Why Do People Get Ill? , by Darian Leader and David Corfield 376pp, Hamish Hamilton, £16.99
Nervous System, by Jan Lars Jensen 273pp, Icon, £12.99
The authors of Why Do People Get Ill? quote the definition of a doctor from The Devil's Dictionary: "One on whom we set our hopes when ill, and our dogs when well." Let us suppose that, having a pain in your chest and having set your hopes, you visit your general practice. "How are you today?" the doctor asks, gazing not at you but at a computer screen. You mention your problem. "How long have you had it?" Three months, you say, giving a simple answer to a simple question. Tapping ensues: not of your chest, but of the keyboard. Signs and symptoms must be resolved into words, into numbers. A figure is noted, and added to all the other uninterpreted figures the computer has collected about your body.
But suppose instead the doctor asks: "This pain, when did it start?" Your answer might well be "Three months back, just after my father died." Only the most bone-headed medic will regard these two responses as just the same. And yet "stress", the authors say, is such a catch-all, debased notion that it hardly helps us. If we are to treat our pain, we must consider its complexity, its layered nature, and accept that few illnesses have a single cause. Symptoms exist within a body, but the body exists within society. No two pains, no two diseases are quite alike, because the terrain - the patient - is different.
This seems so obvious that it hardly needs restating. Yet daily, and in practice, doctor and patient unite in a need for easy answers, a clear line of cause and effect. Psychological factors are hard to measure, and in many fields of research, what can't be quantified is taken not to exist. Our bodies are speaking, but who is listening? In the US, on average, a patient speaks for 23 seconds before being interrupted by the doctor. Yet patients may solicit such an interruption. They want someone to ask a question, the right question, the one that will unlock not just the name of their disease and its prognosis, but also its meaning in the story of their lives.
David Corfield is a researcher in the history and philosophy of science. Darian Leader is a psychoanalyst, who wrote the infuriatingly named Why Do Women Write More Letters Than They Post? - a question that invites the reply "Because they are emotionally incontinent idiots". He makes up for it by his part in this succinct exploration of the latest thinking on the routes between our mental states and their physical manifestations. Freud and Lacan keep peeping round the door of the consulting room, and for some bluff and healthy readers the speculations will stretch a little far, but people who are worrying that their personality type is disposing them to disease will take comfort from the authors' scepticism about the simplistic approaches that for years dominated our perceptions of the mind-body link. This is not a doctor-bashing book, though it has harsh words about the social context in which medical research is contaminated by the expectations of those who finance it. It is not, either, a simple adjuration to "treat the whole person". It sees the medical encounter from both sides, and notes how it is charged with the power to heal or harm. What it does is to plead for coherence of approach as against compartmentalised thinking, and for the individual to be seen as such, rather than as a unit of profit.
When the Canadian novelist Jan Lars Jensen fell ill, it was not a doctor but his editor who made the diagnosis: "You're going nuts." Graduate of a creative writing school, marking time as a librarian, he had his first novel accepted by the prestigious publisher Harcourt Brace. When he saw his editor's suggestions - every single page marked up in red - he felt confidence ebbing, then sanity slipping away. The book was called Shiva 3000. It was a fantasy novel, and drew on themes of Hindu mythology. He had never been to India, and was panicked into last-minute online research. He became afraid that he had insulted a major world religion, and envisaged Rushdie-style persecution. A full-blown psychosis took him over, and soon he believed that his text had unleashed powers that would destroy the world.
Laconic, smart and queasily funny, Jensen's memoir makes excellent sense out of a hideous episode. His fertile brain invents plots, for that is what novelists do; at this point in his career, he invents plots by lurking gunmen to shoot him dead. Many delusions have an inner logic, a dark process of their own, and Jensen's account of his day-to-day hospital life is so engaging that it is easy at first glance to miss the thought he has put into analysing his predicament. He resists romantic nonsense about links between madness and creativity. He does not for a moment deny how ill he was, and also knows how little creativity remained after he had been dosed with anti-psychotic drugs that left him stupefied and almost paralysed. As he feels his way back to reality, he takes charge of his own narrative again, a walking illustration of Leader and Corfield's thesis that healing occurs most readily when a patient can patch together his own story.
Jensen's story is not simple, and it is open-ended. "The doctors wouldn't give me a definite explanation as to why it had happened. But for me, the answer was clear. It was stress. A lack of sleep. It was triggered by an anti-malarial drug. It was genetic ... It was society. It was this city ... It was years of overcast skies. A crisis of the spirit. Bad karma. Bad decisions. Self-sabotage. Fear of success. It was symptomatic of a subtle shift in the fabric of life, caused by the internet ..." All these things are true. Causes multiply and feed each other. In the end a few candid words draw the threads together: "It was just me. All me ... It was the whole thing."
· Hilary Mantel's novel Beyond Black is published by HarperPerennial
