In 2015, Young Black Jack, a television anime adapted from Osamu Tezuka’s 1973 manga Black Jack, began airing. In a reversal of the original’s socially satirical tone, its “saintly” Black Jack becomes a model portrait within a traditional view of medical history. The story follows Black Jack, who survived thanks to skin-graft surgery, as he performs miraculous cures on his way to becoming a professional physician. Physician-centered narratives conceived as tributes, diseases presented in technical terminology, medical ethics and benevolence, miraculous rescues of the dying… By establishing a classic heroic figure, the work serves to inspire its audience and popularize knowledge.
Looking forward from the period when medicine became scientific, we can discern at least three traditions in the arts. One consists of internalist historians’ accounts of medicine’s development as a story of rescue—history told from within the discipline. The doctor appears as a concretely realized “person.” Whether these works emphasize helplessness before reality or sing the profession’s praises, they build their stories around the doctor’s emotions and will. Alongside Young Black Jack are works such as JIN and Iryu—Team Medical Dragon, while Saitō in Give My Regards to Black Jack more often shows his helplessness when confronted with questions of social resources and ethics. Yet both Black Jack and Saitō are doctor-protagonists with independent personalities of their own.
The second tradition explores human nature through people living with disease. Shiki is one example.
Synopsis of Shiki:
One day, large numbers of people in Sotoba village suddenly begin dying of unknown causes. They become “shiki,” living on human blood. Megumi Shimizu, Natsuno… These former humans and the humans who remain move through the village, each holding to their own convictions. At the story’s end, the doctor Toshio Ozaki leads the surviving humans out of the village.
Works of this kind share a narrative model. Looking back at Camus’s The Plague and Solzhenitsyn’s Cancer Ward, we find that their shared model also applies to the original novel Shiki and its anime adaptation. It comprises the following elements: ① an enclosed society and large numbers of infected people; ② an exploration of life and death, and people cast as types; ③ a doctor who plays both narrator and savior.
Camus’s The Plague centers on the North African city of Oran; the fever in Yan Lianke’s Dream of Ding Village breaks out in Ding Village; and Shiki, too, makes a village the principal site of its outbreak. These places are not entirely cut off from the world, but all are partly enclosed, providing ample scope for unusually large numbers of patients to accumulate locally and for illness to become more densely concentrated. Certainly, one can say that infectious disease naturally clusters geographically. Yet Solzhenitsyn’s Cancer Ward and the tuberculosis sanatorium in Thomas Mann’s The Magic Mountain suggest that gathering the incurably ill within a confined area may well be a deliberate choice on the writer’s part. The “madhouse,” meanwhile, had long since become a tradition as medicine became embedded in social institutions. In practical terms, only in this way can otherwise scattered, “representative” human beings, with differing values and backgrounds, be brought into the same time and place.
Suggesting that The Plague reflects the social circumstances of France at the time, Camus says: “But what does it mean, the plague? It’s life, that’s all.”1 Another reading is that the so-called city of the incurably ill is simply a social metaphor created through a dense concentration of people cast as types.
The traditional figure of the beaked plague doctor demonstrates that, when mass death is inevitable, healing the body has already become secondary. Drug treatments and response strategies are not these works’ principal concern. Instead, their authors turn their attention to “people”: incurable illness on a mass scale is inseparable from the study of life and death. Ordinarily, death is an absolute but still latent possibility. Its unpredictability allows us not to think about it; incurable illness makes it impossible to set aside. And within a confined area, the death ultimately brought about by a “disease” that kills so many in so small a space, or by panic at the unknown, is not the disappearance of individuals in body or spirit. It is absolute death: the complete disappearance of the concept “human.” Incurable illness is merely the trigger; what is really at stake is life and death, and the choices people make about their lives. Writers deliberately gather patients into the same time and place so that they can represent different choices about what to value. Among these people cast as types, there may also be a universal “human nature”: if the work does not express the author’s own values, it offers viewers freedom of choice through “human complexity.”
What distinguishes Shiki from these traditional works is that the dead must also make choices, footing the bill for the years the living still have left. Beyond its reflections on life and death, it adds another layer of thought about the human species. In figures such as Megumi Shimizu, the pursuit of love and goodness is intertwined with self-interest. Faced with a strictly finite life, those who shoulder social responsibilities and those who live for the moment are fundamentally no different with regard to “clinging” and “bringing worldly attachments to an end.”2 What deserves admiration and tears is their deluded attachment and their absurd ends.
@Cochlea
In times of widespread epidemics and war, doctors powerless to avert disaster could do no more than put on their “beaks” to guard against infection and search among the heaps of corpses for anyone still alive.
