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Exilic Effects of Illness and Pain in Solzhenitsyn’s Cancer Ward: How Sharpening the Moral Imagination Can Facilitate Repatriation

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Abstract

This essay uses Solzhenitsyn’s Cancer Ward to explore the exilic effects of illness and pain. The novel is uniquely suited for such an analysis given the theme of exile that predominates both in the narrative and in the composition of multiple characters within that narrative. I argue that illness, and in particular pain, is a liminal state, an existential hinterlands. The ethical approach to literature and medicine may suggest, as a response to these exilic effects, the need to cultivate connection and empathy by sharpening the moral imagination. If pain and illness exile the sufferer, the imperative to reach out takes on ethical content.

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Notes

  1. D Leder, “Illness and Exile: Sophocles’ Philoctetes,” Literature and Medicine 9 (1990): 2.

  2. P Schlesinger, “W.G. Sebald and the Condition of Exile,” Theory, Culture & Society 21 (2004): 57.

  3. Though there are many sources for such claims, among the most well-known are Arthur Kleinman’s The Illness Narratives and Arthur Frank’s The Wounded Storyteller.

  4. R Charon et al., “Literature and Medicine: Contributions to Clinical Practice,” Annals of Internal Medicine 122 (1995): 599–606; KM Hunter, “Narrative, Literature, and the Clinical Exercise of Practical Reason,” Journal of Medicine and Philosophy 21 (1996): 321–40; P.A. Scott, “The Relationship Between the Arts and Medicine,” Medical Humanities 26 (2000): 3–8.

  5. R Charon, “Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust,” Journal of the American Medical Association 286 (2001): 1897–1902.

  6. A Solzhenitsyn, Cancer Ward, trans. Nicholas Bethell & David Burg (New York: Farrar, Straus and Giroux, 1969), 556. All subsequent notations are from this same edition and will be cited parenthetically in my text as CW, followed by the page number.

  7. A Milbauer, Transcending Exile: Conrad, Nabokov, I.B. Singer (Miami: Florida International University, 1985), 1.

  8. J Woodcock, “Healing rituals with families in exile,” Journal of Family Therapy 17 (1995): 339.

  9. Schlesinger, 47.

  10. G Russell, “Machiavelli’s Science of Statecraft: The Diplomacy and Politics of Disorder,” Diplomacy and Statecraft 16 (2005): 230.

  11. J Hankins, “Humanism and the Origins of Modern Political Thought,” in The Cambridge Companion to Renaissance Humanism, ed. Jill Kraye, 134 (Cambridge University Press, 2004).

  12. G Russell, “Machiavelli’s Science of Statecraft: The Diplomacy and Politics of Disorder,” Diplomacy and Statecraft 16 (2005): 227–250.

  13. Ibid., 227.

  14. E Scarry, The Body in Pain: The Making and Unmaking of the World (New York: Oxford University Press, 1985), 4–5.

  15. DS Goldberg, “The Sole Indexicality of Pain: How Attitudes Towards the Elderly Erect Barriers to Adequate Pain Management,” Michigan State Journal of Medicine and Law 13(1)(2008): 51.

  16. Scarry, 4

  17. Leder, 5.

  18. Scarry, 4.

  19. J E Jackson, “Stigma, Liminality and Chronic Pain: Mind-Body Borderlands,” American Ethnologist 32, no. 3 (2005), 340.

  20. Leder, 4.

  21. The community of the ward itself is important in the novel. Indeed, for Rabinovich, his colleagues in the cancer ward are the only people he does not feel alienated from: “Even his own family had got tired of him. It was only here, on the steps of the cancer clinic, that the patients listened to him for hours and sympathized” (CW, 76).

  22. Leder, 2.

  23. Ibid., 4.

  24. BM Sourkes, The Deepening Shade (Pittsburgh: University of Pittsburgh Press, 1982), 32.

  25. Leder, 3.

  26. Jackson, 332.

  27. Ibid., 335.

  28. Ibid., 338.

  29. Much of Jackson’s article is devoted to explaining why chronic pain patients are stigmatized because their pain lacks an organic cause and therefore frustrates the mind-body distinction that is at the core of traditional models of pain medicine. While the alleged lack of organicity of chronic pain admittedly results in different attitudes and perceptions towards chronic pain and acute pain patients, the latest pain research suggest that the distinction between chronic pain and acute pain may not be substantive at all (Fields 2007). That is, the newest pain models suggest that pain does not occur in the peripheral nervous system, but rather is represented in the brain, and then projected into a kind of somatic space (such that the brain tells the nervous system that there is pain in the hand or the foot, rather than the pain originating in the hand or foot) (Fields 2007). I will provide a full account of these models and their implications in my dissertation, but for present purposes, it is sufficient to note that insofar as pain originates in the brain rather than the peripheral nervous system, the consequences may be that the experience of pain itself—not just chronic pain—undermines the mind-body distinction.”

