actively impersonal relationship to their own bodies and bodily sensations.
The secondary functions of hypochondriasis are better known and have been more frequently described than the primary functions. It is only secondarily that the hypochondriacal individual unconsciously strives to gain sympathy or support through his suffering, to tyrannize over others or to use his bodily preoccupation and physical difficulties as vindication for his lack of success, lack of incentive or lack of active living, and as a way of gaining attention.
There does not appear to be a specific character structure giving rise to hypochondriasis, but there are special components which make this neurotic solution for severe inner conflict absolutely imperative for certain individuals, and particularly for those who have enormous