A Cultural History Of Hypochondria
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This is Fresh Air. I'm Terry Gross. I think I may have a mild case of a health condition I just learned about, and you may have it too. It's called cyberchondria. It's a cousin of hypochondria. Cyberchondria is when you Google your symptoms and convince yourself you have the worst case scenario and are doomed. My guest describes the internet as the most expansive and spacious playground that hypochondria ever had.

Carolyn Crampton is the author of a new book about hypochondria because she's pretty sure she has it. She has a reason to be hypervigilant about her health. When she was 17, she was diagnosed with Hodgkin's lymphoma, a form of blood cancer. After months of treatment and monitoring, she was given the all-clear and went to college.

But a year later, she found a lump in her neck. The cancer had returned, requiring more chemo and a stem cell transplant. She spent weeks in a hospital isolation ward. After five years had passed, she was told again she was in the clear.

Is it any wonder she's always feeling the sight of the tumor and going to the doctor every time she feels a twinge in her neck or any suspicious symptom? Crampton's new book is called A Body Made of Glass, A Cultural History of Hypochondria. It's about her own experience of hypochondria, and it examines how our understanding of hypochondria has changed from ancient times to today. And she reports on the latest therapies for treating it.

Crampton is also a critic who has written for The Guardian and other British publications, and she appears regularly on BBC Radio 4. She's the creator and host of the detective fiction podcast, She Done It. She's speaking to us from her home in England. Carolyn Crampton, welcome to Fresh Air. And how is your health? Are you in good health now? I'm in good health at the moment, yes. Thank you, Terry. I suppose what I generally mean by that, though, is that I'm not currently sick.

investigating myself for any serious illnesses. Well good, keep it going as long as you can. So we think of hypochondria as a condition when you're convinced you're sick but you're not and the common expression is hypochondria is when the symptoms or the illness you're experiencing is quote all in your head. It's a form of catastrophic thinking. What's the definition now?

So the definition that I like and that I use comes from the Oxford English Dictionary, and it runs a mental condition characterized by the persistent and unwarranted belief or fear that one has a serious illness. I think that has all of the different components in. Yeah, with an emphasis on unwarranted.

Exactly. The persistent and unwarranted has really been my experience of it. It continues for a long time. And unwarranted suggests it's a fear that can't be substantiated by any medical tests you might do. And there's two kinds now. There's somatic symptom disorder and illness anxiety disorder. Would you describe the difference?

Yes. So illness anxiety disorder is pretty much as it sounds. It's the stuff going on in your head. It's an excessive hypervigilance and anxiety around potential health problems. Somatic symptom disorder is

has some of that in it but then adds this extra thing of phantom symptoms somatic is a quite an archaic word meaning just meaning body or bodily but it's used in medicine today to mean things people can feel in their bodies that then can't be picked up on tests so that's what they mean when they say somatic symptom disorder might be someone who presents convinced that they've got

a terrible wound in their leg, but actually no wound can be detected. That would be a somatic symptom. Do you feel like you fit into a bit of both categories? That has been my experience. I don't know that I or probably many people can be so easily classified as one or the other. A lot of the time I think I would be fall under illness, anxiety disorder, but occasionally I do have

pins and needles or pains that can't be readily explained or identified. And that would put me under the other one. So I don't know whether splitting them has necessarily helped the understanding or enhanced the treatment. And actually, that has been the sort of academic consensus around that way of splitting them too.

I kind of like the expression illness, anxiety disorder because it implies obsessive worrying, but it doesn't imply that you're making something up or that you're totally delusional or mentally ill.

I agree. I also think it's readily understandable by most people that you might say it to. This has been a big part of writing the book, actually, and talking to a lot of people about it, is this feeling that hypochondria, illness, anxiety disorder, health anxiety, whatever you want to call it, is in some ways just...

a yearning to be understood and to be seen and to be empathised with. So if you use words that most people don't fully know the meaning of, then you've kind of fallen at the first hurdle. So illness, anxiety, two words everyone understands, I think.

