Commonly argued among readers is whether fiction or nonfiction brings the most value to understanding any particular issue. These arguments sometimes end with one interlocutor saying, “I only read nonfiction,” and the other saying, “I only read fiction.” Choosing either one alone, however, can deprive readers of valuable knowledge and perspectives that only both together can provide. Such is the case when reading Laura Spinny’s history, Pale Rider: The Spanish Flu of 1918 and How it Changed the World, and Kathryn Anne Porter’s “short novel”—as she insisted it be called—Pale Horse, Pale Rider. Spinny researches the effects the pandemic had on exposed populations and Porter conjures the effects it had on infected individuals.

The titles for both Spiney’s book and Porter’s story draw from the the Four Horsemen of the Apocalypse in the Book of Revelation (6:8) in the New Testament, and one of the horsemen in particular.

And I looked, and behold, a pale horse! And its rider’s name was Death, and Hades followed him. And they were given authority over a fourth of the earth, to kill with sword and with famine and with pestilence and by wild beasts of the earth.

Both books speak of death, not as the natural course of human life, but resulting from an apocalypse of a biblical scale, of a vengeful god, and of a plague in form. Spinney applies the apocalypse metaphor to peoples and Porter to persons.  

Spinny’s account focuses on how the 1918 flu pandemic altered history.

The flu resculpted human populations more radically than anything since the Black Death. It influenced the course of the First World War and, arguably, contributed to the Second. It pushed India closer to independence, South Africa to Apartheid, and Switzerland to the brink of civil war. (p. 8)

She also describes how national public health and global health organizations reorganized and generated momentum towards today’s more sophisticated agencies. She suggests further that the flu pandemic affected literature and art as well, and speculates about why it’s not remembered in any way like the two world wars of the same century. The bulk of the book, though, describes what happened to populations, and how this pandemic could be considered an apocalypse.

The number of dead could have been as high as 100 million—a number so big and so round that it seems to glide past any notion of human suffering without even snagging on it. It’s not possible to imagine the mystery contained within that train of zeroes. All we can do is compare it to other trains of zeroes—notably, the death tolls of the First and Second World Wars—and by reducing the problem to one of maths, conclude that it might have been the greatest demographic disaster of the twentieth century, possibly of any century.(p. 171)

This is where Porter’s literary contribution to capturing “any notion of human suffering” comes in—the personal apocalypse. Based to a degree on her own experience surviving a case of the 1918 flu, her short novel follows Miranda, a reporter for a local newspaper in Denver, Colorado, during a time when she is early in a courtship with Adam, a soldier on leave from camp but who is soon to be shipped overseas to the battlegrounds of WWI. Together they start to see the flu engulf the area.

“I wonder,” said Miranda. “How did you manage to get an extension of leave?”
“They just gave it,” said Adam, for no reason. The men are dying like flies out   there, anyway. This funny new disease. Simply knocks you into a cocked hat.”
“It seems to be a plague,” said Miranda, “something out of the Middle Ages. Did you ever see so many funerals, ever?” (p. 281)

Then, the flu engulfs Miranda, and Porter helps us imagine what a personal apocalypse could be like when an individual succumbs to it. She imagines the Pale Rider pulling her away from her physical moorings on Earth.

I must give up, I can’t hold out any longer. There was only that pain, only that room, and only Adam. There were no longer any multiple planes of living, no tough filaments of memory and hope pulling taut backwards and forwards holding her upright between them. There was only this one moment and it was a dream of time, and Adam’s face, very near hers, eyes still and intent, was a shadow, and there was to be nothing more… (p. 304)

Eventually the Pale Rider tries to pull her away from even any vestige of her corporeal being itself, and were it for a mere particle of life force would have done just that.

