ILLNESS AND THE MEDICALIZATION OF THE BODY IN PHILIP ROTH'S NOVELS

Abstract

A central, recurrent theme in Roth 's oeuvre, the process of aging and illness has been widely explored by the writer in close relation with the medical realm. I shall focus on three novels that, in varying degrees, reveal the complex meaning of this phenomenon, all having the writer's alter-ego, Nathan Zuckerman, as protagonist: The Anatomy Lesson, where Roth exposes the painful awareness of biological vulnerability as part of becoming older, Exit Ghost, a novel of solitude and defeat, and American Pastoral, one of Roth 's cardinal works, questioning the truth and mythology of one's biography.

Headnote

Abstract: A central, recurrent theme in Roth 's oeuvre, the process of aging and illness has been widely explored by the writer in close relation with the medical realm. I shall focus on three novels that, in varying degrees, reveal the complex meaning of this phenomenon, all having the writer's alter-ego, Nathan Zuckerman, as protagonist: The Anatomy Lesson, where Roth exposes the painful awareness of biological vulnerability as part of becoming older, Exit Ghost, a novel of solitude and defeat, and American Pastoral, one of Roth 's cardinal works, questioning the truth and mythology of one's biography.

Keywords: aging, illness, medical body, medical intervention, medicine and literature.

1. Introduction

Aging and illness are major themes in Philip Roth's novels, along with a permananent interest in the connection between historical time and individual impermanence. Roth's paradigm of the ailing body is deeply connected to the medical dimension, therefore pain and suffering are inseparable from the clinical and its remedial strategies. The writer unitarily projects, throughout his oeuvre, his conception of the body as shaped by lust, illness, aging (and, subsequently, old age), physical degradation and death. However, Roth's major interest in the life of the body and its medicalization transcends the limits of classical intellectual allegory, as can be seen in Nathan Zuckerman's fixation with Thomas Mann's Magic Mountain in The Anatomy Lesson. His protagonist of nine major novels, clearly an alter-ego of the writer, Nathan Zuckerman is a character with an overactive body, both in a sexual and a medical sense. His aging is a dramatic adventure of loss and lessening, as he gradually becomes aware of the limits he can no longer push further in outbursts of cynical, excessive sexual energy. Pain and old age prove, at times, unsurmountable obstacles in his perpetual quest of biological truths. Novels such as The Anatomy Lesson (1983), The Dying Animal (2001), Everyman (2006), American Pastoral (1997) and Exit Ghost (2007) reveal a complex odyssey, culminating with Zuckerman's realization that the process of aging, unavoidably implying the burden of sickness and pain, irreversibly ties the life of the body to the medical realm. And, as a final attempt at curing and saving himself, in The Anatomy Lesson, Zuckerman decides to study medicine and become a doctor at the age of 40, an obstetrician.

In what follows, I shall explore Roth's acute perception of illness as a form of loss and alienation, and his strategies of transforming the body into the object of medical observation and intervention in three major novels - The Anatomy Lesson (1983), American Pastoral (1997) and Exit Ghost (2007). I will argue that Roth's approach to these issues is mediated by the tension between the body, its medicalization, and Nathan Zuckerman's long and complex intellectual crisis, spanning various ages in his life as a writer. As a code of science and reason, medical language contributes to the articulation of the body paradox that Roth's fiction often invokes - as a site of pleasure and desire, and, at the same time, a locus of pain and decay.

2.Roth and the literature/medicine connection

The field of the humanities and, more specifically, that of literary studies, has long embraced the great potential of a dialogue with the medical field. Medicine has been, in various forms, a constant presence in literature, and the two domains share a vast common ground, enriched by metaphors that reflect their often similar modes of interpreting human existence. New disciplines and research areas, such as medical humanities, illness narratives, disability studies, or the more generous domain of literature and medicine certify the cohesion and validity of this alignment. A growing amount of scholarship and a decent number of dedicated journals have consolidated this neccesary intersection between science and the narrative art. In a cardinal essay concerning literature and medicine, published in the first issue of the journal Literature and Medicine, Edmund Daniel Pellegrino (1982: 19), professor of medical sciences and bioethics, argued, that the two knowledge areas share some fundamentally similar concerns: both "are ways of looking at man and both are, at heart, moral enterprises. Both must start by seeing life bare, without averting their gaze. Yet, neither can rest in mere looking. To be authentic they must look feelingly - with compassion". He also noted their similar inquisitive nature, stimulated by an "unremitting paradox": "the need simultaneously to stand back from, and yet to share in, the struggle of human life. They must see clearly but they must also be involved in the outcome of the struggle" (ibid.). Their inner core is determined by the necessity of a narrative - anamnesis, diagnosis and the doctor/patient dialogue gravitate around storytelling, since the doctor must reveal "a patient's odyssey in the dismal realms of disease, distress, disability and death." (idem: 20). Recently, the connection between the humanities and medical sciences has gained critical attention and has entered mainstream practice as a new strategy, that of narrative medicine. As Rita Charon (2006: 4) defines it, the notion refers to "medicine practiced with these narrative skills of recognizing, absorbing, interpreting, and being moved by the stories of illness". As part of standard healthcare, narrative medicine helps the field "become more effective than it has been in treating disease by recognizing and respecting those afflicted with it and in nourishing those who care for the sick" (ibid.). Literature has long been considered a form of therapy; now its healing potential could be fully activated and targeted towards healing protocols.

