Dr. Susannah Mintz (2:29)

Thank you so much for having me. I'm delighted to be here.

Dr. Miranda Melcher (2:32)

I'm very pleased to have you. Could you start us off by introducing yourself a little bit and tell us why you decided to write this book?

Dr. Susannah Mintz (2:39)

Yeah. So I'm Susannah Mintz. I am professor of English at Skidmore College in Saratoga Springs, upstate New York in the US And I wanted to write this book in part because I have always considered myself a hypochondriac, although I think I learned in the course of writing it that I'm not exactly. But I'm on some continuum of the anxious, healthy people. It really began in Covid in 2020, when it became clear to me that that line between appropriate and excessive or irrational levels of worry about getting sick was highly contestable, not at all fixed. So what constituted a reasonable threat back then, right? What. What were proper measures to take to be safe? Whose authority about those kinds of questions should we be attending to? How do we interpret symptoms and sensations about, especially when something like a tickle in the throat could have such different causes, could be a cold, could also be something to do with this potentially lethal pathogen. So from a circumstance where it seemed obvious that health anxiety, quote, unquote, could have a protective function, I wanted to think about hypochondria more broadly, more historically, but also sort of as a mode, a mode of being rather than a pathology. It struck me that hypochondria poses an intriguing epistemological challenge because it reveals the limits of what we can claim to be sure of in embodied experience. And so maybe it has the potential to challenge us to think differently about other things, things that have nothing to do with sickness. For example, could we tolerate ambiguity a little bit differently? Could we tolerate interpretive disagreement? In fact, could we tolerate never arriving at some final and ultimate truth about what it is that we think is going on in our bodies and our minds. So maybe we can say that some individuals have a kind of excessive preoccupation with sickness. Maybe it's true that some have a sort of uninformed sense of how disease actually occurs. Certainly, as with COVID hypochondria can compel us toward these usefully hygienic routines. But again, more philosophically, I think hypochondria raises questions that, again, are not about illness at all. So how do we feel about being vulnerable beings? How do we find meaning in the unknown? Where do we draw boundaries between ourselves and others? Hypochondria is interesting because it tends to present in a medical office it seems evidently psychological, and yet it has all these philosophical implications. And it's that entanglement, that multifacetedness, rather than hypochondria as a psychiatric diagnosis, that really compelled me to start investigating.

Dr. Miranda Melcher (5:54)

All right, that's a really helpful introduction because it lays out kind of the stakes of this sort of question. Right. It's not just about sort of is this medical diagnosis correct or. Or not. Right. It opens up much, much bigger questions as you've raised. But before we get into exploring some of them further, we should probably do a little bit of clarifying, because what actually is hypochondria?

Dr. Susannah Mintz (6:16)

