Disease and Literature Overviews - Essay


(Twentieth-Century Literary Criticism)

Virginia Woolf

SOURCE: "On Being Ill," in Collected Essays, Vol. 4, The Hogarth Press, 1967, pp. 193-203.

[In the following essay, Woolf reflects on the ways in which being ill altered her perspective on life as well as her approach to reading works of literature.]

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 armchair 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. Novels, one would have thought, would have been devoted to influenza; epic poems to typhoid; odes to pneumonia; lyrics to toothache. But no; with a few exceptions—De Quincey attempted something of the sort in The Opium Eater; there must be a volume or two about disease scattered through the pages of Proust—literature does its best to maintain that its concern is with the mind; that the body is a sheet of plain glass through which the soul looks straight and clear, and, save for one of two passions such as desire and greed, is null, and negligible and non-existent. On the contrary, the very opposite is true. All day, all night the body intervenes; blunts or sharpens, colours or discolours, turns to wax in the warmth of June, hardens to tallow in the murk of February. The creature within can only gaze through the pane smudged or rosy; it cannot separate off from the body like the sheath of a knife or the pod of a pea for a single instant; it must go through the whole unending procession of changes, heat and cold, comfort and discomfort, hunger and satisfaction, health and illness, until there comes the inevitable catastrophe; the body smashes itself to smithereens, and the soul (it is said) escapes. But of all this daily drama of the body there is no record. People write always of the doings of the mind; the thoughts that come into it; its noble plans; how the mind has civilized the universe. They show it ignoring the body in the philosopher's turret; or kicking the body, like an old leather football, across leagues of snow and desert in the pursuit of conquest or discovery. Those great wars which the body wages with the mind a slave to it, in the solitude of the bedrooms against the assault of fever or the oncome of melancholia, are neglected. Nor is the reason far to seek. To look these things squarely in the face would need the courage of a lion-tamer; a robust philosophy; a reason rooted in the bowels of the earth. Short. of these, this monster, the body, this miracle, its pain, will soon make us taper into mysticism, or rise, with rapid beats of the wings, into the raptures of transcendentalism. The public would say that a novel devoted to influenza lacked plot; they would complain that there was no love in it—wrongly however, for illness often takes on the disguise of love, and plays the same odd tricks. It invests certain faces with divinity, sets us to wait, hour after hour, with pricked ears for the creaking of a stair, and wreathes the faces of the absent (plain enough in health, Heaven knows) with a new significance, while the mind concocts a thousand legends and romances about them for which it has neither time nor taste in health. Finally, to hinder the description of illness in literature, there is the poverty of the language. English, which can express the thoughts of Hamlet and the tragedy of Lear, has no words for the shiver and the headache. It has all grown one way. The merest schoolgirl, 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. There is nothing ready made for him. He is forced to coin words himself, and, taking his pain in one hand, and a lump of pure sound in the other (as perhaps the people of Babel did in the beginning), so to crush them together that a brand new word in the end drops out. Probably it will be something laughable. For who of English birth can take liberties with the language? To us it is a sacred thing and therefore doomed to die, unless the Americans, whose genius is so much happier in the making of new words than in the disposition of the old, will come to our help and set the springs aflow. Yet it is not only a new language that we need, more primitive, more sensual, more obscene, but a new hierarchy of the passions; love must be deposed in favour of a temperature of 104; jealousy give place to the pangs of sciatica; sleeplessness play the part of villain, and the hero become a white liquid with a sweet taste—that mighty Prince with the moths' eyes and the feathered feet, one of whose names is Chloral.

But to return to the invalid. 'I am in bed with influenza'—but what does that convey of the great experience; how the world has changed its shape; the tools of business grown remote; the sounds of festival become romantic like a merry-go-round heard across far fields; and friends have changed, some putting on a strange beauty, others deformed to the squatness of toads, while the whole landscape of life lies remote and fair, like the shore seen from a ship far out at sea, and he is now exalted on a peak and needs no help from man or God, and now grovels supine on the floor glad of a kick from a housemaid—the experience cannot be imparted and, as is always the way with these dumb things, his own suffering serves but to wake memories in his friends' minds of their influenzas, their aches and pains which went unwept last February, and now cry aloud, desperately, clamorously, for the divine relief of sympathy.

But sympathy we cannot have. Wisest Fate says no. If her children, weighted as they already are with sorrow, were to take on them that burden too, adding in imagination other pains to their own, buildings would cease to rise; roads would peter out into grassy tracks; there would be an end of music and of painting; one great sigh alone would rise to Heaven, and the only attitudes for men and women would be those of horror and despair. As it is, there is always some little distraction—an organ-grinder at the corner of the hospital, a shop with book or trinket to decoy one past the prison or the workhouse, some absurdity of cat or dog to prevent one from turning the old beggar's hieroglyphic of misery into volumes of sordid suffering; and thus the vast effort of sympathy which those barracks of pain and discipline, those dried symbols of sorrow, ask us to exert on their behalf, is uneasily shuffled off for another time. Sympathy nowadays is dispensed chiefly by the laggards and failures, women for the most part (in whom the obsolete exists so strangely side by side with anarchy and newness), who, having dropped out of the race, have time to spend upon fantastic and unprofitable excursions; C. L., for example, who, sitting by the stale sickroom fire, builds up, with touches at once sober and imaginative, the nursery fender, the loaf, the lamp, barrel organs in the street, and all the simple old wives' tales of pinafores and escapades; A. R., the rash, the magnanimous, who, if you fancied a giant tortoise to solace you or a theorbo to cheer you, would ransack the markets of London and procure them somehow, wrapped in paper, before the end of the day; the frivolous K. T., who, dressed in silks and feathers, powdered and painted (which takes time too) as if for a banquet of Kings and Queens, spends her whole brightness in the gloom of the sick-room, and makes the medicine bottles ring and the flames shoot up with her gossip and her mimicry. But such follies have had their day; civilization points to a different goal; and then what place will there be for the tortoise and the theorbo?

