Transcript for the with host introduction version of Living with Hypochondria: The Real Costs of Imagined Illness

HOST:
From New England Public Radio News, I'm Susan Kaplan.

OUR HEALTH IS ALL OVER THE NEWS THESE DAYS: WHETHER IT'S THE CONTENTIOUS DEBATE ON AMERICAN HEALTH REFORM, THE LATEST STUDY ON CELL PHONES AND CANCER, OR ADVANCES IN GENETIC TESTING THAT CAN PINPOINT WHO'S AT RISK FOR WHICH DISEASE.
THIS FOCUS ON HEALTH CARE MOTIVATES SOME PEOPLE TO EAT RIGHT, EXERCISE, AND STAY IN GOOD MEDICAL SHAPE. BUT OTHERS GROW TO FEAR EVERYTHING THAT COULD POSSIBLY GO WRONG WITH THEIR BODY. AND IN SOME CASES, THEY IMAGINE THAT IT ALREADY HAS.
IN THE NEXT HALF HOUR, AN IN DEPTH LOOK AT "LIVING WITH HYPOCHONDRIA: THE REAL COSTS OF IMAGINED ILLNESS" -- A RADIO DOCUMENTARY, WRITTEN AND PRODUCED BY KAREN BROWN....

OPENING VOX/introduction
(SHELBY) i was one of those kids, whatever we learned about in health class, i developed symptoms of it. 0:01:43.0
GENE: any small symptom that i had, i would actually manage to turn it larger through my mind. … 0:04:30.5
SHEILA: whenever i don't feel a little bit well, i start thinking there's something really wrong, .
(shelby) ... or if i had a headache, it was automatically a tumor.0:01:46.5 (Shelby)
(LEVY) …. i could be afflicted with some parasite that's limited to the southern part of Uganda...0:45:38.0 or a tumor that was described in the literature in 1932 and not heard of since.0:45:44.5
(SHIELA) i remember one day listening to the radio and there was a show about heart disease and heart attacks, and .... it just freaked me out
(GENE) you're laughing at the fact that OK, this is probably nothing, but deep in your heart, you think it's probably something.0:07:15.9

FADE OUT music here

HYPOCHONDRIA IS EASY TO MAKE FUN OF. CERTAINLY WOODY ALLEN -- THE QUINTESSENTIAL NEUROTIC -- KNEW THAT. HE DEVELOPED WHOLE PLOT THEMES AROUND HIS CHARACTERS’ OBSESSIONS WITH MEDICAL CATASTROPHES....
Woody allen: i got the classic symptoms of a brain tumor! (Secretary:)0:03:45.4 two months ago, you thought you had a malignant melanoma. Woody: naturally -- the sudden appearance of a black spot on my back. Secretary: it was on your shirt!....
MEDICAL STUDENTS ARE FAMOUS FOR DEVELOPING HYPOCHONDRIA WHILE STUDYING RARE DISEASES . THE MORE YOU LEARN ABOUT AN AILMENT, THE MORE YOU THINK YOU HAVE IT.... IT'S EVEN AN OCCUPATIONAL HAZARD OF SOME HEALTH JOURNALISTS…. I, FOR ONE, WAS CONVINCED I HAD WEST NILE VIRUS AFTER COVERING A STORY ABOUT MOSQUITO-BORN DISEASES.....

... WOODY: I think i'm developing hearing loss on my right ear...no my left ear, no my right...my left or my right.... 0:00:44.9

THE THING IS, HYPOCHONDRIA MAY SEEM FUNNY, BUT IT'S NOT BENIGN..... IN ITS EXTREME CLINICAL VERSION, IT'S CALLED HYPOCHONDRIASIS -- A CONDITION THAT'S NOT ONLY DEBILITATING FOR THE INDIVIDUAL AND HIS OR HER FAMILY, BUT A STRAIN ON THE ENTIRE HEALTHCARE SYSTEM. AND IN THIS AGE OF ANXIETY, THE HYPOCHONDRIA CASELOAD IS WORRYING DOCTORS, PSYCHOLOGISTS, AND HEALTH ECONOMISTS....WHO ARE ALL LOOKING FOR WAYS TO MITIGATE THE REAL COSTS OF IMAGINED ILLNESS.
(musical interlude)