So within those categories, there's two types of people, the people who go to the doctor and the people who avoid the doctor, avoiding out of fear that you'll be told you really are sick and going to the doctor with the hope of being told you're fine, stop worrying. You're the going to the doctor type. Is that helpful? Yeah. So people fall into either care seeking or care avoidant. People tend to be very polarized. I'm definitely care seeking.

I think whether it's helpful or not often depends on the type of doctor that you see. I've seen some incredibly helpful doctors and I've seen some incredibly unhelpful ones. So in some ways, it feels a bit like the luck of the draw. You never know quite what you're going to get. But I think I would...

I would always encourage people to seek medical help if they have a reason to do so, if that makes sense. I think I, on balance, feel it's always better to go than not go. When you go and the doctor or nurse you're seeing reassures you, I know that you're experiencing a symptom or that you're worried, but there's nothing we can find. Do you find that reassuring? And if you do, how long does that reassurance last? Because it doesn't mean tomorrow something may show up.

No, it doesn't at all. It's no guarantee that you won't test differently another day. I do my best to take medical personnel at face value, if that makes sense. And I try and do this test in my mind.

if it's serious enough for me to worry about, then it's serious enough for me to go to the doctor. And if it's serious enough again, I'll go to the doctor again. I think I used to have a lot of shame and concern over time wasting or

uh taking up resources that other people could be using especially acute because here in the uk we're very lucky to have our health care free and state funded so but it does feel like there are limited resources to go around to everybody and i could be taking a spot that somebody with a more serious condition could use i have with the help of therapy tried to get over those feelings and uh

uh understand that you know i'm worthy of attention just as anybody else is and that i'm not time wasting i am being a concerned and active patient participant in my own care so i try and sort of take give you know in the sense that i'm there in good faith i try and uh

And assume that the doctor or the medical professional is there in good faith, too. And if they're not, I will just go back and ask for a second opinion is what I tell myself. Yeah, you asked the question, am I a hypochondriac or am I just being a responsible patient? And I think that's a question a lot of people ask.

I think it is, yeah. And the whole thing was really amplified for me by my experiences with having cancer. Because part of having an ongoing and serious illness like that is it feels like a collaboration between you and your medical team. They will repeatedly say things to you like, you must tell us if you experience any side effects or you're the first line of defence, you'll notice that something's wrong before we do, you must bring any changes to us. So they're really asking for your help and your participation.

And then once you are lucky to be cleared of all of that and you don't have to go to all those checkups anymore, I retained that sense, I think, of, well, I must always be checking. That's just being responsible. And so I think for a long time didn't consider that what I was doing could be explained by health anxiety or hypochondria because I thought, well, I'm just being a responsible patient like I was told to.

The difference, I think, is that it's a matter of degree. There is a level of responsible patienthood and then way above that is health anxiety. And I think once most of your thoughts are about your state of health and how you feel about it, you've tipped over the edge of responsible patienthood and left that far behind. Yeah.

I mentioned in the introduction cyberchondria, which is when you're always like Googling symptoms and imagining that you have the worst case scenario. Do you Google symptoms? Doctors really don't want you to go on Google. But there are some medical sites that are really helpful.

And these are like, you know, official like hospital sites and, you know, very well respected clinic sites. And they'll give you an overview that can be like super helpful and help you be informed about how to report your symptoms if you do go to the doctor.

I completely agree. So what I do is I try and restrict myself. I don't not look at the internet in relation to my health, but I limit myself only to reputable sources. In particular, here in the UK, the NHS website has a very, very wide ranging catalogue of illnesses and connects all the symptoms together and will allow you to click through and see how things relate to each other. So that's my first port of call. I look at the NHS website because I know it's evidence backed and I know it will tell me

If you think you have this, please go to the doctor and so on. And yeah, there is a short list of others that I take the same approach to. What I try not to do, I would say I never do it, is just type symptoms into Google and

fresh, blind with no sort of guardrails at all, because that's where I can easily find myself falling down a spiral and getting into a really bad place mentally. Yeah, yeah. When you go to the doctor or to the nurse and you report symptoms that are frightening you, and you don't know if they're meaningful or not, you don't know if they're actually a sign of a problem.

