Symtoms and Sensations
On living with health anxiety (in the wake of a devastating pandemic).
What’s shortness of breath? It’s a symptom that’s common to Covid and anxiety. A blurred line is where it all begins.
Is this going to kill me?
As a health anxiety sufferer, I don’t ask myself questions like, Who am I? or What do I really want?
But I always seem to want to know: Am I going to die?
Of course I don’t mean to ask if I’m immortal. The question is closer to, Is this going to kill me?
I am still living decently well, so it’s probably counterintuitive to ask myself that question embarrassingly often. That’s what I try telling my anxiety, but it won’t listen.
India’s very own pandemic
I’ve said it before, and I’ll say it again: India is burning. But this time, I mean it literally. The air is laced with the fumes of funereal pyres. The virus is a relentless one, but the tyranny of our elected government has been far more lethal. We are left a hapless nation, painfully aware of the fact that the carnage has just begun. Every day brings a new set of horrific surprises, reminding us of all the people we are afraid to lose. It is this doomsday scenario—and not a birthday or a wedding—that reminds us of all the people we love truly, simply because of how afraid we are to lose them. Many of these relationships are nameless, defined by a familiarity that transcends the bounds of familial ties, making it that much harder to mourn their loss.
In the wake of this devastating pandemic, I decide to write about health anxiety—my health anxiety. About what it’s like to endure relentless worry and panic at a time when you’re specifically expected to worry about falling ill, given that that’s all you were doing nonstop for years.
Back in March 2020, when COVID-19 was first declared a global pandemic, a friend had expressed concern about my health anxiety. You would expect a chronic health anxiety sufferer to be badly off at a time when an illness was fast spreading its tentacles across the globe. Oddly enough, I was at relative ease back then. That time was perhaps the happiest I had been in a while. Looking back, I see that it was also the happiest I was going to be in a while.
Talking about health anxiety
For a long time, I didn’t feel the need to talk about my anxiety because there’s much being said about it on the Internet already. I’m not complaining; that’s a really good thing. It is what has normalized a kind of suffering that lacks shape and form, for which I am sure many of us are eternally grateful. The discourse is what has enabled millions of people like me to talk about anxiety in axiomatic terms.
But there are also two problems that come with too much talk of anxiety:
First, it immunizes us against understanding it fully. With so many people talking about it, it almost seems like every other person has an anxiety disorder—which is probably true. This type of ‘listening fatigue’ may also be familiar in the case of the coronavirus pandemic.
It eclipses other mental health concerns that are just as crippling, if not more, and just as stigmatized, if not more, making it seem like anxiety and depression are the only (acceptable) concerns we can talk about. This, too, is familiar in the context of the pandemic. Every time I feel a little feverish, I suspect only Covid, and when it seems like it isn’t Covid that ails me, I am at ease. But the truth is that there are so many more dangerous diseases that continue to exist, and in the light of the pandemic, we may forget to watch out for them.
The solution is never to stop talking about anxiety. But, these two problems are harmful to the cause of better mental health, and they ought to be addressed.
Why am I talking about my health anxiety now?
When India entered a harsh nationwide lockdown back in March 2020, there were just over 500 known cases of Covid in the country. In April 2021, India was reporting well over 400000 daily new cases. Even if you choose to believe the grossly underreported official figures, it’s a staggering statistic. Illness and death are rampant, testing and vaccination scarce. At this point in time, I don’t know of a single household that is unaffected by the crisis, including my own.
Here’s the difference between March 2020 and June 2021. In March 2020, I never thought the disease would spread far enough to ever get to me, yet I had the license to behave like it would. In June 2021, it’s already come into my home and I can’t be assured that it’s gone for good. It’s living as one of us now, breathing down our neck.
The pandemic didn’t trigger my health anxiety back in 2020
Until March 2020 came along, I had spent nearly fifteen years worrying about one or the other illness, and suddenly it seemed like the whole world had joined me in that behaviour. It was now a lot more acceptable to worry about falling sick, almost all the time. Something as simple as acceptability gave me a sense of ‘shared burden’. Everyone was worried about everyone, no type of worry was out of bounds, and no behaviour too excessive to be deemed paranoia.
But it has been triggered now
In the present day, my anxiety responds differently vis-à-vis the pandemic.
Anxiety hinges on a sense of control—a nagging sense of losing it, an unbroken attempt to regaining the control we never had.
In the early days of the pandemic, everything seemed to be in my control. Social isolation was encouraged, sanctioned, mandated. That was my dream. And the virus didn’t seem like a threat at all. And if at all there was anything to fear, there was no shame in talking about it.
