Yes, Ebola is here. The news of the first case of Ebola to be diagnosed on U.S. soil is unsettling, no matter how many times health officials calmly implore us not to panic, followed by a reminder that the virus is unlikely to spread widely beyond this one case in Dallas, Texas. But Ebola anxiety, on the other hand, is so far proving to be a highly contagious thing.
On Monday, Texas Health Commissioner Dr. David Lakey told reporters that stress and panic were likely to cause more damage to the community than the fearsome virus itself. In Dallas, some parents are keeping their children home from school, the Dallas Morning News reported, and some nonprofits told the newspaper that some of their volunteers are refusing to enter the neighborhood where the patient, Thomas Eric Duncan, first showed symptoms.
At the national level, a survey back in August by the Harvard School of Public Health found that nearly 40 percent of Americans are “concerned” that there will be a full-fledged outbreak, à la Outbreak, of Ebola within the next year. It’s not altogether surprising, considering some of the near-hysterical television coverage. On Meet the Press this past weekend, Joe Scarborough made his case for mass Ebola panic, saying, “If you think the Atlantic Ocean is going to stop it from coming over here, you’re kidding yourself.” And on a recent Fox & Friends, Elisabeth Hasselbeck demanded to know why she should worry more about flu than Ebola, countering infectious-disease specialist Dr. Dalilah Restrepo’s calm but thorough answer with a simple “But it’s here.”
In a way, what we’re seeing here is hypochondria manifested on a mass scale, said Catherine F. Belling, an associate professor at Northwestern University’s Feinberg School of Medicine, who has written a book on hypochondria. “I know that there are a lot of people, clearly, who are very anxious and panicking at this point, who maybe don’t altogether trust what the CDC is saying,” she said. “And they’re worried that it’s out in America now, instead of being far away in Africa.” We tend to think of hypochondriacs as the irrational individuals who, after spending entirely too much time on WebMD, become convinced that a minor headache means a brain tumor, or that a lingering cough means lung cancer. But that anxiety and fear some of us are having over catching Ebola (a highly unlikely health outcome)? That’s hypochondria, too, Belling explained.
Belling recently talked to Science of Us about hypochondria, how the disorder relates to a mistrust of health officials, and why it isn’t exactly fair to call hypochondriacs “irrational.”
What is hypochondria? Is there an agreed-upon definition?
Well, it’s been defined as an irrational fear of illness. But I think it’s not at all irrational to fear illness. We all fear getting sick, on some level. What hypochondria is, then, is the inability to put that very rational fear into context, where you can continue to function normally rather than being paralyzed by it.
Because, the thing is, it’s entirely rational to be afraid of Ebola. When it crosses the line is when someone who is in, for example, New York, won’t leave their apartment because they’re afraid of getting Ebola. They’re incapable of recognizing that there’s truly an incredibly minuscule likelihood of getting Ebola.
But I would say everyone, at some stage, will act a little like a hypochondriac. For example, you have some kind of symptom, and you go to the doctor and he does some tests and finds no evidence of any sort of disease — and you think, Oh, what if he’s wrong? At some level, hypochondria is that kind of thinking. It’s that initial reflex of: Well, maybe medicine can’t answer all my questions.
It sounds like a lot of hypochondriacs tend to be mistrustful, maybe particularly of modern medicine.
Absolutely. And, really, why shouldn’t we be? It’s perfectly rational in our current culture, where there’s so much ongoing coverage of medical error and inaccurate diagnoses. And what happened at that Dallas hospital didn’t help — it was really just an information-technology screwup. [Though the hospital is now reversing its earlier statement.] But that’s a disaster, because anyone who is inclined to be mistrustful will be even more so.
What is it about Ebola in particular that is sparking anxiety, especially in those prone to hypochondria?
With Ebola, you have the elements of a horror story, largely thanks to things like The Hot Zone. That’s the image people have of this thing, that it’s something that can turn you into some kind of monster. I think that’s what’s kind of special about Ebola, as opposed to something we should truly be worried about, like drug-resistant bacteria, for example.
There’s a very special sense of horror that’s attached to Ebola, and before now, it’s been sort of alien. And now it’s here. And I think that has captured imaginations in a scary kind of way.
But you’ve written in your book that although we dismiss hypochondriacs as being irrational, maybe that’s not entirely fair.
Right. There’s been research on risk perception related to health, involving people who had been diagnosed with hypochondriasis and people who had not. And, not surprisingly, the people with hypochondriasis perceived their health risk as worse than the mentally healthy people. But what they also found was that even the hypochondriacs had an unrealistically positive perspective on what their real health risk was. So the people who were mentally healthy were really deluded about how safe they were.
The idea that mental health is about being rational is not at all true. We’re all, 100 percent, going to die, so it’s actually kind of realistic to be worried about it.
To say it’s rational, or realistic, however, doesn’t mean it’s a good thing. If you focus on that, you’re not going to be able to get out of bed.
Do you have any idea what might cause hypochondria?
For some, it may be a result of things in your childhood, like having a family member get suddenly sick and die. Those things can undermine our ability to keep mortality in perspective.
Also — and you of all people would know this! — you can’t turn on the TV or open a newspaper or magazine and not immediately see articles about health and medicine. It’s become an obsession.
But there are also a lot of things in our culture that predispose people to anxiety about their health. The fact that we tend to think about things like obesity as a disease, for example. And there’s a tendency with a lot of things, obviously within psychiatry, where, for example, in the past someone who would have been considered a naturally shy person can now be diagnosed with social anxiety disorder and get on Prozac. A lot of things we used to see as general unhappiness are now pathologized.
Any advice to someone who is feeling a little (or a lot) anxious over this news about Ebola?
It’s really just a matter of being very patient, and seeing what happens with this case in Texas. But that’s another thing about hypochondriacs — hypochondriacs need a diagnosis, now. They are not content to wait and see what happens next.