Illness and Medicine: A Google+ worldbuilding hangout report

First, let me note that there will not be any worldbuilding hangout today, for any of you who might have been thinking to drop in. I'm going to be resuming my worldbuilding hangouts in January. And some secret plans are afoot... I'll let you know more when we get more tied down.

This past Wednesday I spoke with Janet Harriet, Harry Markov, and Glenda Pfeiffer. Our topic was Illness and medicine. As with many of our topics, it's hard to know where to start with this one, so I started by mentioning one of the fundamental underpinnings of any culture of illness and medicine, namely the idea of cause and effect. The way that we treat people, and the types of medicine we pursue, are based on our understanding of the causes of illness. Thus, when a people believes that illness is caused by evil spirits, the medical approach will typically address this problem directly by providing exorcisms and other spiritual approaches. When a people possesses the idea of germ theory, that fundamentally changes the approach to one of finding medicines to deal with the germs in question. There is also the possibility that medicine may be an empirical/experimental practice, which is to say that a people may have found out through fortuitous circumstance that eating a certain plant will cure headaches, or stop a certain kind of illness. In this case the cause of illness may not be considered particularly relevant. Janet felt that (at least historically) midwives have had an expertise that grows out of this kind of learn-by-experience approach. And Harry mentioned that if you have a magical healing system, the sense of cause might not even be necessary.

On the other hand, a logic of magical healing is necessary. This logic can grow out of the general logic of a magic system, or out of some kind of medically based model, but it needs to feel grounded. I mentioned how I'd worked with Janice Hardy when she was setting up some of the cultural underpinnings of the magical healing system she used in The Healing Wars. In this system, healers are able magically to perceive injury and hurt, and to heal it, but must take the pain of it into their own bodies. Then they have to push the pain out into a magical metal which stores it (and is in short supply). This metal is in turn forged into pain-shooting weapons, creating a pain-based economy. Believe me, this is a fascinating trilogy - but at the start we were looking for answers to questions like these:

Who are physicians?
Why are they chosen as doctors?
What is the role of doctors in the culture?
What are the limitations on doctors?
Is there any alternative to the magical healing system?

In fact, people who use plants and other substances to heal are considered dirty in Janice's world, and dangerously unreliable...but the system would have seemed incomplete without them.

I believe it was Harry who mentioned that in the Anime series "Bleach" there is a character who can do what looks like healing, but is actually a localized reversal of time that reverts the damage to its previous condition. Harry shared a logistical issue he's been dealing with in his work in progress, where magic can be used to heal, but at the same time, using magic is a drain on life force. So what happens if you try to heal yourself? It could be complex...

Glenda asked, "How do the magical healers conceptualize healing and illness?" This is an excellent question. Very often we use metaphors to describe illness; this can influence our treatment of it in addition to our general concept of its cause. Magical healers who are aware of physiology will treat people very differently from those who are not. Harry's system has complex rituals - like recipes - for tissue repair. Thus the healer need not know too much about physiology, only how to follow the rituals, and of course he/she must have the magic ability to activate the process.

It is worth doing research when you're dealing with illness and medicine in your writing. Don't just gesture at what is possible. I've gone and looked up how to treat bruises, and I've looked up the different types of recognized mental illnesses, and a lot of other things as well. It's also worth considering the scope of what doctors are called on to treat. As Harry noted, homosexuality has sometimes been considered a mental condition that requires "treatment."

What can you alter in your world? There are lots of underlying parameters that are open to change. For example, who is more important, the doctor or the patient? Who has the power, and why? Can you ask questions about the recommended treatments, such as why and how they are to be delivered? Can you refuse treatment?

It's important to keep in mind also that doctors are knowledge elites, much like priests. They undergo special training, and have knowledge that must be protected and treated with respect. Often they can engage the services of gatekeepers to help them accomplish this. In the case of a system based on evil spirit possession, the roles of doctor and priest can overlap. Even today, Harry told us, people worry about the "evil eye" in Bulgaria: if people look at you and think you're pretty they will jinx you and make you feel ill; grandmothers will recommend washing your eyes three times at the door and washing the door handle and then you should be fine. Exorcisms still happen, and mental illness can sometimes be labeled as possession.

The metaphors we use to describe our bodies and our health are very resistant to change over time, and they can deeply affect our behavior. If you're worldbuilding, this is a wonderful area to spend time developing because tiny phrases will speak volumes about the way your people think. Here are some expressions that the discussion participants shared:

"The hamster that runs my brain fell off."
"One of your boards is loose."
"Losing your marbles"
"Not playing with a full deck"
"You've let go like liver" (in Bulgaria describes lounging around lazily)
"A seagull has eaten your brain"

I wrote a post some time ago called Body Models and Metaphors, which was about how one decides when to seek medical treatment. Some people base their decision on the amount of time one has been sick, while others base their decision on specific types of changes in the health condition.

Some final things we mentioned were terminal illness and palliative care, medical insurance, and issues of public health and vaccination.

In Japan, very often the person who has a terminal illness will not be told, because it is believed that the knowledge would trouble them unnecessarily. Instead, the family will be told, and the patient simply expected to follow doctor's orders without any knowledge of the reason. In the last session I linked to the article called "How Doctors Die" which is also relevant here, about the cultural conditions that lead us to expend so much money on torturous last-ditch treatments when people are near death. The question of medical insurance comes along with the role of government in public health in the society you're designing. Does this society have a concept of spreading the risk across the population? How might a government respond to issues of public health when it is responsible for safeguarding public health and sponsoring treatment? In Australia, the government puts out pretty stiff advertising against unhealthful behavior that brings significant expense upon the public health system. One would expect vaccinations to be heavily supported in an environment like that, whereas in the US a lot of people have been convinced by fraudulent argumentation that vaccinations cause autism or other disorders... leading directly to public health problems such as the resurgence of diseases like measles and whooping cough. There can also be questions of whether one group in society is disproportionately affected by one health condition or another - such as Tay-Sachs disease affecting Jewish people, or royal families having a tendency to carry hemophilia. In my Varin world the noble caste is heavily inbred and so everybody has some kind of health difficulties (or if they don't have them currently, they still might have had difficulties at birth).

Obviously there's far more than can be covered in one hour, but I hope these thoughts have given you some inspiration. Our next hangout will be in January, and I have a special plan in the works, so I want to ask you: are any of you working on creating languages for your stories right now? If so, would you be interested in a special invitation-only hangout with experts (not just me) on language design for fantasy and science fiction? If you are, tell me about it in the comments below.