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Cyberchondria vs. Hypochondria

What is Cyberchondria – Information Technology Effect on Human Mind – “Google Syndrome” – “Shallow Mind Syndrome”

This page describes my own observations and reflects my personal opinion. This opinion is not necessarily supported by other members of medical community or by professional organizations. Some of the descriptive terminology used on this page is unconventional and may be understood incorrectly outside the page content. I refrain from any professional recommendations on the diagnosis and management of any human disease caused or aggravated by the information technology.

Introduction

“I plodded conscientiously through the twenty-six letters,
and the only malady I could conclude I had not got was housemaid’s knee…
I had walked into that reading-room a happy, healthy man. I crawled out a decrepit wreck.”

Jerome K. Jerome, “Three men in a boat”,
Year 1889

In 1889, and even in 1989, access to scientific and professional sources of knowledge required at least some level of expertise on the subject as well as time and effort. Nowadays, in 2018, the “reading-room” is literally at your fingertips and the do-it-yourself witchery of turning a “happy, healthy men” into a “decrepit wreck” may be effortlessly accomplished at leisure in the comfort of your own bedroom… Thanks to countless websites, which display their own interpretations of published scholarly textbooks and articles for the sake of Google rating and advertising.

Hypochondria vs. Cyberchondria

At first glance, there is no fundamental difference between hypochondriasis and its cyber-version – cyberchondria. In both cases minor sensations within the body are perceived as the signs of serious disease. Both conditions are associated with the search for answers and with visits to multiple doctors.

In hypochondria, negative diagnostic testing does not satisfy the patient. No matter what, the patient remains convinced of having a sickness; and failure to make “the right diagnosis” is explained by “low sensitivity”, by “poor quality”, by “incorrectly ordered test” or by anything else of this sort. Hypochondriasis is a lifetime disease and the prognosis is unfavorable.

Cyberchondria is different in many respects. Normally, a patient with cyberchondria is satisfied with negative diagnostic work up. Reassurance from the doctor also works pretty well. Placebo effect of “therapeutic MRIs” and other diagnostic testing is not a permanent solution but cyberchondriacs, unlike hypochondriacs, are made happy by the “good news”.

Basically, hypochondriacs linger in a perpetual state of search for disease and don’t care much about the symptoms per se. They don’t want to treat those symptoms because they “cherish” them as signs of the “disease”.

On the contrary, cyberchondriacs don’t want to be sick. They also want the symptoms to go away. They often ask questions like “how long is this gonna last?”;“will it ever go away?”; “is there any treatment?”; “may be it is stress?”; “can anxiety cause it?”. They want a reassurance that nothing bad is going to happen to them.

Below are some other observations on the differences between classical and cyber versions of hypochondria.

I am a neurologist and hypochondria is beyond the scope of my specialty. I normally, don’t treat hypochondriacs but due to specifics of my specialty I end up seeing them pretty often. All I do I reassure them that they don’t have strokes, tumors, MS, aneurysms etc. Ten years ago I saw from zero to two such patients per day. This is consistent with statistical data, which says that hypochondria affects 1 to 5 % of general population and 2 to 7% of patient population.

Now, in 2018, this type of patients, or cyberchondriacs, comprise around a quarter of my office visitors! Many others have at least some of cyberchondriacs concerns. In the past, hypochondriacs were mostly in their 30s or 40s and older. This is again consistent with statistics – in males, classical peak of onset is expected in 30s and in females it is in 40s. Now, in 2018, hypochondriac patients are much younger. Most of them are in their 20s and 30s or even teens. This is because they are not hypochondriacs. They are cyberchondriacs.

According to 1992 addition of Merck Manual, “hypochondriasis … is related to narcissistic character organization marked by excessive concern with self and with gratification of dependency needs”. Translation to common language would sound as “hypochondriacs have some degree of personality disorder”. Prevalence of personality disorders is pretty stable year after year and is relatively independent on the external factors. It is a little simplistic, but hypochondriacs are kind of destined to have the disorder long before its onset. On the other hand, I have not noticed any personality issues in cyberchondriacs. All they have is an anxiety disorder.

