“To write prescriptions is easy, but to come to an understanding with people is hard.” -Franz Kafka, in “A Country Doctor”
On January 30th, 1962, three girls at a boarding school in the village of Kashasha, Tanzania (then known as Tanganyika) started to laugh uncontrollably. Though efforts were made to restrain the unusual behavior, they experienced repeated “laugh episodes” that clearly distressed them. Eventually the symptoms spread to 95 of the 159 students. This laughter contagion forced the school to temporarily close, and the girls were sent home. Unfortunately, this spread the disorder to neighboring villages where the girls’ families lived. By the time the Tanganyika laughter epidemic faded eighteen months later, over 1000 people across multiple villages were affected by what is now regarded as a mass psychogenic illness brought on by cultural stressors in the wake of Tanganyika’s gaining independence.1
During this bizarre phenomenon, laughter, often considered a defining human trait used in interpersonal communication and connection2, became a stereotyped symptom of pathology. This detail illustrates an important characteristic of epidemics: elements of humanity are seemingly washed away by a wave of contagion. This is true for mass illnesses that have struck throughout history, including the current COVID-19 pandemic. As such a disease spreads widely, individual personalities get lost in statistics, creating a sense of depersonalization that exacerbates the crisis. This phenomenon, and the unique challenge it presents to physicians fighting the illness, is a crucial theme at the heart of Albert Camus’s absurdist novel, The Plague, one that casts new light on the struggles facing our own doctors treating the novel coronavirus.
Set around the date of its publishing in 1947, The Plague centers on the Algerian city of Oran as it becomes the site of a devastating bubonic plague outbreak. In depicting the epidemic over the course of a year, the novel touches on issues so strikingly like the ongoing COVID-19 crisis that a modern reader could almost be convinced they’re reading a news article rather than a work of fiction. These include struggles between skeptical government officials and medical experts, the closing of the city, social isolation, underequipped doctors, and hospitals overflowing with plague patients.
A major character witnessing these developments is Dr. Bernard Rieux, one of the first physicians to sound the alarm and a doctor working on the front lines to combat the plague. Through Dr. Rieux, Camus illustrates the unique plight of a medical professional in an epidemic that leaves nameless victims in its wake. Doctors are trained to treat individuals, catering their care to the specific needs of each patient. Rieux is so dedicated to this idea that, initially, he can’t imagine the town being laid low by plague even after identifying it. Upon meeting an eccentric government clerk, Rieux comforts himself with the thought that it seems impossible to envision “such eccentricities existing in a plague-stricken community.”3 Someone with such an idiosyncratic personality couldn’t possibly be reduced to an anonymous statistic that Rieux might find in a medical reference text.
Unfortunately, this diminishing sense of personhood is exactly the fate of the citizens. As soon as the city is closed, the plague becomes the primary concern for all. It forces the “townspeople to act as if they had no feelings as individuals,”4 and does so regardless of social standing. This remains true even in the prison, where prisoner and guard alike are at the mercy of the plague’s judgment, and “perhaps for the first time, impartial justice reigned in the prison.”5 Even specific characters mentioned by the unnamed narrator are no more immune to this anonymity. One man is humorously referred to as “Marcel, or Louis” multiple times because he is one of a pair of brothers whom the narrator can’t tell apart.6 Father Paneloux, a respected Jesuit priest initially preaches a sermon suggesting the plague has been sent as punishment for the sinful town. But after seeing the ravages of the illness, a peculiar change in his second sermon hints at his own blurring individuality: “instead of saying ‘you’ he now said ‘we.’”7 This theme of erasure of identity is embedded in the structure of the narrative itself. The narrator isn’t spared a unique identity, and throughout the novel he only uses plural pronouns such as “we” and “our”, whether drawing on his own experiences or those of the town at large. He doesn’t even reveal who he is until the final pages of the novel, and even then continues to refer to himself in the third person.
