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Wasserstein, Alan G. MD

doi: 10.1097/01.ACM.0000403414.62032.e7
Medicine and the Arts

Dr. Wasserstein is associate professor of medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; e-mail:

The origin of the list of disabilities and diagnoses and horrors and merely trivial annoyances that sprawls across seven pages of David Foster Wallace's Infinite Jest is “Madame Psychosis,” an odd and deeply felt radio program, interspersed throughout a narrative (here deleted) about two listeners who could be among the sufferers it names. One is a pimply (“carbuncular”) and “dateless” student-radio engineer; the other is Mario Incandenza, the moral paragon and most pathetic physical specimen of the novel, innocent and empathetic, congenitally deformed, infantile in appearance and in naiveté. We learn that

Mario'd fallen in love with the first Madame Psychosis programs because he felt like he was listening to someone sad read out loud from yellow letters she'd taken out of a shoebox on a rainy p.m., stuff about heartbreak and people you loved dying and U.S. woe, stuff that was real.

In the quoted episode, Madame Psychosis is reading from a recruiting pamphlet of the UHID, the Union of the Hideously and Improbably Deformed. Unbeknownst to her listening audience, Madame Psychosis is a veil-wearing member of UHID, either because her “fatally pulchritudinous” beauty scares men into blockheaded silence and makes her a fatal object, or because her face was scarred by an acid attack. We are not sure which.

In fact, the whole novel is populated by damaged people—addicts, depressives, wheelchair-bound terrorists—physical and emotional and spiritual cripples for whom the language of medicine is appropriate and frequently deployed. More than medical, this catalog of deformities is over-the-top medicalese—obscure, archaic, misspelled, baroque, and mannered. Wallace takes the language of medicine away from the experts and redistributes it into colloquial, Biblical, poetical, and stylized speech. He righteously refashions the language of the novel's doctors, who are self-centered, cold, and (the cardinal sin) unempathetic.

Appropriating the language of medicine, Wallace democratizes and humanizes it. To speak of “the dermally wine-stained” or “the cellulitic” or “the papuled” is mannered and self-conscious but does, at least, name persons rather than diseases or signs. Medical language uses “varicelliform” but never “varicelliformally,” which, by incorporating the word formally, introduces a note of pathos and dignity into the diagnostic term. The “Parkinsonially tremulous” person is not the same as one with a Parkinsonian tremor; he or she is made vividly present with the emotional overlay of the word tremulous. The “sarcoma'd of Kaposi” integrates the medical diagnosis of sarcoma into ordinary speech by making it a bizarre adjectival participle. The “radically -ectomied” generalizes and abstracts the disfigurement of radical surgery and, again by way of the participle, individualizes it.

The problem is, democratizing and humanizing this language also makes a joke of it. Simultaneous with the empathy of this catalog is its mockery. The humanized medical diction is teasing: “the sarcoma'd of Kaposi” and “the ergotic of Saint Anthony” are stilted and weirdly funny. The humor can be cruel and edgy and sophomoric, as in the “Two-Baggers” and “those who undress only in front of their pets.” The carnival barker hucksterism (“come on down”) reaches out to these people who hide their bodies and also mocks them. Alcoholics Anonymous, a positive force in the novel, does not escape mockery either. Here it is parodied with UHID's sentimental and trite language (“Hugs Not Ughs”) and Christian notions of grace (“blessed are the poor in body”). Also mocking and ironic is the inclusion of complaints that are merely annoying and trivial and vain: halitosis, thick ankles, crow's feet, a bad hair year. Some of these complaints exist only in the wounded vanity or stunted social life of the sufferer, the “hated and dateless and shunned.” This is humor at the expense of the patients. It is offensive to those with real disease. And yet people do suffer for these things (any pain is real at some level), and it is generous to sympathize. One of the targets of the irony, as the smarmy hucksterism shows, is self-improvement through consumerism. The UHID catalog is like commercial advertising that creates consumer needs from people's insecurities about their bodies.

This catalog of deformity is simultaneously empathetic and cynical. It mocks the patients or suggests that the profit motive is behind claims of caring for patients. But behind its cynicism is the catalog's solidarity with the suffering and the sick. It is impossible nowadays, Wallace writes, to give up our hip irony and cynicism. As he says elsewhere in the novel,

... for kids and younger people, to be hip and cool is the same as to be admired and accepted and included and so Unalone.... The U.S. arts are our guide to inclusion.... We are shown how to fashion masks of ennui and jaded irony at a young age.... And then it's stuck there, the weary cynicism that saves us from gooey sentiment and unsophisticated naiveté.

Cynicism is cool. Wallace's method is not to suppress irony and cynicism but to use them, to embrace empathy and gooey sentiment in spite of and even through them. Elsewhere in the novel he speaks of the “queer U.S. myth that cynicism and naiveté are mutually exclusive.” There may be a lesson here for educators of young physicians. We may not be able to talk them out of their cynicism, nor shame or inspire them out of it; we may have to acknowledge it and sometimes even reach them through it. As in the UHID catalog of deformities, naiveté does not exclude irony, nor cynicism their high ideals.

Alan G. Wasserstein, MD

© 2011 Association of American Medical Colleges