Hypochondriacal with the World*

Ghalya Saadawi

Nouvelle iconographie de la Salpêtriêre - Credit: Wellcome Collection
Nouvelle iconographie de la Salpêtriêre - Credit: Wellcome Collection

Ill (noun): Old Nors illr “Lost in the mists of time”.  

Sick (adjective): “Ill, diseased; troubled, deeply affected”. “Tired or weary, disgusted from satiety”; “Mentally twisted”; seocmod “infirm of mind”.

What of suffering (noun)?

One time during a pandemic, I felt ill. Really ill for months. They tell me I’m always sick. They tell me I’m a hypochondriac. They tell me it’s just anxiety. Some don’t believe me. Those that do, sometimes don’t. Some disappear. Some reappear. Others are quick with remedies and spiritual balm. This illness felt terminal. An end to end all ends. The inside of my bowels were black and runny like tar. My breath was stunted in my ribcage. My head was hot enough to see all the temperature checks conducted all over cities. Hot and black and runny enough to remember an article out of the thousands circulating, that those could be symptoms. It was hard to tell, after all that we had seen, if this was the pandemic itself hitting me with its potential on day five to turn against me, or turn me against myself. In quarantine, I had obsessions that I would die, suffocate alone in a hospital bed like many. I took my temperature every fifteen minutes, the thermometer broke. My vigilant micro-attention outdoes any thermometer, doctor’s probe, imaging machine, or primitive swab test; I am the probe. And when it can’t outdo, it cracks, it starts to seek like an addict. It seeks the way a lover seeks its object. It desperately needs the confirmation and the confirmation does not come. If the confirmation does come, it is unbelievable, refuted. And it continues to seek.

I drive myself to a Covid-19 PCR test on a dark night in March. For the first time in a long history of hypochondria, my friends are following the developments closely. In KN95, rubber gloves and fake Daniel Hechter large-framed sunglasses (aerosol not sunlight), I arrive disoriented to the testing center. There was no one on the street, no one around, no one to be seen. A comet had hit home, earth, Beirut. It was all still new to us, the apocalypse-horror-genre-cum-15thcentury-plague-aesthetic. Quarantines, curfews, total storefront closures, policed avenues, dark, emptied streets, masked faces, threshold temperature tests, long silhouettes in the distance, utter silence that meant you could hear your breath in a city at night. It was just weird and eerie, this recognizable unrecognizable, and we knew it. [1] I inhale in my mask, my heart pounds. The guy at the desk seductively asks for my phone number. He was wearing the mask the wrong way around. The visor was on the table. What the fuck. I’d begun the vigilante work, well-trained by years of hypochondria. Fuck biopower tech, I was the Covid-19 police; gulags for disobedience. When I went inside, the woman at the other desk told me to step back. That was more like it. Tell me what to do. I felt at home and estranged. I had never seen a full anti-viral suit in vivo before; it was impressive and very white. Yet oh had I been to hospitals, heart pounding, thinking I may die. Later, I would test negative. Three times. I would go on to feel quite sick, like I may die.

In the year 2020 CE, a viral respiratory pandemic is announced by the World Health Organization, the organization someone appointed to manage the body of the world. We witness on newsfeeds, social media apps, and television networks as states lock borders, impose curfews, shutdown cities and towns, squabble over masking equipment and swab tests. Governments are a big deal again. Much is written on the induced naturalness of the biopolitical and economic state measures.[2] And the world has a new viral lingo: lockdown, tier 1, tier 2, PCR, PPE, self-isolate, social distancing, and please, for the love of god, cover your face. Millions lose work; others become very sick because of work. The non-ruling class suffers the cascading side-effects of bringing the supply chains and circulation systems of the body of the world to a halt. Or, quasi-halt because, when were we not suffering?, and because, as one of the only socialist finance ministers in the history of contemporary politics elucidates, the markers of financial markets are pretty, pretty good.[3] The social and economic body had been reeling forever, but it could now be seen again because of the injury posed by a virus and its treatment protocols. The repressed cuts through and brings up what we already knew: the way things are infrastructurally, logistically, simply cannot go on except for the very, very few.[4] So much so that we communists saw glimmers of communism surface in unwitting public realizations. Things can change! Not only the atomized struggle to coordinate, but the coordinating body itself should serve everyone’s existence and everyone’s freedom. (Whilst some rushed into the open arms of their desire for a return to a ‘pre-‘, others remain transformed by the weirdness of the events. The unhomely, which permits the distance to collapse between what we know and how we live).[5]

