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Hermann’s surviving, sickly, scribbling, neurotic first son, Franz, something of an eternal teenager, appears to be what might now be called an anorexic. Despite the fact his mother blithely considered him healthy, and refused to fall for the ‘performance’ of his numerous illnesses, there wasn’t much he could digest; it was always all too much. The boy was certainly strong in his own way; he was pig-headed and stubborn, a refusal artist of some sort, and he was not unusual in that. There are many kinds of starvation, deprivation and protest, and some of them had already become a form of circus.

A generation before, at the end of the nineteenth century, in the sprawling Salpêtrière hospital in Paris’s thirteenth arrondissement, the psychiatrist Jean-Martin Charcot was overseeing another form of exhibitionism of the ill. It was mainly hysterical women he exhibited in his semi-circular amphitheatre on Tuesday afternoons, where ‘all of Paris’ — writers like Léon Daudet and Guy de Maupassant, along with interested doctors like Pierre Janet, Sigmund Freud and George Gilles de la Tourette, as well as socialites, journalists and the merely curious — came to stare at these strippers of the psyche. Some of the women were hypnotised by Charcot’s interns; Charcot also publicly diagnosed patients he’d never met before. And while hysteria was mostly a disorder diagnosed by men and associated with women, there were a few male patients: one had been a wild man in a carnival; another worked in an iron cage at a fair, eating raw meat.

What sort of show was this, and what kind of staged illnesses did they suffer from, these weird somnambulists and contortionists, with their tics, paralysis, animalism and inexplicable outbreaks of shaking and crying? Were their conditions organic, or was it true that illness was merely misdirected sexuality? Were they ill at all, and, if so, which words best described them? And doesn’t the physician, before he can heal, first have to wound?

After one of these crowd-pleasing occasions, and while researching ‘Le Horla’, his story of possession, Guy de Maupassant wrote in a newspaper article, ‘We are all hysterics; we have been ever since Dr Charcot, that high priest of hysteria, that breeder of hysterics, began to maintain in his model establishment in the Salpêtrière a horde of nervous women whom he inoculates with madness and shortly turns into demoniacs.’

Sigmund Freud, studying in Paris for a few months, visited Charcot’s home three times, where he was given cocaine to ‘loosen his tongue’, and was so impressed by him that he translated some of his works, and named one of his sons after him. But Freud was to take an important step on from Charcot. Rather than looking at women, he began to listen to them. From being avant-garde, living works of art, they became human beings with histories, traumas and desires. Rather than action, it was language, with its jokes, inflections, omissions, hesitations and silence which was the telling thing here. The mad are people who don’t understand the rules, or play by the wrong rules, internal rather than official ones; they are heeding the wrong voices and following the wrong leaders. Yet the mad, of course, cannot do absolutely anything. Madness, like everything else, has to be learned, and, as with haircuts, when it comes to folly, there are different styles in fashion at the time. If madness, and questions about sanity and the nature of humanity, are the subject of twentieth-century literature — what is a person; what is health; what is rationality, normalcy, happiness? — there is also a link to theatre, and to exhibitionism. As a form of self-expression, it might be important to be mad, but it might also be significant that others witness this form of isolating distress, for it to exist in the common world, for it to be a show, moving and affecting others. More questions then begin to unravel. Who is sick in this particular collaboration, the watcher or the watched, the doctor or the patient? And what exactly is sick about any of them? Isn’t the exclusive idealisation of normality and reason itself a form of madness? And if these exhibitionists wish to be seen, understood or recognised, what is it about themselves they want to be noticed?

Jean-Martin Charcot’s ‘living sculptures’, as one might characterise them, these divas on the verge of madness — those who can only speak symptom-language — are not unlike Strindberg’s female characters: fluid, disturbing, undecipherable, indefinable, oversexualised. (Kafka loved Strindberg, and writes in his diary, ‘I don’t read him to read him, but rather to lie on his breast. He sustains me.’) Yet in their exhibitionism — the only communication they were encouraged in — these hysterics resemble the self-starver in ‘A Hunger Artist’.

Most great writing is strange, extreme and uncanny, as bold, disturbing and other-worldly as nightmares: think of One Thousand and One Nights, Hamlet, ‘The Nose’, The Brothers Karamazov, Oedipus, Alice in Wonderland, Frankenstein or The Picture of Dorian Gray. If someone had never met any humans, but only read their novels, they’d get an odd idea of how things go here on earth: a series of overlapping madnesses, perhaps. Kafka is no exception when it comes to comic exaggeration, using the unlikely and bizarrely untrue to capture a truth about ordinary life.

However, in most magical tales of imaginative transformation, the subject of the story becomes bigger or greater than he is already, a superhero of some sort, with extra powers: a boy wishing to be a big man. One of the puzzles, ironies and originalities of ‘The Metamorphosis’ is that the alteration is a diminishment. Kafka is canny enough to take his metaphors literally, to crash together the ordinary and the unreal, the demotic and the fantastical. He doesn’t, after all, tell us that Gregor feels like a dung beetle in his father’s house, but rather that one morning Gregor wakes up to find he has actually become a dung beetle. As with Charcot’s hysterics, Gregor had become alien to his family and the world, and the story tells us that almost any one of us could wake up in the morning and find ourselves to be foreign, not least to ourselves, and that our bodies are somewhere beyond us, as strange as our minds, and, like them, also barely within our agency.

‘What shall I become through my animal?’ Kafka asks in 1917, in The Blue Octavo Notebooks. He no longer wants to be either an adult or a man. And we might ask of the hunger artist, whose body is also destroyed, what sort of diminished thing does he want to be? Is he a starving saint, idiot, or sacrificial victim? Self-harm is the safest form of violence; you are, at least, no danger to anyone else. No one will seek revenge. To starve oneself, or to become a bug, is to evacuate one’s character, to annihilate one’s history and render oneself a void. But what are these transformations in aid of? Is this living sculpture showing us that we ask for too much, or showing us how little we need? What sort of demonstration is this spiritual anorexic engaged in?

The hunger artist’s ‘bodywork’ resembles some of the ‘performance’ art of the twentieth century, which existed outside the conventional museum, and was probably most influential in the 1970s. Human bodies had been torn apart in the wars, revolutions, medical experiments, pogroms and holocausts of the twentieth century. Subsequently, artists who had formerly disappeared behind their ideas would become overt autobiographers, literally using their bodies as their canvas or material, mutilating, cutting, photographing or otherwise displaying themselves before an audience, a ‘theatre of torture’, if you like, showing us the ways in which our bodies are a record of our experience, as well as what we like to do to one another.

Kafka, who loved theatre and cabaret, and hated his own ‘puny’ body, particularly in comparison to his father’s hardy, ‘huge’ physique, was more interested in the tortured male frame than the female form. Not that Kafka wasn’t interested in women, and not that he didn’t torture them. This was a pleasure even he could not deny himself. As is clear from his many letters, he practised and developed this fine art for a long time, until he became very good at maddening, provoking and denying women. He also went to enormous trouble to ensure that none of the women engaged with him was ever happy or satisfied. In case she got the wrong idea, or, worse, the right one — that he was a panther masquerading as a bug — Kafka pre-emptively describes himself, to his translator and friend Milena Jesenská in 1919, as an ‘unclean pest’.