What Kafka’s Hypochondria Reveals About His Literary and Personal Life

By the summer of 1913, it had been nearly a year since Kafka and Felice Bauer had begun corresponding, and several months since they’d started speaking of marriage. Speculatively at first, hypothetically, but at some point those weightless words had solidified into a commitment and then, worse still, a plan. For Kafka, this initiated a period of crisis. He truly did want to marry Felice. The problem was that he also wanted not to marry her, and that these two possibilities were incompatible. For as long as his desires had been private, their incommensurability could be contained. Now, ambiva­lence spilled over into panic.

Kafka concocted a plan. He couldn’t break his commit­ment, that was impossible, but by eliciting a refusal from a paternal authority he could ensure the marriage would never come to pass. There were two options. If his own father forbade it, it would be a humiliation; he’d die of shame or else be left with no other option: he would have to march straight to Berlin and marry Felice in defiance. So Kafka set about convincing Herr Bauer to refuse him, a more appealing prospect that could later on be spun into an amusing coffee house tale.

On the morning of August 21, Kafka visited his local book­seller, from whom he acquired the works of Kierkegaard. Kafka approvingly read the Danish philosopher, drawing inspiration from his evasive missives. Then he sat down at his desk. “Dear Herr Bauer,” he began; and, after a few pleasantries, a confession: “I have deluded your daughter with my letters.” But immediately following that, a series of equivocations: “as a rule, I have not meant to deceive her,” he says, “although sometimes I have…I really don’t know.” Kafka then proceeds to list the character flaws that made him unappealing as a potential son-in-law: “I am taciturn, unsociable, morose, selfish, a hypochondriac, and actually in poor health.”

“Well,” he concludes, evoking his recent story about a monstrous father ordering the death of his compliant son, “You be the judge!”

What does it mean to confess, “I am a hypochondriac”? Surely the utterance is a performative contradiction: a true hypochondriac doesn’t say he’s a hypochondriac, he simply says he has cancer or Lyme. Or else, like the comedian Tony Hancock, he says that hypochondria is the one illness he doesn’t have.

Confessing to being a hypochondriac, meanwhile, is like that philosophi­cal paradox that asks whether one can truthfully declare oneself to be a liar. Which is probably why, for the most part, we are better at diagnosing hypochondria in other people than in ourselves: you are a hypochondriac, I have well-founded concerns. And yet online support groups are full of confessions from self-diagnosed sufferers of health anxiety: people whose problem, like Kafka’s, is that they don’t fully believe they have a problem.

Modern psychiatry has a name for this: ‘insight,’ the patient’s ability to recognize that they may be suffering from a mental, rather than a physical, condition. The World Health Organization’s diagnostic manual rates the severity of ‘hypochondriasis’ according to the level of insight, with the rare patients at the extreme lower end of this spectrum being “delusional in the degree of conviction.” This is something that separates hypochondriacs from the paranoiacs whom they otherwise resemble. Paranoia creates zealots; hypochondria is a form of doubt that has doubts about itself.

During the many years that I spent fretting about my health, I had no problem in confessing that friends had a point when they called me a hypochondriac. In fact I welcomed it, invited it. Compared to real illness, after all, the diagnosis was not without its consolations. Insight did not cure me, however. I simply held opposing views on the status of my health. I reasoned that a hypochondriac can also become sick—sooner or later, most of them will—and that I happened to be both. What was more, by one of those remarkable ironies to which each person believes that they alone are susceptible, the identity of my actual illness happened to coincide with the one that I’d imagined.

Undoubtedly helpful, ‘insight’ is not without its downsides. It can create a sort of double consciousness, a feeling of imposture. One’s doubts rebound, and one is forced to ironize a condition one might prefer to simply suffer. And yet it’s not as though the hypochondriac can simply stop listening to their fears: what if, this time, they really are unwell? Simply put, there is no good way to be a hypochondriac: a hypochondriac must take themselves seriously while suspecting themselves to be a joke.