Right. So this is a complicated question because it has changed over time, but also to some degree, I think it does remain kind of constant. So hypochondria, the word refers to the area of the body under the cartilage of the breastbone in the Greek, essentially the guts, the viscera, all the internal organs. But even in Plato's time, it carried this connotation of what it means to be a good citizen in a healthy and orderly state. So that entanglement of body and mind, I think, was there from the very beginning. For a long time, it was associated with disturbances of the gut, even as it began increasingly to take on valences we would now consider strictly psychological. So well into the 17th and 18th centuries, right. It was associated with these problems of internal organs. Liver, spleen, stomach, diaphragm, abdominal veins, the womb, and so on. A good example of all of that is Robert Burton's compendium called the Anatomy of Melancholy, from 1621. He lists various forms of what he calls hypochondriacal melancholy. But he attributes those iterations of psychological trouble to these parts of the body. At the same time, he talks about things like grief and fear, other emotional travails as problems of visceral distress. So. So the origin, the cause, is kind of going both ways for Burton. He also mentions the specific fear of illness we would now associate almost exclusively with hypochondria. He writes, some people are afraid that they shall have every fearful disease they see, others have, hear or read of. So that kind of hypochondria by association that's there for BURTON in the 17th century, well into the 18th and 19th century, there are still these associations between body and mind. James boswell in the 18th century, famous biographer of Samuel Johnson, Charles Darwin in the next century, these were notorious hypochondriacs in the sense that they were preoccupied by the state of their health. They were also prone to bouts of extreme gastrointestinal upset. And those two phenomenon were thoroughly intertwined for them. Boswell's journals are interesting because they repeatedly articulate this conundrum of cause about hypochondria. So in some moments he seems predisposed to pay acute attention to the signals of his body, but in other moments it's his body that is so activated that he simply can't ignore it. So where, where is it coming from? In, in some respects, in these, in this long sort of historical moment, it becomes irrelevant to try to disentangle the two. There's a through line here to some contemporary research that suggests that the kind of obscure symptoms and sensations of hypochondria might actually be caused by misfirings of the immune system's proteins. These are called cytokines and they help generate the body's response to disease. Now there's a thing called a cytokine storm and that can produce the very kinds of symptoms, obscure symptoms that might lead a hypochondriac to fear something really serious, like intense fatigue or diffuse pain, even emotional malaise. By this definition, hypochondria is far from irrational because something is physiologically happening, even if it has a more benign etiology than someone might fear. One theory of hypochondria is kind of precisely this, that the hypochondriac tends to be flooded by a kind of background bodily noise. And again, they just can't ignore that they're acutely attuned to it. By the end of the 19th century, hypochondria gets reclassified as a mental problem rather than this constellation of intellectual and corporeal features that I'm describing. Medical doctors are now really interested in germ theory, sort of a one to one correspondence between cause and diseases. So they're not really interested in this thing that cannot be firmly located in a kind of disciplinary sense. Meanwhile, over the course of the 20th century, the broad field of mental health moves away from a notion of human psychology as dynamic and idiosyncratic toward like ever more mappable neurological phenomena that are then available to management, maybe, maybe primarily pharmaceutical management. Right now what we have are definitions that kind of granulate. This broadcast condition used to be called hypochondriasis. Now we have, at least in the American Psychological Association's dsm, that's the Diagnostic and Statistical Manual, we have Illness Anxiety Disorder, IAD and Somatic Symptom Disorder. These are both characterized by a high state of anxiety about the state of one's health. IAD indicates A kind of undue worry about having or getting a serious medical problem. Somatic symptom disorder tends to focus on physical sensations to a disruptive degree. Now, that should sound a little bit like Boswell. So to some extent, we've come full circle, but we've separated out these phenomena, call them different things. Maybe that makes them available to different forms of treatment. The change was actually by design. I mean, part of the idea was to avoid the pejorative connotations of that term, hypochondria, because it's been subject to derision and mocking for such a long time. The new definitions want to emphasize presence over absence. That means hypochondriasis was characterized by inexplicable symptoms and it was a differential diagnosis. Or that means if it isn't anything else we can figure out, then it must be hypochondria. The criteria for IAD and SSD are different. They focus on positive symptoms. That means anxiety and fixation are real and they can be disabling. In other words, these diagnoses are simply taking seriously the fact that someone is worried rather than the content. So they're thought to generate more holistic possibilities for treatment. Another change is that the characteristic of resisting medical reassurance is also eliminated. This means that health anxiety is no longer defined in terms of that antagonistic dynamic between the individual and the practitioner. Instead, it's really just focused on a disproportionate degree of uneasiness about symptoms. So part of the idea is to sort of return the agency of explanation of what is being felt to the individual, kind of defocusing on the power differential between the practitioner and the patient. Now, still others would claim that hypochondria is an absolutely normal and inevitable response to societal incitement not to be sick. We are, of course, constantly bombarded with messaging about the dangers of being ill. It's a disparaged social position. Interestingly, I think this makes the hypochondriac kind of the realist in the room, because if we're constantly being told not to get sick, then there must be always the possibility of getting sick. And the hypochondriac is the person who understands that fully cognizant of our susceptibility. A final idea here that I take up in later chapters is the idea that if we believe in something that can't be proven through ordinary diagnostic means, I mean, that's a kind of faith, in effect, which curiously, makes hypochondria, among its many different iterations, that I'M recounting here a curious form of spiritual knowing.

