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Referred Pain: Societal Ailments Manifested as Individual Illnesses in Dystopian Literature

By Ms. Margaret Caron, English Faculty

Referred Pain: Societal Ailments Manifested as Individual Illnesses in Dystopian Literature

 “Life is pain, highness. Anyone who says differently is selling something.”

  • The Princess Bride

Perhaps life is indeed pain, as Goldman suggests, or perhaps life is only pain when a government’s control and society’s structure become so stifling and warped that its people develop pains and illnesses as a reflection of that government deterioration. The unbearable agony experienced by Westley in the Pit of Despair is not unlike the pain experienced by the residents of the Thieves’ Forest as they are unjustly forced out of their homes; Buttercup’s sorrow at hearing of Westley’s supposed death mirrors Florin’s morning when they hear news that their new princess has been killed; and Count Rugen’s six-fingered right hand embodies a distorted hand of justice. A corrupt prince, an abuse of power, and manipulative treason are made more palpable by a character’s singular screams and suffering.

This narrative tactic is evident in the novels of Atwood, Zamyatin, Abdel Aziz, and Ishiguro. The Handmaid’s Tale, The Queue, We, and Never Let Me Goshare similar authoritarian governments, sick characters, and broken social systems. Offred, Yehya, D-503, and Kathy are broken, ailing humans, but they are also members of irrevocably broken societies and authoritarian governing bodies. These characters’ illnesses are more than mere byproducts of broken government control and societal values. Rather, these dystopian societies with authoritarian governments posit characters’ physical ailments as representative of larger societal illnesses and failings.

The analogy of the body politic as representative of the state is not a novel concept; it “has its roots in the political writings of Antiquity” (Archambault 22). While in medieval works, “the analogy of the human body served the unvarying purpose of pleading the excellence of the monarchical form of government” (Archambault 31), this paper argues that in dystopian works, the construction and depiction of human bodies in sickness reflects a broken society or government experiencing sickness on a much larger, but less tangible, level. Illness writing is a complicated topic, and connections between the sick and the society emerge as Diane Prince Herndl wonders:

have we learned to think of ourselves as always already subject to the medical gaze, as always already patients? Do we think of disease not as an issue of responsibility, in which we must “fight the good fight” against the invasion of germs, but of ontology, in which illness becomes a state of being? If we are always already” sick, what ethical relationship do we bear to others who are sick? What ethical responsibility do we bear to representation? (Prince Herndl 783)

In this essay, the above personal examination of illness on the individual level is coupled with a close examination of the societal ailments that present as these seemingly isolated instances of death and dying. In a paper examining the representation of outbreaks, Boluk and Lez acknowledge the rise of metaphorical illness:

Indeed, the plague as metaphor has become even more prevalent than the disease itself, whether we speak of the pandemics of the medieval and early modern periods or contemporary illnesses such as AIDS, SARS, or H1N1. Since the early modern period, textual articulations of anxiety regarding biological infection have simultaneously operated as expressions of otherwise largely unspoken anxieties arising in response to the interconnected changes wrought by the onset of modernity generally and the spread of capitalism specifically. (Boluk and Lenz 127)

Thus, this essay seeks to connect individual illness, societal illness, and authoritarian governments in the works of Atwood, Abdel Aziz, Zamyatin, and Ishiguro.