My conclusion is that hypochondria and cyberchondria are two independent conditions. So, why does it matter, where the potential hypochondriac/cyberchondriac gets the information about the diseases? Why is the Web worse than the “reading-room”? The answer is “Google Syndrome”, or “Shallow Mind Syndrome”.

Last note and we go to the next chapter – hypochondriacs are not prohibited to use the Web the same way they used to read books. They have the disorder, which is independent of the Web search. For hypochondriacs Web search is a mere tool of research but not the cause of the disorder. Cyberchondriacs, on the other hand, are the victims of the cyberspace, which is the main cause of the disorder.

“Google Syndrome” or “Web-derived Shallow Mind Syndrome”

You must know ninety percent of the answer before you ask your question! The human mind works by means of anticipation. It creates some mental model of the future based on previous knowledge and experience; and this model is later compared to the actual future events. A significant mismatch between a mental model of the future events and the actual future events leads to confusion and poor understanding of the new reality.

Imagine yourself watching a movie in an unfamiliar language. How much new information will you acquire? Close to nothing! If you know fifty percent of the words, then you might learn a couple of new ones, but the content of the conversations in the movie will remain murky. Knowing ninety percent of the words will allow you to understand almost everything and meanings of unfamiliar words will be easy to catch. You’ll learn to use them almost instantaneously!

Now, let’s see what happens to someone who is researching online some unfamiliar field of knowledge. If you enter “numbness” into the search, the results will indicate you’re suffering from MS, a pinched nerve, or a stroke. “Muscle twitching” will destine you for ALS doom, while “headache” will prompt a nightmare about brain tumor and aneurysm. It took me years and years to learn which numbness is relevant to multiple sclerosis or to stroke and when muscle twitching is relevant, and to which disease.

On the other hand, the vast majority of my patients with migraine self-diagnose without difficulties based on the information available online. Why? It’s because the symptoms of migraine is common knowledge. They just needed a few fine details to confirm the diagnosis. This is the “ninety percent rule “ in action.

Any knowledge or skill may be represented by a pyramid. The base of the pyramid is made of basic or fundamental knowledge and skills, while high level of expertise sits on top. No one has ever been able to build a pyramid starting from its top. For someone, who has no idea on how to use a screwdriver, any instructions on assembling a simple cabinet will be proven useless. Lack of basic knowledge in biology, chemistry, and physiology will prevent even the smartest person from understanding the ridiculousness of some bogus claims about allegedly beneficial or harmful food or its components. When you read a provocative article about some supplement that boosts your mental abilities, concentration and memory up to 300%, you might believe it, unless you have some basic knowledge about the brain physiology. If you do possess the knowledge then you will immediately realize that the claimed supplement effect is physiologically impossible.

In the past, an expert level of knowledge and terminology was at the disposal of a narrow group of experts. Nowadays, these baseless “pyramid tops” are floating in thin air of the virtual world and are readily consumed by everyone. The problem is that consumption of such material by a naive person causes nothing but indigestion.

It has become increasingly unproductive and frustrating to communicate with patients whose anticipation was formed by the virtual world because it has no match to realities of the physical world.

It might sound funny but the major beneficiaries of the modern technological revolution are people of middle age. This generation has a foundation of basic knowledge firmly standing on the ground while they are able to perfect their level of expertise using the Web. As a result, the victim of new technology is the youngest generation that grew up in the virtual world and has no connection to the ground whatsoever.

So, what is “Google Syndrome”? Even though I have been using a “Google Syndrome” term for years, I personally don’t like it because it does not reflect the underlying cause of the disorder and unfairly puts all the blame on Google. Besides, “Google Syndrome” is not precisely a Google phenomenon. It may be caused by any search engine, whether it is Google, Yahoo, Bing, Baidu or Yandex. The number of affected individuals will depend on the market share of the individual Web search company in the each particular country. In China it will be Baidu and in Russia the stage will be mostly occupied by Yandex. Therefore, I will be using “Google Syndrome” in brackets interchangeably with much more appropriate but less catchy and somewhat personally offensive term of “Shallow Mind Syndrome”.