Um, do the doctors and nurses believe you? Do they consider you just someone who is always coming back and there's never anything wrong? And, oh, here she is again. Like, what's what attitude do you feel like you're met with?

Almost all of the time, I find myself taken very seriously. Sometimes a little voice in my head says, maybe too seriously. Maybe occasionally I could benefit from being told, it's nothing to worry about, you can go home. I think because of my serious medical history and the fact that my medical file is like half a foot wide, it's

I feel like every single little thing that I even vaguely mentioned gets tested, which is in some ways an incredibly fortunate thing to happen. I spoke to a lot of people when I was writing the book who have the opposite experience of having health anxiety, where they don't get believed at all. They get dismissed only to have serious diagnosis symptoms.

later on that could have been caught much earlier. So that is definitely a very widespread experience of health anxiety, but it hasn't been mine by and large. Just to give one really minor example, I reported a couple of years back that I could feel strange prickling sensations on the bottom of my feet. And in my head, I thought, oh, this is the beginning of multiple sclerosis or some kind of nerve disease. I mentioned it

in passing to a podiatrist. Three months later, I was sitting in front of a consultant neuroscientist who was checking my reflexes for all the most serious neurological conditions. It sometimes feels a bit like I sort of whisper and they turn it into a shout and I end up getting sent for all kinds of tests that I'd never even imagined, which again feels like an awful thing to complain about. But sometimes I do think mentally I could benefit by not being taken quite so seriously.

So you got very sick at the age of 17 when you were diagnosed with Hodgkin's lymphoma, which is a form of blood cancer. And then you had a recurrence a year later after being told that you were cancer-free. So it is kind of logical that you'd be vigilant, as you explained. But you also missed the initial signs. What did you miss? I missed all of it. This is what is so extraordinary to me in my mind. So

After the diagnosis, I was able, with the doctor's help, to put together the timeline of what had really happened, which was that most likely I had had a bout of glandular fever, which is quite common in teenagers, and that in the process of having glandular fever, some cell somewhere had mutated and

And that had tipped the glandular fever over into Hodgkin's lymphoma, which is, say, a cancer of the blood and the lymphatic system. It attacks your immune system and your ability to make white blood cells. And it also causes tumours in the lymphatic system. In my case, in my left lymph node in my neck and also very substantially in my chest, sort of around where my breastbone is.

The ones in your breastbone, you can't feel or know until they get very, very big. But the ones in your neck, you know, they're quite near the surface, your lymph nodes. And so I had, by the time I was diagnosed, I think in the January, they estimated that I'd had the tumor for maybe four months. And there are even photographs of me from that time. My school had our equivalent of a prom during that time. And I was, you know, photographed wearing a dress, an off-the-shoulder dress, and you can see it there in my neck.

But I hadn't noticed it. My mother, my parents, anyone else who saw me regularly hadn't noticed it because I think it had just grown so gradually and they saw me every day that it did become part of me. It was just, you know, and you can't really see what's in front of you because it's changed so gradually. And then I had also...

been quite ill and run down that term of school, but it was also the most busy and hectic period of my life so far. It was when I was applying to university, preparing for my school leaving exams, preparing for music exams, learning to drive, doing all of these just about to enter adulthood things all at the same time. So again, I and nobody else thought it was odd that I would feel

tired and stretched and pulled in lots of different directions. What eventually prompted us to go to the doctor was that the school term finished, I was home for the Christmas holidays and I didn't get better no matter how long I slept and I was sleeping like 12-14 hours a night at some times.

I never seemed to be anything but tired. I never got better. So after three weeks of this, of complete rest and not being better at all, my mother went, no, this is not normal. We're going to the doctor. And it all unraveled from there, really. So, you know, in terms of like health and cures or treatments,

About a year ago, maybe two years ago, you got a letter from the medical service, the health service in England, saying that the radiation therapy that you had for your cancer has recently been determined to elevate the risk of breast cancer. So now you need to be monitored for breast cancer. So even the cure can create problems you need to be vigilant about. That must be really brutal for you, being hypervigilant to begin with.

