Why Is Illness So Hard to Write About?
A hundred years ago, Virginia Woolf published her second most famous essay. “On Being Ill,” from 1926, cedes first place in the Woolf nonfiction canon to the feminist cornerstone “A Room of One’s Own,” from 1929, but the two essays share a preoccupation with the problem, as she puts it in the latter, of “heart, body and brain” being “all mixed together, and not contained in separate compartments as they will be no doubt in another million years.” In “On Being Ill,” that entanglement is tested by an eternal and indiscriminate form of suffering. Given that illness is an unavoidable feature of human experience, Woolf asks, why has literature represented it so rarely, and so inadequately?
The question accumulates more urgency along the wild ride of an essay that follows. Written during a prolonged bout of illness the previous fall, “On Being Ill,” with its tumbling sentences and exhilarating swerves of imagination, is so febrile that you wonder if it wasn’t written in the grip of an actual fever. The many-claused question of the bravura opening salvo is worth quoting in full:
It’s a remarkable irony that an essay objecting to a generalized literary silence around bodily suffering should come from the pen of such a disembodied writer, one who often, as she does in this passage, assumes the form of a floating consciousness. That lone and bathetic tooth is the only sign that we’re in the realm of the somatic. The high-flown rest—the wastes and deserts of the soul, the pit of death, the waters of annihilation—is made up of incorporeal abstractions, albeit conjured in a tone of wry exaggeration, as if to mock hypochondriac excess. At no point in the essay does Woolf specifically refer to her own body, her own illness, or to any particular person’s experience of ill health, even as she calls for “epic poems to typhoid; odes to pneumonia, lyrics to toothache.” The term “autoimmune” hadn’t yet come into currency, but the self-thwarting character of “On Being Ill” suggests a similar diagnosis; here’s an essay that denies itself the health it seeks. Why couldn’t Woolf summon the explicitness she was calling for?
Occasioned by the centennial, a small publishing house, the New Menard Press, has released a new edition of “On Being Ill,” complemented by essays from twelve contemporary writers on illness. This incarnation of the essay speaks to its durability: unlike human bodies, essays sometimes achieve immortality, or at least extraordinary longevity. It also calls to mind the fact that “On Being Ill,” originally published in T. S. Eliot’s New Criterion magazine, was reprinted three months later in an American journal, The Forum, under a different title: “Illness: An Unexploited Mine.” It cannot be said that the mine remains unexploited today. The intervening century has qualified, if hardly refuted, the claim that sickness is neglected in fiction. In recent decades, narratives of illness have become more frequent, as the omertà around the body, particularly the once extra-unmentionable female body, has faded.
Even in Woolf’s time, the metaphorical mine was not exactly unexploited. Appropriately enough, its foremost miner was an actual coal miner’s son. D. H. Lawrence’s “Sons and Lovers” (1913) and “Women in Love” (1920) both predated “On Being Ill” and featured illness in unignorable ways. Lawrence’s passionately living, intensely feeling characters are afforded bolts of spiritual clarity, even revelations, by their sickbed spells. Abysmal bronchial health dogged Lawrence throughout his life, the wages, perhaps, of a childhood spent inhaling coal dust in a mining town. A bout of pneumonia in November, 1911, when he was twenty-six, appears to have been particularly clarifying. When he emerged from illness in February, he called off his engagement to Louie Burrows (“My illness,” he wrote to her, “has changed me a good deal, has broken a good many of the old bonds that held me”) and soon afterward met Frieda Weekley, who became his wife. Woolf, too, saw illness as a state of heightened perception, one that disclosed “undiscovered countries.”
