Feb/Mar 2010

Medicine Clan

Brian Dillon explores the painful world of imaginary illness

Daphne Merkin


The fact of our embodiment is something we all face with greater or lesser anxiety. We navigate the world as both thinking minds and reacting bodies, with room enough for heady distortion between them. The body, in its declared state of health or illness, can be used to bolster our psychological defenses; a slew of diagnoses can be called on to explain why we're not functioning as we think we should be. That said, though interested in all the mentally agitated, I have never felt particularly sympathetic to the suffering of hypochondriacs, having always consigned them to the vast corpus of the "worried well"—those who, having little real with which to concern themselves, treat their colds as near-fatal illnesses. Yet after reading Brian Dillon's superb collection of essays, The Hypochondriacs, I will never look on this elusive condition (part of its intrigue is its amorphousness) in the same way again, if only because I see bits and pieces of myself writ large in the afflicted figures he deconstructs. Indeed, I can now add my own voice to the collective: L'hypochondriac, c'est moi.

Beginning with "A History of Hypochondria," Dillon describes the way the disease (if disease it be) first presents itself as no more than a flickering suspicion—"Perhaps you and your body were alone in the bathroom, with leisure to examine your naked flesh, time enough for your fingers to find a lump where no lump should be"—that hardens with the passage of days into fear, then certitude. Once you are persuaded that you do indeed harbor the symptoms of a disease, everything begins to revolve around this conviction. "At times you succeed in distracting yourself.… But your thoughts lack the lightness or velocity to escape the gravitational pull of your fear." You become a professional patient—or hypochondriac, a "pretty disreputable" character type who is "well known, anecdotally, to all of us."

We learn that hypochondria is an ancient concept, going back to Plato, and that the word originally referred to digestive dis-orders, linking it to the hypochondrium, situated in the abdomen. In the sixteenth and seventeenth centuries, theorists began to associate hypochondria with a melancholic character, fear, and sorrow, a view given its most significant iteration in Robert Burton's The Anatomy of Melancholy. But even Burton thought of hypochondria in terms of a somatized disease, albeit one that included psychological symptoms. Our contemporary sense of hypochondria as a disease strictly of the imagination—as a fear of illness rather than an illness itself—came into existence only in the nineteenth century, although at that point the term still alluded to a greater variety of ailments (specifically depression) than it does today.

The hypochondriacs Dillon has chosen to document range across the centuries, from the 1780s to the latter half of the twentieth century. They include three women and six men, among them several writers, a pianist, an artist, a judge, a scientist, and a nurse. Some, like James Boswell and Florence Nightingale, used their self-diagnosed hypochondria as a spur to greater industry; others, like Alice James, Marcel Proust, and Charlotte Brontė, used it to find the solitude necessary to sustain their creative lives. Yet others, like Glenn Gould and Andy Warhol, exhibited their hypochondria in a fetishized approach to their own bodies, leading to a terror of ordinary engagement. Then there is Charles Darwin, whose concern with his own flatulence was one side of his hypochondria; the other was a battery of ailments, ranging from boils to nausea accompanied by vomiting for which no diagnosis (or cure) could be found. Dillon also presents the German jurist Daniel Paul Schreber, whose original diagnosis of hypochondria swelled to include a delusional and paranoid cosmology in which his body was attacked from within by all sorts of things—"little men" as well as "flights of rays"—until finally, after thirty-five years, Schreber imagined himself transformed into a woman. (He wrote an account of his lurid experiences, Memoirs of my Nervous Illness, which was the subject of an essay by Freud before becoming a classic of psychiatric literature in its own right.)

