Mantle of Justice: How Nathaniel Hawthorne Will Save Us from the Affluenza Epidemic


dailydose_darkstrokeThis Monday we are pleased to offer a piece on “affluenza” from L. Kerr Dunn. a writer, health humanities scholar, and editor of the collection Mysterious Medicine: The Doctor-Scientist Tales of Hawthorne and Poe. You can find her online on Facebook, Twitter, and her website.

In a 2015 Washington Post article, columnist Ruth Marcus labeled Donald Trump the “affluenza candidate,” comparing him to Ethan Couch, the teenager who killed four people in Texas while driving drunk in 2013. Couch’s defense psychologist argued that he’d been brought up with so much privilege he couldn’t understand the consequences of his actions. This defense strategy relied upon the pretense that affluenza was a legitimate medical diagnosis. It isn’t. It’s worth noting, however, that the term, a hybrid of “affluence” and “influenza,” is rooted in the idea of viral sickness. And it does seem to have “gone viral.” Twenty-first century Americans aren’t the first to conceive of bad behavior as a sickness—or to consider how affluenza sits at the intersection of politics and health. Around 100 years before the term “affluenza” was coined, Nathaniel Hawthorne handled these themes in his tale “Lady Eleanore’s Mantle.”

Portrait of Nathaniel Hawthorne.
Portrait of Nathaniel Hawthorne.

Set in pre-revolutionary America, “Lady Eleanore’s Mantle” is both a political allegory and a cautionary tale of disease. The title character is a British aristocrat who bears striking similarities to 21st century affluenza “sufferers.” She’s reckless and self-involved, and she treads—quite literally— on others. “When men seek to be trampled upon,” she reasons scornfully, “it were a pity to deny them a favor so easily granted—and so well deserved!” Her lack of empathy is so apparent that “right-minded” individuals have doubts about her “seriousness and sanity.” In fact, her “haughty consciousness of her hereditary and personal advantages” has made her “almost incapable of control.”

Of course, Lady Eleanore represents the British aristocrat’s attitudes toward American colonists, but doesn’t this description of her character sound familiar? Trump has been accused of being unable to hold his tongue—to the point that some have questioned his sanity. Ethan Couch’s defense team essentially argued that he didn’t have the emotional tools to be a productive—or at least not a destructive—member of society. A Ryan Lochte defender called him a “kid,” as if to suggest he should be forgiven because his crime was one of youthful carelessness and not the irresponsible action of a 32-year-old man.

Much like the judges in the case of Couch, however, a British Officer, Captain Langford, believes Lady Eleanore is above punishment because of her ancestry. Isn’t this what Couch’s lawyer was arguing with the affluenza defense? Isn’t this the implicit message sent by judges like Aaron Persky who fail to give just punishments to men like Brock Turner, the Stanford swimmer convicted of sexual assault?

In the case of Lady Eleanore, a physician, Doctor Clarke, predicts that justice will ultimately be served: “See, if that nature do not assert its claim over her in some mode that shall bring her level with the lowest!” he proclaims. A cosmic justice does come in the form of epidemic disease. For Lady Eleanore has brought small-pox with her from Britain in the beautiful mantle she wears, a mantle that by her own admission represents her overweening pride. Unfortunately, when justice arrives, it affects not only Lady Eleanore but members of all social classes, indicating that Lady Eleanore’s type of sickness—both literal and figurative—has the potential to ravage entire populations.

Hawthorne’s allegorical tale demonstrates that “affluenza” and all its trappings are nothing new. The metaphor of contagion is appropriate in the 21st century when individuals from across social classes are drawn to and defend the carelessness, bigotry, and even criminal behavior of those who’ve been given every advantage to know and do better. Has affluenza become contagious? If so, how rapidly is it spreading and through what routes of transmission? By providing us a text that touches upon these questions in a broader sense, Hawthorne’s tale invites speculation about the intersections of American politics, privilege, and health. Hopefully, discussions of this tale will include conversations about the importance of empathy, compassion, and social justice, forces for good that may contribute to the affluenza “cure.”



Dooley, Sean and Alexa Valiente. “How an ‘Affluenza’ Label Was Used in DUI Manslaughter Case Involving Drunk Teen.” ABC News Website. (October 14, 2015).

Hawthorne, Nathaniel. “Lady Eleanore’s Mantle: Legends of the Province House III.” Twice Told Tales, vol. 2.

Marcus, Ruth. “Donald Trump is the Affluenza Candidate.” The Washington Post (December 31, 2015).  

Mosbergen, Dominique. “Brock Turner Juror Skewers ‘Lenient’ Judge Aaron Persky in Letter: ‘Shame On You.’” Huffington Post (June 14, 2016).

