From the Gut

By my late twenties, it had gotten so bad I could barely sleep. Many people toss and turn after, say, a baked brie or Blazin’ Buffalo Wings. But at twenty-eight, even less-quarrelsome foods—steak, carrots, celery, pork chops, hummus, jicama, the list goes on—were leaving me churning inside.

I tried pills. Some had cute, punny names (beano, Wind-eze) or sounded like top-secret military programs (Gascon, Gas-X). One came from Italy (DulcoGas, or “sweet farts”). None brought more than fleeting relief. I went to doctors, many doctors. They recommended licorice tea, nettle tea, peppermint tea, peppermint drops, probiotics, Activia yogurt shakes (disaster), a treacle-dark liquid called Nux vomica. One told me to go vegan, another suggested the ominous-sounding Master Cleanse. There was, too, much talk of yoga, the healing power of yoga, something I’d given up years ago, for fear of eze’ing wind mid-downward dog.

Finally, reluctantly, I visited a gastroenterologist. She scheduled me for a colonoscopy and afterward offered up a blunt diagnosis: Irritable Bowel Syndrome.

A decade ago, I would’ve been mortified to type those words. Recent years, however, have seen a surge in awareness of digestive disorders—IBS, celiac disease, lactose intolerance, ulcerative colitis—such that I find myself constantly trading war stories. A journalist friend doesn’t leave the house without his Lactaid. An art-historian pal goes days on white bread and rice, her stomach requiring the blandest fare possible. A musicologist colleague grimly claims he can’t eat “anything with a skin.”

Science and commerce have risen to meet the need: wide-ranging medical research into once arcane procedures like fecal-matter transplants, an over-the-counter digestive-remedy industry valued at more than $20 billion, and endless Instagram and #GutTok gurus hawking stomach cures like aloe-vera juice, ice-water baths, and left-side sleeping. A 2020 survey by the Rome Foundation, which promotes GI health, says that more than 40 percent of the globe suffers from a digestive disorder. Almost half the population, seemingly, feels something isn’t sitting right.

Some months ago, I began to wonder, Where has this crisis come from? And why, given all of this alimentary advocacy, and all of my own dietary austerity, is my stomach, at forty-five, still rioting? Doctors and the internet provided only partial answers, so I went looking in books, where I found a sprawling body of medical history and, surprisingly, literary history on these indelicate matters. The gastrointestinal agonies of writers, it turns out, forms practically its own canon, one that dates back almost to the beginning of Western science’s attempts to understand the digestive tract. For more than two hundred years, countless bizarre theories and treatments were adopted and feverishly promoted by men of letters, including such esteemed figures as Voltaire, Coleridge, Twain, Henry James, Kafka, and Beckett.

While the root causes of our collective dyspepsia eluded me, never mind a cure, I did find strange comfort in such company. And I got some context and understanding. The literary history of indigestion, I came to see, has much to tell us about why we seem to be living, once again, in an age of the stomach.

In 1700, Bernardino Ramazzini, a professor of medicine in Modena, Italy, published his seminal Diseases of Workers. His study of laborers—porters, bakers, blacksmiths, mirror makers—first identified what we now call repetitive-stress injuries: bowed legs, rounded shoulders, humped backs. Ramazzini also considered the travails of “the learned.” By hunching over books for hours on end, he argued, scholars and philosophers brought on arthritis, weak eyesight, and, through compression of their pancreatic juices, dire ventral infirmities. Ramazzini held that the stomach couldn’t properly mulch its food while the brain was busy digesting its own sustenance. Indeed, so deleterious was a life of contemplation, he contended, that it was even possible to “die of wisdom.”

Early Enlightenment anatomists saw the gut as the seat of the imagination; it processed emotions and perception and was so spiritually attuned it perhaps even contained the soul. Any disruption below was of grave import. Following Ramazzini’s study of the learned, physicians theorized and investigated a set of conditions known as les maladies des gens de lettres, wherein mental exertion and overeating led to “engorgement of the viscera of the lower abdomen,” as well as “hypochondria, melancholy, and hysteria.”

