There’s nothing like typing your symptoms into Google and finding, second from top, a tabloid headline screaming ‘AND NINE MONTHS LATER HE WAS DEAD OF CANCER’. That’s how it all started for me, with an online search during a period of high anxiety that accelerated into months of self-inflicted mental torture as I convinced myself I was seriously ill.
This was five years ago. But that same sense of dread and fear is back with the mounting horror of Covid-19: the compulsive symptom-checking and addiction to destructive internet searching, the sleeplessness and imaginary symptoms (or are they imaginary?). I suspect I’m not alone, and that many people will be stuck with health anxiety for some time after this horrible virus has been eradicated.
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This time, at least, I know what to look for and how to avoid the worst of it, and perhaps my story will be useful.
Health anxiety is hugely inflamed by media coverage. So, with a disease like coronavirus — which has achieved ubiquity like no other news story in recent years — it is easy for it to infect our minds even as our bodies remain healthy.
But in normal times, the most prominent illness, and the one that lodges firmly in the consciousness of hypochondriacs, is cancer. Everyone knows someone who has died from it, and everyone knows of a relatively young person who has had the bad fortune to have it diagnosed; on top of this, cancer comes in dozens of different varieties and its symptoms are often indistinguishable from countless other maladies.
And, back in May 2015, I was utterly convinced I had the disease, and nothing could persuade me otherwise.
It all began two weeks after my father’s funeral, which was — obviously — a stressful and upsetting time. Dad had spent the previous five years in a great deal of pain, following a second stroke, and bit-by-bit all the joy was taken out of his life. On his deathbed, he was reduced to a helpless child, feeding on drops of morphine as he prepared for the ultimate journey, in great distress at life but terrified of it ending.
The weekend after his funeral I went camping. I was never a big fan, I have to say, and with three young children the idea of actually seeking discomfort in what passed for my spare time struck me as sort of perverse, especially in a country with dismal weather like England.
I had been suffering for six months from sciatica. It’s unpleasant and perhaps a demoralising physical reminder that I’m in middle age, and that life will get progressively more rubbish for the next few decades until, like dad, I spend the final years staring into space lamenting lost times (stick with me, this article does get more light-hearted). The camping weekend was over a bank holiday weekend and in true British style we were stuck in traffic on the M3 for five hours. The pain exploded, and when I got back home my leg and entire groin area was in agony.
As it happens the sciatic nerve crosses the pudendal nerve, which is why the condition can cause pain in this region — but then so can a hundred other ailments, some minor, some life-threatening, some embarrassing.
It occurred to me that I might have a hernia, which was frightening enough. But on the Monday evening, frustrated at not knowing what this novel pain was, I typed the symptoms into Google and several results came up referring testicular cancer. Lots and lots and lots of them.
The idea went straight into my head and lodged there. I read with growing horror that I perfectly fit the profile — mid-30s, the peak age of diagnosis; an ex-smoker; suffering from several of the symptoms attached, including a pain under the testicles.
I had a slight pain in the chest too, again a symptom of the illness — and a very sinister one, as it suggested it had spread. Mole on my neck? Ditto. Survival rates of testicular cancer have significantly increased in the past few years, from 10% to almost 90%, but if it has spread to the lungs, as chest pains and moles suggest, your outlook is very bleak indeed.
I looked up the many risk factors involved with the illness, desperately searching for facts and probabilities that would reassure me, but they all had the opposite effect. “Such and such disease does not discriminate” is one of those comforting, untrue things you hear, but testicular cancer employs positive discrimination: only men get it, and you’re more likely to suffer if you’re white and from a higher socio-economic group; men who are taller than average also have higher rates, for whatever reason. I ticked every single box.
This is the problem with search engines and their effect on the neurotic mind, a dangerous relationship that causes ‘cyberchondria’.
There have always been neurotics, and indeed it’s something that runs in my family: my granny used to browse her set of medical encyclopaedias, convinced that she was dying. (She was proved right, eventually.) But search engines are far more dangerous, often giving a wildly distorted picture of risk. For example, while brain cancer appears in one-quarter of all searches for ‘headache’, it is in reality pretty rare, with 1 in 150 people getting any sort of tumour over a lifetime.
If you have one of the symptoms of this or any other form of cancer, there are a dozen or so more common illnesses it’s far more likely to be. (Maybe neurotics should have our own search engine that steer them away from horror stories?) My personal advice is: only check the NHS site.
As it was, I found that of the six or so other symptoms of the disease, I had three, at least. Sure, those symptoms could also apply to about 300 different conditions, but my brain wasn’t really thinking that logically.
One website identified 86 possible illnesses I might have, some mundane and everyday, some lethal. I went on one messageboard where someone had typed in similar symptoms and the first response was: “Yo dude, you have chlamydia.” LOL. Really helpful.
That evening I became convinced I had cancer; I knew it, and all the horrific consequences that were to follow were fully mapped in my head. Walking into the hospital, terrified; the general anaesthetic and the terror of not knowing whether I would reawaken or whether this was it; the tiredness from the treatment; the doctor telling me to sit down as he gave the news.
I couldn’t stay still, pacing up and down, sweating, my heartbeat running wild. My body was physically responding to the runaway anxiety produced by my mind. I was both obsessed with checking for lumps, and also transfixed with terror at finding something. I felt cold.
I stayed up that night until 4am, Googling medical sites, reading about symptoms on my phone as my wife slept. Bordering on panic, I wondered whether I should call the doctor first thing in the morning, but was also terrified at the prospect.
The anxiety did not subside the next day, or the day after. I would wake up, then remember I had the disease, and my mind would run around and fall into a trap of its own making. I became distracted, unable to focus; indeed I really understood why people used to refer to the mentally ill as ‘distracted’. I drank more, not for pleasure, just to blot out the fact that I had this disease.