In “On Being Ill” she nods to the posh Marcel Proust and the Oxford-educated Thomas De Quincey, but, by ignoring a peer for whom illness was such a shaping force, Woolf—that true genius, that unrepentant snob—weakens her own case. Her first public mention of Lawrence, a disapproving review of “The Lost Girl” (1920), suggests one reason for the omission: “We conceived him to be a writer . . . for whom the body was alive and the problems of the body insistent and important. It was plain that sex had for him a meaning which it was disquieting to think that we, too, might have to explore.” Later, she insisted, unpersuasively, that “the greatest writers lay no stress upon sex one way or the other,” complaining that Lawrence, Joyce, and Hemingway “spoil their books for women readers by their display of self-conscious virility.” Sex becomes something to be shut down in the manner of a glaring headmistress silencing a cheeky teen-ager. And yet, in “On Being Ill,” Woolf calls for a new language of the body, one that is “primitive, subtle, sensual, obscene.” Who, if not Lawrence, was primitive, subtle, sensual, and obscene?
In fact, Lawrence was no simple counterexample to her thesis. In “Sons and Lovers,” Paul’s pneumonia is rendered from within as a “ghastly, sickly feeling of dissolution,” and his mother’s dying body is observed with almost pitiless exactness, complete with what her daughter calls “a lump as big as my double fist.” But a few years later, in “Women in Love,” the body all but disappears when Birkin takes to his bed. Even while sick—especially while sick—Birkin is more mind than body on the page. He likes being sick, Lawrence tells us, because then “things came to him clear and sure.” Lawrence, the apostle of the body, had turned the sickbed into a chamber of metaphysical revelation. Depictions of illness, as Woolf puts it dryly, tend to “taper into mysticism, or rise, with rapid beats of the wings, into the raptures of transcendentalism.” Woolf’s own ambivalence about embodiment is pronounced and, at times, passionate: she refers to “this monster, the body, this miracle, its pain.” Attraction and recoil seem almost inseparable. Some part of her reticence may simply have been pudeur, a reluctance to render bodily matters too explicitly. Even such a visionary feminist thinker as Woolf could not, it seems, surmount the strictures of her social rank and break this taboo.
A century later, that inhibition has weakened considerably. How I’d like to press Christine Smallwood’s ironically titled novel “The Life of the Mind” into Woolf’s hands, with its opening scene of simultaneous double excretion: shit and bloody miscarriage material are being expelled as we meet the novel’s heroine, Dorothy, in a toilet stall in a library of an élite university where she teaches. Smallwood’s 2021 novel is one of a number of recent books by women who write graphically about the processes and pain of the body. A fresh addition, Lena Dunham’s memoir “Famesick,” in which the writer’s hysterectomized uterus is described as “the Chinatown Chanel purse of nightmares, full of both subtle and glaring flaws,” might be another good contender for blowing Woolf’s mind—and perhaps returning her to her body, too. As Woolf admits in her review of “The Lost Girl,” “We always dread originality, yet with the sense that once the shock was received we should rise braced and purified.” Shock, in other words, might be a tonic, even a form of medicine. But a patient doesn’t always welcome her treatment.
Needless to say, Smallwood and her contemporaries aren’t the first writers to rid themselves of corporeal squeamishness. In Woolf’s own time, Joyce as well as Lawrence had already breached forms of bodily decorum in ways she found dismaying; later writers would make sex, menstruation, excretion, pregnancy, and physical decay increasingly difficult to exclude from serious literature. (Philip Roth is so well remembered for his characters’ priapism that we can forget the meticulously detailed back pain of “The Anatomy Lesson” or the heart disease of “The Counterlife.”)
Yet the strange disparity Woolf identified persists. We have grown much more willing to put the body on the page without necessarily becoming much better at putting illness there. It isn’t that literature has ever been shy about death, that final health crisis. The canon abounds with wounds, murders, consumptions, and deathbeds. Real people, however, mostly die not from florid and punctual acts of violence but from drawn-out sickness. Even Tolstoy’s “The Death of Ivan Ilyich,” one of the most central depictions of illness in fiction, is more concerned with the existential ramifications of impending mortality than, per Woolf’s prescription, the “daily drama of the body.” Likewise, in the canon of AIDS literature from the nineteen-eighties onward, more attention is paid to loss than to the day-by-day specificities of the ravaging sickness that induces it.