In order to discuss these novels and their common illnesses, one must first delve into the scientific worlds of biology, anatomy, and medicine. “Referred pain” is a term “used to describe pain felt in a region where it does not originate but to which it is referred” (“Human Nervous”). It is most frequently used to describe pains that arise in viscera, or internal organs, and are felt in somatic tissues (“Human Nervous”). This referred pain always describes pain in one direction: “from deep to superficial tissues. It is pain referred from an unknown or unfamiliar part of the body to a known or familiar part” (“Human Nervous”). In an interview for this essay, Dr. Robert E. Nixon, MD FACS explains in layman’s terms that when one hurts his shoulder, he feels pain in the shoulder. When one hurts his gallbladder, he feels pain around and near the shoulder both because the areas are mapped near each other in the brain and because one has more experience with and knowledge of shoulder pain than of gallbladder pain (Nixon). The source of referred pain is not completely clear although an “intermingling of inputs in visceral and somatic tissues” is likely the underlying cause (“Human Nervous”). This medical phenomenon provides the scientific basis for the metaphorical crux of this paper: namely that illness in somatic tissues, or humans, is a “referred pain” from the viscera, or core values and structures, of a dystopian society. This goes beyond arguments that may posit physical ailments as mere byproducts of diseased or broken dystopian societies.

Infertility, miscarriages, and stillbirths plague the citizens of the Republic of Gilead and constitute the first example of a novel plagued by physical ailments. For unexplained reasons, the population is in decline, and ordinary people cannot conceive. The main character, Offred, and other women who have previously given birth in newly-outlawed second marriages are seized by the government as breeders for high-ranking male officials and their wives. The responsibility for conception is placed completely on the women and discussing the possibility of male infertility is outlawed: sterile is a “forbidden word” as “[t]here is no such thing as a sterile man anymore, not officially. There are only women who are fruitful and women who are barren” (Atwood 61). Furthermore, when pregnancy is achieved, it is a life-threatening state. Offred says of a pregnant handmaid, “[n]ow that she’s the carrier of life, she is closer to death” (Atwood 26). While social problems exist in the Republic of Gilead, the language of the people is one of medine, sickness, and death. Furthermore, the focus has shifted from the sense of self to the physical or corporeal body. Handmaids are, to borrow from poet Sylvia Plath, “a means, a stage, a cow in calf” (Plath). Their entire existence has been reduced to their physicality and health. Life and death have become intertwined and inseparable in this dystopian society, and the connection between these two ideas highlights the physical illness that dominates societal thought throughout the Republic of Gilead.

The infertility and bodily sickness in The Handmaid’s Taleserves as a “referred pain” for the visceral illness in the Republic of Gilead. Women and men, unable to reproduce, mirror a societal impotence and an inability to produce new governing systems that will sustain life. Rather than resulting from or contributing to societal ailments, infertility is a physical manifestation of societal shortcomings. As in medicine, there is “an intermingling of inputs” and the ailment is referred from “an unknown or unfamiliar part of the body to a known or familiar part” (“Human Nervous”). Therefore, the Republic of Gilead expresses its sickness through the corporeal body, which is a known and familiar entity, rather than through a dismantling or restructuring of the authoritarian governing body. Additionally, the treatment of the physical ailment supersedes any treatment of societal ailments as the refusal to discuss societal sickness because the “Eyes” manifest as a refusal to discuss male infertility (Atwood 18). Those in positions of power address only the shortcomings of physical bodies instead of the failings of the society itself. Thus, the dystopia presents the ailments of the Republic of Gilead through the infertility of its characters. This then posits that the infertility, which predated and led to the establishment of handmaids, results from a far deeper cause in the very structure of a seemingly-normal past society. Infertility and objectification are not mere symptoms of a disease but rather the rerouted or referred expression of those societal pains.

In The Queue, by Basma Abdel Aziz, physical illness permeates nearly every aspect of the plot and the lives of the characters. When not waiting in the eponymous queue, the characters’ actions revolve around sickness. The novel itself begins with the opening of a file containing patient information for Yehya (Abdel Aziz 2) and ends with Tarek, the doctor, closing that same file as we close the book (Abdel Aziz 217). As the characters within the novel travel to save and preserve lives, the reader travels only from the front to the back cover of a medical file, reemphasizing the novel’s primary foci on physical illness and pain. Yehya’s journey features the most prominent physical illness: a bullet in his abdomen. He waits in the queue in the hope of obtaining permission for surgery to remove the bullet. Tarek, the doctor who discovered the bullet in Yehya’s abdomen, spends his time engrossed in the Yehya’s file. Um Mabrouk has lost a daughter after her “heart had given out one day, after she had waited years to replace its malformed valves” (Abdel Aziz 64). She waits in the queue to amend her eldest daughter’s death certificate and to obtain the surgery for her younger daughter that her eldest was not granted. Thus, every aspect of the plot is inextricably tied to ailments of the physical body; these ailments relate to but also predate the construction of the queue itself. Hearts, blood, wounds, and veins link these medical cases, and the prevalence of these physical injuries does not merely reflect societal issues; rather, it is the expression of societal ailments.