At the onset of the pandemic, I was less scared of contracting the virus than the average person and a lot happier about being socially isolated than the average person. It was almost as if the task of being vigilant about an imminent illness had been outsourced to the entire world and my burden was lessened. I can’t say I feel the same way anymore, because here in India things are a lot worse than what I had imagined they would ever be.
The basics; what is health anxiety?
A rudimentary Google search will throw up a lucid definition for you to understand health anxiety.
Apart from the diagnostic definition, it’s useful to look at anxiety as a symptom. When you have it, you know you do. Something like a cough, or a rash. Of course, you can (and you should) always consult a specialist for a diagnosis, if that’s what you seek.
Here’s a quick clinical overview of health anxiety:
Health anxiety is an obsessive and irrational worry about having a serious medical condition. It’s also called illness anxiety, and was formerly called hypochondria. This condition is marked by a person’s imagination of physical symptoms of illness.
Or in other cases, it’s a person’s misinterpretation of minor or normal body sensations as serious disease symptoms despite reassurance by medical professionals that they don’t have an illness.
Health anxiety is no longer included in the American Psychological Association Diagnostic and Statistical Manual of Mental Disorders. It was previously called hypochondriasis (better known as hypochondria).
Now, people who had been diagnosed with hypochondria might instead be classified as having:
Illness anxiety disorder, if the person has no physical symptoms or only mild symptoms.
Somatic symptom disorder, particularly when the person has symptoms that are perceived as distressing to them or if they have multiple symptoms.
(Source: https://www.healthline.com/health/health-anxiety)
Does it help to mention that when I first heard of hypochondria as a young teen, I thought people with the condition were faking being ill? Much to my dismay, a lot of people still understand it as that.
An overview of my health anxiety
My anxiety disorder is not restricted to health-related preoccupations, and that’s important to note, too. At times the anxiety ascends to a more ‘cognitive’ realm, where I fear the intricacies of things outside my body—like losing a loved one, not being able to write ever again, plane crashes, fear of being in social settings, etc. At other times, it regresses to the physiological realm.
Some may see this as an instance of regression, others progression, because I’m allowing the root cause to come ‘closer’ to me, to inhabit my body, as it were.
The body is not feared for what it is, but it’s feared more for what it represents. Among many things, the body represents how you look to the world, how you feel, how you function, and it’s also your only means of ‘showing up’, for yourself, for others, for the next day in tow.
I have lived with health anxiety for at least fifteen years, if not longer, suffering from bouts of heightened worry as frequently as two to three times a month. Needless to say, a more mellow, nagging worry has been a constant companion.
Every time I hear of someone with a particular disease, I have to give it about five days before I start seeing all its signs and symptoms in my own body. Health anxiety, like its countless cousins, is illogical. You can hardly reason with it. It doesn’t help that I have low immunity and an utterly sensitive body that’s prone to mild and transient sickness.
You may have heard of ‘cyberchondria’. If not, you know what to do. Google can incite panic in the best of us; all you need to do is look up “runny nose”.
My bodily anxiety has been a longstanding, faithful companion, far outdating the advent of Google. So, just imagine the (added) havoc the Internet has wrecked on my mind.
The following is a list of just some of the diseases that I was, at one point, 100 per cent sure I had:
Lung cancer
Multiple myeloma
Pulmonary embolism
Appendicitis
Brain tumour
Herpes
Kidney stones
Gall stones
Breast cancer
Imminent stroke leading to instant death
Covid (x10 times)
(There are many more diseases that I have feared in the past, but I’m too ashamed to list them.)
Each time I thought it was already too late, that I was doomed, and that going to the doctor would only confirm my worst fear. So, I never went to the doctor. Not until I was a complete mess and had to confess my state of madness to my mother (who, unlike most people out there, has never judged my anxiety/paranoia), who would reassure me that I will be okay, and that going to the doctor will only reassure me further. Then I would go to the doctor. The doctor would prescribe some tests but also reassure me that I’m okay and I don’t have what I think I have. I would take that reassurance and never get tested (for anything).
Until the madness struck again.
And this has happened to me at least 100 times in the last fifteen years. No joke.
I must also mention the degree of shame that accompanies my symptoms. I am immensely embarrassed to share them with anyone until I begin to feel it’s too ‘late’. Where does the shame come from?
When the lines blur
I developed a raging fever a couple of weeks ago, and I googled to check if heightened stress could cause it. This time, when my body was burning with a fever, I convinced myself that it was psychosomatic and that I would be okay.