In short, Woolf remains basically right: illness still doesn’t have the salience in literature that it has in life. Why? Shame and decorum are obviously not the whole story. Woolf proposes another explanation: “English, which can express the thoughts of Hamlet and the tragedy of Lear, has no words for the shiver and the headache.” Let a patient attempt to describe the particular sensation of a headache, she writes, “and language at once runs dry.” A deeper problem, then, may be the strange elusiveness of language for an experience that eludes none of us.
While suffering from tabes dorsalis, a complication of syphilis involving the slow, excruciating degeneration of the spinal cord, the nineteenth-century French writer Alphonse Daudet embarked on the doomed and invaluable project of trying to put his experience into words. The resulting posthumously published book, “In the Land of Pain,” has since come to embody (as it were) the idea of the incommunicability of pain. When the literary scholar Elaine Scarry, in “The Body in Pain” (1985), states that “physical pain has no voice,” and that “the pains occurring in other people’s bodies flicker before the mind, then disappear,” she’s echoing Daudet, who asks, “Are words actually any use to describe what pain (or passion, for that matter) really feels like? Words only come when everything is over, when things have calmed down.” Like many accounts of illness since, “In the Land of Pain” takes the form of jotted notes and fragments. Who, after all, can sustain long, continuous paragraphs while under physical duress? Woolf’s observation that “illness makes us disinclined for the long campaigns that prose exacts” refers to reading, but she might as well have been discussing writing.
The theme of inexpressibility shades many of the essays in the new edition of “On Being Ill.” The photographer and writer Lina Scheynius, for example, admits that in trying to describe her migraines, she is “attempting the impossible” since “I know I won’t come close to describing them as they truly were.” Here’s one paradox of illness: during an episode of pain, we can think of nothing else, even as it obliterates all thought. So much so that, as Scheynius admits, “I could never attempt to write anything from that place.” Afterward, another difficulty presents itself. We remember that we suffered, often very vividly; but the sensation itself can be strangely difficult to summon. The writer thus faces a peculiar predicament: when the pain is present, it may defeat language; once language returns, the pain becomes hard to recapture. How then can a writer meet the double challenge: to first imaginatively retrieve, and second, adequately render, their experience of suffering? We all know how it feels to be unable to say how it feels.
Ralph Waldo Emerson, in his essay “The Poet,” insists (in keeping with the gendered conventions of 1844) that the poet is “the man without impediment, who sees and handles that which others dream of, traverses the whole scale of experience.” As he rather formidably contends, there’s nothing, including pain, that the poet shouldn’t be able to express.
Woolf herself, curiously enough, supplies evidence for Emerson’s case. In the consulting room of her diary, the body is anything but elusive. During her period of ill health in the fall of 1925, convalescence strands her in “that odd amphibious life of headache”; shortly after sending the essay to Eliot, she records “a good deal of rat-gnawing at the back of my head,” while the tiredness of her body is such that “it lay like a workman’s coat.” Whatever difficulty pain presents to language, Woolf clearly possessed a language for her own malaise—at least when writing in private. In this way, her reticence in “On Being Ill” really does look less like incapacity than inhibition.
Emerson’s proposition gains further support from Garth Greenwell’s remarkable novel “Small Rain” (2024), in which the narrator experiences a medical catastrophe in the form of an aortic dissection—a tear in the body’s main artery. And, yes, it’s as bad as it sounds. The precise descriptions that follow—the lacerating specificity of I.V.-line insertion (it “hardly hurt at all,” until the nurse begins “pushing it in more deeply and moving it side to side”) or the dull, relentless discomfort of a blood-pressure cuff—are proof that acute suffering needn’t escape depiction. It’s probably no coincidence that Greenwell, a poet before he was a novelist, is also one of our best contemporary writers about sex, that other hemisphere of the near-universal and supposedly inexpressible. Greenwell’s narrator is a poet, too, and, as he reflects in one of his reprieves, what he cares about most is “devotion to the actual.”