The unnamed Middle Eastern city of Abdel Aziz’s novel is sick and distorted. The inequity inherent in the city’s authoritarian government presents in the exsanguination of its citizens. While Yehya’s bullet directly results from the state’s actions, Um Mabrouk’s daughter’s ailment is more subtle. Like the wave of infertility in The Handmaid’s Tale, the heart’s “malformed valves” predate the Gate of the Northern Building and the queue itself (Abdel Aziz 66). This suggests that the physical ailments do not merely result from the city’s issues; instead, the pain moves “from deep to superficial tissues” (“Human Nervous”), and thus from the internal depths of the society to the people, outward expressions of the city and society. The ailments of of the city are further illustrated by the construction of the Gate of Maladies prior to the Gate of the Northern building (Abdel Aziz 66). While the “Gate of Maladies act[s] as a liaison between citizens who had complaints about their health care and the doctors and officials responsible for them” (Abdel Aziz 66), its construction prior to that of an central government building illustrates the city’s acknowledgements of a diseased society and the expression of that disease in its citizens. Ultimately, Abdel Aziz’s novel presents a people and a city so sick that they are on the brink of death. The societal consciousness, like a brain interpreting pain, is unable to recognize the true origin of the death and dying in the city. It is not Yehya who is bleeding internally as much as it is the city that is dying.

The use of the human body to reflect political structures is hardly a recent phenomenon as illustrated by the “political treatises of the late mediaeval [sic] and Renaissance periods in England, France, and Italy (Archambault 21). It should come as no surprise that Russian writer Yevgeny Zamyatin employs this same “referred pain” in his 1921 novel, We. Disoriented in an authoritarian state, D-503 laments his perceived “illness” throughout the novel. He remarks that “no one around may see the black, indelible spots [he] is covered with,” having moved beyond that first “tiny spot” (Zamyatin 104). These spots, harkening back to Lady Macbeth’s bloody hands, suggest a physical representation of an intangible ailment. This escalating ailment begins as mere spots, but it rapidly consumes D-503:

My head was splitting, I grabbed people by the elbow, pleaded with them as a sick man pleads to hurry, to give him something that would end his torment in a single moment of sharpest pain. (Zamyatin 167)

D-503’s use of the word “as” here illustrates his subconscious realization that is illness goes beyond physical illness; he recognizes that he is a symptom of a larger disease. He believes his illness to be so catastrophic that he titles the penultimate chapter “The End” and resolves to have the operation to remove his creativity and soul (Zamyatin 166). Though he recognizes the operation to be “the same as killing [himself],” he remarks that it is “perhaps the only way to resurrection” (Zamyatin 166). The illness plaguing D-503 and those around him is so destructive within the confines of the One State that he is willing to undergo an operation he equates to death. This physical manifestation or referred pain of a broken society and government is so extreme that citizens inWelike D-503 are willing to subject themselves to the destruction of self to rid their bodies of it completely.

