22 Aug, 2009

Malignant sadness

Posted by: admin In: Guardian

James Boswell, Charlotte Brontë, Charles Darwin, Florence Nightingale, Marcel Proust, and Andy Warhol – what do they all have in common? They were all hypochondriacs. Brian Dillon examines the relationship between creativity, illness and the imagination

On Saturday 6 August 1763 James Boswell, then aged 22, boarded the Prince of Wales packet boat at Harwich, on the coast of Essex. The ship was bound for the Dutch port of Helvoetsluys; from there, Boswell travelled to the university town of Utrecht where, at the insistence of his father, he was to study law. He was being punished for his scandalous life in London – he’d lately converted to Catholicism and fathered an illegitimate son whom he would never see – but none of this quite explains his dismal mood in the days before he left for Holland. His friend and mentor Samuel Johnson found him agitated, gloomy and dejected as they shared the journey to Harwich. The elder man was moved to remark of a moth that burned itself to death in a candle flame: “That creature was its own tormenter, and I believe its name was Boswell.”

The reluctant scholar’s spirits had sunk even lower by the time he reached Utrecht. He was not cheered by his lodgings, next door to the town’s half-ruined cathedral, and “groaned with the idea of living all winter in so shocking a place”. He woke the next day in profound despair and ran out into the streets, convinced he was going mad. He groaned aloud as he turned from the cathedral square, cried out as he crossed the city’s turbid canals and wept openly in the faces of passing strangers. In the weeks that followed, Boswell’s letters traced a pitiful decline; to his friend William Temple, he described a wretchedness that, he insisted, nobody who had not suffered it could fully comprehend. “I have been melancholy,” he wrote, “to the most shocking and tormenting degree.”

Boswell struggled to effect a cure for his Dutch malaise. He was certain at first that the trouble arose from his native laziness; his body seemed to revolt against the rigours of the diurnal round. He and Johnson had once imagined a machine for raising a sluggard body from its bed; now he determined on a vigorous regime of early-morning exercise and prompt voiding of the bowels after breakfast. At times, he thought his problem was a sexual one, but could not decide if the remedy lay in pious abstinence or “debauching a Dutch girl”. But the most striking thing about Boswell’s grim sojourn in Utrecht is the mania for planning, and for writing, that overcame him as his mood darkened. He filled journals and memoranda with desperate injunctions to better himself morally, socially and intellectually. He tried to parse his days in advance like sentences or equations, but his nights were filled with regret as his therapeutic schedule unravelled time and again.

What exactly was the nature of Boswell’s illness? By the end of his first term in Utrecht, he had self-identified as “splenetic”, “nervous” and “melancholy”. But 25 years later, in the pages of the London Magazine, he cut through his youthful confusion to what seemed a definitive diagnosis: throughout his life, he averred, he had suffered frequent bouts of “hypochondria”. The term would surprise us if Boswell were not already writing, in the essay in question, in the persona of the Hypochondriack: his sickly successor to Johnson’s Rambler and Joseph Addison’s Spectator. Quite what Boswell and his century meant by “hypochondria” is a vexed question. It was considered both a physical and a psychological distemper, an ailment at once of the imagination and the viscera, an extremely common disease that seemed also to set its sufferers apart from the ordinary throng of crocks and invalids. Hypochondria was a real sickness with all-too-actual symptoms – flatulence, constipation, headaches, vertigo, insomnia and palpitations among them – but it was also a painful amalgam of fear, delusion and a strange sort of insight into what it meant to be an embodied being.

In the two and a half centuries since Boswell’s collapse, medical lore and ordinary usage have narrowed our definition of hypochondria to a finer point of anxiety and deception. The idea that the hypochondriac suffered unwarranted apprehensions and false beliefs about his or (less frequently) her body had always been present; Nicholas Robinson, in 1729, writes of the patient’s “impertinent or groundless fears”. But today “hypochondria” usually means little more than this: a simple case of misplaced terror or mistaken conviction about one’s body. The contemporary hypochondriac is well known, anecdotally, to all of us. As a character type, he or she is pretty disreputable, a malingering drain on our capacity for patience and empathy, at worst a parasite on scarce healthcare resources.

