Photo: Fox Searchlight Pictures

In December, the Tatler assembled a decisive(-ish) list of ways to to be upper class in 2019. Lodged between “Audiobooks,” “Sweden,” and “Knowing about plants,” is: “Gout.” Gout! A disease commonly associated with 18th-century kings, brought on by indulging in rich foods, openly heralded as a signifier of modern, 21st-century affluence.

This casual mention isn’t the only instance of gout reentering the cultural consciousness in 2018. In November, months after a tax trial revealed he’d spent hundreds and thousands of dollars on “a waterproof silk blouson,” and jackets made of ostrich and python skin, Paul Manafort was spotted out in a wheelchair, his foot wrapped in a white bandage; various media outlets speculated that he was suffering a bout of gout. A month later, Yorgos Lanthimos’s The Favourite came out, and while the film was technically about the power struggle between Queen Anne’s longtime companion and her appealing new servant, many viewers seemed especially riveted by its depiction of the queen’s severe gout, which factored in nearly every scene. This month, Matt Choi, Brooklyn-based copywriter, released the first episode of a food-related podcast called “Gout Boys,” named for a joke he shares with his friends, who are bonded by their penchant for duck, butter, wine, and cheese.

As far as the reputations of diseases go, gout has done pretty well for itself; for literally hundreds of years it was considered a badge of nobility, a physical manifestation of wealth and success. Ancient Roman authors personified gout as Dionysus, the god of wine, and Aphrodite, the goddess of love; as late as 1926, the author Havelock Ellis wrote of the connection between genius and gout in his book A Study of British Genius. “It happens so often,” he wrote, “in such extreme forms, and in men of such pre-eminent intellectual ability, that it is impossible not to regard it as having a real association with such ability.”

But over the last decade, as wellness (and paying $36 for a single kickboxing class) has moved in on excess (paying an unseemly amount for a leg of iberico ham) as the present way to demonstrate one’s social position, gout became something to hide. In 2008, the same year, incidentally, that Goop launched, writer Geoff Nicholson confessed in a piece for the Times that his doctor had recently confirmed that he was afflicted with gout. “I am,” he wrote, “a member of that shameful, shadowy group, ‘the gout community.’” One day soon, he said, he hoped that gout would become more accepted. Or fashionable, even. “Perhaps in the near future, some cool young women writers will fess up to having gout, and we can look forward to such titles as ‘A Gout of One’s Own,’ ‘Gout and Prejudice,’ ‘Gout and the City,’ and the one I think just can’t miss, ‘Gouty Bitch.’”

Quick-fix diets like keto and paleo, where your intake is very high in fat and proteins, those can lead to gout.

It’s been exactly a decade since Nicholson made his admission, and suddenly “Gouty Bitch” doesn’t seem like such a ridiculous proposition. Our current fascination with the disease, at least in part, has to be a symptom of the world we’re living in right now. Our country is presided over by the human embodiment of overconsumption, after all. Rebelling against what most consider to be in good taste, he is a man who’s been said to eat two McDonald’s hamburgers and drink 16 Diet Cokes a day. That image of Manafort with his leg puffed up like some staggering, drunken king was gleefully parsed by the media for a reason — there are physical consequences, it tacitly communicates, for filing false tax returns, committing bank fraud, conspiring to commit bank fraud, eating richly (the bandaged foot was due to “diet-related issues,” sources later confirmed), and buying $20,000 ostrich-trimmed coats.

There are non-metaphorical reasons for gout’s sudden reappearance into cultural consciousness too, of course. The main one being that it is on the rise in America — cases have more than doubled in the past 20 years. Doctors largely attribute this rise to the increasing prevalence of obesity and hypertension. But Dr. Leigh Vinocur, an emergency physician, said she has also noticed a new crop of young, trim people coming into the hospital with symptoms of the disease; patients who don’t have pre-diabetes, or high blood pressure, or hypertension. She believes that this, in part, has something to do with fad diets like keto, which calls for low-carb, high-protein consumption. “Quick-fix diets like keto and paleo, where your intake is very high in fat and proteins, those can lead to gout,” she says. “It’s ironic: modern living — from the food industrial complex to those brand-new diets like keto — have led to an uptick in one of the world’s earliest diseases.”

It also seems that this newfound interest in a disease brought on by overconsumption has to do with the fact that some of us have begun to sour on the wellness movement — now a bloated, $4.2 trillion global industry. In spring, a membership-based club called The Well, will land in New York’s Flatiron neighborhood: In its 13,000 square feet, there will be a dedicated vibrational energy healer, a reflexology lounge, a vitamin bar, and a restaurant whose menu will not contain so much as a teaspoon of refined sugar. There will be a nutritionist on-site, too, who will help members figure out if, say, they should be eating turmeric with black pepper (yes!), or if they should try out intermittent fasting (probably!).

Which is to say: For a certain, privileged type of person who has already digested and grown sick of of pastel-colored abstemiousness, there is a rebellious satisfaction in not subscribing to the program. This explains the delight some viewers took in the scene in The Favourite where Queen Anne alternately stuffs her face with cake and vomits into a gilded bucket (wrote Priscilla Frank in her HuffPost review: “She went back and ate some more! Yes, mama!”). It explains the satisfaction in Choi’s voice when he told me a he’d recently taken a trip to France so totally indulgent that he’d experienced two weeks of of lactose-intolerance afterward. And it especially explains why, on the Tatler’s companion list, a list of ways to not be upper class in the new year, the first entry is “Dietary requirements” and the last is “Saying ‘I’m alright, thanks’ when offered a drink.” Welcome to 2019.