FOI (f): (Lat. fides ‘bond, engagement’) A belief not founded on rational principles.
FOIE (m): (Lat. ficatum ‘goose liver fattened with figs’): Organ contained in the abdomen, an extension of the digestive tube, which secretes bile and carries out a number of functions in carbohydrate, lipid and protein metabolism.
– Petit Larrousse illustré
Until the twentieth-century the history of making a living out of other people’s bad days wasn’t an edifying one. For close on twenty-two hundred years people thought disease came about if their blood, yellow bile, black bile and what can only be described as slime were not in harmony. The cure was often worse than the disease, yet for all those centuries before the dawn of Incredible Progress doctors never seemed to go out of business.
Now that medicine seems to be limited only by its means, perhaps it’s the vestigial memory of quackery, barber-shops and that odd business with leeches that makes the profession unwilling to admit there are things about the body which leave its observer, if not its tenant, nonplussed. And even though scalpels aren’t much of a weapon compared to scythes, doctors now think of themselves, with the blessing of society at large, as progressive people at the cutting edge of the possible; that’s surely why they get hot under the collar when such nonplussing suggests there is less science in medicine than generally supposed. Particularly if this insight comes from the patient, who may expect his physician to be a soothsayer, prophet and salesman for eternal hope, not just someone insisting that if the one-eyed lead the blind we’ll somehow get there.
When I started up my own practice in Strasbourg, where many of my patients speak in strange tongues (twenty-two different nationalities I once worked out), I suffered such a double embarrassment; not merely one over commonplace terms, but also over the kind of bodily reality those terms expressed.
The embarrassment was due to the fact that I didn’t know what a crise de foie was or how to deal with it. In all my time in medicine, from the mother-country to several of its English speaking daughters, I’d never come across an hepatic storm, an acute liver, bile acid build-up (BABU) or anything else resembling this liverish state of being. Even my own sister, who wrote her PhD thesis on one of the major detoxification pathways in the liver, the cytochrome P450 system, had never heard of it. Something rare like acute intermittent porphyria, about which there’s a film (The Madness of King George), but a crise de foie? It seemed all the odder that such an alarmist—almost Pascalian—label should be given to a condition that clearly wasn’t in the least life-threatening or physically incapacitating: hadn’t the patient just walked in the door unaided?
So I did some reading. It’s what Cecil Helman in his book Culture, Health and Illness calls a folk illness, a configuration of symptoms with no expression in biomedicine, and for which a culture provides both an explanation and a method of healing. There are other similarly tenacious folk illnesses across the world: amok in Malaysia, windigo in north-eastern America, dil ghirda hai (‘sinking heart’) in the Punjab, brain fag in parts of Africa, nervios in Latin America and colds and chills in the English speaking world. Each condition exists in splendid isolation, marooned in its cultural uniqueness; and I wasn’t a jot closer to understanding what a crise de foie was. Like every other medical complaint in France, it had its polypharmacy: strange elixirs containing ‘oligoelements’ in snap-open glass capsules and ‘eupeptic’ granulates to be taken ante cibum that were unknown to chemists in neighbouring countries. Before France started rationalising its drug formulary just a few years ago, at the end of the millennium, there were over one hundred preparations on the market for the fragile liver, most of which harked back to the nineteenth century. Fumbling his lines once in a chemist’s shop in Paris, V. S. Pritchett in an amusing passage in his autobiography Midnight Oil tells us that instead of condoms he ended up with liver pills, and in a wild fit of ‘faith and superstition’ swallowed two before losing his virginity. As the great Canadian doctor Osler said, the real difference between humans and animals is that humans want to take pills.
Besides, that a symptom might be trivial is a value judgement not permitted a nation of amateur body theorists. As Colette Mechin says, ‘you never tell a Frenchman he’s suffering from indigestion, for that would give grounds for suspecting some dietary indiscretion’. Handle the French liver with caution: sensations of fullness, fleeting twinges and malaise may all be heralds of the great adversary.