Accordingly, hypochondriacs are almost always other people; few of us care to admit to the levels of delusion and self-regard that we deprecate in the personalities of the “worried well”. I tend to tell myself, for example, that my own case of chronic health anxiety is a thing of the past. In my teens and 20s, in the aftermath of my parents’ early deaths, I became convinced that I would be next to die, and began to interpret every stray discomfort as a sign of the dread disease that would take me away. It took a complete breakdown in my late 20s to convince me that the problem was not with my body at all, and my “symptoms” started to recede. And yet, I have to admit that even now, more than a decade later, fatigue or stress or a long period of unproductive work can bring on the old fears, and I slip too easily into former habits of thought, apprehension and assurance-seeking. At such moments, one conveniently forgets the rich history – from Molière’s Le Malade Imaginaire to the films and public persona of Woody Allen – of the hypochondriac as comic dupe of medical quackery or anxious existential somatiser.

The narrative of the refinement of “hypochondria” from luridly real disease to the name we give to an overactive medical imagination – and the parallel story of what we might still learn from our fears – begins with the Greeks, for whom the hypochondrium was the area just below the rib cage. That meaning survives in Robert Burton’s prodigious and vagrant Anatomy of Melancholy, published in 1621. In his chapter on the “Symptoms of Windy Hypochondriacal Melancholy”, Burton mentions “sharp belchings, fulsome crudities, heat in the bowels, wind and rumbling in the guts, vehement gripings, pain in the belly and stomach”. At the same time, the hypochondriac may suffer from terror and grief, or imagine himself invaded by some implausible parasite, such as a serpent or a frog. A century later, this combination of physical and psychological symptoms was well established among medical writers; George Cheyne, writing in 1733, goes so far as to suggest that together they comprise a specific “English malady”: a new type of oversensitivity brought on by modern luxury and ease.

When the Victorians spoke of “hypochondria”, they still intended an actual illness, and not merely the tenacious fear of such. Its symptoms, however, now more closely resembled what we might today call anxiety or depression, tended to shade off into the adjacent ailments of melancholy, hysteria and neurasthenia. More than anything, the hypochondriac was a creature of exaggerated sensibility. Take the figure at the dilapidated heart of Edgar Allan Poe’s The Fall of the House of Usher. Roderick Usher, the tale’s narrator tells us, is a chronic hypochondriac, painfully susceptible to the slightest sensations, sounds, tastes and smells; even the air about his rotting mansion seems to him horribly alive and malignant. Later in the century, it is the super-sensitive dandy who is diagnosed as hypochondriacal; in Joris-Karl Huysmans’s feverishly decadent 1884 novel Against Nature, the “hypochondria” of the aesthete protagonist, Des Esseintes, is another name for his morbid allergy to ordinary life.

What these haggard figures share is a sickly sense of their own exceptional nature, and a desperate desire for solitude. Victorian hypochondria seems to have been intimately connected to the need for creative reclusion, nowhere more so than in the lives and writings of certain notable female hypochondriacs. Charlotte Brontë, for example, claimed to have suffered her first hypochondriacal fit while teaching at Roe Head at 19. The illness, she wrote, “made life a continual waking nightmare”. Brontë put her crisis down to the drudgery of teaching, which left her little time to write; she felt, she said, “the heavy gloom of many long hours”. Readers of Jane Eyre may recall that on the night before they are meant to be married, Rochester dismisses Jane’s fear as a “hypochondria” born of excitement and fatigue. But the fullest expression of Brontë’s own malady comes in Villette, when the novel’s narrator, Lucy Snowe, her privacy invaded and her covert desires exposed, succumbs to “that strangest spectre, Hypochondria”.

Brontë seems to have meant by the word a debilitating perplex of panic and despair: something close to a “breakdown” in the modern sense. She was not alone in explaining her crisis in terms of a young woman’s total lack of social or intellectual autonomy. Florence Nightingale, in her anguished polemic Cassandra, deplored the domestic tyranny that constrained her early life: “To be absent from dinner is the equivalent of being ill. Nothing else will excuse us from it. Bodily incapacity is the only apology valid.” Nightingale did not describe herself as hypochondriacal, but her physical and emotional collapse on returning from the Crimean war in 1856 – as Mark Bostridge points out in his recent biography, she may have been suffering from chronic brucellosis – has something about it of Brontë’s “silent suffering”, though she deployed her enfeeblement more energetically. Illness allowed Nightingale to retreat from public life, all the better to campaign tirelessly for medical reform from the sanctuary of her sickbed at the Burlington Hotel. As Lytton Strachey wrote of her “She found the machinery of illness scarcely less effective as a barrier against the eyes of men than the ceremonial of a great palace.”