I still felt this pain in my groin, and remained paralysed at the thought of going to the doctor or talking to anyone about it, even my wife; I suppose I thought it just sounded weak, or crazy. I was also frightened of delving more in case it was all true.
Eventually, the pudendal nerve did calm down, and I finally accepted that there was no lump. But the extreme anxiety didn’t go! I had now developed constant, dulling pain in the back of my neck, regular nausea, and was convinced I had neck or oral cancer. I started developing mouth ulcers, perhaps partly due to stress, which is unfortunately again a common symptom of oral cancer.
The perverse and maddening thing about hypochondria is that your body can start to show real symptoms, which in turn make you more anxious: a vicious mental circle. Neck tightness and heightened sensitivity to pain are very common, but nausea is especially unpleasant.
Inspirational speakers like to talk about the power of the mind, and how much can be achieved with it, but the mind can also be powerfully destructive. People are capable of thinking themselves sick, and of heading down mental routes they cannot get themselves out of.
I had long lost the ability to lie in bed calmly or sleep normally; at night, the anxiety would become especially heightened, with the characteristic clammy, cold feel, the sense of being distracted and – again, really stupid – the constant checking of the iPhone for facts that would calm me down, which usually had the opposite effect.
I had now divided my life into before and after this shadow — that is, the constant feeling of tiredness and just being fed up, dreading every little pain that would trigger off a new wave of panic. I half-hoped I did have cancer, just so I didn’t have to worry about the hypochondria anymore.
Yet while this was going on I continued, in some ways, as normal; I went to work, I interacted with my wife and kids at home. I socialised, although my internal monologue bore no relation to what was going on outside. I continued functioning, almost as normal, yet effectively on autopilot.
Several weeks after it all started, I finally made an appointment to see my GP — not for my imagined cancer, which I just couldn’t talk about, but the sciatica, which was still affecting my leg. After a couple of minutes of my talking he looked at me very curiously. I had briefly mentioned worries about my health, in a throwaway manner, but I obviously sounded very, very jittery. The doctor told me he was less concerned about my sciatica and asked me about this health anxiety. How often did I think about it? Every day? Every hour?
All the time, I replied. Literally every waking moment.
It was the first time I had explained how I really felt. It sounds strange, but before that I couldn’t even countenance that I might not be ill in some way. It was only at that point that I entertained the possibility that I might not be sick.
Health worries are perfectly normal, he explained, especially when there is great stress pouring in from different directions. A death in the family is the most common trigger — something that didn’t even occur to me but which is, I suppose, obvious.
I had felt stupid, but as we talked about it one of us raised the subject of Oliver Sacks, who had just died that week and had written a book called A Leg to Stand On, about how he became trapped in a similar psychological mesh after breaking his leg. Sacks was no idiot, the doctor said, and if it could happen to him, it could happen to anyone.
But I also felt ashamed at being weak and a burden. There had recently been a widely circulated and harrowing picture of an Iraqi dad crying with relief and joy as he finally got his family to Europe. The poor man had escaped both the Iraq and Syria wars, while I worked in an office and lived a comfortable existence in north London; could I not just get a grip?
And so when a couple of weeks later I opened a letter from Haringey mental health services, it was with great self-pity that I tried to remember how my younger self hoped life would turn out, and how this turn of events did not feature in any of the fantasy scenarios.
My course began in the autumn. Whereas traditional Freudian therapy looks at causes, especially childhood trauma, Cognitive Behavioural Therapy focuses at immediate sensations and triggers. It’s about becoming aware that a pain can lead to thoughts of disease and death that further triggers more pain, becoming a cycle.
There is some evidence that CBT can be successful, with researchers in Sweden finding it can have an influence on the brain in just a few weeks, but it presumably won’t work on others.
My anxiety had started to slightly recede or at least plateau by the time I began the six-week one-to-one courses each Wednesday, but the repetitive instructions and mind-training certainly accelerated the way out, and by about week four or five it was having some impact.
I remember suddenly thinking one mid-morning that I hadn’t thought about cancer since waking up. Then, a couple of weeks later, I went a whole day without panicking about my health. According to the weekly questionnaire I took before each session, I had come out of the ‘anxious’ stage.
That November I remember feeling alive again. I began to enjoy music, which really lit up in a positively teenager-in-his-first-crush way. I enjoyed eating far more, having completely lost my appetite (the one upside of the episode was I had the smallest waistline since my teens, soon lost again).
I wanted to return to learning French, one of many things I’d lost interest in, a hopeless ambition of mine but which is nonetheless a good measure of general life force.
At that point, too, I was able to look back at the episode more critically, especially the subject of cancer. My CBT therapist believed that the media reporting of the disease gives people an exaggerated sense of their everyday risk. Cancer is the illness everyone hears about, whereas in fact, she pointed out, heart disease is more likely to kill you (and unlike the Big C, heart disease is actually linked to high anxiety levels).
Now, of course, everyone is checking for symptoms of another Big C, and whether that frog in the throat is a cough, or that hot forehead means a temperature. Is that lethargy I feel — another corona symptom — or am I just worn out by the endlessly depressing news?
I’m worrying about it right now and, once again, find myself lying awake at night, hands sweating and unsure whether those symptoms I feel are real. I’m focusing on those media stories about the very tragic, but rare, cases of younger people dying.
It’s a horrible and familiar feeling, as my mind looks for the worst-case scenario and begins to write the screenplay to a personal horror story. Yet I’ve also learned a few things, the most important being that it won’t last and the odds are that it will turn out fine. It might feel a long way away now, but one day this black anxiety will be lifted, and we’ll be able to enjoy life again.
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