Hypochondriasis as a Form of Sacrifice

by Richard Friedman, PhD, Adjunct Instructor, CHD

March 17, 2019


Years of experience as a modern analyst has left me convinced that Freud got it right in his 1895 “Project for a Scientific Psychology:” what changes people is what they say – an idea, of course, that became the basis of Spotnitz’s work.  Our job, as analysts, is to facilitate people saying everything. One way of doing this is by helping the people who have trusted us to help them expand their vocabulary, both in the sense of introducing specific words for what had been unlabeled feelings as well as suggesting new metaphors to help them flesh out their discourse. I do this by suggesting plausible hypotheses – not presented as the definitive interpretation or only possible truth but as a framework on which they can hang thoughts, feelings, memories, and fantasies.

Let me illustrate this process by describing how I helped a hypochondriacal woman. For many months each cough was an early sign of cancer and each bout of indigestion was the beginning of a heart attack.  Her hypochondriasis was particularly virulent when she expressed worry about her children. While the worries were presented with strong affect, they did not lead to progressive communication and, in fact, became repetitive and almost ritualistic in the sense that they followed a set rhythm: first the symptom, then speculation about what the symptom meant starting with the most benign but moving rapidly to the most frightening, and finally becoming a conviction expressed in a panicky tone that the worst possibility was probably a fact.

Her concern for her children gave me an idea for a plausible hypothesis to help her talk about what she had not yet articulated.  I told her that her health worries reminded me of the kinds of sacrifices that many religions demand: the petitioner gives to the Higher Power part of something valuable in order to be allowed to keep the remainder.  For example, God demanded of the ancient Hebrews the first fruit of the harvest to ensure that the worshipper may keep the remainder of the harvest.  I suspect that among other origins for the practice of circumcision, reasons for the rite include sacrificing a small part of the penis as insurance against total castration.  The woman I am describing sacrificed peace of mind to guarantee that neither she nor her loved ones suffered catastrophic illness.  The woman liked this metaphor very much and has used it now for years as a way of controlling her worries about everything, such as running out of money or losing her job or, in an extension of hypochondriasis to her car, when she begins to imagine that a funny engine noise portends a total mechanical breakdown.  She recognized that her ritualized worry dated from early childhood and had served as a way to control her anxiety about possibly losing her mother who had a chronic illness.  By introducing this woman to the possibility that her excessive worry was a protective sacrifice, I helped her say, if not everything as Spotnitz would have it, at least more.  And that’s a good beginning.