Eminent Malingerers

This is an expanded version of my essay on celebrity hypochondria in today’s Wall Street Journal.

[HYPO]Are you bothered by diverse pains and aches? Do you frequently worry that you might have a serious illness? Are you convinced that something is amiss with your body? Do you find it hard to wrench your thoughts from your own immediate physical or emotional being and apply them to the wider world? Does it seem to you that family, friends and physicians alike have lately failed to show sufficient sympathy? Does the fact of your mortality weigh heavily upon you? Are you, tender reader, afraid?

If you have answered yes to all of these questions (paraphrased from several psychiatric questionnaires) you may be a hypochondriac: that species of fretful and imaginative patient who is such a drain on scarce health care resources and an object of tense humor for medical professionals. But you would need to meet other criteria before a precise diagnosis of hypochondriasis or “health anxiety” could be applied. The true hypochondriac presents a pattern of such fears or delusions, and appears serially resistant to professional reassurance. He or she, according to current therapeutic convention, is a sub-type of the anxious or obsessive; hypochondria sits on a continuum with obsessive-compulsive disorder, body dysmorphic disorder, and generalized anxiety disorder. No single medical explanation for hypochondria has yet emerged, though it has been suggested that patients suffer from “somatosensory amplification:” that is, ordinary harmless sensations press harder upon them. We all worry now and then for our physical well-being, but the hypochondriac’s fears have become toxic and intractable.

The content of an individual patient’s concern – dread of cancer, for example – is but one aspect of hypochondria. Just as intriguing is the way it insinuates itself into a culture and affects how we conceive of our bodies, our illnesses and our social status. In the eighteenth century, the condition became almost fashionable, and was thought to be a symptom of excess luxury and ease. It was known for a time as the “English malady”; there seemed to be a hypochondriac character, and whole hypochondriac civilizations. It is one of the oddities of the disorder that each historical era thinks itself more hypochondriacal than its predecessors; today we imagine ourselves more susceptible than previous generations simply because we have readier access to more information, more fuel for our suspicions. In truth, of course, past centuries did not want for reasons to be fearful.

Where we differ is in our vastly more open interest in a select array of apparently ailing bodies; we appear to have excelled the hypochondriac cultures of the past by elevating the morbidly self-involved to the level of paragon and warning. Doesn’t the hypochondriac imagined above – anxious, death and age-obsessed, hypersensitive and self-absorbed – sound suspiciously familiar? Doesn’t he or she sound, in short, like a certain stratum of contemporary celebrity? The very rich and the very famous seem increasingly condemned to a highly conspicuous and destructive form of hypochondria. Theirs is a strenuous and unenviable calling, demanding rigors previously submitted to solely by the chronic invalid. Pumped into lumpy strangeness at the gym, filleted and stitched by the surgeon, embalmed in Botox: they look more like frail survivors than people who are going places. And this before one has even considered the ravages of drug or alcohol addiction, anorexia and botched body image, clinical depression and other psychic distortions caused by the kind of constant surveillance formerly inflicted only on prisoners.

It will be objected that fame has long made demands on the body and mind. For sure, Hollywood learned swiftly to fix teeth and busts, blur hairlines and efface waistlines, while rock musicians obligingly self-medicated to achieve the proper lean and bleary look. But it’s not only the extent of intervention and vigilance now required by success that seems different. Rather, “work” on the celebrated body – and the ravishing, ghoulish, or comical consequence of that work – is more and more part of the point. Fame increasingly consists in a state of almost constant near-collapse: as if fading, addled pop starlets and surgically enhanced but unhinged actors were really Victorian hypochondriacs in need of a reviving spell at the local “nervine institute.” Time and again in recent years – in the sorry ends of Michael Jackson and Anna Nicole Smith, the oscillating career of Britney Spears, and the tautly panicked faces of countless movie stars – we have seen the morbid effects of success erupt on the famous body itself.

Today’s hypochondriac celebrities have inherited their odd anxieties and patterns of perverse behavior from the eminent malingerers of the last century. Among the latter, Howard Hughes seems to have set the standard for paranoiac tics and conspicuous reclusion. The grim scenography of Hughes’s decline – his solitary, twilit self-neglect, combined with elaborate prophylactic rituals against the outside world – is a familiar warning about the potential price of power and fame, but it was just the terminal point of a life of constant vigilance regarding contagion. His biographers have conjectured that Hughes’s hypochondria began in childhood, with his mother’s excessive concern for his health. It is a tempting and no doubt simplistic explanation, but it has been suggested too in the case of Glenn Gould. The pianist’s manifold eccentricities on the concert stage – playing in coat and scarf, humming along to his own renditions of Bach – were matched in private by his prodigious horror of physical contact, enthusiasm for prescription drugs and keeping a sedulous record of his (largely imaginary) symptoms.

