“Love in the Time of Numbness; Or, Doctor Chekhov, Writer” The New Yorker (April 11, 2017)
(The speech Siddhartha Mukherjee delivered at the Whiting Awards was later adapted and printed in The New Yorker. We present the published version here.)
When my mother’s mother began to die of a mysterious, undiagnosable neurological illness, the first thing she lost was her sense of taste. For most families, perhaps, this would be a rather inconsequential loss, but this had severe repercussions for us. As the matriarch of our heaving, multi-generational family, she had always helmed the kitchen with an efficient, if somewhat despotic, hand. Because all the food in that household was cooked by her—years earlier, an attempted takeover by one of the uncle’s wives had been swiftly and tyrannically rebuffed—my grandmother was, in fact, the ultimate arbiter of taste. For decades, this had been a relatively stable and blissful arrangement: she was an acutely talented cook. But as her taste buds numbed, week by week, the food turned from mild to well-seasoned to intolerably spicy. It was, perhaps, a kind of neural compensation for her—the way people with early hearing loss often begin to speak more loudly—but the fish curry now went off on the palate like a thermonuclear bomb. The lentils exfoliated the tongue. The fried spinach was an incinerating terror; the okra, an endurance sport. When even the white rice, the final refuge of the Asian tongue, began to arrive at the table with halved Thai bird peppers on top, the seeds squinting above it, we squirmed in terror. But we steeled ourselves and kept eating: numbness begetting numbness.
I want to talk to you today about desensitization. In my other life, I am an oncologist. Numbness, you might say, is my occupational hazard. Over the past month or so, I have watched twelve of my patients die from or relapse with cancer. Yesterday, I heard that a friend who ran my favorite restaurant, the place I went for daily refuge while I was writing my last book, passed away from tongue cancer that had colonized her brain and bones. When interviewers ask me how I carry on carrying on, I speak about the startling successes with some of my patients, about hope and the future. But I do not—I cannot—tell them that a certain kind of numbness must be a part of it. I come home from the bone-marrow-transplant wards on a January morning and play with my dog, rearrange the furniture, and practice polynomial factorization with my daughter. I celebrate a recent laboratory paper with a glass of champagne. I return to the wards the next morning and look down a microscope to find a marrow choked up with leukemia cells after a heroic attempt at salvage chemotherapy. And this cycle repeats. You might say that I have an advanced degree in desensitization.
But, of course, I am not here to describe the numbness that accompanies medical practice. There is a different form of desensitization that surrounds us today. When I was asked to give this talk to a roomful of aspiring writers, I had to confront the elephant-in-the-room question: How shall we continue to write in these numbing times?
On April 21, 1890, a thirty-year-old doctor turned writer named Anton Chekhov travelled to Sakhalin Island, a penal colony, in the Sea of Okhotsk, north of Japan. The journey took three months. To get to Sakhalin, Chekhov had to cross, by train, the wind-blown steppes of northern Russia and the still-frozen Siberian tundra. He boarded a horse-drawn carriage, then a steamer across the Amur River, and then a small trawler ship across the Okhotsk Sea.
Why, you might ask, did an unusually sensitive and mild-mannered man—delicate of physical and mental constitution—choose to travel to a hostile, faraway island inhabited by thieves, hustlers, and murderers? Chekhov told some of his friends that he was going to Sakhalin to run a census (and indeed he did run a census, although he didn’t seem to care particularly about the data). He told others that he was doing some sort of ethnographic project on the prisoners and settlers as part of his medical studies. But the census and the medical project were half-lies, each merely an excuse—a “device,” to use his word—to bring him to the island.
So what was the real reason that drove the journey? Chekhov’s medical training had left him spiritually depleted. He had honed his observational skills and matured into an astute diagnostician. But the extraordinary quality of suffering that he had witnessed, and the inscrutable arbitrariness of sickness and death, benumbed him. Much of this anguish would find eventual voice in his later works—particularly in the story “Ward No. 6”—but he wrote virtually nothing about it at the time. We also know that his health was declining. Chekhov’s brother had died, of tuberculosis, in 1889, a year prior to Chekhov’s departure, and Chekhov himself, having spit up blood just before the arduous journey, also knew that he was infected with the bacillus, and that the illness would likely kill him. Perhaps he thought that the island would offer a kind of medical or mental sanatorium.
