Writing While Ill: Pathography, Then & Now

Thomas Larson Click to

Thomas Larson---critic, memoirist, and journalist---is the author of The Saddest Music Ever Written: The Story of Samuel Barber's "Adagio for Strings" (Pegasus Books) and The Memoir and the Memoirist: Reading and Writing Personal Narrative (Swallow Press). He is a long-time staff writer for the San Diego Reader and teaches in the MFA low-residency program in creative nonfiction at Ashland University. He holds workshops on memoir writing as well as delivers multimedia talks on Samuel Barber, the musicians of the Titanic, the craft of nonfiction writing, and the "social author" in the digital age throughout the United States.

Virginia Woolf begins her 1926 essay, “On Being Ill,” with a doozy of a sentence.

Considering how common illness is, how tremendous the spiritual change that it brings, how astonishing, when the lights of health go down, the undiscovered countries that are then disclosed, what wastes and deserts of the soul a slight attack of influenza brings to view, what precipices and lawns sprinkled with bright flowers a little rise of temperature reveals, what ancient and obdurate oaks are uprooted in us by the act of sickness, how we go down into the pit of death and feel the waters of annihilation close above our heads and wake thinking to find ourselves in the presence of the angels and the harpers when we have a tooth out and come to the surface in the dentist’s arm-chair and confuse his ‘Rinse the mouth—rinse the mouth’ with the greeting of the Deity stooping from the floor of Heaven to welcome us—when we think of this, as we are so frequently forced to think of it, it becomes strange indeed that illness has not taken its place with love and battle and jealousy among the prime themes of literature.

One reason I quote this chunk at length—the paragraph it begins goes on for three pages and contains twenty-one sentences, many heavily semi-coloned—is to behold Woolf’s lapidary craftsmanship. It’s a stunningly stylized lead, rich in Proustian intricacies of phrasal singing and delayed cadence. Its craft echoes the essay’s point: she probably wrote this piece only after she recovered. I doubt such a sick person could have shaped such formal lines. It’s further curious that while the writing suggests surviving an illness has been productive—she seems almost caffeinated with getting well—Woolf, nonetheless, doesn’t tell us how bad off she was. Was it the flu, a toothache, a chronic condition, desolation? The insights she claims she has while ill (going to “undiscovered countries,” undergoing “spiritual changes”) seem dependent on the severity of the illness she bore (“how we go down to the pit of death and feel the waters of annihilation over our heads”).

Throughout her six decades, Woolf’s ailment was depression, which, in her diaries, she calls the “glooms.” Depression kept her from writing and socializing; the pain structured her “amphibious life,” half in, half out of bed. (As everyone knows, to escape its torturous cycle, Woolf drowned herself in 1941.) And yet even the “glooms,” once outlasted, were material to the novelists. In her diary she says, “These curious intervals in life—I’ve had many—are the most fruitful artistically—one becomes fertilized.” Her diary records then that the “best of these illnesses is that they loosen the earth about the roots.” In fact, in 1926, the time of “On Being Ill,” she was at work on To the Lighthouse, perhaps the closet peer to her finest work, Mrs. Dalloway.

Most, if not all, of Woolf’s essay analyzes her illness and—counter to her core idea—avoids a physical description of whatever ache has brought her to the writing. One reason, she states, is that the sick are too short-tempered to read or write prose: “Illness makes us disinclined for the long campaigns that prose exacts.” Another way to put it—if laid low, we (writers) can’t essay about our ailing self because we don’t feel good enough to write. Feeling well in the body (a redundancy, I know) makes our minds work; mental effort, on its own, cannot make an illness subside. The circumlocution makes a kind of sense. It’s only when we’re well that we chart the descent we have climbed out of. The brightest insight, then, is that Woolf doesn’t know why literature has shunned disease—and its sensate actuality—so completely. But knowing this is true is what engages her. “The merest school girl,” she notes, “when she falls in love, has Shakespeare or Keats to speak her mind for her; but let a sufferer try to describe a pain in his head to a doctor and language at once runs dry.”