The feckless and endearing Boswell seems to have conflated his sense of the "distracted horrors" of hypochondria with a besetting malaise that resulted in indolence, melancholy, and general dissipation (this last included carnal indiscretions, which his conversion to Catholicism at eighteen did little to stem). His pal and mentor, Samuel Johnson, ever acerbic in his affections, compared the twenty-two-year-old Boswell's suffering to that of a moth that burns itself to death in a candle flame: "That creature was its own tormenter, and I believe its name is Boswell." As befits someone of his time and station (mid-eighteenth century, upper middle class) Boswell thought of his disease, considered by many to be a sign of social distinction, as both real and imagined; he resolved to combat it by way of diligent application to an "Inviolable Plan." He developed a "rage for routine," as Dillon describes it, in order to quell his fear of dissolving into formlessness—"a character without distinct lines, a soul without design, a body without borders." To this end, Boswell devised a series of strict schedules, advocating early rising, studious reading, constant exercise, and meticulous journal keeping. "From this time let plan proceed: seven to eight, Ovid; eight to nine, French version; ten to eleven, Tacitus; three to four, French; four to five, Greek." Needless to say, his resolution was as weak as his ambitions were grand. Years later, Boswell would take on the persona of "The Hypochondriak" in a series of essays written for the London Magazine, spinning gold out of dross—or, at the very least, literature out of an excess of jangling nerves.

As for Charlotte Brontė, who diagnosed herself as suffering from "hypochondria—a most dreadful doom," Dillon seems unclear as to what exactly she meant. Certainly the illness (it is mentioned once in Jane Eyre, when Rochester characterizes Jane's flushed cheeks and glittering eyes as symptoms of hypochondria) encompassed depression, but Dillon notes that by the time Brontė used the designation, in the mid-1840s, it "had come to denote such a dizzying perplex of symptoms and causes that it is almost impossible to picture clearly just what it conjured up for the average physician and his worried patient." Hypochondria was a fashionable malady, in short—its name a catchall that connoted some physical symptoms but also an underlying unease. (It would cede right of way to "hysteria" later in the century.) In Brontė's Vilette, Lucy Snowe's mood swings between a vigilant alertness and sudden descents into weakness and delirium; her despondency or "low spirits" are categorized as hypochondria, but these abject periods have their uses. "Her breakdowns are the necessary conditions," Dillon suggests, "for her making her way in the world; what she calls her hypochondria is a way of retreating into herself, the better to emerge transformed socially, professionally or romantically." Similarly, Brontė's own torments—which included "rampant and violent headaches" and "extreme sadness"enabled her to retreat from responsibilities and duties, allowing her to carve out a private imaginative space within the constricting order of her life: "It is only by falling ill that she can find for herself the right kind of solitude, in which to invent her future self."

Hypochondria, then, emerges as a convenient—and sometimes alarming—obfuscation of individual needs deemed unpalatable or inappropriate by the culture at large. "What exactly was the matter with Florence Nightingale?" is the question Dillon poses in the middle of his chapter on this formidable creature, who after returning from her monumental labors among the typhus-ridden wounded during the Crimean War promptly took on the demeanor of unspecified invalidism. Dillon could easily ask the same question of any of his case studies (with the exception of the mentally ill Schreber); the simple query encapsulates the core puzzle of identity, whether it be that of the unsociable explorer (Darwin) or of the competitive but creatively self-abjuring diarist (James). "Apparently lingering at the point of death for decades," he writes of Nightingale, "she quickened the hands and minds of her helpers with the thought that each campaign was her last, then survived to lead the next charge."

At the heart of this thought-provoking and gracefully written book is a meditation on the lengths to which we go in order to exert control in a world governed by arbitrary conventions and restrictions, thereby gaining access to our desires and obtaining relief from our fears. I found the chapters on Gould and Warhol to be the most original and unexpectedly moving ones, in part because they humanize two larger-than-life, profoundly eccentric characters by revealing the vulnerability—the intricate dance of interpersonal approach and avoidance—that manifested itself in their florid mannerisms. Both were avid students of their own physical beings, filled with anxiety at the ever-present possibility of contagion or disease. Behind this anxiety lurks nothing less than the specter of death, of course, and in their grappling with this morbid reality, Gould and Warhol—and indeed all nine "tormented lives" that unfold here—seem, paradoxically enough, more courageous than the comfortably embodied among us could ever hope to be.

Daphne Merkin, a novelist and cultural critic, is a regular contributor to the New York Times Magazine.

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