A similar sense of agonised but industrious seclusion surrounds Alice James. The younger sister of Henry and William was a lifelong invalid of such ambiguous symptomatology and temperament that she seems to languish apart, in a hypochondriacal category all her own: that of the ironic and cheerful malingerer. In her youth, she was diagnosed as hysterical, and submitted to the fashionable treatments of the day, but neither the rest cure advocated by the neurologist Silas Weir Mitchell, nor the exercise regime she endured at the New York clinic of Charles Fayette Taylor, could rid her of the desire to die, nor of her worsening physical symptoms. By her 30s, she was a confirmed incurable, plagued with disorders of the stomach and the spine, scarcely able to walk but still expressing her sarcastic and scurrilous worldview in her diaries and her letters, especially to William, who seemed best able to grasp the strangeness of her case.

What sets James apart from the ordinary female hypochondriacs of her era is her curious and affecting response to the news, at the age of 42, that she was really dying. On 27 May 1891, she was examined at her house in London by the renowned physician Sir Andrew Clark, who noted his patient’s long-standing “nervous hyperaesthesia”, her “spinal neurosis” and “rheumatic gout”, but now added to the litany a tumour of the breast that was sure to kill her. Four days later, James wrote to her diary: “To him who waits, all things come! My aspirations may have been eccentric, but I cannot complain now, that they have not been brilliantly fulfilled.” It was as if, after decades of obscure symptoms and vague prognoses, bound up no doubt with her peripheral status at the edge of a brilliant family, James truly began to live at the moment she knew she was dying. Her illnesses had been works in progress, and she was ready at last to deliver, in the form of her own death, a masterpiece to rival those of her brothers.

James’s insight into her own case, and her apparent presence of mind as the end approached – “Where does the fun come in?” she asked of death in her last days – are almost enough to disqualify her from a diagnosis of hypochondria; the patient is usually denied such a clear sense of his or her own valetudinarian tendencies. Charles Darwin, for example, seems to have evinced no grasp whatever of his hypochondriacal character, except to say, in an autobiographical fragment, that “ill-health … has saved me from the distractions of society and amusement”. Like Florence Nightingale, Darwin appears to have been afflicted with some authentic organic disease, though none of the suggested disorders he might have contracted on his travels have yet completely convinced. His actual illness is perhaps beside the point. The more intriguing aspect of Darwin’s ill health is to be found in his giving himself up to two high-Victorian enthusiasms: dyspepsia and the hydrotherapy that was meant to cure it. Darwin sedulously recorded his bouts of flatulence and dutifully travelled to Malvern, where he was sluiced inside and out with cold water.

Such attention to his own ailments puts Darwin in the select company of his century’s most creative hypochondriacs. Tennyson, Dickens, Wilkie Collins and Thomas and Jane Carlyle were all adepts of the water cure and keen watchers over their symptoms, real and imaginary. (Tennyson, for instance, became obsessed by the floaters that hovered before his eyes: “These ‘animals’ … are very distressing”, he wrote.) But they were trumped a few decades later, in terms of debility and detailed self-anatomising, by the recumbent figure of Proust, air-locked in his apartment on the Boulevard Haussmann, muffled in sweaters and choking on medicinal powders, surviving on little but coffee and cold beer as he struggled to finish his novel.

The details of Proust’s asthma-induced decline – the cork-lined room and nocturnal habits, his allergy to everything from household dust to a rough handkerchief – are so well known that it is easy to forget that A La Recherche du Temps Perdu is itself a sort of treatise on hypochondria and its artistic uses. Proust, it seems, was well aware of the contemporary explanation for hypochondria – it was thought at the turn of the century to be a disorder of the “common sense” or “coenaesthetic” faculty, by which we apprehend the evidence of our senses – and the book is full of instances of physiological as well as aesthetic oversensitivity. The Proustian hypochondriac feels the world press too keenly on him; he mistakes perfectly ordinary sensations for deep afflictions. (In Proust’s own case, the touch of a damp towel could send him into hypochondriacal paroxysms.) Proust’s genius consists partly in seeing the parallels between sickbed sensitivities and the delicate rigour of aesthetic feeling. What was a vague cliché for the Romantics – the artist’s pallor and susceptibility – becomes for Proust a matter of neurology.

In light of the importance of diseases of the “common sense” to psychiatrists of the late 19th century, it comes as a surprise that Freud wrote so little – and that somewhat confusing, if not confused – on the subject of hypochondria. He seems to have wavered both in trying to describe the condition and to suggest a possible explanation. In 1887, in a letter to Wilhelm Fliess, Freud claimed, rather vaguely, that hypochondria was just an adjunct symptom of neurasthenia. To Fliess again, in 1895, he suggested a sexual origin; but once more, that tells us little about how hypochondria might differ from other neuroses. A decade and a half later, Freud was proffering a neatly aphoristic definition – hypochondria was “the state of being in love with one’s own illness” – but also admitting that the whole subject was “suspended in darkness” and subject to “nothing but suppositions”.

