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Images of Illness

The early romantic sought superiority by desiring, and by desiring to desire, more intensely than others do. And the inability to realize these ideals of vitality and perfect spontaneity was thought to make someone an ideal candidate for TB. Contemporary romanticism starts from the inverse principle—that it is others who desire intensely, and that it is oneself (the narratives are typically in the first person) who has little or no desire at all. We can find precursors of the modern romantic egos of unfeeling in nineteenth-century Russian novels; but Pechorin in Lermontov’s A Hero of Our Time, Stavrogin in The Possessed, are still heroes—restless, bitter, self-destructive, tormented by their inability to feel. (Even their glum, merely self-absorbed descendants, Roquentin in Sartre’s Nausea and Meursault in Camus’s The Stranger, seem bewildered by their inability to feel.) The passive, affectless anti-hero who dominates contemporary American fiction is a creature of regular routines or unfeeling debauch; not self-destructive but prudent; not moody, dashing, cruel, just dissociated. The ideal candidate, according to contemporary mythology, for cancer.

Ceasing to consider disease as a punishment which fits the objective moral character, making it an expression of the inner self, might seem less moralistic. But this view turns out to be just as, or even more, moralistic and punitive. With the modern diseases (once TB, now cancer), the romantic idea that the disease expresses the character is invariably extended to assert that the character causes the disease—because it has not expressed itself. Passion moves inward, striking and blighting the deepest cellular recesses.

The sick man himself creates his disease,” the German psychologist Georg Groddeck wrote. “In him are to be found the causae internae; he is the cause of the disease and we need seek none other.” “Bacilli” heads Groddeck’s list of mere “external causes”—followed by “chills, overeating, overdrinking, work, and anything else.” He insists that it is “because it is not pleasant to look within ourselves” that doctors prefer to “attack the outer causes with prophylaxis, disinfection, and so on” rather than address the real, internal causes.2

Such preposterous and dangerous views manage to put the entire onus of the disease on the patient and deprive the patient of the means for understanding the range of plausible treatment. Cure is thought to depend principally on the patient’s already sorely tested or enfeebled capacity for self-love. A year before her death in 1923, Katherine Mansfield writes in her Journal:

A bad day…horrible pains and so on, and weakness. I could do nothing. The weakness was not only physical. I must heal my Self before I will be well…. This must be done alone and at once. It is at the root of my not getting better. My mind is not controlled.

Mansfield not only thinks it was the “Self” which made her sick but that she has a chance of being cured of her hopelessly advanced lung disease if she could heal that “Self.”

Both the myth about TB and the current myth about cancer propose that one is responsible for one’s disease. But the cancer imagery is far more punishing. Given the romantic values in use for judging character and disease, some glamor attaches to having a disease thought to come from being too full of passion. But there is mostly opprobrium attached to a disease thought to stem from the repression of emotion—an opprobrium echoed in the view of cancer propagated by Reich, and the many writers influenced by him. Reich’s view of cancer as a disease of the failure of expressiveness condemns the cancer patient: expresses pity but also conveys contempt. The theory also contributes to making cancer shameful, and to making cancer patients feel, consciously or unconsciously, guilty for getting cancer.

By vitalist standards, the cancer personality is one of life’s losers. Napoleon, Ulysses S. Grant, Robert A. Taft, and Hubert Humphrey have all had their cancers diagnosed as the reaction to political defeat and the curtailing of their ambitions. And the truly great, those—like Freud and Wittgenstein—whose lives can by no means be called a defeat, have had their cancers diagnosed as the gruesome though stoically endured penalty they had to pay for a lifetime of renunciation. In contrast, there never seems any ground for condescension about the disease that claimed the likes of Keats, Chekhov, Simone Weil, Emily Brontë, and Poe.

III

Cancer is generally thought an inappropriate disease for a romantic character, in contrast to tuberculosis, perhaps because unromantic depression has supplanted the romantic notion of melancholy. “A fitful strain of melancholy,” Poe wrote, “will ever be found inseparable from the perfection of the beautiful.” Depression is melancholy minus its charms—the animation, the fits.

Supporting the theory about the emotional causes of cancer, there is a growing literature and body of research: and scarcely a week passes without a new article announcing to some general public or other the scientific link between cancer and painful feelings. Investigations are cited—most articles refer to the same ones—in which out of, say, several dozen or several hundred cancer patients two-thirds or three-fifths report being depressed or unsatisfied with their lives, and having suffered from the loss (through death or rejection or separation) of a parent, lover, spouse, or close friend.3

But it seems likely that of several hundred people who do not have cancer, most would also report depressing emotions and past traumas: this is called the human condition. And the case histories are recounted in a particularly forthcoming language of despair, of discontent about and obsessive preoccupation with the isolated self and its never altogether satisfactory “relationships,” which bears the unmistakable stamp of our consumer culture. It is a language many Americans now use about themselves.4