Indeed, a study of Roth's medical exploration could start with a meditation on Pellegrino's (1982: 20) belief that the dialogue between literature and medicine favours "subtle encounters of persons and matters medical with persons and matters literary". Not only does the main character of so many of his novels gradually enter the purgatory of medical investigation, but medical professionals and medical authority play a major role in some of his key writings, as well.

In American Pastoral, Jerry Levov, the protagonist's brother, is a renowned short-tempered cardiologist who bluntly informs Zuckerman of the central drama of his brother's life - the atrocious deeds of Merry Levov. Jerry is a typical Rothian doctor, projecting the writer's recurrent assumption that medical knowledge aims for a purer form of approach to the mechanism of life, one that is grounded in certainty and undeniable truths. As if he gave a dire, hopeless diagnosis to a patient, Jerry informs Nathan of the tragedy that blew up the Swede's life:

Meredith Levov. Seymour's daughter. The 'Rimrock Bomber' was Seymour's daughter. The high school kid who blew up the post office and killed the doctor. The kid who stopped the war in Vietnam by blowing up somebody out mailing a letter at five a.m. A doctor on his way to the hospital. Charming child," he said in a voice that was all contempt and still didn't seem to contain the load of contempt and hatred that he felt (Roth 1997: 68).

In The Anatomy Lesson, Bobby Freitag, an old friend of Nathan's who is an anesthesiologist, is portrayed as a man in charge of the tremendous task of managing the line between life and death in the operating room. His admiration for his former school friend, laced with professional envy, reveals Zuckerman's prejudice concerning the medical practice:

(...) what I see is somebody hiding from nothing. Somebody who knows when he's right and knows when he's wrong. Somebody who doesn't have time in the operating room to sit around wondering what to do next and whether it'll work or not. Somebody who knows how to be right - how to be right quickly. No errors allowed. The stakes never in doubt. Life vs. Death. Health vs. Disease. Anesthesia vs. Pain. What that must do for a man! (Roth 1983: 129).

Nevertheless, as the writer himself confessed during an interview, there is a surprisingly limited number of books that directly involve illness and medicine in the Western canon.

Now it seems to me that what I've had instead of Newark or Chicago or Mississippi or Philadelphia has been the human body. When I was writing The Anatomy Lesson I made a list of novels about illness and disease. It was a short list. Cancer Ward and The Magic Mountain. If you want to stretch it, you can toss in Malone Dies. There is no great body of literature on this strain of misery. Astonishing, isn't it? All those great books about adultery and none about diabetes. There's Philoctetes, The Plague, The Death of Ivan Ilych - but pain, the physical pain, remains peripheral. (Roth in Searles 1992: 140)

