Illness and the Limits of Expression Kathlyn Conway http://www.press.umich.edu/titleDetailDesc.do?id=210499 The University of Michigan Press — chapter i — The Cultural Story of Triumph What the American public wants in the theater is tragedy with a happy ending. —William Dean Howells (as reported in Edith Wharton’s introduction to Age of Innocence) What harm can there be in a story of triumph? A person battles a dis- ease, overcomes numerous obstacles, and, in the end, returns to life having learned some important lessons. If anything this story seems to offer hope, providing inspiration and a model for how to act in the face of serious illness or accident. No wonder people are captivated by these stories. And yet not everyone feels so sanguine about triumph narratives. Some people ‹nd the triumph story at best a silly romance and at worst a cruel denial of their situation. After all, most people with a serious illness or injury are or have been in a state of emergency. They are struggling to come to terms with a terrifying diagnosis, serious damage to their body, or a future that feels shattered by the prospect of physical limitation or an early death. They may feel themselves unraveling or fear they will go crazy. While friends and relatives offer encouragement, they feel alone with their fears and preoccupied with the question of how they will cope. While the writ- ers of triumph narratives may acknowledge this initial reaction to ill- ness, they tend to gloss over the continuing dif‹culties of the experi- ence and to write after the fact, imposing retrospectively a story of triumph. Why not just ignore the story if it rings false? For one thing, most people have a complicated reaction: even if the triumph story rings false, it holds an attraction. It highlights those qualities we would all like to exhibit in the face of serious illness—an ability to ‹ght against /17/ Illness and the Limits of Expression Kathlyn Conway http://www.press.umich.edu/titleDetailDesc.do?id=210499 The University of Michigan Press 18 / illness and the limits of expression sickness and limitation, an optimism in the face of adversity. Embrac- ing the triumph narrative also serves various psychological functions: it avoids the fact that suffering may serve no apparent purpose; it sug- gests that the progress of an illness leads in the direction of restored health; and it quells a person’s anxiety over the possibility that his or her story may not have a happy ending. It is also dif‹cult to ignore a story that predominates in American culture and is widely insisted upon. In fact, the voices telling this story are so loud that they drown out others. The media bombard us with different variations on the triumph narrative. Advertisements pound home the notion that any bodily imperfection, or more accu- rately, any deviation from what is deemed the norm, can be over- come with procedures and products—plastic surgery, Botox, creams, lotions, and potions. When illness is depicted in TV ads for pharma- ceuticals, people suffering the ailment not only appear more beauti- ful than the general population but also more vigorous. Television movies bathe the sufferer in soft light that hides the reality of the injured or suffering body. As a culture we hide suffering. By keeping the ill, elderly, and dying out of view, we manage to keep the story of the damaged body, of physical weakness or limitation, out of earshot. When we do encounter the ill and disabled, we meet them with a coercive insis- tence that they rise above their suffering, battle their disease, and believe that everything will be ‹ne in the end. We insist on opti- mism, put a spin on illness, and silence those who hurt, complain, or give up, labeling them “bad patients.” We endlessly celebrate “sur- vivors,” while ignoring their equally valiant counterparts who did not survive. By subscribing so insistently to the narrative of triumph, we participate in a hysterical denial, as if by chanting “triumph” we can ward off mortality. Often hospital customs and routines seem designed, whether intentionally or not, to keep the patient from telling a story different from that of triumph. Questions asked about the patient’s medical history suggest a logical progression of events focused on symptoms, with little room for the patient’s subjective experience. Technical medical terminology replaces an honest acknowledgment of the emotional toll serious illness and injury in›ict. Some doctors, no Illness and the Limits of Expression Kathlyn Conway http://www.press.umich.edu/titleDetailDesc.do?id=210499 The University of Michigan Press The Cultural Story of Triumph /19 more comfortable with illness than anyone else in our culture, avoid asking their