Silenced she sank easily through deeps under deeps of darkness until she lay like a stone at the farthest bottom of life, knowing herself to be blind, deaf, speechless, no longer aware of the members of her own body, entirely withdrawn from all human concerns, yet alive with a peculiar lucidity and coherence; all notions of the mind, the reasonable inquiries of doubt, all ties of blood and the desires of the heart, dissolved and fell away from her, and there remained of her only a minute fiercely burning particle of being that knew itself alone, that relied upon nothing beyond itself for its strength; not susceptible to any appeal or inducement, being itself composed entirely of one single motive, the stubborn will to live. This fiery motionless particle set itself unaided to resist destruction, to survive and to be in its own madness of being, motiveless and planes beyond the one essential end. Trust me, the hard unwinking angry point of light said. Trust me. I stay. (p. 311)

Many published histories of the 1918 flu pandemic concentrate on the devastation visited upon nations and populations. Most stop at the individual, because historians rely on tangible and verifiable facts, but literary fiction writers can turn personal narratives into stories that render pictures of what individuals could experience with particular illnesses. These two books referencing Pale Horse, Pale Rider in their titles—one a nonfiction history and the other a literary fiction—work well in combination to capture the experiences and consequences of this flu on both populations and individuals. Further, these two books show why fiction and nonfiction accounts of particular subjects should not be considered a choice, but rather as opportunities to get fuller accounts of diseases on populations and individuals.

Revelation 6:8, English Standard Version (ESV). © 2001 by Crossway; text edition: 2025.
‘Pale Horse, Pale Rider’ In The Collected Stories of Katherine Anne Porter, Harvest, 1979.
Spinney L. Pale Rider: The Spanish Flu of 1918 and How it Changed the World. New York; Public Affairs, 2017)
Web image generated by Gemini AI

What could it be like to have dementia? We can’t know. But the arts can imagine what people with dementia could be going through, and many works have been produced for that purpose. We feature a literary novel (The Wilderness), and a play (The Father) and its movie adaptation, offering sophisticated renderings of dementia for consideration. In the course of our conversation about these works and how they imagine dementia, we include: how an illusionist was part of the creative team in The Father to produce a sense of disorientation among audience members; how the metaphor of “the wilderness” is used in the novel and more broadly in various texts from the beginning of civilization; and how well the psalm used in the novel worked and builds on the place of psalms as texts for understanding how people react when threatened by significant life events.

Featured Content Sources:
• The Wilderness, by Samantha Harvey, Anchor Books, 2009.
• The Father (play), Florian Zeller playwright, Doug Hughes director, Christopher Hampton translator, NYC Broadway 2016 + tour sites, London West End 2015 + tour sites.
• The Father (movie), Florian Zeller screenwriter and director, Christopher Hampton translator, Trademark Films, release date US – 2/26/21, available through many streaming services. 

Links:
Russell Teagarden’s associated blog pieces at According to the Arts: 
• The Wilderness: the novel and literary excerpts compared with biomedical text
• The Father: the play and the movie

Russell Teagarden’s review of The Father (movie) in the journal, The Pharos.
Podcast episode 6, which features dementia related to Parkinson’s disease and expressed through the poetry (sonnets) of Micheal O’Siadhail is here.
Background information on development of Alzheimer’s disease as an obscure and rare disease to a broad categorization of dementia: 
Claudia Chaufan, Brooke Hollister, Jennifer Nazareno, Patrick Fox. Medical ideology as a double-edged sword: The politics of cure and care in the making of Alzheimer’s disease. Soc Sci Med 2012;74:788-795.
Patrick Fox.  From Senility to Alzheimer’s Disease: The Rise of the Alzheimer’s Disease Movement. The Milbank Quarterly 1989; 67:58-102.

Feature image by Margarida CSilva

On this episode, we talk with Dr. Ross Slotten about his memoir, Plague Years: A Doctor’s Journey through the AIDS Crisis. He covers the time from when he entered family medicine practice just as AIDS was emerging, through the crisis, and the decades since as both a physician and a member of the at-risk community of gay men on the north side of Chicago. We also talk with Dr. Slotten about two other sources covering the early years of the AIDS crisis: a documentary film about the first country’s first AIDS unit at San Francisco General Hospital, and a literary novel about a group of gay men with AIDS or at risk for AIDS in Chicago. 

More about Dr. Slotten’s background is here, which includes authorship of the book, The Heretic in Darwin’s Court: The Life of Alfred Russel Wallace (published by Columbia University Press, 2006).