Naturally, the patriarchal nexus of medicine and letters produced further absurdities. Women, due to supposed softness in their “cerebral pulp,” were thought incapable of the intellectual endeavor necessary to truly injure the bowels. Even as hysteria came to be seen as a feminine complaint, doctors remained stubbornly fascinated by the straining of men. Or, as Anne Vila, a scholar of French literature, puts it, science found a way for les gens de lettres to be “nervous in a manly way.” 1

If Europeans had a theory of diet before the eighteenth century, it was the one propounded sixteen centuries earlier by Galen, the Greco-Roman philosopher-surgeon, who counseled that the four humors be bolstered or curbed by four corresponding categories of food—hot, cold, wet, dry. As the Enlightenment overthrew such ancient notions, the Age of Exploration likewise revolutionized the European diet, which had remained largely unchanged since the Neolithic period. From the New World came all manner of unfamiliar foods—potatoes, corn, turkey, tomatoes, chocolate, and beans among them. Nouveau riche merchants wanted meals more elaborate than what could be had at home; in 1765, the first restaurant, as we’d recognize it today, opened in Paris. Following the excesses of Louis XIV, courtly feasts featured novelty dishes ranging into the hundreds: peacock pies, cheese wigs (cheese-sauce-drenched buns shaped like hairpieces), and sugar sculptures formed into various religious and mythological scenes, including, at one banquet, a nine-foot-tall rendering of the Palace of Circe. Waistbands and stomachs strained to keep up. “All the geniuses of the age,” Horace Walpole once remarked, “are employed in designing new plans for dessert.”

Meanwhile, physicians worked to discover what happened to food once it entered the body, mostly through direct, unglamorous experimentation. “Early nutrition scientists,” says Elizabeth Neswald, a historian of science, “spent a large part of their time—or their assistants’ time—inspecting and analysing other people’s excrement.” Eventually, they would develop an idea we now take for granted: Food is used as fuel by the body, “a combustion like that of a candle burning,” as the influential French chemist Antoine Lavoisier put it. The intellectual world was busy, too, with its own explorations. In a 1774 article on “Passions,” Voltaire mused, “Tell me what secret connection nature has created between an idea and a bowel movement.” 

If poor digestion was a supposed prerequisite for creativity by the end of the eighteenth century, a badge of enervated honor for the Romantics, and an emerging market for the Victorians, by the twentieth century, the ailing stomach had become almost allegorical.

In 1802, Pierre Jean Georges Cabanis, a French amateur poet turned physiologist, provided a partial answer: “The brain digests impressions, as it were, and produces organically the secretion of thought.” Cabanis, however, did not see the ideal relationship between stomach and mind as untroubled. “The greatest aptitude for work that requires either a strong, active imagination, or persistent and profound meditations, often depends on a generally ill state introduced into the system by the disturbance of the functions of certain abdominal organs.”

For previous students of les gens de lettres, weakness down below was an unfortunate consequence of overstudy. After Cabanis, this tendency came to be seen, according to Vila, as “a prerequisite for intellectual talent.… Visceral sickliness in men was not the result of but the enabling mechanism of sustained, intense mental labor.”