This devotion, however, is paired with the contradictory-sounding wish to “pull away from the concrete, to make it representative.” And so Greenwell’s formulation poses another challenge: How can writing remain faithful to the particular while allowing it to become representative? For most of “Small Rain,” the narrator’s world scarcely extends beyond his hospital bed, where his body becomes a terrain of eloquent fascination, horror, and tenderness. The narrowness of Greenwell’s optic authenticates an important property of suffering: the immediate emergency of the body eclipses everything else.
Inconveniently for literature, the suffering body can even eclipse story. Pain may be difficult to put into words; illness can be harder still to put into plot. The chronic kind, especially, may offer neither the clean resolution of recovery nor the finality of death. It threatens us with plotlessness. Writing six years after the Spanish-flu epidemic had killed an estimated fifty million people and sickened countless more, Woolf imagined that “the public would say that a novel devoted to influenza lacked plot; they would complain that there was no love in it.” Katherine Anne Porter’s 1939 novella “Pale Horse, Pale Rider” is indeed “devoted to influenza” and, contra Woolf, supplies both love and a highly consequential plot. (“Illness,” our wise Woolf notes, “often takes on the disguise of love, and plays the same odd tricks.”) Miranda survives influenza; her beloved Adam, infected while caring for her, does not. The solitary derangement of illness thus gives way to the perhaps even less communicable derangement of grief. Dramatically speaking, the latter has more force. Porter’s story works because influenza is attached to those older narrative engines, love and death.
“The Magic Mountain,” however, suggests another possibility: instead of rescuing illness from plotlessness, a novelist can make plotlessness the point. Published in English the year after “On Being Ill,” Thomas Mann’s great novel of protracted sickness is set in a sanatorium where tuberculosis has suspended the ordinary lives of its inhabitants. Mann does on a grand scale what the Lawrentian sickbed epiphany does on an individual one: illness effects a caesura. Time seems to pause; patients enter an eerie, irresolute realm of exemption in which contemplation can flourish because action has stalled. The sanatorium becomes a space of ideas, its patients’ tuberculosis-tethered lives opening onto questions about civilizational decay.
Yet this solution introduces another difficulty. If illness does not readily generate action, there’s a powerful temptation to make it generate meaning instead—to turn the sick body into allegory or revelation.
No writer has objected more forcefully to this tendency than Susan Sontag. In her 1978 book “Illness as Metaphor,” written after her own treatment for breast cancer, she attacks the imaginative distortions that gather around disease and demands “real geography” rather than “sentimental fantasies.” Two egregious examples preoccupy her: the old myth of tuberculosis as the disease of the sensitive and spiritual, and the modern notion that cancer afflicts “the sexually repressed, inhibited, unspontaneous,” or those “incapable of expressing anger.” Illness, as anyone who has ever been ill knows, is not a metaphor. Its exactions call for something more like testimony: here is what happened; here is what it felt like to this specific body.
Yet as a rule for writers, Sontag’s injunction may be too absolute. Devotion to the literal need not preclude the representative. Indeed, Greenwell’s novel suggests the opposite: close enough attention to the actual may be what allows an account of one body to acquire meanings beyond it. The rootedness of testimony in facts and sensation may be what’s needed for a narrative of illness to take flight into the universal.
