The Genre of Affliction

And how does reading another hybrid essay/memoir about mental illness make you feel?

Mental health concept - person's head with chaotic thought pattern, depression, sadness, anxiety. Mi...
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Houman Barekat

You may, at some point in the past few years, have encountered a nonfiction book arranged along the following lines: an author recounts a series of facts about a particular mental or physical ailment, alongside the story of their own struggles with it; this is interspersed with nuggets of cultural history or literary criticism pertaining to said ailment. The erudition will be lightly worn but nonetheless insistent. The prose will be parceled out in relatively short, non-sequential paragraphs, of which a percentage will comprise just a single sentence; some of these will be gnomic, others merely elliptical. There will be comma splices, and a quote, somewhere, from the personal correspondence of Virginia Woolf. The word “liminal” will feature at least once. Publicists and reviewers alike will call it a “meditation,” because that’s what it is.

Graham Caveney’s new memoir, On Agoraphobia, is the latest addition to this hybrid genre. Caveney, who has suffered for decades with a crippling fear of open spaces, writes candidly about this little understood condition. “Panic,” he writes, “is a pitbull with a rag doll”: “A rollercoast lurch in the stomach, the tightening twirl of the solar plexus, an offbeat disco of the heart.” The day-to-day anxiety is “anticipatory” in nature: “Panic attacks do not lead to agoraphobia. The fear of them recurring does. Agoraphobia is a meta-fear, a pre-emptive strike against the fear yet to come.” Various treatments proved ineffective: he tried Cognitive Behavioral Therapy but was irritated by its jargon (“They say things like toxic and challenges and use evidence as a verb”); the behaviorist technique known as “flooding” — whereby the sufferer is made to confront their fears in the hope of reprogramming their nervous system — didn’t work; benzodiazepines and antidepressants did little more than “instil a perplexed nonchalance, an unenlightened Zen.”

The author was sexually abused by a priest when he was 15 — an experience he wrote about in his 2017 memoir, The Boy With the Perpetual Nervousness — and this trauma inevitably looms large as a possible cause of his phobia, which has overlapped with bouts of depression and alcoholism. Other possible explanatory factors are also explored. Caveney hails from Accrington in the North of England, a town which was once a hub of the cotton trade but stagnated economically in the post-industrial era; born in 1964, he was among the last generations of working-class Britons to attend university with the help of government grants. As a young man Caveney underwent multiple displacements: he lost his Catholic faith, moved from a small town to a bustling metropolis and into the mainly middle-class world of journalism. He wonders if his agoraphobia might, in essence, be a more pronounced version of the intense homesickness that sometimes afflicts people from tight-knit communities when they venture to the big smoke — “small-mindedness writ large, a catastrophic failure of the imagination.”

Caveney suggests this illness is a historically recent phenomenon. With the advent of urban modernity, “The agoraphobe . . . took his place alongside those other inventions of the nineteenth century: the hypochondriac, the kleptomaniac, the neurasthenic.” The philosopher William James believed it might be an atavism — a built-in emotional response that had certain protective benefits for our distant ancestors — while Sigmund Freud speculated, hilariously, that agoraphobia in women stemmed from a subconscious desire to become a prostitute. Caveney conducts a cursory sweep of agoraphobes in literary fiction, touching on works by Ford Madox Ford, Anita Brookner, Sue Townsend and Anne Tyler. (Ford, who suffered from the condition himself, is playfully reproached for having led a nomadic life — somewhat off-brand for an agoraphobe.) He discusses several notable agoraphobes from literary and popular culture, including the horror writer Shirley Jackson,the pop singer Alison Moyet, and the famously reclusive poet Emily Dickinson. We have the scholar Jean Mudge to thank for observing that the words “house” and “home” or their cognates appear in 12 percent of Dickinson’s poems — which looks like a revealing statistic until you remember that 12 percent is not a lot.

It is by now almost obligatory to point out that the fragmented, non-linear memoir format lends itself to telling stories of trauma and mental ill health, insofar as it transposes onto the page the associative and disordered thought processes of an unsettled mind. Caveney maintains it’s impossible to describe a phobia in conventional, linear prose: “You end up imposing a consistency — a rogue sequentiality — on an experience which has precisely neither.” Fair enough, but there’s a flip side to this, which is that an unstructured hodgepodge might just as easily be said to evoke the half-assed, dissipated torpor of a depressed person in a rut. The apparent capaciousness of the format can lull an author into padding out their work with insipid filler under the auspices of freewheeling intelligence. Mercifully there isn’t too much of this in Caveney’s memoir, although fey musings on his love of second-hand bookshops and the uncanniness of parked cars (“like a solitary glove at a bus stop, or soil on a carpet”) don’t do much for the book.

Lately, I’ve noticed myself defaulting to weary, eye-rolling cynicism when confronted with this type of memoir. This is probably due, in part, to accumulated readerly fatigue from having had to indulge too many twee, insubstantial or only tenuously pertinent vignettes for too little intellectual payoff. But there’s more to it. Even when they are well executed — and Caveney’s is a competent, well-crafted exemplar of the form — these books lack something: voice, direction, a sense of personality and purpose. The house style of the fragmentary essay-memoir is a studiedly unobtrusive cleverness, a kind of literary anti-matter.