It really is, yes. It took me a long time to get my head around the idea that I had done all the things I was told I was supposed to do. You know, I'd accepted all the treatments, even though they were unpleasant and in some cases painful. I'd done all of it. And then I felt a bit betrayed, not necessarily by the

doctors or anything themselves, but almost by the science. I felt a bit betrayed that I'd been told that this would cure me, but actually it turned out it could make me ill in another way. And so, yes, now I have to have this annual round of monitoring under the breast cancer centre near where I live, all aimed at early detection of any potential breast cancer that might be caused by that radiotherapy 15 plus years ago. And I

I really, really hate it and I find it mentally very difficult to do. I really have to psych myself up every year to go through those scans and those treatments.

It gives me some comfort to understand that I don't think anyone getting a diagnosis of Hodgkin's lymphoma today would be given that treatment. I think, you know, just as the science has moved on in terms of the risks, it's moved on in terms of the treatments as well. So I do feel oddly better that people now won't have this same risk, but they might have other risks. The treatments that are being given now might have risks that we don't know about anymore.

It has helped me, I think, to understand science, medicine generally, as a work in progress, that we're always just doing the best we can in any given moment. It's not necessarily the best, absolute, perfect treatment we could ever give. And that...

I found really interesting to think about when I was writing the book that we have to believe, I think, otherwise no one would ever submit themselves to being injected with chemotherapy drugs if they didn't believe that this was the right thing to do and the best science available. If you had to confront the fact that, well, this is just the best we have today in a week, a month, a year from now, we might have a better version of

I don't know we would ever be able to bring ourselves to do it. So it's this convenient fiction almost that we have to believe in in order to go through with any of it. Well, sometimes the alternative is dying. Sometimes the alternative is dying. Or I think the more pernicious version is you might feel like, well, if I just wait, if I just wait a little bit longer, maybe there'll be something better when actually waiting can be a terrible decision to make. Right, because the cancer just advances. The cancer doesn't wait.

Yeah. Well, we need to take another short break here. So let me reintroduce you again. If you're just joining us, my guest is Caroline Crampton. Her new book is called A Body Made of Glass, A Cultural History of Hypochondria. It's also part memoir. We'll be right back after a short break. I'm Terry Gross, and this is Fresh Air. This message comes from NPR sponsor, Sattva. Founder and CEO Ron Rudson shares the story of how he got started creating Sattva.

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Carolinas now kind of believed that hypochondria is related to PTSD. What is the relationship?

The idea is that hypochondria can be a response to some past trauma in the same way that post-traumatic stress disorder is related to a trauma in your past, that hypochondria and illness anxiety can be a response to such a past trauma in a illness or medically related sense. In my case, having had a cancer diagnosis and treatment in my past life,

that seems very plausible. I spoke to some people when I was working on the book that had some more circuitous roots to it, such as someone who was a twin and her twin had had some quite serious childhood illnesses that required them to be hospitalised.

She, the other twin, had been completely healthy, but watching her twin go through that had then, as an adult, surfaced for her as hypochondria. Other people who'd had a very close friend pass away young from a serious condition, and then after that had happened, that trauma, they had then developed anxiety about their health, having previously never suffered from it before.

So it feels like an idea that checks out to me that you might respond to a really traumatic event by developing the anxiety that something similar might be going to happen to you in the future.

And another thing you think of as traumatizing was when you were told that the treatments for your cancer might ruin your fertility, that therefore you should extract eggs and save them for later if you wanted to become a parent. So you did that. No one prepared you for the fact that it's actually very painful. I didn't know that either. So that was kind of traumatizing too. Yeah.

Definitely, yes. Some of the therapy I've done has been very specifically about that procedure, actually. The larger question of, oh, this might affect your fertility, I don't even really remember registering with me very hard at the time. I was 17 and the idea of having children felt very remote to me. I was still technically a child myself, according to the health service. I was in children's wards and so on because I was under the age of 18. So it felt like a very remote possibility.

and like just another medical hoop to jump through. But the actual procedure I really found very unpleasant and all of the self-injecting and so on you have to do in the run up to it.