Sources:
Plague Years: A Doctor’s Journey through the AIDS Crisis by Ross Slotten, published 2020, University of Chicago Press
5B, directed by Paul Haggis and Dan Krauss, released June 2019
The Great Believers by Rebecca Makkai, published 2019

Russell Teagarden’s blog pieces on episode sources:
Plague Years
5B
The Great Believers

Recommendations (we didn’t have time to talk about):
Rent (play, movie), Jonathan Larson
Angels in America (play, movie), Tony Kushne
Blue (movie), Derek Jarman

The Clinic & The Person is a podcast developed by our editor Russell Teagarden to summon or quicken the attention of health care professionals, their educators, researchers and others to the interests and plights of people with specific health problems aided through knowledge and perspectives the humanities provide.

Feature image by Iluha Zavaley 

We feature four different angles addressing the opioid crisis, mostly as the opioid product OxyContin is involved and as the Appalachian region is affected. Our objective is to show how realms outside Biomedicine—the Humanities, in this case—can provide a range of perspectives suited to preferences, interests, and needs for understanding a particular issue. The four angles we feature are: nonfiction investigative journalism; nonfiction dramatization; narrative nonfiction; and literary fiction. We consider different approaches to selecting the best choice or the best order among available options.

Source Citations:
Macy B. Dopesick. New York; Little, Brown, and Company, 2018
Strong D. Dopesick. John Goldwyn Productions, 2021 (streamed on Hulu)
Keefe PR. Empire of Pain. New York; Doubleday, 2021.
Kingsolver B. Demon Copperhead; Harper, 2022. (Winner of the 2023 Pulitzer Prize for Fiction)

Links:
Russell Teagardens According to the Arts blog pieces mentioned in the podcast: 
Dopesick (nonfiction book – investigative)
Dopesick (TV miniseries)
Empire of Pain (narrative nonfiction)
Demon Copperhead (novel)

Russell Teagarden’s article in The Pharos comparing Dopesick (the book and the TV miniseries) with Demon Copperhead

Recommendations:
De Quincey T. Confessions of an English Opium-Eater. New York; Penguin Classics, 2003. (See Russell Teagarden’s blog piece on this book here.) 
Daudet A. In the Land of Pain. (Translator Julian Barnes) New York; Alfred A. Knopf, 2002. (See Russell Teagarden’s blog piece on this book here.)

The Clinic & The Person is a podcast developed by our editor Russell Teagarden to summon or quicken the attention of health care professionals, their educators, researchers and others to the interests and plights of people with specific health problems aided through knowledge and perspectives the humanities provide.

Feature photo by ANTIPOLYGON

We consider “illness as loss” through three different scenarios from Lionel Shriver’s novel, So Much For That. The three scenarios are: sociopsychological, financial, and clinical. We focus on how the literary novel form isolates these scenarios and offers fully reflective accounts of how people can be affected by them. We also note how literary fiction can be the only or best medium for subjects often too sensitive for public forums such as whether money can be an object in health care decisions. We spend some time distinguishing illness as what people experience subjectively from a particular health problem, and disease as the pathophysiological basis for a particular health problem. Dan talks about how illness as loss is a useful concept for discerning the help people may need, and how using the word “loss” can be a valuable tool for helping them.

Citation:
Shriver L. So Much For That. New York; HarperCollins, 2010.

Links:
Russell Teagarden’s blog pieces mentioned in the podcast:
Review of So Much For That

A comparison of biomedical and literary descriptions of familial dysautonomia
Distinguishing disease, illness, and sickness
Elements of illness
Illness as loss

Recommendations:
Rick Beato interview with Keith Jarret, recommended by inhouse musical director and cultural editor, Benedict Teagarden
The Diving Bell and the Butterfly, by Jean-Dominique Bauby (memoir and movie)
On His Blindness, John Milton, poem, recommended by inhouse rhetorician and literary editor, Alexis Teagarden

The Clinic & The Person is a podcast developed by our editor Russell Teagarden to summon or quicken the attention of health care professionals, their educators, researchers and others to the interests and plights of people with specific health problems aided through knowledge and perspectives the humanities provide.

Feature photoo by Andrik Langfield