Proust and Medicine
Prior to undertaking the project to read In Search of Lost Time in the coronavirus era, the only biographical fact I knew about Proust was that he insisted on completing his landmark novel in the cocoon of a cork-lined room—an idiosyncratic signature—but perhaps one that would have resonated in the long hours of early quarantine when we wished we could silence the ambulance sirens below and, now, the relentless explosions of fireworks.
I have since learned that Proust’s father, Dr. Adrien Proust, was a respected pathologist and epidemiologist who dedicated his life to studying cholera, an infectious disease that continues to wreak havoc in communities without access to clean water today; as a result of his research, he was the first physician to propose a cordon sanitiare to quarantine ships entering harbors in France in order to prevent the spread of disease. Proust’s brother Dr. Robert Proust was a surgeon recognized for having pioneered a mobile operating theatre in World War I. Although Proust does not reference the Spanish Influenza in his texts, between the publication of the novel’s first volume in 1913 and the second volume in 1919, this epidemic H1N1 flu ravaged France, killing over 100,000 individuals. Proust himself suffered from terrible asthma attacks—a threat that was to challenge him from age nine until his death by bacterial pneumonia secondary to seasonal influenza in 1922. Constantly crippled by the anxiety of another attack, he is an individual who would have been at high risk of succumbing to COVID-19 disease.
In light of the current pandemic, these biographical facts about the author of an auto-biographical novel seem too remarkable to overlook. Although the head of the protagonist’s family is not portrayed as a physician, medical figures appear throughout the novel. They come alternately as charlatans treating the frail protagonist’s bouts of respiratory illness with prescriptions of milk and whiskey—not unlike those in our own day touting UV rays or bleach as coronavirus prophylaxis—or as reputed practitioners, who rally for a more evidence-based approach. One can imagine that the disparate portraits of physicians across In Search of Lost Time reflect the author’s own contentious relationship with the medical field. For most of his life, Proust relied heavily on a coterie of doctors, leading a convalescent existence between house calls and natural springs touted for salubrious effect. However, because asthma was believed to be a “neurasthenia,” or an illness with a purely emotional rather than a biological cause, at the time, young Proust was subjected to many treatments with little scientific basis even while his father pioneered data-driven practices in infectious disease.
Now that I am familiar with medical jargon, I’ve come across countless uses of a technical language that would have only been familiar to a writer immersed in this milieu. Nowhere is the presence of medical terminology more prevalent than in “Un Amour de Swann,” the only chapter of the first-person narrative written in the third person. The eponymous Charles Swann is the young protagonist Marcel’s neighbor, a man who provokes the curiosity of Marcel’s family through the juxtaposition of his erudite taste in art and literature with his mediocre taste in romance. The chapter’s narrative centers upon Swann’s obsessional love for his mistress Odette. When his friends cannot understand why he is so distressed when she threatens to reject him, the narrator writes, “It’s a bit like how one is surprised that one deigns to suffer from cholera at the fact that it is a being as small as the comma bacillus.” (The bacteria that causes cholera is shaped like a comma.) Then there is this hair-raising simile used to describe how Swann presses Odette to confess to an act of infidelity: “not letting go, like a surgeon who awaits the end of a [muscle] spasm that interrupts his procedure, but does not make him abandon it.”
While coming across these medical morsels tickles the joy of recognition, what strikes me most is how Proust’s attention to Swann’s cognitive habits, behaviors, and motivations approximates a psychological case study. Early in “Un Amour de Swann,” Proust introduces the concept of mental pain:
As if it had been a physical pain, Swann’s thoughts could not lessen it, but at least physical pain, because it is independent of thought, thought can stop it, observe that it has diminished, has ceased momentarily. But this pain—thought—just recalling it, recreated it. Wanting to not think of it was to think of it again, to suffer more.
Here, Proust’s articulation of mental pain, which is different from—yet as tangible as—physical pain, does not fully appreciate the biological underpinnings of mental illness we recognize today; still, it resonates with a contemporary understanding of perseverative thought content, which is not a clinical entity per se, but rather a symptom on the spectrum of maladaptive cognition.
Proust goes on to characterize Swann’s mental anguish, which, it becomes apparent to a medical student trained in the fundamentals of psychiatry, is consistent with a diagnosis of clinical depression: the bachelor finds himself “detached from all interest,” no longer concerned with the people and pastimes that previously dominated his routine, suddenly tearful for no reason at soirées, and endorsing passive suicidal ideation, almost wishing “he would die of a brain tumor” to end this “mental” suffering. Later in the chapter, which takes place about a decade after Swann first meets Odette and they have married, he reflects on “the depression of the prior years,” describing how his “illness…was so closely mixed with all his habits, in his actions, thought, health, sleep, life, even is desire for death.” In psychoanalytic terms, this capacity for Swann to reflect on his mood and its manifestations as different from his personality plays a pivotal role in his functional improvement, which comes about with a gradual reengagement in activities he previously enjoyed through the tincture of time.
