Medicine and the Arts

Infinite Jest
[Excerpts]
By David Foster Wallace

Obesity. Obesity with hypogonadism. Also morbid obesity. Nodular leprosy with leonine facies. The acromegalic and hyperkeratosistic. The enuretic, this year of all years. The spasmodically torticollic. Those with saddle-noses. Those with atrophic limbs. And yes chemists and puremath majors also those with atrophic necks. Scleredema adultorum. Them that seep, the serodermatotic. Come one come all, this circular says. The hydrocephalic. The tabescent and chachetic and anorexic. The Brags-Diseased, in their heavy red rinds of flesh. The dermally wine-stained or carbuncular or steatocryptotic or God forbid all three. Marin-Amat Syndrome, you say? Come on down. The psoriatic. The exzematically shunned. And the scrofulodermic. Bell-shaped steatopygiacs, in your special slacks. Afflictees of Pityriasis Rosea. It says here Come all ye hateful. Blessed are the poor in body, for they. The leukodermatic. The xanthodantic. The maxillofacially swollen. Those with distorted orbits of all kinds. Get out from under the suns cove-lighting is what this says. Come in from the spectral rain. The basilisk-breathed and pyorrheic. All ye peronic or teratoidal. The phrenologically malformed. The suppuratively lesioned. The endocrinologically malodorous of whatever ilk. Run dont walk on down. The acervulus-nosed. The radically -ectomied. The morbidly diaphoretic with a hankie in every pocket. The chronically granulomatous. The ones it says here the ones the cruel call Two-Baggers one bag for your head, one bag for the observers head in case your bag falls off. The hated and dateless and shunned, who keep to the shadows. Those who undress only in front of their pets. The quote aesthetically challenged. Leave your lazarettes and oubliettes, Im reading this right here, your closets and cellars and TP Tableaux, find Nurturing and Support and the Inner Resources to face your own unblinking sight, is what this goes on to say, a bit overheatedly maybe. Is it our place to say. It says here Hugs Not Ughs. It says Come don the veil of the type and token. Come learn to love whats hidden inside. To hold and cherish. The almost unbelievably thick-ankled. The kyphotic and lordotic. The irremediably cellulitic. It says Progress Not Perfection. It says Never Perfection. The fatally pulchritudinous: Welcome. The Actaeonizing, side by side with the Medusoid. The papuled, the macular, the albinic. Medusas and odalisques both: Come find common ground. All meeting rooms windowless. Thats in ital: all meeting rooms windowless. Nor are excluded the utterly noseless, nor the hideously wall- and cross-eyed, nor either the ergotic of St Anthony, the leprous, the varicelliformally eruptive or even the sarcomad of Kaposi. The multiple amputee. The prosthetically malmatched. The snaggle-toothed, wattled, weak-chinned, and walrus-cheeked. The palate-clefted. The really large pored. The excessively but not necessarily lycanthropically hirsute. The pin-headed. The convulsively Tourettic. The Parkinsonially tremulous. The stunted and gnarled. The teratoid of overall visage. The twisted and hunched and humped and halitotic. The in any way asymmetrical. The rodential- and saurian- and equine-looking. The tri-nostrilled. The invaginate of mouth and eye. Those with those dark loose bags under their eyes that hang halfway down their faces. Those with Cushings disease. Those who look like they have Down Syndrome even though they dont have Down Syndrome. You decide. You be the judge. It says You are welcome regardless of severity. Severity is in the eye of the sufferer, it says. Pain is pain. Crows feet. Birthmark. Rhinoplasty that didnt take. Mole. Overbite. A bad-hair year.

Sixty minutes more or less with Madame Psychosis on YYY-109, pp. 181198 (excerpts). From Infinite Jest by David Foster Wallace. Copyright 1996 by David Foster Wallace. By permission of Little, Brown and Company.

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Medicine and the Arts

Commentary

he origin of the list of disabilities and diagnoses and horrors and merely trivial annoyances that sprawls across seven pages of David Foster Wallaces 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 studentradio 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 naivete. We learn that
Mariod 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 shed 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.

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 selfconscious 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 sarcomad 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 sarcomad 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 UHIDs 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, crows 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 peoples 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 catalogs 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 its stuck there, the weary cynicism that saves us from gooey sentiment and unsophisticated naivete.

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 peopleaddicts, depressives, wheelchair-bound terroristsphysical 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 novels doctors, who are

Cynicism is cool. Wallaces 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 naivete 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, naivete does not exclude irony, nor cynicism their high ideals.
Alan G. Wasserstein, MD
Dr. Wasserstein is associate professor of medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; e-mail: alan.wasserstein@uphs.upenn.edu.

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