• HYPOCHONDRIASIS: AN INNER CALL FOR “REAL” LIFE?

Hypochondriasis (Hypochondria), also known as Illness Anxiety Disorder, or Health Anxiety, was defined by DSM-IV as a somatoform disorder and was replaced with the diagnoses of somatic symptom disorder and illness anxiety disorder.

The DSM-IV defines hypochondriasis according to the following criteria^[1]:

A. Preoccupation with fears of having, or the idea that one has, a serious disease based on the person’s misinterpretation of bodily symptoms. 
B. The preoccupation persists despite appropriate medical evaluation and reassurance. 
C. The belief in Criterion A is not of delusional intensity (as in Delusional Disorder, Somatic Type) and is not restricted to a circumscribed concern about appearance (as in Body Dysmorphic Disorder). 
D. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. 
E. The duration of the disturbance is at least 6 months. 
F. The preoccupation is not better accounted for by Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, a Major Depressive Episode, Separation Anxiety, or another Somatoform Disorder.

Having put the required explanation of the disorder, I would like to state that my personal focus throughout the paper will be on the possible psychological dynamics beyond the symptoms, and I would like to succeed this through exploring the psychology of typology. For this reason, I should first be bringing in the already existing approach of C. G. Jung to neurosis of man.

• JUNG ON NEUROSIS

For C. G. Jung, neurosis was not simply an indication for repressed events, disappointments, or traumas as Freud simply put, but also “an attempt at self-cure… an attempt of the self-regulating psychic system to restore the balance, in no way different from the function of dreams— only rather more forceful and drastic.”^[2]

Neurosis is a pronounced state of disunity with oneself, and it seems that we are all familiar with it more or less throughout our lives. This “disunity” was taken by Freud as a problematic issue and hence, psychotherapy had to aim at solving this problem through reason and through finding out its possible causes. However, C. G. Jung was not content with this approach and he got the sense that the existing situation might have been seeking for a final. Thus, he focused on the psychic dynamics as active components, saying, “Psychological data necessitate a twofold point of view, namely that of causality and that of finality.I use the word finality intentionally, in order to avoid confusion with the concept of teleology. [Teleology implies the anticipation of a particular end or goal; finality assumes purpose but an essentially unknown goal.] By finality I mean merely the immanent psychological striving for a goal. Instead of “striving for a goal” one could also say “sense of purpose.” All psychological phenomena have some such sense of purpose inherent in them, even merely reactive phenomena like emotional reactions.”^[3]

However, we are generally advised not to forget that finality itself is not the only way to understand the whole process -we need to bring those two approaches together. Jung says, “Neuroses, like all illnesses, are symptoms of maladjustment. Because of some obstacle—a constitutional weakness or defect, wrong education, bad experiences, an unsuitable attitude, etc.—one shrinks from the difficulties which life brings and thus finds oneself back in the world of the infant.”^[4] It seems to be true that finding out the causes of a problem brings us much relief, but we tend to get healed more, I guess, once we start to understand the aiming factor within our obstacles. “The energic or final point of view, coupled with the concept of compensation, led Jung to believe that an outbreak of neurosis is essentially an attempt by the psyche to cure itself.”^[5]

Is it really possible to see any kind of pathology through the lenses of finality? To me, it is, but also, I remind myself that those lenses are so alien to us that I still need to take the causality into account. As long as I keep them both, I feel more balanced in the process of seeing the whole picture. The two views seem not to be incompatible but rather complementary: the mechanistic approach looks to the personal past for the cause of psychic discomfort in the present. However, since I will be discussing the pathology of the types, I will stick with the final, or the energic, approach of Jung, and emphasize the present situation (here hypochondriasis) under the light of the compensation of the conscious attitude, which means that the individual psyche knows both its limits and its potential, and if the former are being exceeded, or the latter not realized, a breakdown occurs. The psyche itself acts to correct the situation. It seems to me that the psyche always aims at connecting the conscious with the unconscious and it does that through building bridges -through dreams, symbols, visions, synchronicities, or neurosis. Thus, a renewed way of life could be possible. And for understanding this, maybe the main question that should be asked when it comes to truly examine a neurotic situation would be “Where does the energy (libido) want to go?” The answer might take us to the life that we have ignored, we haven’t owned for some reasons. And the disowned life (or the psychic content), sooner or later, will come to claim its own life. 