One State, too, is sick. Despite the illusion of perfection, the state’s dire situation is as transparent as D-503’s glass apartment walls. D-503 highlights this when he realizes that “the same white, frightening rash” of protest posters has spread across the city (Zamyatin 112). The description of these posters as a “rash” is a moment wherein both D-503 and Zamyatin acknowledge the sickness devouring the One State. In this instance, D-503 provides the reader with a metaphor for the city that is both physical and dangerous. This sickness is exemplified when the rigidity of the One State forces citizens like D-503 and I-330 to move in perfect synchronized harmony and to visit doctors who might prescribe “truths” for them when they do not perfectly ascribe to the rigidity of One State. Essentially, the One State has removed “being human” from its humans. In doing this, the state itself has entered into the same identity crises that D-503 faces as he contemplates the nature of having a soul. Just as D-503 is unable to process his discomfort with knowledge and must resort to the operation, so does the One State demonstrate a discomfort with human knowledge and must resort to removing that which is human from its citizens. Thus, the societal ailments of the state manifest themselves in the physical illnesses of D-503 as he contemplates the nature of his existence. This is most perfectly expressed by D-503:

As now, I remember the sharp physical pain in my heart. I thought: If nonphysical [sic] causes can produce physical pain, then it is clear that… Unfortunately I did not bring this to conclusion. (Zamyatin 106)

D-503, familiar with physical pain and unfamiliar with societal pain, feels the societal sickness as his own physical sickness in a clear example of referred pain. Ultimately, D-503’s corporeal sickness is a referred pain of the One State’s clear structural flaws as the societal consciousness, or brain, cannot accurately process visceral pain.

In Never Let Me Go, Kazuo Ishiguro presents numerous images of physical illness through Kathy, Ruth, and Tommy as well as the population of England. The novel presents an alternate reality wherein clones are raised for their organ donations to non-clone humans. This reality is explained to Kathy and Tommy by Miss Emily only within the final pages of the novel:

After the war, in the early fifties, when the great breakthroughs in science followed one after another so rapidly, there wasn’t time to take stock, to ask the sensible questions. Suddenly there were all these new possibilities laid out before us, all these ways to cure so many previously incurable conditions. That was what the world needed the most, wanted the most. (Ishiguro 262)

The prevalence of these previously incurable illnesses demonstrates that Never Let Me Go, too, is characterized by sickness. By creating the clones “only to supply medical science,” the society acknowledges the pervasiveness of disease and sickness in England (Ishiguro 261). Furthermore, the creation of the clones leads to increased sickness as the clones themselves deteriorate and “complete,” or die, after a certain number of donations. Tommy recounts how he “got a bit of bleeding” (Ishiguro 221), and Kathy later learns that Ruth’s first donation “hadn’t gone at all well” (Ishiguro 214). Even when they are well, the clones are conditioned to work with or think about donations and therefore sickness and death. As a student at Hailsham, Tommy is fascinated by the idea of “[w]hat’s going to happen to [them] one day. Donations and all that” (Ishiguro 29). Ultimately, Tommy and the other clones are bred or grown for death, reversing the natural order, and creating lives that exist for death. Though much of this illness and death results from the evolution of the donation and clone processes, it is yet another example of referred pain from the viscera of English society.

The alternate reality presented by Ishiguro presents a distortion of what means to be both human and humane. The construction of the disposable clones and the subsequent abandonment of human(e) ethics for the preservation of humanity is contradictory and therefore sick. In this society, the human become inhumane while the “unhuman” clones become most human. To the clones, “[t]he sense of something not being right grew stronger and stronger” (Ishiguro 214), and the societal ailments manifest themselves as physical ailments in the somatic or human tissues. The removal of organs for donation mirrors the simultaneous removal of ethics from the body of English society, and each clone’s completion brings the society closer to its own demise. The morbid nature of the word “completion” in the novel further illustrates the reversal of ethics within the society. While it may be tempting to view the deterioration of the clones as a symptom of the society, the “convergence of impulses form viscera and soma onto the same neurons” (“Human Nervous”) blurs these lines and further reinforces an argument for referred societal pain onto the external somatic tissues, or human clones, in Ishiguro’s novel.

