Culture Trips

Pain on the page: is this the end of the hysterical, ill woman of literature? | Books

“I am fascinated by the line between writing and physical survival,” Hilary Mantel wrote in her 2010 essay “Meeting the Devil”. After an operation for endometriosis, she was writing about the need to express pain on the page. With her notebook always within arm’s reach, even in her morphine-fuelled fug she wrote incessantly, recording the hallucinatory and the real, inventing stories and gathering almost enough for a collection during her time as an in-patient.

A notebook by the bedside is hardly revolutionary, but in the hands of an ill woman, and especially one with a gynaecological illness, its symbolism speaks to the past. Women over the centuries have not always expressed their own pain in art and literature. More often, they have had it expressed for them by men, in what Susan Sontag calls “sentimental fantasies” of suffering. Those fictions reflect the medicalised notion of the female body as inherently infirm and incapable of articulating its pain with any degree of reliability. For so long, women were advised even against reading or writing by their 19th-century doctors for fear it would inflame their maladies. Their physical survival was apparently contingent on their silence, not their testimonies.

That has changed and a tide of contemporary writers is offering correctives to the fantasies, often in first-person memoir form and with a note of urgency. “I’m not going to die. I’m going to write a book,” Sinéad Gleeson tells her mother in her essay collection, Constellations, in the midst of serious illness, as if a written-down narrative offers its own continued existence.

The ailing female body, variously romanticised, demonised and fatally bound to its biology, is – finally – being reclaimed from within. Mantel’s account spoke of the body’s “sewer pipes and vaults” to describe an illness whose pain, for hundreds of years, was seen as an inevitable consequence of being female. Even today, writes Elinor Cleghorn in Unwell Women: A Journey Through Medicine and Myth in a Man-made World, “women are frequently dismissed as neurotic, anxious, depressed, hypochondriac and even hysterical when they report the early symptoms of endo.”

The poet Sarah Manguso, at the vanguard of this new wave of writers, wrote about her rare autoimmune disorder in 2009. Her memoir, Two Kinds of Decay, used language that was pared down and scientific, with little euphemism or metaphor. She led us into every nook and crevice of her body, from injections inserted into her arms to suppositories inserted into her rectum. Manguso was not only unravelling her bandages but showing us the anatomical grist of the female body and, in effect, demystifying its “sacred” parts.

Sarah Manguso has written about her rare autoimmune disorder.
Sarah Manguso has written about her rare autoimmune disorder. Photograph: Barry J Holmes/The Guardian

Many newer narratives point to the political inequalities around pain. Cleghorn’s book, published in June, is a rigorous history of gendered prejudices in medicine, which have, in turn, bled into culture. Irenosen Okojie offers an alarming account of experiencing Covid in the anthology Disturbing the Body, in which her pain is dismissed by the emergency services. “I am a Black woman. I do not have the time to fully rely on the systems where the odds are stacked against me,” she writes, and goes to A&E anyway, to be told by a doctor there that she had a “50/50 chance” of survival because of her breathing difficulties.

But there is a paradox at the heart of the old myth of sick femininity that is trickier to dismantle; illness is seen to be built into biology – emanating from the womb, ovaries and menstrual blood itself – but also, perversely, suspected of being “all in the head”. The figure of the hair-pulling hysteric is born out of this paradoxical distrust and is strewn across the literary and medical canons.

Alice Hattrick responds to this problematic figure in their memoir Ill Feelings, to be published in August. Both they and their mother are accused of hysteria after they become ill with ME. “We were told we were hysterical, that we were inventing a language of our own demise, that for some reason we needed to be ill to get the attention we desired. My illness could be explained by my mother’s. It was as if our personalities were sick.”

Florence Nightingale was accused of making up her debilitating illness.
Florence Nightingale was accused of making up her debilitating illness. Photograph: The Press Office/PA

Hattrick ties their personal story to a medical culture that defines some illnesses as “invisible” and “mysterious” (through a lack of research into traditionally female ailments) and assigns them “imaginary” status. In other words, women are still being told that it’s all in their heads. They engage with the biographies of Alice James (Henry James’s sister), Elizabeth Barrett Browning, Emily Dickinson and Virginia Woolf, whose diaries and letters are quoted, and it is shocking to learn that even Florence Nightingale was accused of making up her debilitating illness (believed to have been chronic brucellosis), which her doctors deemed to have no physical basis.

What is especially resonant in Hattrick’s narrative is the eloquent anger that streaks through their painful personal story. “I don’t want to be without it, that anger. Sometimes I think I have the right to be angry all the time … but it is exhausting.”

Anger, even if it comes at the emotional expense of its sufferer, is at least a counterpoint to passivity and powerlessness. Jenn Ashworth begins her hybrid memoir, Notes Made While Falling, with a bloody description of a disastrous caesarean and haemorrhage: “Rage returned, and compared to the fear and panic, anger was a comfort – so I held on to it as well as I could.”