I don’t know who coined the term “Google Syndrome” and what the original meaning was. My own interpretation of a “Google Syndrome” is an inability to think independently caused by reliance on cooked, packaged, served, and semi-digested information provided by online search results. Brain processing power is no longer required. Why bother when an “external hard drive” and an “external processor” can do the job effortlessly? There no need for the fundamental knowledge and critical thinking since everything is analyzed and prepared for consumption by an external processor. There is no need to strain the “internal memory” because the external back up drive is always at hand. There is no curiosity and no sense of wonder – the Wizard of the Web knows everything. Hard work of mining knowledge from piles of dusty books has become obsolete. All that is needed is a “magic word” – a key word!

We are surrounded by vastness of an immensely deep ocean of knowledge, but “shallow mind” is two-dimensional.  It is incapable of penetrating even the water surface tension. Like a water bug, “shallow mind” simply glides along the surface of the ocean of knowledge.

It doesn’t even wet the feet! No matter how you call it, “Shallow Mind Syndrome” is one of the major factors that contributes to an astonishingly high rate of cyberchondria. “Shallow Mind Syndrome” prevalence rates have reached pandemic proportions. This syndrome is extremely contagious and it has no more respect to the educational and intellectual differences between individuals than it has to the borders between states and countries. Doctors themselves are readily susceptible to shallowmindedness. There are no countries and no cultures that are immune to this beast.

Some Other Effects of Information Technology of Humans

The exact magnitude of damage caused by information technology to the youngest generation is yet to be seen. One thing is certain – it will be devastating. The only question is how exactly the damage will materialize. This statement is applicable to information technology in general and lack of critical thinking due to “Google Syndrome” will be the least of the problem.

Let’s start with the basics. In order to develop normally, the brain has to receive some essential sensory input. Normal brain development is impossible in the medium of an information vacuum, because the appropriate networks in the brain are formed only under the influence of the incoming data. Using IT terminology, the hardware is capable of substantial plasticity and builds itself to suite the task of processing a specific kind of information. The developing brain is a self-learning hardware, while the human mind is a software that evolves in sync with the hardware.

In a child born with serious but correctable loss of vision the vision has to be restored by the age of five years. Once this critical stage in development is passed, the child will never be able to process a visual information even if the eye function is restored later on.

Lack of hearing from birth causes even more serious problems, likely caused by absence of verbal communication. Yes, there are multiple examples of very intelligent people with profound hearing loss but for an average person the picture is not so rosy. Besides the level of average intelligence being frozen at the level of a fifth-grader, there are other issues. These people are very straightforward, tend to understand things literally, don’t lie, and don’t get jokes. Isn’t it too much for loss of just one of five senses, which is believed to be providing less than 20% of total information input to the brain?!

Information technology based gadgets produce very similar sensory deprivation. Persistent interaction with the two-dimensional world of touchscreens deprives young children of multiple sensory modalities, such as texture, smell, wind, pain, temperature, and various pleasures and displeasures associated with the material world.

Even the interaction itself is awkward at best because the language of the physical world is different from the language of a virtual one. Simple tapping on some icon or object will not produce any effect on real world objects. Driving a car on a monitor is not associated with a sense of motion, vibration, acceleration/deceleration; and negligence and risk taking are not punished by injuries or death. The rain is not wet and the snow isn’t cold. The sun does not burn and no action is associated with pain, fatigue, thirst, or hunger. Once again, I have no idea about the future consequences of growing up in such an environment but they are inevitable.

