If an illness is not visible, does it exist? This is a question that a number of Tissot’s patients grapple with. Unsurprisingly, it’s an issue that comes up in relation to the various sins of the flesh.

For some patients, the invisibility of illness appears to serve as a justification for engagement in otherwise illicit activities. Witness, for example, the case of a 40 year old man, described in a 15 page consultation dating from February 1777. His doctor begins by observing that the patient has been gifted with a strong corporeal legacy passed down from his parents, who were strong, healthy folk who lived lives of moderation.

The patient, too, appears, at least on the surface, to be healthy as well. Though less inclined to moderation – particularly in the realm of sexual pleasure – than his parents, he does not appear to have suffered the physical manifestations of his moral disorder; that is to say, he has no visible signs of sexually-transmitted disease.

But that’s not to say that he’s safe. In the words of his doctor?: “il n’a aucune maladie vénérienne visible quoique souvent il en ait couru le danger.” [Fonds Tissot, IS3784/II/].

There’s more than a hint of moral censure in this part of the letter. The doctor suggests that although illness isn’t visible, it may well exist (given what appears to be a gesture towards his patient’s immoderate sexual exploits). In this reading, venereal disease is not the real disease. Rather, it is but a symptom of a much more menacing disorder that resides in the individual’s psyche and in what his doctor understands as immoderate sexual practices.

The patient, however, disagrees. Through his doctor’s mediation, he asks Tissot a number of pointed questions, among them the following:

“L’usage modérée des femmes est-il si pernicieux qu’il faille absolument se l’interdire, et comment peut on croire qu’une Evacuation si naturelle provoque une maladie qu’on attribue a surabondance? …. Le consultant doit ajouter que dans les différentes attaques (portant l’observation à tout) il a fait usage des femmes, et que loin d’en sentir de mauvais effet, il a cru se trouver mieux.” [Fonds Tissot, IS3784/II/]

Is it so very terrible to engage in sexual encounters with women? Is it really necessary to avoid these practices at all costs? For this patient, the opposite appears to be true: he finds that he feels better after his sexual encounters. From this, it is clear that the patient in question has his own meanings about his body and how it works. As far as he’s concerned, there should no cause for worry in this regard; after all, his body has manifested no physical signs of sexual malady. Indeed, how could something so natural cause illness?

This oscillation between moderation and excess, particularly in relation to visible signs of disorder, appears as a tension in many letters regarding questions of sexual pleasure. Depending on their moral stance, patients will either ascribe all of their sufferings to immoderate engagement with the sins of the flesh, or they will pledge allegiance to lives of balance and moderation.

Others find external justifications for their sufferings. Sexual initiation – at the hands (quite literally) of friends or in the illicit encounters with maids and other servants – is imagined as the gateway to their current excessive behaviours and physical disorders. Such individuals put the responsibility for their actions squarely on the shoulders of others. Innocent lambs, these patients imagine themselves as victims of the salacious intentions of those around them. In this way, they are able to maintain the appearance of virtue, even as their bodily habits suggest something entirely different.

But another group – one which includes our first 40-year old patient – is very different. These patients claim their right not only to sexual pleasure, but also to sexual debauchery and excess. Going against the advice of doctors and of friends, such individuals assert that their illnesses and sufferings are not related to their lives of excess, but must have another cause. In other instances, patients take care to assure Tissot that they have suffered no ill-effects as a result of their actions.

Finally, some patients filter the Enlightenment’s emphasis on ‘Nature’ through their own experiences, in the process turning Tissot’s vision of the strong and healthy peasant who lives his life in moderation and draws his inspiration from the beneficence of Nature, on its  head. Witness, for example, a certain M. de Gounon. Like others, Gounon discusses his youthful indiscretions and positions himself as “victim” of excessive passions. Nevertheless, he accepts this as a part of who he is: “I loved women with a fury, my whole life was play and I drank much wine and consumed coffee continually. The temper of my soul has always been to seize everything with passion.” [Fonds Tissot, IS3784.II.].

When is an illness not an illness? It’s a good question. If the letters to Tissot are any indication, illness was always subject to interpretation.


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