At war

Iain McGilchrist

  • The Faber Book of Fevers and Frets edited by D.J. Enright
    Faber, 364 pp, £12.99, November 1989, ISBN 0 574 15095 1

‘What, into this?’ It is the essential incongruity they capture which makes the words of Haile Selasse, Emperor of Ethiopia, Lion of Judah, as he was unceremoniously bundled by the revolutionary guards into the back of an orange Volkswagen van, so much more telling than other images of revolution – the lonely figure on the balcony of the Winter Palace, besieged by his hungry people, the voluptuary tyrant shot through his immaculate shirt-front at his own banqueting table and bleeding into the fish, the scurrying fugitive clutching the crown jewels as he escapes to Claridge’s in his private jet. All too single, the dramatic images miss their mark. ‘What, into this?’ The words are those of the king of infinite space up against his nutshell, the ‘etherial spirit of man’ as Carlyle put it, up against ‘two or three feet of sorry tripe full of–’, the voice of whatever it is in us which in love, in religion and in ill health, sees itself as emperor, betrayed by his own base subject, the body.

Mind and body have been at war in the literature of love and religion for millennia, and it has been the body that has come off worse. Marvell’s ‘A Dialogue between the Soul and Body’ is almost unique in allowing the body its say, in giving it in fact the last word. If Virginia Woolf is right that illness is one of the great neglected themes of literature – and the evidence from Enright’s literary anthology of illness suggests she is – it is probably because it is precisely in illness that the body gets to have its say. Love and battle and jealousy and the rest of the well-worn literary themes give the soliloquies to the soul. Only illness – not even death – is subversive in this way. Hence the fascination of illness: we live so close to the body that we literally cannot see it. Only when it steps out of line are we able to see what it is like – this enigmatic element whose form, substance and functioning we had and have no part in determining.

A headache: ‘memory, reason, every faculty of my intellectual part, is being whelmed in muddy oblivion ... Is the soul something other than the mind? If so, I have lost all consciousness of its existence.’ Gissing’s headache gives him enough space, however, to philosophise: ‘the very I, it is too plain, consists but with a certain balance of my physical elements, which we call health ... If I chance to become deranged in certain parts of my physical mechanism, I shall straightway be deranged in my wits; and behold that Something in me which “partakes of the eternal” prompting me to pranks which savour little of the infinite wisdom. Even in its normal condition (if I can determine what that is) my mind is obviously the slave of trivial accidents.’

At once trivial, and yet capable of enslaving the imperial soul – the indignity and perplexity is captured with good humour by Peter Reading:

I used to pepper my poetics with sophisticated allusions to dear Opera and divine Art (one was constantly reminded of A. du C. Dubreuil’s libretto for Piccinni’s Iphigenia in Tauris; one was constantly reminded of Niccolo di Bartolomeo da Foggia’s bust of a crowned woman, doubtless an allegory of the Church, from the pulpit of Ravello cathedral, ca 1272) but suddenly these are hopelessly inadequate. Where is the European cultural significance of tubes stuck up the nose, into the veins, up the arse? A tube is stuck up my prick, and a bladder carcinoma diagnosed. One does not recall Piccinni.

The mind rightly rebels against this rebellion. The ensuing counter-revolution is the substance of Enright’s collection.

Good humour is one of the mind’s most effective ploys when faced with the dereliction of the body – that and the stoical indifference exemplified by the ninth-century Chinese poet Po Chü-I, who, stricken with a paralysis, tells his friends: ‘there is no cause for so much sympathy ... All that matters is an active mind, what is the use of feet? By land we can ride in a carrying chair; by water be rowed in a boat.’ Imperial to the last, if the mind is usurped by its own body there are at least the bodies of others to rely on. In the whole collection it is only Kipling whose anti-intellectualism, populist inclinations and cult of endurance side with the body, in a ‘Hymn to Physical Pain’ for the relief Pain offers from ‘the Soul’s distress and memory of her sins’.