There is, let us confess it (and illness is the great confessional), a childish outspokenness in illness; things are said, truths blurted out, which the cautious respectability of health conceals. About sympathy for example—we can do without it. That illusion of a world so shaped that it echoes every groan, of human beings so tied together by common needs and fears that a twitch at one wrist jerks another, where however strange your experience other people have had it too, where however far you travel in your own mind someone has been there before you is all an illusion. We do not know our own souls, let alone the souls of others. Human beings do not go hand in hand the whole stretch of the way. There is a virgin forest in each; a snowfield where even the print of birds' feet is unknown. Here we go alone, and like it better so. Always to have sympathy, always to be accompanied, always to be understood would be intolerable. But in health the genial pretence must be kept up and the effort renewed to communicate, to civilize, to share, to cultivate the desert, educate the native, to work together by day and by night to sport. In illness this make-believe ceases. Directly the bed is called for, or, sunk deep among pillows in one chair, we raise our feet even an inch above the ground on another, we cease to be soldiers in the army of the upright; we become deserters. They march to battle. We float with the sticks on the stream; helter-skelter with the dead leaves on the lawn, irresponsible and disinterested and able, perhaps for the first time for years, to look round, to look up—to look, for example, at the sky.

The first impression of that extraordinary spectacle is strangely overcoming. Ordinarily to look at the sky for any length of time is impossible. Pedestrians would be impeded and disconcerted by a public sky-gazer. What snatches we get of it are mutilated by chimneys and churches, serve as a background for man, signify wet weather or fine, daub windows gold, and, filling in the branches, complete the pathos of dishevelled autumnal plane trees in autumnal squares. Now, lying recumbent, staring straight up, the sky is discovered to be something so different from this that really it is a little shocking. This then has been going on all the time without our knowing it!—this incessant making up of shapes and casting them down, this buffeting of clouds together, and drawing vast trains of ships and wagons from North to South, this incessant ringing up and down of curtains of light and shade, this interminable experiment with gold shafts and blue shadows, with veiling the sun and unveiling it, with making rock ramparts and wafting them away—this endless activity, with the waste of Heaven knows how many million horse-power of energy, has been left to work its will year in, year out. The fact seems to call for comment and indeed for censure. Ought not someone to write to The Times? Use should be made of it. One should not let this gigantic cinema play perpetually to an empty house. But watch a little longer and another emotion drowns the stirrings of civic ardour. Divinely beautiful, it is also divinely heartless. Immeasurable resources are used for some purpose which has nothing to do with pleasure or human profit. If we were all laid prone, stiff, still the sky would be experimenting with its blues and its golds. Perhaps then, if we look down at something very small and close and familiar, we shall find sympathy. Let us examine the rose. We have seen it so often flowering in bowls, connected it so often with beauty in its prime, that we have forgotten how it stands, still and steady, throughout an entire afternoon in the earth. It preserves a demeanour of perfect dignity and self-possession. The suffusion of its petals is of inimitable rightness. Now perhaps one deliberately falls; now all the flowers, the voluptuous purple, the creamy, in whose waxen flesh the spoon has left a swirl of cherry juice; gladioli; dahlias; lilies, sacerdotal, ecclesiastical; flowers with prim cardboard collars tinged apricot and amber, all gently incline their heads to the breeze—all, with the exception of the heavy sunflower, who proudly acknowledges the sun at midday and perhaps at midnight rebuffs the moon. There they stand; and it is of these, the stillest, the most self-sufficient of all things that human beings have made companions; these that symbolize their passions, decorate their festivals, and lie (as if they knew sorrow) upon the pillows of the dead. Wonderful to relate, poets have found religion in Nature; people live in the country to learn virtue from plants. It is in their indifference that they are comforting. That snowfield of the mind, where man has not trodden, is visited by the cloud, kissed by the falling petal, as, in another sphere, it is the great artists, the Miltons and the Popes, who console not by their thought of us but by their forgetfulness.

Meanwhile, with the heroism of the ant or the bee, however indifferent the sky or disdainful the flowers, the army of the upright marches to battle. Mrs. Jones catches her train. Mr. Smith mends his motor. The cows are driven home to be milked. Men thatch the roof. The dogs bark. The rooks, rising in a net, fall in a net upon the elm trees. The wave of life flings itself out indefatigably. It is only the recumbent who know what, after all, Nature is at no pains to conceal—that she in the end will conquer; heat will leave the world; stiff with frost we shall cease to drag ourselves about the fields; ice will lie thick upon factory and engine; the sun will go out. Even so, when the whole earth is sheeted and slippery, some undulation, some irregularity of surface will mark the boundary of an ancient garden, and there, thrusting its head up undaunted in the starlight the rose will flower, the crocus will burn. But with the hook of life in us still we must wriggle. We cannot stiffen peaceably into glassy mounds. Even the recumbent spring up at the mere imagination of frost about the toes and stretch out to avail themselves of the universal hope—Heaven, Immortality. Surely, since men have been wishing all these ages, they will have wished something into existence; there will be some green isle for the mind to rest on even if the foot cannot plant itself there. The cooperative imagination of mankind must have drawn some firm outline. But no. One opens the Morning Post and reads the Bishop of Lichfield on Heaven. One watches the church-goers file into those gallant temples where, on the bleakest day, in the wettest fields, lamps will be burning, bells will be ringing, and however the autumn leaves may shuffle and the winds sigh outside, hopes and desires will be changed to beliefs and certainties within. Do they look serene? Are their eyes filled with the light of their supreme conviction? Would one of them dare leap straight into Heaven off Beachy Head? None but a simpleton would ask such questions; the little company of believers lags and drags and strays. The mother is worn; the father tired. As for imagining Heaven, they have no time. Heaven-making must be left to the imagination of the poets. Without their help we can but trifle—imagine Pepys in Heaven, adumbrate little interviews with celebrated people on tufts of thyme, soon fall into gossip about such of our friends as have stayed in Hell, or, worse still, revert again to earth and choose, since there is no harm in choosing, to live over and over, now as man, now as woman, as sea-captain, or court lady, as Emperor or farmer's wife, in splendid cities and on remote moors, at the time of Pericles or Arthur, Charlemagne or George the Fourth—to live and live till we have lived out those embryo lives which attend about us in early youth until 'I' suppressed them. But T shall not, if wishing can alter it, usurp Heaven too, and condemn us, who have played our parts here as William or Alice, to remain William or Alice for ever. Left to ourselves we speculate thus carnally. We need the poets to imagine for us. The duty of Heaven-making should be attached to the office of the Poet Laureate.