We were caught breathless, suffocating, turning our heads away from the screen at the sight of George Floyd’s filmed death under a pig’s knee. We get the same physical sensations when we learn that a mother gave her son seawater to quench his thirst before he died en route somewhere. How can remote looking provoke such physical ricochet? Does looking through the eyes make empathy somatic? Neurologists tell you it does this through neurons in the frontal cortex. Via imaging technologies, en apparence, most of us are wired for empathy and mirroring. Michel de Montaigne in 17th century France knew this in relation to the sight of illness and the power of his imagination: “I am one of those by whom the powerful blows of the imagination are felt most strongly.[…] It cuts a deep impression into me: my skill consists in avoiding or resisting it.[…] The sight of another man’s suffering produces physical suffering in me, and my own sensitivity has often misappropriated the feeling of a third party. A persistent cougher tickles my lungs and my throat.”[6] An epigram from the Roman poet Martial quoted by Montaigne reads: “How great is the power of counterfeiting pain: Caelius has ceased to feign the gout; he has got it.”[7] Stories of soldiers feigning blindness to avoid proscription, and realizing de facto they could no longer see. When we were young, our parents told us not to cross our eyes as they may get stuck that way. Feigning then falling. Falling ill. Falling for a trick. Falling apart.

What about falling ill beyond and against yourself? In a split from yourself? You feel thoroughly invaded; or you are protected by symptoms that—you rationalize—keep you whole. Or, you cannot tell the difference. The more successful you become at guessing, winning your way out, the worse you are at the game.

Ida Bauer had a troubled relationship with her father, became hysterically mute, and was the model for conversion disorder. In my family, when not living an on-off civil war, we grew up on an oversized American medical book that we read when we developed symptoms. And for leisure. It had symptom trackers before the internet. I learned how to self-diagnose before I could think abstractly.[8] In fact, diagnosis forged my thinking, abstractly.

Prenom Carmen. Jean-Luc Godard is as an actor who plays a writer in his film. A double of himself, he checks into a psychiatric hospital so he can write – they threaten to kick him out if he does not develop a fever the next day. Each day he says: “Je suis sûr que je vais tomber malade.”[9]

Whilst Europe was engaged in its dark Imperial, and rationalist enlightenment, bourgeois men and women suffered nerves, spells, bouts, sensibility, terror, and despair. In 18th and 19th century Europe is where the hypochondriac lives. In ancient Greece, the Roman Empire, and the worlds inside those, too. The Stoics and the Persians wrote that mind affects body. In 2024, Lauren Olamina develops hyperempathy.[10]

The hypochondrium is nestled under the ribcage, between the belly and the lungs. It is a site. An illness with symptoms-not-imaginary, but a physical malady. The division of functional disease from organic disease in late medical science obliterated the question, ‘what is not a physical malady?’ A subject will find themselves anachronistic. Maladies get banished from the gardens of medicine, even if—or because—the soul is now said to live in the nerve networks of the brain.[11] Inside rib and soul, Hypochondria journeys from the body, where she had historically lived, and is told that her obsession, hope and dread are to be housed in the brain of somatic symptom disorder, or better, latent depression.[12] Perhaps that is what she wanted all along. To be evicted to a home of diagnostics, treatment, and prognosis. Hypochondria brought her future into being. In disavowing her affliction under the new façade of a treatable psychopathology, she was now cured! She could finally deny the topography of her symptoms and the site of her complex grievances once and for all. Her and her sister Melancholy. They could find peace. Peace in norepinephrine and dopamine reuptake inhibitors; peace in learning to stop repeating.

“2024: Prodigy is, at its essence, adaptability and persistent, positive obsession. Without persistence, what remains is an enthusiasm of the moment. Without adaptability, what remains may be channeled into destructive fanaticism. Without positive obsession, there is nothing at all.”[13]

What is the degree of illness that qualifies you as fit to be ill? —and by whom? When, for others, your affliction is a symptom not an illness. When, by consensus, your non-illness serves a psychic purpose, unlike ‘actual’ illness.

