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

Egon devotedly cares for his sick wife despite her warning, “You will get it from me” (p111). Soon she is unresponsive. As Egon listens for a heartbeat with his ear against Edi’s motionless chest, he can only auscultate the distant, faint beat of his unborn child’s heart that is quickly silent. He tragically describes Edi’s corpse: “Her body being both cradle and coffin, within a minute” (p128). Egon feels compelled to make multiple sketches of his dead wife. 

Before long, Egon experiences harsh bouts of coughing, fever, and chills. He becomes remorseful about the drawings he made of Edi and burns them in the kitchen stove. Egon gazes at the fire, knowing he too will die shortly but aware that he will be survived by all his other artwork. 

This short story imagines the final days of Austrian painter Egon Schiele and his pregnant wife Edith. He died at age 28, just three days after she passed away, both victims of the 1918 influenza pandemic. 

A stunning and sorrowful re-creation of what the end of life might have felt like for a young husband and his expectant wife during the 1918 pandemic. The tale highlights the risk of love, the inescapable weight of dread, and the connection between creativity and illness. 

Primary Source 
Blank Pages and Other Stories (pp105-138) 

Publisher 
W.W. Norton & Company, New York, 2022: 34 pages 
A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.
Web image by Medhum.org

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Although his story opens with the establishment of the Johns Hopkins Hospital in 1876, Barry immediately takes a detour into the history of medicine dating back to Hippocrates, and traces the history of medical/scientific thought from Ancient Greece to the end of the 19^th century. He then introduces a series of physicians, scientists, and medical researchers who will play their parts in the story of the pandemic (this first section is called “The Warriors”) and outlines their training, research, and interactions.  

It isn’t until page 91 that he takes us to the rural Kansas county in which the story of the pandemic begins. For although it was called the “Spanish Flu,” that was actually an eponym of convenience; in fact, the first cases of pandemic flu seem to have arisen on the American prairie. However, newspaper reporting on the new pandemic was felt by the Allies and Central Powers alike to be contrary to the public interest (the war was still raging), so it was left to neutral Spain, whose king had come down with the disease, to publish the early reports. In this section, “The Swarm”, Barry also briefly reviews the basic (not to worry, very basic) microbiology of viruses and the history of some prior pandemics. He follows this with the section called “The Tinderbox,” in which he traces the events leading up to the entry of the United States into World War I, and the importance of that war and the political and social conditions surrounding it in the history of the pandemic. From here on in the influenza itself takes center stage; in sections called “It Begins,” “Explosion,” “Pestilence,” “The Race,” and “The Tolling of the Bell,” the rapid and lethal course of the pandemic is described in gripping (no pun intended) detail. The last two sections discuss the scientific advances (and some false starts) brought about by the cadre of researchers working day and night to tame the outbreak, and then Barry finally turns to the retreat of the virus and ultimate end of the pandemic. The book ends as it began, returning to the stories of the individual men and women of science who engaged in the battle to beat the disease of which it had initially been said by many that “[t]his was, after all, only influenza.”  

For anyone seeking to understand the 1918 influenza pandemic not only from a scientific and medical historical standpoint, but also with an appreciation of the political and sociocultural milieu in which it took place, you can’t do much better than Barry’s work. It is not short—it clocks in at 461 pages, with another nearly 40 pages of endnotes and a 20 page bibliography—but it is well-paced and reads smoothly; the narrative carries you along, a testament to the author’s writing style. Barry succeeds in putting a human face on the pandemic and creates a mental image of the horror of pandemic disease which can stand up alongside those we have of the Black Death of the mid-fourteenth century, with which it is often compared. For those of us who know the flu as a seasonal visitor, (for most of us a major annoyance, but nonetheless a disease that kills tens of thousands each year), the images of massive and rapid death—villages abandoned except for piles of corpses, trains that “left one station with the living…[and]…arrived with the dead and dying”—seem surreal. Barry paces the book in such a way that one can almost hear the stopwatch ticking in the background; The Great Influenza is scientific and historical reporting done with great attention to detail and to getting the medical facts right, but it is reporting done with a novelist’s flair.  

Even as the pandemic begins to recede, leaving in its wake not only the dead but those living with its sequelae, such as post-encephalitic syndromes (the Woodrow Wilson/Treaty of Versailles anecdote is particularly striking), the helplessness of medical science is reaffirmed; the pandemic recedes of its own accord, because the virus mutates to less virulent forms, and the very large number of those who have survived helps to create herd immunity.   