PART ONE: WHAT IS HYPOCHONDRIA
MOST PEOPLE HAVE, AT SOME POINT, WONDERED IF THAT NAGGING HEADACHE COULD BE A TUMOR..... OR IF THAT DARK SPOT COULD BE SKIN CANCER. THAT’S HUMAN NATURE. WHAT MAKES YOU A TRUE HYPOCHONDRIAC IS THE EXTENT TO WHICH YOU ARE WILLING – OR NOT -- TO BELIEVE GOOD NEWS.
(LIPTZIN) pp who are true hypochondriacs aren't reassured by test results.
BENJAMIN LIPTZIN IS CHIEF OF PSYCHIATRY AT BAYSTATE MEDICAL CENTER IN SPRINGFIELD, MASSACHUSETTS.
so if you do a ct scan, to look for a brain tumor, they want to have an MRI. if the MRI is normal, they want to have a Pet scan. it's very hard to reassure somebody who's convinced there is something terribly wrong.0:02:53.0
PSYCHIATRISTS DESCRIBE HYPOCHONDRIASIS AS A FORM OF CLINICAL ANXIETY – ONE THAT TYPICALLY SETS IN AFTER ADOLESCENCE. IT CAN GET SO EXTREME, PATIENTS ACTUALLY FEEL SICK. THOSE TWINGES AND RUN-OF-THE-MILL SENSATIONS THAT MOST PEOPLE JUST IGNORE.... THEY GET MAGNIFIED IN HYPOCHONDRIACS.

(Shelby) I’m tired of people saying, it’s all in your head. It’s really not all in my head.
(gene) if you're a hypochondriac, you feel pain. you're not imagining pain. you're creating pain thru your mind.
(MORGAN) hypochondriacs can create these feedback loops, that's a classic thing they do, where if you keep poking something, it will start to hurt.
THAT'S MORGAN GRIFFIN -- A NORTHAMPTON-BASED HEALTH WRITER. HE'S TAKEN A KEEN INTEREST IN THE PSYCHOLOGY OF HYPOCHONDRIACS....HE CONSIDERS HIMSELF A CLASSIC ONE.
i remember my first awareness of lymph nodes was watching an episode of ER. and 0:30:24.5 and it was one of things that, huh, Ok, lymph nodes in my neck, i gotta keep an eye on that. i went through a period where i was checking them so frequently that they did start to swell up. ..
HYPOCHONDRIACS WILL OFTEN COMPLAIN OF A VAGUE, GENERAL MALAISE. AND IN FACT, DR LIPZIN SAYS THE WORRYING ITSELF CAN WREAK HAVOC ON YOUR SYSTEM…SAY, THROUGH LACK OF SLEEP, OR CONSTANT TENSION... .
(LIPZIN) *i think some of it is the person just doesn't feel well and they don't know why. and it's easier to come up with a physical explanation, than to accept that i'm depressed or unhappy or something else going on in my life. 0:03:27.2
Gene: I think it affects pp who are intense about life. ...I’m the sort of person who obsesses about every public appearance, I’m always sure my life will collapse into abject failure, even though I’m getting nothing but accolades.
GENE WEINGARTEN IS A PULITIZER-PRIZE WINNING NEWSPAPER JOURNALIST WHO WROTE THE QUASI-HUMOROUS BOOK, "THE HYPOCHONDRIAC'S GUIDE TO LIFE AND DEATH"…. HE TRACES HIS OWN HYPOCHONDRIA TO A BELOVED CHILDHOOD DOCTOR.
(GENE) doctor Katziv was a man who really believed in letting things take their course. 0:03:01.8 …he didn't believe in babying you. and he didn't baby me, and i got better all the time whenever i was sick. ...i really loved dr. katziv and respected him. Until when i was 21 years old, he died of a cold. ….and i think from that time on, i no longer thought the best way to deal with illness was to ignore it.
WEINGARTEN DIDN'T JUST WORRY ABOUT COLDS THAT COULD TURN DEADLY....HE'D OBSESS ABOUT COMPLETELY UNLIKELY OR OBSCURE DISEASES, BASED ON LITTLE TO NO EVIDENCE. LIKE THE TIME WEINGARTEN WAS FEELING A MILD PAIN IN HIS JAW. HE WENT TO A DENTIST, WHO DISTRACTEDLY MENTIONED A SYNDROME THAT AFFLICTED WORLD WAR ONE SOLDIERS. THEY WOULD FALL ON THEIR RIFLES IN BATTLE -- AND THE JOLT WOULD CAUSE SEVERE DENTAL TRAUMA.
(GENE)...about six months afterwards, their teeth started falling out, one by one. and from that point on, my pain got a little worse... I kept seeing if I could shake my teeth, and they seemed loose. and i imagined myself six months hence, not having a tooth in my head.0:05:53.6
(MORGAN) hypochondriacs are like magpies. 0:06:46.8 they pick up information from all over the place, and store it away…
MORGAN GRIFFIN
for me, it was the encyclopedia brittanica, the kid who's spleen ruptured in high school, it was that afterschool special about the kid who had a cough and it turns out to be something horrible.0:07:07.4

