|Portrait of Virginia Woolf in 1902. By George Charles Beresford. Public Domain. Via Wikimedia.|
“While I was as busy as anyone
on the sunny plain of life, I heard
of you laid aside in the shadowy
recess where our sunshine of
hope and joy could never
penetrate to you.” – Harriet Martineau1
Literary works can illustrate the loneliness and social isolation experienced by people when they are sick.2 The chasm between health and illness is addressed in Virginia Woolf’s “On Being Ill,”3 Susan Sontag’s Illness as Metaphor,4 and Harriet Martineau’s Life in the Sick-Room.5 These three texts highlight important psychological aspects of what it means to be sick and raise awareness of the need for holistic care.
On Being Ill—Virginia Woolf
In 1925, Woolf’s record of her confinement to a bed for months, with “all writing forbidden” showed readers the harsh reality of illness.6,7 The days in the sickroom were very distressing—a state, however, “not only imposed by illness itself, but also the undulations of the mind as an inevitable corollary.” Woolf later wrote that “[a] great part of every day is not lived consciously” but in a state of “non-being”8 that unfolds as “a stream of dream-like thoughts, covering not only illness, but language, literature, the cinema, human nature, and life as a whole.”9 Woolf argues that illness is inadequately represented because suffering cannot be adequately expressed. The inner experience of the invalid is purely subjective and cannot be expressed through language. Rather than accurately conveying the actual message, the subjective experience only “serves to wake memories in his friends’ minds.”10,11 The true experience is not transferable: once it enters “the symbolic register of language, it gets distorted and thus rendered void.”12 The healthy being outside the orbit of the sick individual cannot truly sympathize; “without the shared experience or mutual knowledge it is predicated upon, the so-called sympathy is no more than a masquerade, behind which nothing exists.”13
The opening sentence of “On Being Ill” asks why illness and the sick person are marginalized in literature given “how common illness is, how tremendous the spiritual change that it brings.”14 “Novels, one would have thought,” Woolf writes, “would have been devoted to influenza.”15 The implied absurdity of a novel devoted to influenza sets the tone for the essay and takes on sinister undertones when one compares and contrasts the ravishing destruction caused by the global 1918 influenza pandemic with World War I. Compared to the estimated nine million that died in the war’s four years, the gargantuan estimates of deaths related to the 1918 pandemic—fifty million worldwide and probably closer to 100 million in less than two years16—implies that the body’s failings have not only stripped our language of expressive nuance but also foreclosed opportunities to inhabit, or even imagine, the private pain of others. Woolf suggests that a “recourse to language and story can foster empathy, self-awareness, and sensitivity” toward others.17
Sontag’s dual citizenship
Susan Sontag, in her 1977 Illness as Metaphor, writes that “illness is the night side of life.”18 She continues: “Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.”19 The metaphor recasts wellness and illness as a “fluid ebb-and-flow between spaces” that we are all, she argues, inevitably “obliged to travel.”20 Although Sontag does not directly refer to empathy, her words tacitly urge it. Fellow-feeling is not a social nicety, she implies, but a human imperative. Paying homage to Sontag’s citizenship metaphor is Leslie Jamison’s The Empathy Exams, a collection of essays detailing the politics of empathy in contemporary medical culture. Jamison defines empathy as “a penetration, a kind of travel. It suggests you enter another person’s pain as you’d enter another country, through immigration and customs, border crossing by way of query: What grows where you are? What are the laws? What animals graze there?”21, 22 The similarity of these formulations points to the persistent entanglement of wellness, illness, and the difficult politics of feeling—formulations which humanity needs to navigate unchartered borders during sickness. Both caregiving and empathy require border-crossing: to maneuver the threshold between wellness and illness is to replace the comforts of the known with the startle and shock of the unfamiliar. As Jamison explains: “Empathy is not just something that happens to us—a meteor shower of synapses firing across the brain—it is also a choice we make: to pay attention, to extend ourselves.”23 But exertion, or concerted expression, plainly infringes upon our belief that empathy ought to be there already. As Jamison explains, such “effort chafes against the notion that empathy should always rise unbidden.”24
The metaphor of dual citizenship in Sontag’s Illness as Metaphor suggests that illness gives rise to its own civic customs, traditions, practices, and even language. In the course of crossing borders, we encounter new idioms—and, removed from the familiarity and comforts of home, the tongue becomes inert and inexpressive and we become immobilized. The use of metaphors may seemingly allow normalcy to reign in a discourse precipitated by illness.