Of course insight also poses a problem for the person who hopes to evade marriage by presenting himself as completely deluded. Kafka’s solution to this was practical: he was, as he said, a hypochondriac—and he was actually in poor health.

Unfortunately for everyone involved, Kafka’s careful letter did not have the desired effect. This was not simply because the punitive father might ultimately be a fantasy of the guilty son, but also because Felice did what any lovesick person in her position would do: she intercepted the embarrassing document and tucked it away in a drawer. The following spring the two were officially engaged. It was a whole family affair: the Bauers and Kafkas in Berlin. Kafka’s mood that day was grim. “Was tied hand and foot like a criminal,” he later wrote. “Had they sat me down in a corner bound in real chains…it could not have been worse.” As he permitted himself to be taken around furniture shops, Kafka was distracted by sound: the tolling of a funeral bell.

The next month, the engagement broke down. As Kafka explained to a friend of Felice: “If I were healthier and stronger, all difficulties would have been overcome.” In that case, he would be ‘sure’ of his relationship with Felice; indeed, he would be “sure of the whole world.” As things stood, however, he was certain of only one thing: “Undoubtedly,” he suffered from “an enormous hypochondria, which however has struck so many and such deep roots within me that I stand or fall with it.”

With these words, Kafka was placing hypochondria—this self-doubting doubt—at the very center of his existence. For him, this was connected with his vocation as a writer. His hypochondria was “the earthly reflection of a higher necessity;” it was, as he’d tried to warn Herr Bauer, the incurable condition of a person whose “whole being is directed toward literature.”

What could be more familiar, more hackneyed, than the figure of the sickly artist? The writer as society’s most esteemed and eloquent sufferer. And yet re-reading Kafka’s diaries and letters, I can’t help but feel that the connection he is drawing between hypochondria and writing goes deeper than the Romantic myth asks to suppose.

To be a hypochondriac is to assign the most important place in one’s life to something that no one else believes is real, and which even you yourself have doubts about. It is therefore to be haunted by a certain groundlessness. Isn’t something similar true for the writer, too? What today could possibly justify a life spent inventing situations, writing them down? In the secular world the writer, like the hypochondriac, suffers from a crisis of legitimacy: each is embroiled in a battle with meaning that is at once all-consuming and strangely immaterial.

Here is how one of Kafka’s finest readers, the French critic Maurice Blanchot, expresses it: “The writer find himself in the increasingly comic condition of having nothing to write” while “being constrained by the utter necessity of always writing it…It seems wretched and preposterous that anguish, which opens and closes the heavens, needs, in order to manifest itself, the activity of a man sat at his table tracing letters on pieces of paper.”

Likewise, Kafka never ceased to be tormented by everything that weighed lightly on him: “what frail or even nonexistent ground I live on,” Kafka once wrote to Max Brod. “Writing sustains me, but isn’t it more accurate to say that it sustains this kind of life?”

In one of his earliest letters to Felice, Kafka told her of his “self-enamored hypochondria,” a confes­sion that came in response to Felice’s request that he exercise more “moderation and purpose” with his writing. Felice’s letters do not survive, but I think we can presume that Kafka’s response would not have reassured her:

Shouldn’t I stake everything I have on the one spot where I have a firm footing? If I did not do so, what a hopeless fool I would be! It is possible that my writing is nothing, but in that case it is quite certain, beyond any doubt, that I am absolutely nothing. If I spare myself in this respect, then properly speaking I am not really sparing myself, but killing myself.

It is, I think, these entangled experiences that led Kafka late in his life to invent a new, decidedly un-Romantic myth of the writer. “First Sorrow” concerns a trapeze artist who has mastered “his art in all its perfection,” and who refuses, between acts, to set foot on earth. The sorrow of Kafka’s melancholy aerialist consists in this: his insight into the absurdity of his fate. The fact that, in his groundless pursuit of perfection, he is compelled to sacrifice everything to what might really amount to nothing.

__________________________________

From Hypochondria by Will Rees. Copyright © 2025. Available from Coach House Books.