THE RARER THE DISEASE, THE BETTER TO FIXATE ON....BECAUSE, FROM THE HYPOCHONDRIAC'S PERSPECTIVE, THOSE ARE THE ONES THE DOCTOR IS MOST LIKELY TO MISS.... MORGAN GRIFFIN'S WORRY OF CHOICE WAS LUPUS, AN AUTO-IMMUNE DISEASE THAT'S ALMOST NEVER FOUND IN MEN. TO WIN OVER HIS DOCTOR, GRIFFIN BECAME INTENT ON PROVING HE HAD A LOW-GRADE FEVER – ONE POSSIBLE SYMPTOM OF LUPUS....AND MANY OTHER THINGS.
(morgan) 0:10:28.6 i started to carry a thermometer around with me , i was out bowling with my inlaws, and i would go into the bathroom, close the bathroom stall, take out the thermometer and take my temperature. it was this total conviction, at some point i would be vindicated.

THAT OBSESSIVENESS IS WHAT MAKES HYPOCHONDRIASIS SO HARD TO LIVE WITH. THIRTY-EIGHT-YEAR-OLD SHELBY MAROWITZ OF EASTHAMPTON HAS BEEN ANXIOUS SINCE CHILDHOOD.
(shelby) *my parents divorced when i was very little.0:03:51.7 so i think i always had like a big worry in my life, that things are uncertain.
TODAY, SHE'S A PRESCHOOL TEACHER, WIFE, AND MOTHER ... WHO IS EASILY PUSHED INTO MEDICAL PANIC....
(Shelby) like when Magic Johnson had HIV and i was like, i developed HIV symptoms.0:05:34.0 … the night sweats were happening, and now i have lesions, and i definitely have full blown AIDS!.0:09:15.7 ...
(ZAK: like she had this, what she always calls choking feeling. in her throat.
SHELBY'S HUSBAND ZAK.
(ZAK) and so she woke up one night deciding this was oral thrush, which can be a symptom if you have HIV. she didn't even know what oral thrush was. so she was convinced it was a sign of HIV. ... this is despite already having had three tests that said she didn't have HIV. and us being in a monogamous relationship for years. so it gets pretty irrational.

Music Interlude
PART 2: WHY SO MUCH OF IT NOW?

