A School of Life — Patrick Autréaux (translated by Tobias Ryan)

From the beginning of my studies, I considered the progressive inner desiccation that medical thinking induced as though it were a symptom to be concealed. If at first I had been keen to master its knowledge and methods, I felt there was a tendency in medicine to systematize a kind of reasoning that threatened to extinguish the irreducible mystery one might want to interrogate when faced with a body going haywire, with madness, or when confronting the fate of a sick individual. I sometimes even had the impression that in depriving me of that, it was undoing me.

Later, when I started transcribing the reports of hospitalized patients, those little-known morsels of literature, I often felt a reticence to confidently employ words that seemed so distant from the experiences they were intended to relate. What link was there between the exhausted woman with a delirious look and the “hallucinatory and intuitive delusions” which led to her being committed? What between the word “avolition” and that sad, old man with the wrinkled brow, who spoke to me of a daughter who had died? Or between the profoundly understated movements of the head which gave such and such young man the appearance of an angelic musician and the phrase “attentive attitude” on the office’s certificate of hospitalisation? So many semiological terms obscuring subjective realities that escaped me, leaving me suspended above a banal enough question, whose depths, nonetheless, leapt vehemently out at me from certain hospital rooms or ER cubicles.

I subsequently have a persistent memory of my embarrassment as a young doctor who endeavoured to flout patients’ interiority, to marginalise it, at least, for the sake of reasoning, or reduce it to psychological symptoms – thus avoiding consideration of his own emotions, that which he rejected or to which he had aversions, his urges and his sympathies, and sometimes his attraction.

These little medical writings are structured around the representation of illness, and a series of procedures to follow and their side effects. For them to have a reason to exist, they must be simple and reliable. This is how a pact forms between inquisitor and medical history: it demands facts, and writing without hidden traps, writing which puts up no façade. Medicine tends to bring everything it touches into line with its logic. Its power comes through its ability to reveal the causes of pain, but it quickly wearies and abandons that which, once it has been unravelled, seems to remain a mystery. The extent of its understanding often ends at the threshold of the most singular realities. Medical knowledge generally neglects this other, more complex and formless, zone, with which art, and more particularly literature, tends to be charged (in the electrical sense of the term): an active space never entirely unveiled. And if, according to Virginia Woolf, a simple flu can provides us an astonishing tale, I have noticed that the doctors who take interest in it are few.  

In breaking with its witchy element, medicine has also rent itself of a powerfully troublesome weed: subjectivity. Subjectivity is not, as we well know, the self of psychology, or is so only in approximation. And that of patients is not simply emotion or anxiety, manifestations of which easily frustrate doctors, but a rift which opens up an illness, a crack that risks devouring the methods of Father Hippocrates – and which threatens, also, to reverberate through the fractures of the medical staff themselves. Subjectivity is the semi-consistent fog which awaits a listening ear, which hopes for encounter, which must extend for relationships to take form – even if they are to end in loss.  

Medical histories bear the mark of this sacrosanct notion of therapeutic distance. To interpret symptoms in a scientific frame of mind is to take a step back, allowing for the most rational possible analyses and syntheses. However, what has appeared, from the beginning of my practice, damaging as a writer, and as an individual, is the way in which this distanced retelling overruns the field of thought, discrediting the imaginary which illness can cause to proliferate: giving us a glimpse of an evil moon, but obscuring its private face.  

The kind of narration which is the foundation of medical writing is rarely the object of reflection. If, for my part, I was sensitive to it, it is because I was working under a literary pull. And because I felt inhabited by a formlessness which, since my adolescence, had demanded representation; because I sensed within myself that hidden face which I took care to delimit in my everyday professional activities, and so frequented, in parallel to the school which taught me my trade and responded to a confirmed vocation, another, wherein an understanding of human life was less precise and yet more powerful – this other, this folk-school, was literature.

In certain regions or from within certain pages, long seasons open out. The summer will always be, for me, not the sea or walks in the mountains, but a bedroom in which I lie, blinds half closed, or a deck chair in the shadow of a tree, bathed in the green and yellow light of epiphany – spaces which strongly recall the room of a patient or convalescent, where our eyes zip back and forth from a book to the spiralling path of a fly that circles above our head, where we follow the black mark of a little spider meandering across the ceiling: a truant space of the fleeting madness that is dreamy thinking. 

Folk-school: at the beginning of the Reformation, in the first third of the XVI century, this was the name for the improvised classes which took place beyond the control of priests and official education, away from the churches, in the countryside – in the bushes. They were schools which, far from idleness, were first and foremost those of the margins, schools of contestation, and which, above all, made a return to the text. In order to listen to human beings, we must, without doubt, know how to listen to texts. And vice versa.

