Medicine - A Perilous Prescription? A study of 3 postmodern works
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The twentieth century witnessed paramount revolutions in the field of medicine, impacting the lives of millions of people around the world. The large-scale wars, specifically – which hosted on-site mobile hospital units and healthcare professionals from all backgrounds –expedited the advancement of medical knowledge by providing an environment where experimentation was endorsed and the need to discover healthcare solutions was incontrovertibly grave.
It is generally accepted that ethical medicine is based upon four main principles: beneficence, non-maleficence, respecting patient autonomy, and seeking justice for the greatest amount of people. As much as possible, the purpose of healthcare is to be non-discriminately altruistic. But what happens when the doctors we place so much faith in fail to live up to the bar of our standards of nobility? Even more alarming is the reality that some seek to maim us rather than heal us. This paper analyzes how three postmodern texts – Joseph Heller’s Catch-22, Thomas Pynchon’s The Crying of Lot 49 and Tracy Letts’s August: Osage County – depict the rarely discussed deficiencies and decadences of medicine, a force that shapes the everyday lives of the protagonists.
The inadequacy of the healthcare system is especially apparent in Catch-22, a novel by American writer Joseph Heller, which follows a squadron of bombardiers in action during the Second World War. Yossarian explains, in the opening scene of the novel, that the nurses and medics had a very limited understanding of what was wrong with him (or whether there was anything wrong in the first place): “They read the chart at the foot of the bed and asked impatiently about the pain. They seemed irritated when he told them it was exactly the same” (Heller, page 7). What’s immediately noticeable is the lack of personal care or communication between doctor and patient. Rather than appearing to be concerned with the wellbeing of the sick, the doctors perceive Yossarian to be a formality; something they must attend to as part of their job. This motif corresponds with the theme of bureaucracy that the novel ultimately presents forth: a system that reduces the people that work for it to a name on a list that needs to be checked off. What is the doctor’s solution for Yossarian’s unrelenting pain? Simply: “Give him another pill” (Heller, page 7).
The medical professionals at the camp: Doc Daneeka and his two orderlies – Gus and Wes – also act as archetypes portraying the stark inadequacy of an impersonal, administrative medical system. Doc Daneeka, the primary squadron physician, is more concerned with his own welfare than the soldiers stationed with him at Pianosa. In the novel, he explains that his ambitions before the war revolved around making a successful business venture out of his New York practice: “I don't want to make sacrifices. I want to make dough” (Heller, page 36). Consistently, we see that he makes decisions with the sole objective of self-preservation. Doc Daneeka never directly embodies the ethical standards that medical professionals swear by, as outlined in the Hippocratic Oath. Rather, he embodies the theme of healthcare consumerism. Gus and Wes similarly fail to provide a much-needed holistic standard of care to the soldiers of the 256th Squadron. Of them, Heller writes: “they had succeeded in elevating medicine to an exact science” (Heller, page 36). In a sense, this is ironic; one would be inclined to say that medicine is in fact based upon empirical information in science, but it is also so much more than that, and that is the point that Heller makes when discussing the orderlies’ shortcomings. A section of the Hippocratic Oath states that doctors need to remember “that there is an art to medicine as well as science, and that warmth, sympathy and understanding may outweigh the surgeon’s knife or the chemist’s drug” (Modern Medicine, page 34). Gus and Wes are caricatures of a system that is calculated but has little actual substance. They send all soldiers with a temperature above 102 to the hospital. They also employ the use of gentian violet on the feet and gums of the soldiers and the prescription of a laxative as a panacea: a remedy that is applied to all forms of disease (whether it is effective or not). Heller writes: “Men with cut fingers, bleeding heads, stomach cramps and broken ankles came limping penitently up to the medical tent to have their gums and toes painted purple by Gus and Wes and be given a laxative to throw into the bushes” (Heller, page 413).
Towards the end of the novel, even Doc Daneeka himself becomes a victim of the bureaucratic process when his plane is flown into a mountain and he is assumed dead because his name was forged onto the manifest (to get extra flight hours). Despite his efforts to convince others he is alive, including Gus and Wes, the other soldiers of Squadron 256 no longer “recognize” him: “You’re dead sir,” they tell him, “The records show that you went up in McWatt’s plane […] You must have been killed in the crash” (Heller, page 391). This satirical ending emphasizes once and for all that a society that is bureaucratic directly reduces the quality of its citizens’ lives. It also implies that that even the noblest of professions, such as healthcare, is only as infallible as the men and women that constitute it, and the system it operates in.
Despite this, it must be noted that hospitals aren’t depicted in an entirely negative light in the novel. They are also places of sanctuary. The opening sequence of the novel involves Yossarian discussing the different inhabitants of the clinic. There is an element of anonymity for the patients. Other than Yossarian and Dunbar, the other patients are nameless: The Texan, the Warrant Officer, the twenty-four-year-old fighter-pilot with the golden moustache, and of course, the soldier in white – “encased from head to toe in plaster and gauze” (Heller, page 8)– who is also faceless. And in this anonymity, there is metaphorical security. By being members of a hospital, these patients are excused from their responsibilities in the war. They adopt a different role: that of the sick – who need to be looked after by society. In this way, Yossarian uses hospitals to seek refuge from the perils and threats of World War II.