A rigorous essayist, Woolf fleshes out every nuance of this point (her style might be termed an enraptured discursive wandering, cavorting as analysis), namely, that we are not drawn to make art of, or while, we wallow in misery. Excepting nineteenth-century ill souls like Dostoevsky’s Raskolnikov and Hardy’s grotesque boy, Father Time, literature and illness are close but unpartnered. Literature can’t cope with disease as a “prime theme.” The lacuna may be why she and other modernists pinnacled the stream-of-consciousness technique—to intimate a mentally or physically sick person’s woe via the muddle of one’s thoughts. Such was presented in the paranoid delusions of the suicidal ex-soldier, Septimus Warren Smith, in Mrs. Dalloway. But the essayist’s technique (at least, Woolf’s and her tradition) was reserved for thinking about its subject. One’s anguish is not embodied; it is reflected—more, reflected upon. Woolf marks this while pondering Proust: “Literature does its best to maintain that its concern is with the mind.”

Such maintenance, Woolf argues, exemplifies the healthy mind, in which “our intelligence domineers over our senses.” As she says, we seem to write (or our literary tradition tells us to write), “always of the doings of the mind; the thoughts that come into it.” And, of course, such doings are more rationally constructed than wildly thrown up in literature. Emotions may be dramatized, but they are rarely as meaningful as reason is to a character. Physical health is one-dimensional. Anyone who has read the undisciplined artistic jottings among the mentally ill, whose damaged minds have taken over their rationality, knows this. What’s more, even though Woolf’s or Proust’s or David Foster Wallace’s sentences have palpable effects on us, language keeps the thinking apparatus going, using sensate experience merely as a context for the vagaries of one’s thought. (I find it fascinating that these three writers were depressives, their long bouts of suffering seeding their work.) Still, sickness doesn’t quite give us the words for sickness. But being ill helps us portray the gap between body and mind, between self and shared experience, between what we do and what we don’t want to be. This is Woolf’s essay’s thesis.

We feel good one day, lousy the next; literature doesn’t care what the body experiences day-in and day-out. Such sensations are, in a sense, anti-literary. Let me get at this by comparing our experience of our bodies to our experience of music. In music, its passage is everything, reflecting on it, nothing. In music, we are locked in the present, slave to its ongoingness, seduced by its quotidian drive. We don’t need music to think; we need music to feel. How much anguish and joy, mustiness and light, longing and satisfaction, is borne by a listener in the twenty-eight minutes of Arnold Schoenberg’s Verklärte Nicht? Could it be that the body, and its musical aptitude, shrugged literature off long ago as a source of emotional immediacy? Has literature moved away from speech (the improvised) and into writing (the composed) for better or worse? Has the body preferred music, drama, film, and dance to the page-bound tongue?

The corollary with language is, we need words to shape what we feel in words. Once shaped, words tend to mean more than how they’re said. And yet, ironically, emotion is not excluded from writing—which Woolf the journal-keeper knows well.

Proof that the feeling domain exists is not in Woolf’s essays but in her diary. There, we find her embodying her depression, albeit primitively. Consider this fragmented, literal cry of the “glooms,” from an entry entitled “A State of Mind,” Wednesday 15 September, 1926:

Woke up perhaps at 3. Oh its beginning its coming—the horror—physically like a painful wave swelling about the heart—tossing me up. I’m unhappy unhappy! Down—God, I wish I were dead. Pause. But why am I feeling this? Let me watch the wave rise. I watch. Vanessa [her sister]. Children. Failure. Yes; I detect that Failure failure. (The wave rises). Oh they laughed at my taste in green paint! Wave crashes. I wish I were dead! I’ve only a few years to live I hope. I cant face this horror any more—(this is the wave spreading out over me).

