Thursday, October 30, 2014

Illnesses, Ailments, and Medicine: A "Dive into Worldbuilding!" hangout summary with VIDEO

It always feels a bit odd to me to come into a hangout with a smile saying "Let's talk about Illness!" but that's what we did last week.

Illnesses and ailments often get oversimplified in worldbuilding - a sort of "massive plague or nothing at all" situation. It's not as though no character has ever been portrayed as having a cold/flu (Glenn Cook has done it), but that minor ailments and physical inconveniences tend to be treated as unnecessary and distracting. Meanwhile, in real life, people get sick and have to deal with it.

In fiction, must illnesses and ailments always be plot-related? It's certainly possible to treat them in an unnecessary and distracting way - but it's also possible to do this well. We all agreed that the events that occur in books should have consequences, and illnesses should be no different.

I talked a bit about the situation in my novel, For Love, For Power. The noble caste is severely inbred, so every family has at least one person with something slightly wrong (heart condition, hyperthyroidism, mental illness, etc.). Furthermore, they are all deathly susceptible to viruses that for other castes would be more like the flu. In this book, all of these things are part of the larger picture of the caste's decline, and so including them was very important.

Often in genre we have quests and big tasks that must be performed, which would be hampered by illnesses and ailments.

We don't often see dental problems, vision or auditory problems in fictional worlds.

Pat pointed out that treating yourself for an illness is pretty rare. It's important to ask, "Where are the doctors/healers/midwives?" Kameron Hurley's Beldame Apocrypha was mentioned as a great example of a book with hedge witches. Vonda McIntyre's Dreamsnake also features a healer. Janice Hardy's series The Healing Wars features an entire economy based on magical healing and the taking and giving of pain.

I pointed out that First Aid kits were an invention of the great Clara Barton, and so it's worth thinking about what kinds of things people might carry with them for healing purposes. Ointment? Are there any first aid-related movements in this world that would make kits available?

There's also a lot of history in which people are treated for illnesses and the treatments kill them. People used powdered mummies to ward off plague - but some of those had died of plague, which only spread the plague further. You still see weird treatments today, many being propagated via the internet.

People believed in miasmas and humors and didn't understand the functions of organs. How much knowledge about the human body and germ theory is present in your world?

Reggie mentioned her own work in which she has village healers who help when home remedies don't work. They sometimes use magic, but sometimes use herbs and potions, etc. I liked the idea of a multi-pronged solution to health problems.

Pat mentioned that she's working with the idea of a disease that causes a disconnect between a person's recognition of faces and their feelings about a person. She said this would lead to a delusion that everyone had been replaced by impostors, and cause a paranoia plague.

Take a look at your world and its health care resources. Are those resources scarce? Which ones are? Who gets good care and why? Is it all about money? Can you trust people in the hospital to take care of you, or will you get turned away for social reasons?

People might want to restrict medical care for the "wrong sort" of people, but contagious disease makes that a ridiculous proposition for public health.

Pat brought up that if you get medical care, you might be incurring obligation or an ongoing relationship with the person who provides that treatment. You might have to pay off bills after death, or be obliged to serve someone for life.

What is the situation for mental illnesses in your world? Is care available? Are the illnesses well understood? Are there limitations on care? Is there a stigma associated with mental illness?

What about drugs? Are there controlled substances? What does drug addiction look like? The substances used will depend on the time period, as will the kinds of medicines used for the treatment of illness. Opium and laudanum were used at a certain point. In Tintin we see chloroform and quinine used constantly. The Romans used poppy seeds, and the native American Indians used willow bark. There is also a wide world of poisons out there. People didn't learn how to tell reliably whether someone had been poisoned until the 1920's. There are also medicines that people have used to treat people which will actually be more harmful than helpful (such as mercury).

It can be exciting to see people figure things out about what makes an effective medical treatment. Medical experimentation can be cool, or it can be scary, or both.

We didn't even get a chance to get into all the details of cultural practices surrounding health and health beliefs before we ran out of time!

Today's hangout topic is going to be Economics of Resources and Magic. We'll be on Google+ at 11am Pacific today. I hope you can attend!



  1. Having just recovered from a (fortunately mild) cold, I had to smile at this topic. There's something in the nature of illness, where when we're feeling well it's hard to imagine ourselves being sick, and when we're sick it's hard to imagine ourselves well. I wonder if that's why ordinary maladies tend to get left out of stories a lot. One of the characters in my nip is a healer, so I've spent a lot of time thinking about some of these issues.

    Thanks for including this topic in your worldbuilding series. I always enjoy looking them over.

    1. Thanks, E.L.! I think you're right about how we don't want to think about it, and the way we are "in the moment" with our state of illness or wellness. I'm glad you enjoyed the topic, and thanks so much for following.

  2. It's hard enough not letting a realistic treatment of illness take over a novel set in the real world - it seems even more difficult to manage in a work in which so many other things have to be explained as well.

    When the effectiveness of a character depends on the slight edge that character has over others - and illness is present - the illness can end up destroying the slight advantage.

    And illness affects so many relationships.

    A good one to tackle and be aware of. Those who live with chronic illnesses are underrepresented as characters, because dealing with illness takes to much energy.

    But illness/disability can also strip away the unnecessaries of life - a valuable addition to the novelist's toolkit. Does a woman with a disability also have the capacity for love, or to be spaceship captain?

    And readers: it is 5 times more likely to become disabled before retirement than to die. There are many readers dealing with health issues - and while it may be nice to read about people without problems, it gets tiresome when identification with characters is hard to do because they are so healthy and sunny.

    Good questions.

    1. Thanks for your comment, Alicia. Dealing with illness realistically is very challenging, certainly. I think you point out some excellent things about dealing with issues of chronic illness and disability - which can make stories that much deeper and more meaningful. I appreciate you contributing to the discussion.