The text of Freud’s in which we can grasp something of the full horror of a florid hypochondria, and learn a startling lesson about just how far an individual may stray from a realistic conception of himself, is his 1911 essay on the delusions of Daniel Paul Schreber, a German judge who suffered 35 years of almost constant mental illness, most of it expressed through bizarre beliefs about his body. “Psychoanalytic Remarks On an Autobiographically Described Case of Paranoia (Dementia Paranoides)” is based on Schreber’s own Memoirs of My Nervous Illness, in which the scarcely recovered jurist recounts his extraordinary symptoms. Diagnosed in middle age with a case of hypochondria, Schreber quickly declined: among countless fantastical notions, he thought he was turning into a woman, that he was destined to be impregnated by God, that his head had been colonised by “little men” and his stomach been removed so that food consequently accumulated in his legs.

Schreber’s agony is one extreme outcome of the hypochondriac affliction: a generalised and catastrophic misreading of the state of one’s physical being. For centuries, physicians had recorded cases that were hardly less weird. The “glass delusion” that flourished from the late middle ages onwards is perhaps the most striking. The patient imagined that he was made of glass, entirely or in part; Thomas Walkington, in 1607, wrote of a Venetian “fool” who was afraid to sit down for fear of shattering his “crackling hinderparts”.

By the middle of the 20th century, “hypochondria” had come to denote little more than the exaggerated fear of illness or the erroneous belief in its actual presence. (Freud’s ambivalence is partly to blame for this etymological shrinkage; it seemed that “hypochondriasis” was always explicable in terms of another, more comprehensively theorised neurosis.) The condition had meanwhile lost its frequent, and even fashionable, association with the artistic temperament. But that is not to say that hypochondria cannot still teach us something about the relationship between creativity and embodiment, illness and imagination. Consider the case of Glenn Gould, whose numerous eccentricities at the piano and in his daily life – Gould wrapped himself in scarf and gloves in the hottest weather, shrank from physical contact with others and kept voluminous records of his mostly imaginary symptoms – point to a physical retreat from the world that mirrors his retirement from the concert hall in 1964. Just as the recording studio then became Gould’s musical prosthesis, so his hypochondria allowed him to engage with the world at a comforting distance.

The visual artist of the late 20th century who knew most about the dangers and pleasures of physical proximity and aesthetic distance was Andy Warhol, and it is no surprise to discover that throughout his life he was a hypochondriac with a fretful and fertile imagination. The sources of Warhol’s bodily unease are well known – his hair loss, his bad skin, the physical and emotional scars from his shooting in 1968 – but his diaries record a much wider variety of fears: cancer, brain tumours, Aids (“the magic disease”) and the medical profession itself. (In the end, this last fear hastened his death: had he attended earlier to his inflamed gall bladder, he might have survived the rigours of the hospital; instead, he died of a heart attack in 1987, just hours after surgery.)

Warhol is also our hypochondriac precursor: his life and art appear to predict precisely the obsessions – weight, complexion, age, aesthetics, the virulence of new diseases and the efficacy of the cures for the old ones – of a society whose medical imagination is better informed than before, but just as susceptible to grisly images of illness and anxious prophylaxis against decay. Though we live at a time when hypochondria is routinely described as merely another anxiety disorder, to be treated with drugs and cognitive-behavioural therapy, we do well to recall the fundamental questions it invites us to ask about disease and well-being, and about the proper attitude to our mortality. Every historical period has felt itself to be an era of heightened hypochondriacal anxieties; the disorder remains current, but its manifestations shift and alter and overlap from one century, or one decade, to another. The history of hypochondria is an X-ray of the more solid and familiar history of medicine; it reveals the underlying structure of our hopes and fears about our bodies.

The young Boswell’s hypochondria lingered on, in fits and starts, for several months. He tried to distract himself by learning French and falling in love with two women at once; one of them also declared herself a chronic hypochondriac. He consulted notable physicians in The Hague and Leyden, who prescribed either total rest or constant activity. At length, he paid a visit to Jean-Jacques Rousseau, who concluded of his agitated admirer: “He is a convalescent whom the last relapse will infallibly destroy.” Years later, in the London Magazine, Boswell wrote, he said, solely to distract himself and others from their hypochondria: “I myself have been frequently terrified, and dismally afflicted in this way; nor can I yet secure my mind against it at gloomy seasons of dejection.”

Brian Dillon’s Tormented Hope: is published by Penguin on 3 September. He will chair a public symposium, ‘Culture and Hypochondria’, at Tate Britain on 18 September.

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