In my book, Consumed, a memoir about sisterhood and illness, I write about my late sister, Fauzia, who had a lifetime of depression and eating disorders, and felt both let down and angered by the system. Her final illness remained a mystery to her intensive care team and was only diagnosed as tuberculosis – ancient and curable – the day after she had a fatal haemorrhage at the Royal Free, a leading research hospital in north London. Fauzia was a volubly angry ill woman, her pain the opposite of the genteel fantasies of suffering that Sontag talked about. It was obnoxious and “unfeminine”, spiky and real. I’d be embarrassed when she would raise her voice in her hospital bed but now I see it as her own – and perhaps only – form of power in a system that she distrusted, and that, perhaps, distrusted her. After she died, a doctor at the hospital even claimed that she was not the most reliable narrator of her pain.

Mia Wasikowska in the 2011 film adaptation of Charlotte Brontë’s Jane Eyre.
Not ill or ‘mad’ but enraged … Mia Wasikowska in the 2011 film adaptation of Charlotte Brontë’s Jane Eyre. Photograph: Laurie Sparham/BBC Films/Allstar

The angry “hysteric” in the literary canon has been conjured by female novelists, too, and cleverly subverted for their own ends. Charlotte Perkins Gilman (“The Yellow Wallpaper”) and Charlotte Brontë (Jane Eyre) suggest that this kind of woman is not ill or “mad” but simply enraged at a world that holds her in chains. Their characters may appear deranged, clawing at the wallpaper, raving in their attics, but they could just as well be protesting against patriarchal tyranny in the only way they can: by shouting, behaving in disruptive, overtly unfeminine ways. Michel Faber does something similar for modern audiences in his book The Crimson Petal and the White. The 2002 novel is set in Victorian England and features the prostitute, Sugar, whose skin suppurates with eczema rashes, and the upper-class anorexic, Agnes Rackham, who appears to be a hammy hysteric, but is slowly revealed to be an abused woman who lives in fear of the “asylum”. These two central characters play with the 19th-century archetypes of the diseased prostitute and the idle upper-class housewife, although they run the risk of confirming the stereotypes they seek to subvert.

Where Faber is adept at creating compelling female characters in fiction, it is more complicated for some women writing about personal pain when set against a legacy in which female embodiment itself is seen as a sickness. Leslie Jamison, in her 2014 essay, “Grand Unified Theory of Female Pain”, describes the “double-edged shame and indignation in talking about my bodily ills and ailments”. She worries that a woman speaking of her wounds might end up consolidating the toxic tropes of damaged and diseased womanhood, even in the attempt to dismantle them.

Hattrick has one answer to that – if illness or its expression is a source of shame, that feeling should be attended to: “Shame, in this sense, is a valuable emotion.” But it remains a Gordian knot for some contemporary authors. Perhaps it is why the poet Jo Shapcott wrote a collection of poems, Of Mutability, without mentioning her cancer diagnosis once. Illness is tucked inside the poems but it manifests as metaphor. “I’m not someone chasing her own ambulance,” Shapcott said in an interview, shortly after Of Mutability was published in 2010. Even Mantel seemed slightly apologetic about writing confessionally from her hospital bed.

“Women writing about illness risk equating womanhood with illness,” Ashworth writes, although this need not mean that writers should be barred from finding creative solutions to the problem, and Ashworth herself writes of sickness in original ways. She also suggests that the subject is harder to contain in fictional form: “I am admitting that the novel, my best beloved one, cannot hold this. That fiction will not do … Why can’t I write fiction about this?” Perhaps the expression of such personal pain cannot be spun into “story” just yet, and must be recorded in its bared reality first.

In her 1926 essay, “On Being Ill”, Woolf said, somewhat more categorically, that there was a “poverty of language” around writing creatively about illness. English, she wrote, “has not words for the shiver and the headache”. That seems like a dated view now. Mantel, for one, shows us how illness fires her literary imagination. Words spill out of her and build stories, even when she is too weak to hold a pen. “The torture chamber is where people ‘speak’,” she says, in response to Woolf.

Writers are increasingly speaking from inside their own ambulances too, unravelling their bandages without embarrassment and showing why it might be important to pick at old wounds. “Why am I talking about this so much?” Jamison asks herself when an old boyfriend accuses her of being a wound-dweller. “I guess I’m talking about it because it happened,” she concludes. “Women still have wounds. Broken hearts and broken bones and broken lungs.”

Arifa Akbar’s memoir, Consumed: A Sister’s Story, is published by Sceptre (£16.99). To support the Guardian and the Observer order a copy at guardianbookshop.com. Delivery charges may apply.

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