But the symbolic weight carried by the French liver still wasn’t obvious to me. Why should being liverish rather than being splenetic, say, be the mal national? Come to think of it, wasn’t being liverish too literary, too poetic, to be much of a symptom? For me it was reminiscent of port decanters and portly gentlemen in one of Cruickshank or Rowlandson’s merciless copperplate etchings of eighteenth-century English quacks and society characters.
Reading encyclopaedias can take you places where people speak far stranger languages than French even.
A patient with a crise de foie has the following symptoms: he feels bloated, has a thick head (but not necessarily headache), water-brash (a bad taste in the mouth), lassitude and a general feeling of what Kafka once told his diary was ‘seasickness on dry land’. It seems to resemble what most stolid folk would call a hangover (gueule de bois in vulgar French) and doctors dyspepsia, arriving like bad weather the morning after social surfeit. Surfeit entails disgust; and fatty foods are particularly contaminating and disgusting by virtue of their cloying properties.
Examination of such people is usually—as the phrase goes—unrevealing. My response is usually to show sympathy and tell him (nearly always a him) to take a couple of paracetamol and change his diet. Primum non nocere. Some doctors even stick—more out of curiosity than conviction, presumably—an acupuncture needle into the cure-all Liv 3 point which is on the dorsal side of the foot between the first two toes. The once famous moral tract Traité de médecine générale (still in print) recommends ‘water only for 24 hours, vegetable broths, herbal teas, light meals, no alcohol and sleep’, a regimen not likely to offend anybody’s common sense. But I often have the impression that such a pragmatic response falls short of expectations, especially when the liver can excite such purple passages as this: ‘Her Shen was low. This could be seen in the bronze colour of her face, the slightly rolled-back position of her eyeballs and her fatigued demeanour. Her pulse was wiry and rapid, indicating Uprising of Liver Fire syndrome’ (Acupuncture in Medicine 11.96).
True enough, Chinese meridians make a big deal out of the liver. But what turns this little outpouching of entoderm, tucked above the yolk sac stalk, into the seat of humanity? In physiological terms, the liver is the body’s (extremely efficient) sewage-plant, protein producer, and sugar and fat regulator. It’s also the biggest organ, and its right-regal size may well explain its preponderance in cultural affairs. A ‘critical liver’ is a leftover from Galenic medicine, medieval theories of the spirits (in fact, Galen believed the liver was the receptacle of the ‘natural’ spirit, as opposed to the ‘vital’ and ‘mental’ spirits lurking in the heart and brain respectively), and Plato’s suggestion in Timaeus that it was a divining mirror for cosmic space (chora); but while a recent evening-long search through Rabelais provided me with lots of extravagant remedies and nostrums, and the splendid line ‘for I love you with all my liver’, nothing very clearly emerged that might explain the quintessential liver in all its majesty, nor all the sublime hot air it has given rise to in French medicine. I therefore concluded that, French or otherwise, the liver is a signal instance of how we all think magically about our bodies. Not that our bodies are magical, but nobody, not even the most brick-headed enzymologist, is likely to view his liver in terms which exclude its miraculous ability to exempt him from toxic lapses. My own explanation therefore errs towards the Promethean.
Everyone remembers one thing about Prometheus (‘fore-thinker’): he had such a rush of feeling for early man that he gave him a spark of fire he’d stolen from Zeus as it smouldered in a tube of fennel (a penis substitute, according to Freud, who thought that early man liked to snuff out fire by urinating on it). The myth is more intricate. Prometheus had been one of the assistants at the headbirth of Athena; later she’d taught him all the applied arts of civilisation including architecture, astronomy and navigation. Decently enough, he passed them on to the human creatures he so favoured.
It was an act of expediency that led to Prometheus’ eventual downfall: he showed Homo sapiens sapiens how to trick Zeus by leaving him only the bones and gristle when the sacrificial animals were apportioned. After being called in to judge a dispute at Sicyon, in the north-eastern Peloponnese, Prometheus flayed an ox and made two bags of its skin; one containing all the prime cuts but with the tripe cunningly arranged on top (in the hierarchy of organs the stomach was always the lowest and most contemptible), the other the bones and gristle hidden under a layer of succulent fat. Zeus—‘whose wisdom is everlasting’—chose as the divine share the bag with the layer of fat on top and bones beneath. He had been duped. All the edible meat had been left for the creatures Prometheus was bent on being kind to, except that Zeus arranged a subtle revenge: humans might get the ‘better share’ but it would always be accompanied by the demands of the stomach—that imperious, shameless, all-consuming organ. Humans would become meat-sacks, hollow bags that would have to be filled every day in order to sustain life. The imperiousness of hunger would empty all our more noble convictions and ideals and in times of neediness turn us into animals. We would become, in a word, appetites.
