I have always found my history, myself, hard to read. Not that I haven’t tried: I’ve been psychoanalyzed for years and hospitalized for suicide attempts and lupus flares, sojourns meant to unravel my body’s mysteries. Yet women like me—the sick and the mad—have been read, over and over again, through the centuries. In addition to the curious literary subgenres within medicine (the medical chart, the patient’s autobiography, the Freudian case study), canonical literature has visited countless sickbeds.This strange corpus of sick women stretches far back into literary history. As early as the thousand-year-old Tale of Genji, the most celebrated work of Japanese literature and the world’s first novel, court lady Murasaki Shikibu established the poetics of female illness—or as one scholar called it, “the beauty of the moribund.” In a famous scene, Murasaki describes how the philandering protagonist discovers affection for his neglected wife only when she is on the verge of death: “[F]or the first time, as she lay there in her vulnerable, helpless condition, she struck him as not just precious but voluptuous.” Women weaken throughout the novel, becoming more beloved to Genji in death’s dishabille. On their deathbeds, their unbound hair suggests a charged eroticism that the era’s literal and figurative screens shielded in healthier days. Illness was license for looking, for trespass, for love.
It took a while for the aesthetic of the corpse bride to be embraced by the West. Plague in Europe perhaps tainted the reading of literary cadavers. Classics like The Decameron are inspired by a fleeing of illness rather than an admiration for its handiwork. Religion may have also dampened deathbed longings; given Christianity’s focus on the iniquities of the flesh, death is less likely to ignite Eros than relief. But in the nineteenth century, the wild-haired wraiths of the Heian-era court were echoed in the tuberculosis victims of European opera and literature. Consumptives like La Bohème’s Mimi burn from within, their pink cheeks suggesting a heart or soul on fire. (In such romanticized portraits, the promise of death’s-door hedonism must make up for the stinking breath of a person dying from TB.)
Running on a parallel and contradictory track to this sexualizing of sick women was the pathologizing of those who traded sex for money. In 1836, the French hygienist Alexandre Parent-Duchâtelet published a study called De la prostitution dans la ville de Paris, or Prostitution in the City of Paris. A dozen years earlier he had written a seminal work on the city’s sewers, and he did not hesitate to draw an analogy between the two systems that would influence both public policy and novels, including Eugène Sue’s Les Mystères de Paris and Émile Zola’s Nana. Armed with medical authority, he declared the sex worker contaminated, poised to spread filth and disease, and from his warnings a number of legal-judicial dictates flowed. This period marked the beginning of state-run brothels and the mandatory registration of Parisian sex workers.
The ramifications of these policies played out in literature, most shockingly in the final scene of Nana, which exposes the heroine’s corpse. Its shortest sentence encapsulates its pitiless tone and theme: “Venus was decomposing.” Readers can smell the putridity as Nana’s charms are exorcised. Only in this final passage is the reader truly alone with the courtesan, for earlier chapters were always mediated by her many male companions. Once granted a private audience, the reader is treated to a spectacle of horror. In its admonitory staging, Nana’s final scene could only have pleased Parent-Duchâtelet’s ghost more if her maggot-laced limbs had poured out of a sewer pipe.
While Parent-Duchâtelet was right that many women of the night suffered from venereal disease, his conflation of harlotry and sickness was a dangerous and damning one. Even today, I believe our reading of sick women is tainted by his and similar ideologies that blame the victim, particularly when it comes to diseases like depression, addiction, and HIV.
As complicated as its readings have been across time and cultures, physical illness has always been viewed differently than mental illness. Sure, victims of skin diseases like leprosy were shunned and segregated, but for the most part, the physically ill were tolerated, if barely. Meanwhile, those perceived to be crazy were ostracized, abused, caged, exploited, tortured, raped, and demonized.
By the nineteenth century, however, things had started to change. By then, madness was considered, in some circles, to be thrilling theater. The Tuesday Lectures orchestrated by neurologist Jean-Martin Charcot in late-nineteenth-century Paris, with their female hysterics who performed under hypnosis, were perhaps seen by those in the know as a chic alternative to the Paris Opéra. Those women performed beautifully, cackling, rattling, and shrieking on command. I bet few stopped to wonder if they might be doing it to receive attention and consistent meals in Charcot’s hospital, the Salpêtrière, through the enactment of an illness.
The Salpêtrière also circulated images of these madwomen—influenced by family portraiture, early forensic photography, and religious iconography—in several volumes of photography. Doctors at other nineteenth-century institutions indulged in this pastime as well, with one English doctor dressing up his charges as Hamlet’s Ophelia for the camera. Such practices carry with them a whiff of procurement and prostitution, which should come as no surprise. In the seventeenth century, Louis XIV founded a hospital for prostitutes and the mentally ill, and at least since then, the two groups have been linked in the minds of men with power.
Charcot parted the curtains on female mental patients, but the grand finale didn’t come until Freud. In Invention of Hysteria: Charcot and the Photographic Iconography of the Salpêtrière, Georges Didi-Huberman elucidates the link between Freud, who visited the famous doctor and hospital in 1885, and Charcot: “Freud had had to pass through the great theater of hysteria at the Salpêtrière before beginning to listen, and before inventing psychoanalysis . . .[H]e had to get an eyeful.” It would take Freud to swing the focus from the flesh to the interior narrative of health. If Charcot understood how to stage madness, Freud knew how to tell a story. The latter acknowledged, “I have not always been a psychotherapist. Like other neuropathologists, I was trained to employ local diagnoses and electro-prognosis, and it still strikes me as strange that the case histories I write should read like short stories and that, as one might say, they lack the serious stamp of science.” His case histories do read like eerie versions of Sherlock Holmes tales, not just in that he is reasoning out a conclusion based on scattered clues but because they share a set textual structure. Frau Emma, Miss Lucy, Fraulein Elisabeth: Each woman is cracked open like a once-cold murder case, but after you have read one or two, the surprise lies in the details, not the outcome.