What a contrast to the operatic opening of “On Being Ill.” From essay to diary, we have the former, highly literary and literate, and the latter, definitely not that—not with its repeated words, its clumsy syntax, its overdramatic exclamations, its indulgent whining. Such is not what we’re accustomed to from the female genius of Bloomsbury. Can it be this simple, this overt: the essay/the novel perform a literature of the mind while the diary/letter/journal engage a language of the body? The sufferer in the diary (I’m certain Woolf would agree) has no equivalent voice in the essay. Different sports entirely. It’s almost shocking to hear Woolf’s messy complaints in her diary: she is upset, stymied, histrionic. No, don’t go back to work. You’ll sound crazy. Wait until you’re well. Mere worry is uncomely, unshaped, compared to the essay’s burnish. Yet what I love about the diary’s rawness is how it reduces our comeliness, our shapeliness, our burnishing. The diary invites in the person the essay rejects.

How do we make sense of language’s expression of the body (Woolf’s diary) and literature’s avoidance of the body (Woolf’s essay)? What I think she is suggesting in “On Being Ill” is that the glooms she undergoes do not translate to experiences she has, or would like to have, as a writer. Woolf would like to sing of being sick but, instead, she invents a short symphony about literature’s missed effort—hers included—to embody illness. She shows us that a literature of those living with cancer, heart disease, or profound loss is possible. It’s just that she’s not the writer who will accomplish it.

Let me suggest a few reasons why I think she’s not the one. First, Woolf tells us as much in her essay. She identifies herself as a woman of “English birth,” and, thus, cannot, perhaps will not, like her contemporaries, “take liberties with the language” and mimic the infection that’s laid her low. (She suggests that American writers, freed from Brit-Lit conventions, might take such liberties.) Were she to do so, Woolf says, she must find “a new language,” “more primitive, more sensual, more obscene” than the style she writes in, often, in homage, to the essays of Hazlitt, Arnold, and Beerbohm. Second, she realizes there’s “a childish outspokenness in illness,” but she cannot resort to such childish, diary-like phrasing herself. Even though health is “the genial pretence” of civilization, Woolf is not game enough (she is in her fiction) to wield the possibilities that sickness offers the writer. For example, when she notes that “lying recumbent, staring straight up, the sky is discovered to be something so different from this that really it is a little shocking,” she seems content with the self-indulgence. Bed-rest is a respite from writing, not a new subject. And third, such uncertainty about her illness pushes Woolf to re-elevate the style, to remind herself and her readers that artful writers avoid the poor-me complaints anguish and pain force us into. An illness’s value is fleeting. Its “rashness” is momentary, when, she says, we disregard what the critics have said about Shakespeare, and, nursing a temperature, are left with “nothing but Shakespeare and oneself.” If only we could read Shakespeare during our a bout of influenza or diphtheria, how abnormal he might sound!

Any new writing whose untrod expanse sickness might unleash remains untrod in Woolf. By choice, by character, by a lifetime spent perfecting her style. This inherent reticence with the essay is echoed by her most capacious biographer, Hermione Lee, who notes in her essay on Woolf’s essays: “Woolf does not speak about herself directly. She never refers to herself in her essays as a novelist, or to her life as Virginia Woolf, or to her personal relations with anyone she is writing about. She speaks from the ground of the literary, the historical, and the cultural, not the personal. Yet her character, her experience and her voice come very close to us.”

I get this closeness; it’s why I, too, continue to read her. But we’re still left with literature’s neglect of the ill body. It also reminds us that the literature of Woolf’s era was far less modern than we think. Its practices remained puritanical, chastened, stultifying, despite many eminent novels and poems before Woolf, Pound, Joyce, and Eliot. Woolf upholds the essay’s long tradition of pedastaling the dispassionate observer. From Isaac Newton to E. M. Forster, the English essay corralled only its worldly subject—remaining above it all, resisting any descent into the inner self of the essayist. In the phenomenal formal gold Woolf mined in her novels, it seems she found no outlet in nonfiction to massage or manage her illness.