• ON PSYCHODYNAMICS OF THE PATHOLOGY OF TYPES

To discuss further about the overall picture of hypochondriasis in a nutshell, I should proceed with how Jung saw the psychic compensation when it comes to types. To him, the ignored content (by the conscious) would have destructive character -that means it would not get mature, but would stay very primitive, and this could be destructive for the conscious, i.e. ego. To connect this point with Jung’s approach to neurosis, I should give way to his words: “Sooner or later, depending on outer circumstances or inner disposition, the potentialities repressed by the intellectual attitude will make themselves indirectly felt by disturbing the conscious conduct of life. When the disturbance reaches a definite pitch, we speak of a neurosis.”^[6] So, to me it is almost clear that the consciously unlived function or the attitude (the inferior; the fourth function) will eventually want to play its part in my life. And since we talk about the “wholeness” of the psyche, which we say is the aim of individuation, it is understandable that the disowned part of my psyche aims at living its own life -just like me. However, the problem comes along when I, as an ego, cannot deal with this character. If, for example, I am strictly closed to the possibilities of life, which I believe have so much to do with not being open to harvest the parts that I am “not good at” using or owning, I cannot know what to do with them and this brings a disbalance, thus, a disunity within my own being. This disunity becomes the neurotic element which will probably become pathological if I underestimate or ignore the symptoms, or the symbols, it brings with itself. And this risk takes us to the inferior function, “which acts autonomously towards consciousness and cannot be harnessed to the latter’s intentions. It lurks behind every neurotic dissociation and can only be annexed to consciousness if the corresponding unconscious contents are made conscious at the same time.”^[7] So, Jung says that the inferiority of a function (thinking, feeling, sensation, or intuition) does not disappear but goes on living in the unconscious -and can lead to a pathological situation if not handled well, that is to say, understood and owned consciously. And interestingly enough, this so-called pathology (neurosis) can be a chance for the individual to see through his disowned life and “we shall now see clearly why it is that the values which the individual lacks are to be found in the neurosis itself.”^[8]

Since I have chosen to discuss a body-oriented psychological disorder, I should move on with the possible dynamics within the concept.

I suppose that there is an element of attitude which should be counted in hypochondriasis. One can see in such a case the possessive thought of losing one’s bodily health (wholeness), preoccupations about one’s health in the future, and even sensations than can be felt as real. So, there seems to be some unconscious elements of thinking or sensing; an inner urge pushes the individual to experience sensations that are illusionary. To me, hypochondria is kind of an anxiety disorder which is crying out for the individual’s attention for his physical body, or for the real world. Since this outcry comes from inside, there should be a conscious attitude to suppress the sensation function. And this conscious attitude, either it is extraverted or introverted, seems to be a compensation for too one-sided of the function of intuition, which is taken as the opposite of sensation.

• HYPOCONDRIA AS THE PATHOLOGY OF THE INTUITIVE

Jung says that a type is the typical (habitual) conscious attitude of a person and it is one-sided. And thus, the unconscious has its own functional attitude compensating the conscious. For example, Jung talks about the extravert’s danger, saying that “he gets sucked into objects and completely loses himself in them. The resultant functional disorders, nervous or physical, have a compensatory value, as they force him into an involuntary self-restraint.”^[9] This helps us understand how the unconscious sensation function, as the 4^thfunction, might react towards too one-sided intuitive attitude. About the introverted intuitive in the extreme, Jung says, “What the introverted intuitive represses most of all is the sensation of the object, and this colors his whole unconscious. It gives rise to a compensatory extraverted sensation function of an archaic character. Instinctuality and intemperance are the hallmarks of this sensation, combined with an extraordinary dependence on sense-impressions. This compensates the rarefied air of the intuitive’s conscious attitude, giving it certain weight, so that complete ‘sublimation’ is prevented. But if, through a forced exaggeration of the conscious attitude, there should be a complete subordination to inner perceptions [apprehended images], the unconscious goes over to the opposition, giving rise to compulsive sensations whose excessive dependence on the object directly contradicts the conscious attitude. The form of neurosis is a compulsion neurosis with hypochondriacal symptoms, hypersensitivity of the sense organs, and compulsive ties to particular persons or objects.”^[10] He also says a very similar thing for extroverted intuition in the extreme: “His conscious attitude towards both sensation and object is one of ruthless superiority. Not that he means to be ruthless or superior—he simply does not see the object that everyone else sees and rides roughshod over it, just as the sensation type has no eyes for its soul. But sooner or later the object takes revenge in the form of compulsive hypochondriacal ideas, phobias, and every imaginable kind of absurd bodily sensation.”^[11] Here we see the compensation of the unconscious, extreme or superior intuition being balanced by the primitive sensation, and thus, a kick from the unconscious comes as neurosis -but it does not have to be a neurosis. Here I should remind myself that this primitive attitude of the unconscious might not result in neurosis -but if the conscious attitude cannot meet this primitive urge, cannot deal with it, we come up with neurosis.