THE AMERICAN PSYCHOLOGICAL ASSOCIATION ESTIMATES THAT CLINICAL HYPOCHONDRIASIS AFFECTS FIVE PERCENT OF THE POPULATION -- AND THAT'S NOT COUNTING THE MILDER CASES -- "THE WORRIED WELL", AS THEY'RE OFTEN CALLED. ALTHOUGH THERE'S LITTLE EMPIRICAL RESEARCH ON HYPOCHONDRIA, MANY DOCTORS -- JUDGING FROM THEIR OWN CASELOADS -- THINK THE RATE IS GOING UP.
BARKSY: a lot of pp feel that it seems to be an increasing problem and there certainly is a societal focus on health now that sort of fosters that.
PSYCHIATRIST ARTHUR BARSKY AT HARVARD MEDICAL SCHOOL IS ONE OF THE COUNTRY'S PREMIER HYPOCHONDRIA EXPERTS – HE WROTE THE BOOK, “WORRIED SICK: OUR TROUBLED QUEST FOR WELLNESS.”
(BARSKY) every single study with vitamin D and every report of a brain tumor from a cell phone and all this kind of stuff really does heighten pp's anxiety.0:03:23.2 so there is a sense that pp are more concerned about health and more worried about than they used to be.
AND THESE DAYS, SCARY INFORMATION CAN SPREAD VERY QUICKLY. ARTHER BARSKY THINKS THE INTERNET DRIVES HEALTH ANXIETY -- ESPECIALLY THOSE MEDICAL WEBSITES THAT LIST EVERY CONCEIVABLE SYMPTOM AND WORST-CASE OUTCOME. THERE'S EVEN A TERM "CYBER-CHONDRIA" … [add sound of computer chime] A UNIQUELY MODERN COMBINATION OF TOO MUCH STRESS AND TOO MUCH INFORMATION.
AMBI - typing...
"just looking up swollen glands, fever ...29:30"
GRIFFIN HAS THOUGHT A LOT ABOUT CYBER-CHONDRIA - AS A WRITER FOR A MEDICAL WEBSITE HIMSELF, AND, IN HIS WEAKER MOMENTS, A CONSUMER OF THAT SAME INFORMATION....(more typing)
"This is the classic nightmare for the hypochondriac: causes of swollen lymph nodes. the first one is common cold,.... infection, viruses, mono,.... THE hypochondriac will now skip past all the benign ones, and start looking for the truly horrible ones....lymphoma, hodgkins disease. 0:29:58.6 leukemia, tuberculosis. ....

GRIFFIN IS AWARE THAT OTHER HYPOCHONDRIACS ARE PROBABLY READING HIS OWN MEDICAL WEB ENTRIES IN A PANIC AT 4 IN THE MORNING, SO HE TRIES NOT TO SENSATIONALIZE MEDICAL CONDITIONS .... AND HE ALWAYS INCLUDES HARD DATA ON RISK AND PROBABILITY .... BUT HE DOESN'T THINK THE MEDIUM PER SE IS THE PROBLEM....
(MORGAN) all the health information on the internet is actually reflective of a larger issue. 0:26:46.0 which is the proactive patient who is looking after her own health, being vigilant,...obviously that is good in lots of ways, but the bad way, the one bad thing -- the hypochondriac being told you're responsible for your health is a disaster.
(LEVY) the classic well-educated patient comes in to the exam room very worried with a handful of printouts from internet sites, …and it may say that we really have to do a high sensitive dc protein test to make sure they don't have heart disease, 0:13:43.2
NORTHAMPTON DOCTOR DANIEL LEVY HAS WORKED IN PRIMARY AND EMERGENCY CARE FOR TWENTY YEARS, AND HE THINKS CLASS, EDUCATION, AND INCOME PLAY A ROLE IN HYPOCHONDRIA.
(LEVY) if you treat the academic population around Amherst, you're going to see far far more pp worried about the minutia of their health care, 0:10:08.1 than if you are running a health center in springfield.
WHEN LEVY WORKED WITH INDIGENT PATIENTS, HE HAD PROBLEMS GETTING THE TRULY SICK TO COME IN AT ALL. WHEN HE STARTED WORKING WITH MIDDLE AND UPPER INCOME PATIENTS, HE SAW MANY MORE PEOPLE WHO DIAGNOSED THEMSELVES WITH UNLIKELY DISEASES -- AN OBSERVATION THAT'S BEEN BORN OUT IN RECENT NATIONAL STUDIES. (BIDMC celiac...) LEVY BLAMES A CULTURE OF MEDICAL PARANOIA....ONE THAT'S STRONGLY ROOTED IN MEDIA TRENDS....
AMBIENCE: START PLAYING DRUG ADVERTISEMENT..... "i had ongoing pain, a deep ache....
(LEVY) there are certainly a lot of drivers of medical anxiety that can be traced to drug companies and their advertisments. the fact that we do direct to consumer advertising on TV makes a big impact.
[MORE AMBI OF ADS]

