Updated: Feb 26, 2020
Hypochondria main feature is fear of disease ( a serious disease, not any disease), all his life goes around that. Hypochondriac people suffer a lot, they have a lot of anguish. Hypochondria is a problem the individual has with himself and the relationship he has with mortality, they are patients who fear death. When the hypochondria is serious, it can limit a lot the life of the patient as they have to go continuously to the doctor. They are very anguished patients, they need to go to the doctor over and over again, to be told they are fine in order to calm their anguish and then, they believe again they have a disease. Hypochondriac individuals suffer from painful somatic sensations similar to those experienced by individuals suffering from an organic disease. Hence it is very difficult for a doctor to distinguish between organic and hypochondriac patients: their account of the symptoms and complains are the same. The doctor performs a lot of unnecessary tests until he realises he doesn’t have such a disease. However, they feel very sick.
Main difference between hypochondria and organic disease is that in the organic disease painful sensations come from ascertainable somatic disorders and in hypochondria dont. This means that even when the account of the symptoms is the same, findings in the medical tests are normal in the hypochondria and pathological in the organic disease. However, those normal findings do not reassure the hypochondriac individual who thinks that the doctor is mistaken, that he didn’t do the right medical test and he was unable to give a proper diagnosis. The patient is totally convinced he suffered from a certain organic disease, he is certain about it: reality, the medical findings which probe him wrong are not enough to reduce the “hypochondriac delirium”. Quite often, hypochondriac patients feel disregarded because they dont fit in the criteria to be considered sick people: they go to the doctor with physical symptoms but all the test are normal. Hypochondriac patients tend to have hostile relationships with doctors, they want to know more than doctors, they think they are incompetent who dont find the disease they have because they haven’t done the test they should.
Sometimes, hypochondria is said to be “inherited”, however we need to understand that here “inherited” does not refer to genetic legacy but to the family structure, regarding the sentences we are told, how we are being educated to think in a certain way. It is very visible in the eating disorders related to the food or the jouissance related to it. Within the family structure, the relationship with the body is transmitted and the most important thing for the hypochondriac individual is his body.His relationship with the outside world is almost inexistent. Freud describes it when he talks about narcissism, in the sense that everything would be “inside the individual”. Would it then belong to the group of the narcissist neurosis? In fact, it belongs to the actual neurosis: anxiety neurosis, neurasthenia and hypochondria. Freud describes hypochondria when he talks about narcissism , because in his work about narcissism, he is talking about libido as psychic energy which is constant for each individual and it is divided between the outside world and the subject. I direct this psychical energy to the outside world, I surround an object (it can also be an idea) and then, it comes back over me: It is a continuos movement.
Regarding the distribution of the libido, hypochondria and organic disease are also similar: hypochondriac individual retracts his interest and libido from the outside world objects and localise it on the organ he is concerned about.
We only have “one libido”, it can be in the object or in the ego (narcissist libido). Under normal conditions, libido is mobile being able to leave from the ego, surround the object and be back to the ego. In the hypochondriac person, there is no movement of the libido, it is fixed in the sick organ. In the clinical practice, we observe everyday, that the individual is a social individual, meaning that we can only understand what is going on with a person if we take into account his relationships with the others. Libido, does not exist, it is constituted since we move it. Freud work about actual neurosis (anxiety neurosis, neurasthenia and hypochondria) differentiating them from psychoneurosis or transferences neurosis (phobia, hysteria and obsessive neurosis).. Hence, If we take the energy away from the outside world and we keep it all in ourselves, we get sick. Freud says “we get sick if we do not love”, in the sense that we need to move the energy as opposed to keep it on ourselves. We are not isolated individuals, we depend on all the other relationships with the real (sometimes phantasmatic) world. Mental disorders, affect the whole life of the individual (all his relationships are disturbed) not only his speech (about his fear of getting sick). “The Imaginary Invalid” by Moliere shows the concern of the hypochondriac about his health and how all his life is around that: the search for treatment, his ongoing complaint about his symptoms and body sensations, how the others around him make mock of him and dont take him seriously. “Nobody knows what happens to me” would be the sentence of the hypochondriac. When someone is sick, all his energy is focused on getting better, the individual cares about whatever is related to that disease. He cares about his headache and that is all what he cares about. It is interesting how narcissist disorders are related to selfishness. Why? Because in an organic disease, I take away the energy from the outside world to focus on the cure of that ailment however, in the hypochondriac there is not such an ailment and still he takes away the energy. He is an individual deprived from the “human chain”, from social work, from love… like if he did not accept mortality, the hypochondriac individual is at unconscious level, an immortal. Hunger and love are the instincts which lead us to survive and allow the kind to continue. On top of them, there is sexual desire, sexual energy, libido which makes us human beings and leads us to look for something else.
All in all, all the libido localise in the ego, without anybody else, sicken and all the libido in the object also sicken. Selfishness to a certain extent protect us from getting sick, however, at some point we need to begin to love (libido objectal) in order not to sicken and we sicken when frustration prevent us from loving. That is why every broken love relationship, any lost can lead to disease. In reality pain comes does not come from the lost object but from the deprivation of libido objectal that the individual needs.