Turns out, it was not psychosomatic. It was (probably) Covid. But because I couldn’t get tested on time, I’ll never know for sure, so I’ll continue to fear contracting the virus.
The symptoms of a panic attack, which notoriously mimic that of a heart attack, are all too familiar to me. Most people with anxiety will know what I’m talking about. But, what do you when you have health anxiety—do you rush to the ER every time, or do you soothe yourself with placatory chants that it’s only anxiety? What if it’s not? And that’s the loop I am almost always caught in.
Recently, I came across this little test that can somewhat help put things into perspective.
The thing about anxiety is that it is neurotic in nature. If I were afraid of the invisible person in the room, you would admonish my hallucination. Sure, madness is nothing but the reality that you don’t share with the majority, but what if your fear comes from that which can very easily be feared—an illness that’s all too common, or a plane that can very well nosedive? Anxiety is too clever to outsmart.
What am I doing about my anxiety?
Early in 2019, I began what I call ‘self-work’. I started to take detailed notes of not only my bodily sensations and symptoms, but also of other thoughts, feelings, memories and (nightly) dreams.
We’re always eager to talk about ourselves to others, but sometimes it’s useful to talk about yourself, to yourself.
Here are some examples of the observations as part of my self-work:
I could easily be counted among the world’s most fearful people—I am afraid of some shape or form of literally everything. I am afraid of possibilities, so I am afraid of everything. The only place in the world that brings me immense comfort is the inside of a car. Still or moving, it doesn’t matter. Mine or not, it doesn’t matter. The shell of a car is a balm to my soul.
Growing up, I could never play on a seesaw. It entailed a partnership I couldn’t trust. Teamwork, partnerships, collaboration, etc. are still some issues.
Most external stimuli and sounds are very distressing, but the one that disturbs me the most is the sound of someone coughing. This has long prevailed and has nothing to do with the pandemic. Every time I hear someone cough, I almost always believe that they are going to die. And people cough all the time, especially in India.
For as long as I can remember, I have loved painting my nails. Yet I don’t do this more than a couple of times a year, because I fear that it will be seen as ‘indulgent’, ‘frivolous’, etc. That my painted nails will somehow detract from my sense of seriousness, sobriety, sadness.
Over time, I have tallied these observations with my anxieties (which are also varied in nature).
For example, I developed sudden, acute airplane anxiety in the year 2015. Despite having been exposed to airplane travel all my life, I was now very afraid of getting on a plane. Anxiety is ‘illogical’—I wasn’t looking to be convinced about plainly obvious facts like airplane travel is the safest kind.
The idea of being suspended between point of origin and destination, and the fear of my life being cut short before I could make it to my ‘destination’, was simulative of a situation I was in at the time. Of course, it took me a while to see it as clearly as that, and it explained why the fear had come on suddenly and inexplicably. Soon after the insight, the anxiety began to retreat.
When you atone with your body for a sense of guilt that pre-dates the acquisition of language, maybe that’s one way to look at health anxiety. When an allegiance to someone feels like a betrayal of the self, maybe that’s health anxiety—you’re reminded of the many ways your body, your most trusted ally, can betray you.
It is time to start seeing the mind as another body. The other body that needs as much nurturance.
It’s easy to blame others from whom I may have acquired the excessive need for surveillance over my body, but at the end of the day, all I have left to do is to live with this mind and this body.
Every time I think of painting my nails, I decide to wait until everything is okay. Until after the next meeting. Until after the next party. Until after this gloom passes. My life is on hold, until ‘everything is okay’. Not everything is always okay.
What you can do, if you have (health) anxiety:
If you have health anxiety that has either been triggered or exacerbated by the pandemic:
Don’t Google your symptoms. It’s a death trap.
Think, talk and reflect relentlessly.
Try therapy, which is a guided way to think, talk and reflect. If you’re looking for something more engaging and long-term, try psychodynamic therapy. If you’re looking to cope, try CBT (which is useful in the short term, but may not be very fulfilling, especially if you’re someone with an appetite for ‘self-work’).
Would you like to talk about (your) anxiety?
I love this post and I love you! It's overwhelming, enlightening, and heartbreaking to hear about this in such an evocative and detailed manner.
thanks for the educative article. I myself wouldn't have got all the doubts cleared up in one place.
In the two weeks i had covid, i had all sorts of strange ideas about my health. I can not imagine how one copes anxiety for longer periods of time. Glad to know it can be managed to some degree with therapy and reflection.