Dear Therapist:

I work as a social worker in a New York area hospital. I work closely with patients and families of some very sick people. I love what I do and wouldn't trade it for anything. Every year, around the same time (early summer) my anxiety about becoming ill really ratchets up. I have discussed this with supervisors and fellow clinicians and have come to understand this as being something that comes along with the territory of my job being involved with people dealing with serious illness. That being said it gets worse every year where I am not able to get rid of the irrational thoughts (and perceived symptoms) that I have some horrible illness. I would appreciate any guidance you can give me. I would hate to have to give up a job I love because of these emotional fears.

Response:

What you are referring to is relatively common among students and early practitioners. It is not unusual for medical school students to diagnose themselves with new illnesses on a regular basis. Obviously, this is due to their focus on the symptoms of these illnesses. Without proper knowledge and experience, it can be difficult to discern normal “symptoms” from those associated with a particular illness. Add to this the emotional factors inherent in self-diagnosis, and the term “a little knowledge is a dangerous thing” is taken to a new level. Today this phenomenon has become much more widespread. Even laypeople are being educated and informed (and often misinformed) about many aspects of health.

(Incidentally, symptoms related to mental health may be all the more subject to issues of “self-misdiagnosis.” Where physical symptoms are typically more concrete and can be more directly described, tested, and treated, emotional symptoms can be subjective, vague, and difficult to define. For instance, it’s difficult to “show” your feelings to a colleague in order to be assured that you don’t have an anxiety disorder.)

I don’t know how long you have been working in the hospital. I also don’t know what your level of knowledge is with regard to diseases in general or with regard to any particular illnesses that you fear. Generally with more knowledge and experience, these types of fears decrease. However, in your capacity as a social worker, your exposure to knowledge and experience in the field of medicine may be low.

If your fears tend to be of the same one or two specific illnesses each year, studying up on those illnesses can help you to better allow your conscious mind to grapple with your concerns. It would be best to enlist the aid of a physician who is competent in that specific area. This will help you to be more concise in your understanding of the illness. Clearly understanding your fear will help your conscious mind to take more control of the fear, which will limit your unconscious (emotional) mind’s capacity to create irrational fear. If, however, your specific fears constantly change, it will be more difficult for you to educate yourself on each. Nevertheless, doing so for just a few illnesses may have a generalization effect, thereby decreasing your fears even for illnesses that you haven’t studied.

However, you state that your fears get worse each year, that you recognize your fears to be irrational, and that these fears are related to having “some horrible illness.” If you haven’t identified a specific illness, your conscious mind has very little to work with, thus relegating the contemplation of your symptoms to your unconscious mind. This could easily lead to irrational (unconscious/emotional) thoughts, which in turn can lead to continually worsening fears. Your first step may be to clearly identify a specific disease that concerns you. Each step that you then take to better define and focus on your fear can help to shift your irrational fears toward a more rational, logical concern.

Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Brooklyn, NY   |   Far Rockaway, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317

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