Health

The Lineage Of Hypochondria And Gender

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July Westhale

TThe technician slides the wand across my abdomen, and the lubricant — cold and slick — makes a sound like a deft ice skater on a rink of frozen water. On the screen in front of us is a dark, black thicket, gray snow with shapes that are discernible in their negativity.

“The black is liquid, or tissue,” she says cheerfully. I am making her day; it is rare to have a patient so interested in what’s actually happening on an ultrasound, particularly if said patient isn’t pregnant. I ask to see my uterus.

“Unfortunately, your bladder is voided,” she replies. “And that makes it difficult to locate.” I respond that I could point exactly to the place where my uterus resides, by the orange-peel of my left hip bone, but she doesn’t have time. She skips over my reproductive organs and instead shows me a kidney, like the muddy lobe of an ear.

It startled me at first, her use of “void” to mean empty. You expect it when talking about abstractions: space, or apathy, maybe. But your own body — even if it’s the bladder, even if you want an empty bladder — is different. You want your body to be as full-to-brimming as it can be, of something textbook that will point the provider in the right direction, particularly when you’re trying to find a diagnosis.

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Years ago, I contracted a parasite while traveling with a friend in Bolivia; we’d eaten llama, which wasn’t the culprit, and a Greek salad, which was. Years before that, I’d contracted dysentery while working at a town built on top of a garbage dump in Peru — Milagro — a town whose name means Miracle in Spanish. The parasites, collectively, have wrecked my stomach, or thrown me off-kilter, and the result is that I occasionally suffer what feels like an ulcer, at the lower left-hand corner of my solar plexus.

I keep lists of what makes my gut sigh like a fire-spewing lizard, curled and nightmaring inside of me, lists on a disconnected part of my phone that I don’t use for anything else. When I stumble upon the lists, invariably looking for some other void to place my thoughts or quotes into, it looks like a disembodied heap, like the island of plastic in the middle of the sea must look like.

I am nervous enough about my follow-up appointment that it ties my stomach in knots. My acupuncturist, who finds procedures like endoscopies invasive, is convinced it’s my gallbladder and recommends a cleanse in which I eat five to ten apples a day for five days, and I carry around heavy, pregnant Pink Ladies in all of my bags. I crunch through my editorial job. I starch myself through my teaching gigs, I leave stickers with SKU numbers on my nightstand.

I expect my students to make comments about their teacher, who has just eaten three apples while showing a video on Media Literacy, but they don’t, and I love them for it. At the end of the five days, I stand after urinating and find the toilet bowl full of stones, like a scattering of stars in a suddenly dark place, or the beads of a broken rosary on bright tile. Apparently, we all have stones that need clearing out.

I am not nervous that my doctor will find something. I’m nervous that she won’t.

I lived in the high desert as a child, and my memories as such are arid, oppressively hot, and unbearably bright: Saguaros and Joshua trees, woodpeckers stumbling out a quick SOS before breakfast (then again at lunch), the way the pages of books felt and sounded like deciduous leaves. I remember — as a fine layer of scrim or silt overlaying everything — the crabgrass of my mother’s funeral, the cold ambrosia salad at the church after, a hushed chorus of long skirts.

“Rebecca, you know, was a hypochondriac.” The iron-hot sear of betrayal when I turned to see who’d said it, and found my grandmother holding the words between her lips, as sure and cleansing as a communion wafer.

There is scant little orienting, very little outside the words of your elders when you are little, and so I took the word hypochondriac inside me like an heirloom. I placed it in a safe with the word sensitive, next to the word orphan.

“You’re a very delicate creature,” a now ex-partner once told me the morning after I’d gotten sunstroke while backpacking in Yosemite. We’d climbed too quickly up the side of a mountain and the descent left me breathless and hallucinating in our tent. To prove how very untrue the statement was, I led our hike back out, the ten miles out of Rancheria Falls, and when we got back to the car, I vomited quietly, cleanly, behind a rock.