There is a coda to the myth, and a somewhat misogynistic one at that. Prometheus stole an ember from the sun-chariot and wrapped it in a fennel stalk for ready use at the ceremony of the barbecue. Humans might be condemned to eat meat, but at least they could cook it first. According to Hesiod, Zeus turned vindictive: he made the beautiful but simpering Pandora (‘all gifts’)—a gift being, as the German root-word alarmingly suggests, nothing other than poison—and sent her to Prometheus’ seemingly slower-witted brother, Epimetheus (‘afterthought’), whose name suggests that, like the chorus of a classical tragedy, his role was to bemoan the consequences of his brother’s actions. Her receptacle contained all the spites and evils like Vice, Labour, Bipolar Disorders and Geriatric Infirmity that have subsequently plagued the world, and made necessary such lesser evils as doctors.
And once the spites had flown the jar and caused Pandora and Afterthinker nearly to die from anaphylactic shock, what was left? A booby-prize called Hope, which must have been heavier than air to get stuck inside; it was Hope that prevented their descendants, driven nearly out of their minds by the spites, from doing away with themselves. (The nineteenth-century German philosopher Arthur Schopenhauer once suggested that Hesiod got it completely wrong: it wasn’t the evil but the good things of the world which flew away from Pandora’s jar, leaving hope behind like a kind of miasmal slurry; and Friedrich Nietzsche tried to seal the jar again, precisely because for him hope was evil: it condemns what exists for something better.) Prometheus pyrphoros, the Fire-Carrier, ended up clamped to a rock in the Caucasus, his liver being pecked out daily by an eagle only for it to regenerate overnight—which sounds like the modern biomedical concept of the liver. Only the rock, insisted Franz Kafka in his minuscule fable about Prometheus’ apprenticeship in suffering, is the really inexplicable part of the legend.
So much for Prometheus and the longwindedness of evolution, since the descendants of the eagle stopped pecking his liver and started nesting in his rib-cage, and Pandora’s gift, it became clear in time, was a black box to tell us what had happened in the heroic days when the gods mixed it with humankind.
But the myth made me think of the French again, confused—as only a deeply conservative people can be—by their self-appointed role for the last few hundred years as the fire-carriers of modernity. Progress is a no less exhausting idea than its opposite: to think our bodies a metaphor for the decrepitude of the world. A crise de foie must therefore be a kind of chronological vertigo—a morning’s retributive visitation for sitting down the night before to sup nectar, in that sense of complete and utter well-being the French exude only at the dinner table, as if the pays légal ruled by Reason had given way to a pays réel of gastronomic abandon—Cockaigne or Schlaraffia—where the day’s only order is the tripartite call to table. Botanising with their palates, as it were, in a world hermetically sealed against phasal eating stations, ‘buns on the run’ and the golden ‘M’.
Yet gourmandising and apocalypse come together rather neatly in French consumptive habits, as seen to good effect in Marco Ferreri’s painfully bulemic film La grande bouffe (1973), in which four men, in a parody of Jules Verne’s voracious heroes, whose aim was that of ‘eating everything, in impossible quantities, as often as possible’, stuff themselves to death on every gastroglobal delicacy money can buy. Diagnosis? Fast food, slow food: myths are stratagems to enclose their opposites. And livers follow a cannibal logic. We have to sleep on them and they have to process those terrifying opposites, faith and doubt, which they do without fuss until dawn comes out, not rosy-fingered as Homer has it, but with a grey hair or two.
Now you know the answer to the biliously rhetorical question once posed as a title by the sociologist of terminal man, Jean Baudrillard. What are you doing after the orgy? Going to see the doctor, stupid.