Another common issue is addiction to social networks. The cause of this disorder is straightforward – instant gratification. Tiny but numerous stimulants of the brain reward system are the cause of this sort of addiction. Humans have found an infinite number of ways to stimulate the ever hungry reward system – from gambling and drugs to sex and food. Browsing social networks is just another way to get a quick fix for the reward system. The sum of infinity plus 1 will remain infinity. So, there is no point going any further on another “addictive substance”.

“Acquired Somatosensory Hypersensitivity Syndrome”

It is time to go back to Cyberchondria. What are the triggers of Cyberchondria. The triggers are variable symptoms and sensations. In the neurology world they are numbness, dizziness, variable pains and discomforts, sense of imbalance, muscle twitching, concentration problems, poor sleep quality, etc. The vast majority of complaints have no association with any known disease. So, why are so many people are running around from one doctor to the other with minor nuisance sensations like “slight numbness in the tip of the index finger” or “slight headache and dizziness for a few days”? I believe that the explanation goes far beyond obsession with health or anxiety disorder. I call it “Acquired Somatosensory Hypersensitivity Syndrome”. This is my own descriptive term, which I invented while writing this article. The cause of this syndrome is sensory deprivation.

Basic things are first, as usual. People with hearing loss often hear noise in their ears. Some of them even hear music or other complex sounds. People with poor vision commonly experience visual illusions and hallucinations. Korsakoff syndrome, or profound loss of ability to register and remember new information, causes confabulations, or false memories. These people can make up a whole story about the yesterday’s events that did not take place or took place sometime ago. What do all these disorders have in common? In all of them the brain is deprived of some sensory input and attempts to fill the empty space with a hallucinatory false perception.

What does this have to do with “slight numbness in the tip of the index finger”?

Modern life style has deprived people of many physical displeasures. They are pain, tiredness due to physical exertion, cold and hot temperature, prolonged hunger, etc. If you reside in the United States then ask yourself: “When was the last time I was experiencing a real long-lasting sense hunger?” Unless you are old enough to remember WWII; you fast for religious reasons; or you are an adventurous person, the answer will likely be “never”.

Yes, modern humans do experience pain, cramps in the stomach, nausea, fever, or shivering, but all of them can be easily mitigated by medications. Female body is meant to experience pain while giving birth, but it gets anesthesia. Men were always hurt while hunting or in a war fair throughout evolution, but most of them don’t hunt and don’t fight. They are sitting most of the time that they are awake – sitting at work, sitting behind the wheel, sitting at the dinner table. In the modern world, an average human body experience is limited to all sorts of pleasures or the absence of such, but pains and discomforts are muffled.

It might be the right time to share my experience in the Afar region of Ethiopia. The Afar nation leads a very basic life style in extremely harsh weather conditions. I learned from the local guide that the Afar population has remained stable for the past 200 years, in spite of very high birth rate. There are 10 kids born in an average Afar family. You can estimate the death rate yourself! Guess, what Afars are asking for, when they meet occasional visitors from the developed part of the world?! They are asking for all sorts of pain medications. For them – “no pain” means “no disease”.

Don’t get me wrong! I am not trying to sell pain and suffering and I don’t work for an Ethiopian tour agency. Nevertheless, we are paying the price for lack of suffering. Human body has evolved under the conditions of an episodic perception of pain, heat, cold, or hunger, and it has adapted to it. Once the pain and other types of suffering are removed from the “equation” of normal body experience, the body doesn’t know how to react to this sensory vacuum. Similar to visual hallucinations in blind people, in modern humans, “hallucinatory” sensations in the  body are perceived due to another bizarre variety of sensory deprivation – lack of natural unpleasant sensations from the body itself. Digital technology has dramatically increased the percentage of people leading this plant-like lifestyle. An office job has become even more sedentary than ever before. No physical objects have to be moved around at all!

Moreover, the information technology overloaded us with visually perceived information without matching it to any other sensory input.
In summary, sensory deprivation leads to overactivity of the hungry pain processing system, which balloons to unreasonable proportions every minor sensation from the body.