And it was also quite an interesting and bizarre experience to be in fertility clinics at that age and for that reason, when everyone else in the waiting room is there because they're trying to have a child. And then here's this 17 year old. What on earth is she doing here? It was it was very strange. But anyway.

It was interesting nonetheless. And actually, it has equipped me quite well when I've had, you know, now that I'm in my late 30s, when I've had friends who've gone through IVF for the reasons of wanting to have a child, I've done it in a bizarre kind of way. I can support from a place of genuine experience.

A couple of the treatments used for hypochondria are also used for post-traumatic stress disorder. One of those treatments is EMDR, which stands for eye movement, desensitization and reprocessing. You did EMDR. Would you describe what that treatment is? Yes. So it's a combination of a talking therapy and a physical process that is intended to help people

traumas that you're still experiencing in the present moment, even though they happened a long time ago, you're still experiencing the psychological effects of them in the present. It's to help move those into the past, help them become memories rather than things that are affecting you every single day. So the form it takes is that you...

take part in some kind of what they call bilateral stimulation. So the most common version is the eye movement where my therapist used an LED light bar on a stand in front of me with a light that moved from side to side and you follow this with your eyes keeping your head still so that your eyes are going from one extreme side to the other and while you're doing that movement the therapist is based on previous extensive work you've done asking you questions about the

the trauma that you're trying to process and they'll ask the question, you'll do the eye movement and then you just say whatever comes into your brain after the, I think, 20 second period of doing the eye movement. They can also do it by tapping on alternate sides of your chest. The idea is just that side to side movement is what's required. And you keep doing this for as long as it takes for the memory to stop feeling like it's happening to you in the present anymore.

And I have to say I went in sceptical and I still do have some of that scepticism because the experience of doing it feels a little bit like hypnotism. I can't lie. The eye movement and the talking and it becomes this very rhythmic exchange with the therapist that feels a bit sort of mesmeric almost. But I can't deny the effect of its results. You know, the fertility procedure,

that we just talked about, that was one of the traumas that we used this EMDR process for. And it went from being something that I was almost every night having nightmares based on it to being something that I don't think about for months at a time. You know, you just mentioned it and I thought, oh yeah, I haven't thought about that in months, which never used to be the case. It used to be something that I thought about every single day because I was having these nightmares based on it. So

I can only say that it seems to have worked, but I can't really explain how it worked. Another treatment that is used both for PTSD and for hypochondria is CBT, cognitive behavioral therapy. Would you describe that? Because you've tried that too.

This is a more traditional talking therapy and it's very results focused. So it's not particularly interested in why you might be exhibiting certain behaviours. It's focused on how can your behaviour be changed.

And so for health anxiety, this mostly means confronting the fears, confronting the triggers and learning to react to them differently. And it can be a very uncomfortable process because it does mean that things that you've maybe avoided or only allowed to penetrate as far as your subconscious, suddenly you have to make them the entire focus of your day and you actually have to do exercises that mean that you are putting yourself in the way of

But ultimately, it's a process of desensitization. The more times you do it and the terrible outcome that you expect doesn't happen, the more likely you are to accept that it's not going to happen anyway. I spoke to several different CBT therapists today.

who describe different ways in which they use it for chronic health anxiety. A really big one that presents a lot these days is people who have diabetes and who have a device that's connected to their phone that allows them to monitor their blood sugar level. And in its simplest form, that's a great technological advance that helps people manage their health better.

But at a certain point, the checking of the device can become completely obsessive and it can even start causing sort of phantom memories where you think you heard it, the alarm go off, but actually it didn't. And so they have to do exercises like you're not allowed to check the device for 24 hours or you have to give the device to somebody else.

And they will tell you if your blood sugar spikes. But other than that, you're not allowed to look at it. Whereas if you've been completely attached to this thing and looking at it every 10 seconds for six months, that will be very, very difficult to do. But after you survive 24 hours and then 48 and then 72 without it being a problem, you gradually learn that you don't need to look at it as much as you have been doing.