In the book’s Afterword, added in 2018, the author discusses and compares influenza pandemics which followed the 1918 experience, talks about some of the antiviral drugs introduced over the years and how they work, and speculates about what the next great influenza pandemic might look like and how it might be prepared for. His concern was prescient, although it would be a coronavirus, rather than influenza, that would cause widespread death and societal disruption. In fact, one of the most jarring aspects of this story is the fact that, if one changes the dates and the names, the tale bears an uncanny resemblance to the COVID-19 story, right down to the attempts at minimization by the government and even the isolation and victimization of an ethnic group (in 1918 the Germans, who were the enemy in the world war, rather than Asian-Americans, as it would be during COVID).  

The Great Influenza is a detailed, highly readable, and sobering account of an episode which demonstrated once again that despite what we may think, we are not the masters of the world in which we live, and that a microbe could rapidly kill on a devastating scale and upend society—again—and there was initially little that could be done to stop it.  

THE GREAT INFLUENZA: A Story of the Deadliest Pandemic in History
John Barry 
Penguin Books, New York, 2004 (reissued with new afterword, 2018)
461 pages 

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.
Web image by Medhum.org

When he arrives, he finds that the hospital is an expropriated village church overrun by rats and ravaged by typhus, and he is the only physician. The hospital is run by a nun, Sister Margarete, assisted only by orderlies, and the patient load runs the gamut from fractures and gunshot wounds to gangrenous legs and massive head trauma. The front is only a few kilometers away, and the wounded arrive continuously; the quiet and formal Sister Margarete confidently and unobtrusively guides him through rounds, surgeries, and battlefield medicine. Lucius is initially wary of her, perhaps a bit awed by her, and ultimately falls in love with her.  

The transforming event is the arrival of the “winter soldier,” Jozsef Horvath, brought in from the snow mute and shell-shocked, but with no visible wounds. For Lucius, who is fascinated by diseases of the brain and mind, this patient presents a tremendous challenge. Lucius is sure that Horvath has “war neurosis,” what the British physicians of the time were calling shell shock and what we today would call PTSD, and he is determined to understand and heal him. Lucius and Margarete make slow progress with their patient, but his attempts to care for the patient have unintended effects, and Lucius must then deal with the consequences of his actions.

The war, and the hospital routine, go on. One day, while Lucius and Margarete are relaxing in the woods, Margarete runs off; Lucius returns to the village, but Margarete is not there. While Lucius and the staff search for her, Lucius gets lost; he stumbles onto a battlefield and is dragooned into service with a regiment of the Austrian infantry. He ultimately escapes and tries to make his way back to the field hospital, and to Margarete, but Lemnowice has fallen to the Russians. The hospital has been evacuated—and Margarete has disappeared.  Lucius’ search for her will take him across the war-torn remnant of the Empire.

The Winter Soldier is a war story, a doctor story, and a romance, and it also poses a wrenching question of medical ethics. This is a lot to ask of any novel, but Mason pulls it off with aplomb. The writing is lyrical; the author’s descriptions of the variation of the seasons in the Carpathian forests are poetic and beautifully detailed, and his characterizations are finely drawn. We can not only clearly see, but also feel that we know, these people, not only the major figures of the doctor and the nurse, but also the orderlies, the Austrian soldiers, Lucius’ somewhat bemused Professor Zimmer, and Lucius’ parents (who are marvels of characterization: the retired military officer father who lives on past glory and cannot see his son for who he is, and the controlling, clever, acid-tongued society grande dame mother who can only see her son for who she thinks he should be). Lucius and Margarete feel real, and their interaction feels real…and complicated. The historical setting comes alive with detail, and the reader truly feels that they are in that place at that time, whether at a formal dinner in a Viennese mansion or treating war casualties in a Galician backwater. And the medical details are correct, not just the medical terms but even the way in which they are used in dialogue, which is not surprising, as Mason is a physician; it isn’t always easy to get this right, but Mason does.  

But the true heart of the medical story here is the ethical quandary in which Lucius finds himself—the complex nature of the doctor-patient relationship, the motivations which drive it, and the decisions we make. Although this takes up a relatively short page count, its repercussions continue throughout the novel.