3.Medical Roth

In her study on the medical dimension of Roth's work (particularly, The AnatomyLesson), Laura Mure Dan (2015) argues that Zuckerman's illusion regarding the clarity of medicine (and of obstetrics) is contradicted by the very name of the field, having as its root the Latin verb 'obstare', meaning 'to stand by'. I believe Zuckerman was well aware of the partially passive nature of the obstetrical field - he believed that "being an obstetrician - you just wash your hands and hold out the net" (Roth 1983: 68). One may speculate that it is this apparently uninvolved position that drew Nathan to it in the first place, along with his fascination with the mysteries of the female body. Later, this mystery proves hard to bear. The ravages of illness on the female body reach a climactic point in Exist Ghost, when Zuckerman, an elderly man himself seeking treatment, sees Amy Bellette in the hospital hall and follows her out to a diner a few blocks away. Bellette, now seventy-five and a ghost of her former glorious presence, closes the temporal arch defined by Roth's ghosts. An impressive character in The Ghost Writer, a novel set in 1956, when Zuckerman was a young man himself and she was twenty-seven, Amy resurfaces half a century later in Exist Ghost as a brain cancer patient. Although he follows her, Nathan keeps his distance while looking at the very visible signs of a radical surgical intervention on Amy's once vital, exuberant body: "a sinuous surgical scar cut a serpentine line across her skull, a raw, well-defined scar that curved from behind her ear up to the edge of her brow" (Roth 2007: 18). His refusal to approach her is motivated by his wider rejection of the damage inflicted by illness and time. Those who were once young, lively, unstoppable (himself included) are, in their old age, mere ghosts kept alive by aggressive medical treatment: "The astonishing reappearance and pathetic reconstitution of Amy Bellette" (ibid.) suggest that Zuckerman's physical fate is not close from disaster either.

Medical procedures are regarded, in many of Roth's novels involving illness and physical suffering, as the only real chance one has at restoring health. They are of paramount importance in The Anatomy Lesson, when Zuckerman suffers from intense, apparently impossible to diagnose, chronic pain, and in Exit Ghost, a novel detailing Zuckerman's return to New York after eleven years spent in seclusion, seeking a cure in Manhattan for the humiliating incontinence he had been suffering from after his prostate surgery. Radically different from his previous encounters with the limits of medical knowledge, this experience gives Roth's alter-ego writer new hope that he may resume a normal life:

The procedure the next morning took fifteen minutes. So simple! A wonder! Medical magic! I saw myself once again swimming laps in the college pool, clad in only an ordinary bathing suit and leaving no stream of urine in my wake. I saw myself going blithely about without carrying along a supply of the absorbent cotton pads that for nine years now I had worn day and night cradled in the crotch of my plastic briefs (Roth 2007: 18-19).

In her well-known essay Illness as Metaphor, Susan Sontag exposes the cultural depth of the symbolic reading of illness, focusing on two major afflictions that plagued the 19th and the 20th centuries - tuberculosis and cancer. In a preliminary conclusion, she states that illness "suggested judgments of a deeper kind, both moral and psychological, about the ill" (Sontag 1978: 39). Roth's moral dimension is not straightforward, but rather contaminated with irony and sarcasm. The sexually prodigious Zuckerman, a writer constantly entertaining the idea of a harem, even in difficult times of debilitating pain, becomes frustrated and angry, once prostate surgery implacably renders him unable to have a sex life.

Sexual decline could be understood as cultural seclusion (Shipe 2009: 46), thus biological decay could be read as a literary allegory of alienation. Exit Ghost, announced as the final Zuckerman novel, cannot escape de paradigm of hubris triggering catastrophe, as the voluptous is symbolically and ironically punished to lose what he once enjoyed most. The Anatomy Lesson, as its title suggests, is mainly a lesson in observing the body, not in intervening with regulatory acts. It is, in fact, an exploration of a less frequently dissected element in the life of the medicalized body - pain. Zuckerman, tortured by agonizing pain that none of the numerous doctors he visits seem to be able to diagnose and treat, carefully observes his estranged body, while, at the same time, exposing it to his doctors and narrating the symptoms of his bizarre affliction. As Roth declared about his intentions regarding The Anatomy Lesson, "The job was to give pain its due while at the same time rendering accurately the devastation it wreaks upon reason, dignity, pride, maturity, independence-upon all of one's human credentials" (Roth in Searles 1992: 140). The act of medical investigation revolves, as Michel Foucault argues in The Birth of the Clinic, around the medical gaze, an element he (2004: 9) identifies as having "a strange character", as "it is caught up in an endless reciprocity. It is directed upon that which is visible in the disease - but on the basis of the patient, who hides this visible element even as he shows it; consequently, in order to know, he must recognize, while already being in possession of the knowledge that will lend support to his recognition". Zuckerman's illness proves impenetrable and resists deciphering, though. At the age of 40, his imminent midlife crisis coincides with the debilitating episode of back pain that contradicts his belief in the efficiency and clarity of the medical act. By obsessively monitoring his body and his pain, the protagonist tries to control it while investigating his past, the death of his parents, and his failed relationships. His countless doctors - "three orthopedists, two neurologists, a physiotherapist, a rheumatologist, a radiologist, an osteopath, a vitamin doctor, an acupuncturist, and now the analyst (Roth 1983: 12) -