With Gould and Hughes, hypochondria was mostly a matter of keeping the world at bay; today’s celebrities, by contrast, seem to advertise their fears and symptoms. The most obvious precursor of our present hypochondriac culture was surely Andy Warhol, who despite his legendary laconism was not well known for an addiction to privacy. Having been cossetted as a child after a bout of St. Vitus’s dance, Warhol lived most of his life in a state of anxiety regarding the ailments and imperfections of his “bad body.” (He grew more anxious after he was shot by Valerie Solanas in 1968, and developed a phobia for hospitals.) The artist’s diaries record an impressive array of obsessions, including acne, baldness, weight loss, weight gain, aging, cancer, AIDS, pneumonia, and brain tumors. Warhol raveled up his fear of disease with the misery of being physically unattractive, so that in the end he seemed to be looking for a catch-all cure, from the numerous alternative healers he attended, for the vexing problem of being Andy Warhol.

In this sense, Warhol seems to predict the fate of the figure that best exemplifies the hypochondria at the heart of contemporary celebrity. At the time of his death in June 2009, the depredations Michael Jackson had visited on his own body had perhaps been overshadowed by his 2005 trial and, latterly, his worsening financial embarrassment. We had slowly grown used to his spectral appearance, and in truth he looked in recent years only marginally more peculiar than countless other cosmetically altered performers, reality TV stars and aspirant or waning actors. In the decades since Jackson’s surgery and skin-bleaching first made us wonder about his mental state, a fretful but reckless attitude to one’s body has become an essential requisite for the strange vocation of modern fame. But as the abject circumstances of Jackson’s death began to emerge, one was reminded again of the sheer weirdness of the physical refashioning that he seems to have pioneered for the rest of the culture.

It would be hasty and trite to say that Michael Jackson was merely a hypochondriac in the sense we mean when we apply that word to our over-anxious relatives or the legions of the ordinary “worried well.” His case was certainly extreme, and the “cures” to which he had recourse unthinkable for most of us, even in our darkest, dead-of-night moments of self-doubt or suspicion. Even conservative estimates suggest that his ruined nose was the result of at least ten operations. The bleaching of his skin – which Jackson maintained was due to the skin condition vitiligo – seemed intended not so much to make him look like a white person as to ensure that he vanished altogether. (Becoming physically neutral or null is a classic hypochondriac fantasy; Warhol once wrote of “the best American invention – to be able to disappear.”) Beyond a certain point of success, it seems he lived in a welter of bodily and mental pain. His fascination with surgery was such, it was said, that for a time he regularly attended operations at UCLA Medical Center. If Jackson’s problem was a sort of hypochondria, it was on an ambitious and Gothic scale.

The medical catastrophes suffered by contemporary celebrities are often, of course, the result of (or deliberate covers for) drug dependence. Yet even here a species of hypochondria is at work. It is surely no accident that prescription painkillers have featured so tragically in recent celebrity deaths, such as those of Heath Ledger and (allegedly) Brittany Murphy. It seems somehow normal to us now that success brings with it agonies that can only be treated with opiates. Even where illness may be shammed to excuse recreational use, there is something wretchedly apposite about the litany of analgesics that attends such deaths, as though celebrity were something that simply hurts.

Having studied the case histories of various historical hypochondriacs – from Charles Darwin’s palpitations and dyspepsia to the protracted collapse of Marcel Proust – I can only surmise that there is a point of crisis beyond which excessive concern with one’s body turns into an actually dangerous or even lethal pathology in itself. It seems that for some sufferers hypochondria is a way of guaranteeing inviolable privacy; consider Proust laboring in his cork-lined room, or Alice James (neurasthenic sister of Henry and William), who faded away rather cheerfully in her London sickbed. An inward-tending obsession with one’s own body, whether expressed as illness or an excessive urge to improvement, can guarantee certain advantages in the outside world. Unstopped, however, it will tend to the morbid, and few, historically, have had such resources or occasions for self-mutilation as the rich and famous in our century.

As to why celebrities’ curious relationships with their own bodies should seem especially troubled today, it is perhaps as much a question of exposure as a combination of morbidity and wealth. Where once the revered body – of a monarch, say, or a legendary beauty – was distant and unattainable, today we learn much from the wealthy and conspicuous about how to comport ourselves and treat our own bodies. It is as if they are testing out our feelings and fears about ourselves, conducting experiments at the limits of what is physically and emotionally endurable, so that we may in time emulate them or (if the experiment fails) turn away, appalled. Their excessive self-care and paradoxical risk-taking with their health are symptoms of our wider hypochondriac culture.

Clinical experience does not disprove this notion of a collective health anxiety. We tend to think of hypochondria as a kind of selfishness; though it is a common enough diagnosis – the condition is usually treated nowadays with a combination of cognitive-behavioral therapy and antidepressants – the hypochondriac remains a disreputable figure, solipsistic and even immune to the real suffering of others. But psychologists tell us that hypochondria is often also part of a group or family dynamic; the patient acts out the expectations of others who somehow need him or her to be sick. What better description could there be of our attitude – at once awed and repelled, envious and disproving – to the bodies of certain celebrities? What better image of our grisly concern when the heroic patient takes an Icarus fall? The wealthy and adored may toil to stay youthful and fit, submit periodically to the surgeon’s knife, and drift across our screens in an opiate haze. They will be doing it for us, and our morbidly projected fears for our own bodies.

[Photo illustration by Wes Duvall, Corbis (photo).]

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