As the nineteenth century ripened, the connection between illness and brilliance seemed cemented. A View of the Nervous Temperament, an 1807 treatise by the physician Thomas Trotter, argued that “all men [whose] mental qualifications…prompt them to literary attainments and pursuits are endued by nature with more than usual sensibility of [the] nervous system.” Doctors came to find les maladies des gens de lettres, Vila says, as “most common among dark-haired men with slow gaits and perpetually sad demeanors.” The Romantics accordingly idealized their passions and frailties alike. Ailments like tuberculosis became sexy. “How pale I look!” Byron wrote. “I should like, I think, to die of a consumption.” Byron was likewise admired for his slenderness and kept up his wraith-like figure by drinking vinegar, which often caused him diarrhea. Coleridge once wrote to a friend, “Whatever affects my Stomach, diseases me; & my Stomach is affected…immediately—by disagreeing Food, or distressing Thoughts, which make all food disagree with me.” While we might now struggle to hear the proud note, Coleridge happily complained to friends, family, and strangers alike about his constipation and wind. This, too, was suffering for art. The cultural historian Elsa Richardson claims that “the melancholic temperament and disordered digestion that blighted Coleridge’s daily life also arguably helped to secure his place among history’s heroic artistic geniuses.”  

It wasn’t just food that became productively unsettling in the nineteenth century. Writers were similarly agitated by the expulsive and inspirational effects of coffee and tea. Balzac wrote that coffee “acts like a food and demands digestive juices…it brutalizes these beautiful stomach linings as a wagon master abuses ponies; the plexus becomes inflamed; sparks shoot all the way up to the brain.” Across Europe, gut trouble became a mark of the consummate artist.

Literary men in America, however, were less sure. In 1858, an advice column, “Manly Health and Training,” appeared in the New York Atlas newspaper. One Mose Velsor stumped for early-rising, fresh air, and bare-knuckle boxing, and warned of “The Great American Evil—Indigestion.” Velsor advised against fried potatoes, prostitutes, condiments, and “too much brain action and fretting”—all of which might result in a sickly male specimen whose “bowels are clogged with accumulations of fearful impurity.”

Mose Velsor was one of Walt Whitman’s many pseudonyms and used for the hackwork he undertook after the first printing of Leaves of Grass received little notice. The Atlas columns can read less like advice than a wounded man’s self-exhortation. “To you, clerk, literary man, sedentary person, man of fortune.… Up!” And “Eat enough, and when you eat that, stop!”

Mark Twain also took up the cause. Motivated by either his notoriously bad business sense or his own frequent stomach pain (or, more likely, both), he peddled a digestive powder, licensed from the English Plasmon company, as both treatment for dyspepsia and a superfood: “One teaspoon is equivalent to an ordinary beefsteak.” George Bernard Shaw was convinced and “generally dined off a Plasmon biscuit and a bean.” To the novelist William Dean Howells, Twain instructed, “stir it into your soup…use any method you like, so’s you get it down.” Perhaps unsurprisingly, given such appeals, the Plasmon Company of America, like many of Twain’s other commercial ventures, quickly went bust.

Others fared far better. Particularly in America, new ideas about purity, diet, and hygiene proliferated in the second half of the century. A Connecticut minister, Sylvester Graham, introduced his Graham Bread (later, Graham Cracker), which was bland enough to stomach easily while also aiding in the avoidance of drink and masturbation. (Graham believed that sugar fueled intemperate feelings like lust and greed.) At his Battle Creek, Michigan, sanitarium, John Harvey Kellogg (of Corn Flakes fame) treated his digestively ailing patients by prescribing them abstinence, hydrotherapy, electrotherapy, phototherapy, and yogurt enemas. At one point, Kellogg claimed his sanitarium hosted more than seven thousand patients a year, many of them wealthy and willing to pay the rapidly increasing fees. A gastric boom was well underway and about to take another curious turn.

By the late nineteenth century, constipation was dreaded as the “disease of diseases.” ² In 1895, an entrepreneur named Horace Fletcher set out to cure it. Fletcher had been a gifted athlete in his youth but at forty found his energies sapped by stoppages below. His solution: Produce as little bodily waste as possible. His system: digesting “in the head” by chewing his food at least two hundred times, ³ into a slurry that slid down unaided.

