Hektoen International

A Journal of Medical Humanities

Holden Caulfield’s coughing conundrum: A medical perspective

Anthony Gulotta
Bethesda, Maryland, United States

First-edition cover of The Catcher in the Rye, 1951. Via Wikimedia.

J.D. Salinger’s 1951 novel, The Catcher in the Rye, captivates readers with the story of Holden Caulfield, a disillusioned teenager. Was Holden’s constant coughing due to pulmonary tuberculosis (TB), as he claims, or some other illness? His own words paint a bleak picture. He mentions being “dead tired,” harboring a “lousy cough,” and his reluctant admission to a “sanatorium.”1 Furthermore, the shared living spaces at his boarding school could have increased the risk of contracting TB,2 as this disease ravaged American communities in the 1950s.3 Yet Holden is no textbook patient. He is notoriously unreliable, exaggerates his experiences, and his emotional turmoil—a maelstrom of grief, alienation, and existential angst—could manifest in physical symptoms resembling TB.

Holden’s triad of fatigue, incessant cough, and weight loss form a worrisome medical constellation. Nevertheless, these symptoms necessitate the exclusion of other diagnoses, such as persistent asthma, bacterial pneumonia, or a viral infection, while his family history of cancer warrants consideration of a malignancy. His overall presentation also aligns with chronic bronchitis, a potential consequence of his heavy smoking. This overlap makes pinpointing the cause more challenging, as smoking-induced lung damage can mimic TB’s features.4 Thus the novel fails to provide a conclusive answer on Holden’s precise illness.

Assuming Holden did have TB, could it have been prevented? In the 1950s, the BCG vaccine, good hygiene, public education, and skin testing were the mainstays of prevention.3 However, his youthful defiance may have led him to disregard these health measures. Compared to the 1950s, advances in TB medications have been considerable, and modern therapy has been shown to achieve a 95% success rate—but only with compliance to the prescribed schedule. Completing the entire regimen is paramount, as it minimizes the risk of recurrence or the development of drug-resistant TB strains.5

Imagining Holden as a modern patient paints a grim picture. His recalcitrant spirit, distrust of authority, and penchant for self-destruction would make treatment challenging. He would likely balk at the constraints of a strict and lengthy medication regimen, viewing them as an intrusion on his freedom. A multidimensional approach would be key for Holden’s journey to well-being, combining targeted medication for his TB with support for his emotional challenges, potentially through therapy, shared experiences in groups, and tailored coping mechanisms. Grief counseling could also help Holden process the loss of his beloved younger brother Allie, who died from leukemia.

Beyond the diagnosis, Holden’s story highlights the importance of holistic care, where physical and mental health are not experienced as separate entities but as intertwined elements in a patient’s recovery. Although the exact diagnosis remains elusive, this ambiguity provides an opportunity to assess the complexity of the human spirit. In this realm, truth and fiction, health and illness, dance a poignant and enduring waltz.


  1. Salinger, J.D. The Catcher in the Rye. Little, Brown and Company, 1991.
  2. Pan, D., Lan, R., Graviss, E.A., Lin, D., Liang, D., McNeil, E., Lin, M., & Chongsuvivatwong, V. Adolescent tuberculosis associated with tuberculosis exposure in classrooms and dorm rooms in Guangxi, China. International Journal of Infectious Diseases 2019;78:8-14. https://doi.org/10.1016/j.ijid.2018.09.019
  3. Snider, G.L. Tuberculosis then and now: A personal perspective on the last 50 years. Annals of Internal Medicine, 1997;126(3):237-243. https://doi.org/10.7326/0003-4819-126-3-199702010-00011
  4. Casara, A., Turato, G., Marin-Oto, M., Semenzato, U., Biondini, D., Tinè, M., Bernardinello, N., Cocconcelli, E., Cubero, P., Balestro, E., Spagnolo, P., Marin, J.M., Cosio, M.G., Saetta, M., & Bazzan, E. Chronic Bronchitis Affects Outcomes in Smokers without Chronic Obstructive Pulmonary Disease (COPD). Journal of Clinical Medicine 2022;11(16):4886. https://doi.org/10.3390/jcm11164886
  5. Rabahi, M.F., da Silva, J.L.R., Ferreira, A.C.G., Tannus-Silva, D.G.S., & Conde, M.B. Tuberculosis treatment. Jornal Brasileiro de Pneumologia, 2017;43(6):472-86. https://doi.org/10.1590/S1806-37562016000000388

DR. ANTHONY PAUL GULOTTA, a United States Army physician and an alumnus of the Philadelphia College of Osteopathic Medicine, is an Occupational and Environmental Medicine resident at Walter Reed National Military Medical Center, concurrently pursuing a Master of Public Health (MPH) degree at the Uniformed Services University of the Health Sciences.

Disclaimer: The opinions and assertions expressed herein are those of the author and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences or the Department of Defense.

Spring 2024



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