Indeed it is to the poets that we turn. Illness makes us disinclined for the long campaigns that prose exacts. We cannot command all our faculties and keep our reason and our judgment and our memory at attention while chapter swings on top of chapter, and, as one settles into place, we must be on the watch for the coming of the next, until the whole structure arches, towers, and battlements stands firm on its foundations. The Decline and Fall of the Roman Empire is not the book for influenza, nor The Golden Bowl nor Madame Bovary. On the other hand, with responsibility shelved and reason in the abeyance—for who is going to exact criticism from an invalid or sound sense from the bedridden?—other tastes assert themselves; sudden, fitful, intense. We rifle the poets of their flowers. We break off a line or two and let them open in the depths of the mind:

and oft at eve
Visits the herds along the twilight meadows

wandering in thick flocks along the mountains
Shepherded by the slow unwilling wind.

Or there is a whole three-volume novel to be mused over in a verse of Hardy's or a sentence of La Bruyere. We dip in Lamb's letters—some prose-writers are to be read as poets—and find 'I am a sanguinary murderer of time, and would kill him inchmeal just now. But the snake is vital', and who shall explain the delight? or open Rimbaud and read

O saisons o chateaux
Quelle ame est sans ddfauts?

and who shall rationalize the charm? In illness words seem to possess a mystic quality. We grasp what is beyond their surface meaning, gather instinctively this, that, and the other—a sound, a colour, here a stress, there a pause—which the poet, knowing words to be meagre in comparison with ideas, has strewn about his page to evoke, when collected, a state of mind which neither words can express nor the reason explain. Incomprehensibility has an enormous power over us in illness, more legitimately perhaps than the upright will allow. In health meaning has encroached upon sound. Our intelligence domineers over our senses. But in illness, with the police off duty, we creep beneath some obscure poem by Mallarme or Donne, some phrase in Latin or Greek, and the words give out their scent and distil their flavour, and then, if at last we grasp the meaning, it is all the richer for having come to us sensually first, by way of the palate and the nostrils, like some queer odour. Foreigners, to whom the tongue is strange, have us at a disadvantage. The Chinese must know the sound of Antony and Cleopatra better than we do.

Rashness is one of the properties of illness—outlaws that we are—and it is rashness that we need in reading Shakespeare. It is not that we should doze in reading him, but that, fully conscious and aware, his fame intimidates and bores, and all the views of all the critics dull in us that thunder-clap of conviction which, if an illusion, is still so helpful an illusion, so prodigious a pleasure, so keen a stimulus in reading the great. Shakespeare is getting flyblown; a paternal government might well forbid writing about him, as they put his monument at Stratford beyond the reach of scribbling fingers. With all this buzz of criticism about, one may hazard one's conjectures privately, make one's notes in the margin; but, knowing that someone has said it before, or said it better, the zest is gone. Illness, in its kingly sublimity, sweeps all that aside and leaves nothing but Shakespeare and oneself. What with his overweening power and our overweening arrogance, the barriers go down, the knots run smooth, the brain rings and resounds with Lear or Macbeth, and even Coleridge himself squeaks like a distant mouse.

