“Sickness Is a Place”: The Foreign Culture of Illness

Abstract

The illness experience-time spent in the place of sickness-has been a defining topos of biomedical ethics since that discipline's birth in the early 1970s. All students of medical ethics and many preclinical medical students are assigned Tolstoy's The Death of Ivan Ilych as a way to begin to understand the torment of a man isolated from his family and friends by his terminal illness.Long part of the literary canon, in part because it is a manageably short sample of Tolstoy's writing that showcases his satire of the middle class of his day, this late nineteenth-century (1886) novella was seized upon by the medical ethics community for its close look at existential suffering and the harm wrought by lying to patients about their prognoses. Ilych blames the deception for plunging him into loneliness that "could not have been more complete anywhere-either at the bottom of the sea or under the earth" [2].