(levy) every day, pp are getting bombarded with this large list of very general symptoms which the company then tells them, this could be a sign of ... fill in the blanks here. 0:30:00.7
[more ad ambi]
IT DOESN’T HELP THAT IN RECENT YEARS…. THERE’S BEEN INCREASING PUBLICITY … AND PATIENT ADVOCACY… AROUND CHRONIC HEALTH CONDITIONS WITH VAGUE SYMPTOMS...FROM HEADACHES TO FATIQUE.
more ad:the pain just doesn’t go away, my muscles ache all the time. does this sound like the pain you’ve been experiencing? This is fibromyalgia...?"
(LIPTZIN) *…and they'll come in ... saying, .... i want you to do a test for lyme disease or i think i have fibromalgia, or chronic fatique syndrome…
BAYSTATE PSYCHIATRIST BENJAMIN LIPTZIN SITS ON A STATE MEDICAL COMMITTEE THAT EVALUATES THE OVERUSE OF MEDICAL SERVICES.
and one of the things that goes with hypochondriasis is, they'll go doctor shopping. 0:04:03.3 so if doctor A won't take them seriously and go along with request, they will try to go see Doctor B.0:04:17.0
IN SOME CASES, OF COURSE, GETTING A SECOND OPINION IS PERFECTLY REASONABLE. IT'S SOMEWHERE, LIPZIN SAYS, BETWEEN THE SECOND OPINION.... AND THE TENTH ONE.... THAT HYPOCHONDRIA BECOMES NOT JUST THE PATIENT'S PROBLEM, BUT EVERYONE'S.