Interestingly, Caveney addresses the question of literary form in an intriguing segment looking back on his intellectual formation in the 1980s. He recalls encountering the works of Jacques Derrida, Michel Foucault, and Julia Kristeva at an impressionable age: “Like the Catholic theology I had abandoned, the spell was in the enigma. It was proof of revelation. Nothing this strange could be anything other than true.” Their influence shaped his writing as he cut his journalistic teeth in the UK music press, with magazines such as The Face, NME and Melody Maker. These publications

“were an arts school education, a how-to manual . . . Their writers had absorbed all that elegiac theory and allied it to writing about contemporary popular culture. It produced some of the most vital prose of its time, written by journalists as experimental and elliptical as the musicians and film makers they were writing about.”

Caveney’s passion for this mode of writing remains undimmed today. In a passage that could double as an elevator pitch, not just for his book but for others like it, he proclaims:

“We speak in the codes of realism: character, cause and effect, the world faithfully represented. . . Yet we know this version does not quite fit, that it is framed and shaped, sculpted… Lives are messy, contingent and mysterious. Our stories about them should never be too neat. . .”

It’s tempting to suggest that the genre’s appeal has something to do with its congeniality to the diminished attention span of the internet-addled 21st-century reader, but in truth it’s probably as much to do with supply as demand. Imagine you’re a writer with a limited amount of interesting material — more than an essay’s worth but not enough for a conventional book: the fragmentary essay-memoir is a neat workaround, both for you and your publisher.

Brevity is key. Marina Benjamin’s 2018 memoir, Insomnia, was less than 150 pages long and all the better for it. Caveney’s book is just about taut at 180 pages, roughly the same length as Eula Biss’s On Immunity (2016). Anything much over 200 pages and the format starts to feel gimmicky and forced, perhaps even a little patronizing; readerly engagement wanes as the absence of through-line is more keenly felt. As the author’s mind wanders, so too does the reader’s — elsewhere. I enjoyed Sergio Del Molino’s essay-memoir on psoriasis, Skin (2022), but it was — if you’ll forgive the pun — patchy: there was maybe half a book in it. A lengthier work only hangs together if the author actually has something worthwhile to say in addition to all their cud-chewing, as in the case of Anne Boyer’s cancer memoir, The Undying (2019), which threaded its essayistic digressions with an urgent polemic about health inequality and societal attitudes to ill health.

Other varieties of illness memoir are available. Horatio Clare’s Heavy Light (2021) tells the story of his manic breakdown, incarceration at a mental asylum, and subsequent recuperation in a narrative that is no less lively for being conventionally linear. The New York-based indie press, Sagging Meniscus, is about to publish Jake Goldsmith’s Neither Weak Nor Obtuse, an earnest if at times verbose philosophical disquisition on cystic fibrosis and what it means to live with chronic illness. This summer, Bloomsbury will publish the first English translation of a bestselling memoir by Korean writer Baek Sehee, magnificently titled I Want to Die but I Want to Eat Tteokbokki. (Tteokbokki is a type of spicy rice cake.) This is a frank account of the author’s dysthymia, dissecting her anxieties around social relationships and feelings of low self-worth. You’ll find no Woolf or Didion references here; the register is as naive as a teenage diary — but it works on its own terms. Baek alternates between conversations with her psychiatrist and brutally self-flagellating interior monologues:

“My face looks pathetic and shabby to me during these times of inner war. Eyes that are bloodshot and unfocused, my fringe all messy, a dim and stupid expression as if I have no idea what my own brain is thinking. I look like someone of no consequence, an invisible person. My mood plunges, and the mental balance I’d carefully built up to that point completely collapses.”

Perhaps the most intriguing illness memoir of recent years is George Scialabba’s How to Be Depressed (2020). Despite its title, this is not a self-help book, although it does contain one chapter’s worth of handy tips. The bulk of the book comprises an edited selection of the author’s therapists’ notes spanning several decades. We meet Scialabba, a literary critic working a part-time clerical job at Harvard University, in 1969, and follow his mental health travails all the way to 2016. During this time he receives just about every diagnosis under the sun, and undergoes a range of treatments from SSRIs to electroconvulsive therapy. The book’s banal repetitiousness is strangely mesmeric: “Patient reports severe anxiety and obsessionality. . . He continued to demonstrate obsessive thought processes . . . my assessment . . . is that this man suffers from a rather severe endogenous depression. . .” etc. etc. It makes for an intrusive but grimly absorbing portrait, punctuated by moments of bathos. Here he is in the summer of 1989, fretting over his relationship:

“Patient. . . Created moral dilemma for himself. If he suddenly got 3 million dollars, would he gladly share it with her? Or would he be relieved if she died? Patient very preoccupied with this.”

In the opening chapter, Scialabba explains his decision to disclose his records: “Our distractible human intelligence needs as many ways of talking about depression as can be provided — that’s all my motivation in publishing them.” One way is to let others do the talking for you: How to Be Depressed plays out like a polyphonic biography with a distinctly unreliable narrator; we can see, in the haphazard straw-clutching of successive therapists over 40 years, the growing pains of a psychiatric profession still in its infancy. It’s an unorthodox approach, but the upshot is that we learn something — both about the nature of the illness and attempts to cure it.

What do we read for, if not to gain insight? By contrast, the trouble with the fragmented essay-memoir is that it prioritizes affect over insight, rumination over elucidation. At its best it can make for a useful entry-point, an exploratory corridor between the realms of medicine and the humanities. At its most formulaic, however, it’s a cloyingly sycophantic form: the judicious sprinkling of erudite tidbits flatters the reader into feeling like they’re engaging with a work of depth and substance, rather than an extended musing. Once you’ve read several books in this mould, it becomes increasingly difficult to buy into the artifice — until, eventually, all you can see is the template.

Houman Barekat is a writer and critic based in London.