In no particular order and for months I could not eat food without my upper right abdomen aching, swelling, hardening, tender to the touch, sometimes even without food; I burped huge bubbles up my trachea, making it hard to swallow. I lost 6 kgs; I could no longer shit except twice a week; I developed rashes around my eyes and bellybutton. I woke in the middle of the night with a tight noose around my chest, and dashed out of bed to the balcony for air. Consecutively, for months, I had a corset around my mid-body, my hypochondrium. I simply could not breathe. And I’ve been unable to breathe or sleep the same since. I had repeat yawning attacks; night sweats and headaches, a deep, sharp beckoning to awake; my vagina hurt on the right side, red and aggravated; I missed my period for the first time since I was 11, or pregnant. I was terrified, obsessive, spontaneously tearful; I developed bruises on my legs; I was shaving in the shower and I found raised lymph nodes. In no particular order of arrival, suspicion, or severity, I diagnosed myself with: Abnormal visceral sensitivity. Hepatomegaly. Coronavirus. Lymphoma. Bile obstruction. Brain tumor. Cluster headache. Small intestine cancer. Multiple sclerosis. Anaphylaxis. Allergies. Heart disease. High blood pressure. Low blood pressure. Paroxysmal nocturnal dyspnea. Restless leg syndrome. Celiac disease. Non celiac gluten intolerance. Vulvar cancer. Early onset menopause. Coronavirus. Cervicogenic headache. Occipital neuralgia. Lymphoma. Asthma. Lung cancer. Mere dyspepsia. MALT.

In no particular order and on a regular basis, I open and check my eyeballs for discoloration; I examine my breasts and under arms; I feel my liver for distention; I take my temperature (before it was en vogue); I sit in warm sitz baths; I inhale hot essential oils; I boil and swallow herbs, roots, leaves, powders, and oils; I drop dark bitter liquids in my water; I gargle with warm salt water; I take shots of concentrated blossom water and chew tree nectar; I check throat and tonsils with my phone light; I measure my pulse; I dissolve salts coated in sugar under my tongue; I use an inhaler, and I dilute collagen in my juice. The top shelf of my fridge is full of remedies I bought on the internet.

“[…] hypochondria has a performative ability to ratify its own testimony, to convert anxious foreboding into self-fulfilling prophecy. Illusion of this sort has the uncanny ability to prove itself true: anxiety generates what it dreads, the fear of falling makes you fall.”[14]

The hypochondriac believes no one. We want to trust because we love to sit in doctors’ offices, in waiting rooms, on dry white sheets, in dark imaging rooms, waiting for answers. We simultaneously retreat, fear, perseverate, disobey science, and question the edicts of the medical establishment. Unknowability is the hypochondriac’s condition of being. Nothing is authoritatively sanctioned, nothing is fully known about anything and certainly not about many an illness. Paradoxically, we know with confident certainty. So hypochondria can say: I know before you that the construct of the body as a system of immunity is a modern invention (E. Cohen); that the scarred body is also the social body (E. Scarry). What I know is that I am sick. Me, and you with me. The I that utters is split in time. One used to hear it, yet one no longer does because it has to travel across centuries. It’s a condition of mutual disbelief—no one believes the hypochondriac and the hypochondriac believes no one.

“Sensation is the enemy of quantification. There is no machine, yet, to which a nervous system can submit sensation to be transformed into a sufficiently descriptive measurement.”[15]

I feel shame when brooding over, or writing about the body, sickness, and death when writers like Anne Boyer, Audre Lorde, Susan Sontag, Kathy Acker, and others were themselves ill with aggressive cancers, subjected to tubes, chemo, and painful radiation therapies. In fact, they all, save for Boyer, died from their illness. They lost their life. After Sontag wrote (against) Illness as Metaphor, she died of cancer. Is the hypochondriac a metaphor? The anxiety and entrapment of being stuck inside a metaphor, whilst trying to make sense of your condition metonymically.[16] Boyer’s book begins with an ode to all the women writers who died of breast cancer, her lineage, her contemporaries. All the unnamed care, all the material history of that stuff they inject into you, your cancer, and everyone else’s. Who are ours? Perhaps they are the mockery of contemporary medical science, which makes the hypochondriac unbelievable, rendered a waste of time or medical resources. Yet, volumes have been written. Hypochondria is illness with etiology. To consider hypochondria is to consider “the nature of sickness in a fundamental sense… What can be called a disease and what cannot.”[17]