Newly energized by his method, Fletcher set about promoting it, performing somersaults and high-dives in his underwear before crowds, mailing his own ash-like turds—no more odor than “a hot biscuit”—to scientists. He eventually converted Kellogg to his regimen; every meal at Battle Creek began with a “chewing song.” Other celebrity chewers included John D. Rockefeller, King Edward VII, and writers like Sir Arthur Conan Doyle, Twain (again), both William ⁴ and Henry James, and Upton Sinclair, who called Fletcherism “one of the great discoveries of my life.” Its benefits, apparently, weren’t only physical. In 1903, Fletcher observed a “literary test subject” who subsisted off a glass of milk and four exhaustively chewed corn muffins per day. After eight days, the subject had made just one hot biscuit but had written sixty-four thousand words.

Legitimate medicine would soon discredit Fletcher, but the literary world’s infatuation with mastication lingered in the imagination of an insurance lawyer from Prague. In Franz Kafka’s “A Hunger Artist,” an anonymous professional faster starves himself in view of the public, at first to great curiosity and acclaim, then absolute indifference, until finally he dies unnoticed and un-mourned. The story has been interpreted as religious parable, self-portrait, and as representing modern man’s alienation from family and nation. But perhaps we might read it more directly.

Kafka struggled with constipation. He visited sanitariums, tried laxatives made from powdered seaweed, and obsessively notated his meals and bowel movements, or lack of them. No surprise, then, that he was drawn to Fletcherism. Kafka’s father was so disgusted by his son’s incessant chewing he would hide behind his newspaper at dinner. The hunger artist is likewise unimpressed by his own feats of starvation. “I have to fast,” he says, “I can’t help it.… I couldn’t find the food I liked. If I had found it, believe me, I should have made no fuss and stuffed myself like you or anyone else.” 

I read this line with a shudder of recognition. In the worst nights of my sleepless stomach, I ate nothing for days at a time. Sometimes wasting away seemed preferable to enduring yet more intestinal agony. I’m struck, too, by how much the family-dinner scene early in The Metamorphosis resembles Fletcherism. “It seemed remarkable to Gregor that among the various noises coming from the table he could always distinguish the sound of their masticating teeth.” Fletcher’s method seems insane now, but in the grip of dyspepsia, you’ll try anything. The internal turbulence doesn’t just “mar the soul’s serenest hour,” as Twain once wrote; it seems to choke the very life and joy out of you.

If poor digestion was a supposed prerequisite for creativity by the end of the eighteenth century, a badge of enervated honor for the Romantics, and an emerging market for the Victorians, by the twentieth century, the ailing stomach had become almost allegorical.⁵ 

The bumbling protagonist of H. G. Wells’s 1910 novel, The History of Mr. Polly, “suffered from indigestion now nearly every afternoon in his life, but as he lacked introspection he projected the associated discomfort upon the world. Every afternoon he discovered afresh that life as a whole and every aspect of life that presented itself was ‘beastly.’” Queasiness becomes existential. In Sartre’s Nausea, Roquentin experiences a constant “sweetish sickness” that makes him ever more isolated from and repulsed by society. “The Nausea is not inside me: I feel it out there in the wall, in the suspenders, everywhere around me. It makes itself one with the café, I am the one who is within it.” 

The gastrointestinal agonies of writers, it turns out, forms practically its own canon, one that dates back almost to the beginning of Western science’s attempts to understand the digestive tract.

In the 1930s, Samuel Beckett found himself barely able to eat or expel his meals and, in desperation, sought out not conventional medical or dietary aid but psychoanalysis. What succor the Irishman found has been kept confidential. However, Beckett—author of Krapp’s Last Tape and Foirades (a bit of French wordplay on “fizzles,” aka diarrhea)—never had stomach upset far from mind or pen. He became fascinated by laxative adverts, noted how similar their metaphors were to his own, and joked that his writing could itself be used to sell such cathartics.⁶ Laura Salisbury, a medical-humanities scholar, notes that Beckett’s “urge to purge” leads to texts that “oscillate between force-feeding and the compulsive evacuations of emetic and enema.” The author himself used more immediate language to describe his work: “The Beckett Bowel Books,” “turds from my central lavatory,” and, blunter still, “wordshit.” 