The most dramatic instance of the mind/body revolution is that of mental illness – a rich vein which Enright mines to good effect. Edmond de Goncourt, describing how his brother Jules in his last illness returned to ‘the cruel egoism of childhood’, notes with profound distress that ‘it was not enough that his busy mind should stop producing, should cease creating, should be inhabited by nothingness. The human being had to be stricken in the qualities of grace and elegance which I imagined to be inaccessible to sickness.’ The image he uses is telling: ‘as in the old vengeance of the gods, all the aristocratic virtues in him ... had to be degraded to the level of animality’ (my italics).

The most devastating productions of the human mind are those poems which result from the marriage of mental suffering and poetic genius. Hopkins and Clare are here, and so are Cowper’s ‘Lines Written upon a Window-Shutter at Weston’ –

Me miserable! how could I escape
Infinite wrath and infinite despair!
Whom Death, Earth, Heaven and Hell consigned to ruin,
Whose friend was God, but God swore not to aid me!

– and the, to me, unknown poem by Ivor Gurney, addressed to God, which he wrote in Barnwood Mental Hospital, as much as a portrayal of what used to be done to patients in the name of sanity as of the insanity itself:

Why have you made life so intolerable
And set me between four walls, where I am able
Not to escape meals without prayer, for that is possible
Only by annoying an attendant. And tonight a sensual
Hell has been put on me, so that all has deserted me
And I am merely crying and trembling in heart
For death, and cannot get it. And gone out is part
Of sanity. And there is dreadful hell within me.
And nothing helps. Forced meals there have been and electricity
And weakening of sanity by influence
That’s dreadful to endure. And there is Orders
And I am praying for death, death, death,
And dreadful is the indrawing or out-breathing of breath
Because of the intolerable insults put on my whole soul,
Of the soul loathed, loathed, loathed of the soul.
Gone out every bright thing from my mind.
All lost that ever God himself designed.
Not half can be written of cruelty of man, on man,
Not often such evil guessed as between man and man.

Gérard de Nerval has a dream in which doctors shout at him to confess his illness, and are satisfied only when ‘I agreed to let them classify me under a disease defined by the doctors and called either Theomania or Demonomania in the medical dictionary’.

Faced with this suffering, we may find it hard to maintain that life’s a jest and all things show it. It is, of course, the puritanical direction of Rosaline in Love’s Labour’s Lost that Berowne should tame his frivolity by attempting to ‘jest a twelvemonth in a hospital’. Enright’s collection, while not exactly uproarious, shows the triumph of good humour over intolerable circumstances. E.B. White discovers that ‘there is a gadget in every hospital set-up called a “colon lavage”, and it is exactly the right size and shape for cooling splits of champagne ... You have to know these things, otherwise you die.’ Sydney Smith, as one would expect, finds wit even in the excruciating pains of gout, the ‘only enemy I do not wish to have at my feet.’ W.N.P. Barbellion, alias the diarist and biologist B.F. Cummings, who died of multiple sclerosis at the age of 30, treated his afflictions with a bitter humour. A woman on a bus, ‘exposing a large red udder’, offers it to her infant with the words ‘Come on, there’s a good boy – if you don’t I shall give it to the gentleman opposite.’ ‘Do I look ill-nourished?’ Barbellion asks. Apparently he does: a leg is so dead ‘that if you put my body out in the sun the flies in error would come and lay their eggs on me.’ To ridicule doctors he need only list their own description of the symptoms of indigestion: ‘excessive pandiculation, excessive oscitation, excessive eructation, dyspnoea, sphygmic flutters, abnormal porrigo and a desiccated epidermis’. The 17th-century accounts furnish their own unintentional humour. Hooke, ‘bloody windy and melancholy’ despite taking clysters, brews of scurvy grass and plumb broth, though ‘much relieved by blowing out of my nose a lump of thick gelly’, only in the end recovers after drinking ale and falling asleep, of which he comments ‘dreamt of riding and cream’. Another of Enright’s inclusions, derived from the index to the New England Journal of Medicine, demonstrates that there is no pleasure without its pain: ‘Cyclist’s Pudendum, Dog Walker’s Elbow, Jogger’s Nipple, Crab-eater’s Lung, Space Invader’s Wrist, Unicyclist’s Sciatica, Jeans Folliculitis, Flautist’s Neuropathy, Urban Cowboy’s Rhabdomyolysis’.