But as much as he was encumbered by the diseased state of his body, Chekhov was repulsed by the diseased state around him—by the sickness of the body politic. “To a certain extent,” his biographer Ernest Simmons writes, “his anxieties mirrored those of all thinking people of the Eighties, this ‘epoch of social stagnation.’ ” Tsarist Russia in the eighteen-eighties was suffused with moral and economic depravity. It was a society overrun by corruption, bribery, and nepotism. Censorship abounded. The news was frequently manipulated and false. Political dissidents were kidnapped, assassinated, or packed off to prison. The élites ensconced themselves in grotesquely opulent homes while poverty, violence, illness, and incipient famine haunted parts of the land.
It wasn’t just disease or death that Chekhov was trying to escape; it was deadliness. “There is a sort of stagnation in my soul,” he wrote to a friend. Chekhov, then, was looking to resensitize himself—to un-numb the numbness. He sought a place where he might inoculate himself against the ennui that was slowly destroying his soul.
Sakhalin Island, to put it mildly, was not a place for the faint-hearted. What Chekhov found there was a community even more depraved than the one he had left behind—an island society on the edge of sanity, law, and self-discipline. The men on this island hunted each other for sport. Women were routinely sold into prostitution. The children were malnourished and enslaved by adults. The prisoners bribed the guards, and the guards beat the convicts nearly to death.
Two examples from Chekhov’s writings about Sakhalin Island serve as conduits or portals to a deeper point. One is an encounter on the ferry across the Amur River:
On the Amur steamer going to Sakhalin, there was a convict who had murdered his wife and wore fetters on his legs. His daughter, a little girl of six, was with him. I noticed wherever the convict moved the little girl scrambled after him, holding on to his fetters. At night the child slept with the convicts and soldiers all in a heap together.
The second describes a meeting with a woman on the island:
An old woman called Miss Ulyana cohabits with a prosperous old peasant in exile. Once, a very long time ago, she had killed her baby and buried it in the ground; at the trial, she said that she had not killed the child but buried it alive—she thought that she would stand a better chance of being acquitted that way. The court sentenced her to twenty years. Telling me about this, Ulyana wept bitterly, but then she wiped her eyes and asked, “Fancy buying a nice little bit o’ pickled cabbage?
In Plato’s Republic, Leontius, the soldier, forced to confront a glut of decaying human corpses, turns his eyes away in horror and shame. But the appetite to look overtakes him; he rushes toward the bodies, forcing his eyes open and shouting, “Look for yourselves, you evil wretches.” Chekhov, the writer, neither turns away in disgust nor rushes forward to satisfy a sadistic curiosity. He simply looks, and looks again. The gaze is unsparing and penetrating, clear-eyed, clinical—a word used often in association with Chekhov. You cannot see if your eyes are clouded with tears, he seems to tell us: a weeping doctor is a useless doctor. He cuts away the artifice. He cauterizes our indulgences in pity or piety: it is impossible, he reminds us, to feel pity for the self-pitying.
But Chekhov, importantly, does not only cauterize. If the nerve ends were left seared, dead, and blunted—numbed—then he would be a lesser writer. In Chekhov, the clinical detachment—that cool, unsparing, astringent gaze—gives way to tenderness, to a sensitivity that is precisely the opposite of dispassion. The dissecting lamps must be turned on and left on, he realizes, but the patient cannot be left to wither under the mercury bulbs. She must be tended and resuscitated, made whole again. It is easy for the doctor to express moral outrage or indignation at the patient’s illness, but there is narcissism in that revulsion. It is easy, too, to concoct a moral fable out of sickness—“this is a punishment that the patient brought on himself”—but there is sadism in that confabulation. It is vastly more difficult, and more courageous, to observe, describe, diagnose, empathize, and heal. “Six principles that make for a good story,” Chekhov would later write, “are: 1. Absence of lengthy verbiage of a political-social-economic nature; 2. total objectivity; 3. truthful descriptions of persons and objects; 4. extreme brevity; 5. audacity and originality . . . and; 6. compassion.” The first five principles cleanse and desensitize our wounds. But it is the last—compassion—that moves us beyond numbness toward healing.