Since one of the issues that you faced was being traumatized by the egg extraction treatment that you went through. So you're not going to keep going through that in order to desensitize yourself to it. What kind of exercises were you assigned to do? No. So this is why I ended up doing a combination of CBT and EMDR, because I found that CBT was really helpful for

call it the small day-to-day problems such as googling your symptoms and reading health-related stuff on the internet or watching too much wellness things on Instagram or spending too long checking all your moles, that kind of thing. That can be really helpful in changing those kind of daily behaviours. So exercises mostly just included not doing them for long periods of time and having to record things

every time you felt the impulse to do it and how you were feeling at the time so that it was very helpful to be able to associate oh I'm feeling anxious about this work thing I've got coming up

oh, I seem to be checking WebMD a lot more than I normally would. Maybe those things are related. So it was very helpful for things like that. But even after I'd been through that and really improved in those regards, it wasn't treating those bigger trauma memories that were causing things like the nightmares. So that's why I was recommended to do EMDR as well, because that does actively look back into your past to find the source of your problems.

So when you feel yourself getting anxious or hypervigilant, can you distract yourself by listening to music, watching TV, exercising, taking a walk?

Yes, those are all good coping strategies. And even just knowing that distraction is possible is actually a really good strategy in itself. One of the other things I do is I set check-in times for myself. So I say, okay, we're worried about this now. We're going to get on with our day, go to this event, whatever we need to do. And then in four hours when I get home, I'll check in on it again. I'm not allowed to think about it until then.

And so I sort of set these little deadlines for myself. And often it can be as simple as I'll sleep on it. You know, I'll see how I feel in the morning. And if you can eliminate all of the other factors that can affect

add to anxiety. So can you eliminate what might be causing you stress? Or are you hungry? Or are you tired? Or have you spoken to anyone today? Have you been outside? This is what I say to myself. If you do all those things and you are still really worried about this, then you have to make a doctor's appointment. That's the process that I go through. And it works? It largely works, yes. The doctor's appointment test is a really good one for me, actually, because I do have a lot of

fears and baggage and shame around taking up medical resources. So if I think it's serious enough to need to go to a doctor, then make the doctor's appointment. If I don't, then I'm not allowed to worry about it anymore because it's not serious. Well, let me reintroduce you again. If you're just joining us, my guest is Caroline Crampton, and she's the author of the new book, A Body Made of Glass, A Cultural History of Hypochondria. We'll be right back after a short break. This is Fresh Air.

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How do you think your cancer, its recurrence and your medical hypervigilance have affected your feeling of the relationship of your mind and your body? You're the kind of person who, and you write this in the book, you're the kind of person who lives in your brain and, you know, didn't used to pay attention to your body. You were never an athlete or anything.

Has your connection between your mind and body been changed by everything we've been talking about? Yes, it's been changed very profoundly, actually. I think I say in the book that until my diagnosis when I was 17, I very much thought of myself as a brain in a jar, that I thought the only part of me that would ever produce any value was in my mind and that the body was just the way I moved the mind around the world. It would never do anything remarkable.

Since going through all the treatment, as difficult and traumatic as it was at times, I did come out of it with this incredible appreciation for the myriad complexities of the human body. And actually writing the book and doing all of this research into medical history and the different ways different people and cultures and times have conceived of the body in all of these extraordinary ways gave me this...

almost sort of rapturous appreciation for it. Sometimes I feel a bit like if you go into a really incredible building like a cathedral or a civic hall and you have this feeling of awe that, wow, you know, so someone conceived of this design and then it was built and now I can stand inside it. I sometimes feel a sense of awe a bit like that, thinking of my own body. You're a critic professionally, and I imagine you review books? I do, yes.

And so you have to examine a book really critically. It seems to me maybe you've been applying the same kind of critical faculties to your own body.

I think that's right. Yes, I have been judging my body very harshly and holding it to a very high standard, perhaps. You know, it's been through a lot. You're about to get to bed review. It hasn't. One out of five stars. It's still going. I think that's maybe what the process has brought me to now is that, you know, it's definitely not perfect and there are better ones out there, but it's still going. And that's something worth noting and worth celebrating, perhaps.