My folk-school was therefore a little underground. Modest and intimate, it tended to instruct me in more delicate and complex attentions. All the same, as I was already finding the hospital, as it is today, unbearable with its invasive and mutilating managerial logic, it was also a space of resistance. To protect what others may have identified as a crack, there were the authors with whom I came face to face. Not only so that I might grow in compassion and deepen my understanding, but that I might attempt to glimpse a poorly delineated psychic space, to unearth from within myself the possibilities of those muzzled emotions, not to imagine myself as preserved from evil, to believe myself “healthy”, but dare to embrace my moments of distress, to guard my faith in the power of what they revealed about who I was, revelations that none could have offered better. 

If I were engaged in self-revitalisation through the refusal to separate myself from a fate shared, potentially, with certain patients, this personal development was left at the hospital door. I had to accommodate myself to the growing distance between modes of psychic life that seemed to rule one another out, and which I was unable to reconcile. What shook this division, and tentatively shifted its frontiers, was that I was learning how to write, and that writing was leading me along a tightrope toward a place from where one can see at least two ways at once: the lip of a volcano discovered in the bushes. It was a matter of rediscovering the fluidity which exists in the mind between thoughts that issue from logic and those that issue from reverie, or at least those in which logic is not manifest, whose structures do not follow a causal sequence but one more associative and dreamlike. It was wanting to write like a doctor but forgetting I was one.

To become this crucible of psychic reconciliation, it took me falling ill (with a cancer that initially condemned me), which is to say, doubting the tacit fidelity of my body, becoming a stranger to myself, and submitting to hands that considered me an object of investigation, of protocol and of care.

Becoming such an object is a source of violence, real and symbolic, of unconscious and verbal abuse, as well as a lot of attention. In any case, it confronts you with a representation of the self which risks swallowing you whole, transforming you into an object in your own eyes. The majority of doctors seemed indifferent to (or were hiding their embarrassment at?) the way I looked at them and followed their gestures, indifferent to my awareness of having passed, in their view, from a person to thing to be analysed – despite the oratorical precautions and apparent empathy they displayed. 

As I never stopped being a doctor, slipping between one and the other, I superimposed these antagonistic representations of myself: a well-ordered garden in the French style, raked by medical reason, and a wild forest, the terrifying poetry of what was happening to me. I was, myself, the border; my instincts pricked. I would observe the abyss of uncertainty from the promontory of meagre knowledge I had been given as to what would become of me. I didn’t know if I would survive, but I wanted to remain spiritually alive until the end. I had known the shock of a death sentence; I was being offered the chance of recovery through heavy treatment, and was full of a life that strove to regain the ground that had been pulled out from under it. As a student, I had fought against an inner desiccation; as a patient, I was fighting not to be extinguished before the flame burnt out. One has to have known this force of anxiety, this urgency, to have accepted its consequences, so as not to panic when actually left on the lip of the volcano, to glean that even there an invitation to become fully alive can be found.

Knowing you have an identified illness moves you from the anxious interpretation of symptoms and phantasmagorical projections to a circumscribed and more tangible reality. In my case, it meant the conversion of an inexplicable pain, one that I had called my Rosemary’s Baby (child of the Devil), into gastrointestinal non-Hodgkin lymphoma, type B with kappa chains, stage 1E. 

Becoming ill is to belong to the club of the “recumbent”, that which is qualified by Virginia Woolf in her short essay On Being Ill; to that rather large club which includes all those for whom life has stopped, driven to their beds or onto chaises longues, in rooms or quiet little corners, who are suffering, convalescing, mourning, in love or reading in isolation. Once the diagnosis had been established and the routine of treatment initiated, I found myself on the side-lines to which we retreat to read, in that folk-school again, from where I could listen more attentively to the multitude of voices and impressions escaping from the existential explosion that had stunned me; but also, as I’ve said, resist spiritually, remain joyous even, despite the effects of the treatment and the exhaustion, and rescue myself from the inner wreckage I would dread no sooner did I consider the loneliness of the little man I was – who also experienced, nonetheless, as Maurice Blanchot evokes in The Instant of My Death, a strange peace in feeling an intense “compassion for suffering humanity.”  

To experience through illness one’s belonging to the human race is to feel, perhaps, what the first astronauts who travelled beyond terrestrial limits have described: an exclusion from humanity that offers a profound awareness of that very humanity, and of its unity. In extending an intimate ordeal into that of an exemplary condition, we are a little like those pioneers of space who powerfully felt how they belonged to the planet, and understood the relativity of borders and identities, whether chosen or imposed; we undergo a quasi-religious experience, close to oceanic feeling, which momentarily annuls the divisions of human history. Fantasy or wisdom, the overview effect that I experienced believing myself to be damned nonetheless transformed the man I am, and realised the writer in me.