Is the Pen as Mighty as the Scalpel? Literature and the Saving of Lives

dailydose_darkstrokeLois Leveen, PhD is a Kienle Scholar in Medical Humanities at Penn State College of Medicine and the author of the novels Juliet’s Nurse and The Secrets of Mary Bowser.  Her public humanities work focuses on how content and approaches from literary studies, history, the visual arts, and related fields can foster greater reflection for individuals and deeper bonds of community among practitioners, patients, and families.  Contact her through

Lucy Kalanithi, widowed in her thirties by lung cancer, describes her neurosurgeon husband’s final year not as a period of dying but as a period of living:  

By the time he had become too sick to continue working in the operating room, he was writing furiously about his struggles — as a physician, a lover of literature and a terminally ill patient — to continuously seek and live his values. Returning to writing kept him serving others and helped him to live well.

The result of this furious writing is Paul Kalanithi’s memoir, When Breath Becomes Air, a deeply moving literary work.  As a record of how to cope with terminal illness and a document of how to accept suffering as part of what makes us human, the memoir does indeed serve its readers.  In the coming years, it will likely become a favorite text for medical humanities courses and scholarship.  But the greatest power of the book lies in what it tells us not only about Kalanithi’s slow demise from cancer, but about how his own dying contrasts with that of his close friend and fellow resident “Jeff” (like many memoirists, Kalanithi uses pseudonyms for nearly all of those he writes about), whose life ends suddenly, by suicide.  

For all the emotional impact of Kalanithi’s memoir, what strikes me most about it is how little attention Jeff’s death gets from critics and readers.  Both Paul Kalanithi and Jeff are highly skilled surgeons and caring human beings, yet as captivated as we are with the dramatic and rare death of a young physician from cancer, we seem unable to confront the equally awful reality of physicians dying from suicide.  It may strike us as incomprehensible that a thirty-something non-smoker could suffer from advanced lung cancer, but when it comes to physician suicide, we are more willfully refusing to comprehend how wide spread the problem is.

To put it more bluntly, how can we expect physicians to care for and save us, unless we acknowledge how difficult it has become for them to care for and save themselves?  

Answering that question can have important consequences for physicians, patients, and public health.  Approximately 400 physicians die by suicide every year in the US.  Thousands of others experience such intense burnout they leave the profession.  Still more continue to practice, despite untreated depression or burnout.  In The Hidden Dying of Doctors: What the Humanities Can Teach Medicine, and Why We All Need Medicine to Learn It, I argue that Kalanithi’s memoir—and medical humanities more broadly—can provide an important model for addressing these problems.

I have many friends who are healthcare practitioners, from ER doctors to infectious disease specialists, from hospital nurses to physicians serving indigent patients.  Sometimes I feel a little ridiculous (or self-important) to suggest to them, or to anyone who deals with sickness and dying in their workplace that there can be something lifesaving about bringing literature, art, philosophy, and other humanities into their already busy professional training and careers.  But the response I’ve gotten from physicians to The Hidden Dying of Doctors underscores how imperative this work is.

Medical Utopias and Dystopias in Science Fiction Films: The case of Elysium (Blomkamp, 2013)


This morning we have a post from Maria Katsaridou, a PhD candidate at Aristotle University, Greece. Her fields of study include animation, films, video games, semiotics, narratology, and adaptation theory. She has published many articles and book chapters. In addition to her main studies, she holds a degree in biochemistry. You can find her at LinkedIn and

The presence of innovative medical and technological breakthroughs in science fiction movies, which is offering us a glimpse of either a probable or a completely fantastic future, is far from new – it is a rather very common practice within the science fiction genre.

While many other science fiction films refer to medical advances in order to lend plausibility and reasoning to the movies, Elysium (2013) is highly focused on discussing the articulation between the possible medical and technological progress with the social structures. The film raises questions about social disparity concerning medical treatment and the access to new, innovative medical practices. The answers lie in social choices, rather than pure scientific ones: there are those who have the right to access the new, innovative medical practices and there are those who do not. Not only does this fact define quality of life for different social classes but, eventually, it also defines who will live and who will die.

The film takes place in the year 2154. Earth is a dystopic world, overpopulated, polluted and ruined. The great majority of people still live on Earth and in dramatic conditions, struggling for their everyday survival, suffering from poverty, unemployment, starvation and disease, in addition to lack of sufficient medical care and the access to advanced therapies and technologies. The very few wealthy (around half a million people) who consist the upper class, live on Elysium, a torus-shaped, high-tech utopian space station where illness, poverty and hunger are eliminated.1 The rich live a luxurious life, with access to advanced technology and private medical care, which cure any medical condition instantly and prolong their lifespan indefinitely. Any access to Elysium and its medical services is strictly forbidden to Earth’s citizens.   

Elysium resides so close to earth that it is visible to the suffering residents of the planet, who try to reach it in order to be cured, at any cost, even if this means risking their lives in the process.

Spoiler Alert: the summary reveals important plot details! Continue reading “Medical Utopias and Dystopias in Science Fiction Films: The case of Elysium (Blomkamp, 2013)”