Kafka’s literary productivity moved forward in different steps. Peaks of creativity and writing were followed by a vast remission. Did his unstable health have any influence over these cycles? Did he write in spite of his illness and distress?
Since he was twenty, Frank Kafka suffered a number of syndromes that –as we will soon explain– are part of the Central Sensitivity Syndrome, aggravated by tuberculosis, which led to his death. Since this age, the main symptoms in Kafka’s clinical condition were widespread musculoskeletal pain, headaches, insomnia, fatigue and weakness, precordial pain, functional gastrointestinal disorders, cognitive pendularity and depression. When he was thirty-three years old, he suffered his first hemoptysis, being diagnosed with pulmonary tuberculosis. He dies seven years later, diagnosed with laryngeal tuberculosis.
Fibromyalgia is the diagnosis given to patients with widespread musculoskeletal pain, where other causes of pain, such as inflammatory processes or tissue damage, are not found. The dominant finding of fibromyalgia is musculoskeletal pain of variable intensity. It has been characterized as a chronic widespread allodynia. Allodynia is defined as the perception of pain resulting from a stimulus that is normally not painful. In the case of fibromyalgia, pain would be the consequence of a dysfunction in the central control process of pain (nociceptive control), secondary to over expression of pathways that promote the feeling of pain (pronociceptive pathways).
It has recently been suggested that fibromyalgia should be included within Central Sensitivity Syndromes –which include, among other entities, chronic fatigue syndrome, chronic low-back pain, tension headache and migraine. Clinical patterns will depend on the specific overlapping of these entities in each subject.
A clear overlapping of diverse psychiatric entities that are part of Central Sensitivity Syndromes has been observed, particularly in a comorbid relationship with fibromyalgia.
Patients with fibromylagia frequently complain about cognitive difficulties, which have been called “fibrofog” –the cognitive haze in fibromyalgia. Clinical features include a slowed processing of information, trouble to perform multiple tasks, memory failure, poor concentration and clarity of thought, and a deficiency in the executive function. Cognitive dysfunction is more correlated to pain than depression.
Kafka’s depiction of pain leads us to infer the existence of allodynia: “If I try to defend myself and use force, the spikes only press in the deeper”. Chronic widespread musculoskeletal pain with allodynia, without any evidence of musculoskeletal disease, leads us to suspect Kafka suffered from fibromyalgia. The intensity of his headaches, the damage to the left half of the cranium, the duration and recurrence of headaches, which is associated with phonophobia, the activation of insomnia, as well as deactivation causes, enable us to believe Kafka suffered migraine occurring without an aura. He also experienced headaches that affected both temples. The bilateralism of these episodes leads us to infer that he suffered from migraine combined with tension headaches. The clinical impact headaches exercised over Kafka was so important that when he was twenty-eight he thought he would hardly reach forty.
On the basis of our analysis, it is possible to conclude that, since he was twenty years old –and during his whole adult life–, Franz Kafka experienced a group of syndromes that today are included within Central Sensitivity Syndrome, later aggravated by tuberculosis. His symptoms – particularly the unbearable headaches, insomnia, fatigue and extreme weakness, widespread musculoskeletal pain, digestive difficulties and depression– tormented Kafka’s adult life and exerted an influence over the irregular rhythm of the fiction author’s literary work.
Juan Enrique Perea