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).

Medical Humanities as an Intersection: Fostering Cross-Disciplinary Intellectual Spaces, A Commentary


This Wednesday we’re pleased to have a post from Julia Knopes. Julia is a PhD candidate in anthropology at Case Western Reserve University, and serves as the administrative coordinator for the newly-launched MA Track in Medicine, Society & Culture in the CWRU Department of Bioethics. Julia’s research examines the socio-material basis of professional role development amongst American medical students. She holds an MA in Humanities from the University of Chicago and a BA in English from Washington & Jefferson College. You can learn more about Julia’s work and current research here.

When I set out to write this commentary, I first intended on penning a blog piece about my own definition of the medical humanities as someone trained in both the humanities and the social sciences. Having come to medical anthropology from a past life in literary studies, my work has straddled the fissure between humanities and qualitative social sciences. I have presented work both on the history and theatrical presence of anatomical learning in the English Renaissance, and on my ethnographic research with medical students in the gross anatomy lab today. Sometimes, my work is focused solely on the present; in other instances, I turn to the historical past to inform my work as a scholar of contemporary medical training. My vision of the medical humanities is one that arrives from both within and beyond traditional disciplinary boundaries.

My approach, however, is but one. I recognize that the medical humanities do not offer a single or unified outlook on human health, illness, and medical practice. In fact, the medical humanities are populated by historians and artists, poets and literary scholars, philosophers and social scientists. Our individual professional identities may be firm—I identify now as an ethnographer and anthropologist, not a literary scholar—but the social, cultural, historical, experiential, and existential study of medicine is simply too complex to be dominated by a single field. The medical humanities (and its ally, social medicine), welcomes perspectives on the humanistic study of medicine informed by our varied native disciplines. More than a single field, the medical humanities often serve as a crossroads: an intellectual intersection (physical, virtual, or social) at which scholars across fields gather in dialogue, whether they identify with a single specialty or as interdisciplinary scholars. For this reason, and regardless of disciplinary allegiances, we can all benefit from the medical humanities as a site of discussion that welcomes myriad voices. Diverse perspectives encourage us to analyze human health and medical problems from numerous angles. As we all carry with us our own analytical methods and theories to this junction, so too do we leave these dialogues having ourselves learned and gained the critical perspectives of our peers. This sharpens our focus anew on social, cultural, and medical problems for which one discipline lacks all answers.

The value of the medical humanities is that they enable all of us to see medical and social problems through multiple lenses. If we cannot fully grasp a complex medical problem through ethnography alone, we turn to historical approaches to complete our understanding of the issue at hand. If individual illness narratives beg to be woven together through other data, we look to sociology and economics to conceptualize the underlying health inequities faced by diverse populations, amongst other socio-medical problems. And, further, when we strive to understand how medical science is confronting illness and suffering today, we turn to nurses, social workers, therapists, physicians, and other health professionals whose day-to-day interaction with patients is deeply informative for our own research. Indeed, clinicians also benefit from our work: the humanities have been widely integrated into coursework for physicians in the United Kingdom[1] and the United States[2]. While obstacles remain in the creation and implementation of medical humanities curricula for future medical practitioners[3], this coursework has widened the intellectual space in which medical humanists exchange ideas with multiple audiences.

Whether medical humanities programs are physically housed within humanities departments, or whether they are exported into numerous health education venues, they remain a space for invaluable cross-disciplinary conversation. I have been fortunate to serve as the administrative coordinator of a medical humanities and social medicine collaborative that has overcome departmental boundaries in creating a new space for scholarly dialogue. This new university-wide initiative in medical humanities and social medicine (MHSM) is anchored by a Bioethics MA degree track entitled Medicine, Society and Culture at Case Western Reserve University. Though the degree program is housed in the School of Medicine, our MHSM (Medical Humanities and Social Medicine) advisory committee (which oversees university-wide activities in medical humanities[4]) includes historians, philosophers, literary scholars, social scientists, rhetoricians, and many others. Across the university, we facilitate lectures, administer competitive conference and research grants for students, and support faculty scholarship and teaching innovation. In the region, we collaborate with neighboring institutions to spearhead events that bring together scholars in all disciplines to discuss common themes in the social and contextual study of medicine, illness, and human health. In addition, we look forward to welcoming our first entering class of graduate students in the Medicine, Society, and Culture track in the Bioethics graduate program this Fall 2016. These students will complete clinical rotations, bioethics coursework, and multidisciplinary training in medical humanities and social medicine.

In sum, the Medicine, Society and Culture initiative has become another significant intersection at which scholars—both practicing academics and new graduate students alike—are able to trade theories, exchange methods, and discuss contemporary intellectual issues with fellow medical humanists and social scientists. Thus, our program seeks to both produce new scholars who approach illness and medicine as inherently multi-faceted human experiences, and to facilitate dialogues with current scholars within various departments who strive to complicate their own understandings of health and the human condition.

Beyond university programming, however, there are many ways that all medical humanities scholars strive—and should continue—to reach across departments and disciplines to share our methods, theories, approaches, and reflections on medicine with one another. This blog is one such space that beautifully forges virtual connections across academic audiences with a shared interest in health, illness, and medical practice. My own field, medical anthropology, by its nature requires researchers to inform their claims through many kinds of data that necessitate several forms of analysis: all which dovetail approaches in other fields. So too did my previous training in literary studies require me to be conversant in historical methods, in close reading techniques, and in the same inductive reasoning skills that I now apply to my ethnographic work. No discipline is an intellectual island: and if there is a universal value of the medical humanities, it is that it has made junctures out of disparate disciplines. It is at once clinical, scientific, and humanistic.


[1] Macnaughton, Jane. (2000). “The humanities in medical education: context, outcomes and structures.” Journal of Medical Ethics: Medical Humanities 26: 23-30.

[2] Hunter, KM; Charon, Rita; Coulehan, Jack. (1995). “The study of literature in medical education.” Academic Medicine 70(9): 787-794.

[3] Shapiro, Johanna; Coulehan, Jack; Wear, Delese; Montello, Martha. (2009). “Medical Humanities and Their Discontents: Definitions, Critiques, and Implications.” Academic Medicine 84(2): 192-198.

[4] Information on members of the CWRU MHSM advisory committee can be found here:

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.