A colleague sends me something from the internet - the summary of a research paper by Professor Giovanni Andrea Fava, editor of that popular top shelf publication Psychotherapy and Psychosomatics. "Hypochondriasis can be treated, but is nurtured by medical information," is the title. Even if this makes Prof Fava sounds like ante-post favourite for editorship of Bleeding Obvious Monthly, I suppose there may be something in his "explanatory theory". However, I feel much too sinusy to examine the matter today.
I awake, as always, feeling thick-headed and with a face that aches from the forehead to the cheekbones that lie buried beneath so much fat. More and more I regret cancelling the submuchosal resection on my significantly deviated septum, because my breathing is worse than ever. I am even thinking about a homeopath recommended by a friend with chronic cystitis - a practitioner more likely to improve my quality of life, it occurs to me, than Prof Fava of the University of Bologna.
I still cannot read the hypochondriasis paper, as I tell Rebecca while she is juicing some mouldy mangos - a diet-related activity which, in her hands, takes on an unsettlingly Freudian air. "You don't want to read it in case it's helpful," she says, grabbing a particularly withered piece of fruit. "You're terrified of being cured. If you lost your hypochondria, you'd lose the crutch on which you limp through life." Somehow the pedantic mid-sentence placement of the preposition irritates me even more than the sentiment, but I respond maturely by saying "yaiss, yaiss, very wise, oh yaiss", while nodding my head in savagely ironic agreement, until a familiar tinkling sends me scurrying for dustpan and brush.
"Hypochondriasis (the conviction of being seriously ill despite no objective medical evidence) is often regarded as a chronic and disabling condition, refractory to treatment," writes Prof Fava. "A randomized controlled trial performed at the University of Bologna would suggest this is not the case." The finding, if this isn't too technical, seems to be that patients whose doctors explain why they can't possibly have the illnesses they fear tend to worry less than those whose doctors don't. And all those years I thought Italian medicine began and ended with prescribing suppositories.
Over the years, I reflect while browsing through the vitamins at the Pestle and Mortar chemist, I have enjoyed a fair amount of "explanatory therapy" from my physician Sarah Jarvis, of the "You do not have colon cancer because you do not have any symptoms" variety, and from my wife. And yet the hypochondriasis is, if anything, worse than in 1991, the year I first entered Room 19 at the Grove surgery and later became shackled by the bonds of holy wedlock.
After lunch, we put explanatory theory into practice when I complain vigorously of pain in my left thumb and elbow. I diagnose the onset of motor neurone disease, but Rebecca, taking the role of Prof Fava, dissents. "Can you think of any activity that might explain it?" she asks pleasantly, allowing the good cop half of her routine an early outing in the tacit understanding that the bad cop was not too far away. "Nothing," I reply, "nothing at all." "What were you doing until 2.30am with your friend Giles?" "Playing FIFA 2000 football on the Playstation." "Show me how you hold the thing when you play." Reluctantly I mime. My elbow is held at an artificially raised angle, while the thumb is extended and at full pressure to the button. I take her point. Perhaps there is something in explanatory theory after all.
I awake feeling nervy and distressed, having passed a very troubled night. In this dream, I am lying on the mortuary slab while Dr Jarvis and Rebecca discuss what they should put down as cause of death. "Well, literally, it was the colono-rectal cancer," says the doctor. "Yes," says my widow, "but every time he complained of passing blood, I pointed to all the empty jars of beetroot and told him not to be so silly. If he'd been treated sooner, he might have been all right." "Perhaps," says Dr Jarvis, "but at least you cured him of his hypochondriasis." Taking a fountain pen to the death certificate, the doctor writes "explanatory theory" under cause of death, and pausing only to laugh at the irony, the two women leave me to eternity.