MUSIC BRIDGE

PART 3: HOW DO DOCTORS DEAL WITH IT/EFFECT ON HEALTH CARE SYSTEM?
Woody Allen: phone rings, 0:02:53.0 Mickey, what's the matter with you? w: I feel dizzy, i don't feel well. Do you hear a ringing? … if i have a brain tumor, i don't know what i'm gonna do. s: you don't have a brain tumor! he didn't say you had a brain tumor. w: no, they're not gonna tell you, bc sometimes the weaker ones will panic...
ALTHOUGH HYPOCHONDRIA IS CONSIDERED A MENTAL DISORDER..... IT SHOWS UP MOST FREQUENTLY IN THE PRIMARY CARE OFFICE. DOCTOR ARTHUR BARKSY SAYS A NATIONAL CRISIS IN PRIMARY CARE ONLY MAKES MATTERS WORSE. OVER THE LAST DECADE, THE NUMBER OF PRIMARY CARE DOCTORS HAS DECLINED, WAITING TIMES HAVE GOTTEN LONGER, SICK VISITS HAVE GOTTEN SHORTER.
(BARSKY) i think there is a general erosion of trust in the doctor relationship. pp really are a lot more suspicous. and feel they have to look out for themselves. you can trust the doctor to have your best interest at heart. i think that erodes the doctor's power to reassure.0:04:32.8 to comfort pp, to ease their concerns.
Morgan: *i feel sorry for a lot of hypochondriacs who've developed really bad relationships with their doctors, bc they're constantly 0:18:44.9 -- they don't trust them and they're constantly second guessing them, convinced their doctor is blowing them off, which some do.0:18:53.5
(LEVY) i've had pp threaten to sue me. they said, Oh, why aren't you ordering an MRI. 0:43:01.2 you doctors, you're all in cahoots with the insurers and you're not ordering an MRI. and it's very hard to convince such a person that's not the case.
DANIEL LEVY IS A GOVERNING MEMBER OF THE AMERICAN COLLEGE OF PHYSICIANS. HE SAYS MANY DOCTORS FEEL THEY HAVE LITTLE RECOURSE BUT TO INDULGE PATIENTS’ WORRIES.
it's a pretty litigious society. and actually one of the commonest bases of a malpractice suit is failure to diagnose.0:03:13.0 so if someone comes in complaining of symptoms which they're afraid might be the harbinger of serious illness, no matter how improbably, one feels compelled to go ahead and allay their fears.
THE PROBLEM, HE SAYS, IS WHEN DOCTORS ARE PUSHED TO INVESTIGATE NOT BY THEIR MEDICAL KNOW-HOW, BUT BY A FEAR OF LAWSUITS, OR BY A SIMPLE WISH FOR EXPEDIENCY.
Levy: doctors are hugely rushed, and I’m interested in my patients being happy they’re getting the care they want… but there’s a lot of pp getting tests they don’t need, and a lot of expenses being dumped to the healthcare system which don't buy us anything.
(BARSKY) and there are actually interesting studies in which physicians will order a diagnostic study, not bc they think it's indicated medically, but just for the purposes of reassurance,
HARVARD RESEARCHER ARTHUR BAR SKY....
BARKSY: and what they found in those studies, if those pp are sufficiently anxious to start with, then a negative test does not reassure them.0:06:21.1
[(SHEILA) i went to my doctor quite often, 0:06:30.1 i would get reassured and then i would be back there in another two months. bc the symptoms changed slightly.
SHEILA MURPHY IS A 50-YEAR-OLD NONPROFIT ADMINISTRATOR -WHO'S BEEN ANXIOUS ABOUT HER HEALTH EVER SINCE HER COUSIN DIED IN CHILDHOOD OF LEUKEMIA. AFTER MURPHY'S SECOND SON WAS BORN, THE STRESS CAME OUT IN THE FORM OF VAGUE PAIN AND DISCOMFORT IN HER CHEST. IT TOOK YEARS BEFORE MURPHY'S DOCTORS COULD ASSURE HER THE SYMPTOMS WERE LIKELY A COMBINATION OF EARLY MENOPAUSE AND ANXIETY.
0:06:47.1 i did end up having quite a few tests. i had, an EKG a couple of times, i had a -- they sent me home with a monitor for a while. and eventually i even saw a cardiologist for interpretation of the results.]
MORGAN GRIFFIN HAS ALSO RACKED UP HIS SHARE OF TESTS....
(MORGAN) Tests for things like rheumatoid arthritis, lupus, lyme disease, some xrays.
SO HAS SHELBY MAROWITZ....WHO ASKED FOR A MAMMOGRAM IN HER EARLY THIRTIES, SOONER THAN GUIDELINES SUGGEST, DESPITE HAVE NO SYMPTOMS OF BREAST CANCER.
(SHELBY) my doctor realized she had to let me have a mammogram or i was gonna be calling every day with, i think it's a lump, i think it's changed.0:11:06.4
AND THIS IS WHY ARTHUR BARSKY SAYS HYPOCHONDRIA -- AND THE CHAIN REACTION IT SETS OFF IN THE HEALTHCARE SYSTEM -- IS A MAJOR DRIVER OF MEDICAL COSTS.
(BARKSY) they're terribly expensive patients to take care of.0:06:52.0 and the point isn't so much that it's expensive, but it's not helpful expense.
BARSKY AND HIS COLLEAGUES CONDUCTED A STUDY OF PEOPLE WHO HAVE UNEXPLAINED SYMPTOMS WITH NO MEDICAL BASIS -- THEY ACCOUNTED FOR 16 PERCENT OF ALL MEDICAL COSTS. ANOTHER HEALTH RESEARCHER AT COLUMBIA UNIVERSITY (Brian Fallon, columbia univ.) PUT THE ANNUAL COST OF HYPOCHONDRIA IN THE BILLIONS OF DOLLARS.
(BARSKY) … they're often getting the same study repeated more than once, they're seeing two difference physicians for the same problem, there's this duplication of services, ....0:07:30.0
AND THERE’S LITTLE FINANCIAL INCENTIVE FOR DOCTORS OR PATIENTS NOT TO ORDER TESTS. MOST INSURERS PAY BY THE PROCEDURE -- A SYSTEM CALLED FEE-FOR-SERVICE. PATIENTS MAY BE CHARGED A COPAY OF 20 TO 100 DOLLARS; THAT'S MUCH LESS THAN THE ACTUAL PRICE OF, SAY, AN MRI OR A CT SCAN.
(LIPTZIN) our health insurance system protects patients from the cost of tests.
PSYCHIATRIST BENJAMIN LIPTZIN…
that encourages pp to order expensive tests, as though they're free, but they're not free, bc every month you get a premium statement and you have to pay for it.0:20:27.2
AND THERE ARE COSTS BEYOND MONEY -- CERTAINLY FOR FAMILIES....AND RELATIONSHIPS. SHELBY MAROWITZ'S HUSBAND ZAK -- HIMSELF A PSYCHOLOGIST - IS THE KIND OF GUY WHO RARELY GOES TO THE DOCTOR. ZAK USED TO BELIEVE SHELBY WHEN SHE INSISTED SHE WAS GRAVELY ILL...THEN HE BEGAN TO GET FRUSTRATED AT THE FREQUENCY OF HER EPISODES. FINALLY, HE'S ACCEPTED HER HYPOCHONDRIA – AND THE STRAIN IT PUTS ON THE WHOLE FAMILY.
ZAK: now's there's a way to almost predict. she was going through a very stressful period. she was applying for a new jobs, we were getting ready to move, at one point, i remember thinking, we're gonna end up going to the hospital pretty soon.0:08:35.6 (laughs).
AND SURE ENOUGH....