Without doubt, this is why I have always defended the facile designation which threatens all autobiographically-inspired writing: my books are in no sense testimonials. There is often something degrading in talking about testimonials, a way to reduce (I almost wrote “defuse”) the aesthetic impact, which is to say the ethics of the text. Perhaps it is done only to soften the subversive violence – a violence done to the denial which, for the most part, blinds us – or from reticence at unveiling a buried and elusive form: the structure of a certain manifestation of Evil (mapped by the literature of the camps, for example) or the vertiginous effects of intruding upon that which alienates us from ourselves (thinking of Jean-Luc Nancy’s The Intruder.)

As such, the very first book I was able to write, In the Valley of Tears, was not an account of having cancer, but rather gave shape to the adventure of survival and a return to the world of the healthy. It depicts the unexpected trap into which healing and the impression of re-birth sometimes tumble, overlapping, in the wake of a traumatic shock. We can become prisoner of an overview effect, of the retrospective fascination such an opening exerts, of an influence that, long term, can become a heroic narrative. Threatened by the risk of posturing, we can lose, by virtue of this same fascination, that which makes up the meat of another quest: that singular literary voice, the sap composed of sensation and reminiscence, which rises under the impulse of extreme danger but does not get bogged down in the discourse of the convert, in thaumaturgical language or in moral ideals.

Illness, it seems, does not instruct, but may sometimes only teach no more than that we are inaccessible to ourselves, as well as a compassion, beyond the simpleminded, for our human condition. It leaves nothing but questions and the indelible certainty of our fragility. And yet that was exactly where I began, in that place from which, following my implosion, I was able to perceive, though not clearly discern, a deep form that was to overwhelm my relationship with literature and my “vocation” as a carer. 

As a medical student, I believed, or wanted to believe, that books nourished me and helped to condense my empathy, and make it more complex – even if I felt that I had never fully immersed myself in the flesh of the world, and that, paradoxically, my folk-school was keeping me on the margins of the very body of which it offered greater understanding. For a long time I sought the moment in which I would incarnate myself in literature – without ever really knowing what that would truly mean. Before falling sick, however, for all those books which I had avidly read, I didn’t know what I was doing. The death sentence stunned me. A slow transformation followed. Something else emerged, the beginning of an outline forming in literature, a form which I had to invent, like how from earth one can imagine the contours of constellations.

What could it mean to have discovered such a thing as this deep form? It would not mean having a design, a goal or a project. But to feel that what is diffuse, without sense or patent logic, is underpinned by a possible structure. It would mean seeking and accepting the singularity of our point of view; it would perhaps mean accepting that we each have our place. Long, hard graft. Shifting. Unattainable. We must battle on all plains: interior and exterior. First against the doubt which rarely lets up in alternating between uncertainty and conviction, and which belongs to those of faith engaged in spiritual combat; and then against those who would dissuade us, well-intentioned friends and loved ones, reasonable people who try to advise us but who are ignorant of the imperative one might call, in line with Socrates and the Ancients, our guiding “demon” or “genie”. 

Having a place, therefore, in spite of this new awareness which re-forms and disorients us, that makes us, we who are no more than that, survivors. Having a place which finally integrates, within our contradictory impulses, the inclination that leads us to care for others. In lasting remission, however, as I was starting to write again, beginning to discern that care and writing are very subtly linked, the consciousness of that deep form and the persistent sensation of being henceforth settled on the lip of the volcano, demanded of me that I find my own way of writing, and perhaps a mode of care that was compatible with what I had received – and could pass on. Caring differently, writing differently. 

(Opening a brief aside: I have written the word lip several times, and let it be understood as that which makes speech intelligible, but also that which borders a wound, like those of Christ, which were shown in medieval devotional texts with quasi-vulval representations – and which seem to me, there, to make a shortcut between birth and death, big and small, putting us in an impossible space of joy or extasy, something which I tried to grasp in my first book.)

We know this all too well: what doctors rely on technical wherewithal to name is only a limited part of the experience of illness. When sick, I accepted that I would be troubled by the permeability of these two faces of the moon; having recovered, I sought a way to give that form. To that end, I worked, without having in the least renounced the reality through which I had lived, to find a way of writing that, taking up Varlam Shalamov’s maxim, I could call “new prose”, which is also to say a subjective reappropriation; and to accomplish, for myself, the programme the late writings of Georges Canguilem established: the reappropriation, through writing, of that which medical reasoning had reduced to an aggressive but curable cancer, even when the prognosis was uncertain (a wonderful euphemism).