A close friend has a tumor. The night she told me, I could not sleep. In fact, I could not breathe; I had an asthma attack I thought would wring me to death. Her cancer is aggressive and unexcepted, as cancer is a lying, stealing companion who eventually tells you the truth too late. What can I tell her other than I love her and I feel with her in the deepest way? Because it is the truth. More than anyone who is not dying more than anyone else (aren’t we all dying?), the hypochondriac’s terror and imagination can make for radical empathy as they embody the pain, the fear, the numbness of illness and imminent death like no other. That is, if not in large part most essentially, their condition. To be in illness as if it were their own. Because in a way, it is their own. (Sooner or later, you have to die of something. Sooner or later, the illness you preempt with wars and alerts, will find you). تعددت الأسباب والموت واحد [18]

“You will die, not because you are ill, but because you are alive; even when you have been cured, the same end awaits you; when you have recovered, it will be not death, but ill-death, that you have escaped.”[19]

Is it possible to have all these diseases and more, all the time, in a series? Is it possible to be sick at all times, combined, in no order? [20] (Isn’t a body a body when it does things? Defends? Fights? Reacts? Maybe a body isn’t a body unless it’s sick all the time). The body defending and/or the body killing. What’s the difference and distance between symptom and diagnosis? Is it impossible to be sick all the time, we asked ourselves after the Lebanese uprising? Is it possible to have debt, crash, Covid-19, lockdown, recession, inflation, and 10% of an atomic bomb, consecutively? Turned out it was. When will it end? Or, as my friend reminds us, we desire, or joke about an end to end all ends, believing that that would put us out of our misery, structuring the denial of the fact that things can get worse.[21] And they do.

I was rarely more quietly melancholic and chronically ill than in the midst of the euphoria of the first revolutionary uprising I had ever lived.

When there is sickness we are in contagion, by metaphor, by imagination, or by verification. They say we are a body politic, corporate entity, corps-d’état, sovereign. Leviathan overlooking many bodies. Allegedly, body loses immunity when its borders, its inner guard is down. The social body caught off-guard, porous, invaded. A body plagued in need of purges and deposals; detox enemas and Triphala, but more bloody. Corporal and military metaphors were plethoric when nation-states pronounced their fight against Covid-19. We also saw a staging of the global imaging of classification: the magnification of our transnational body in the map of the world lighting red, orange and blue at different stages of outbreak and quarantine in one large PET scan.

(Note: Good public health vs. good economy is false. What it does confirm, though, is precisely a capitalist mode of production underpinning the world. An inadvertently avowed historical materialism).

“Because health, like existence, is not a possible object of cognition, we can never decisively determine if we are healthy (the very need to pose the question already suggests that something’s not quite working), and every attempt to answer it not only inevitably begs the question but opens up a raft of new pathologies that extend from the individual to the collective body, and can even toxically blur the distinction between these.”[22] 

“What happens when you see the sight of someone’s suffering?”, my homeopaths asked. “Is there a medicine for that?”, I asked. I was put on a salt. Natrium Muriaticum: “Emaciation, weakness, nervous prostration, nervous irritability […]. There is a long chain of mental symptoms; hysterical condition of the mind and body; weeping alternating with laughing[…]. This will be followed by tearfulness, great sadness, joylessness. She is benumbed to impressions, easily takes on grief, grieves over nothing. Unpleasant occurrences are recalled that she may grieve over them. Consolation aggravated the state of the mind – the melancholy, the tearfulness, sometimes brings on anger[…]. This remedy belongs to hysterical girls. The stomach is distended with flatus[…]. We find fullness in the region of the liver with stitching, tearing pains.”[23]