But enough of Shakespeare—let us turn to Augustus Hare. There are people who say that even illness does not warrant these transitions; that the author of The Story of Two Noble Lives is not the peer of Boswell; and if we assert that short of the best in literature we like the worst—it is mediocrity that is hateful—will have none of that either. So be it. The law is on the side of the normal. But for those who suffer a slight rise of temperature the names of Hare and Waterford and Canning ray out as beams of benignant lustre. Not, it is true, for the first hundred pages or so. There, as so often in these fat volumes, we flounder and threaten to sink in a plethora of aunts and uncles. We have to remind ourselves that there is such a thing as atmosphere; that the masters themselves often keep us waiting intolerably while they prepare our minds for whatever it may be—the surprise, or the lack of surprise. So Hare, too, takes his time; the charm steals upon us imperceptibly; by degrees we become almost one of the family, yet not quite, for our sense of the oddity of it all remains, and share the family dismay when Lord Stuart leaves the room—there was a ball going forward—and is next heard of in Iceland. Parties, he said, bored him—such were English aristocrats before marriage with intellect had adulterated the fine singularity of their minds. Parties bore them; they are off to Iceland. Then Beckford's mania for castle-building attacked him; he must lift a French château across the Channel, and erect pinnacles and towers to use as servants' bedrooms at vast expense, upon the borders of a crumbling cliff, too, so that the housemaids saw their brooms swimming down the Solent, and Lady Stuart was much distressed, but made the best of it and began, like the high-born lady that she was, planting evergreens in the face of ruin. Meanwhile the daughters, Charlotte and Louisa, grew up in their incomparable loveliness, with pencils in their hands, for ever sketching, dancing, flirting, in a cloud of gauze. They are not very distinct it is true. For life then was not the life of Charlotte and Louisa. It was the life of families, of groups. It was a web, a net, spreading wide and enmeshing every sort of cousin, dependant, and old retainer. Aunts—Aunt Caledon, Aunt Mexborough—grandmothers—Granny Stuart, Granny Hardwicke—cluster in chorus, and rejoice and sorrow and eat Christmas dinner together, and grow very old and remain very upright, and sit in hooded chairs cutting flowers it seems out of coloured paper. Charlotte married Canning and went to India; Louisa married Lord Waterford and went to Ireland. Then letters begin to cross vast spaces in slow sailing ships and communication becomes still more protracted and verbose, and there seems no end to the space and the leisure of those early Victorian days, and faiths are lost and the life of Hedley Vicars revives them; aunts catch cold but recover; cousins marry; there are the Irish famine and the Indian Mutiny, and both sisters remain to their great, but silent, grief without children to come after them. Louisa, dumped down in Ireland with Lord Waterford at the hunt all day, was often very lonely; but she stuck to her post, visited the poor, spoke words of comfort ('I am sorry indeed to hear of Anthony Thompson's loss of mind, or rather of memory; if, however, he can understand sufficiently to trust solely in our Saviour, he has enough') and sketched and sketched. Thousands of notebooks were filled with pen-and-ink drawings of an evening, and then the carpenter stretched sheets for her and she designed frescoes for schoolrooms, had live sheep into her bedroom, draped gamekeepers in blankets, painted Holy Families in abundance, until the great Watts exclaimed that here was Titian's peer and Raphael's master! At that Lady Waterford laughed (she had a generous, benignant sense of humour); and said that she was nothing but a sketcher; had scarcely had a lesson in her life—witness her angel's wings scandalously unfinished. Moreover, there was her father's house forever falling into the sea; she must shore it up; must entertain her friends; must fill her days with all sorts of charities, till her Lord came home from hunting, and then, at mid-night often, she would sketch him with his knightly face half hidden in a bowl of soup, sitting with her sketch-book under a lamp beside him. Off he would ride again, stately as a crusader, to hunt the fox, and she would wave to him and think each time, what if this should be the last? And so it was, that winter's morning; his horse stumbled; he was killed. She knew it before they told her, and never could Sir John Leslie forget, when he ran downstairs on the day of the burial, the beauty of the great lady standing to see the hearse depart, nor, when he came back, how the curtain, heavy, mid-Victorian, plush perhaps, was all crushed together where she had grasped it in her agony.

Jeffrey Meyers

SOURCE: "Introduction: Disease and Art," in Disease and the Novel, 1880-1960, The Macmillan Press Ltd., 1985, pp. 1-18.

[In the following excerpt, Meyers examines works by nineteenth- and twentieth-century authors that reveal differing attitudes and ideas relating to disease.]


Disease and the Novel explores an important theme in modern fiction. The Death of Ivan Ilych, "The Snows of Kilimanjaro," The Immoralist, The Magic Mountain, Doctor Faustus, The Black Swan, The Rack and Cancer Ward concern the mental and physical changes that take place when a character is attacked by disease—cancer, gangrene, tuberculosis, syphilis—and threatened by death. In all these novels illness isolates, exposes, intensifies and transforms character; structures the work as we follow the progress of the diseased heroes to recovery, remission, invalidism or death. These works portray what Freud calls the "pathology of cultural communities," the sickness of society. For the effect of disease on a victim is both the realistic subject of the book and the symbol of moral, social or political pathology; the illness of the hero, who is both an individual and a representative of his epoch, is analogous to the sickness of the State.

Disease has always been a great mystery: a visitation, a curse, a judgment. The creation of literature is one way of transcending mortality and celebrating human existence, despite the threat of death. We have inherited from the Greeks a view of the artist that explains the phenomenon of creativity and its relation to disease, and that has persisted in our culture, with many variations, until the present time. This Greek concept is revived by Neoplatonic thought in the Renaissance, reappears in the Romantic period, is exalted by Dostoyevsky and Nietzsche, and exerts a powerful influence on twentieth-century literature. Disease and the Novel considers how these ideas about the relation of disease and the artist have been challenged and changed by modern novelists.

The Greeks provided two important and quite distinct ideas about creativity, which was closely related to disease and derangement. First, the concept that poets have fallen foul of the gods and are cursed with a physical defect. The idea that the artist is diseased, that his illness gives him psychic knowledge, spiritual power and creative genius, originates with the figures of Tiresias the blind prophet and Homer the blind poet. Edmund Wilson used such a figure to represent a dominant theme in modern literature. In the symbolic myth of the wound and the bow, as interpreted by Wilson, the essential sickness of the artist is represented by the Greek archer Philoctetes, who is degraded by a malodorous disease that renders him abhorrent to society, but "is also the master of a superhuman art which everybody has to respect and which the normal man finds he needs."

The Greek heritage suggests that art, which is synonymous with knowledge, truth and insight, is available only to those who suffer for it like the mythic figures of Oedipus, Orpheus and Prometheus. (In modern times Camus has given a similar interpretation to Sisyphus, whose moment of insight comes when he returns to his rock and renews his suffering.) The belief that suffering is a necessary, even indispensable component of creativity is basic to our culture, and to a large degree our literary history traces the way artists have dealt with this paradox. The power of this idea rests in the meaning it gives to suffering and death; it has continued for centuries despite the intervening Judeo-Christian period, which provides another, redemptive purpose for physical pain and decay.