Behind these figures, however, we find another, distinctive group: doctors. Toshio in Shiki—like doctors in other works of art—plays a heroic role. They always live a long time, as though insulated from disease. They appear as war correspondents covering a campaign of annihilation, assuming as a matter of course the roles of decision-maker and coroner.
An important early step in an “infectious disease” outbreak is public disclosure. Naming the disease and making information public are not merely about treatment and tracing its origins, since both a treatment and an account of its origins may very well be unavailable. More important is the imagination of whoever makes the information public: that person must be fully conscious of how people will feel and act afterward—and this important task always falls to the doctor. What makes Shiki distinctive is the cold resolve it gives Toshio, at odds with his role as a “doctor”: his experiments on his wife, his campaign to encircle and wipe out the shiki… (Unlike the medieval tradition of dissection, Toshio’s experiments carry no religious feeling.) Faced with the rise of another species, Toshio’s “protection” is a goodness incapable of empathy. Yet at the story’s end, “survival” itself still indicates some justification for it. In Shiki, Toshio is the person least likely to become a shiki, just as in the usual infectious-disease narrative the doctor serves only as coroner and does not die along with the others. Death and transformation are not chance outcomes of causes and conditions coming together. Anyone might become a shiki; Toshio alone cannot.
Breaking with this tradition, Han Song asks: How does the doctor die? The third tradition in art about medicine takes this question as its basis, continually shifting from an internalist perspective toward a bird’s-eye view from the standpoint of humankind. Placed within society as a whole, the figure of the “doctor” is reconsidered. Han Song’s Hospital contains this exchange:
“A Möbius strip?” I muttered.
“Don’t you recognize the DNA double helix?”
This exchange moved me deeply. The infinite Möbius strip yields to the DNA double helix; mythic imagination retreats before medical punk. What, then, does “infinity” mean in society today? In a humorous vein, Hospital addresses medicalization and demedicalization, the religious character of medicine, its social roots, and much else. When he turns to doctors, Han Song invokes “A human birth is hard to attain; the Buddha’s teaching is hard to hear” to poke fun at the doctor as seen through the traditional outlook:
“Contemporary Buddhist doctrine offers detailed, specialized discussions of ‘medicine as an art of benevolence.’ Although Guxing believes that eliminating illness and even extending life through medicine is a different matter from attaining Buddhahood, staying healthy is the most basic requirement if one wishes to become a Buddha. … Xiao Yang, do you know what it means to entrust someone with your life? Do you understand what it means to practice medicine for the good of the world? Have you heard of the physician’s art of benevolence? When it comes down to it, doctors are living bodhisattvas of boundless compassion, scalpels in hand. It’s understandable if they accept a few cash gifts in red envelopes. Haven’t you seen people scattering banknotes before Buddha statues in temples?”
The undying doctor will move from the traditional pole into the future, where only mechanized, formula-governed doctors remain. The immediate purposes of artistic creation cannot permit the former to die; the latter’s death is difficult for the public to imagine. Doctors are cut off from inspection, listening and smelling, questioning, and palpation; their depersonalization, together with cumbersome bureaucratic procedures, makes seeking treatment increasingly frightening—so much so that “going to the hospital alone” tops the list of the “Ten Loneliest Things to Do.” (Unfortunately, with my terrible Japanese and extremely limited reading, I have yet to encounter any anime or manga belonging to this kind of narrative.)
I am not presenting these three traditions in evolutionary terms. Rather, I am chiefly voicing a doubt: has dissecting those doctors, made proletarian and depersonalized, already become an unavoidable path in the development of medical history and related works?
Take this past July: medical students and medical workers looking to top up their faith joined a public seeking accessible knowledge, phones in hand or seated at their computers, to watch Cells at Work! Does this tell us something? On an emotional level, giving the working cells personalities makes communication possible—both among the characters within the work and between viewers and characters. Neither the mere inculcation of knowledge nor deconstruction offers this opportunity. Creating images of doctors that reflect reality is certainly an urgent task, but it also means refusing the emotional expectations most people bring to them. We still need medical heroes who work miracles and possess nobility of spirit. Attention to the internalist perspective can at least fill medicine itself with warmth, offering some small chance of answering history’s mockery. As John C. Burnham says when comparing traditional and modern views of medical history, one history is not necessarily better than another; they simply offer different perspectives on the past. Or might we seek “another tiger” beyond these two histories of medicine?4
Suetonius:
In antiquity, people had not yet distinguished facts from norms: moral concerns were inseparable from inquiry into nature. After ethical meaning was expelled from science, however, the natural sciences achieved unprecedented success.
But clinical medicine differs subtly from the other natural sciences. The latter arise from the pursuit of universality and necessity; the former does not deny that pursuit, but also arises from human finitude. Concern for patients therefore cannot—and certainly should not—be excluded from clinical work. Our clinicians now recognize this, yet there is still a long way to go in building doctor–patient relationships in China.