However, to limit Sontag to her opening message is to ignore her wider rhetoric on illness and its extension to metaphor. Sontag’s two books, Illness as Metaphor25 and AIDS and its Metaphors,26 shows how metaphoric language to describe illness is intertwined with political and medical responses assigned to it. In the context of AIDS, the use of the “plague” and “pollutant” metaphors “signal the political weaponization of disease and the diseased.”27 Sontag explains how metaphors for illness both “shame and blame, cursing the afflicted who, in turn, avoid treatment—or more often, have treatment withheld.” The stigmatizing power of metaphor has fatal consequences: “metaphors and myths, I was convinced, kill.”28
Harriet Martineau’s Life in the Sick-Room
The social stigma and Sontag’s dichotomy of illness and health reverberates in Harriet Martineau’s essay Life in the Sick-Room.29 Whether a prison or a haven, the sick-room (the home) becomes “a legitimised site for the representation of an alternative society and mode of existence.”30 As Juhani Pallasmaa’s phenomenological approach to the home postulates, home is not “simply a roof over one’s head; nor is it a mere notion of architecture, but of psychology, psychoanalysis, and sociology.”31 A home encompasses rituals, our own personal rhythms, and everyday routines. A home is a “gradual product of the dweller’s adaptation to the world.”32
Martineau’s reference to the “shell” is an apt metaphor because a house offers a form of enclosure and protection. It not only provides intimacy and repose, but also an outlook of possible directions in which to move: a promise of mobility as well as a measure of openness and metamorphosis. Durand argues that “the shell with the emotional force that it carries stands for Martineau’s most eloquent sign and ability of being within change.”33 It duly represents the permeability between home and world that Martineau was able to construct for her own well-being and wholeness in her fulfilled middle-age years at the end of a protracted process of longing and suffering—a process of growth in which she could reconsider and reorient her future only after excruciating face-to-face confrontations with her own tensions, limits, and contradictions.
The second important consideration from this work involves conceptions of pain and suffering. Elaine Scarry’s The Body in Pain has influenced current pain theorists to distinguish pain as a physical experience and suffering as the emotional consequence of that experience.34 Central to Scarry’s account is the opposition of “psychological suffering” and “physical pain.” “Physical pain does not simply resist language,” she argues, “but actively destroys it.”35 Psychological suffering, by contrast, “does have referential content, susceptible to verbal objectification, and [so is] habitually depicted in art.”36 Scarry offers this as a statement about the basic nature of pain, regardless of whether it is acute or chronic, the product of torture, childbirth, or exhaustion.37 Yet for Martineau, the distinction Scarry makes between physical and psychological suffering means very little. Martineau consistently resists any disaggregation of the physical and the mental. Although reviewers often remarked on the novelty of Life in the Sick-Room for the way it brought together practical recommendations and spiritual advice, her account of pain or suffering, or her conflations of the two, are not singled out as unusual.38
In conclusion, this article illustrates the schism and border between health and illness. Modernist literature, in particular texts by Virginia Woolf, Susan Sontag, and Harriet Martineau, present new insights and provide a meaningful template for health professionals to understand the turmoil endured during illness. They accurately portray the isolation and vulnerability of illness from a sick person’s point of view. Citizens holding the passport of health need to truly put themselves in other people’s shoes.
- Harriet Martineau. Life in the Sick Room: Essays by Harriet Martineau. (Boston: William Crosby, 1845).
- J. Hall, J. Power. “Understanding the person through narrative”, Nursing Research and Practice, 2011. doi:10.1155/2011/293837.
- Virginia Woolf. “On Being Ill”, Family Business Review, 6.2 (1993): 199-201. doi:10.1111/j.1741-6248.1993.00199.x
- Susan Sontag. Illness as Metaphor. (New York: Macmillan Publishers, 1978).
- S. Pett. “Rash Reading: Rethinking Virginia Woolf’s On Being Ill”, Literature and Medicine, 37.1 (2019): 26-66.
- Virginia Woolf. A Writer’s Diary (New York: Harcourt, Brace and Company, 1953).
- Virginia Woolf. Moments of Being (New York Times, 1976).
- Woolf, A Writer’s Diary.
- Woolf, A Writer’s Diary.
- H. Glowinski, Z. Marks, S. Murphy. A Compendium of Lacanian (London: Free Association Books 2001).
- C. Hindrichs. “Virginia Woolf and Illness”, Virginia Woolf Miscellany, 90. 1 (2016): 44-48.
- Woolf, A Writer’s Diary.
- M. Popova. “Virginia Woolf on Being Ill and the Strange Transcendence Accessible Amid the Terrors of the Ailing Body”, Brain Pickings, 2019.
