Roy Porter, writing about the conversational preoccupations of a certain class of English society in the eighteenth century, noted that health was among their primary concerns. The state of one’s body occupied the drawing room with a persistence that suggested, to Porter at least, something worth remarking on.
Nothing has changed. The class has expanded.
What was once an indulgence of leisure is now widely available. The conversation has not broadened. It has simply found more participants.
The machinery that enables this has grown considerably more sophisticated. The Diagnostic and Statistical Manual of Mental Disorders—the DSM, in its successive editions—was produced for clinical use, as a reference for trained practitioners navigating the complex and genuinely difficult territory of mental illness. It has become, in practice, a catalogue available to anyone with internet access and a willingness to spend an afternoon matching their symptoms to its entries.
Mine is an observation about what happens when a diagnostic tool designed for specialists is used by people who are not specialists, without the clinical context that gives the tool its meaning.
What happens is a diagnosis. Self-administered, cross-referenced with further internet searches, confirmed by communities of people who have arrived at similar conclusions by similar routes. The diagnosis is then named, shared, discussed, and occasionally expanded—because if the available diagnoses do not quite cover the full range of what one experiences, there is always the possibility of identifying something new, gathering others who identify with it, and establishing a shared condition that has the social weight of a medical one without having passed through any of the processes by which medical conditions are established.
Mental illness exists, and the expansion of its discussion has produced real goods—the reduction of stigma, the increased willingness of people who are genuinely suffering to seek help, the recognition that the mind’s difficulties deserve the same attention as the body’s.
What I am describing is something adjacent to this and distinct from it. The conversion of general unhappiness, ordinary difficulty, and the routine friction of being alive into clinical categories that then become the primary subject of social interaction. The replacement of the examined life—which Socrates commended and which involves looking outward as much as inward—with the medicalised life, which looks inward exclusively and with extraordinary thoroughness.
Joanna Lumley observed in 2022 that people spend too much time looking at their miserable selves and not enough at the remarkable world outside them. The remark was received as controversial, which is itself worth noting. The suggestion that the primary orientation of one’s attention might be outward rather than inward—toward the world, toward other people, toward the extraordinary range of things that are available to notice—was treated as an imposition. As though the right to contemplate one’s own suffering were being questioned. It was not being questioned. The proportion was.
I have a chronic illness. I mention it only to make a distinction.
My health is not a conversational subject, not because I am concealing something shameful but because it is nobody’s concern but my own. This position does not go down well in all quarters. There are people who interpret it as withholding—as a refusal of intimacy, a failure of trust, a kind of emotional parsimony. I have been told, in so many words, that I was being a princess for declining to allow my partner to discuss my condition with his friends, who were, he assured me, genuinely interested.
Genuinely interested is doing significant work in that sentence. The interest of people in the medical details of another person’s condition is not always the interest of concern. It is sometimes the interest of curiosity, which is a different thing, requiring a different kind of response. Concern asks: how are you, and what do you need? Curiosity asks: what exactly is wrong, and can you be more specific? The first is oriented toward the person. The second is oriented toward the information. I declined to provide the information. This was not well received.
The partner in question had his own relationship with illness, which was instructive in a different way. He developed a skin rash. He consulted the internet. The internet provided a range of possible causes, most of them dietary, all of them requiring the elimination of something he enjoyed eating. He proceeded methodically—removing from his diet, one by one, the foods the internet had implicated. He refused other approaches. He was, in the manner of a man who has found a framework and intends to exhaust it before considering alternatives, committed to the process.
The rash persisted. The dietary eliminations multiplied. The process continued.
Eventually, I offered him a pot of moisturiser. The rash cleared within days. The internet had not suggested moisturiser. The internet had suggested that the inside of his body was the problem.
The outside of his body was the problem. These are different locations, requiring different remedies. The difference was not visible from inside the framework the internet had provided, which was oriented entirely inward—toward diet, toward internal cause, toward the body as the source of its own distress in ways that could be identified and managed through the application of sufficient information.
The moisturiser was not information. It was a solution. They are not the same thing, though the current age tends to treat them as equivalent.
My parents were in their seventies when this pattern became fully visible to me. Both retired academics. Both, at that point, still writing—books, papers, the kind of sustained intellectual work that requires engagement with ideas beyond the self. Both had travelled extensively and continued to do so. There was, in other words, material available for conversation that extended well past the personal.
I would ask, as one does, how they were. The question was the mistake. Not because asking after someone’s wellbeing is a mistake—it is basic courtesy—but because in this context, the question opened a channel that then ran for the duration of the conversation. Doctors. Appointments. Falls, since there had been falls. Cuts, abrasions, the incremental failures of vision and hearing that arrive with age and announce themselves in clinical detail. By the time the litany had been worked through, the conversation had reached its natural end.
I do not suggest my parents were unusual. They were not. They were behaving in exactly the way that many people of their age behave, and that many younger people are now learning to behave, with the assistance of tools that were not available in the eighteenth century but would have been recognised immediately by the people Roy Porter was writing about. The audience has expanded. The platform has changed. The conversation is the same.
What has changed, and this is where the technological age has made its specific contribution, is the reach of the conversation. The eighteenth-century hypochondriac could bore the drawing room. The contemporary equivalent can bore a network of thousands, asynchronously, with the added feature of search—so that not only can one’s symptoms be shared, they can be found, by people who have the same symptoms, or similar ones, or are simply in the market for a community organised around the experience of not feeling well.
The community, once found, is self-reinforcing. Symptoms are compared. Diagnoses are refined. New symptoms are identified. The DSM is consulted again. The conversation deepens, grows more specific, develops its own vocabulary and its own hierarchy of suffering. The question of whether any of this is moving toward resolution—whether the people in the community are feeling better, recovering, returning to the world outside themselves—is not the organising principle of the community. The organising principle is recognition. The shared experience of the symptom. The comfort of being among people who understand, which is real comfort, genuinely experienced, but which can be maintained indefinitely without either party getting better.
Porter’s observation about the eighteenth century is useful precisely because it establishes that this is not new. The technology is new. The scale is new. The vocabulary is new—the DSM was not available to the hypochondriacs of the drawing room, who had to make do with the humours and whatever their physician was currently proposing. But the orientation—the sustained, detailed, socially central preoccupation with one’s own physical and psychological states, shared with others who are expected to find it as interesting as one finds it oneself—is not a product of our moment.
It is, if anything, a feature of leisure. When the primary demands of survival are met, attention turns inward. The eighteenth century drawing room had met those demands. The current moment, at least for the people who have the time and the connectivity to post about their health on social media, has also met them. What fills the space is, apparently, a reliable constant.
Lumley’s observation was not that suffering doesn’t exist or that illness is not real. It was a question of orientation. The world outside the self is, by any objective measure, more varied, more interesting, and more available to attention than the interior of any single body. This does not mean the interior of the body should be ignored. It means it should not be the primary exhibit.
We are in an age of enlightenment—the technological version, equipped with tools that would have seemed miraculous to Porter’s hypochondriacs. We can access any information. We can reach any community. We can find, within minutes, a name for whatever we are experiencing and a group of people experiencing the same thing.
The question Porter might have asked, watching this from his particular vantage point, is the same one available to us now.
Is the conversation moving anyone toward the world? Or is it moving them further from it, inward and downward, into the specific and the symptomatic, away from the remarkable thing happening outside the window?
The answer, in the drawing room and on the platform, appears to be the same.
The conversation continues. The world waits.
“Enlightenment: Britain and the Creation of the Modern World”, Roy Porter
