Jane Austen’s Hypochondriacs

by Jason Tougaw

Jane Austen in watercolor, painted by her sister Cassandra (c. 1810). She looks a little "sick & wicked here," which is probably why this portrait is idealized when publishers use it to market Austen.

Jane Austen in watercolor, painted by her sister Cassandra (c. 1810). She looks a little “sick & wicked here,” which is probably why this portrait is idealized when publishers use it to market Austen.

Jane Austen wants us to know at least four things about hypochondriacs: 1.) They are compulsive storytellers, 2.) They have little sympathy (a quality she valorizes in other characters), 3.) They use their stories to control others, 4.) Their suffering is real nonetheless, so they deserve the sympathy they can’t give others.

I’m teaching the nineteenth-century British novel this semester, so I thought I’d blog about the biology and psychology of the novels we’re reading over the course of the semester: Jane Austen’s Emma, Charlotte Brontë’s Jane Eyre, Charles Dickens’s A Christmas Carol (a book I never thought I’d teach), Wilkie Collins’s The Moonstone, Sheridan Le Fanu’s Carmilla (a vampire tale), and Robert Louis Stevenson’s The Strange Case of Dr. Jekyll and Mr. Hyde. Emma‘s up first. What follows is an adaptation of a chapter on Austen and hypochondria from my book Strange Cases: The Medical Case History and the British Novel.

On March 23, 1817, four months before her death, Austen described her “ideas of Novels and Heroines” in a letter to her niece Fanny Knight: “pictures of perfection as you know make me sick & wicked.” Hypochondriacs provide an excellent antidote, because they paint pictures of a world rife with pathology and imperfection. Nonetheless, Austen got a little wicked when she satirized them. When she died, she had yet to finish Sanditon, a novel she’d been writing about a family of hypochondriacs in search of a healthful place to live. She’d published Emma the year before, with its two irritatingly controlling hypochondriacs, and apparently she developed a taste for lambasting manipulative malingerers.

Emma’s father Mr. Woodhouse wields his hypochondria over the town of Highbury with his hypochondria, borrowing the medical authority of Mr. Perry , the town apothecary, to prevent people from eating cake, riding in carriages, enjoying picnics, or getting married.  Mr. Perry never actually appears in the novel, but he is repeatedly quoted and misquoted by Mr. Woodhouse, as in the early seen when he loses Emma’s longtime governess Miss Taylor to marriage:

There was no recovering Miss Taylor—nor much likelihood of ceasing to pity her: but a few weeks brought some alleviation to Mr. Woodhouse. The compliments of his neighbors were over; he was no longer teased by being wished joy of so sorrowful an event; and the wedding-cake, which had been a great distress to him, was all eat up. His own stomach could bear nothing rich, and he could never believe other people to be different from himself. What was unwholesome to him, he regarded as unfit for any body; and he had, therefore, earnestly tried to dissuade them from having any wedding-cake at all, and when that proved vain, as earnestly tried to prevent any body’s eating it. He had been at the pains of consulting Mr. Perry, the apothecary, on the subject. Mr. Perry was an intelligent, gentlemanlike man, whose frequent visits were one of the comforts of Mr. Woodhouse’s life; and upon being applied to, he could not but acknowledge (though it seemed rather against the bias of inclination) that wedding-cake might certainly disagree with many—perhaps with most people, unless taken moderately. With such an opinion, in confirmation of his own, Mr. Woodhouse hoped to influence every visitor of the new-married pair; but still the cake was eaten; and there was no rest for his benevolent nerves till it was all gone. There was a strange rumour in Highbury of all the little Perrys being seen with a slice of Mrs. Weston’s wedding-cake in their hands: but Mr. Woodhouse would never believe it.

Mr. Woodhouse needs Mr. Perry to justify his resistance to change—to the marriage plot that requires heroines to marry and daughters to leave their fathers’ houses. That wedding cake is unwholesome because it presages his own daughter’s wedding at novel’s end. In his efforts to prevent this, Mr. Woodhouse surveys the world, finds potential sources of sickness, and imagines hypothetical symptoms in his own body and then casts these symptoms over everybody in Highbury. You will all be sick, he seems to say, if you don’t do as I say.