Writing, therefore, and, as I noted in my tenth book Se suvivre (Verdier, 2013), finding a kind of prose, “which touches on truth, on rediscovered compassion, perhaps, on everything that is terrible in the desire to love that which dies. A prose hidden in the caverns of a time which has no bearing on today, and that wears away at much more than time: at that truth which renders everything what it is not, crumbling – illegible.” 

Writing for seasons of woe.

The repository of such an ambition, as far as I can see, can only be a book which never ends, as open, fragile, and stubborn as a ruin or a living spring. And I had to take the risk of writing that book. I had already written on this coupling of illness-convalescence, written about having been upended by the announcement of my death, that which tore up everything I thought I had known about the self. People kept telling me: Do something else now, turn the page. What remained to write was that which was least apparent, that which had been for me, until then, a foundation I believed mute, made of the unexpressed thoughts of my convalescent life. To write about chemotherapy in particular, but from within, as an inner experience, and so to rediscover the bewitching elasticity of sick time, its dreamlike deformations, frantic and staccato pounding, its unanticipatable organicity and transformative effects, in the hollow of the parentheses that opens up within us with the haunting awareness that an illness is in course of being treated. 

The results, Se Survivre, although not a thick book, took me ten years to write. I had wanted to compose a text – an origin story of some kind, even if it wasn’t the first published – which would accommodate shreds of mystery, of anguish and of nightmare between the more sturdy foundations of observation – wild grass sprouting between the granite flagstones. I had combined the view of the doctor whose postures I had adopted and those of the patient assailed by terrified convictions and feverous nights. Sickness, and more generally trauma, dislocating any sense of unity and exposing a disquieting reality. A pulsating mass with a thousand eyes, that you are unsure whether will pounce at your face and devour you or offer you treasure among skeletons. That reality (a treasure island) is constantly present in the mind of patients but rarely expressed. Its involuntary manifestations can become embarrassing. The sick person sees that this life, half-invisible to those of good health – even if they are empathetic carers – and the flagrant dissymmetry this vision imposes on relationships, is the cause of many misunderstandings: “Well, doctor, I’d like to see you there!” an old woman, and companion in chemo, summed it up to our physician.

To what ended up being the writing of my sick self, I could contrast the medical history taken by the intern in the haematology department where I was monitored. The contrast is obvious. And it is not impossible that I have written my books to respond to the dryness of that brief page, to rescue from oblivion an adventure to which almost none bore witness, and which seemed, nevertheless, a source which offered life itself, ambivalent, dangerous, beautiful and uncertain; to cry out that what had just happened to me was far more complex than that which the doctor had summarised, that the pain and its consequences overcame me and demanded something new from me: profound change. I hadn’t been suffering, I had undergone a metaphysical experience. I had come into a knowledge the intensity of which had dazzled and terrified me – even if I was incapable of describing the substance from which it was made. It was a carnal knowledge which seemed steeped to its fibres in notions of fate, and thus in a mystery far more ancient than me, the very mystery that envelops human beings faced with their own existence.

I sensed from then on that to be a writer would mean not only writing, but guarding what is most intimate to you and which, you discover, does not belong to you. 

The paradox was that recovered health threatened to dam this bubbling source, which was something I refused even before I had fully healed. “That health built a prison,” Paul Éluard wrote.

The paradox was that medicine appeared not to have the power to cure something which, perhaps, did not concern it. 

The paradox was that I had just discovered that which remains in the margins, in the undergrowth of resistance, and on the lip of the volcano where I was stood: and it was another vocation, like that of the Jewish mystics, the Therapeutae, described by Philo of Alexandria, whose spirituality was entirely marked by care – but in a sense that not only encompassed medicine but extended to nature, to the seas and the skies, to the stars and the void, to the body and to countless voices, to the visible and invisible world, and to everything hidden in the womb of time. 

The paradox was that this experience truly reminded me that a vocation to care was one that medicine alone could not fulfil. And that if I were to write, it would be to tend to that which nobody is able to heal. 

***

In the Valley of Tears — Patrick Autréaux (tr. Eduardo A. Febles, UIT Books, NYC 2019)

Patrick Autréaux was born in 1968. He practiced emergency psychiatry until 2006. Author of a dozen books and numerous articles on art and literature, he lives between Paris and Cambridge, USA. Website: https://www.patrickautreaux.fr/

Tobias Ryan lives in Paris, France, where he works as an English teacher and translator. He is also Co-Editor-in-Chief of minor literature[s]. Twitter: @TobiasvRyan