(SHELBY) i woke up at 4 oclock, and i was like, i can't breathe, my heart's racing, and i felt like that elephant sitting on your chest....i was positive there was something really wrong, like i was having a heart attack, or i don't know, collapsed lung. (laughs)
LIKE MANY TIMES BEFORE – THEY FOUND NEIGHBORS TO WATCH THEIR CHILDREN, LOST MOST OF THE NIGHT’S SLEEP, MISSED A DAY OF WORK. IN THE END, THE EMERGENCY ROOM DOCTORS FOUND NOTHING, AND SHELBY WENT HOME…. BUT SHE’S RARELY REASSURED, NO MATTER THE EVIDENCE.
SHELBY: my family is really healthy. … my grandparents lived until their 80s and 90s. but i have big fears i'm not gonna be that lucky.

MUSIC BRIDGE
PART 4: WHAT CAN BE DONE?
SO WHAT CAN BE DONE TO RELIEVE THE BURDEN OF HYPOCHONDRIA – ON INDIVIDUALS AND THE SYSTEM? IN THE CASE OF GENE WEINGARTEN – THE NEWSPAPER REPORTER – HIS BLUFF WAS CALLED.
(GENE) i got a fatal disease. in my case, it was Hepatitis C. and once you have something real and serious to deal with, you don't bother with the phony baloney stuff anymore. (6:50)
WEINGARTEN BEAT THE HEPATITIS SEVERAL YEARS AGO….AND NO LONGER CALLS HIMSELF A HYPOCHONDRIAC. BUT FOR MOST PEOPLE, CONTRACTING A POTENTIALLY FATAL ILLNESS IS HARDLY A PRACTICAL CURE. PSYCHIATRISTS FOCUS ON TREATING THE ANXIETY. ARTHUR BARSKY IS OPTIMISTIC ABOUT A TREATMENT CALLED COGNITIVE BEHAVIORAL THERAPY - OR C-B-T. THAT’S A METHOD OF PSYCHOTHERAPY THAT TRAINS PEOPLE TO OBSERVE AND CONTROL THEIR OWN THOUGHT PATTERNS. WITH FUNDING FROM THE NATIONAL INSTITUTE OF MENTAL HEALTH, BARSKY'S STUDIES HAVE SHOWN THAT C-B-T REDUCES SYMPTOMS OF HYPOCHONDRIA. THE CHALLENGE IS TO GET THE TREATMENT TO PEOPLE WHO DON'T KNOW THEY NEED IT.
(BARKSY). ..most of these patients are very resistant to any psychiatric or mental health intervention.0:09:49.1 they say, i don't need to talk to anyone -- i need a biopsy! i need another CT scan! i don't need to sit and talk about my problems.
SO IN HIS CURRENT FEDERALLY-FUNDED STUDY, BARSKY TRAINED NURSES IN PRIMARY CARE PRACTICES TO IDENTIFY HYPOCHONDRIA -- AND TO USE COGNITIVE BEHAVIORAL THERAPY RIGHT THERE IN THE OFFICE.
(BARKSY) a lot of these pp are really caught in a cycle of symptom amplification -- their concern amplifies the symptom… they pay more attention to it and it seems to get worse. … and the treatment is primarily trying to unravel that. to get pp to understand you can have severe, bothersome symptoms, but that doesn't mean you have a serious disease to cause them.0:14:35.5
[MORGAN GRIFFIN HAS HAD SOME SUCCESS WITH THIS METHOD ….
(morgan) you try to think through rationally, what is the likelihood i have this, what is the evidence, and that actually does help.]
IN 2010, SWEDISH RESEARCHERS FOUND THAT C-B-T CAN BRING DOWN THE COSTS ASSOCIATED WITH HYPOCHONDRIA, ALTHOUGH ANOTHER GROUP OF RESEARCHERS POINTED OUT THE TREATMENT ITSELF CAN BE LONG AND EXPENSIVE. ARTHUR BARSKY SAYS THERE ARE ALSO PROMISING SIGNS THAT ANTI-DEPRESSANTS CAN RELIEVE ANXIETY AND REDUCE SYMPTOMS OF HYPOCHONDRIASIS. BUT BEFORE THE MORE CLINICAL METHODS, DANIEL LEVY WOULD RATHER START WITH THE DOCTOR-PATIENT RELATIONSHIP....
(levy) if you're good at what you do, … you learn to be direct and forthright about the probabilities, you learn to have them accept the risk of not diagnosing a very unlikely thing, to wait and watch, and that is an important ingredient in good primary care medicine.0:11:43.7
FROM A POLICY PERSPECTIVE, ECONOMISTS AND INSURERS ARE THINKING UP WAYS TO REDUCE UNNECESSARY TESTING -- FOR EXAMPLE, GIVE DOCTORS A LUMP SUM TO TREAT PATIENTS, SO THEY'D BE LESS INCLINED TO SPEND MONEY ON MERE PEACE OF MIND. PHYSICIAN GROUPS ARE PUSHING FOR MEDICAL MALPRACTICE REFORM, SO DOCTORS DON'T ENGAGE IN WHAT'S CALLED "DEFENSIVE MEDICINE" -- ESPECIALLY WHEN FACED WITH OBVIOUS HYPOCHONDRIA.
many people in health care approach this as the patient's problem, which I think is a mistake.