I understand that the attitude of the shadow or inferior function is of primitive nature, and thus, it can be totally extreme, and destructive in the bodily sense (here I take sensation). The attitude of the unconscious, then, will be focusing on the bodily sensations and they will be even “like real” experiences. If the person is extroverted intuitive, the shadow would have more introverted sensation attitude, and thus it can “obscure the influence of the [outer] object,”^[12] which, in this case, could be the body itself. And this may result in insensitiveness towards body, and I think that this might be an outcry of the unconscious, as if saying, “Look at me! I am body and I am real!” And this outcry in the hypochondriac person brings with itself the real sensations -especially in Somatic Symptom Disorder. And since the introverted type would also have a more or less a primitive thinking or feeling attitude towards (inner and outer) things, he might get lost in “perceiving” whatever the unconscious is bringing to him -without “judging”. 

If I examine the extraverted intuition type, I think I need to have a look at the introverted sensation type in extreme, and for such, “…the subject [individual] has an illusory conception of reality, which in pathological cases goes so far that he is no longer able to distinguish between the real object and subjective perception.”^[13] Introverted sensation type perceives the object as a very subjective experience, and this is very similar to what a hypochondriac does experience. He cannot differentiate the real sensation from his perception about it because the sensation as the inferior function acts autonomously and unconsciously. So, the individual gets lost in his sensations and cannot differentiate those unconscious sensations. This seems to be a lack of adaptation to the existing inner condition, i.e. unconscious, and thus, neurosis breaks in. As Jung says, it seems that “…sooner or later the object takes revenge in the form of compulsive hypochondriacal ideas, phobias, and every imaginable kind of absurd bodily sensation.”^[14]

CONCLUSION

I find it quite useful to look at any kind of pathological case through compensatory function. Especially, taking neurosis as complementary, and seeking some meaning in it brings me relief. Jung says, “…as soon as a neurosis is present, it is a sign of a special heaping up of energy in the unconscious, like a charge that may explode.”^[15] Thus, “Where does the energy want to go?” becomes a key question for me. I would like to see what is hidden behind the walls, and what is trying to be seen in a patient. I wonder what kind of a life has been denied, and what is really manifesting through the pathological case. And I feel that typology is a good way to look at the possible lives of the patient. Besides, I frequently remind myself of one of the most outstanding expressions of Jung: “A neurosis is by no means merely a negative thing, it is also something positive. Only a soulless rationalism reinforced by a narrow materialistic outlook could possibly have overlooked this fact. In reality the neurosis contains the patient’s psyche, or at least an essential part of it; and if, as the rationalist pretends, the neurosis could be plucked from him like a bad tooth, he would have gained nothing but would have lost something very essential to him. That is to say, he would have lost as much as the thinker deprived of his doubt, or the moralist deprived of his temptation, or the brave man deprived of his fear. To lose a neurosis is to find oneself without an object; life loses its point and hence its meaning.”^[16] Hence, it seems that it is quite a challenging way to distinguish the psychic contents, as well as their aims within the human life. And regarding the hypochondriasis, I believe that it might be a call for the individual to go back to real life, which consists of the objects that belong not to the unconscious, but the conscious, and most necessarily, it is I think a call for re-membering and integrating the physical body as an aspect of the whole being, the psyche.

Didem Çivici  – Copyright ©2021

*This article was written in May 2021, as an exam paper for “Fundamentals of Psychiatry and Psychopathology” – C.G. Jung Institut, Zürich.

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^[1] https://en.wikipedia.org/wiki/Hypochondriasis#cite_note-American_Psychiatric_Association-6

^[2] Carl Jung, CW 18, par. 389

^[3] “General Aspects of Dream Psychology,” CW 8, par. 456.

^[4] Carl Jung, CW 13, par. 473

^[5] Daryl Sharp’s Jung Lexicon

^[6] CW 6, par. 587

^[7] Jung, C. G., Hull, R. F.C., Adler, Gerhard. “Collected Works of C.G. Jung, Volume 11: Psychology and Religion: West and East”, par. 292.

^[8] Jung, C. G., Hull, R. F.C., Adler, Gerhard. “Collected Works of C.G. Jung, Volume 7: Two Essays in Analytical Psychology”, par. 93.

^[9] CW 6, par. 565

^[10] CW 6. Par. 663

^[11] CW 6, par. 615

^[12] CW 6, par. 651

^[13] CW 6, par. 651

^[14] CW 6, par. 615

^[15] Jung, C. G., Hull, R. F.C., Adler, Gerhard. “Collected Works of C.G. Jung, Volume 7: Two Essays in Analytical Psychology”., par. 192.

^[16] Jung, C. G., Hull, R. F.C., Adler, Gerhard. “Collected Works of C.G. Jung, Volume 10: Civilization in Transition”, par. 355