“That’s right, wordshit, bury me, avalanche.”

Of course, indigestion hasn’t been the torment solely of the literati. Other artists suffered, too, some famously. There has been a surprising amount of scientific investigation into whether Beethoven had IBS. Kurt Cobain harbored for years an undiagnosed stomach pain. His love of Kraft mac & cheese and strawberry milk probably didn’t help, but lactose intolerance wasn’t much discussed, or not so publicly, in the 1990s. “Thank you all,” Cobain wrote in his suicide note in 1994, “from the pit of my burning, nauseous stomach.”

For those who suffer thusly, the physiological and the psychological may, indeed, be more tenderly bound together. Harvard Medical School advises:

The gastrointestinal tract is sensitive to emotion. Anger, anxiety, sadness, elation—all of these feelings (and others) can trigger symptoms in the gut.… [A] person’s stomach or intestinal distress can be the cause or the product of anxiety, stress, or depression…. In addition, many people with functional GI disorders perceive pain more acutely than other people do because their brains are more responsive to pain signals from the GI tract.

Perhaps les maladies des gens de lettres is a kind of anti-talent. Kafka’s hunger artist and Beckett’s wordshitters are not wholly negative figures. What they refuse, repudiate, and expel becomes a mark of pride, however abject. Indigestion as a sign of exquisite sensitivity—the pale Byronic hero returns as the gaunt existentialist—filters down through the literary landscape. In his 2008 thriller, The Angel’s Game, the Spanish novelist Carlos Ruiz Zafón scripts this almost archetypal exchange: 

“You don’t look well.” 
“Indigestion.” 
“From what?” 
“Reality.”

One begins to wonder if indigestion, even when not explicitly on the page, can be something of a creative prime mover, a disquiet subtly but constantly felt. In 1874, Flaubert (author of the “The Beautiful Explanation of Famous Constipation”)  received a letter from his friend Ivan Turgenev: “A slight excess of dairy produce… has left me with the most violent colic!! I think it must be possible to detect it in the very shape of the words and letters that I write… What a damned stomach!” Bram Stoker had the nightmare that inspired Dracula after a crab dinner sat badly. Perhaps the wry twist in Twain’s output came from a similar torque in his guts. A friend once called my prose voice “acidic.” With an iron stomach, might I read less bitter? Or maybe the very act of writing, as in Beckett, is purgative, an inner pressure desperately trying to relieve itself.

Those of us with sour guts could well be attuned to a more generalized aching and thus be incapable—physically, intellectually, emotionally—of stomaching this tainted world. Perhaps that is the gift, however curdled, les maladies des gens de lettres bestows.

All of this said, indigestion is still a fucking drag. It isn’t just all the delights crossed off my menu: pizza, burgers, brisket, fried cheese curds, jalapeño poppers. What really hurts are all the canceled plans, all the dinner dates I’ve squirmed through, the intimate moments when I’ve prayed not to fart, the nights when, as carefully as I’ve eaten, I still lie awake writhing inside. So many of our most cherished moments are around the table. Good food, good drink, good friends, the crescendo of laughter and cheer and affection that make a good dinner party, all of it fueled by a full, content belly—no, it isn’t fun to be estranged from all of that. However tortuous the logic it required, les maladies des gens de lettres fashioned a weakness into a strength. But maybe we simply long to make meaning, any meaning, from even our most unglamorous suffering.

There’s no cure for IBS. Despite the current pace of gut research, science still doesn’t know much about its causes. It isn’t necessarily inherited, but it does seem to run in families. In case of emergency, my father always kept a flattened toilet roll in his briefcase. He never knew to change his diet, and drank heavily, in part to numb his guts. You can’t die of indigestion, let alone wisdom, but a perforated ulcer was sufficient to kill him.

