A little over a decade ago a number of Americans began to report a novel and alarming disorder: they itched like the damned, convinced that tiny threads or fibres were poking from their skin, or that they were infested with minuscule creeping things. The victims felt alien, bristling. They were also disbelieved. Morgellons disease – the name derived from a passing reference by the 17th-century physician Sir Thomas Browne – appeared to the professional gaze an impure emanation of Google-borne hypochondria. To journalists too: before long it seemed every enterprising US feature writer was poring itchily over online accounts of symptoms and the struggle for acceptance. Morgellons was a template instance of medical anxiety in the internet age.
To Leslie Jamison – whose essay collection includes pieces on extreme running, gangland tours and the history of saccharin, but is at its disconcerted best when describing bodily predicaments – the "disease" was and remains something more. It's a test case for human affinity in the face of manifest but indefinable suffering. Jamison passes swiftly over the online epidemic and instead fetches up at a Morgellons conference in Austin, Texas, where she listens rapt and then ashamed to the stories of patients and advocates. The tales are uniformly dismal: brittle, pretty women who have scratched their faces raw; couples and families united by pain and the guilt of contagion; the uninsured resorting to draughts of veterinary-grade dewormer.
How to properly hear such confessions? Jamison has her own dermatological horror stories – a maggot in the ankle, no less – and understands the Morgellons patient's loneliness, disgust and fugue-state vigilance. But at length she retreats to her hotel pool and a sense, however provisional, of her own physical integrity.
The Morgellons essay crystallises what Jamison does very well: forensic attention to corporeal detail and self-aware reflection on the extent to which she, or any of us, can imagine life in another body. Her title essay is an account of time spent as a paid medical actor, not only feigning symptoms but working up the backstory and motivations of her character, presenting that history to trainee doctors whose degree of empathic response is depressingly rote-learned. Jamison match-cuts these scenes with an account of her own heart surgery and an abortion: the latter made more traumatic by a seemingly callous comment from one of her physicians. As a study in vulnerability, but also in types of speech and silence that surround the ailing body, The Empathy Exams is exceptional, Jamison concluding that empathy is a matter of the hardest work, "made of exertion, that dowdier cousin of impulse".
The piece also functions as a frame along with the final essay, "Grand Unified Theory of Female Pain". Here, in well-patterned fragments, Jamison analyses the historical but newly fraught problem of disbelief in and distrust and dismissal of women's cultural expressions regarding their ailing bodies, or minds. Jamison is herself a novelist: her debut The Gin Closet was published in 2010. She's keenly aware of literary models for the porous, abject or prostrate body: Bram Stoker's drained and punctured Mina, Miss Havisham and Blanche DuBois in their withered gowns, the erupting adolescent of Stephen King's Carrie. She cites Susan Sontag on picturesque tubercular women, and recalls being huffily dismissed in a creative-writing class for the gaucherie of quoting Sylvia Plath on female wounding. But the essay has a more pressing, generational, import. Jamison is in her late 20s, so grew up with the legacy of 1990s confessional culture – her heroines were Björk, Tori Amos, Mazzy Star: "They sang about all the ways a woman could hurt" – then found herself accused by a boyfriend of being a "wound dweller". She self-harmed as a teenager, and now lives in a culture where Facebook groups are devoted to "hating on cutters". How, she wants to know, did women of her age learn to be embarrassed by personal and artistic accounts of their pain?
"I'm tired of female pain, and also tired of people who are tired of it," Jamison writes. "Grand Unified Theory" is at several levels a fantastically assured and revealing treatment of a contemporary predicament: so wrapped in ancient and recent mythology is the spectre of the suffering woman that it seems at once essential and illicit to speak or to write about everyday and ordinary pain. But the essay is also one of the places in The Empathy Exams where the limits of Jamison's response to her moment begin to make themselves felt. The problem is hard to isolate, in part because her point is about accusations of wallowing triviality, in part because as she rightly says descriptions of "minor" suffering may be the royal road towards our best insights into larger catastrophes – Virginia Woolf's "On Being Ill", for example, with its amazing slippage from colds and flu to devastating grief. "I happen to think that paying attention yields as much as it taxes," says Jamison – "You learn to start seeing."
Attention to what, though? Medical emergencies aside, you could object that too much of the personal revelation in this book – the bruised past and bruited pain – is of an order that would not alarm anyone out of adolescence: drink, drugs and bad sex presented as a kind of radical dysfunction. It's the same with some of Jamison's forays into more violent milieus, which can feel (even if it's not true: she recounts a hideous mugging) like slick Vice-style slumming. (Actually, there's just one piece from that woeful magazine; others appeared in the likes of Harper's and the Believer.)
The more vexing problems, I think, are tonal and stylistic. For all her exacting attitude to her own place in the stories she tells, and her clear indebtedness (along with everyone else) to David Foster Wallace, Jamison gives in at times to dismayingly vague, cod-poetic or plain overfamiliar formulations. On Frida Kahlo: "Frida's corsets hardened around unspeakable longing." Aligning herself improbably: "Many nights that autumn I went to a bar where the floor was covered with peanut shells, and I drank, and I read James Agee." Too many essays conclude, as "Grand Unified Theory" does, with trite expressions where it seems the expectations of the well-formed lit-mag essay have pressed too hard: "I want our hearts to be open." Indeed, this feels like more of a retreat at the level of thought than that of style.
It's a measure of Jamison's timidity in this regard that several times while reading The Empathy Exams I longed for the echt if muddled confessional writing of an author such as Elizabeth Wurtzel. (A surprise, this – because if you were young and depressed in the 1990s, measuring your days in Prozac's blister-pack panacea, Wurtzel seemed a dubious ally at best.) The more instructive exemplars for the kind of essayism Jamison wants to practice areJoan Didion and Janet Malcolm, whom she either cites or passingly invokes, though neither is notably "empathetic" and probably the better for it. But also American writers with amore capacious sense of the political stakes of the localised narratives they light on – Rebecca Solnit, William TVollmann – or books with a more antic,less generic idea of confession: Wayne Koestenbaum's Humiliation, forexample. Jamison at her best – in the essays on bodies, her own and others' – is almost their equal.