Language is an essential tool for limiting the power of illness over our minds, which is partly why patients sometimes seem as happy to know the name of their disease as to be offered a cure. Attempting to convey the horrors of physical suffering in words, we are caught up in the ‘cool web of language which winds us in’. It is good to know that even under the dehumanising effects of such suffering, literary style remains true to the man. Henry James, who in his last illness, believed he was Napoleon, and gave orders, not for the field of war, but for the redecoration of the Tuileries, is ‘smitten with a violent attack of the atrocious affection known as “shingles” ’. Sydney Smith gets hay fever, and ‘my fear is of perishing by deliquescence – I melt away in Nasal and Lachrymal profluvia.’ That illness doesn’t affect style is perhaps not surprising in view of the long-held belief that illness can heighten the creative imagination, as Baudelaire noted of the intensity of sound and colour experienced during convalescence. It is not just approaching health, however, but approaching death which clears the sight. ‘I muse with the greatest affection on every flower I have known from my infancy,’ Keats writes in a famous passage, ‘their shapes and colours are as new to me as if I had just created them with a superhuman fancy.’

The illness itself is usually left out of the creative turn which it inspires. To rend the cool web of language requires a ferocity of inward gaze and outward expression which suggests either an element of madness or a great degree of hard-headedness, and the best descriptions of both kinds come from women. Emily Dickinson characteristically produces the most electrifying phrases:

I felt a Cleaving in my Mind –
As if my Brain had split –
I tried to match it – Seam by Seam –
But could not make them fit

Or:

After great pain, a formal feeling comes –
The Nerves sit ceremonious, like Tombs

Alice James, describing a dental extraction, perhaps instinctively adopts the Dickinsonian manner: ‘I had a tooth out the other day, curious and interesting like a little lifetime – first, the long drawn drag, then the twist of the head and the crack of doom!’ The extraordinary fortitude of Fanny Burney, who underwent a mastectomy in Paris in 1811 and then felt able to describe it, yields the most astonishing account in the whole of medical literature: ‘Yet – when the dreadful steel was plunged into the breast – cutting through the veins – arteries – flesh – nerves – I needed no injunctions not to restrain my cries. I began a scream that lasted unintermittingly during the whole time of the incision – – I almost marvel that it rings not in my Ears still! so excruciating was the agony. When the wound was made, – the instrument was withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp – forked poniards, that were tearing the edges of the wound.’ What is perhaps most remarkable about the piece is not its physical accuracy (‘Oh Heaven! – I then felt the Knife [rack]ling against the breast bone – scraping it!’), but its evocation of the feelings of the surgeon, who spoke to his attendants throughout ‘in a tone nearly tragic’, and at the end appeared ‘pale nearly as myself, his face streaked with blood, – its expression depicting grief, apprehension, – almost horrour’.

The only piece nearly as harrowing is Waiblinger’s description of Hölderlin in his madness. The author of the Hyperion could be found hunched over a piano keyboard, executing some trivial phrase again and again while ‘rapid convulsive cramps’ carried him up and down the keyboard ‘with the speed of lightning’, until ‘his soul has become tender, his eyes suddenly close, his head is lifted, he seems about to languish and fade away, and he begins to sing. In what language I could never discover, often as I have heard it; but he did so with extravagant pathos, and it made one shudder in every nerve to see and hear him.’ At other times he would regale his visitors with readings from Hyperion, and when he had grasped a passage he would ‘start to call out, with passionate gesticulations, “O beautiful, beautiful, Your Majesty!” and then read on, suddenly interjecting: “Look, gracious Sir, a comma!” ’