In 1817, the year Austen died and the year after Emma’s publication, Dr. John Reid published Essays on Hypochondriacal and Other Nervous Affections. Reid, like many of his contemporaries, portrayed hypochondriacs as pathological storytellers:

The constitutional or inveterate hypochondriac is apt to view every thing only in the relation which it may bear on his malady. In the rich and diversified store-house of nature he sees merely a vast laboratory of poisons and antidotes. He is almost daily employed either in the search after, or in the trial of, remedies for a disease which is often to be cured only by striving to forget it.

But even if such a plan of life were really calculated to lengthen the catalogue of our days, it would still be equally wretched and degrading to the dignity of our nature. Nothing, surely, can be more idle and absurd than to waste the whole of our being in endeavours to preserve it; to neglect the purposes, in order to protract the period, of our existence.

Sounds a lot like Mr. Woodhouse. Because the “hypochondriac is apt to view every thing only in the relation which it may bear on his malady,” he is constantly misreading the world around him, which leads him to “neglect the purposes” of his existence.

The hypochondriac is a storyteller, and as Walter Benjamin famously asserted, “Death is the sanction for everything that the storyteller can tell.” In the case of the hypochondriac, however, diagnosis will do.

Emma’s two hypochondriacs, Mr. Woodhouse and Mrs. Churchill, make this quite clear. Throughout the novel, Mr. Woodhouse and Mrs. Churchill use their phantom symptoms to control the actions of those around them. Mrs. Churchill’s death makes Mr. Woodhouse’s constant self-diagnoses a little more plausible:

An express arrived at Randall’s to announce the death of Mrs. Churchill! . . . A sudden seizure of a different nature from any thing foreboded by her general state, had carried her off after a short struggle. The great Mrs. Churchill was no more . . .. Mrs. Churchill, after being disliked at least twenty-five years, was now spoken of with compassionate allowances. In one point she was full justified. She had never been admitted before to be seriously ill. They even acquitted her of all fancifulness, and all the selfishness of imaginary complaints.

Jane Austen’s irony is subtle, but it spares no one. Though the seizure that kills Mrs. Churchill is unrelated to her previous sufferings, death acquits her of “all fancifulness.” The hypochondriac is indicted for her confabulations, but “they” (all the other characters in the novel) are also indicted, for the fact that only death could rouse their compassion. For Austen, this contradiction needs no reconciliation. Her novels insistently accommodate multifaceted interpretations; in them, delighted disgust and suspicious compassion are not contradictions but reasonable reactions to the contingency of human existence.

Austen achieves this through a technique of narration called free indirect speech (or style or discourse), whereby her narrator drifts from her own point of view into that of a character. When the narrator reports the “strange rumors” about the Perry children eating that noxious cake, we know we’ve slipped into Mr. Woodhouse’s point of view. He’s dramatic and foolish where Austen’s narrator is measured and insightful. When Mr. Woodhouse invokes Mr. Perry’s sentiments, we get two layers of free indirect speech: the narrator paraphrases Mr. Woodhouse paraphrasing Mr. Perry. In his book How Fiction Works, James Wood uses a simple question to detect moments of free indirect speech: “Whose word is this?” If the narrator delivers language that clearly belongs to a character, without flagging it with some version of “he thought” or “she felt,” you’ve got free indirect speech.

Austen is widely credited for being the first novelist in English to develop this technique into a style. Other novelists (and poets) had used it, but none as frequently or centrally as Austen. It’s how she manages to let readers know we should be magnanimous in the face of the various social pathologies she satirizes. In Wood’s words,

Thanks to free indirect style, we see things through the character’s eyes and language but also through the author’s eyes and language. We inhabit omniscience and partiality at once. A gap opens between author and character, and the bridge—which is free indirect style itself—between them simultaneously closes that gap and draws attention to its distance.