The second, quite separate Greek idea of the deranged artist found expression in the primitive and archaic cult of Dionysos, whose worshippers sang and danced themselves into a frenzy. This concept is expressed in Plato's Ion, which equates poetic power with a state of divinely inspired insanity: "For the authors of those great poems which we admire, do not attain to excellence through the rules of any art, but they utter their beautiful melodies of verse in a state of inspiration, and, as it were, possessed by a spirit not their own. Thus the composers of lyrical poetry create those admired songs of theirs in a state of divine insanity, like the Corybantes, who lose all control over their reason in the enthusiasm of the sacred dance.… For a poet is indeed a thing ethereally light, winged, and sacred, nor can he compose anything worth calling poetry until he becomes inspired, and, as it were, mad, or whilst any reason remains in him." Nietzsche, whose philosophical thought had the greatest influence on modern literature, combines both these ideas. He uses the concept of the diseased artist to define himself as a creator and the concept of the deranged artist to define the nature of creativity.

The idea that suffering and insanity are necessary to learn the truth and the consequent image of the mad poet were introduced into English literature during the Renaissance and reached their tragic apotheosis in Shakespeare. In Lear the heroic truth-seeker pays for his perceptions with madness, degradation and death. Artists have been treated like madmen since the Renaissance, when Neoplatonic doctrine extended the prerogative of the saint and the prophet to the poet and artist, and accounted for the superhuman achievement of the secular genius by a godlike inspiration that produced what Plato had called divine madness. This dangerous gift places the creative mind on a lonely height and threatens to topple him into the abyss of insanity. The artist sees the normal ways of established society as corrupt, while mental illness appears to him as spiritual health.

The idea that poets themselves were likely to be mad was also current in the age of Swift and Johnson. While insisting on the necessity for a sane and rational grasp of life, Dryden acknowledged the poet's proximity to insanity:

Great wits are sure to madness near allied, And thin partitions do their bounds divide.

In the Life of Savage, Johnson develops another important aspect of this idea. He draws on his own experience in depicting a life of neglect, exploitation and poverty; and his portrait also emphasizes the idea that the artist is cast out by a society which needs his insight and beauty.


During the early part of the nineteenth century, writers associated creativity with one specific disease, tuberculosis. At this time a number of factors combined to revive and reinforce the traditional connection between disease and art: the growth of cities; the advance in medical knowledge; the portrayal of disease in literature and (later on) in immensely popular operas like La Traviata (1853) and La Boheme (1896); the sudden interest in the aesthetic aspects of consumption; the number of mad poets (Collins, Smart, Cowper, Hölderlin, Kleist); the early death of important literary figures (Chatterton, Keats, Shelley, Byron); the extraordinary appearance of a whole series of tubercular artists. As Rudolf and Margot Wittkower observe in their study of the melancholic artist, the relation of genius and madness was extended to include physical illness: "During the nineteenth century clinical diagnosis confirmed the previous assumption of an alliance between genius and madness. Early in the century Lamartine already talked of 'cette maladie qu'on appelle génie'; by the end of the century the idea of disease was so firmly established that a popular magazine declared 'evidence is not lacking to warrant the assumption that genius is a special morbid condition.'"

At the turn of the century, when the maximum morbidity for tuberculosis in England occurred among the ill-housed and ill-fed inhabitants of industrial towns, medical evidence began to replace superstitious and religious explanations of disease and epidemics. The major scientific contributions of Jenner, Dalton and Davy coincided with Auenbrugger's discovery of chest percussion (1761) and Laënnec's invention of the stethoscope (1819), which led to important advances in the understanding and diagnosis of tuberculosis.

The horrors of tuberculosis were described as early as Deuteronomy 28:22: "The Lord shall smite thee with a consumption, and with a fever, and with an inflammation, and with an extreme burning … and they shall pursue thee until thou perish." But in nineteenth-century literature "the disease was rarely presented as something loath-some … Rather, it was used as a device to enlist the sympathies of the reader… It was believed to affect chiefly sensitive natures, and conferred upon them a refined physical charm before making them succumb to a painless, poetical death." Tom Moore's account of Byron's posturing shows how appealing the consumptive had become by 1810, when physical disease followed fashion: "Standing before a looking-glass one day, Byron said to Sligo: 'I look pale; I should like to die of a consumption.' 'Why?' Sligo asked. 'Because the ladies would all say, "Look at that poor Byron, how interesting he looks in dying." '"

Writers of the Romantic period continued to interpret the phenomenon of tuberculosis, an infectious and incurable disease of epidemic proportions, in terms of the ancient Greek paradox. The disease was fearful and marked the end of one's life, but it bestowed privileged perceptions upon the poet-victim and was seen as a spur to creativity. Goethe defined the difference between the literature of the eighteenth and nineteenth centuries in terms of disease: "I call the classic healthy, the romantic sickly. In this sense, the Nibelungenlied is as classic as the Iliad, for both are vigorous and healthy. Most modern productions are romantic not because they are new; but because they are weak, morbid, and sickly." Schlegel unequivocally declared: "Health alone is loveable." But even Goethe, who described Kleist's stories as "tainted with an incurable disease," expressed the ambivalent attraction-repulsion toward disease that was characteristic of his age. He complained that "The poets all write as though they were sick and the whole world a hospital," but also acknowledged that wisdom could be won only through pain: "Misery too has its virtues. I have learned much in illness that I could have learned nowhere else in my life."

The definition of the consumptive personality in Havelock Ellis' Study of British Genius (1904) perfectly matched the literary qualities of the Romantic hero: intense, instinctive, individualistic; intuitive, imaginative, idealistic; tormented, escapist, rebellious. This definition once again brought disease and art into pathological conjunction: "The psychology of the consumptive [is] marked by mental exaltation, hyper-excitability, the tendency to form vast plans and to exert feverish activity in carrying them out, with … egoism, indifference, neurasthenia.… [Consumptives] with their febrile activities, their restless versatility, their quick sensitiveness to impressions, often appear the very type of genius."