Fifty-two years later, such restraint is echoed in Susan Sontag who, in writing about illness, also leaves a personal sickness unmentioned, especially in her eloquently distant Illness as Metaphor (1978). Sontag’s treatise surveys how literature for the last two centuries has misrepresented humankind’s most dreaded diseases, cancer and tuberculosis, subjects and their treatment Woolf had missed. Sontag begins by declaring that she rejects self-involvement. “I want to describe,” she confesses in the second paragraph, “not what it is really like to emigrate to the kingdom of the ill and live there, but the punitive or sentimental fantasies concocted about that situation.” Her goal is, she says, to “elucidate” this metaphoric way of thinking and to “liberate” us from it. In other words, the representation of “what [disease] is really like” is, for her, more telling than “what it is really like” to “live” with a disease. By “more telling” I mean Sontag’s advocacy: We have to see the bars of the cage that surround us before we, and our culture, know how to break free.

In 1976, Sontag had a mastectomy and chemotherapy for breast cancer. As a survivor, she characterizes her struggle with the disease has been far more literary than physical. (If ever one might contract a “literary illness,” Sontag did.) With her treatments, she no doubt endured terrible pain. But the literary outcome of such a sickness, dramatic or reflective, recall Woolf’s—it’s unrecorded. Instead, Sontag is devoted to her reading, which echoes the life she has always led with or without cancer.

It’s not until our time—and the age of pathography, a virulent subset of memoir—that sick, wounded, diseased, bereaved, and even dying authors are revealing how their conditions have disoriented them as they essay and narrate those conditions via new forms of personal writing, forms which feel much different from what has come before. Notwithstanding Woolf’s and Sontag’s grand analyses, very few writers sidle up to the subject of illness essayistically these days. Instead, they (we) write pathography.

Pathography is a term Joyce Carol Oates used in a 1988 review to lament biographies whose authors overemphasize the decadent, sordid, or disordered traits of their subjects’ lives. Since then, the term has been appropriated to typify any writing heavily soiled by grief or loss. Unfortunately, pathography substitutes now for almost any illness memoir, in part, since memoir, by authors and critics, is too easily reduced to the self in turmoil, rarely in wonder, in love, in art. And yet, writing about (or, if you like, authoring) one’s disease has value because the sick-to-well author lingers, at times overlong, on the underside. My view is that narratives of personal illness and tragedy are worthy when they challenge those nagging exclusionary clauses that literature has always traded in.

A brilliant instance of the contemporary illness memoir is The Two Kinds of Decay (2008) by Sarah Manguso. In it, the writer lays out almost mechanically the stages of her autoimmune blood disease, some nine years spent enduring transfusions, paralysis, and depression. “I resisted as long as I could,” she notes of her delay in starting the book. “A narrator must keep a safe distance from the story, but a lyric speaker must occupy the lyric moment as it’s happening. Or so it seems to me at this moment.” Which is to say Manguso found a form and a voice once she began working her material lyrically. Her confessional voice is both emotionally detached and intimately personal. Such scoring means the story is less plotted, less in the foreground, while moments, often of clinical ill-being, are quickly captured, embraced, hung onto, and let go. The effect has literary and purgative shape.

Each of Manguso’s eighty-one chapters (“Secrets,” “Cured,” “More Medicine”) isolates a moment or a medial idea or a treatment fact or its consequence that the chapter cracks open. Each paragraph, five to ten per chapter, is followed by a space break, Internet style. Each chapter weighs emotionally at least ten pounds. Once the chapter lays out a minimal set of statements or facts, Manguso stops. Often abruptly. Before an emotion and its self-possession overtakes her.