The novel has a particular, though minor, resonance for the time of COVID-19 (though it was released two years before the pandemic occurred). The action of the novel is set in motion when, due to a war-induced doctor shortage, medical schools decided to allow upper-level students like Lucius to graduate early and become doctors, and then immediately posted them, often with little practical experience, to field hospitals near the front lines.  Several American medical schools took a superficially similar action in Spring 2020 when doctors were desperately needed to help staff hospital units during the coronavirus pandemic, although this only applied to fourth-years who were but a few months short of graduation and would have already had the clinical experience which Lucius lacked. So while the situations aren’t entirely analogous, the concept of students opting into a trial by fire is.

The Winter Soldier can be appreciated for its historical perspective, its story of human relationships, the ethical dilemma it poses, and the beauty of its prose. Or enjoyed for what it is—a great read.

The Winter Soldier
Daniel Mason
New York, Little Brown & Co., 2018; 318 pp.

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.
Web image created by Medhum.org

The narrator in this three-stanza poem observes men in a mental hospital who suffer from what at the time (World War I) was called shell shock and now might be labeled post-traumatic stress disorder. In any case, they are insane; they relive the “batter of guns and shatter of flying muscles.”

For these tortured souls, “sunlight seems a bloodsmear” and “dawn breaks open like a wound that bleeds afresh.” They cannot escape their hideous memories of the warfare. The narrator sees them as living in hell, and he accepts for all society the blame for what has happened to them–we, he says, have “dealt them war and madness.”

Wilfred Owen is recognized as the master poet of the First World War. Writing from firsthand experiences, both in combat and in a hospital recovering from battle fatigue, Owen gave us image after image of how horrible this war was — how the idealized notions of heroism and manly valor meant next to nothing when one was trying to survive gas attacks and bombs dropped from planes. Owen was killed a week before the armistice.

In this poem he opens with a series of questions about who these mental cases are, why they rock back and forth in some kind of purgatory, why they are so tortured with panic and misery. In the second stanza, he answers the opening questions: these are the men whose minds have been ruined by their war experiences, for whom the grotesque carnage of the war was “rucked too thick for these men’s extrication.”

In the final stanza, he explains why these men are so tortured by their memories. And, typical of Owen, he points out that everyone who supported the war contributed to the madness of these mental cases.

📖 Read the poem

The Poems of Wilfred Owen
Wilfred Owen
Publisher: W. W. Norton
Edition: 1986
Editors: Jon Stallworthy
Place Published: New York

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database (Litmed).
Web image created by Medhum.org

The Eye in the Door, the second in the trilogy, turns its attention to the Home Front, and more specifically describes the rampant paranoia during the war, as the government targets two groups:  homosexuals and “conchies,” or conscientious objectors.  While it too is tethered to historical fact, it is more of a fictional narrative concentrating on the state-sponsored witch-hunt, refracted through the story of Billy Prior, a patient of Dr. Rivers.  Billy is bisexual; he also grew up with childhood friends who became pacifists and objectors, and who may or may not have been involved in a plot to assassinate the Prime Minister, and so he moves in both of these marginalized and persecuted worlds.  He also has fallen in love with a woman whom he wants to marry.  During his ongoing treatment of Billy, Rivers confronts his own repressed childhood memories.   

The Regeneration Trilogy has much to recommend it in considering works of literature in the area of medical humanities.  First—and obviously—it is about the psychological damage suffered by young men pressed into military service during wartime, and the way in which medicine approaches their resultant illness with the tools it has at hand.  Each one of these soldiers has a story, each one has a trauma, and there are no pharmacological options. Much like Freud (a contemporary whose work was well-known to him), Rivers felt that the way to treat the shell-shocked soldiers was a “talking cure,” making the traumatic events unrepressed and having the patients recognize and address them.  The stories of the soldiers’ treatments are engaging, Rivers’ warmth and compassion for his charges is unmistakable, and the nature of physician-patient interaction during treatment is explored.   

Barker also poses questions about gender; more specifically, about the nature of manhood and the role of women in a male-dominated society turned upside down by a cataclysm.  Being a man in England during the war means being in uniform and preferably fighting in France; the conchies and the gay men are seen by many, including many women, as being “less than” men, and in their otherness, as subversive.  Women, for their part, have had to step up and assume the roles in the workforce that men have vacated to go off to fight.   It is supposedly the love of their fellow men that allows the soldiers to fight as a unit, to want to enlist and to want to re-up after they are wounded, and this comradeship is trumpeted by those in command.  But it is crucial that everyone understand that this must be the right kind of love; the wrong kind of love is ferreted out and made example of. 

