Valetudinarian

Valetudinarian (pronounced val-i-tood-n-air-ee-uhn or val-i-tyood-n-air-ee-uhn)

(1) An individual in chronically poor health; sickly; an invalid.

(2) An individual who believes themselves in chronically poor health.

(3) An individual obsessively or excessively concerned about their health or ailments; a hypochondriac.

(4) Of, relating to, or characterized by invalidism.

1695-1705: A learned borrowing from the Latin valētūdinārius, from valētūdō (state of health (good, bad or indifferent) (from valeō (to be strong) or valēre), the construct being valēre (be strong (from the primitive Indo-European root wal- (to be strong)) + -tudo (the abstract noun suffix).  The construct of valetudinarian was the now obsolete valetudinar(y) (Sickly, infirm) + -ian.  The suffix -ian was a euphonic variant of –an & -n, from the Middle English -an, (regularly -ain, -ein & -en), from the Old French –ain & -ein (or before i, -en), the Modern French forms being –ain & -en (feminine -aine, -enne), from the Latin -iānus (the alternative forms were -ānus, -ēnus, -īnus & -ūnus), which formed adjectives of belonging or origin from a noun, being -nus (cognate with the Ancient Greek -νος (-nos)), preceded by a vowel, from the primitive Indo-European -nós.  It was cognate with the English -en.  Valetudinarian & valetudinary are nouns & adjectives and valetudinarianism & valetudinariness are nouns; the noun plural is valetudinarians.

The form valetudinarian (one who is constantly concerned with his own ailments) was in use by 1703 and developed from the adjective valetudinary, documented as early as the 1580s and is an example of the profligate ways of English being nothing new, hypochondriac (as both a noun & adjective) first noted in the 1570s, developed from the earlier noun hypochondria which was in use as early as the 1550s.  Like hypochondriacs, the valetudinarian is on a spectrum, the comparative “more valetudinarian”, the superlative “most valetudinarian”).  Hypochondria was from the Late Latin, from the Ancient Greek, the neuter plural of Greek ὑποχονδριακός (hupokhondriakós (pertaining to the upper abdomen which, in the medical orthodoxy of Antiquity, was the supposed seat of the condition of melancholy).  The construct of the anatomical area the ὑποχόνδριος (hupokhóndrios) (the region between the ribs and navel) was ὑπό (hupó) (below) + χόνδρος (khóndros) (cartilage).  One very modern derived form was the portmanteau noun cyberchondriac, the construct being cyber- (the prefix here used as a clipping of cyberspace thus denoting the Internet, or computers generally) +‎ (hypo)chondriac.  First documented in 1997, a cyberchondriac belongs to a subset of hypochondriacs who research their medical condition(s) (real, imagined and, more controversially, desired) using the internet, thus the popular label “Dr Google”.

Lindsay Lohan in hospital bed in I Know Who Killed Me (2007).

The most extreme (or skillful) of the valetudinarians & hypochondriacs often seek to spend as much time as possible admitted to hospital ignoring the warning of Evelyn Waugh (1903-1966) that “…the greatest danger to one in hospital is being murdered by the doctors.”, a phenomenon thought statistically under-recorded because the legal system is complicit in allowing an extraordinary definitional largess in the matter of “medical misadventure”.  “Medical misadventure” is a deliciously vague term which began as a way to add a scientific gloss to “act of God” but it has come to appear with such frequency in tort cases and coronial inquests that some doctors claim it now conveys the very implication of “responsibility” to profession originally concocted the phrase to avoid.  Some have suggested it be replaced with “death while under medical care” but the way the linguistic treadmill works means that this too would come similarly to be vested with the same hint of guilt.

The baron surprising gunners by arriving on a cannonball, an illustration from a nineteenth century edition of The Adventures of Baron Munchausen by Rudolf Erich Raspe.

At the margins, it can be hard to tell where hypochondria end and Munchausen syndrome begins.  Munchausen syndrome (also known as factitious disorder (FD)) is a rare type of mental disorder in which a person fakes illness, either by lying about their symptoms or using some trick or technique to make themselves appear unwell.  There are cases in the literature where the conditions have overlapped, patients, convinced they are suffering some ailment despite the contrary opinion of physicians, inducing the requisite symptoms by some means in order to be admitted to hospital.  There, they assume they’ll be more closely examined and their elusive conditioned diagnosed.