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Dr. Miranda Melcher (16:26)

All right, that's really helpful as an evolution, I suppose, of the term, because it's. I mean, I think already just in that one answer kind of justifies what you were telling us at the beginning of why this is such an intriguing thing to look at and kind of how it opens up so many different possibilities and explorations to have. Because I asked you what seems like a very simple question, right? What is hypochondria? And if it wasn't contested, then it would have been a very simple answer, right? So the fact that it has gone through all these evolutions and there are so many different perspectives in many ways kind of proves the point. But of course there's more things for us to talk about in further detail that you've mentioned already. So I think the thread I want to pick up next is sort of in this realm of kind of agency and power differential, as well as something you mentioned earlier around in the pandemic, sort of lockdown period, kind of who gets to make decisions and who gets to kind of have the correct information, right? And if we put these sorts of things together in the context of what you've just Explained to us for hypochondria. What happens if we think about hypochondria not as miscommunication, the way I think it's often portrayed, if kind of the medical authority says X and a hypochondriac is someone who doesn't agree, who doesn't listen. What if we think about it in terms of communication? Right. Taking up the point you just made around what if they're the realists?

Dr. Susannah Mintz (17:56)

Right. Excellent. Yes, you're so right. We tend to think of hypochondria, as you say here, miscommunication between the mind and body. First of all, we might say, right, sensations are being misinterpreted, miscommunicated, in effect, by the worried individual, and then of course, between the patient and the doctor, as those two figures are battling for primacy in the diagnostic process. Hypochondria was also for a long time interpreted as a failure of emotional communication. This is much less prevalent now, but. But it really held sway for some time here. The idea is that the, the blocked, immature hypochondriac is expressing in a somatic way, and the theory was a largely manipulative way, what can't be acknowledged or confronted psychologically. But if we set aside the dominant framework of proving sickness, for example, like whether something is really wrong in a nosological way, in a disease sort of way. Right. What else is getting communicated? So what else might we learn from and about our bodies, about being alive, right, Other than just a demonstration of diagnosable illness? What's going on in our bodies? What happens if we pay attention to all of these myriad symptoms that don't seem to lead clearly to a diagnosis that can be treated? What do we convey to and learn from each other through the mechanism of illness? Worry that might actually have more to do with personhood writ large? Personhood in an ontological sense. So what does it mean to be a human being after all, if it's not just about sickness? I think hypochondria may be unexpectedly given, again, the sort of one to one battle between patient and doctor, but also related to the way in which the hypochondriac gets isolated as a mockable figure. What if hypochondria is really companionable? Because of course, we do reach toward others when we're worried. We want connection, we're seeking empathy and understanding. We're trying to say something about what it feels like to be alive, about our sense and awareness of the risks of human mortality. We're saying something about the kind of world we want to live in what are our notions of interpersonal, but also collective caretaking, for example. So during COVID I read Daniel Defoe's novel Journal of a Plague Year that was written in 1722 as a kind of justification for the closing of England's trade borders. Plague was sweeping west across Europe. And I started to think then about health anxiety as this collective utterance, maybe not just to warn of impending disease, sort of the way Defoe does, but again to re. To stimulate a recalibration of how we relate to things, to ourselves, our mortality, to each other, also things like authority, to notions of time, productivity and success, aging, intimacy and caretaking, family. I mean, everything that the book goes on to take up. So I really wanted to think about it as a statement, an urgent statement of something that wasn't just I think I have X, Y or Z. But what sort of people are we? And how might we kind of reconfigure our attitudes about all these things I'm mentioning about truth, about listening to each other, and ultimately about our sense of fragility and vulnerability in the mortal beings that we are?

Dr. Miranda Melcher (22:01)

Lots of big questions there, not all of which I can tackle in one follow up question. So I'm going to ask a few,

Dr. Susannah Mintz (22:08)

not all of which I answer, of course, in this book, of course.

Dr. Miranda Melcher (22:12)

But one thing you do talk further about in the book is time, which you just briefly mentioned there. So what is hypochondria? Time. Hype Time.

Dr. Susannah Mintz (22:20)