Anne Boyer’s righteously furious memoir, “The Undying,” demonstrates how this can work. Her book details the graphic horror of chemotherapy and a double mastectomy—“everything we were supposed to keep inside of us now seems to fall out”—but refuses the imaginative smallness that ill health often inflicts, pushing outward from the suffering body to the world in which that body suffers. Rather than making cancer an occasion for spiritual transformation, she situates herself as a political subject, reckoning with a country in which corporations profit from sick citizens and the logic of individualism tries to impose its own narrative on cancer: “of the atomized individual done right, self-examined and mammogramed, of disease cured with compliance, 5K runs, organic green smoothies, and positive thought.” Boyer’s illness means something, then, but not because it reveals some hidden truth about her soul. Its significance lies in the material arrangements surrounding it. In this sense, her memoir realizes what Greenwell’s narrator aspires to: both the particular and the general.
Boyer tells a recovery story only of the cold and broken kind. In her book’s unpitying and radiant last pages, she writes, “I lost some neural mitochondria and my looks and many of my memories and a lot of my intelligence and an optimistically estimated five to ten years of life span to the curative forces of medical decimation.” Yet her insistence on the material conditions of illness does not exclude more existential meanings: “It’s like the condition of lostness is, when it comes to being a person, what finally makes us real.”
Lostness sounds like a condition of solitude, and illness certainly is one. As Woolf writes, “Here we go alone.” But that is only half the truth. Illness is also a shared misfortune in the most literal sense. The sick depend on doctors, nurses, lovers, families, institutions. How does literature enlarge its field of vision without forgetting the singular body whose suffering gave the subject its urgency in the first place?
Epidemics, even more than sanatoriums, make the problem unmissable. Albert Camus’s 1947 novel “The Plague,” in which the Algerian coastal town of Oran is besieged by bubonic plague, enjoyed a remarkable revival during the early months of COVID. The appeal was obvious. Camus’s plague is both a collection of individual bodily ordeals and an affliction of an entire society. Often read as an allegory of Nazi occupation, the novel, with its grisly descriptions of the lancing of swollen buboes, has plenty of nonmetaphorical specificity. Plague may operate with “the efficient impartiality of its ministrations,” as Camus’s narrator observes, but its consequences are anything but equal; common danger is no guarantee of common feeling. The novel’s moral center is the doctor Rieux, whose vocation requires him to apprehend the epidemic in the aggregate while tending to its victims, again and again, one sick body at a time. Cures are not always forthcoming and sainthood is unattainable. But being present to life, as Emerson exhorts, is possible.
The premise of literature, of course, is that we can be both patients and doctors. José Saramago’s “Blindness” (1995), in which a doctor becomes a patient, takes the question of collective suffering still further. Its premise seems almost aggressively allegorical: an inexplicable pandemic of sudden, total blindness strikes an unnamed town of unnamed inhabitants. Yet Saramago refuses to let his sufferers disappear into metaphor. Blindness remains insistently bodily: a predicament of touch, orientation, hunger, filth, exposure, and dependence. The first victims are sequestered in a derelict mental asylum, where fragile bonds of coöperation soon give way to terror and degradation. As unspeakable acts are witnessed by the reader who can “see” what Saramago’s characters can’t, any notion of suffering as a basis for solidarity seems laughable: here’s humanity as selfish, violent, and base as it gets. Yet after the befouled asylum is abandoned, a small community of mutual aid slowly, falteringly takes shape; its members’ reliance on one another is a kind of grace. Here we go alone. But not entirely: suffering may isolate us, but the sick body depends on other people.
Woolf’s diaries make a similar turn outward. In November, 1925, after recording the rat-gnawing headache and the body lying like a workman’s coat, she writes, “The best of these illnesses is that they loosen the earth about the roots. They make changes. People express their affection.” The enclosing experience of illness opens onto other people—and, for Woolf, onto writing, as well. Five years later, not long after typesetting a limited edition of “On Being Ill,” Woolf was again confined to bed. Recovering, she remembered how, during earlier illnesses, she would furtively pull a piece of paper toward herself, out of the nurse’s sight: “what a tremendous desire to write I had.” After a few more days, and another of her “usual” headaches, she announced her recovery in the terms that were the most meaningful to her: “I will signalise my return to life—that is writing—by beginning a new book.” ♦