Investigations carried out by a few doctors in the mid- and late-nineteenth century showed a high correlation between cancer and that era’s complaints. In contrast to American cancer patients, who invariably report having feelings of isolation and loneliness since childhood, Victorian cancer patients described overcrowded lives, burdened with work and family obligations, and bereavements. These patients don’t express discontent with their lives as such or speculate about the quality of its satisfactions and the possibility of a “meaningful relationship.” Physicians found the causes or predisposing factors of their patients’ cancers in grief, in worry (noted as most acute among businessmen and the mothers of large families), in straitened economic circumstances and sudden reversals of fortune, and in overwork—or, if the patients were successful writers or politicians, in grief, rage, intellectual overexertion, the anxiety that accompanies ambition, and the stress of public life.5

Nineteenth-century cancer patients were thought to get the disease as the result of hyperactivity and hyperintensity. They seemed to be full of emotions that had to be damped down. As a prophylaxis against cancer, one English doctor urged his patients “to avoid overtaxing their strength, and to bear the ills of life with equanimity; above all things, not to ‘give way’ to any grief.” Such stoic counsels have now been replaced by prescriptions for self-expression, from talking it out to the primal scream. In 1885, an American doctor advised “those who have apparently benign tumors in the breast of the advantage of being cheerful.”6 Today, this would be regarded as encouraging the sort of emotional dissociation now thought to predispose people to cancer.

Modern researchers into the psychic aspects of cancer like to cite old authorities, such as Galen’s observation that “melancholy women” were more likely to get breast cancer than “sanguine women.” But the meanings have changed. What Galen (AD 130-200) meant by melancholy was a physiological condition with complex characterological symptoms; we mean a mere mood. In 1870 Sir James Paget declared that “mental depression is a weighty additive to the other influences favoring the development of a cancerous constitution.” What a nineteenth-century physician meant by “mental depression” was a passionate state (mainly grief), something close to our manic-depressive syndrome.

Grief and anxiety,” said the English surgeon Sir Astley Cooper 150 years ago, are among “the most frequent causes” of breast cancer. The same theory, put in the same terms, had long been in circulation for TB. In his Morbidus Anglicus (1672), Gideon Harvey declared “melancholy” and “choler” to be “the sole cause” of TB, for which he used the metaphoric term “corrosion.” In 1881, a standard medical textbook gave as the causes of tuberculosis: hereditary disposition, unfavorable climate, sedentary indoor life, defective ventilation, deficiency of light, and “depressing emotions.”7 The entry had to be changed for the next edition, for in 1882 Robert Koch had published his paper announcing the discovery of the tubercle bacillus and demonstrating that it was the primary cause of the disease.

The modern work on the psychological causes of cancer finds its true antecedent and counterpart in the large nineteenth-century literature on the causes of TB. (Not in that small body of medical work from the last century on the emotional causes of cancer.) Applied to TB, the theory that emotions cause diseases survived well into this century—until, finally, it was discovered how to cure the disease. The theory’s fashionable current application—which relates cancer to feelings of isolation and depression—is likely to prove no more tenable than did its application to tuberculosis.

In the plague-ridden England of the late sixteenth and seventeenth centuries, it was widely believed that “the happy man would not get plague.”8 The fantasy that a happy state of mind would fend off disease probably flourished for all infectious diseases, before the nature of infection was understood. Theories that diseases are caused by mental states and can be cured by will-power are always an index of how much is not understood about the physical terrain of a disease.

Moreover, there is a peculiarly modern predilection for psychological explanations of disease as of everything else. Psychologizing seems to provide control over the experiences and events (like grave illnesses) over which people have in fact little or no control. Psychological understanding undermines the “reality” of a disease. That reality has to be explained. (It really means; or is a symbol of; or must be interpreted so.) For those who live neither with religious consolations about death nor with a sense of death (or of anything else) as “natural,” death is the obscene mystery, the ultimate affront, the thing that cannot be controlled. It can only be denied. A large part of the popularity and persuasiveness of psychology comes from its being a sublimated spiritualism: a secular, ostensibly scientific way of affirming the primacy of “spirit” over matter. That ineluctably material reality, disease, can be given a psychological explanation. Death itself can be considered, ultimately, a psychological phenomenon. Groddeck declared in The Book of the It (he was speaking of TB): “He alone will die who wishes to die, to whom life is intolerable.”9 The promise of a temporary triumph over death is implicit in much of the psychological thinking that starts from Freud and Jung.

At the least, there is the promise of a triumph over illness. A “physical” illness becomes in a way less real—but, in compensation, more interesting—so far as it can be considered a “mental” one. Speculation throughout the modern period has tended steadily to enlarge the category of mental illness. Indeed, the denial of death in this culture has led to a vast expansion of the category of illness as such.