Chekhov, in short, invented a new kind of literature at Sakhalin. It was a literature inflected with clinical humanity—a literature of keen, nearly medical observation about human nature and its imperfections and perversions, but also a literature of expansive sensitivity and tenderness. “These stories are inconclusive, we say, and proceed to frame a criticism based upon the assumption that stories ought to conclude in a way that we recognize,” Virginia Woolf would later write about Chekhov. “In so doing we raise the question of our own fitness as readers. Where the tune is familiar and the end emphatic—lovers united, villains discomfited, intrigues exposed—as it is in most Victorian fiction, we can scarcely go wrong. But where the tune is unfamiliar . . . as it is in Tchekov, we need a very daring and alert sense of literature to make us hear the tune, and in particular those last notes which complete the harmony.”
It was this world—arbitrary and strange, not unjust but simply lacking justice, without moral or spiritual tidiness, with no simple harmonies, no hum-along tunes—that would find its full-throated voice in Chekhov’s most powerful later works. This world would be actualized in the plays and stories that he crafted after 1890, which would define his oeuvre and establish his reputation: “The Seagull,” “Uncle Vanya,” “The Cherry Orchard,” and “Ward No. 6.” These works indubitably define modern writing. But, perhaps more significantly, they launch modern writing.
Indeed, we might argue that Chekhov invented the modern novel—and, for that matter, contemporary narrative nonfiction—along the way. If the immensity of that achievement escapes us today, it’s because the fundamental elements of Chekhov’s writing—its clinical humanism, its keen compassion, its steadfast rejection of the narcissism of moral outrage and the sadism of moral fables—have become so familiar in the greatest of our literature that, like the air we breathe, they escape notice. We want to see Chekhov through the lens of the modern novel, but it’s the novel that must be seen through the lens of Chekhov.
I hesitate to make this story into a parable—its protagonist would have protested—but this, after all, is a keynote address. What—how—shall we write during this time of numbness? One temptation, perhaps, is to succumb to Leontius’ first urge: to turn our eyes away. Numbness begets numbness, and it’s easy to steel ourselves to our times, or to withdraw from engagement altogether. There’s a more insidious and seductive temptation: to indulge in self-pity and piety. Anger, like false news, is cheap and easily digestible; it is the fast food of the indignant.
Chekhov used Sakhalin as an antidote. It may not have restored his health, but it restored his sensitivity. He moved beyond his own numbness and found a new means of engagement with his world—and, in doing so, invented a new kind of writing. Today, and especially today, as the threat of desensitization—and the accompanying seductions of detachment, outrage, revulsion, indignation, piety, and narcissism—looms over all our lives, we might need to ask ourselves the question that Chekhov asked himself in the spring of 1890: What will move me beyond this state of anesthesia? How will I counteract the lassitude that creeps over my soul?
Each of us will find individual answers to these questions. There is no formula that describes what your solution might be (although Chekhov’s six principles of storytelling certainly come close to such a formula). But it is humbling to recall the breadth and depth of our literary debt to a thirty-year-old physician who set out to cure his anesthesia. The opposite of “anesthetic,” we might recall, is “aesthetic”—a word that originally referred to whatever could be perceived or felt but that came to refer to the nature of beauty. Beauty, in all its myriad forms, can only be created in opposition to numbness. That, at least for me, serves as a quiet manifesto for our times.
Siddhartha Mukherjee is the author of The Emperor of All Maladies: A Biography of Cancer, winner of the 2011 Pulitzer Prize in general nonfiction, and The Laws of Medicine. He is the editor of Best Science Writing 2013. Mukherjee is an assistant professor of medicine at Columbia University and a cancer physician and researcher. A Rhodes scholar, he graduated from Stanford University, University of Oxford, and Harvard Medical School. He has published articles in Nature, The New England Journal of Medicine, The New York Times, and Cell. He lives in New York with his wife and daughters.
Photograph © Deborah Feingold