The role of disease in fiction

Why do diseases and disorders play such an important role in modern fiction? Some of the most famous characters in film and literature are famous precisely because they are not well. From borderliner Norma Desmond in Sunset Boulevard to cancer patient Hazel in The Fault in Our Stars, we seem to enjoy fictional characters on the verge of collapse, either physically or mentally.

Sunset Boulevard
Sunset Boulevard (1950)

I was reminded of the potency of illness in fiction while reading “Hersenschimmen” (translated as “Out of Mind”) by Dutch writer J. Bernlef. The novel, written in 1984, deals with Maarten Klein, an elderly man who suffers from a rapidly developing form of Alzheimer’s disease. The writer adheres strictly to Maarten’s perspective, showing the destruction of the human mind from the point of view of the mind being destructed. The result is a terrifying chronicle of human frailty.

You’d think people would shy away from such an intensely confronting story. But instead, the novel became a perennial Dutch bestseller and was translated into many languages. So why do we enjoy stories like that? Why put ourselves through an ordeal like Maarten’s?

Strong emotions

First of all, there is inherent drama in people falling ill. Sickness makes people weak, insecure, needy, angry, sad and depressed. It makes characters speak their minds, makes them honest and direct. These strong emotions exacerbate conflict, especially when the illness is grave. And conflict is the basis of all drama.

Physical sickness can also provide the narrative with a ticking time-bomb. A protagonist who finds out he has a fatal disease suddenly has only so much time left to solve that decade-old family conflict, reconnect with his long-lost lover, or experience the good things in life before the curtain falls. Every day counts.

Love Story (1970)
Love Story (1970)

But it’s not just the physical diseases that add drama to a story. Mental illnesses can serve that purpose as well. In real life, many psychological ailments are in some way extreme versions of normal human traits. And that’s exactly how a lot of writers use mental disorders: as a form of psychological exaggeration, to heighten conflict and drama.

So illness in fiction is a way to enlarge the drama of every-day life in a way that makes us reflect honestly and directly on ourselves, our choices and actions. Apparently we sometimes need representations of sickness to understand what’s important in life. But there is more to it than that.

Anticipating the inevitable

Illness in fiction can also help us deal with illness in real life. Stories about cancer survivors, AIDS victims and the mentally ill enable us to prepare ourselves for what is practically inevitable: that we will one day become sick ourselves. Fiction helps us anticipate, or, if we are already sick, manage the onslaught of complicated emotions, negative thoughts, and changes in relationships that are the consequences of falling ill.

As with other complex subjects that stories deal with, disease is presented to us at a safe distance. We see a fictional character make those tough decisions any sick person has to make, and witness from afar what the results are. These second-hand experiences equip us to make our own decisions, or more easily accept our fate, when we ourselves become infirm. Our minds are no longer blank slates in the face of disease; our minds are preloaded with stories that help guide us through those difficult times. In this regard, the distance that fiction provides is essential to its potential benefit.

La Bohème (film adaptation 1926)
La Bohème (film adaptation 1926)

Superficially, these two functions disease has in fiction seem contradictory. At the one hand, illness is used as a way to approach touchy subjects in a manner more direct than usually is inappropriate in real life. On the other hand, disease functions as a way of looking at the touchy subject of disease itself from a safe distance. What those two approaches have in common though, is that they both provide us with tools to reflect on life, as the best stories do.

So what does Maarten Klein teach us, the protagonist in “Hersenschimmen” who loses his memory? Well, the most tragic aspect of his ordeal turns out not to be his pending death, but the fact that he loses his ability to express himself, and grasp the words of the people around him. As a result, he loses his connection to the outside world. Gradually, in the minds of others and his own, Maarten becomes something less than human, a breathing object devoid of thought and purpose. In those last minutes we spend with Maarten, we understand that without words, life loses its meaning. Without words, there is only chaos.