patients how they feel. Or they themselves employ the vocabulary of triumph, assuring themselves the patient will recover. “We’ll beat this together,” they say. They may congratulate those who are “good patients”—that is, uncomplaining, strong, and brave. Because some insurance companies encourage doctors to see a ‹xed number of patients per hour, doctors may avoid asking open-ended questions in order to keep the encounter short. Even those close to the sufferer suggest a triumph narrative when they talk about battling disease and remaining optimistic. Christina Middlebrook, disturbed to learn that the treatment she was given achieved a remission of more than a short duration only one-quarter of the time, relates her mother’s response: “My mother tells me that I am not thinking right. She says that. Aloud. Over the phone. To me, her daughter. I am not thinking right! She tells me that I should focus on the percentage of patients who make it three years.”1 People feel discomforted by the ill person’s expression of despair, so they offer stories of recoveries from serious illness—even if the recovery is from a different disease. The journalist Marjorie Williams, who died of liver cancer in 2005, describes her anger when “someone tried to cheer me up by reciting the happy tale of a sister-in-law’s cousin who had liver cancer but now he’s eighty and he hasn’t been troubled by it in forty years. I wanted to scream, DON’T YOU KNOW HOW SICK I AM?”2 Friends or relatives who tell this story are also members of a culture that denies illness and declines to honestly acknowledge sick- nesses that are not readily overcome. They tell a story of survival in a desperate attempt to set things right, to reinstall denial. Meanwhile, the ill person who is told these stories is alone with the reality that recovery is not assured. As Williams, facing her own death, put it, “I felt abandoned, evaded, when someone insisted that I would live.”3 Much of the brilliance of the play Wit, by Margaret Edson, lies in its depiction of the verbal exchanges between Vivian Bearing, the main character, and those caring for her. Bearing, a professor of English literature in the hospital with terminal ovarian cancer, is repeatedly called upon to live out the denial of death implicit in the triumph narrative. The play opens with Bearing saying to the audi- ence, “Hi. How are you feeling today? Great. That’s just great.” Illness and the Limits of Expression Kathlyn Conway http://www.press.umich.edu/titleDetailDesc.do?id=210499 The University of Michigan Press 20 / illness and the limits of expression Mimicking the greeting of those who enter her room all day, she alerts the audience to the absurdity of this question, with its call for cheeriness in her dire situation. She goes on to say, “I have been asked ‘How are you feeling today?’ while I was throwing up into a plastic washbasin. I have been asked as I was emerging from a four- hour operation with a tube in every ori‹ce, ‘How are you feeling today?’” Finally, she states, “I am waiting for the moment when someone asks me this question and I am dead.”4 Bearing’s subjective emotional experience as well as her knowl- edge of what is happening to her body is irrelevant to most of those who treat her in the hospital. She is expected to answer “‹ne” to all inquiries about how she feels. Her complicated emotional reactions and the thoughts she communicates to the audience stand in bold contrast to the shallow and limited communication she engages in with her doctor. The play charts the ways the other characters do everything they can to deny her reality: they cut off serious conversa- tion about dying, insist on a cheerful tone, and ignore her emotional suffering. In American culture the narrative of triumph functions as a kind of myth: “a belief given uncritical acceptance by the members of a group especially in support of existing or traditional practices and institutions. It is also used to designate a story, belief or notion commonly held to be true but utterly without factual basis.”5 The tri- umph narrative not only attempts to explain a phenomenon that is unknown and frightening—namely, illness and dying—but also embodies a belief that is given uncritical acceptance in our culture— that one can, with suf‹cient effort, triumph over illness. The literary scholar Anne Hunsaker Hawkins has explored the variety of tem- plates that underlie stories of illness, including rebirth, battle, the journey, and “the myth of healthymindedness.”6 I use the term tri- umph narrative to refer primarily to the myth that those who are ill can confront their illness as a battle, do so with courage, and ‹nally triumph and share with others the lessons they have learned.