Mr. A was the kind of patient no doctor wanted to deal with.
A few years ago, he showed up in the office of Dr. Brian A. Fallon, complaining of nonstop headaches, which he was sure meant a brain tumor.
Tests showed nothing in the 52-year-old stockbroker's head other than a normal-looking brain. And it was clear to Fallon -- at the time a young psychiatric resident at Columbia University -- that Mr. A had hypochondria.
Mr. A, however, was not convinced, says Fallon, who recalled their first meeting.
"I feel I have a serious medical illness, but the doctors won't tell me what it is," Mr. A ranted. "You are a psychiatrist. I don't want to talk about my problems. I don't care how well-trained you are, you can't help me. I have a physical problem, not a mental one!"
What Fallon did next, however, not only convinced Mr. A that he did have hypochondria, it also convinced both doctor and patient that hypochondria is indeed "a serious medical illness."
On a hunch, Fallon prescribed Prozac -- which is used for depression and obsessive-compulsive disorder -- because he believed Mr. A's excessive fears mimicked the obsessive doubts and expectations of harm that people with obsessive-compulsive disorder typically experience.
Within six weeks Mr. A was a new man. No headaches. No irrational fears. No obsession over dying.
Equally ecstatic was Fallon. To him, Prozac represented a key that unlocked a big, black box in psychiatry.
Until recently, hypochondriasis -- unremitting fears about disease and a preoccupation with bodily symptoms despite reassurance from doctors -- was considered one of the mental disorders most unyielding to psychotherapy. Medications were not considered useful.
Now, however, the picture is brightening for hypochondriacs and the exhausted retinue of doctors who try in vain to treat them for everything but hypochondria.
Adding greatly to the new understanding of hypochondria is a New Jersey journalist named Carla Cantor, whose new book on hypochondria details her ordeal with the disorder. "Phantom Illness: Shattering the Myth of Hypochondria" (Houghton Mifflin) contains a forward by Fallon, assistant professor of clinical psychiatry at Columbia University.
The progress in understanding hypochondria reflects the mind-body movement in medicine, in which emotions and thoughts are accepted as having a large effect on physical health.
Moreover, the promising use of Prozac for hypochondria suggests that the brain's serotonin neurotransmitters may be highly influential in "mediating" this disorder, Fallon says.
The first emotional bomb to fall in Cantor's life occurred when she was 17. Driving to a ski outing with a friend, Cantor's car collided with a tractor-trailer. Cantor, now 41, walked away. Her friend was killed. Morose and shaken, she developed an eating disorder in college and became preoccupied with the fear that she, too, would soon become ill or die. Cantor underwent years of psychotherapy.
"We need to know what the psychological underpinnings are for each patient," says University of California, Los Angeles, psychologist Marc Schoen, an expert in mind-body medicine.
While some people may have a predisposition toward worrying, hypochondria seems to emerge to fill a need in someone's life, he says.
For example, hypochondria can be used to seek attention or to punish oneself, to withdraw from personal responsibilities or because some traumatic event has led to a feeling of being unsafe. (In his preliminary research, Fallon has found a high rate of early psychological trauma, such as sexual abuse, among hypochondriacs.)
Cantor believes her car accident "fell on fertile ground."
"I'm sure a lot of doctors, behind my back, rolled their eyes and couldn't stand me," Cantor says. "Hypochondriacs are begging the doctor to diagnose them and yet they are so frightened of having a disease that there is no pleasing them."
Then, a few years ago, Cantor spotted a newspaper article on hypochondria and "something clicked," she says. She made a series of phone calls that led to Fallon, who was recruiting patients for his study using Prozac.
Cantor opted not to enter the study but found a nearby psychiatrist willing to prescribe Prozac. She felt better in weeks. Her pains disappeared. The hair she had been losing began to grow back. And her obsessive fear of having lupus no longer dominated her thoughts.
She began researching the illness and was stunned to find out how common it is. Studies suggest that 6 percent to 10 percent of all people who visit doctors have no physical malady but have some degree of hypochondria. But Cantor believes that the stigma -- the ugly connotation associated with the word "hypochondria" -- keeps many people who suspect they are afflicted from seeking help.
"From very early on, I couldn't understand the stigma," she says of her decision to become the poster girl for the disorder. "When I realized how common hypochondria is, the whole stigma thing to me became absurd."
Cantor knew she had stumbled over the mother of all shameful conditions when she found there was no support group or organization for hypochondriacs.
What concerns Fallon and other pioneers in the treatment of JTC hypochondria is that most hypochondriacs aren't steered toward effective treatment.
"We are trying to change the way people view this we are much more optimistic now," says Dr. Javier Escobar, chairman of psychiatry at the Robert Wood Johnson Medical School in Piscataway, N.J.
Escobar, like Fallon, is enthusiastic about the family of anti-depressants, called selective serotonin reuptake inhibitors, for treating hypochondria. Escobar has begun a study with an SSRI called Effexor on people who believe they have multiple chemical sensitivity or Gulf War syndrome, both disorders that produce vague physical complaints but are difficult to diagnose.
Fallon has also discovered that most hypochondriacs are receptive to treatment once they accept the diagnosis.
"A lot of doctors have assumed that you can never work with these patients because they want to hold on to their symptoms," he says. "My experience is that this is not true. I would say 90 percent of the patients I treat are quite eager to get better."
Pub Date: 8/06/96