That, like hypochondria, can be understood as an aspect of the human condition but what is truly mysterious is what the American Psychiatric Association (APA) insist has been re-named factitious disorder in another (FDIA): Munchausen syndrome by proxy (MSbP).  It also once was called factitious disorder imposed on another FDOA) or factitious disorder by proxy (FDP) but most agree MSbP is best.  Its primary characteristic is the production or feigning of physical or psychological symptoms in another person (usually a young child or but the proxy subject can be an adult or even an animal) under the care of the person with the disorder. The symptoms are problems which are inexplicable, persistent or resistant to interventions which, based on clinical experience, would have worked, after adequate evaluation and treatment attempts.  MSbP is a variation of Munchausen syndrome (which the APA lists as factitious disorder (FD)), a mental disorder in which those affected feign (or sometimes even induce) disease, illness, injury, abuse, or psychological trauma to draw attention, sympathy, or reassurance to themselves.  The name is from the fictional character Baron Munchausen from the 1785 novel Baron Munchausen's Narrative of his Marvellous Travels and Campaigns in Russia, by German author Rudolf Erich Raspe (1736-1794), a collection of extraordinary stories, based (loosely) on the tales told by the real-life Baron Hieronymus Karl Friedrich, Freiherr von Münchhausen (1720-1797).  The real baron was prone to quite some exaggeration in the tales of his travels but never went as far as Herr Raspe who included in his volume the eighteenth century baron flying to the moon.

So valetudinarian & hypochondriac are synonyms as use of the former evolved in English, losing the specific senses enjoyed in antiquity and that one became popular and one fell into obscurity is the way the language develops.  While it can be argued it might have been useful had the valetudinarian retained the sense “an individual in chronically poor health; sickly; an invalid”, there’s hardly a lack of words and phrases to describe that.  Although hypochondria & hypochondriac remain common in popular use (whereas valetudinarian and the related forms are used only by historians or as a literary device), in the lexicon of medicine & psychiatry they endured (officially) only until the early twenty-first century.  Hypochondria (historically known as hypochondriasis) did appear in the earlier editions of the APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM), last used in the DSM-IV-TR (Text Revision, 2000) when Hypochondriasis listed as a somatoform (having no physical or organic cause) disorder but when the fifth edition (DSM-5) was released in 2013, the terms were replaced with two classifications said better to capture the range of symptoms associated with the condition:

Somatic Symptom Disorder (SSD): SSDs are characterized by one or more somatic (physical) symptoms that are distressing or result in significant disruption of daily life, causing the patient excessive numbers of troubling thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns.

Illness Anxiety Disorder (IAD): IADs are characterized by a preoccupation with having or acquiring a serious illness.  Individuals with IAD have minimal or no somatic symptoms but exhibit a high level of anxiety about health and frequently engage in excessive health-related behaviors which can include seemingly contradictory behavior patterns such as repeatedly & obsessively checking their bodies for symptoms of illness or exhibit maladaptive avoidance, the most common of which is not attending medical consultations.

The tenth edition of the World Health Organization’s (WHO) International Classification of Diseases (ICD-10, 1990) classified hypochondriasis as a mental and behavioral disorder (substantively unchanged in ICD-11, 2018) but the trend in recent decades has been for the DSM & ICD to align so there may in the future be changes to either.

Trends of use 1800-2019: Hypochondriac & Valetudinarian.

Impressionistically, the decline in use of valetudinarian is unsurprising and the twenty-first century resurgence probably reflects nothing more than proliferation of on-line dictionaries, etymology sites and lists of bizarre, archaic & unusual words.  Just as impressionistically, it seems remarkable hypochondriac appears more frequently to have appeared in print in throughout the nineteenth century than today.

Because of the way Google harvests data for their ngrams, they’re not literally a tracking of the use of a word in society but can be usefully indicative of certain trends, (although one is never quite sure which trend(s)), especially over decades.  As a record of actual aggregate use, ngrams are not wholly reliable because: (1) the sub-set of texts Google uses is slanted towards the scientific & academic and (2) the technical limitations imposed by the use of OCR (optical character recognition) when handling older texts of sometime dubious legibility (a process AI should improve).  Where numbers bounce around, this may reflect either: (1) peaks and troughs in use for some reason or (2) some quirk in the data harvested.