The poet-hero whose life and writings most perfectly embody the Romantic idea of the diseased and doomed artist is John Keats, who contracted consumption while nursing his brother. In sonnets like "After dark vapours" and "When I have fears that I may cease to be" Keats expressed his fear that death would prevent the full realization of his genius but also conveyed his intense desire for dissolution. These morbid feelings reach an apotheosis in "Ode to a Nightingale," which describes the death of a tubercular youth and the longing to escape the limitations of the flesh through the morbid transcendence of the songbird. Keats associates dreams, fantasy and poetry with death, which is transformed into a positive experience and leads to welcome oblivion:

Fade far away, dissolve, and quite forget
What thou among the leaves hast never known,
The weariness, the fever, and the fret
Here, where men sit and hear each other groan;
Where palsy shakes a few, sad, last gray hairs,
Where youth grows pales, and spectre-thin, and
Where but to think is to be full of sorrow
And leaden-eyed despairs,
Where Beauty cannot keep her lustrous eyes,
Or new Love pine at them beyond tomorrow.…
Darkling I listen; and for many a time
I have been half in love with easeful Death,
Called him soft names in many a mused rhyme,
To take into the air my quiet breath;
Now more than ever seems it rich to die,
To cease upon the midnight with no pain.

Keats lived the last year of his life under the constant threat of death. He had been trained in medicine and recognized his fate on the very day of his hemorrhage in February 1820: "I know the colour of that blood," he exclaimed, "—it is arterial blood—I cannot be deceived in that colour; that drop is my death warrant. I must die." After that date he led an intensified "posthumous existence" and was alienated from ordinary life. Keats explained to Fanny Brawne that "A person in health as you are can have no conception of the horrors that nerves and a temper like mine go through." But, like Goethe, he also believed that suffering would lead to spiritual insight: "Do you not see how necessary a World of Pains and troubles is to school an Intelligence and make it a Soul?"

The Romantic attitude toward the suffering Keatsian artist was brilliantly expressed in a poetic apologue by Kierkegaard, who synthesized the idea that pain was intrinsic to art. He compared the torments of the artist to the prisoners roasted by Phalaris within the brazen bull, in whose nostrils reeds were placed so that their agonizing shrieks were transmuted into music: "What is a poet? An unhappy man who in his heart harbors a deep anguish, but whose lips are so fashioned that the moans and cries which pass over them are transformed into ravishing music. His fate is like that of the unfortunate victims whom the tyrant Phalaris imprisoned in a brazen bull, and slowly tortured over a steady fire; their cries could not reach the tyrant's ears so as to strike terror into his heart; when they reached his ears they sounded like sweet music." Kierkegaard also distinguished between the positive pain of the isolated Philoctetes, which he effectively transmuted into military action (the bow), and the negative paralyzing pain of the unheroic man, which can become involuted and self-consuming (the wound). Philoctetes "complains that no one understands his pain.… Here is manifested the difference between his pain and the reflective pain which always wants to be alone with its pain, which seeks a new pain in this solitude of pain."

The Romantic theory of disease is constructed out of literary and social history, for as Gottfried Benn remarks: "The early death of so many men of genius [is] something that the bourgeois-romantic ideology likes to connect with the notion of the consuming and devouring character of art." But in The White Plague, Rend and Jean Dubos note that the toxins and low fever produced by the infecting organism actually stimulate intellectual capacity and quicken artistic powers: "Throughout medical history there runs this suggestion that the intellectually gifted are the most likely to contract the disease, and furthermore that the same fire which wastes the body in consumption also makes the mind shine with a brighter light." They explain that art can compensate for disease, and justify the theory on physiological and psychological grounds: "There may be, nevertheless, some basis for the statement that consumption fosters and nourishes genius. Within certain limits fever from any source can heighten emotion, sharpen perception and render intellectual processes more lucid and rapid.… Since consumptives often experience mild fever without gross toxemia and without physical prostration, they may crave a full life and exhibit eagerness to seize the fleeting moments for creative efforts. Furthermore, the decreased physical vigor of the tuberculous patient limits his ability to fulfill natural urges and thereby increases his tendency to sublimate them into those forms of mental activity that are most natural to him." Though there is no scientific proof that tuberculosis inspires genius, this idea has been used as a literary theme for one hundred and fifty years.


The Romantic attitude toward disease was developed and deepened in the second half of the nineteenth century by two of the greatest writers of the age—neither of whom admitted the possibility of an exotic Keatsian escape: the epileptic Dostoyevsky and the syphilitic Nietzsche. Four characters in Dostoyevsky's novels—Nellie in The Insulted and Injured, Myshkin in The Idiot, Kirilov in The Possessed and Smerdyakov in The Brothers Karamazov—are epileptic. The epilepsy of Prince Myshkin, the most striking example, is a metaphor for spiritual insight, for his moments of ecstatic devotion and perfect harmony attempt to transcend the limitations of the disease that is responsible for the disintegration of his personality: "There was a moment or two in his epileptic condition almost before the fit itself (if it occurred during his waking hours) when suddenly amid the sadness, spiritual darkness and depression, his brain seemed to catch fire at brief moments, and with an extraordinary momentum his vital forces were strained to the utmost all at once. His sensation of being alive and his awareness increased tenfold at those moments which flashed by like lightning. His mind and heart were flooded by a dazzling light.… But those moments, those flashes of intuition, were merely the presentiment of the last second (never more than a second) which preceded the actual fit. This second was, of course, unendurable.… [But] all those gleams and flashes of the highest awareness and, hence, also of 'the highest mode of existence,' were nothing but a disease. As Dostoyevsky insists in Notes From Underground, "too great lucidity is a disease, a true, full-fledged disease," because this heightened consciousness forces one to see terrible truths about the nature of human existence. Proust agrees that "An invalid, a Baudelaire, better still a Dostoyevsky, in thirty years, between their crises of epilepsy or whatever, can create a work of which a long line of healthy writers could not have produced a single word."