- JE. Fisher. Envisioning Disease, Gender, and War: Women’s Narratives of the 1918 Influenza Pandemic (New York: Palgrave Macmillan, 2012).
- Woolf, A Writer’s Diary.
- Woolf, Moments of Being.
- Woolf, Moments of Being.
- Woolf, Moments of Being.
- L. Jamison. The Empathy Exams: Essays, (Minneapolis: Graywolf Press, 2014).
- Sontag, Illness as Metaphor.
- Susan Sontag. AIDS and its metaphors, (New York: Macmillan Publishers, 1989).
- M.H. Frawley. Invalidism and Identity in Nineteenth-century Britain (Chicago: The University of Chicago Press, 2004).
- M. Bailin. The Sickroom in Victorian Fiction: The Art of Being Ill (Cambridge: Cambridge University Press, 1994).
- P. Juhani. “Identity, Intimacy and Domicile: Notes on the Phenomenology of Home”. 20 Jan. 2008. <www2.uiah.fi /esittely/historia/e_ident.htm>
- E. Scarry. The Body in Pain: The Making and Unmaking of the World (Oxford: Oxford University Press, 1987).
- G. Bachelard G. The Poetics of Space, 2014. https://garagemca.org/en/publishing/the-poetics-of-space-by-gaston-bachelard
- E. James. “A lexicon for the sick room: Virginia Woolf’s narrative medicine”, Literature and Medicine, 37.1 (2019): 1-25.
- Bachelard, G. 2014. The Poetics of Space. https://garagemca.org/en/publishing/the-poetics-of-space-by-gaston-bachelard
- Bailin, M. 1994. The Sickroom in Victorian Fiction: The Art of Being Ill (Cambridge: Cambridge University Press).
- Fisher, JE. 2012. Envisioning Disease, Gender, and War: Women’s Narratives of the 1918 Influenza Pandemic (New York: Palgrave Macmillan).
- Frawley, M.H. 2004. Invalidism and Identity in Nineteenth-century Britain (Chicago: The University of Chicago Press).
- Glowinski, H., Marks, Z., Murphy, S. 2001. A Compendium of Lacanian (London: Free Association Books).
- Hall, J., Power, J. 2011. “Understanding the person through narrative”, Nursing Research and Practice. doi:10.1155/2011/293837.
- Hindrichs, C. 2016. “Virginia Woolf and Illness”, Virginia Woolf Miscellany, 90 No 11: 44-48.
- James, E. 2019. “A lexicon for the sick room: Virginia Woolf’s narrative medicine”, Literature and Medicine, 37 No 1: 1-25.
- Jamison, L. 2014. The Empathy Exams: Essays (Minneapolis: Graywolf Press).
- Juhani P. 2008. “Identity, Intimacy and Domicile: Notes on the Phenomenology of Home”. <www2.uiah.fi /esittely/historia/e_ident.htm>
- Martineau, Harriet. 1845. Life in the Sick Room: Essays by Harriet Martineau. (Boston: William Crosby).
- Pett, S. 2019. “Rash Reading: Rethinking Virginia Woolf’s On Being Ill”, Literature and Medicine, 37 No1: 26-66.
- Popova, M. 2019. “Virginia Woolf on Being Ill and the Strange Transcendence Accessible Amid the Terrors of the Ailing Body”, Brain Pickings.
- Scarry, E. 1987. The Body in Pain: The Making and Unmaking of the World (Oxford: Oxford University Press).
- Sontag, Susan. 1978. Illness as Metaphor. (New York: Macmillan Publishers).
- Sontag, Susan. 1989. AIDS and its metaphors (New York: Macmillan Publishers).
- Woolf, Virginia. 1993. “On Being Ill”, Family Business Review, 6 No 2: 199-201. doi:10.1111/j.1741-6248.1993.00199.x
- Woolf, Virginia. 1953. A Writer’s Diary (New York: Harcourt, Brace and Company).
- Woolf, Virginia. 1976. Moments of Being (New York Times).
MARIELLA SCERRI, BSc, BA, PGCE, MA, is a teacher of English and a former cardiology staff nurse at Mater Dei Hospital, Malta. She is reading for a PhD in Medical Humanities at Leicester University and a member of the HUMS program at the University of Malta.
VICTOR GRECH, MD, PhD, FRCPCH, FRCP, DCH, is a consultant pediatrician to the Maltese Department of Health, and has published in pediatric cardiology, general pediatrics, and the humanities. He has completed PhDs in pediatric cardiology and English literature. He co-chairs the HUMS program at the University of Malta.