There are many paradoxes, and many instances of doubling or of opposites, in the novels.  Rivers wants to cure his patients, although curing them will render them fit to be sent back to combat and likely be killed.  Several bisexual men lead bifurcated lives.  And underlying all of it is a society rigidly divided along class lines, with the WC’s—the working classes—distinguished not only by their living and working conditions but also by the idiomatic speech put into their mouths by the author.   The war may be in some ways a great “we’re all in this together” moment, but it can’t erase class distinctions.   

It is worth noting that Barker’s style can range over to the gritty and realistic, as well as the graphic, whether describing the events occurring on a battlefield in Picardy or in a bedroom (or back alley) in London. The writing style is crisp, and the narrative moves along nicely.  The author’s characterizations are on point, especially William Rivers and Billy Prior.  Barker has a great feel for language, although some of the words and expressions several of the characters use are distinctly British and may be unfamiliar to American ears.  She conveys an England—or at least, a segment of England—tired of war, tired of being bombed, often living hand to mouth in cold water flats with faded wallpaper and trying gamely to carry on despite being ground down. 

And underlying it all, The Great War—its idealization, its senselessness.  The three volumes of this trilogy are beautifully written, hold the attention, and move quickly, and its relatively spare language has a lot to say. 

The Eye in the Door
Pat Barker 
Dutton: 1994, 288 pages 

Photo of Chester from  The Cleveland Museum of Art 

As The Ghost Road begins, Prior has been cured of shell shock and is preparing to return to the front in France. Rivers takes care of his patients and his invalid sister, amid memories of his experience ten years earlier on an anthropological expedition to Melanesia (Eddystone Island). He befriended Nijiru, the local priest-healer who took Rivers on his rounds to see sick villagers and also to the island’s sacred Place of the Skulls.

Rivers entertains very un-British thoughts about the morality of these headhunting people, and about the power of symbolic healing. As these thoughts intrude upon his consciousness, Rivers is himself in the process of curing by suggestion a soldier with hysterical paralysis. Meanwhile, Billy Prior returns to the front. It is the autumn of 1918 and the last inhuman spasms of the war are in progress. In a futile battle that takes place a few days before the Armistice, Billy and his friend Wilfred Owen are killed.

To me The Ghost Road, which won the Booker Prize in 1995, is the most gripping and fastest paced of Pat Barker’s trilogy. The first two novels are Regeneration (1991) and The Eye in the Door (1993). As W. H. R. Rivers reflects on the culture of death on Eddystone Island, World War I, a culmination of the culture of death in Europe, grinds to a close, taking with it the poet Wilfred Owen. Of course, the characters in The Ghost Road are unaware of the new heights (or depths) that the culture of death will attain later in the 20th Century.

The Ghost Road
Pat Barker
Dutton, 1995
New York, 256 pages

Web image by  Claudio Carrozzo 

Mental Cases by Wilfred Owen

Carol Donley Aug 11, 2025

Owen’s stark poem portrays shell-shocked soldiers haunted by war, exposing both their torment and society’s complicity in their suffering.

Shortly before the outbreak of The Great War, a young engineering student arrives at a tuberculosis sanitorium high in the mountains of Central Europe. Over the course of his visit there he will share many meals (and drinks) with some of the other patients, a group which will include among others a Catholic conservative and a liberal humanist; there will be long, leisurely after-dinner discussions of varied philosophical topics; temperature charts will be compared; and he will become intrigued by a mysterious woman who is also a patient.  

And no, this is not The Magic Mountain. 

The Empusium is the latest novel from the Nobel- and International Booker Prize winner Olga Tokarczuk. The author subtitles her book “A Health Resort Horror Story,” which is exactly what it is. But it is a horror story which the author has cleverly folded into not just the setting of Thomas Mann’s novel, but the setting and certain elements of the plotline, all of them slightly altered, but recognizable. In fact, recognizing them is part of the fun of this well-plotted, rather Gothic tale. 

As the novel opens Mieczysław Wojnich, a young Pole from Łwów, has arrived at the tuberculosis sanitorium at Gӧbersdorf, in Lower Silesia (currently Poland, formerly Prussia), to be treated for his illness. There is no room at the main building, so he is assigned a room at Opitz’s Guesthouse for Gentlemen, where he meets his fellow (male) patients, who come from various Central European cities and differing viewpoints, but who seem to agree on one thing: the general inferiority of women. Philosophical discussions, which often take place over or after leisurely meals and the consumption of a magic mushroom-laced liqueur called Schwӓrmerei, range widely over several topics (war, language, the nature of reality) but most of the time are intensely misogynistic—what is the purpose of women? Do women have smaller brains than men? Do women’s bodies belong to the State? Have any great discoveries ever been made by women? Should women even be educated at all? (Tokarczuk helpfully includes an appendix to the novel in which she notes that all of the quotes of her characters on this subject are paraphrased from quotes by well-known prominent authors of the past, from Augustine of Hippo to William Butler Yeats)  

