WALL STREET JOURNAL - Thursday, January 25, 1996 (p.1+8).

"Norwegian Doctor Takes Patients Who Only Need Understanding".

By Lawrence Ingrassia, Staff reporter.

Bergen, Norway - Dr. Ingvard Wilhelmsen has just finished his morning appointments. He has seen a 45-year-old business executive who doesn't have heart disease. And a 38-year-old engineer who doesn't have stomach cancer.

Other patients in his practice include a 51-year-old teacher who doesn't have a bad thyroid and a 40-year-old man who doesn't have lung cancer or a brain tumor.

They're all on the road to recovery. "I feel much better now. I'm very grateful", says Jostein Ekrem, the 45-year-old executive who has been seeing Dr. Wilhelmsen for about six months.

Over time, in fact, Dr. Wilhelmsen expects to cure all his patients. And why not? They're hypochondriacs. Don't laugh. Dr. Wilhelmsen's practice, which he runs one day a week at a hospital here, has proved so popular he has a waiting list of patients referred by other physicians.

Hypochondriacs aren't nuts, says Dr. Wilhelmsen. It's just that they aren't sick and refuse to believe it, despite being "very sensible otherwise", he notes. "In any week, 80% of all people have symptoms of something, but it is usually nothing. Hypochondriacs choose the least likely, but most dangerous, possibility."

Frequent headaches? Must be a malignant tumor. Chest pains? A heart attack. Swollen glands? Cancer of the lymph nodes. Upset stomach? Stomach cancer. The tests are negative? Take more. Still negative? Get a second opinion. And a third. "You can never be 100% sure, which is one of the things that hypochondriacs find hard to accept," notes Dr. Wilhelmsen, whose patients receive free care in the state health care system. "Nothing is 100% except dying - which doesn't exactly comfort them."

Hypochondria isn't funny, the jokes notwithstanding. (Heard the one about the hypochondriac who died after living to the ripe old age? His gravestone read, "Do you believe me now"") Indeed, a small but growing number of physicians are starting to take hypochondriacs seriously.

Pauls Salkovskis at the University of Oxford in England calls them people with "severe health anxiety." Says Dr. Salkovskis, a research clinical psychologist who has studied and treated hypochondriacs off and on for a decade. "Hypochondria has become a prejorative."

Whatever it is, Dr. Wilhelmsen hypothesizes that hypochondria increases with wealth: "In a society where you have to fight for food to survive, where you have to fight for your basic needs, there aren't many hypochondriacs. When all your need are taken care of, you have more time to worry about your health." There probably weren't many hypochondriacs among the Vikings, who sent raiders to rape and pillage Europe, he says.

Nowadays Norwegians are affluent and, some say, prone to hypochondria. "Norwegians are melancholy. It's very dark here most of the year," says Niels Geelmuyden, a 35-year-old author in Oslo who is a confessed hypochondriac.

Providing medical care for people who aren't sick is "a luxury of modern society," concedes Oyvind Saebo, acting director general at the Norwegian Health Ministry. Still, he adds, treating them could actually reduce medical costs. "It could save primary doctors from a lot a unnecessary consultations."

Indeed, hypochondriacs can drive doctors crazy. "They're a pain in the neck," confides Arthur Barsky, a psychiatrist at Brigham & Women's Hospital in Boston. While many psychiatrists have patients who are hypochondriacs, the American Psychiatric Association isn't aware of any U.S. clinics that seek out hypochondriacs for continuing treatment.

Dr. Wilhelomsen uses a treatment that involves "cognitive behavior therapy," a treatment studied by Dr. Salkovskis. Translated, that means getting patients to recognize that they misinterpret body signals, always fearing the worst instead of realistically evaluating the danger of disease. By examining the reasons, they can overcome their anxiety.

Doctor's Setting

Dr. Wilhelmsen, a 46-year-old gastroenterologist and specialist in psychiatry, was always interested in both "the psyche and the soma" - the mental and the physical. What better way to meld these two interests than to treat hypochondriacs?

So he set up his practice last spring here in this city of 220,000 in fjord country. He works with hypochondriacs one day a week while teaching medicine and performing his other duties the rest of the time.

Jostein Ekrem, the patient, looks perfectly healthy. That's because he is perfectly healthy - and always has been, though he long believed he was terminally ill.

A couple of years ago, he began feeling dizzy and faint. "I thought, 'Could it be my heart? Could it be cancer?' "says Mr. Ekrem, who runs a cleaning company that employs 150.

His state health doctor couldn't find anything. Mr. Ekrem didn't trust the test results; two relatives died of cancer that had long gone undetected. So he went private. That doctor couldn't find anything, either. He flew to Oslo. Twice. Doctors there couldn't find anything. By then, he had run up a US dollar 3,000 bill.

So, he visited Dr. Wilhelmsen. "I had given up," Mr. Ekrem recalls. Now he is almost cured. Dr. Wilhelmsen didn't do a single test; in fact, with hypochondria he avoids tests, knowing that patients have already been thoroughly tested by the time they are referred to him. And there's another reason, he says: "The patient thinks, 'If he's doing a test, he must believe there is something there.' "

Eliminating Stress

Instead, the doctor got Mr. Ekrem to focus on the main cause of his symptoms: stress. Mr. Ekrem is a workaholic. That contributed to his problems, and anxiety compounded them. Mr. Ekrem finally learned to read his body's "signals," he says, "but not think the worst."

Others aren't so easily cured.

Bjorn, a 39-year-old engineer, has a serious case. In 1989, he began having severe stomach pains and diarrhea. Tests proved negative. In 1991, he fainted with intense pains and spent two weeks in hospital. Still nothing. A year ago, so worried about his health he couldn't work, he quit his job.

After many visits with Dr. Wilhelmsen, Bjorn is slowly getting better. "I have a low threshold for pain. I'm aware of that now, and try not to think about it so much," he says. "If I have stomach pain now, I think of it as normal because every person has it from time to time."

Not all hypochondriacs want help. Mr. Geelmuyden, the writer, doesn't mind worrying that every ache and pain could be a sign of fatal disease. "I'm not sure I want to be healed. Many creative people suffer from this," he explains.

And Jan Eggum, a popular singer, isn't planning to see Dr. Wilhelmsen either. "My fear of getting sick made me stop smoking," he says. Mr. Eggum even wrote a song about his hypochondria. The ending of each verse: "Every evening he goes to sleep with the lights on and dies of fear."

Alas, it never became a hit. "Too depressing," he says.