triumphantly joined by a dolorogist, as a last resort, sometimes make wild assumptions about the cause and nature of his pain, and at other times choose to treat it with heavy drugs. Where the medical gaze fails, opiates and alcohol prove, destructively and for short intervals, rather efficient: it seems that nothing "alleviated Zuckerman's pain like the oxycodone that the master chef at Endo Laboratories, Inc., mixed with a little aspirin, a little caffeine, a little phenacetin, then lightly sprinkled with a dash of homatropine terephthalate, to make mellow, soft, and cheering Percodan" (Roth 2007: 137-138). Faced with "untreatable pain of unknown origins" (Roth 1983: 20), Zuckerman finds that his despair is aggravated by his disappointment in the only authority he had placed his trust in - the medical one. Exasperated and exhausted, Zuckerman's perspective is bleak and hopeless: "It wasn't leukemia or lupus or diabetes, it wasn't multiple sclerosis or muscular dystrophy or even rheumatoid arthritis - it was nothing. Yet to nothing he was losing his confidence, his sanity, and his self-respect" (idem: 22).

Although pain in The Anatomy Lesson is clearly located and Zuckerman mentally traces it along his neck and back, its effects do not concern a single organ, as more generally illness does in Exit Ghost and American Pastoral, where the prostate becomes the locus of sickness. Both functionally and symbolically, this specifically male organ, is, in some of Roth's later novels, a major source of health troubles - Zuckerman finds himself impotent and incontinent following prostate surgery in American Pastoral, and the crisis triggered by the operation is closely dissected in Exit Ghost. More severely, Swede Levov dies of prostate cancer, despite an apparently successful surgical intervention. As Elizabeth Moran (2015: 8) noted, "often his [i.e. Roth's] protagonists find that the body betrays, rather than constitutes, manhood".

It could be argued, as Matthew Shipe (2009) does in his study on Exit Ghost as an expression of Roth's "late style", that it is not only this last Zuckerman novel that could be regarded as a product of the writer's interest in the process of aging and the inevitable closeness to death. Drawing from Adorno (1993: 107) - "In the history of art late works are the catastrophes" - and Edward Said (2007: 7), who argued that the final works of musicians and writers "tear apart the career and the artist's craft and reopen the questions of meaning, success, and progress that the artist's late period is supposed to move beyond", Shipe (2009) explores Exit Ghost from the perspective of Roth's lateness, defined by a sense of mortality and loss. Elements pertaining to this style surfaced long before the actual publication of Exit Ghost, in 2007. A decade earlier, American Pastoral sets out as an expression of nostalgia and the loss of a historical paradise never to be revisited. An older Nathan Zuckerman, living in seclusion, severely scarred by medical interventions following a serious diagnosis, delivers a tragic and nostalgic meditation on the fate of his postwar generation and its pitfalls. Here, aging and illness are processes of slowly exiting history. American Pastoral is permeated by a sense of no longer belonging to the present, of no longer being part of contemporaneity. Nathan Zuckerman's personal and political perspective belongs to the 1960s and 1970s, and the story of his childhood hero, Swede Levov, marks the demise of both the generic American Dream and of his own illusion of historical coherence and harmony. A sick, elderly Zuckerman receives the news of Swede's death from Jerry Levov, the cynical raisonneur who sums up his brother's life in a harsh, truthful manner: "He was very stoical. He was a very nice, simple, stoical guy. Not a humorous guy. Not a passionate guy. Just a sweetheart whose fate it was to get himself fucked over by some real crazies" (Roth 1997: 65). Those crazies were The Weathermen Underground terrorist group and one of its members, Swede's daughter, Merry. The death of "the powerful, the gorgeous, the lonely Swede, whom life had never made shrewd" (idem: 79) triggers one of Zuckerman's most bitter meditations upon the meaning of Seymour Levov's desire to ask Zuckerman to write about Swede's father: the letter he had sent Nathan asking for an encounter

grew out of Swede Levov's belated discovery of what it means to be not healthy but sick, to be not strong but weak; what it means to not look great - what physical shame is, what humiliation is, what the gruesome is, what extinction is, what it is like to ask "Why?" Betrayed all at once by a wonderful body that had furnished him only with assurance and had constituted the bulk of his advantage over others, he had momentarily lost his equilibrium and had clutched at me, of all people. (Roth 1997: 29)

Ultimately, all verbal constructs articulating the past merely attempt to create the illusion of distance from death. The novel itself, as a fictional biography of the protagonist and of the house of Levov, lies on the narrator's declared effort to tame the obvious fear of death that a commemoration of the past may heighten:

let's speak further of death and of the desire-understandably in the aging a desperate desire-to forestall death, to resist it, to resort to whatever means are necessary to see death with anything, anything, anything but clarity (Roth 1997: 47).