Hype time. Right. So. So hyp. I'm calling it hip time. Hyp. Hip was a common slang for hypochondria, primarily in the 18th century. Hip time is my play on a disability studies concept which is called crip time. Crip is a kind of word that's been reclaimed by the disabled community. Crip time refers to how disability experience takes shape within, but also in opposition to what some have called chrono normativity, normative ways of occupying time. So the idea is that crip time pushes against normal ways of organizing time, such as a typical work day, a school day, how long we presume something to take to accomplish as well as life arc and the kinds of experiences that are associated with a good life presumed to be a long life, such as marriage, child raising ideas about the future. For example, the construction of time in industrial nations is thoroughly bound up with productivity. So it's no surprise that hypochondria has long been derided as a time wasting interruption of the proper forward motion of life. It's a kind of emotional Uselessness. Nothing is happening when we're being hypochondriacal. If you think about our common language of sickness generally, it's freighted by idioms of estrangement. So we say when we're feeling better that we're ourselves again, as if being ill constitutes a failure, even an erasure of self. And of course, we also talk in terms of cost and burden and loss, right? Lost work days, for example. So we think of sickness specifically as a rupture of work a day, rhythms and productivity. And in that context, hypochondria is going to seem even worse because it's a kind of unreal sacrifice of the possibility of getting legitimate things done. So I wanted to posit hip time, like crip time, as an alternative to this idea of hypochondria as stuck in a sort of helpless recursiveness, right? The hyper, the hypochondriac can only keep saying the same thing over and over again. Instead of feeling horrified by that, by hypochondria as this wasted intermission in the onwardness of a life. I mean, what if we take up the invitation to wonder about what we are in such a hurry to get back to? So I wanted to propose a distinction between stasis and stalling. To suggest that hypochondria might encourage a reorganization of how we relate to expectations of progress, of achievement, of completion in a variety of social contexts. So what if instead of a waste, hypochondria becomes this provocative pause? It's diverting our attention to what else might be possible. What if hip time allows us to reconsider again what we demand of progress in our lives, or how we think about things like adulthood or family. Maybe we disrupt the influence of medical authority as the primary guarantor of our well being because that tends to be linearly goal oriented toward getting better. Maybe hiptime reminds us that we don't actually move forward. We don't really inhabit our lives in this strictly linear way. We inhabit life in circular ways. We loop back, we find ourselves again, we have memory that is not straightforward. Maybe hip time could be inquisitive and disorderly and kind of proliferate, proliferative in that sense. In this chapter I explore some writers and scientists whose hypochondria actually facilitated their work. Maybe it acted as a necessary counterpoint to the mental and physical strains of significant research or. Or composition. Someone like Darwin again, for example. Or maybe hypochondria actually was the work. An example there would be Alice James. She was the sister of William and Henry James and a sort of notorious 19th century invalid, quote unquote. But she was getting a lot of work done while she was sick. Oh, another really good example is Harriet Marineau. I'll talk about her maybe a little bit later. Another sort of famous lifelong invalid who got a lot of intellectual work done from that position. I also think here, I mean, I think this, the idea of time really came to me because on the one hand I was reading a lot of research repeatedly referring to the uselessness and the waste of hypochondria. And then I read the novel Emma. And you may remember characters in that novel, first of all, Emma's father, Mr. Woodhouse, and second of all, the sort of nefarious Mrs. Churchill, two classic hypochondriacs. And it seems like part of their health anxiety is serving the purpose of getting in the way of the forward romantic motion, the evolution of that romantic plot of our main characters, because they're doing things to prevent the couples from normative life together. But what's interesting is that those pauses allow for other things to happen, different kinds of configurations of intimacy, of love, of caretaking. Maybe it also serves that novel as a way of suggesting there's another kind of endpoint for a woman that isn't just marriage. So this idea that hip time could really kind of restructure the way we think about how we move around, let's say, in our lives and our consciousness became really intriguing to me.

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Dr. Miranda Melcher (31:12)

Yeah, I think this is definitely an aspect of the book that will be very thought provoking to a lot of people and does apply across, as you said, so many kind of areas of current thinking with disability studies, but also sort of. Yeah. What does this mean for looking back from example, particular famous people or famous books like it can be applied in a lot of different ways and you do have another term in the book as well, hip epistemology. So can we talk about that one too?

Dr. Susannah Mintz (31:39)