This expansion proceeds by means of two hypotheses. The first is that every form of social deviation can be considered an illness. Thus, if criminal behavior can be considered as an illness, then criminals cannot be condemned or punished but must be understood, treated, cured.10 The second is that every illness can be considered psychologically. Illness is interpreted as, basically, a psychological phenomenon, and people are encouraged to believe that they get sick because they want to, and that they can cure themselves by the mobilization of will; that they can choose not to die. These two hypotheses are complementary. As the first seems to relieve guilt, the second reinstates it. Psychological theories of illness are a powerful means of placing the blame on the ill. Patients who are instructed that they have, unwittingly, caused their disease are also being made to feel that they have deserved it.

(This is the second part of a three-part article.)

  1. 2

    Georg Groddeck, The Book of the It (Vintage, 1961), p. 243. Cf. p. 101, where Groddeck describes sickness as “a symbol, a representation of something going on within, a drama staged by the It….”

  2. 3

    Most recent articles refer to at least the following: the study started in 1946 by Dr. Caroline Bedell Thomas of Johns Hopkins University School of Medicine; the writings of Lawrence LeShan, a New York psychologist and psychotherapist; a study started in the 1960s by Drs. Claus and Marjorie Bahnson at the Eastern Pennsylvania Psychiatric Institute in Philadelphia; and the work of Dr. O. Carl Simonton, a radiologist in Fort Worth, Texas, who, with his wife Stephanie, gives patients both radiation and psychotherapy. As far as I know, no oncologist convinced of the efficacy of polychemotherapy and immunotherapy in treating patients has contributed to this kind of speculation about cancer.

  3. 4

    Dr. Caroline Bedell Thomas’s study was thus summarized in one recent article (“Can Your Personality Kill You?” by Joan Arehart-Treichel, New York, November 28, 1977): “In brief, cancer victims are low-gear persons, seldom prey to outbursts of emotion. They have feelings of isolation from their parents dating back to childhood.” The often-quoted Lawrence LeShan (You Can Fight for Your Life: Emotional Factors in the Causation of Cancer [Evans, 1977]) divides “the basic emotional pattern of the cancer patient” into three parts: “a childhood or adolescence marked by feelings of isolation,” the loss of the “meaningful relationship” found in adulthood, and a subsequent “conviction that life holds no more hope.”

    The Bahnsons are reported (in “Cancer and the Emotions,” by Barbara Yuncker, New York Post, December 11, 1976) to have “charted a personality pattern of denial of hostility, depression and of memory of emotional deprivation in childhood.” Dr. Simonton describes the “cancer personality” (in the same article) “as prone not to be able to forgive and to hold deep-seated resentment. There’s a great tendency for self-pity and a markedly impaired ability to make and maintain meaningful relationships.”

  4. 5

    Always much trouble and hard work” is a notation that occurs in many of the brief case histories in Herbert Snow’s Clinical Notes on Cancer (1883). Snow was a surgeon in the Cancer Hospital in London, and most of the patients he saw were poor. A typical observation: “Of 140 cases of breast-cancer, 102 gave an account of previous mental trouble, hard work, or other debilitating agency. Of 187 uterine ditto, 91 showed a similar history.” Doctors who saw patients who led more comfortable lives made other observations. The physician who treated Alexandre Dumas for cancer, G. von Schmitt, published a book on cancer in 1871 in which he listed “deep and sedentary study and pursuits, the feverish and anxious agitation of public life, the cares of ambition, frequent paroxysms of rage, violent grief” as “the principal causes” of the disease.

    The proponents of the contemporary theory of the emotional causes of cancer who appeal to these nineteenth-century studies seem unable or unwilling to grasp that they undermine rather than support contemporary speculations. See Samuel J. Kowal, MD, “Emotions as a Cause of Cancer: 18th and 19th Century Contributions” Review of Psychoanalysis, Vol. 42, No. 3 (July 1955), pp. 217-227, from which I have taken the quotations from Snow and von Schmitt.

  5. 6

    The English doctor was Herbert Snow; the American doctor was Willard Parker. Both are quoted in Kowal, op. cit., pp. 223 and 221.

  6. 7

    August Flint and William H. Welch, The Principles and Practice of Medicine (fifth edition, 1881) cited in René and Jean Dubos, The White Plague (Little, Brown, and Company, 1952), p. 69. The Harvey quote is on p. 255.

  7. 8

    Keith Thomas, Religion and the Decline of Magic (Scribner’s, 1971), p. 9.

  8. 9

    Groddeck, op. cit., p. 101.

  9. 10

    An early statement of this view, now so much on the defensive, is in Samuel Butler’s Erewhon (1872). In Erewhon, those who murdered or stole are sympathetically treated as ill persons, while tuberculosis is punished as a crime. Butler thought criminality came from an unwholesome environment, and that TB was hereditary.

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