A bridge is a kind of gap, as David Ginsberg, one of the students in my course, pointed out. It’s a metaphor that captures Austen’s unique style of narration, which puts readers in a pleasant but strange relation to her characters and their rule-bound social worlds: intimate and distant, mocking and loving, discerning and forgiving.

Free indirect speech is often described as a uniquely literary use of language–but I’d argue there’s no such thing, because there’s no solid boundary between literary language and other forms of language (social, business, scientific, journalistic, etc.). In fact, in case histories about hypochondria, nineteenth-century medical writers routinely use free indirect speech to tell their patients’ stories. I’ll give you one example.

U.S. Army surgeon Samuel Akerly reported a case of hypochondriasis—or “tristimania”—in the New York Medical Magazine (also published in London) in 1814-1815.[1] Like most cases, it begins with background information not directly observed by the surgeon but reported to him by witnesses and then moves directly to the surgeon’s first visit. Not until Akerly intervenes, as physician-interlocutor, does the generalized lunatic becomes the clinically diagnosed hypochondriac:

In the month of July, 1807, a man of small stature, a shoemaker by trade, and apparently about forty years of age, was attacked by that form of mental derangement denominated hypochondriasis, or, more properly termed by Dr. Rush, tristimania. Sad, indeed, was the state of his mind, and great were his sufferings. . . . On the 6th of July, 1807, the maniac was running at large in the city of New York, lacerating his flesh, and beating his head with violence against the sides of houses. 

Akerly characterizes this poor guy as a rabid storyteller, like most good hypochondriacs:

In the afternoon of the 6th of July, a crowd attended the unhappy being to the Hospital gate. With his arms tied behind him and in the greatest agony, his face bruised and swollen, his lip torn to pieces and streaming with blood, his attendants ushered him into the Hospital. I met them at the door and inquired into the case. The poor maniac was eager to tell his own misery, but with difficulty collected words to convey it. His language was, indeed, copious, but his agitation was so great that he could hardly utter a sentence, being interrupted by constant efforts to tear his lip to pieces. His attendants knew nothing of the man, but that they prevented him from beating out his own brains. At length he conveyed the information where his distress was, and upon which his mind was deluded.

In his upper lip there was a worm gnawing his flesh and penetrating into his body, and unless he could tear him out he would soon be beyond his reach, and inevitably destroy him. This was the cause of his misery.

Whose words are these? Surely Akerly doesn’t believe there is a worm gnawing through his patient’s lip, intent on destroying him. This is free indirect discourse–in a medical magazine, published the year after Austen published Pride and Prejudice. Because Akerly describes the “worm gnawing his flesh” without discrediting the story, even describing it as “the cause of his misery.” As in Austen, indirect discourse here creates the irony that signals the reader to understand whose story is valid and whose is flawed. In the process, though, the patient’s thoughts and feelings are displayed with such intimate detail that they become emotionally compelling despite his story’s obvious intellectual shortcomings. In fact, Akerly takes his patient’s point of view so seriously that he assembles a surgical team and goes through the motions of extracting the fictitious worm. He even sends somebody out to collect a worm so that he can show the patient how successful the surgery was. Just as Mr. Perry seems to indulge Mr. Woodhouse’s fear of wedding cakes and carriages, Akerly seeks a cure in the psyche of his character. If he can make him believe the threat has been excised, he can ease the maniac’s suffering.

One lesson of free indirect speech is that stories make reality. A hypochondriac’s symptoms are real because they feel real. Their stories can’t be dismissed as fictions. In that sense, Austen’s hypochondriacs represent a fundamental quality shared by all her characters: their realities are contingent, their perspectives subjective, their stories in need of careful interpretation. Astute readers will recognize that we’re implicated by proxy. It would be arrogant and simple-minded to imagine we are any more objective about our own lives. Austen’s style of narration is like a well-appointed philosophical prison. If you enter, you are required to confront your imperfections, your subjectivity, and the partiality of your understanding.



[1] Akerly borrows his terminology from Dr. Benjamin Rush, whose Essays on Hypochondriacal and Other Nervous Affections outlines a theory of hypochondria, suggesting that unlike other forms of madness, hypochondria involves sound reasoning based on a single error in judgment.

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