Illness is an isolating experience in the most concrete sense, as Roth literalizes its metaphorical one. Nathan Zuckerman's choice to live, after 9/11, in the region of the Berkshire Mountains signals his departure from community and his sense of disembodiment. Although a detachment from the body politic corresponds to a loss of control over his own body, Zuckerman claims he felt no loss. In the opening passage of Exit Ghost, he declares that "with no sense of loss - merely, at the outset, a kind of drought within me - I had ceased to inhabit not just the great world but the present moment" (Roth 2007:1). As Roth projects the medicalization of the body, the pathological contaminates the intellectual - Zuckerman's incontinence following prostate cancer surgery is mirrored in his progressive incoherence and memory loss. The ghost is a surface metaphor of the physical dissolution of the body and the spectral value of the character as verbal construct. It also recalibrates Roth's consolidated interest in the stages of his bodily estrangement prefigured by illness.

Medical language and the trajectories of pain dictate the narrative flux in The Anatomy Lesson. Moreover, illness becomes a defining part of the character's fictional self. The narrative style of this novel is proof of Roth's search for "an organic and corporeal writing" (Mure Dan 2015: 78) that remains unique in his oeuvre. Although this is not Roth's only novel focusing on aging, illness and the medical approach to the life of the body, it is certainly the one focused on them exclusively.

4.Conclusion

While The Anatomy Lesson and Exit Ghost are fictional maps of Roth's continent of illness and alienation, American Pastoral projects Zuckerman's nostalgic recollection of his personal past into the starting point of a vast meditation on the pitfalls of history and the demise of the American Dream. From the tragic vantage point of his own illness and of Swede Levov's death following a medical issue Zuckerman survived, Roth's fictional double aims at connecting individual fate to a universal frame. Whenever invoked, the complexity of illness deeply permeates and transforms the narrative, as Roth aims to reveal the expressive potential of language when involved in the inexprimable experience ofpain.

Sidebar

Gabriela Glǎvan is an Associate Professor at the West University in Timişoara, Faculty of Letters, History and Theology, where she teaches Comparative Literature. She is the author of a book on Romanian modernism (2014) and of a critical essay on Franz Kafka's short stories (2017). She has published numerous academic studies on modernism, the avantgarde and post-communism and is a contributor to several cultural magazines.

E-mail address: [email protected]

References

References

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Charon, Rita. 2006. Narrative Medicine. Honoring the Stories of Illness. Oxford: Oxford University Press.

Foucault, Michel. 2004. The Birth of the Clinic: an Archeology of Medical Perception. Transl. by Alan M. Sheridan. London, New York: Routledge.

Moran, Elizabeth. 2015. "Death, Determination and 'the end of ends?': Nathan Zuckerman from My Life as a Man to Exit Ghost" in Philip Roth Studies 11(2), pp.5-30.

Mureşan, Laura. 2015. "Writ(h)ing Bodies: Literature and Illness in Philip Roth's Anatomy Lesson(s)" in Philip Roth Studies 11(1), pp. 75-90.

Pellegrino, Edmund D. 1982. "To Look Feelingly - the Affinities of Medicine and Literature" in Literature and Medicine 1(1), Johns Hopkins University Press, pp. 19-23.

Roth, Philip. 1983 (ebook 2013). The Anatomy Lesson. Toronto: Collins Publishers.

Roth, Philip. 1997. American Pastoral. New York: Vintage Books.

Roth, Philip. 2007. Exit Ghost. Boston. New York: Houghton Mifflin Company.

Said, Edward. 2007. On Late Style: Music and Literature Against the Grain. New York: Vintage Books.

Searles, George J. (ed.). 1992. Conversations with Philip Roth. Jackson, MS: University Press of Mississippi.

Shipe, Matthew. 2009. "Exit Ghost and the Politics of 'Late Style'" in Philip Roth Studies 5(2), pp.43-58.

Sontag, Susan. 1978. Illness as Metaphor. New York: Farrar, Straus and Giroux.