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First Person

‘Now write out your obituary’

Hypochondria can be debilitating. So I tried an extreme cure.

By Kara Baskin

It’s almost my 40th birthday, and I maintain a well-oiled, orderly life: devoted husband, two healthy sons, and a successful writing career that allows me to work from home in zipperless pants. My sheets are washed. My bed is made. My countertops smell like Mrs. Meyer’s Clean Day. Next to my laptop, there’s a neat to-do list with items meticulously checked off. Nothing out of place. Everything just right. Secure.

But now I’m in my therapist’s office writing longhand on a legal pad about my impending death.

My life is too perfect. I have everything, and soon it’s going to be yanked away because I’ll be dead. The lump in my breast is cancer. It’s hard, it’s immobile, and it’s fatal. Soon, it will spread to my bones, my brain, my liver — and when it hits the liver, you’re done. What will my kids do? Will they remember me? It’s just a matter of time.

I stop writing and pause. My therapist, a woman around my age with whom I’d probably drink wine under normal circumstances, looks at me.

“How anxious are you?”

“A six out of ten,” I reply.

“OK. Now write out your obituary.”

To be clear, I don’t have cancer — not that I know about, anyway. But I go through bouts of hypochondria so debilitating that I’ve given myself bruises on my breasts and stomach from prodding for lumps. Over the years, I’ve convinced myself that I have esophageal cancer (which turned out to be acid reflux), breast cancer (dense breasts), kidney failure (my ankles seemed swollen), skin cancer (dead skin near my hairline, and I nearly picked my scalp bald in spots), early-onset dementia (I called my son by his brother’s name), and colon cancer (um, undigested tomatoes).

I have Ativan’d my way through school plays and Googled through family vacations convincing myself that something is devastatingly, quietly wrong. I go through periods of “remission”— weeks or months when I enjoy a relatively serene existence. But then I  sprout a rash or some mysterious bruise, and I’m on the edge again.

Hypochondria is a very real psychological affliction — called “illness anxiety disorder” in the psychiatrists’ diagnostic manual — but anyone with a conscience feels ashamed to have it, since there are real people out there dying real deaths every day. While I’m palpating my body fishing for tumors, a needling voice in the recesses of my brain hisses, “Don’t you know how lucky you are to be alive?” My lowest point was probably texting a friend from a dermatologist appointment, nearly speechless with terror over a rogue mole after reading about a woman who was diagnosed with stage four melanoma that she discovered while shampooing. My friend was recovering from chemotherapy for ovarian cancer at the time, and she had a much calmer attitude about her actual cancer than I did about my imagined version.

Which is why I’m sitting here in a therapist’s office doing Exposure and Response Prevention, which is used to treat anxiety disorders and obsessive-compulsive disorder. The exposure part is obvious: You subject yourself to the images or thoughts that trigger extreme, obsessive anxiety. My therapist and I hone in on whatever strange bodily function taunts me that week. Then, I write down the story of my own demise.

“Kara Baskin died of stage III breast cancer after discovering it just six months ago. Doctors tried to tell her it was a simple cyst, but she insisted on following her instincts. Ultimately, several mammograms and an ultrasound revealed tumors throughout her body, and she was given palliative care.”

If I dread enough, I’ll never be surprised. If I wrap myself in preemptive fear, life won’t betray me.

Under normal circumstances, in the privacy of my own sofa, this is when I’d log onto WebMD or an obscure Mayo Clinic website to self-diagnose. ERP seeks to break that fruitless cycle. Google is like Doritos for hypochondriacs — totally satisfying in the moment, but you’re left hungry and wanting 15 minutes later, so you go back to the bag until you feel awful.

Sitting here in the office, I’m not allowed to engage in ritualization. I’m not allowed to rush to the doctor or ask my husband if he thinks it’s just a lymph node for the 50th time.

“She was a gifted writer and a devoted mother,” I write, flirting with the demon.

Why did I end up like this? Part of it is how I’m wired. My grandmother suffered from debilitating anxiety and got zapped with shock treatments in the 1950s. Part of it is my background: The specter of death always loomed over my family. My dad’s brother had a stroke and drowned at summer camp when he was 13. His father died right before his bar mitzvah. My other grandfather spent a year in quarantine for tuberculosis. And my mother was diagnosed at 26 with mixed-connective tissue disease, which corrodes the skin and the organs because the immune system attacks itself.

Mothers are supposed to be indestructible and sturdy. Mine had paper-thin skin and a ginger gait, and I never knew when she would slip away.

But my mother is still very much alive — she just took my toddler for a haircut last week, in fact — and so am I.

 “She leaves her husband and two sons, who are just seven and two years old…”

At first, this feels performative and self-indulgently melodramatic. Where is my fainting couch? But as I reread the words, the thought becomes real. There is something earnest about the act of writing, longhand, instead of just thinking terrifying thoughts in the supermarket or in bed late at night. I am giving my dread a platform, an audience, a picture frame. And as I write, it is as though I’ve splintered into two selves — the self that feels guilty and ridiculous for writing the word “tumor” in cursive, and the part of me that feels increasingly terrified and bereft, knowing that cancer is the thing that claims most of us, and that the world offers no protection at all.

“She fought her illness bravely,” I sum up, feeling like a big old liar. I’m not brave. I’m on the verge of tears, and I don’t even actually have cancer. Do I?

“How do you feel now?” the therapist asks.

“A nine.”

“OK. Read the obituary aloud.”

And so I do.

“Kara Baskin died of stage III breast cancer…”

My voice feels tinny, foreign. And slowly the anxiety drops on its own, like a pot of water brought to boiling and then taken off the burner. Hanging in the air, the words begin to lose their meaning.

This response is called habituation. Eventually, the scary thoughts aren’t so scary anymore. It’s the mental equivalent of standing on top of a skyscraper, poised to jump. But instead, you just look down and observe.

“Doctors tried to tell her it was a simple cyst…”

If I dread enough, I’ll never be surprised. If I wrap myself in preemptive fear, life won’t betray me. Wait, it’s not even as logical as that. It’s simply that my default setting is fear. It’s what I know and what has been reinforced by a mind that longs for safety — for crisp clean sheets and a tidy, pleasant Colonial. My brain is rigged with false maps and misfiring signals.

“Now how are you?” my therapist asks.

“Eight.”

“Touch the lump.”

I touch the lump on my right breast — a wormy, squishy thing that I’ve coaxed out of fleshy obscurity to become the central focus of my world.

“…She leaves her husband and two sons…”

My son is at daycare. My other one is at school. Who wrote these words? They’re not me, and they’re not true.

Crash. My breath gets deeper. My chest loosens. This language is history now. I’ve run my macabre marathon. I’m done now — wrung out, detached.

I write a check and run off to make daycare pickup. And I don’t touch the lump for the entire ride across town.

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Kara Baskin is a writer based in Boston.


Illustration by Geoffroy de Crécy

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