Things at the sanitorium go badly from the beginning of Wojnich’s stay. He stumbles upon the dead body of a woman laid out on a table, who turns out to be the wife of the guesthouse proprietor, and his companions tell him surreptitiously that she may have been murdered. He hears noises—voices—coming from empty rooms, and cries in the night from outside the guesthouse. An art student who is terminally ill confides that “people die here,” and not just from tuberculosis; every November, apparently, a young man disappears in the surrounding woods, only to have his body turn up ripped to pieces. And what exactly is going on with those woodsmen in the forest, anyway? 

The Empusium works on many levels. It is an homage to The Magic Mountain, but it is definitely not a retelling of The Magic Mountain. The allusions to Mann’s novel are multiple: the pre-World War I setting at a sanitorium in both novels; the fact that both Mieczysław Wojnich and Hans Castorp are engineering students; the philosophies of Settembrini and Naphtha in the Mountain, analogous to the conservative and humanist positions taken in The Empusium; the close childhood relationship between Castorp and Pribislav Hippe (Mountain) and Wojnich and Anatoly (Empusium), in each case bonding over a pencil. And as in The Magic Mountain, there is a narrator who occasionally breaks the fourth wall; verb tenses in The Empusium shift repeatedly from third-person singular past tense to first-person plural present. These are not subtle, nor are they intended to be.  

Allusions aside, The Empusium is its own story, and a totally different narrative. It is a horror story, a revenge story, a wryly feminist tale of the supernatural set in a place hopefully of healing but also of chronic illness and the ever-present specter of death. Tokarczuk builds suspense slowly, bit by bit, with increasing tension. Almost from the beginning there is the undeniable sensation that something is very wrong at Gӧbersdorf, although it’s hard to pin down exactly what it is. Wojnich often has the feeling that he is being watched. The story line draws from a tradition of folk horror, and specifically from the notion that bad things can happen to “city people” when they are out in the country, among the “old ways.”  

The Empusium is also more than just a horror story, and an important aspect relates to the misogynistic attitudes mentioned earlier. Tokarczuk takes a position on the nature of male-female relations (perhaps the use of a sanitorium as the setting is meant to suggest that misogyny is an illness infecting educated society). In this book “civilization” seems to be identified with maleness, and maleness is located in the sanitorium and the guesthouse, a controlled environment with its dining rooms and drawing rooms and intellectual conversation—and in the medical world, since this is a facility for medical treatment— and it is here that women are demeaned. The forest, on the other hand, is the home of the Tuntschi, female figures created by laborers out of sticks and moss and other forest detritus. It is a place both beautiful and enchanting—and dangerous. Men venture into the (female) forest, and the forest—in the form of the Schwӓrmerei, which Wojnich describes as redolent of mushrooms, moss, and earth—is brought into the guesthouse; boundaries are porous. Male and female, the guesthouse and the forest each have their secrets…and Wojnich is the last to know. But Wojnich has a secret of his own.   

And the title? A word created by the author. Empusa, in Greek mythology, was a shape-shifting female spirit who seduced young men, drank their blood, then devoured them.  

The Empusium
Olga Tokarczuk 
Riverhead/Penguin Random House, New York, 2022 
302 pp. 

Web photo by Marek Piwnicki 

What makes The Magician so unique as a novel is its depiction of writing as an all-encompassing creative activity that consumes the author’s full psychic energy and that emerges out of his personal struggles as an individual. It would be impossible to affix The Magician to the back cover of all editions of Buddenbrooks or The Magic Mountain. Tóibín offers more than a page of scholarly references to help a reader gain background knowledge about Mann, his life, and the times. But if you are interested in what it might have been like for Thomas Mann to compose these monumental works, Tóibín’s book might offer the best entry point into Mann’s artistic mind and his creative persona.  

The novel covers the full panorama of Mann’s life, from his somewhat pampered childhood in Lübeck, Germany, to his final years spent in the German expatriate community of Los Angeles. The writer’s camera is laser focused on ground level details and refuses to zoom out to the big picture and lose its granular tone. The texture of the bourgeois lifestyle of the Mann family is captured in all its minutia including rowdy family meals, community engagements, and professional insults. One can almost feel the temperature rise and the climate change as Mann and his family move from Munich to Princeton and finally to Pacific Palisades. Mann exerted very tight control over his daily routine and one senses his absence on the page as he withdraws to his private study every morning after breakfast to write without any interruptions. We are excluded from this sanctuary just like his wife and children as they waited for him to emerge after lunch for his afternoon walk and some playtime with them.

