June/July/Aug 2008

Head Cases

Two memoirs recount the psychic and physical intricacies of illness

Wendy Lesser


In general, we don’t enjoy hearing about other people’s illnesses. If you say, “How are you?” to an acquaintance or a new friend, you want to get back a pat “Fine,” not some lengthy disquisition on the latest ache or pain. The exception to this rule occurs when both people have something wrong with them: In that case, a person is willing to listen for a while so that he can later work off his own complaints. (The late Gardner Botsford called such encounters among his old-men circle of friends “organ recitals.”)

Reading is a different matter, apparently. People seem to have a nearly unlimited appetite for consuming published medical tales. These range from the inspirational to the bizarre and can be written by cancer survivors, emergency-room doctors, hospice nurses, grieving relatives, drug addicts, philosophically inclined diagnosticians, and sufferers from a wide variety of mental-health complaints. In most cases, the allure is somewhere between a car accident’s and a mud fight’s. We seem to enjoy (pace Susan Sontag) regarding the pain of others.

At their best—as, for instance, in Oliver Sacks’s Awakenings, Bert Keizer’s Dancing with Mister D., and Kay Redfield Jamison’s An Unquiet Mind—such books can cross the barrier between the medical and the literary, becoming valuable pieces of writing, as well as news reports from the darker recesses of mortality. Frigyes Karinthy’s A Journey Round My Skull and Sarah Manguso’s The Two Kinds of Decay do just that. Vernon Duckworth Barker’s marvelous English translation of Karinthy’s memoir (which was first published in Hungarian in 1939) has been reissued, with an introduction by Oliver Sacks. A Hungarian writer of the ’20s and ’30s, Karinthy was so famous for his comic novels, his well-turned newspaper essays, and his other entertaining writings that his man-about-town activities were chronicled by the Budapest equivalent of Liz Smith. So when, in about 1936, he was diagnosed with a brain tumor, people he didn’t even know began to greet him sympathetically on the street, mourning his imminent demise. Meanwhile, the well-wishers he did know thronged to his hospital room. “I found pleasure in studying their characters with the eye of a connoisseur,” he tells us:

Sympathy, which is the most sensational faculty of man, was holding an exhibition of its positive and negative manifestations. Orgies of sympathy were going on around my room, in the arm-chairs, on the divan and on the edge of my sick-bed. Two extremes were noticeable amongst these sympathetic friends. There was the noisy, exuberant, jocular type, who affected to treat the whole matter as a mere bagatelle, and, by making light of it, sought to hide the panic which steals over every one in presence of the great Enigma that awaits us all. Then there were the quiet, serious ones, braver than the first, who had examined their own hearts and knew that there can be no sympathy without egoism. It is the elder sister of sympathy, our own fear of death, which introduces us to it when the first danger threatens us in childhood. . . . There was also a third type—utterly frank, straightforward, and without false scruples. I received a letter from a relative of mine who said he had heard that I was about to “leave them.” In view of his serious situation, he hoped I would not forget him. I was to be sure and arrange for him to receive 300 pengoes on the day I “went away.”

That passage gives some sense of Karinthy’s graceful, self-mocking style, but it does not begin to convey the book’s greatness. For behind the lightness of the Mozartean patter lurks a Wagnerian drumbeat of mortal terror and pathos, stemming not only from the fear of death by illness but also from the encroaching darkness of central Europe in the mid-’30s. The book’s fleeting references to Hungarian Jews, the Third Reich, and the Krupp armaments factory are enough to send a deep chill through us.

Nor is such a method in any way accidental. Karinthy, who was married to a psychoanalyst-in-training and who excelled at transcribing his own weird dreams, gives as much credence to the unspoken and the un­­speakable as he does to the straight­­forwardly rendered. He is just the man you want for a de­scription of the onset of brain-tumor symptoms (his began as he was sitting in his favorite café, with the sound of an imaginary train bearing down on him). His report on his open-skull surgery—which a brilliant Swedish doctor, the memorably named Olivecrona, conducted while Karinthy was awake—leaves Hannibal Lecter and his ilk in the dust. Karinthy is his own best subject (which is a lucky thing, since his personality and his presence infuse every page, every paragraph, of this book), and he uses this occasion to delve into his brain in all sorts of ways: not just via the surgeon’s scalpel but with equally piercing analyses of his own complicated motives, dreams, pleasures, fears, and memories. The things he tells us might well be unbearable if he himself were not such good (if hair-raisingly scary) company throughout.