I’m glad for the widening awareness and acceptance of dietary restrictions. (I’m no longer accused of being a “picky eater.”) Perhaps our current digestive crisis is the industrialized West coming to grips with how radically food has been manipulated over the last century. The bland temperance pioneered by Graham and Kellogg in hopes of healing has mutated into a laboratory science that’s made many foods both more harmful and more addictive. Especially in America, the last half century has turbocharged such dubious invention. Taco Bell’s ever-shifting menu, for example, once offered seventy-seven unique items (RIP Jalapeño Popper Quesarito). At the same time, numerous studies warn that highly processed foods are detrimental to cognition, memory, and happiness. It’s thought that their chemical stabilizers wreck both the stomach’s microfauna and sensitive mucus membrane, which in turn plays havoc with the nervous and enteric systems.

In a roundabout way, the lessons of the Enlightenment scientists are still with us. The brain and the “second brain” have an intimate, sometimes volatile relationship. And while maintaining such delicate peace has more to do with sensible habits than avoiding or embracing scholarly work, or yogurt enemas, abstinence, or “digesting in the head,” the weird magic-bullet cures keep crowding my local health-food aisle: G.I. Fix, Belly Brew Tea, Complete Belly Reset, Healthy Gut, Apple Cider Vinegar Plus (Byron would approve), Gut Assist, Gut Collagen, Leaky Gut Revive, Leaky Gut Revive Max, and on and on. Meanwhile, every other gut guru on social media and in bookstores is a would-be Graham, Kellogg, or Fletcher trying to save us from our own tormented and tormenting appetites.

In this new age of gastric anxiety—if it ever left us at all—people everywhere are beset by the “disagreeing Food” and “distressing Thoughts” that bedeviled Coleridge and his compatriots. The glories and gripes of les gens de lettres may seem bizarre in retrospect. But, barring some miracle, many of us will go on suffering just as those ink-stained wretches once did. 

¹  And when women’s digestion took center stage, derision quickly followed. In the early 1700s, however fleetingly, a new genre flourished: “flatulent literature,” whose largely female readers sought to relieve their suffering through “therapeutic farting.” Soon after came the parodies. In 1719, Thomas D’Urfey published The Fart, Famous for its Satyrical Humour in the Reign of Queen Anne. Jonathan Swift, who derided D’Urfey’s work as “excrement,” answered with his own The Benefit of Farting Explain’d: The Fundament-All Cause of the Distempers Incident to the Fair-Sex, written under the pseudonym Don Fartinando Puff-Indorst, Professor of Bumbast in the University of Crackow.

²   Twain once visited Nikola Tesla’s lab in New York with a bad case. The famous inventor had his humorist friend stand on a circular metal platform that vibrated with enormous speed and violence. After a few minutes on “the earthquake machine,” Twain made a sprint for the water closet.

³  And once, for a green onion, seven hundred twenty-two times.

⁴  William James wrote admiringly of Fletcher in The Varieties of Religious Experience but soon soured on his method: “I tried Fletcherism for three months. I had to give it up. It nearly killed me.”

⁵  There was at least one parable-like precursor, 1853’s Memoirs of a Stomach: Written by Himself, That All Who Eat May Read, by Sydney Whiting, a London barrister turned comic novelist. This singular book is narrated by the stomach of an upper-class gentleman (descended from the “celebrated Sternums of Eaton Hall”) and follows the sensitive organ’s triumphs and travails from infancy to old age. According to the scholar Hannah Markley, “Memoirs’ fiction of the gentlemanly body overcome by the whims of an upset stomach acts metonymically to register the shifting and often unstable boundaries of British identity as foreign foods, drugs, and microbes circulated throughout the Victorian body politic.” The ever more varied comestibles brought to the metropole have their way with the once disciplined Mr. Stomach, who finds “my constitution undermined, and not with blowing up but with blowing out.” 

⁶  Albert Camus took a similar curiosity in laxative ads and, in The Stranger, has Meursault clip one from a newspaper and paste it into his scrapbook.