Yes. So I apologize up front for all these little coinages. This is another coinage of a coinage. So again in disability studies we have this concept of crip. We call it crypistomology from crip. Again that word that is reclaiming a disabled identity and epistemology. This is the concept that simply says we know something through disabled experience. So it's redirecting us from what is known about disability as an individual bodily problem, say, subject to medical scrutiny, reorienting us toward disability as a source and a site of knowing. So how, for example, might various disabilities help us rethink ideas about what it means to be independent and autonomous? There's so much emphasis on interdependence and assistance and caretaking and disability situations. How might disability encourage a reconsideration of what we mean by beauty? How might we differently think about something like human rights? How might we think differently about something like the future? Hipistemology, for me, works kind of similarly. So what can hypochondria teach us about what and how we know? I've been saying something of that all along. Whether the subject of knowledge is the body, but maybe it's also something like institutional authority, or again, something that doesn't have anything to do with sickness at all. Hypochondria is, of course, sort of, in its conventional iteration, a debate about proof. Who knows best what something is, and in turn, who is best positioned to allay fears when maybe we don't have a definitive explanation for something. And that contest pits the patient against the practitioner in a struggle over domains of knowledge. The paradox of hypochondria is that the patient is turning to the professional as presumably more knowledgeable and at the same time tends to resist interpretation. Right again, that was a diagnostic criterion of hypochondriasis well into the 21st century. The fact that the hypochondriac sort of by definition continues to have symptoms is casting doubt on the authoritative knowledge of medicine. But it's also in some ways calling into question what can be known of the state of the body through our own subjective experience of it. So what do we do with this alarming circumstance of sensations and pains and lesions that readily attach themselves to a vast database of possible diagnoses? But also, what do we lose if we disparage hypochondria's way of answering that question? So doctors can get really frustrated by hypochondriacs for that insistence on knowing better. But again, away from that strict clinical setting, what is it that hypochondria knows? Maybe the hypochondriac is better positioned to understand the open ended quality of our human experience, the way in which our quest for knowledge, our sort of fascination, even fetishizing of mastery, is really elusive. Maybe hypochondria's search, and that habit of constantly searching, presents us not with some Embarrassing nothingness like the disease that isn't. But it's teaching us something about testing alternatives or seeking anew, or bearing the frustrations of contradiction. To think of hypochondria only in terms of its fear of what isn't, we might say, misses the profound attentiveness to what is. And that means people are never entirely well. And again, maybe that stimulates some different ideas about how to conduct ourselves in this life. So I mentioned Harriet Martineau a moment ago. She was a very famous 19th century sociologist and an invalid quote, unquote, as the 19th century used that term. Her book, Life in the Sick Room, she writes this. She declares that from the sickbed she could analyze life in its entireness. That's a pretty bold idea, that sickness is generative of knowledge, not just in a scientific sense, but everything. Right. It's stimulating to our imaginations and our ways of knowing things rather than being an interruption to that. So if the hypochondriac, Certainly in the 19th century, it had something to do with simply being sick in a. In an ill defined way, I wanted to think about it as a source of knowing rather than a subject of the expertise of someone who presumably knows better. So it returns a kind of intellectual agency to the hypochondriac.

Dr. Miranda Melcher (37:11)

And that goes back to some of the other things we've been talking about in terms of who kind of gets to have knowledge and communicate and sort of pushing back against some of these assumed power differentials when it comes to an individual engaging with medical community or kind of the wider society's perceptions of hypochondria. What if, though we move this beyond thinking about the. An individual, or even an individual in their kind of immediate circle, how might hypochondria relate to ideas like national identities or national borders?

Dr. Susannah Mintz (37:44)

So, you know, our, our own Covid era and also Defoe's 18th century British Imperial context demonstrate how fear of disease can get conflated with fears of otherness. So a fear of contagion can be leveraged alongside nationalist, racist, religionist anxiety to mobilize behaviors that support privilege and power. So that's one way in which it can work. At the same time, because hypochondria is so alert to the porousness of bodily boundaries, it can also be deployed to expose the essential porousness, the factitiousness of geopolitical borders also. So in other words, borders can always be breached. And a culturally, racially interconnected world is, among other vulnerabilities, an epidemiologically exposed One also, however anxiously, we guard those borders and boundaries. In some literature, this can serve to articulate the disastrous consequences of expansion. Here I'm thinking of a dystopian novel like Mary Shelley's the Last Man. It's apocalyptic, it uses a global plague as a form of political critique. There's also a theory of racial hypochondria. This is the idea that hypochondria manifests the friction of assimilation in which a racial or a cultural difference might be felt within the immigrant or the othered body as a kind of unhealthiness. Then too, I think about works like Kafka's story Metamorphosis or Herman Melville's story Bartleby the Scrivener. These are stories where hypochondria protests against the dehumanizing effects of the workplace. So a body that doesn't stay put in medically recognizable way disrupts the organization. In both of these stories we have a sickly quote unquote character who throws the work system into disarray. But then hypochondria works in the opposite direction because it amalgamates itself, in effect in explicit defiance of commercial interests that depend on regularity and sameness. That hypochondriacal body where something is wrong but we can't quite tell what, right. It throws the entire system into disarray. It sort of exposes the fact that the system is based on expectations of normalcy and regularity. In these various scenarios, part of what hypochondria is doing is revealing the way in which we react to unfamiliarity. Someone else's, but maybe also our own. And again, at the same time, it kind of holds out this provocation to reevaluate our ideas about wholeness. What does it mean to be a. A whole body, a body politic, or an individual body? And again, maybe allows for all the eventualities of our fragile selves, our ever on the brink selves. My favorite moment from Metamorphosis, for example, is when Gregor Samsa, he's turned into a bug. He realizes he can walk across the ceiling and he delights in that newfound freedom. So maybe there are other possibilities that we haven't even thought of.