For example, in “Walking,” Manguso describes her failure at trying to move on her own, even with crutches. Here’s about twenty percent of the chapter:

I wasn’t safely mobile on the crutches. I shouldn’t have gone back to school. My doctors were doing the best they could, but they must have been delusional to think it was safe to let me go back to Cambridge [Harvard] without a wheelchair. I was still poisoning myself a little more with every beat of my heart, barely able to manipulate my crutches, just waiting until I wasn’t able to manipulate the crutches at all.

In the end, walking is too difficult to manage, so she is literally carried in and out of classes. To her (obvious) chagrin. And on that beat—like a good poem—the chapter’s over. Sentiment resisted. Complaint engaged. There’s a restrictive sensibility at play, which keeps the focus on the problem: her being wasted and trying to walk. When she writes, “I was still poisoning myself a little more with every beat of my heart,” Manguso reminds us that her disease continues no matter what she does. It’s more than chronic; it’s her. Like Woolf’s cerebral intimacy, it’s curious how this flat affect adds up to our feeling it. One key to getting readers to feel is to put the feeling off-center: lessening the drama heightens the drama.

Such a tack is an effective distillation, a long exhalation. Brevity, statement, and word choice balance one another and deliver each chapter’s singularity. We get it. We breathe in sync with Manguso. We sit with her and we move on. A long illness is its day-by-day tedium. How regularly her treatments for the blood disease hurt and fail. Nine years on, however, she does get well. Maybe the bittersweet arrival of wellness eventually allows her to craft just the right spread of emotion, which, in turn, turns back the sentimentality Woolf and Sontag so feared they would indulge.

The grandparent of the contemporary illness memoir is Girl, Interrupted (1993) by Susanna Kaysen. The book charts her psychiatric breakdown for which, at eighteen, she was forcibly detained at Boston’s McLean hospital. The book is highly original in its fragmentary nature, its accusatory tone, and the reproduction of her actual files, albeit partly redacted. Kaysen reframes her condition to be as much rebellion as psychological illness—part severe depression, part self-inflicted pain, part adolescent immaturity, part “compulsive promiscuity” (a diagnosis), part parental and institutional overreaction, part 1960s high-school anti-establishment madness and/or flirtation with madness. The fact that she recovers from her ordeal makes a reader wonder at the efficacy of McLean’s treatment programs let alone why she was committed in the first place. The memoir’s brilliance, written in flurries of miniature narratives, almost like a flip book, is that the collaged style authenticates, even mimics, her year-and-a-half incarceration and its crazy-making rituals.

And then there’s the explosion of emotion in the recent Blue Nights (2011) by Joan Didion. What is so striking in this confession about the death of her daughter Quintana is how maniacally present Didion’s inner world has become in her writing. Of her three memoirs, this one is most locked in the burdensome now, where bereavement will not pass. The writing is near diary-like in its unadorned directness. Losing her daughter and the author’s regret occupy past and present simultaneously: the past is the present. The prose is often lodged in—or devolves to—statement. Much is declarative, much is echoed, much is harbored, much is, like Manguso, entrancingly flat. It’s the curse of being pinned, post-death, to the endlessness of every day as a day without Quintana. Set in the rocking chair, a good deal of Blue Nights wallows in what if’s. On occasion Didion gets the ice-flow moving. But it’s quickly halted and re-directed to lingering on what’s missing. In a peculiar way, the book may be over-felt, a trait I would have never thought Joan Didion capable of.

This was never supposed to happen to her, I remember thinking—outraged, as if she and I had been promised a special exemption—in the third of those intensive care units.

By the time she reached the fourth I was no longer invoking this special exemption.

When we talk about mortality we are talking about our children.

I just said that, but what does it mean?

All right, of course I can track it, of course you can track it, another way of acknowledging that our children are hostages to fortune, but when we talk about our children what are we saying? Are we saying what it meant to us to have them? What it meant to us not to have them? What it meant to let them go? Are we talking about the enigma of pledging ourselves to protect the unprotectable? About the whole puzzle of being a parent?