  30. Ibid., 338.

  31. Ibid.

  32. Ibid.

  33. MS Holmes and T Chambers, “Thinking Through Pain,” Literature and Medicine 24 (2005): 132.

  34. This phenomenon is the subject of my forthcoming dissertation.

  35. Goldberg, 7–10.

  36. Leder, 2.

  37. Jackson, 339.

  38. Ibid.

  39. Ibid. Interestingly, Solzhenitsyn identifies a moral hierarchy of exile in the novel with culpability as the ranking criterion, but the hierarchy is one of political exile, not of illness or pain exile. The true unfortunates were not the exiles, but the ones who had been given passports with the sordid Article 39 conditions. They spent their time blaming themselves for all their false moves . . . This prisoner, on the other hand, entered exile with all his rights intact. As he hadn’t picked the place, no one could throw him out (CW, 266). This closely resembles Jackson’s description of the pain hierarchy; those who had not “picked the place” could not be thrown out (i.e., stigmatized or exiled).

  40. A Chapple, S Ziebland, A McPherson, “Stigma, shame, and blame experienced by patients with lung cancer: qualitative study,” BMJ 328 (2004): 1470–1475.

  41. Jackson, 339.

  42. Ibid., 333.

  43. Ibid.

  44. Moreover, if the new pain models are correct, the very existence of pain undermines the mind-body distinction and suggests that the notion of objective pain may literally be an oxymoron.

  45. Richard G. Wilkinson, “Ourselves and Others – For Better or Worse: Social Vulnerability and Inequality.” In Social Determinants of Health, 2d eds., eds. Michael Marmot and Richard G. Wilkinson (New York: Oxford University Press, 2006), 341–358.

  46. Eric Brunner and Michael Marmot, “Social Organization, Stress, and Health.” In Social Determinants of Health, 2d ed., eds. Michael Marmot and Richard G. Wilkinson ( New York: Oxford Univesity Press, 2006), 27.

  47. M. Shaw, D. Dorling, and G.D. Smith, “Poverty, Social Exclusion, and Minorities.” In Social Determinants of Health, 2d ed., eds. Michael Marmot and Richard G. Wilkinson (New York: Oxford University Press, 2006), 210.

  48. Shaw, Dorling, and Smith, 211.

  49. C.F. Corvalan, T.R. Driscoll, and J.E. Harrison, “Role of Migrant Factors in Work-Related Fatalities in Australia.” Scandinavian Journal of Work, Environment & Health 20 (5): 364–370.

  50. F. Trovato, “Violent and Accidental Mortality Among Four Immigrant Groups in Canada.” Social Biology 39 (1): 82–101.

  51. S. Harding, “Mortality of Migrants from the Indian Subcontinent to England and Wales: Effect of Duration of Residence.” Epidemiology 14 (3): 287–292.

  52. T.J. Etienne, A. Spiliopoulos, and R. Megevand. “Surgery for Lung Tuberculosis and Related Lesions: Change in Clinical Presentation as a Consequence of Migration of Population.” Acta. Chir. Belg. 94 (2): 101–104.

  53. Leder, 6.

  54. Ibid., 8.

  55. Ibid.

  56. Of course, I am not ignoring the fact that Kostoglotov and Dr. Gangart do not join each other and form a union, nor that the novel seems to end darkly, with Kostoglotov lying like a “dead man” on the floor of the train juxtaposed with the image of the blinded monkey. For all this darkness, however, Kostoglotov is no longer in illness exile, and the end of his political exile is close at hand. He has been repatriated, even if he loses his Beatrice in the process.

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  1. Health Policy & Ethics Fellow, Chronic Disease Prevention & Control Research Center, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Daniel S. Goldberg

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Goldberg, D.S. Exilic Effects of Illness and Pain in Solzhenitsyn’s Cancer Ward: How Sharpening the Moral Imagination Can Facilitate Repatriation. J Med Humanit 30, 29–42 (2009). https://doi.org/10.1007/s10912-008-9072-2

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