In a similar fashion, Rimbaud follows the Greek tradition and calls for an artificially-induced, self-destructive, deliberate derangement of all the senses that would enable the tormented, sacrificial, even insane artist to become "the great invalid, the great criminal, the great accursed" and to plunge into unknown, "unheard of, unnameable" spiritual visions. Nietzsche—who confessed that Dostoyevsky was "the only psychologist, incidentally, from whom I had something to leam"—also associates exuberance of the spirit with extreme pain and mental anguish. Like Dostoyevsky and Rimbaud, Nietzsche believes that artistic greatness can be earned only by physical suffering: "To make oneself sick, mad, to provoke the symptoms of derangement and ruin that was [equated with] becoming stronger, more superhuman, more terrible, wiser."

Nietzsche defines man as "the sick animal" and believes that disease stimulates the strongest feelings, deepest thoughts and highest energies: "The sick and weak have had fascination on their side: they are more interesting than the healthy.… The great 'adventurers and criminals' and all men, especially the most healthy, are sick at certain periods of their lives: the great emotions, the passions of power, love, revenge, are accompanied by profound disturbances." Nietzsche feels that disease can bring new awareness to the artist who is able to survive its grave assaults, for the damage can be valuable when physical pain is transformed into intellectual achievement: "Sickness itself can be a stimulant to life: only one has to be healthy enough for this stimulant." "We seek life raised to a higher power, life lived in danger … What does not destroy us makes us stronger." Nietzsche, who believed the artist's derangement gave him the power to see and tell the truth, exclaims: "One pays dearly for immortality: one has to die several times while still alive." He would have agreed with Keats' insight: "Until we are sick, we understand not." Nikos Kazantzakis, a disciple of Nietzsche, declares that illness both inspired and destroyed the philosopher:

Disease served as your great enemy and also your greatest friend, the only one that stayed loyal to the death. It never permitted you to relax or remain where you were, never allowed you to declare: I am fine here, I shall go no further. You were a flame; you flared up, you were consumed.

The final phase of the Romantic idea that the artist is necessarily sick and socially outcast, and that this condition alone produces the greatest art, reaches its apotheosis in Thomas Mann, the most important Nietzschean of the twentieth century. Mann believes: "Romanticism bears in its heart the germ of morbidity, as the rose bears the worm; its innermost character is seduction, seduction to death." He gives the ideology of disease its most profound and ironic portrayal in The Magic Mountain and Doctor Faustus, and employs this theme to diagnose the sickness of German culture.

In his great essay on "Goethe and Tolstoy" and his more cautious "Dostoyevsky in Moderation," Mann places himself firmly in the Romantic tradition by an exaltation of the aesthetic aspects of "genius-bestowing disease." In the first essay he paradoxically claims that disease gives dignity to man because it brings out his spiritual qualities; inspires gravity, reverence and respect: "Disease has two faces and a double relation to man and his human dignity. On the one hand it is hostile: by overstressing the physical, by throwing man back upon his body, it has a dehumanizing effect. On the other hand, it is possible to think and feel about illness as a highly dignified human phenomenon.… In disease, resides the dignity of man; and the genius of disease is more human than the genius of health."

In the second essay Mann quotes Nietzsche's dictum: "Exceptional conditions make the artist … conditions that are profoundly related and interlaced with morbid phenomena; it seems impossible to be an artist and not to be sick." He then connects Dostoyevsky's and Nietzsche's psychological insight and artistic genius with their diseases. He concludes with the Rimbaudian paradox that the health of humanity can be achieved only by the sacrifice of its artists: "Certain attainments of the soul and intellect are impossible without disease, without insanity, without spiritual crime, and the great invalids are crucified victims, sacrificed to humanity and its advancement, to the broadening of its feeling and knowledge in short, to its more sublime health."

Disease in Mann's fiction is always based on a germ of reality: Death in Venice on a cholera epidemic that took place in Italy in August 1910; The Magic Mountain on Mann's three-week visit to his wife in a Davos sanatorium in May-June 1912; Doctor Faustus on the medical history of Nietzsche; The Black Swan on the true story of a middle-aged woman deluded by the return of her monthly periods. In Mann's works, as Erich Kahler observes, the artist is portrayed as an outcast who renounces life in order to create art: "culture and intellect are represented as decadence, love is associated with decline; the artist is seen as a pariah from the start, iridescent with suspect hues, shading into the daemon, the invalid, the social outcast, the adventurer, the criminal; already he is stranded in the ironic situation of expressing a life he himself is unable to live."

The Romantic tradition found its finest expression in Mann, who accepted and dramatized in his fiction Nietzsche's ideas about disease and art, but it also persisted in English literature throughout the twentieth century. Katherine Mansfield, dying of tuberculosis, complains that her husband Middleton Murry (who was infatuated with Keats) was fascinated by the aesthetic connotations of her disease. He believed tuberculosis endowed its victim with spirituality and creative genius, and was more than half in love with Katherine's easeful death: "This illness getting worse and worse.… He stood it marvellously. It helped very much because it was a romantic disease (his love of a 'romantic appearance' is immensely real)." Yet Katherine Mansfield also makes a direct, Keatsian connection between suffering and insight: "I, being what I am, had to suffer this in order to do the work I am here to perform.… The more I suffer, the more of fiery energy I feel to bear it.… I do not see how we are to come by knowledge and love except through pain." Auden says in "Letter to a Wound": "Knowing you has made me understand." And even the reserved and reticent T. S. Eliot, who wrote The Waste Land while recovering from a nervous breakdown, confesses: "I know that some forms of ill-health, debility or anaemia, may (if other circumstances are favourable) produce an efflux of poetry."