Here is another example. Lack of exposure to allergens and infections leads to overactivity of the immune system and, eventually, to autoimmune disorders. Since this type of adaptation is typical for all body systems, it is not surprising that the brain follows the same pattern of adaptation.

Any Solutions?

How do Cyberchondriacs end up in a doctor’s office or even in ER. The sequence of events usually follows this pattern:

  • False alarms produced by overactive body sensing systems alert the potential victim
  • A tiny seed of strange sensation falls onto fertile soil of anxiety and quickly grow into a “burning bush”
  • Search online overloads the unprepared mind with poorly understood terminology and causes fear of horrible disease
  • Finally, all fuses blow up and escalating sense of doom sends the anxiety level through the roof

Now, referred from ER or Urgent Care, this person is sitting in front of me and refuses to accept the fact that he or she is physically healthy and that he or she has no problems whatsoever, besides the one that has no scientific name and no identifiable cause. Whatever you call it – Cyberchondria, “Google Syndrome” or “Acquired Somatosensory Deprivation Syndrome”, or anything else, – no one knows how to deal with it. These people subconsciously beg their doctors to call them officially sick with some known “disease” in hope to get cured. They don’t like to have just “sensations”. They want to know “what the heck is wrong” with them and “how to stop being dizzy and numb” or if “it will ever go away”.

Any solutions!?

Below is a 130 years old doctor’s script offered to the hypochondriac character whose words were taken as an epigraph to this article:

“1 lb. beefsteak, with
1 pt. bitter beer every 6 hours.
1 ten-mile walk every morning.
1 bed at 11 sharp every night.
And don’t stuff up your head with things you don’t understand.”

Well, drastic change in the lifestyle will definitely help but this solution is often impractical. Any advice to do so will provide no benefit. The major reason is the fact that the real world is too expensive and too uncomfortable. So, less and less people can afford it. Virtual live is cheap, comfortable, and requires minimal effort to keep it sustainable. Besides, it is getting cheaper day by day.

IT has changed numerous aspects of human life. Face-to-face and even phone communications are substituted by socializing in numerous networks, where you can effortlessly befriend or unfriend anyone. Disposable pens, disposable plastic bags, disposable cars, disposable houses, disposable friends… disposable… World… Humans are social creatures and IT eroded the most human of all human qualities, the quality that made us humans – social interactions. Some of us are trying to find comfort in pets, which have become much more popular than ever before. But dogs are not “real” friends. Real friends are not sold in stores! Dogs are human-made creatures, programmed for unconditional love to their masters… Dog’s love is embedded into their DNA by force rather by free will! Is it a solution?.. I guess not.

The repercussions of IT revolution are numerous and damage to the human sense of well-being is only one of them. There is another human necessity that no one ever talks about and the one that virtual world stripped from us. It is an “anchor in the past”. This anchor is buried deep in the soil that we came from. This soil is places where grew up and things that surrounded us back then. This necessity is comprehended later in the midlife but anchoring in the past comforts us even while we are young. Substitution of normal thing for virtual ones creates an illusion that the past has never existed. There is no old toy that you discovered by surprise in grandma’s house… or some craft that you made as a present for someone. I don’t know if I make any sense, but I hope that I do…

What is the solution for all this mess?.. Looking back into Homo sapiens’ 200,000 years history reveals that we are both troublemakers and problem solvers. Some day we will overcome this problem by creating another one! It has never been different!

“Dice rolled…
Two legged brainy creatures
Evolved to challenge Nature’s will.
They carry Good and Evil features,
Which don’t blend, which never will!

Any comments about this page will be greatly appreciated at doctorstrizhak@gmail.com Content copyright 2017. DOCTORSTRIZHAK.COM. All rights reserved.
Disclosure: This Web Site is intended for education purpose only. The information provided on this site must not be perceived as a guide for self-diagnosis or self-treatment. Every effort is made to keep the information current, but there are absolutely no guarantees of timely updates. By Andre Strizhak