This thorough analysis of both physical and societal ailments in The Handmaid’s Tale, The Queue, We, and Never Let Me Gomake clear the connections between individual pain and larger-scale social illnesses, particularly in dystopian literature with overreaching authoritarian governing bodies. We must, now, return to the definition and conditions of referred pain in human anatomy to analyze why this referred pain occurs in literature. In the human body, “the mere convergence of impulses from viscera and soma onto the same neurons does not alone account for the false localization of visceral pain” (“Human Nervous”). This suggests that proximity alone cannot account for the phenomenon of referred pain. Rather, it is:

probable that in sensory areas of the brain, the skin is served by a large number of neurons, the muscles with fewer, and the viscera with least, the visceral representation in the cortex being very small compared with that of the somatic tissues. It is supposed that, as the input to these sensory regions of the cortex usually comes from the skin and body wall, localization of the visceral input will be to these tissues and not to the viscera, the cortical region of which is small and relatively unused. (“Human Nervous”)

How can we apply this scientific knowledge to our literary exploration of pain? To analyze the former quote, we recognize that the convergence of similar pain cannot account for the referred experience; that is, the similarities between the physical and societal pains are not enough for the pain to be referred onto the citizens rather than onto the social structures that are truly suffering. Instead, the in brain, or the societal consciousness, the people of the society have far more neurons than the visceral organs and structures of the society. Therefore, both the quantity of neurons and the familiarity with physical suffering cause the transformation from societal pain into its expression as individual physical illness, pain, and suffering. From decades of medical and anatomical study, drawings and diagrams exist of the somatic locations of referred visceral pain. Given the information presented within this essay, one might similarly construct a mapped diagram of the somatic referral of societal pains, shortcomings, and flaws in dystopian literature with authoritarian governments.

Far from coincidental, these four distinct occurrences of referred dystopian pain result from authors’ intentional messages about the destructive nature of authoritarian governing bodies and the harmful impacts they have on their citizens. While the use of the body politic has varied throughout history, Archambault clarifies that its messages are inextricably tied to the perspectives of its authors:

We discover this literary [depiction of the body] to be almost infinitely variable; it clarifies or buttresses the most diverse political arguments. We notice, paradoxically, that the image is also used with the greatest caution; for the variation given the analogy provides a fairly accurate idea as to the author’s political tendencies. The image one paints of the human body in this type of literature is a direct consequence of his political orientation: to a large extent, the author’s political colors determine the shades of the image. (Archambault 21)

Thus, Atwood, Abdel Aziz, Zamyatin, and Ishiguro construct the same representations of sick bodies to reflect parallel dissatisfaction with authoritarian governments in their dystopian societies. The illnesses experienced by the citizens of the Republic of Gilead, an unnamed Middle Eastern city, One State, and England are not merely symptoms of broken societies, but rather the referred pains expressing themselves erroneously through neural pathways in the consciousnesses of the cities’ minds.

Perhaps, after all, life is indeed pain because our brains perceive this to be true. The concept of referred pain is a complicated one that lacks concrete or definite explanations. What can be said for sure is that visceral pain is expressed externally on somatic tissues. Not every instance of external pain is a referred visceral pain, but this referred pain is referred in only one direction: outward. Therefore, if a society is sick, hurting, or flawed, its illness will not manifest within the government or social structures but rather on the bodies and in the lives of its people. This is especially true of authoritarian governments in the dystopian literature of Atwood, Abdel Aziz, Yamyatin, and Ishiguro, but the same could be said for our present-day American society. When the government is sick, the people will display illness; it is our job as the social consciousness or brain of this body politic to interpret the neural messages to avoid misdiagnosing their pain.

Ms. Margaret Caron teaches III and V Form English, and she lives in Thieriot South with her husband and golden retriever, Finn. She is pursuing a Master of Fine Arts (MFA) degree, and this essay was her term paper for a course on utopian, dystopian, and apocalyptic literature.






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