In her essay "On Being Ill" (1930), Virginia Woolf—fascinated by morbid psychic states and the extraordinary perspective of the sick notes the importance of disease as a means of moral exploration. She develops Jane Austen's belief that "A sick chamber may often furnish the worth of volumes" and wonders why literature has not seriously concerned itself with this crucial area of human experience: "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 … it becomes strange indeed that illness has not taken its place with love and battle and jealousy among the prime themes of literature."

Disease and death are traditionally used to reveal the psychological development of the characters and to structure the events of the novel. But in nineteenth-century English fiction the facts of the characters' pain, treatment and death are rarely the focus of interest. Disease is always symbolic (Esther Summerson's small-pox in Bleak House, Mr. Rochester's blindness in Jane Eyre); characters in deathbed scenes are always etherealized. Even in Flaubert the details of disease are used more for moral than for realistic significance. The operation of Hippolyte's clubfoot reveals the ignorant ambition of Charles Bovary; the death by prussic acid is a cruel punishment for the desperate adulteries of Emma.

But in the twentieth century European writers (including a number of doctors) have increasingly turned to the kind of clinical literature that English authors tended to avoid. Modern European literature often concerns the abnormal and the pathological. It is characterized by a macabre sensibility, an attraction to decay and nothingness, an obsession with physical corruption and death; defined by a mood of dissolution and disintegration, of paralyzing anxiety and metaphysical despair. Disease both expresses and emphasizes the dominant themes of the modern age: hyper-sensitivity, self-doubt, loneliness, alienation, loss of identity. Bernanos emphasizes the traditional connection between sin and disease by observing: "All the wounds of the soul give out pus." But after the loss of faith in the twentieth century, disease replaced hell and became one of the most horrible punishments imaginable.

The modern anti-hero who experiences a physiological dialectic of suffering, a painful life and early death is typified and condemned by disease. He is the archetype of the artist, the martyr and the criminal. He is inwardly infected; tormented in body and mind; tested by the endurance of pain; estranged from himself, from his fellow-sufferers and from healthy men. Disease is a punishment that inspires guilt and shame, fear and self-hatred; as in Kafka's Penal Colony, the "crime" is imprinted on the body of the victim.

Disease puts its mark on a high percentage of writers and sets them apart from society. Illness seems to stimulate creative genius, for the constant anxiety, terror and sense of doom intensifies isolation and introspection; heightens the intellectual defiance of the social outcast who questions and challenges conventional ideas about morality; and encourages him to control the potentially dangerous element in his character through the order and form of art. As Nietzsche exclaims: "one must still have chaos in oneself to be able to give birth to a dancing star."

Disease is a grim but fascinating subject that provides insights about how to deal with the ultimate threat of death. Sickness is a shocking experience that exposes the victim's physical and psychological nakedness; plunges him into the anguished aesthetics of despair; jolts him to a recognition of his loneliness and vulnerability; forces him to contemplate the destruction of his body in the silence and solitude of the sickroom. The grand mortuary moment provokes self-probing and internal inquiry, inspires an inward voyage of self-discovery. It often leads to an attempt analogous to aesthetic or religious experience to transcend the limitations of the body and draw on the resource of illness for intellectual illumination and spiritual enlightenment. As Alice James recorded when her fatal cancer was diagnosed: "It is the most supremely interesting moment in life, the only one in fact, when living seems life, and I count it as the greatest good fortune to have these few months so full of interest and instruction in the knowledge of my approaching death."

The horrors of dissolution, not through the natural process of aging but by the hasty and tremendous experience of disease, also resemble the extreme situations that characterize the modern age. The patient lives close to catastrophe; his radical treatment is a form of torture, the hospital like a prison or concentration camp in which the condemned man endures the cruelty of power and the threat of execution. Like the prisoner, his will to live is of crucial importance; if he abandons himself to Arab fatalism, like the Musselmänner in the camps, he has no hope of survival.

The freedom to choose life or death, to determine one's destiny, places the sick hero in an existential situation. He discovers that "it is possible to live without appear and accepts "the certainty of a crushing fate, without the resignation that ought to accompany it." Man knows he is mortal; disease makes mortality visible and forces the victim to realize what it means to be an isolated being irreparably condemned to death. Illness makes the victim aware that his existence can be destroyed, that he can lose himself and his world, that he can become nothing. As Stevenson, a lifelong tubercular invalid, observes: "The changes wrought by death are in themselves so sharp and final, and so terrible and melancholy in their consequences, that the thing stands alone in man's experience, and has no parallel upon earth."

In the modern age a number of complex biographical, religious, social, scientific, medical and moral factors have contributed to the creation of and interest in the literature of disease. Goethe's distinction between healthy and sick writers has disappeared, for disease has become a virtual necessity for creation. Like D. H. Lawrence, modern writers use art for catharsis and insight, and would agree that "One sheds one's sicknesses in books repeats and presents again one's emotions, to be master of them." The moral authority of these writers is based on the paradoxical privilege of sickness and suffering.

The sceptical modern writer no longer assumes that death leads to salvation and a new life, and must attempt to find meaning in suffering and extinction without the consolation of religion. For Keats, easeful death was a release from pain into oblivion; for Tolstoy, a revelation of spiritual truth. But for Ellis and Solzhenitsyn, personal agony has no redemptive quality.


Because of the great number of novels about disease it was necessary to be selective. I have therefore chosen [for inclusion in Disease and the Novel] both difficult and significant fiction that was written between 1880 and 1960 when this theme achieves its finest literary expression, that treat the complex theme in various ways and that lend themselves to intensive analysis from this point of view. I feel it would be more valuable and interesting to concentrate on a small number of great works than to write a general survey of novels about disease.

These eight works are...

(The entire section is 24006 words.)