Freud’s close collaborator Josef Breuer fell for dreamy Anna O., and what went on between Carl Jung and his patient and eventual colleague, Sabina Spielrien, is still a subject of debate. But in general, these doctors seemed to find less allure in the woman herself than in her story. Among themselves, they exchanged their female patients’ histories like Pokémon cards. Jung waited to court Freud until he had a whopper in Spielrein’s anal fixations and masturbatory fantasies. The famous doctor responded just as he’d hoped: “The defecation story is nice.”
When the female patient tried to write her own narrative, it was often difficult. Spielrein attempted it, becoming one of the first female psychoanalysts and publishing dozens of papers, yet discussing her debut article together, Jung and the usually more sympathetic Freud stooped to condescension, labeling her “the little authoress.” A woman might not always be mad, under the new paradigm of psychoanalysis, which flirted with the idea of a cure for mental illness. But she would always be a woman, so her story wasn’t hers.
The voices of these early patients reverberate through literary and cultural corridors. In The White Hotel, one of my favorite novels, the main character, Lisa, is healed enough by psychoanalysis with Freud to sing opera, marry, and help her husband raise his child. That Lisa is murdered at Babi Yar emphasizes what was stolen from her: a life reclaimed by analysis. The beautiful thing is that author D. M. Thomas admitted afterward he had not known about Sabina Spielrein when he crafted Lisa, yet like Sabina, Lisa is a privileged, young, Russian-Jewish woman who undergoes treatment by one of the greats and later perishes in the Holocaust. Call it a cosmic therapeutic dialogue, with pain across time noted and honored. Ghosts clasp hands, their puffs on the air like those of Freud’s cigar, their agony the ether.
While Freud and Jung talked their patients to health, twentieth-century literature used physical and mental illness as constants in a whirlwind of shifting literary techniques. As an exception to the everyday world of health and tedium, sickness was the perfect touchstone for explorations of subjectivity and the experience of time.
Early modernist literature from both West and East favored the sanatorium as a setting, the perfect place for characters to fall in love and wrestle with mortality. Cut off from the routine in resort-type hospitals, often situated in the mountains, fictional patients and their caretakers occupied a liminal space of sensual and emotional license. The most famous example of the sanatorium in literature is Thomas Mann’s The Magic Mountain. Another can be found in Hori Tatsuo’s 1936 novella, “The Wind Has Risen,” which was one of the inspirations for the film “The Wind Rises” by Miyazaki Hayao. “The Wind Has Risen” chronicles the love and death of a young woman with tuberculosis, particularly her final months in a sanatorium located in the volcanic mountains bordering Japan’s Nagano and Yamanashi prefectures. Accompanying her in the hospital, the narrator relishes their time together as somehow outside of time. Influenced by European literati such as Mann, Rilke, and Valéry, Hori’s embrace of Western literary subjects and trends in fact united him with that familiar facet of the Japanese literary tradition: its fetishism of illness and death.
Postwar literature seized on the ruptures and tensions in diseases and cures. Writers like Ken Kesey, Sylvia Plath, and New Zealand author Janet Frame gave voice to the horrors, contradictions, and power struggles involved in mental illness and the places and people who treat it, while also articulating the resistance to social norms one might locate within neurosis and psychosis. Frame’s mind was in fact saved by her writing; right before she was scheduled for a lobotomy, a hospital official happened to read that she’d been awarded a literary prize and released her.
Postmodernist writers like Abe Kōbō went one step further, diagnosing the insanity of modern life with surreal narratives centered on sickness and medicine. Written in 1977, Abe’s novel, Secret Rendezvous, focuses on the ludicrousness of Japan’s contemporary health industry. Its plot is catalyzed by the apparent abduction of the protagonist’s wife. One morning, an ambulance arrives at their house and efficiently collects her, even while she protests her perfect health. In the course of his disorienting hunt for his wife, the husband encounters a giant, nightmarish hospital, replete with subterranean tunnels, extensive surveillance, baroque sexual experiments, and orgasm competitions.
Come to think of it, living with mental illness has made me feel, for many years, as if I were searching endlessly through such a hospital, the one sane person in a kingdom of the mad. My mind swarmed with distended and distorted clowns with my bone structure, the innermost me struggled to weave through a grotesque arcade. Stopping to try to toss the ball into the right hoop, the right hole, to win the game. To win my freedom from—it sounds crazy—myself.
If only I were easier to read. Cultural history scatters its clues everywhere, out in the open. But our personal histories of mental and physical illness tuck theirs behind delusion’s rocks and denial’s stone walls. The mind and body don’t open like a book.
Cynthia Gralla is the author of The Floating World and The Demimonde in Japanese Literature. This essay is taken from the book she is currently working on, Chronic: Blame, Bodies, and Decades of Madness, which is inspired by her own struggles with mental illness. She holds a Ph.D. in Comparative Literature from the University of California, Berkeley, and is happy to live in Victoria, British Columbia.