I'd like you to explain the title of your book, A Body Made of Glass. So the phrase A Body Made of Glass came from the existence of this thing called the glass delusion, which is this centuries-old delusion

psychological condition disorder whereby people suddenly think that they are made of glass instead of being made of flesh and bone. And this goes back a very long time. The French King Charles VI thought he had it in the 14th century. Cervantes wrote a novella about it in the 16th, 17th. There are lots and lots of documented cases of it.

And I don't think the glass delusion is hypochondria, but the more I became fascinated by it and researched it, the more I began to think that it was a very good image or metaphor for what it feels like to have hypochondria. Because the sufferers from the glass delusion were absolutely obsessed with the idea that they were breakable and fragile because they were made of glass. And that if anyone hugged them too hard or if they fell off anything or if they got jolted around on a horse, it was a good image.

they would break into a million pieces. And that's sometimes I think what it feels like to have hypochondria is you feel incredibly fragile and breakable, but to everyone else, you just look completely normal. And they might think that, oh, this is just all in your head and a delusion that you've got. So that's why I gave the book that title because I felt it really encapsulated the feeling of what it's like to have hypochondria.

What effect did writing this book have on you mentally and in terms of your obsession with your health and with anything that might be a symptom of something serious? Did it calm you down or did it make you more hypervigilant? Sometimes talking about it, whether it's with a friend or a therapist, takes it off your shoulders.

It does. And I would say, largely, it's been very positive. I'm not sure that I could recommend writing a book as a treatment to everyone with hypochondria, but it's certainly been good for me. The actual process sort of day by day of especially writing the personal sections of the book was sometimes quite unpleasant, reliving memories and sorting through recollections and deciding what would be good in a book and what wouldn't be. I didn't find that very enjoyable. But I

The overall process of putting it all down and then being able to send it out into the world, almost like it's a chapter that I'm closing and giving over to everyone else to have their thoughts about, that I think was mentally very helpful. And also just realising that I could talk about these things and nothing bad would happen to me. I think I had...

without realizing it, I'd lived with this fear for a very long time that if I spoke about having cancer, having hypochondria, people would judge me, people would think less of me. And I was braced all the time, I think, for that reaction. And there's been absolutely none of it. People have been nothing but kind and interested and wanting to share their own stories and so on. So I think

That was a very good realization for me that I could do this and it could actually have a good outcome instead of a bad one was maybe the culmination of a lot of therapy of doing hard things to find out what the outcome is and then finding that actually they're not that bad after all. Well, thank you so much for talking with us and I wish you good health. And you. Thank you very much, Terry. Caroline Crampton is the author of the new book, A Body Made of Glass, A Cultural History of Hypochondria.

After we take a short break, John Powers will review two new TV spy series. He says each takes a radically different approach to the espionage genre. This is Fresh Air. This message comes from GiveWell. There are millions of nonprofit organizations in the world. How do you know which ones can make the biggest impact? GiveWell was founded to help donors with that exact question.

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Spy series have become a staple of the modern TV landscape. Two big new ones are closing out the year. The Netflix series Black Doves and Paramount Plus's The Agency, a reworking of the acclaimed French series The Bureau. Our critic at large, John Power, says that one of them is fast and one is deliberate, but both will keep you hooked. Ever since I saw my first James Bond movie as a kid, I've had a thing for spy stories.

They always draw me in, be they nuanced like John le Carré, witty like Slow Horses, or pot-boiling like Homeland. I love their labyrinthine plots, their bubbling menace, their deep-dish paranoia. Never trust what you see on the surface. I'm happy to report that the year is ending with two good new spy series, Black Doves on Netflix and The Agency on Paramount+.

They make an interesting pair, for while both are compelling and feature top-drawer talent, each takes a radically different approach to the espionage genre, where one flashes with pop energy, the other is a slow burn.

Set in London, the mecca of spy stories, Black Dove stars Keira Knightley as Helen Webb, the wife of Britain's defense minister, who secretly works for the Black Doves, a private espionage firm that sells information to the highest bidder. When her lover is murdered, Helen vows revenge, much to the disapproval of her boss, Reed. That's Sarah Lancaster of Happy Valley fame.