Dr. Miranda Melcher (41:35)

And maybe some of those possibilities might be correcting things we know are problems like systemic biases in medicine, right?

Dr. Susannah Mintz (41:44)

So some patients are accused of hypochondria as a corollary of other biases that precede the clinical encounter. So gender, race, class, sexuality, fatness. Some patients are scorned as hypochondriacal. That Means they are declared to be unbelievable, some would say even non existent, even before they've crossed this threshold of care. And that can have direct and often dire consequences for access to and quality of healthcare. So there's ample evidence, for example, of enormous disparities in the treatment of both acute and chronic pain for women. For people of color, this owes in part to very deep seated stereotypes about black and female bodies as simultaneously better able to withstand pain and more prey to exaggerate their suffering. And that's despite the fact that opioid use is statistically higher among whites. Another factor influencing claims of hypochondria is that because so much less medical research is conducted with non white, non male subjects, marginalized groups are much more likely to experience misdiagnosis. So if symptoms don't align with the body type that practitioners expect of particular diseases, those symptoms can be readily discounted as hypochondriacal. Proper diagnosis may be serious. Delayed heart disease, as a notorious example, is often misinterpreted in women as mental illness these days, right? In different medical response to long Covid, it's this new and amorphous syndrome that has been loudly decried in the press as a form of medical gaslighting that distorts the reality of the patients. That's just a recent instance and a really long history of misreading some individual symptoms. What I want to suggest here is instead of simply denying hypochondria, that would seem obvious, I'm not being hypochondriacal, right? I'm having heart trouble in, in the face of that pre existing belief. What if counterintuitively, we cultivated hypochondria in a sense, in a. In a philosophical way, precisely because it keeps insisting on alternative possibilities, it has alternative truths to tell, it has these protective assertive qualities. Maybe the idea isn't to just discount being a hypochondriac because something else, something quote unquote real, is at work, but actually to keep on being a hypochondriac because it challenges standard ways of knowing, it challenges culturally accepted knowers, it rebuts the ontological hierarchies of the medical encounter, right? The doctor is more important in some way than the patient. And it insists on the wisdom of how we know ourselves to be and feel. So maybe there's a kind of shielding function of hypochondria in these moments. Something may be happening that requires treatment, but what if we sort of hold on to that hypochondriacal utterance that we've been talking about that says there's another thing to be discovered here. There's another way of going about getting at something like the reality of what I'm feeling.

Dr. Miranda Melcher (45:13)

Hmm. There are a whole bunch of different characteristics people might have that maybe make them especially in need of kind of the medical establishment going, hang on a second. Right. Maybe we need to rethink some things. One thing, though, that we haven't mentioned yet is age. So can we talk about hypochondria and ideas and attitudes of aging?

Dr. Susannah Mintz (45:34)