The indifference of the heavens is hard to accept, and the belief that there is a divine logic to our sufferings roused Samuel Johnson to his finest diatribe, the review of Soame Jenyns’s ‘Free Enquiry into the Nature and Origin of Evil’, extracted here by Enright. ‘Many a merry bout have these frolic beings at the vicissitudes of an ague, and good sport it is to see a man tumble with an epilepsy, and revive and tumble again, and all this he knows not why.’ In a letter to his mother Thackeray writes: ‘I can’t request any special change in my behalf from the ordinary processes, or see any special Divine animus superintending my illnesses or wellnesses. Those people seem to me presumptuous who are forever dragging the Awful Divinity into a participation with their private concerns.’ If God can be expected to intervene to save you from a burst appendix, what is he doing allowing the next man to suffer a stroke? The absurdity is particularly keen when it is a child who is ill, and Laing describes having to tap the ventricles of a ten-year-old boy with malignant hydrocephalus, whose one request of God was that he should live long enough to finish The Pickwick Papers. He died before it was half-finished.

Divine malignity would be something to take up arms against: indifference is by its nature hard to frustrate. Yet doctors, in my experience, rarely see themselves as engaged in a battle on their patients’ behalf. More often, and more honestly, they see themselves as importing interested skill into an area of divine neglect. This has its dark side. Some of Enright’s collection refers to this darker side, from the use of electric shocks in the 18th century (‘universally effective’ in an episode of mass hysteria) to Brigid Brophy learning that she had multiple sclerosis in the 20th. ‘He that sinneth before his Maker, Let him fall into the hands of the physician.’ Miss Brophy finds the experience chilling:

Indian files of medical students practised their gavel technique one by one on the reflexes of my knees. Swarms at a time of medical students settled about my bed. I was asked to walk about the ward for them, which I did leaning on the umbrella I had taken into hospital, and they were asked to note that my way of walking was ‘highly characteristic’. I did not know what of.

When she is finally told the diagnosis, she is told not that she has MS, but ‘that the results of all the tests thoroughly conformed with my having it – a presumably legalistic formula that reminded me of my sending down. My college wrote during a vacation to say not that I had been sent down but that I should be if I attempted to return to Oxford when the new term began.’

There are also accounts of great compassion in the treatment of the sick, but tenderness is an acute – not a chronic – response to the ill. ‘The sadness comes,’ Francis King writes, ‘when one realises the tenderness is not something personal, a tribute to some quality in oneself, but merely professional. As one gets better, so inevitably the manner of one’s nurses – now concerned with other patients in crisis – becomes brisker, more peremptory.’ His words echo Charles Lamb’s exclamation: ‘How convalescence shrinks a man back to his pristine stature!’

There are many, however, for whom being ill is itself a grave loss of stature. This is particularly true of the mentally ill, who very often neither feel a legitimate demand on the compassion of others nor receive it. For them illness is not to lose peace and liberty and self-respect only, but their own selves – the continuous history, their past, which constitutes their identity. An entry by J.S. Mill recounts how, under the experience of profound depression, he lived, as it were, automatically and could remember next to nothing of the time that had passed. He felt that his was ‘not an interesting, or in any way respectable distress’, that ‘there was nothing to attract sympathy,’ and therefore no point in seeking advice, which ‘if I had known where to seek it, would have been most precious’.

That illness is a neglected theme in literature is attested by the fact that almost all the entries in this anthology are from diaries, letters and notebooks. Not finding enough of other men’s flowers to pick, Enright has picked his own, under such transparent headings as ‘anonymous patient’, former resident of Singapore, and even, characteristically, ‘MS found in a bottle’. It could be said of many of the moving, funny and disturbing passages in this book that they were, like manuscripts found in a bottle, strange, fragmentary communications written in crisis, consigned to the operations of chance, signalling the remoteness and inaccessibility of suffering.