Hysterikos; of the womb. Hysteron; madness of the womb. Suffocation of the womb. Wandering of the womb. Uterine Melancholy. “In the Eber Papyrus (1600 BC) the oldest medical document containing references to depressive syndromes, traditional symptoms of hysteria were described as tonic-clonic seizures and the sense of suffocation and imminent death (Freud’s globus istericus).”[24]  The pounding in my ribcage woke me from my midnight’s sleep. The air stopped in the upper hypochondrium. I would hold my breath hoping that the inhale would be full. I jittered from fear and lack of oxygen, and rushed for my blue inhaler. My tender abdomen, my racing heart, my tingling body, my itching belly, my stunted lungs drove me to imagine death at all times. To be terrified of it in my midst. Finitude as the end of this one and the goodbyes in my wake. What if I don’t arrive in time? For medical science to rescue me with its needles, cameras and lights, cold, black, plastic leather beds, cotton coats and name tags, ice cold gels and thirst-inducing opiates. Its power to differentiate on my behalf.

The wise woman past reproductive age is a pursued witch burnt at the stake not for her infusions of herbs, shrubs, and bones but because she threatens the division of labor. If you produce that special commodity of labour power, you cannot imagine what could happen if it came to a halt, stopped working. Or if someone stopped it; the way in which the melancholic, maybe the hypochondriac (certainly the hysteric) threatens to: withdrawal, refusal, dejection, angst, rage, disbelief, bottomless doubt. Hark! the new generation.

Class after class I apologize to my students: “It’s my asthma, I’m sorry, I’m not yawning, it’s just that I need air.” On March 3, 1888, M. Charcot gave a lesson at the Salpêtrière and brought forth to the student body the yawning hysterical woman—she would oft yawn 8 times per minute—with a warning: Do not let yourselves be made suggestible, intoxicated. Yawning is onomatopoeic (bâiller, sbadiglio, gähnen, تثاؤب). Don’t look.

Post-viral symptoms are ghostly. The body, in the absence of organic damage, displays sensations as symptoms, as though it is melancholic after illness. Melancholy: The ego is altered through ingestion of and identification with the lost object such that the lost object is no longer the object of loss but loss itself. You don’t let go of the loss, nor of the object and thus internalize them both to obliteration inside you. It is not grief then recovery, it is incorporated grief. It forms part of the machinery of the self in a ghostly manner (G. Agamben). The loss of the object never happened since, not only was it never possessed but its disappearance is already staged internally, to secure full possession. If the loss is staged, this means the object was never really the object but a fantasy, a double object.

Only fools psychoanalyze themselves.

What is the death drive (inversed)? [25] Egoism into altruism, cruelty into pity, intense love and intense hate in the same person for the same object; Freud calls defense mechanisms deceptive forms. Repetitive thoughts and actions of dread of illness a desire for it. Like ‘humanitarian camps’ keeping human refugees and sans papier less than human, and ‘keeping the peace’ as policing is, intrinsically, brutality, my hypochondriac wish for precise, confirmed, eternal health, for immortality, is death drive; is the journey backwards to the pre-individuated. Do I want to annihilate myself in order to return to a prehuman life? To the womb? To Her? The first love, the umbilical cord, the lost way back.

“Even in her mother’s arms she was still alone with her secret disease and alone to puzzle over the loss of innocence and security that accompanied her fearful acknowledgment of death.”[26]

Or, the repressed impulse to a most radical freedom, admonished by the establishment of parenting and turned against itself. When the vocalization really is: I am invincible, I am unalterably free. I am, in fact, immortal. [27]

Hypochondriasis in its social appearance is a deceptive form – an externally learned constraint on an otherwise radical and erotic compulsion. One read, perhaps, in poets and writers that stun, and in the melancholy that leads to the suicide of others. If the death drive has compulsions gone awry, so, writing and death and writing and hypochondriasis become historically woven.

*[This text is comprised of abridged fragments of a manuscript in progress]

[1] Mark Fisher, The Weird and the Eerie (London: Repeater Books, 2016).