Time passes.

Yes, agreed, a banality, of course time passes.

Then why do I say it, why have I already said it more than once?

Have I been saying it the same way I say I have lived most of my life in California?

Have I been saying it without hearing what I say?

Could it be that I heard it more this way: Time passes, but not so aggressively that anyone notices? Or even: Time passes, but not for me? Could it be that I did not figure in either the general nature or the permanence of the slowing, the irreversible changes in mind and body, the way in which you wake one summer morning less resilient than you were and by Christmas find your ability to mobilize gone, atrophied, no longer extant? The way in which you live most of your life in California, and then you don’t? The way in which your awareness of this passing time—this permanent slowing, this vanishing resilience—multiplies, metastasizes, becomes your very life?

This—Didion’s self-questioning bravura, her avowals undercut by doubt, her slippage from clock to psychological time—feels in Didion’s traditional style but also hewn to the core emotional facts. The self-questioning is chilling. I think this tack may be what Virginia Woolf dreamed of. Had the culture permitted her directness with illness in the essay, she might have used some of her artless diary, letter, and journal entries to enhance her work. The value of the contemporary memoir lies in its having evolved to allow in to literary writing the varying and competing voices of diary, essay, narrative, journal, letter, even email. The literary, the non-literary, cohabit. A new form, indeed. Right now my stomach hurts a great deal, which means I must be direct as I write, though it’s also an occasion to wonder why it’s so hard to get this suffering into words when the pain is this bad.

The essays of Woolf and Sontag remind us that the ill body is persona non grata in traditional literature. (In literature’s evolving definition, we must include its many-eras’ avoidance of the personal.) The memoirs of Manguso, Kaysen, and Didion (and hundreds of other pathographers like Nancy Mairs, Bonnie J. Rough, Jean-Dominique Bauby, Joshua Cody) prove that one’s disease or loss are literarily worthwhile because authors are commingling personal data with the stylistic possibilities of prose. In spite of that surge, it—memoir as literature—is still an irksome, backwards-leaning notion. What I’m reminded of, as we transition to a transliterate culture, is that we may no longer need the “L” word. This echoes something Harold Brodkey stirs up in This Wild Darkness: The Story of My Death: “One may be tired of the world—tired of the prayer-makers, the poem-makers, whose rituals are distracting and human and pleasant but worse than irritating because they have no reality—while reality itself remains very dear.”

In Brodkey, you can hear an ill man’s “irritation” with the succor of artists and their languages while life offers what prayer and poem cannot: the dearness of “reality itself.” Literature, the thing we often seek when the real becomes unbearable, is useless when actual illness rears its head, useless when we need, or may want, to bear our end.  Another, non-literary writing must take its place. The irony is that as literature-making creatures, we can’t help but want writing to be part of that end—albeit a lousy representation of, or besotted substitute for, reality. Imagining death in a novel, for examples, may be useful to the person who’s not dying. It may prepare us, get us to feel the inevitable prior to its arrival. How I will perform when my time comes a good novel may help me understand. But to the chronically ill, those in treatment, the terminal, literature gives scant relief. As Brodkey recognized on his deathbed, the literary is a distraction to keep the mind off the end. Which, I suppose, can’t be helped. The closer we are to dying, the more precious are life’s distractions. Is there any way, other than a coma, not to be alive while dying?

Does a memoir’s hand-wringing get us any closer to a qualitative expression of illness? I’m pursuing that in my own work, in the work other writers, and in our literary canon. Perhaps the memoir is charting a new course, built of immediacy, lyricism, concentration, and bald emotionality. However, it seems a body’s ailment must remain unvoiced, prey to a kind of entropy that accompanies any sustained inwardness. Like depression. Like dying. Can any literary form get the pain out? I wonder. The language of life is its literary unspokenness. Therein lies its draw for the writer. To be outspoken about what’s unspoken.