In “Three essays on sexuality” (1905) Freud explains that certain parts of the body (erogenous zones: mouth, anus…) can represent the genitals and behave as them 1. In parallel to the disturbance on the erogenicity of the organs, there is a disturbance on the libido in the ego. In hypochondria, there is an stagnation of the ego libido. In hypochondriac individuals, the object and the erogenous source are merged.
This is different from what happens in hysteria, where the organ affected, for example the leg, becomes an erogeneous source. In hysteria there is a displacement of the sources (from the usual sources to the affected organ, in this case, the leg), however, this doesnt lead the patient to abandon the object (with which he maintains a phantasmic relationship). Hysterical patient maintains the four main essentials (source, impetus, aim and object) separated. However, in hypochondria and psychosomatic disease, source and object are merged in the body of the patient.
“Jouissance” 2 in the psychosomatic and hypochondriac patients is autoerotic because the object is in their own body. Drive movement is interrupted (under normal conditions is should leave the subject, surround the object and get back to the subject).
We could think the hypochondriac person is like a player: now the arm, then the knee, the kidney… It is a partial delivery to death. It is like if the hypochondriac person foresees the matter of “ I am going to die”, “We are mortals”. Hypochondria, is a way to elaborate mortality. Could we then say that the hypochondriac person is an obsessive person? He looks like an obsessive person whose fear is about the body or health. Freud set out that anxiety neurosis, is fear of something bad happening to someone else. However, the hypochondriac person has fear about his own health. Hypochondriac person is also a bit psychotic, in the sense he raves something which doesn’t happen to him in reality. How could we position hypochondria? Obsessive in the sense that it is a fixed idea: “I have a disease”. Although, the terms of the obsessive individuals are completely different, it is true that it is an irrational idea he cant abandon. No one can tell him anything to make him change his mind. In that sense, it its an obsession. It is true that his speech is delirious because he does not have any organic desease and all his speech is about him having an organic desease. He does have a pathology, but a mental one, not organic. Freud showed that traditional medicine (and psychiatry) cannot cure the mental diseases.
According to Freud, hypochondria is a type of “ actual neurosis” which is characterised by an strong anxiety component. Its fear is fear to become sick. Traditional medicine treats the anxiety with trankilisers and sometimes contactual cognitive psychology (which is covered by NHS in Spain).Actual neurosis shows symptoms in the actual sexuality. In the case of the hypochondriac, he only cares about his disease. A very common phantasy in hypochondriac patients is that they are going to be punished because they have masturbated. They have a very troubled relationship with masturbation, there is a moral matter in the hypochondria. Masturbation is not good or bad in itself. If an individual has trouble with masturbation is because his phantasies are related to incestuous, forbidden objects. It is a moral judgement. Masturbation does not lead to any cognitive damage but the patient can have that phantasy. Psychoanalysis is very effective treatment because this human dilema isnt related to the past, will take place many times in the life of the subject. Sometimes, the individual doesn’t want to accept his sexuality and prefers to get an organ sick instead of recognising that it is something psychic and that he needs to talk about. There is a nice poem from Menassa “In order not to die in life, we have to dance and have sex at any chance and if no one wants to have sex nor dance, let’s write a poem and it won’t be that bad”. This is related to jouissance: having sex, dancing, reading a poem… is related with the ability to enjoy and sutitue, to put the object outside ourselves. From the jouissance point of view, the hypochondriac has a very primitive way jouissance, not even narcissist because there is not an object. Everything is merged, it is autoerotic. It goes back to the initial stages of the psychic constitution (autoerotismo is typical in babys).
Previously we have talked about expectations (what I expect from the outside world) and aims. When facing these aims and expectations, ideas against them arise. This is what we called anguished wait.
All in all, normal individuals needs to learn to be patient with reality and with the others.
In anxiety neurosis, this anguished wait is regarding the health of others.
In hypochondria, is about his own health, he fears he has an organic disease.
In neurasthenia, the individual distrust his ability to achieve his aims.
In all the actual neurosis, there are issues with the actual sexuality, with genitality. In anxiety neurosis, is mainly coitus interruptus, in neurasthenia is masturbation and in hypochondria is the particular relationship the individual has with masturbation: he thinks it will make him sick. In the hypochondriac, his fear to get sick, it is It is a moral issue.
Neurosis rarely happen alone, they re normally mixed. The most frequent combination of neurosis are: neurasthenia and obsessive neurosis; hysteria and anxiety neurosis and hypochondria and psychosis.
Erogenicity: ability of sending exciting sexual estimulus to the soul life. This is a feature of all the organs in the body
Jouissance, and the corresponding verb, jouir, refer to an extreme pleasure. It is not possible to translate this French word, jouissance, precisely. Sometimes it is translated as 'enjoyment', but enjoyment has a reference to pleasure, and jouissance is an enjoyment that always has a deadly reference, a paradoxical pleasure, reaching an almost intolerable level of excitation. Due to the specificity of the French term, it is usually left untranslated. Lacan makes an important distinction between jouissance and plaisir (pleasure).