[2] See the Coronavirus Pamphlet Series, accessed November 1 2020, https://www.versobooks.com/lists/4893-coronavirus-pamphlet-series. The Politics of Covid-19, last accessed August 2020, https://covid19syllabus.substack.com/archive?sort=new

[3] “Yanis Varoufakis on the Economic Situation,” The Dig Radio, https://www.thedigradio.com/podcast/yanis-varoufakis-on-the-economic-situation/ accessed October 15, 2020. See also Robin Wigglesworth and Sujeet Indap, “Distressed debt investors still await rich pickings from pandemic,” https://www.ft.com/content/ca5fbc8a-61da-4585-9ca4-092255189497 accessed November 7, 2020

[4] By way of illustration: “Covid job losses lead MPs to call for trials of universal basic income,” accessed October 31, 2020, https://www.theguardian.com/society/2020/oct/31/covid-job-losses-lead-mps-to-call-for-trials-of-universal-basic-income?CMP=Share_iOSApp_Other

[5] Fisher, ibid.

[6] Brian Dillon, Tormented Hope: Nine Hypochondriac Lives (London: Faber and Faber 2009).

[7] Martial. Epigrams vii. 39, book 8, quoted in Michel de Montaigne, “Not to counterfeit being sick,” accessed October 8, 2020, http://essays.quotidiana.org/montaigne/not_to_counterfeit_being_sick/

[8] G.W.F Hegel, “Who Thinks Abstractly,” accessed October 12, 2020, https://www.marxists.org/reference/archive/hegel/works/se/abstract.htm

[9] I am sure that I will fall ill.

[10] Octavia E. Butler, Parable of the Sower (London: Headline Publishing, 1993).

[11] George S. Rousseau, Nervous Acts: Essays on Literature, Culture and Sensibility (Hampshire: Palgrave Macmillan, 2004).

[12] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 5th ed. (DSM-5), (American Psychiatric Association: Arlington, 2013). See George S. Rousseau, ed., The Languages of the Psyche: Mind and Body in Enlightenment Thought, Clark Library Lectures; 1985-1986 (Berkeley and LA: University of California Press, 1998).

[13] Butler, ibid.

[14] Rebecca Comay, “Hypochondria and Its Discontents, or the Geriatric Sublime,” Crisis and Critique: Politics and Melancholia 3 no. 2 (2016): 41-58, 45.

[15] Anne Boyer, The Undying: A Meditation on Modern Illness (London: Penguin, 2020).

[16] The hypochondriac is a composite of many images, many signs, many figures condensed, like in a dream, to One. Or, the hypochondriac herself condenses real, much more structural anxiety, into displaced ones: her bodily symptoms.

[17] Dillon, ibid.

[18] Causes are many but death is one.

[19] Lucius Anneaus Seneca. “On the Healing Power of the Mind,” accessed September 7, 2020, http://essays.quotidiana.org/seneca/healing_power_of_the_mind/

[20] See, differently, Gilles Deleuze, “The Exhausted,” in Essays Critical and Clinical. Translated by Michael A. Greco and Daniel W. Smith (Minneapolis: University of Minnesota Press, 1997), 152-174.

[21] Nadia Bou Ali and Ray Brassier. “Hegel’s 250th Anniversary: After too late,” September 9, 2020, Beirut, https://www.youtube.com/watch?v=dISWecCpAS0

[22] Comay, ibid.

[23] Natrum Muriaticum, https://www.vithoulkas.com/learning-tools/materia-medica-kent/natrum-muriaticum

[24] Cecilia Tasca, Mariangela Rapetti, Mauro Giovanni Carta and Bianca Fadda. “Women and Hysteria In The History Of Mental Health.” Clinical Practice & Epidemiology in Mental Health 8 (2012): 110-119.

[25] Projection, sublimation, displacement, reaction-formation, etc.

[26] Susan Baur, Hypochondria: Woeful Imaginings (Berkeley and LA: University of California Press, 1988).

[27] “It is indeed impossible to imagine our own death; and whenever we attempt to do so we can perceive that we are in fact still present as spectators. […A]t bottom no one believes in his own death, or, to put the same thing in another way, that in the unconscious every one of us is convinced of his immortality.” Sigmund Freud, “Thoughts for the Times on Death and War,” in The Standard Edition of the Complete Psychological Works Of Sigmund Freud Vol XIV, trans. by James Trachey (London: Hogarth press and the Institute of Psycho-Analysis, 1957), 275-300.