[bring in concluding music]
BUT FOR NOW, MOST SUFFERERS HAVE TO MAKE THEIR OWN WAY THROUGH THEIR ANXIETY…. SHEILA MURPHY DECIDED TO SEE A PSYCHO-THERAPIST – SHE TRIED AN EMERGING TREATMENT CALLED E-M-D-R THAT DESENSITIZES PATIENTS TO ANXIETY TRIGGERS. AND SHE TOOK STRESS MANAGEMENT CLASSES THAT USED DEEP BREATHING TECHNIQUES.
(SHEILA) i have calmed down a lot. one thing i've learned is, if you wait a lot of times, symptoms go away, and if they don't, then that's when you pursue it. 0:15:13.]
SOME PEOPLE JUST LEARN TO ADAPT. SHELBY MAROWITZ DECIDED NOT TO SEE A THERAPIST -- WHICH HER DOCTOR HAD RECOMMENDED. BUT SHE HAS FOUND SOME RELIEF WITH PAXIL, A MEDICATION SHE TAKES FOR ANXIETY. THAT HASN'T STOPPED HER FROM ASKING HER HUSBAND TO BUY HER A FULL-BODY CAT SCAN FOR CHRISTMAS – THAT'S A PRIVATE IMAGING SERVICE NOT COVERED BY INSURANCE …JUST TO MAKE SURE HER DOCTORS HAVEN'T MISSED ANYTHING.

(Shelby) *. i wish i didn't have these feelings or these thoughts.0:24:01.2….it's like i can't really keep it from happening, but i can contain it. i know the things i shouldn't do to make it worse. and it probably helps having a psychologist as a husband, he doesn't let me go on those websites! he's like, don't google that, whatever you do!0:08:23.8
(morgan) 40:41 one thing that helped for me was having kids.
MORGAN GRIFFIN
For someone who sees the body as a sort of enemy who's always gonna fail you, it was sort of amazing to watch my wife’s pregnancies, …. To see it all go so well, and these wonderful kids come out. 41:28… this realization that our bodies work pretty well most of the time. 42:30
BUT GRIFFIN….AND MAROWITZ….. AND MURPHY.....KNOW THEY’RE ALWAYS GOING TO NEED MORE ASSURANCE THAN THE TYPICAL PATIENT. AFTER ALL….AS THE OLD SAYING GOES: EVEN HYPOCHONDRIACS GET SICK.

HOST OUTCUE: THAT WAS "LIVING WITH HYPOCHONDRIA: THE REAL COSTS OF IMAGINED ILLNESS." IT WAS WRITTEN AND PRODUCED BY KAREN BROWN, EDITED BY FRED BEVER, WITH CONSULTATION FROM CLAIRE SCHOEN. ORIGINAL MUSIC BY JOHN TOWNSEND. THANK YOU FOR LISTENING.