In a recent article in the British Medical Journal a psychiatrist, Tyrer, describes something called ‘health anxiety’ and argues that it is due to increased ‘pathologisation’ and ‘cyberchondria’ and will respond to a range of psychological therapies: this is a good example of psychologisation where the patient has to learn to adapt to the capitalist medical world, rather than considering the underlying political and economic ideological causes.
‘ ….a more likely explanation is the increased pathologisation of our society combined with internet browsing, appropriately called cyberchondria.’ (Tyrer, Eilenberg, Fink, Hedman, and Tyrer, 2016)
‘Several highly effective psychological treatments are now available, ranging from traditional cognitive therapy, to group based mindfulness, and acceptance and commitment therapy.’ (ibid)
Contrariwise, I think this is missing something much more fundamental, and, as so often, medicine seems to be in a form of denial of its capitalist ideological role. I think health anxiety is a kind of avaricious medical consumerism, it may seem anxious, but may be ‘enjoyed’, in a sense, as well, or at least provides an enjoyment for the Other. I would suggest that so-called ‘health anxiety’ is a phenomenon of capitalism and the treatment for health anxiety is unlikely to be found in psychological band-aids, which may exacerbate the problem by further medicalisation and labelling.
We could say that ‘Health Anxiety’ is a manufactured state of constant precarity or a created sense of biological insecurity. There are parallels with discourses of the intensifying loss of personal freedoms and increased surveillance we are witnessing across the USUKNato empire in response to perceived enhanced threats from international terrorism (Dillon and Lobo-Guerrero, 2008).
Health anxiety, or compulsive medical consumption as it might be better dubbed, is the result of an intensification of medical ‘prophylactic procedures’, an intensification that is structurally necessary because capitalism has to continually work to fill life’s limitless ‘vacuum of sense’(Esposito, 2008). For the subject with health anxiety the resulting constant and ever increasing sense of a threat to health requires a constant search for the next test for reassurance. There is a sequence of steps by which this threat is generated.
Firstly, intensifying diagnostic prophylactic procedures are instrumental in feeding this anxiety, ‘if a test is advised it must be because the doctor thinks I am already at risk.’ There is a cascade of investigations flooding out of a well spring of innovation. So, secondly, ‘innovation’ is essential, it is the source of raw material, it is consubtantial with capitalism (Schumpeter cited in Foucault, 2004) because innovation is essential to the ongoing creation of surplus economic value, otherwise known as profits or wealth creation. Innovation is rewarded and once innovative technology is approved by e.g. UK NICE (National Institute of Clinical Excellence) they create an illusion of truth in the form of knowledge that makes sense of a fantasy of immortality: ‘as if’ I might live forever. Then, finally we have the compulsion to be sure: “I must have this test”, “I know well I will die one day, but even so …”(Mannoni, 1969). The fantasy is what sustains belief in medical science and its advances as if they are objective reliable knowledge. In psychoanalytic terms medical science provides the fetish (the test result) as an anti-castration device that allows the patient to imagine they may live forever, as a way of ‘making sense’ of their need for repetitive testing, and the anxiety is due to the failure, ever, to be satisfied.
We can see, ironically, that Tyrer’s quote about ‘highly effective psychological treatments’ is an example of an intensification of Esposito’s immunity mechanisms – we have a crescendo of care, thus, medicine creates the anxiety in the first place, so now this anxiety becomes ‘the problem’ so then medicine produces, researches and legitimises ‘innovative’ called things like ‘acceptance and commitment therapy’ to treat the anxiety – and so it goes on, and on.
It will be interesting to compare a psychoanalytic treatment of sexuality with corporeality, where we might have gender as ‘health’ and masculine and feminine in terms of all-compliant or not-all complaint with medicines normative commands.
Dillon, M. & Lobo-Guerrero, L. (2008) Biopolitics of security in the 21st century: an introduction. Review of International Studies, 34: 265-292.
Esposito, R. (2008) Bios: Biopolitics and Philosophy. Minneapoli: University of Minnesota.
Foucault, M. (2004) The Birth of Biopolitics: lectures at the Collège de France 1978-1979. New York: Palgrave Macmillan.
Mannoni, O. (1969) “I Know Well, But All the Same …”. In Perversion and the Social Relation: Duke University Press, pp. 68-92.
Sheperdson, C. (2003) Lacan and Philosophy. In: J. Rabaté (ed.) The Cambridge Companion to Lacan: Cambridge: Cambridge University Press.
Tyrer, P., Eilenberg, T., Fink, P., Hedman, E., & Tyrer, H. (2016) Health anxiety: the silent, disabling epidemic. BMJ, 353.