The Invisible Kingdom: Reimagining Chronic Illness

One dominant experience for O’Rourke is that of having her symptoms pathologized, either by medical experts, friends, or even herself. The theme of pathologizing patients instead of treating illness relates to the overarching experience of the author of having her sickness become a problem that she herself is burdened to solve. As O’Rourke points out, the word “autoimmunity” is often turned into a metaphor of the self attacking the self. In this way of imagining autoimmune disease, the patient, or those people witnessing the patient, often begin to view the illness as a problem with “the self.” However, as with most disease concepts that O’Rourke encounters, she makes it a habit to question the preconceptions that surround society’s views of illness. In the introduction, she writes:

As Susan Sontag pointedly observes in Illness as Metaphor, illnesses we don’t understand are frequently viewed as manifestations of inner states. The less we understand about a disease or a symptom, the more we psychologize, and often stigmatize, it. Doctors once thought of multiple sclerosis as a form of hysteria. Tuberculosis […] as a disease that afflicted romantic young souls. For decades, certain forms of cancer were thought to be a consequence of repressed emotions (18).

This quotation points to the ways in which society’s lack of understanding often places blame squarely on the patient. The less objective knowledge the medical system has, the more likely it is that the patient’s inner state will come under attack. By citing other illnesses that used to be susceptible to this same critique, O’Rourke effectively argues that the more we learn about autoimmunity and other unnamed chronic illnesses, the more absurd it will seem that a patient’s inner emotional state was ever to blame.

What often occurs throughout the text, however, is that even with the manifestation of real bodily symptoms, the psychological impacts of O’Rourke’s experience are tremendous. She experiences depression, loneliness, anxiety, and stress as results of her illness. The management of chronic illness also requires caring for one’s psychological state because of the toll that inner stress can have on one’s physical health. As she asserts, “Inflammatory and autoimmune diseases can affect the brain, causing neuropsychiatric disease along with other symptoms. The trouble was that in the face of uncertainty, this doctor viewed my problems as exclusively psychological” (109). O’Rourke takes care to emphasize the interconnectedness of psychological states and physical states and ultimately argues that care for those with chronic illnesses should integrate all types of health. This does not mean, however, that doctors should stop looking for a physical cause upon discovering a plausible psychological explanation.