It is no wonder that Proust penned this text when modern psychiatry was emerging from clinical neurology at the start of the 20th century (a nosological schism that I hope will be rectified within my lifetime). He was friends with students of the founder of modern neurology, Jean-Martin Charcot, and his interest in memory that pervades In Search of Lost Time was also shared by Freud, a neurologist by training. Perhaps the caricatures of doctors who appear throughout the novel serve to undermine the authority of the medicinal establishment, paving the way for Proust’s own medico-literary practice. By examining characters like Swann and the protagonist Marcel’s maladaptive thought patterns in a fictional realm, his sympathetic portrayals examine the anatomy of suffering distilled from and yet in close proximity to the exigencies of modern life. Although Proust does not go so far as to proffer a cure for mental illness, he is quoted as saying, “I am more of a doctor than the doctors.” Through his boundless literary efforts, he fashions himself as a physician of sorts.
What Proust Can Teach Us
In the first installment of “Proust in Pandemic,” I discussed the key role I believe imagination and memory will play in helping us navigate the immeasurable anxiety instigated by this crisis on a global scale. These tools are valuable in part because what may be the most lethal part of the coronavirus—beyond the insensible loss of human life it takes—is the mental health epidemic in its wake. Proust makes clear in his depiction of Swann and, later, a young adult Marcel that the same tools of imagination and memory that were so salutary for a young Marcel in the form of a magic lamp or madeleine can also be a source of emotional distress. For instance, for Swann, memory warps into obsessive rumination and imagination morphs into delusional thoughts. Once established, neural circuits developed to respond to aversive triggers in the environment tend to become reinforced, such that minds gather evidence to support maladaptive cognitive and behavioral patterns, rather than correct them.
While we navigate these unprecedented times, it is difficult to read the newspaper or walk down the sidewalk and not feel overwhelmed. Those with existing chronic illnesses or risk factors for severe COVID-19 disease may fear for their health and access to quality healthcare. Others may find themselves undomiciled or unemployed, and anxious about meeting the most basic of human needs. With continued restrictions on movement, many individuals find themselves, survivors of a rising trend in domestic violence, in unwelcome physical proximity to their partners. This pandemic has also augured a radical national soul-searching of the glaring racial and ethnic disparities at the heart of American life—disparities which are a cause of ongoing distress to those whose health and well-being have suffered as a result of inequity and those who have perpetuated it intentionally or unintentionally for centuries.
All of this is to say, something is rotten in the state of the world. These conditions lend themselves to precipitating or worsening mood disorders like anxiety and depression, but also substance use, and, as we are finding in the clinical setting, psychotic illness. How an individual copes in moments of crisis, however, can either strengthen her identity and resiliency or threaten and undermine them. A degree of depressed mood, concern, and anger is a healthy, even appropriate, affective response at this time. However, when they are turned inward or externalized to the degree that they incapacitate, negatively impacting “actions, thought, sleep,” and, as they did Swann, induce a “desire for death,” they become pathological. According to the Center for Disease Control, suicide is the second leading cause of death among individuals age 10 to 34 and the tenth leading cause of death in the United States. On any given day in the United States, there are 132 deaths due to suicide on average. To put this in perspective, on July 4, 2020, there were 265 deaths attributed to COVID-19 disease, or double that number. And yet, we don’t have infographics in our news feed to inform us of this threat. This number is only predicted to rise in the setting of the pandemic. While we have not yet developed a vaccine or identified a proven treatment for coronavirus disease, we do have effective treatments for mental illness, and there is hope that these will continue to be improved upon. Mental health, like infectious disease, has long been a neglected sphere in American discourse, in part due to shame and stigma. It is my hope that as the contemporary cordon sanitaire reveals the inner workings of our society, it will also unmask the mental health pandemic in our midst. These contemplations bring me to a last question—or rather, opening: why would a writer whose only sibling operated in field hospitals (not unlike those employed during the current pandemic) operate in the theatre of the mind? Proust spent a lifetime riddled by physical illness mastering the art of rendering psychological experience. Perhaps he felt, as I do, that acknowledging the facticity of mental pain constitutes a therapeutic start.
Catherine Parker is a medical student at Columbia University Vagelos College of Physicians and Surgeons in New York City, where she is part of a team investigating the impact of COVID-19 on mental health. She received an MPhil in European Literature and Culture from Cambridge University and a B.A. in Philosophy and French Studies from Scripps College.
Albaret, Céleste. (Barbara Bray, trans.) Monsieur Proust. New York: New York Review of Books Classics, 2003.
Centers for Disease Control and Prevention (CDC) Data & Statistics Fatal Injury Report for 2018. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/ndi/index.htm
Coronavirus Disease 2019. National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/us-cases-deaths.html
Proust, Marcel. Du côté de chez Swann. A la recherche du temps perdu I. Paris: Gallimard, 1988.
Tadié, J-Y. (Euan Cameron, trans.) Marcel Proust: A life. New York: Penguin Putnam, 2000.
All translations are the author’s own.