Literature and medicine: narratives of physical illness

an early account of rebirth that focuses on the spiritual aspects of physical suffering. This 17th-century work, composed of 23 tripartite sections consisting of a meditation, expostulation, and prayer, describes Donne’s “acute, febrile, infectious, life-threatening illness”. Despite substantial critique of their appropriateness and usefulness, military metaphors are ubiquitous in illness narratives. Disease becomes an invading enemy; drugs are given to combat infections; people win or lose battles with cancer. Martha Weinman Lear’s Heartsounds, for example, a wrenching description of her husband’s heart disease, is deeply marked by battle metaphors. Stories of sickness have also been described as narratives of restitution, chaos, and quest. The narrator of a restitution story wants her health back; this voice is almost always heard in all types of illness narrative. The chaos story focuses on what is most untellable about sickness: the nearly incomprehensible nature of loss and suffering, sometimes reflected through a haze of perception-altering treatments. The late comedienne Gilda Radner’s It’s Always Something, about her ovarian cancer, tries to sort out this chaos while she contemplates videotaping one of her chemotherapy sessions in an effort to recapture lost time. The quest narrative depicts illness as a mythical journey, in which the hero undergoes a series of trials before being granted upon his return a boon—if not health, perhaps empathy, insight, a special sensitivity, or a deepened awareness of life’s transience and value. In A Whole New Life, for example, the American novelist Reynolds Price describes his gratitude for the literary productivity he has achieved despite his experience with a crippling spinal cord tumour. As in Price’s exploration of his “unfolding bafflement”, the narrator of an illness story may be the patient telling his own story in his own voice, however shaky that voice may sometimes sound. “I had somehow”, Price realised, “to build my life on radical uncertainty”. Another notable firstperson narrative is Lucy Grealy’s Autobiography of a Face. The memoir details the extensive treatment and multiple, disfiguring surgeries Grealy underwent for Ewing’s sarcoma throughout her childhood and adolescence. When the patient is unable to relate his own story, someone close to him may become the narrator, either in whole or in part. John Gunther, for example, wrote about his son’s fatal illness in Death Be Not Proud. Sometimes the ill person’s story is finished by another person after the patient’s death, as when Alexandra Broyard compiled and edited the work of her husband, Anatole Broyard, in Intoxicated by My Illness. Likewise, A Complex Sorrow: Reflections on Cancer and an Abbreviated Life was written by Marianne A Paget and later edited by a friend and colleague. An example of dual narration, in which the journal structure of the work was designed as a therapeutic tool, is found in the powerful Cancer in Two Voices. Multiple narrators are a hallmark of a new form of illness narrative that is being created on the Internet, in discussion “I have never been anywhere but sick. In a sense sickness is a place, more instructive than a long trip to Europe, and it’s always a place where there’s no company, where nobody can follow.” They have been called stories of sickness, pathographies, and narratives of illness. However they are characterised, patients’ stories are an increasingly important contribution to forms of autobiography and to clinical practice. They may also serve as important resources for medical education and medical ethics. These usually autobiographical stories deal with a wide range of illnesses. Obviously, persons with chronic or slowly progressive diseases are more likely to be able to write about their experiences than those in the throes of an acute, lifethreatening event; thus, cancer and some neurological conditions are common topics. There are also increasing numbers of narratives devoted to mental illness and to AIDS; these are beyond the scope of this discussion. Exactly when the narrative of illness began to appear as a distinctive phenomenon is unclear. The book-length firstperson account may have arisen only after 1900 and was rare before 1950, but clearly there are precursors in earlier, related forms. Letters and diaries bear abundant witness to their suitability for the telling of such personal experiences (panel 1), especially in eras when suffering was understood as a common part of life rather than a singular experience worthy of special examination; stories of sickness were thus encompassed by a larger perspective on one’s life, work, family, and day-to-day events. Those who had lingering, chronic illnesses that were once untreatable, such as tuberculosis, could also create full accounts over long periods of time. Effective therapeutics have expanded the possibilities of the illness narrative by creating time for writing and reflection in the cycles of treatment, remission, and recovery that can now characterise some experiences of illness. Narratives of illness have been grouped thematically on the basis of their authors’ intent and on their dominant metaphors and images. The most straightforward type of illness story is a testimonial one—a chronicle of events, thoughts, and feelings by an author often motivated by a desire to help others in similar situations (panel 2). Some narratives are primarily angry, their tone usually a result of misdiagnosis or other bad experiences with medical care. Alternative medicine is the basis for the third type of illness narrative, a prime example of which is Norman Cousins’ Anatomy of an Illness. Familiar myths and metaphors recur across the range of stories: rebirth and cure, illness as a battle. John Donne’s Devotions upon Emergent Occasions is