Yeah. When I first started writing the chapter on age, and I'm very interested in aging, when I. When I have written books about disability, I always include a chapter on age because of course, as we age, things will inevitably happen to us. We become impaired in one way or another. Given normal aging here, what really surprised me is to find out that statistically speaking, the elderly as a demographic are not actually more prone to being hypochondriacs in a kind of clinically diagnosable sense than any other group. I think we indulge this stereotype of the cranky old person who has no interesting thoughts or activities other than obsession with illness. We were supposed to apologize for talking about our ailments as if that in and of itself signals our encroaching decrepitude. This happens among my own, my own circle folks, my age all the time. And I think these attitudes reveal associations that we make between aging and frailty and also between illness and irrelevance. Of course, it is true that normal aging is characterized by changes to function and ability. And to the degree that youth and fitness are prized, culturally speaking, as evidence of social value, then old age becomes inevitably tainted as proof of our vulnerability, which we are culturally encouraged to fight against. To demean the elderly as hypochondriacal, I think, is to go a step further by mocking that concentration on inevitable changes as a kind of purposeful rather than inevitable or unwitting withdrawal from approved ways of being socially meaningful. Again, it turns out that's not really true of the elderly, statistically speaking. And many gerontologists would argue that health anxiety at that stage of life is entirely appropriate. Right. It's a functional response to the experience of age. Meanwhile, the so called positive aging movement tries to rescue our advance in years from these pitiable narratives of decline and loneliness and uselessness, but really only by reinforcing the ideal of perpetual youth. So we're aging well, if we're being young. It's a fantasy, in fact, in which old people don't get sick and suffer no diminishment of capability. I would argue that that version of thriving elderly folk is really just a repackaging of ageism. I wanted in this chapter to propose a different way of thinking about aging that essentially embraces all of the ways in which hypochondria also explicitly rejects cultural pressure to hold fast to youth and health. So what if we celebrate the mistakes and the goofing up and the repetitiveness of aging, even the unfiltered narration of ailments, just like hypochondriacs? Because that's evidence of ongoingness, that's evidence, actually of being alive, its compelling modes of discovery and storytelling. We might think of advancing years not as this inexorable slide into burdensomeness and helplessness, but rather hip time, where we do the work of finding out who we are now, even if we're transforming daily. Maybe we honor the inwardness of age as epistemological self reliance, right? A subtle process to acclimating, to surprise. So we might value again precisely those qualities of aging that enact hypochondria and hypochondria's own brand of everything we've been talking about, of existing in time, of knowing, of connecting, maybe even of flourishing.

Dr. Miranda Melcher (49:57)

There are so many takeaways, I think, from the many aspects of the book that we've been discussing. Is there anything further you want to throw into our conversation about what you hope readers do or maybe stop doing after reading and listening to all of this?

Dr. Susannah Mintz (50:12)

Yeah, well, I primarily hope, I think, that people who do not identify as hypochondriac hypochondriacs might understand others who do evince that kind of worry with a little less impatience, and that anyone who might feel a little more curious about what hypochondria can teach us about the mysteries of our embodiment, Even a little more openness to how it is that we know, maybe more awareness that that dividing line between healthy and sick is much more poor, as much blurrier than we tend to believe. One expected consequence, I think, of rethinking hypochondria might be to contest what we understand as the obviousness that health is better than illness. We don't want to be in pain, surely. And many conditions that derive from, say, unsafe work practices or socioeconomic inequities deserve our attention as potentially avoidable. But equally unavoidable is the susceptibility of our bodies and our minds to anomaly, to change, to loss, to disease, and ultimately to mortality. So does the hypochondriac not remind us of this reality and invite maybe a different kind of response to these ever present possibilities. Maybe we all, wherever we are on that spectrum, just manage the unpredictability and fragility of ourselves with a little more equanimity, a little more grace.

Dr. Miranda Melcher (52:01)

Well, I think that's a lovely way to end the conversation about the book, but not quite our conversation, because I would love to know what you might be working on now that this book on hypochondria is out in the world.

Dr. Susannah Mintz (52:12)

It is possible that I might be embarking on a cultural history of depression that's just in the very early stages with reaction, but I'd be very eager and interested in doing that. I really had a great time researching hypochondria, which in effect I knew only from my own childhood and frankly adulthood experiences of it and some of what I'd read in literature. So that was great fun and I'm eager to do something similar to it. And believe it or not, I am also working on a memoir of ballroom dancing, which I took up at age 60 last summer. And I'm having, forgive the pun, a ball.

Dr. Miranda Melcher (52:51)

Well, those both sound like very interesting projects. And of course, while you are pursuing the very different ideas there, listeners can read the book we've been discussing titled Hypochondria In Sickness and in Story, published by reaction in 2026. Susanna, thank you so much for joining me on the podcast.

Dr. Susannah Mintz (53:09)

Thank you, Miranda, so much. It was delightful. Foreign.

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