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Glamorizing Disease: Then and Now

“In yet another display of his famous vanity, Lord Byron once wrote: ‘How pale I look!—I should like, I think, to die of consumption…because then the women would all say, ‘see that poor Byron—how interesting he looks in dying!’”

If you want to lose some sleep, read the recent piece by Jeff Wise in New York. It is a vivid (and horrifying) description of how COVID-19 takes over your body; then, you die, and, in Wise’s words, “the doctors take away the ventilator and give it to a patient who arrived this morning. In the official records of the COVID-19 pandemic, you’ll be recorded as victim No. 592.”

Not fun, to say the least. Yet, strangely, in human history some epidemics have had an unexpected allure to them. The bubonic plague occasioned great works of art, such as Boccaccio’s Decameron. However, it never occurred to Medieval artists to depict the plague as something glorious. Artists might have seized the occasion to explore an aesthetic of horror—but not one of sublimity. In medieval times, there was dance macabre, but it was never glamorous.

Tuberculosis changed that. Whereas smallpox (the disease that likely killed the most people in human history) frequently disfigured faces, tuberculosis gave patients a pale complexion with plump cheeks. By the 19th century, this was in line with the aesthetics of Romanticism. It was popularly believed that tuberculosis made necks larger, making people more attractive. 

Patients lost weight. Europe was no longer threatened by famines. So, as opposed to previous centuries, being thick in complexion was no longer a sign of privilege. In fact, it was becoming the opposite: If you wanted to signal that you were part of the elite, you would be thin. Tuberculosis patients had that look.

We now know that tuberculosis is an extremely contagious disease; however, in the early 19th century, people did not know about germs. They believed that “consumption” (as the disease was then called) was a hereditary condition. It, thus, became a sign of elite status, as it afflicted certain privileged families.

The young were especially affected. Just as they began to see some of the symptoms (coughing blood on an elegant handkerchief), they would also taste the bittersweet delights of love. So, it was believed that tuberculosis had something to do with being lovesick. And, we all know how lovesickness can inspire powerful poetry. Before long, tuberculosis and poetic genius became associated with one another. 

And indeed, they may well have had a connection. Once symptoms were evident, perhaps artists hurried to create great works of art, knowing that time was running out for them. Consumption, thus, became elegant, even romantic. In yet another display of his famous vanity, Lord Byron once wrote: “How pale I look!—I should like, I think, to die of consumption…because then the women would all say, ‘see that poor Byron—how interesting he looks in dying!’”

Needless to say, when it comes to disease, one ought to trust doctors and not poets. There is nothing elegant about tuberculosis. It is a horrible disease, and commoners, indeed, suffered often as the aristocracy. (We now know that tuberculosis was strongly associated with the unhygienic conditions of slums in European cities.) And, once Robert Koch discovered the bacillus that causes tuberculosis in 1882, there were massive efforts to improve sanitation, and, in turn, cases of the disease dwindled. It finally lost all its glamour.

With hindsight, we can look with amazement at how the Romantics could ever be so foolish in glamorizing such a horrible disease. We can take refuge in the fact that—in our scientific age—we do not engage in that sort of silliness. 

Not so fast. We still do. Plagues might no longer be glamorous. But, the aesthetic of tuberculosis survives. Nobody thinks that coughing blood into the handkerchief is a sublime moment, yet the pale, thin semblance still attracts. Take a look at most covers of Vogue. Not exactly the epitome of robust health. Nutritionists have long struggled with this. Anorexia is much more than just a disease. It is an aesthetic on its own. Fragility due to a low Body Mass Index is somehow poetic for many young people. Adolescent girls form chat groups not to discuss how anorexia has negatively affected their lives, but to actually support each other in not eating.

By the mid-1990s, heroin addiction was also part of this trend. The Calvin Klein brand never told anybody to stretch their arms to get a shot, but its models (both male and female) did look like heroin addicts: thin, pale, disoriented, yet eerily glamorous. It was the junkie chic. In the 19th century, John Keats (who himself died of tuberculosis at the age 25) wrote Ode to a Nightingale, a glamorization of death (presumably by consumption). Poets of our age have had similar inspirational moments. In 1995, Kurt Cobain (also pale and thin) committed suicide with a gun, while high on heroin. Some grunge fans still perceive that event as some sort of tragic yet brilliantly sublime moment.

Of late, the opioid epidemic has taken away any allure from heroin addiction. There is nothing elegant about an overdosed woman in the backseat of a car with an unattended baby nearby. And, though fashion magazines might still feature people with anorexia on their covers, thankfully, the likes of Kim Kardashian and Beyoncé are making “bootylicious” popular (though, in turn, the obsession with large buttocks and breasts may induce another mental condition, body dysmorphic disorder). So, for now, it seems as if we are no longer in the business of glamorizing disease.

Again, not so fast. It seems to me that gender dysphoria may be the new chic. The disorder is obviously real, and it has existed in every epoch—and in all cultures. As such, patients need treatment, and gender transitioning must never be ruled out as an option (though, given the possibility of remission, this option should wait until adulthood). But, there does seem to be a recent explosion of cases. And, even more puzzling, there appear to be many cases in which, out of the blue (i.e., with no earlier signs whatsoever), a young person feels the urge not to conform to his or her birth gender. 

Dr. Lisa Littman calls this condition “rapid onset gender dysphoria.” Littman has taken some heat as a result of her findings because this diagnosis would imply that—at least for these cases—a dynamic of social contagion is at play. To many transgender activists, this is anathema, because, according to them, gender dysphoria cannot just come from the social influence of others. For them, gender dysphoria is a disorder with brain correlates, and young people who wish to transition are doing so because that compulsion comes from the inner workings of their body, not just social influence.

The jury is still out, and, as with any scientific topic, we would do well to wait for further evidence. However, Littman may be onto something. Of course, there are cases in which the compulsion to transition is entirely grounded in biology. But perhaps not in all cases. Hasn’t the history of glamorization of disease taught us anything? It is perfectly possible for a disease to become so trendy, that some people may actually want it. Some girls choose not to eat because their lateral hypothalamus may be injured, so they do not feel hungry. But, many others choose not to eat because, “Oh, isn’t Victoria Beckham so beautiful?”

In recent years, gender dysphoria has had its own glamour. So, just as some girl who reads Vogue may ultimately refuse to eat, I don’t believe it is outrageous to think that some boy who sees Caitlyn Jenner walking on the red carpet may suddenly feel uncomfortable with his own sex. Now, this is thin ice, so we must be very careful in what we demand. Caitlyn Jenner has the right to receive all the media attention that she desires, and transgender people ought to be allowed to have normal lives. (This includes the ability to go on television shows to tell everyone how wonderful they feel.) Censorship is a dangerous thing, so, like it or not, we should let media run its course. But, given the long history of glamorization of diseases, we should at least be on the watch and acknowledge that perhaps some cases of gender dysphoria in young people (especially those with no earlier symptoms) may indeed come from a social contagion fueled by media glamorization. 

Crucially, the acknowledgement of this would have great implications for treatment options. If a particular case of gender dysphoria in a young person does come from social contagion, then transitioning (either via hormonal replacement therapy or surgical modification) must be put on hold, for it is much more likely to remit. Again, when it comes to disease, we need to trust doctors, not poets.

Dr. Gabriel Andrade is a university professor. He has previously contributed to Areo Magazine and DePauw University’s The Prindle Post. His twitter is @gandrade80

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