August: Osage County, is an American drama written by Tracy Letts, which depicts the events that follow the suicide of an Oklahoma family patriarch, Beverly Weston: alcoholic and once-established poet. Violet, Beverly’s wife and mother of three daughters, is a drug addict. One cannot say that substance abuse is the sole cause for this character’s inner turmoil, since it is revealed in the film that she – and her sister, Mattie-Fae – endured an abusive relationship with her own mother. However, in many ways, Violet is cruel and vindictive to her family (though she claims to only be “truth-telling”). In one dinner-table scene, Barbara – the eldest daughter and only one to really inherit her mother’s mean streak – confronts her mother about her drug addiction. Essentially, she is her mother’s main foil. Violet admits to the problem, and says: “Y’see these little blue babies? […] Try to get ‘em away from me and I’ll eat you alive” (Letts, page 91). In a way, she cherishes her pills more than the approval or respect of her children.
Before his death in the film, Beverly explains that the pills Violet takes “affect, among other things, her equilibrium. Fortunately, they eliminate her need for equilibrium” (Letts, page 4). Violet uses the drugs as a means to escape the ordeals of her past, but in turn becomes detrimental to those around her, as is witnessed by her relationship with every member of her family, barring Mattie Fae. Most significantly, however, is the revelation that many different doctors perpetuated Violet’s addiction and substance abuse. Although a cancer patient, she was on a superfluous list of painkillers and narcotics. Beverly explains to Johnna that his wife takes “Valium. Vicodin. Darvon. Darvocet. Percodan. Xanax for fun. OxyContin in a pinch. And of course Diluadid. I can’t forget Diluadid” (Letts, page 9).
After coordinating a “pill raid” of the house, Barbara visits one of Violet’s doctors – Dr. Burke – to confront him about writing her unnecessary prescriptions. Dr. Burke is the only doctor we see in the film, and thus he serves as the analogy of rural healthcare. The script describes him as “A genial, charming and remotely creepy small town doctor” (Letts, page 103). The physical appearance of the character parallels the deceptive façade of medicine that Letts is pointing out. Dr. Burke maintains a professional appearance, yet there is also something unsettling about the character. More about this fraud is revealed when he tries to explain away Violet’s erratic behavior, claiming that her chemotherapy and radiation caused her to have a condition called ‘Mild Cognitive Impairment’. He then suggests committing Violet to an institution, all to conceal the fact that he is liable for a malpractice lawsuit. Barbara pulls out a bag of the many prescriptions Dr. Burke wrote for Violet, revealing that she knows of his involvement in her mother’s substance abuse and is ready to seek legal action against him. In August: Osage County, the only doctor we see represents corruption and dishonesty in the medical field. Much like Doc Daneeka in Catch-22, Dr. Burke proved to be ultimately selfish in his pursuits.
The Crying of Lot 49 doesn’t only depict how healthcare can be flawed or corrupt, it goes further and presents an outright malicious side to medicine. The abuse of drugs, particularly LSD and marijuana, is a motif throughout the novel. It is first introduced to the reader when Oedipa receives a phone call from her psychiatrist, asking her to participate in a study involving the effect of LSD on suburban housewives. At the end of the novel, it is revealed that Dr. Hilarius managed to convince Oedipa’s husband, Mucho Maas, to join the program. Mucho very clearly becomes addicted to the drug and perceives nothing wrong with its use. There are parallels between Lot 49 and Osage County in that the main characters are debilitated by the abuse of substances or medicines. The hallucinogenic world of Lot 49 is one where interpersonal communication has deteriorated and creating order in the universe is arduous. Is it made more impossible by the poisonous effect of medicine on society? When Oedipa goes to Dr. Hilarius at the end of the novel, it is to seek reassurance that she is mentally stable. She explains that she went to him “hoping [he] could talk [her] out of a fantasy” (Pynchon, page 108). To this, Dr. Hilarius replies: “Cherish it […] what else do you have?” (Pynchon, page 108.) The doctor is thus presented as a proponent of disorder and chaos.
In a surprising turn of events, Dr. Hilarius eventually admits to being a former Nazi doctor at Buchenwald. He boasts about how he used facial expressions as a weapon in a study of experimentally induced insanity to render Jews catatonic. He submits himself to the authorities when Oedipa subdues him. This confirms the notion that Thomas Pynchon uses Dr. Hilarius’s LSD plot to mirror the unethical use of human subjects in Nazi experimentation. It is only after these events that the standards of medical ethics, including the Nuremberg Code, were constructed. Thus, in the world of Lot 49, medicine acts as a symbol or driving force of chaos and uncertainty. Ultimately it raises the question of whether the faith we have in medical professionals – the fact that we can trust them with our lives – is misplaced.
In conclusion, all three works are characteristic of twentieth-century literature in that common assumptions – like the infallibility of a doctor – are called into question. One postmodernist critique explains that “For medicine to retain all that is good of the modern revolution, it must address three key issues: the use of informed choice as an outcome; the use of computers to repersonalise clinical practice; and the empowerment of patients” (Gray, page 1551). Likewise, the three twentieth-century texts analyzed throughout this paper remind us that no matter the societal class, background or area of expertise, the darkness of human nature is ubiquitous. It must be sought out and eradicated.
Gray, Muir. “Postmodern Medicine.” Lancet. (1999). 354:9189, p. 1550-1553.
Heller, Joseph. Catch-22. London: Random House, 2011. Print.
“Hippocratic Oath.” Maryland Medicine. (2011). 12:4, p. 34.
Letts, Tracy. August: Osage County. The Weinstein Company, 2013. Web.
Pynchon, Thomas. The Crying of Lot 49. London: Random House, 2000. Print.