Perhaps even more strikingly, the dead too are denied rights to an identity as the epidemic progresses. At first, they receive quick burials in unmarked coffins, but as coffins grow scarcer, plague victims are forced to share. When this becomes insufficient, two pits are dug for mass burials, one for men and one for women, as “the authorities still gave thought to propriety.”8 But eventually even this is abandoned, and the dead are thrown in indiscriminately, completely devoid of distinction.
Throughout this progression, Dr. Rieux realizes the hope he placed in the uniqueness of his fellow citizens is no match for the epidemic. Rather, he too must face the truth that “no longer were there individual destinies; only a collective destiny.”9 But for a doctor devoted to the care of each patient, this fact forces him to fundamentally change how he approaches his responsibilities. He sees that “his task was no longer to cure but to diagnose.”10 Upon finding a plague patient, his only recourse is to get them to the hospital and away from others they could infect. His job isn’t one of protecting the ill from death but protecting the healthy from the ill. The doctor is forced to work at a population level, doing what he can to limit the spread of the bacteria, engaging the plague on its terms and treating statistics rather than people. But here the doctor can only do so much, and he feels “as helpless as these unhappy people.”11 Though ultimately inevitable, forestalling death is often a doctor’s immediate goal. Being unable to do this for individual plague patients, Rieux admits that the endemic means “a never-ending defeat”12 for him. And this feels true for him even in spite of his working to limit the overall loss of life. Much like the ancient Greek legend Sisyphus pushing his boulder up a mountain, Dr. Rieux feels he is forever struggling to no avail. (Interestingly, one of the crimes for which Sisyphus was sentenced to his never-ending punishment was chaining Death to a rock and preventing humans from dying.)
Similar feelings of helplessness rooted in the unique population-wide approach to treating pandemics are certainly tormenting physicians facing the novel coronavirus (even if the current crisis is only further highlighting health disparities rather than acting as the great equalizer that the disease is in The Plague). In a revealing piece written for the New York Times, Dr. Helen Ouyang details her struggles with treating this pandemic in New York, and her words reflect closely many of the feelings expressed in Camus’s novel: frustration with not being able to offer as much treatment as usual, being forced to work at a community level and judiciously decide which patients receive care as they all start to blend together into a common set of symptoms, and feeling one’s own vulnerability to this illness that doesn’t spare healthcare workers.13 It’s not hard to see why one might feel pangs of defeat in this situation.
Still, there is much to be said for the good being done by the physicians pushing through these difficult feelings. After all, many patients can and do recover thanks to their efforts. But when patients don’t and it feels like an overwhelming loss, Dr. Rieux offers some consolation in the closing lines of the novel after finally revealing himself to be the narrator. Explaining why he chose to record his experiences, Rieux claims to “bear witness in favor of those plague-stricken people; so that some memorial of the injustice and outrage done them might endure.”14 And while it may be easy to get lost in the depersonalization of pandemic statistics and identical patient symptoms, healthcare workers can rest assured that even when lives can’t be saved, they can be remembered.
- Provine, Robert R. Laughter: A Scientific Investigation. (Penguin, 2000).
- Belarde, James. “Laughter Part 1: Which Came First, the Language or the Laugh.” Medical and Health Humanities, 15 Sept. 2019, https://medicalhealthhumanities.com/2019/09/15/laughter-part-1-which-came-first-the-language-or-the-laugh/. Accessed on 29 Mar. 2020
- Camus, Albert. The Plague. Translated by Stuart Gilbert. (Vintage International, 1991), 47.
- Ibid, 68.
- Ibid, 170.
- Ibid, 152.
- Ibid, 222.
- Ibid, 175.
- Ibid, 167.
- Ibid, 192.
- Ibid, 193.
- Ibid, 128.
- Ouyang, Helen. “I’m an E.R. Doctor in New York. None of Us Will Ever Be the Same.” New York Times (New York, NY), April 14, 2020.
- Camus, 308.