At the back of every illness has been the cyclorama of hypochondria, a legacy that I was born to bear out, underscored by my losses, but inherited as surely as my widow’s peak and my small feet. When my mother turned twenty-six, she’d sold everything she owned, changed her name, and moved to Hawaii. She didn’t talk to my grandparents for a year. When she returned, she told them nothing of where she’d been or what she’d done, and she settled eight hours from them, in the concrete jungle of Phoenix, Arizona.

Reportedly, she left her boyfriend when she became pregnant at thirty. She spent nearly the entire duration of the pregnancy in the hospital and told no one that she was there. My grandparents received a collect phone call in early October of 1986 from the Phoenix Good Samaritan Hospital, asking if they’d like to accept charges from a Rebecca Gerdes. When they confirmed, they were greeted with a low moan, one of my first screams in the world.

I sit in the exam room, waiting for my doctor to come in and tell me about the normalcy of my dark and bloated organs — which looked so similar to punctuation scrawled in the overturned mess of an inkpot — and when she does, I am tearing apart the protective paper on the table.

I work in patient advocacy, and I have chosen my provider, with whom I’ve now seen for four years, because she sits before she speaks to me, because her hands are as open as those of a child feeding a bird in a public park. She is sure to ask me how my book is charting, if I sleep any better than I have been, and if I’m managing my stress. We engage in a long, thoughtful conversation about rape culture, spurred by an article she had read on the way to the office. And then she tells me that my ultrasound is normal.

“Meaning,” she says, “Nothing came up.”

My heart sinks. The air in the room grows expensively, as if I’m suddenly aware of how very much of this woman’s time I am taking up in the pursuit of expensive resources. She notices.

“This is good. We don’t actually expect the ultrasound to show anything.” She turns her computer towards me and shows me the report, the photographs of my liver. “The ultrasound was ordered so that we could show the insurance company that we made efforts before referring to a gastroenterologist.” She hands me a referral, and a request for an endoscopy, and by the time I leave the office I have a voicemail from someone in her colleague’s office, asking when I can come in.

I breathe easier on my walk home than I did when I left in the morning; we are following a protocol, and following a protocol, for all intents and purposes, typically means a trajectory. It means we are still moving forward and that movement further signifies that I am not imagining things.

My grandmother died in December. Her cause of death, like the death of my mother, is vague to me. It seems to me that she died because she was ready to, and that’s the extent of the conversation my family had about it. Twenty-eight years after my mother died, I have as much information about what killed her as I do of my grandmother; that tells you about the legacy of silence and politeness that my family carries, more than anything else could.

At the funeral, I read Rilke as translated by Joanna Macy: You are not surprised at the force of the storm — /you have seen it growing./ The trees flee. Their flight/sets the boulevards streaming. And you know: /he whom they flee is the one/ you move toward.

I wore a faux fur leopard print jacket my grandmother had loved, and I held my sisters close to my body, as if we were the girlchildren we’d once been, making boats out of palm fronds in a potato field, or coaxing scorpions down from bougainvillea bushes. As if the blurred years of teenhood and adulthood that came between then and now had been but a regrettable blip.

I ended with a humorous story about how my grandmother would sneak drinks from the milk carton in the middle of the night and leave a crime-red ring of lipstick around the rim. An estranged cousin spoke next. “That last story isn’t true,” he said. I felt the congregation turn towards me, but in a very Baptist fashion, meaning that they looked at the space next to my head rather than my eyes.

A year has gone by, or most of a year. I am helping my grandfather — who was married to my grandmother for sixty-five years — donate her clothes, which have been cycled through all of the women in my family since as long as I can remember. I find a pair of emerald green heels that were mine, then hers, now to be my niece’s, that I bought with my aunt. As I painstakingly check to see which of my grandmother’s makeup is still useable and label with the name of an intended family member, my grandfather folds leopard print scarves.

His hands are papery, the scarves are crepe, we are in a sound bath of things that are barely discernible.

And then, without looking at me, drops the bomb: “Your grandmother was a hypochondriac. They never really could find anything wrong with her.”

I do not know where these women end and I begin, and it isn’t for lack of trying. When my grandmother lay dying in the hospital, I climbed into her bed immediately upon arrival and wrapped her in myself — same length of limbs, same small and pale narrow feet, same red hair, same green eyes. It was near Thanksgiving, so we watched the Macy’s Day Parade and when I finally left, I was covered in her mascara and she mine or maybe each our own.