To keep her safe, Reed enlists Helen's dear friend Sam Young, a gay contract killer played by Ben Whishaw. Soon Helen and Sam are sucked into a bloody maelstrom that touches everyone from the Chinese embassy and the CIA to No. 10 Downing Street and the world's most powerful criminal gang.

Telling a complete story in an admirably brief six episodes, the show starts fast and just keeps coming. Jokes and plot twists and fight scenes and flashbacks. Heck, even Tracy Ullman turns up. Black Doves was created by Joe Barton, who did Geary Haji, an exhilaratingly original Netflix series about a Tokyo cop in London.

While this new show is more conventional, you can feel Barton's sensibility in its deft shifting from violence to comedy to surprisingly deep emotion. Even the villains have more dimension than you'd expect. Of course, it's the heroes who hold us, especially since Knightley and Wishaw play off each other with such ease.

Here, for example, Sam and Helen are driving to kill one of the men who murdered her lover. And she thinks he's acting a bit odd. These webs we weave, they are tangled, are they not? Have you been drinking? What? Your breath smells of wine. Um, I was at dinner. Are you pissed? I think that I can have three glasses of Sauvignon Blanc and still do my job. Thank you. Was it three glasses, though? Four.

And a line of what I thought was cocaine, but I'm starting to suspect may have been.

Oh, great. Cool. So a bottle of wine and some horse tranquilizer. Anything else? Did you shoot up under a bridge on your way here? Listen, I have just left a very enjoyable evening with some old friends to come and murder a hired contract killer for you. So let's tone down the judgment a tad, shall we? Helen and Sam are so enjoyable in such scenes and their friendship so palpable that it's easy to lose sight of the immorality of what they do.

especially as both are capable of profound love and generosity. The human cost of spying is less breezy in the agency, whose provenance could hardly be finer. It's an American transposition of maybe the best spy show of all time, the French series The Bureau.

Based in a CIA outpost in London and dealing with issues torn from our headlines, it centers on the spies who live for years in foreign lands under fake identities and the desk jockey agents who run them. Ambiguously handsome Michael Fassbender stars as the crack agent known as Martian. As the series begins, he's suddenly called back to London from Addis Ababa, forcing him to leave behind his Ethiopian lover Sami. That's Jodie Turner-Smith.

He tells his superiors, played by the likes of Jeffrey Wright, Katherine Waterston, and Richard Gere, that he and Sami are over, but he's actually still in love with her. In the spy world, this lie is profoundly compromising, and it sets in motion all manner of trouble. You see, not only is he training a young woman agent, played by Saura Lightfoot-Leone, for an undercover job in Tehran, he's helping endangered assets in Ukraine.

If Black Doves gallops forward like a racehorse, the agency is quieter and more precise, like dressage. Although I've only been able to preview the first few episodes, the show closely follows the Bureau's template. It carefully lays out the agency's daily life, with its strong personalities, office politics, and murky missions. Then it starts tightening the screws of suspense.

Like most spy stories, the agency taps into our modern obsession with identity. As Martian tries to juggle his romantic passion and his sworn duty, the show offers a heightened version of something universal, the gap between our public selves that act in the world and who we feel we really are inside. For all their differences, black doves in the agency address the same fundamental questions. Can you be a spy and still keep your humanity?

At what point does your mask become your actual face? And at what point, if any, do you start saying no? John Powers reviewed Black Doves and The Agency.

Fresh Air's executive producer is Danny Miller. Our technical director and engineer is Audrey Bentham. Our interviews and reviews are produced and edited by Phyllis Myers, Roberta Shorrock, Anne-Marie Boldenado, Sam Brigger, Lauren Krenzel, Teresa Madden, Monique Nazareth, Susan Yakundi, and Anna Bauman. Our digital media producers are Molly C.V. Nesper and Sabrina Seward. Thea Chaloner directed today's show. Our co-host is Tanya Mosley. I'm Tariq Rose.

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