Oddly enough, a similar hospital-room scene occurs in Sarah Manguso’s The Two Kinds of Decay, a new memoir by an excellent young writer who has published two books of poems and a story collection. The incident takes place during the author’s years as an MFA student (though even to refer to a single “incident” and its “place” in time belies the structure of the book, which loops back and around itself, constantly skipping and revisiting). Manguso, having suffered for years from a possibly fatal disease that had finally gone into remission, suddenly found herself back in the hospital due to an overdose of illness-suppressing steroids. Confined to her room in a near-psychotic state (she hallucinated red-coated soldiers surrounding her bed), she received many visits from her classmates and friends—visits that she later forgot completely. Apparently, they were all there to bid her good-bye, because the head of the writing department, mishearing “renal failure” when the hospital representative mentioned “adrenal failure,” told all the other students to visit her before she died.

Actually, quite a bit of The Two Kinds of Decay is set in hospital rooms of one kind or another. A lively nineteen-year-old who enjoyed singing in her college choir, Manguso one day discovered that she had a blood disease so rare that it barely had a name, and that required she have transfusions every couple of weeks or months. Her life, for a few long years, became a never-ending cycle of hospital visits and home recoveries, during which it was never clear how long she had to live. Luckily for us, she writes this account from the far end of the illness, looking back on it from a position of physical strength, biting ferocity, and unsentimental wit.

Manguso, not being a mid-twentieth-century central-European boulevardier, is not as sardonically amusing about her illness as Karinthy is about his, but she does have her own powerful streak of angry humor. Occasionally, reading this book, I snorted with laughter, as when she described her parents’ visit to her in the psych ward one October. (The physical illness, or possibly its treatments, had brought on a state of clinical depression.) “That Sunday was the day of an important football game,” Manguso tells us, “and my father sat in the dayroom with the other mental patients and watched it. While he was there Ed the psychotic came out of his room in hospital pajamas and asked Paulette, a near-catatonic depressive, what she was going to be for Halloween, since it was only a week away. Ed said, I’m going as a mental patient.”

I am drawn to that phrase “with the other mental patients.” Other besides Sarah Manguso, or other besides her father, whose suffering on her behalf has practically driven him mad? Either way, the line has the kind of rich, hardworking ambiguity that is typical of Manguso’s stark style. She, too, knows how to leave things out: Her paragraphs are mostly two sentences or even one, her chapters a mere two or three pages. There is a lot of white space in this book, and it is like the white of a hospital room or a Chinese mourning dress—an ominous white, a melancholy white, the white of absence and of death.

Both Karinthy and Manguso use the occasions of their illnesses to take a deep look at their own characters. Sontag blamed society (along with its outgrowths such as literature, opera, and film) for making patients with cancer and tuberculosis feel as if their disease were somehow their own fault. But we do not need society to make us feel this. It is natural, when the body has turned against us in this way, to imagine that some inner and largely inaccessible part of the self is sabotaging the rest of the enterprise, and no amount of rational medical talk can entirely do away with that feeling.

Karinthy’s is finally the better book, I think, in part because it looks outward as well as inward—and looks inward with the knowledge and intelligence of a person who has already spent sufficient time looking outward. But Karinthy is from the past, and they do things differently there. For a modern-day American, and for such a young American at that, Manguso has addressed her illness with a surprising degree of sharpness and style. Hers is not an inspirational work, nor is it a medical thriller; its appeal lies elsewhere, in the realm of poetry set to prose’s rhythms and coping with prose’s concerns. That she is immensely talented is never in doubt, and that her illness is itself one source of this talent only adds to the book’s many ironies.

Wendy Lesser is the editor of the Threepenny Review. Her latest book, Room for Doubt (2007), is recently out in paperback from Vintage.

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