The men in my family, to my knowledge, do not have to rub the adhesive of hypochondria as a label from their bodies. They rarely even suffer accountability of their lifestyles. My uncles — who all worked long hours at the PG&E plant during the height of the crisis in Hinkley — suffer in silence, hide their medical records, blame liberal conspiracies, flash the gold watches with the company’s emblem embossed along the side.

When my uncle Doug was found drowned in an irrigation canal when I was sixteen, drunk and bloated, everyone just said poor angel, and left the mystery alone. I live in a lineage of mysterious ghosts, with no foothold into their final moments, and I suspect it is because everyone assumes that it’s too horrible to bear. We cannot be trusted to handle the truths of the body, and so these truths either go undiscussed, or when they are discussed, believed to be erroneous.

I know from my work as a patient advocate, and from my own experiences as a patient, that the medical industry does not take seriously the complaints of people socialized as female. This is not uniquely true for this demographic, of course — it applies to poor men, men of color, queer men, trans men — however, when it comes to hypochondria specifically, it appears to be largely agreed upon that women experience the diagnosis and/or effects of it significantly more than women. And for that reason, they are not taken as seriously when they do come in presenting with concerns — and sometimes, the combination of this toxic dynamic is deadly.

A preternatural preoccupation with one’s physical comfort and wellness is highly femininized, with bullshit gender essentialism stretching back to the days of cave people, but it still infiltrates our medical system today. At best, women who complain too frequently of ailments are diagnosed with illness anxiety disorder and encouraged to see mental health treatment. At worst, they aren’t treated at all.

“These gender biases in our medical system can have serious and sometimes fatal repercussions. For instance, a 2000 study published in The New England Journal of Medicine found that women are seven times more likely than men to be misdiagnosed and discharged in the middle of having a heart attack. Why? Because the medical concepts of most diseases are based on understandings of male physiology, and women have altogether different symptoms than men when having a heart attack…

To return to the issue of chronic pain, 70% of the people it impacts are women. And yet, 80% of pain studies are conducted on male mice or human men. One of the few studies to research gender differences in the experience of pain found that women tend to feel it more of the time and more intensely than men. While the exact reasons for this discrepancy haven’t been pinpointed yet, biology and hormones are suspected to play a role.” — Harvard Health

In my case, and my mother’s case, and likely in my grandmother’s case (I have fuzzy memories of being told that my great grandmother, too, was often in hysterics), I suspect we fall prey to the whole kit and caboodle of hodge-podged medical opinions surrounding women’s ability to make or not make decisions about their own bodies. And that we dually suffer — or really, I suffer, since I’m the only one in this lineup who is still alive — from the double-edged sword of both being victim to illness anxiety disorder, and the allopathic world’s inability to recognize ancestral trauma and its intersection with medical lineage, instead leaving the brunt of that burden to naturopathic communities, and plant healers.

Hypochondria, I was astonished to find, actually has some historically useful roots. “Weirdly, hypochondria has a feminist significance, writes JR Thorpe of Bustle:

“It’s sometimes suggested that Florence Nightingale, who often suffered from serious illness and was confined to her bed, may have been a hypochondriac as a way of escaping the horrible societal confines of her gender in upper-class Victorian England. In her bed she could write and be an activist freely, without pressure to occupy normal feminine roles.”

I call my doctor back to thank her for the referral. When she sounds confused by the gratitude, I explain to her my nervousness going into the appointment — my almost knee-jerk refusal to allow myself to have physical ailments, much less bring them to the table, just in case I’m fulfilling exactly what is expected of me in a line of many.

Her voice is kind and thoughtful, even with the passing wind sounds that tell me that she is driving somewhere — it is 3 something in the afternoon. She must be heading to the elementary school. “Likely your people were just victim to a generational and institutional misogyny that allowed them to feel as if their pains were psychosomatic. The world unfortunately still operates under the patriarchy, but I don’t.”

She asks me again when my next book is coming out, and as we say goodbye, I hear her call out for her daughter.

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