Mann was more than a prominent novelist. He was a winner of the Nobel Prize in Literature in 1929, globally recognized and one of the most famous personalities of his time. He hobnobbed with dignitaries and the leading figures of the pre-World War II era, including Einstein and FDR. They parade across the pages of the novel with all their foibles and idiosyncrasies. Tóibín details Mann’s tempestuous relationship with Agnes Meyer, a leading figure in high society along the New York-Washington DC corridor. I had to look her up to learn that she was a well-known journalist and civil right activist and Katherine Graham’s mother to appreciate her impact on the world during the 1930s and 40s. 

The most striking feature of the book is the intimate recounting of Mann’s tortured struggles with his sexual orientation, which infiltrated his fiction from the very beginning of his career. He never denied his homoerotic longings and Tóibín delicately describes the many occasions during his long life when Mann was overwhelmed with desire for a particular man and his secretive attempts to act on his cravings. But he was a man of his era and was forced to submerge his identity as a gay man most of the time. The emotional cost of a life lived closeted on the one hand, and as the married father of six children on the other, is readily apparent. Reading The Magician motivated me to reread Death in Venice and made me realize the courage it must have taken for Mann to portray Aschenbach’s tragic story in such complex but precise prose, to reify his own emotional turmoil without sanctimony or defensiveness. Tóibín’s prose is the ideal conduit to channel the roiling interface between the Mann of the larger world and the inner literary mind of a flesh and bones historical human being. 

The Magician is an engrossing reading experience that also has special salience for followers of the MedHum website, which explores the role of the individual in a changing society. A key element that drives the narrative forward is Mann’s engagement with the political developments in Germany over the long period spanning from the lead-in to World War I, to the outbreak of hostilities in August 1914 and again in September 1939 and the devastating war years, and ending with the rebuilding of his native country. At the start, Mann saw himself as heir to a tradition of German intellectual excellence and nobility. He took great pride in his country and patriotically defended the decision to go to war against France, Britain, and Russia in August 1914. However, he recognized the dangers posed by the Nazi seizure of power and openly decried the degradation of public life. Mann felt the Nazi destruction of the German cultural heritage as a personal betrayal. Mann recognized early on the brutality of the antisemitic legislation and the attacks on his Jewish colleagues. He was forced to weigh loyalty to country against the defense of universal humanistic principles and he struggled to find a path forward between these competing ideals.  

As Hitler rose to power, were Mann’s instincts right that this would bring calamity to Germany, or should he have had trust in his fellow citizens that things would right themselves? How much could Mann rely on his interpretation of unfolding political events and his prediction of what the future would look like? Once the Nazis consolidated their dictatorial control of the Reich and set out on a course for total war and extermination of the Jews, should Mann have been a strident and outspoken opponent of the regime or should he have worked more discreetly behind the scenes? Should he have remained in Germany and risked his own life and the safety of his family, especially his wife’s Jewish relatives, or sought refuge in America, where he could serve as a champion of cultural enlightenment and world peace? How does one weigh the facts and decide on an effective course of moral action? How does one choose among imperfect options? 

Like all of us, Mann was forced to anticipate events and make painful decisions—decisions that would play out over time and have consequences for others– in real time and with only partial or inaccurate data. Much like the case with physicians and other health care professionals, most of these decisions will work out well, some will be imperfect, and a few will even be wrong. Tóibín’s novel, history as fiction, vividly illustrates the human predicament of living while moving forward with uncertainty and anxiety because full clarity only comes in retrospect — something that doctors understand because they experience it nearly every day in encounters with their patients.  

The Magician – Reading by Colm Tóibín & Conversation with Friedhelm Marx at the Thomas Mann House 

The Magician: A Novel 
Colm Tóibín 
New York: Scribner, 2021, 512 pages  

Photo of Thomas Mann generated from Wikicommon Photos

Charles Glass is a news correspondent who has written several books. His latest, Soldiers Don’t Go Mad: A Story of Brotherhood, Poetry, and Mental Illness During the First World War gives an account of a remarkable bit of history. Craiglockhart, a hospital near Edinburgh that had previously served the “worried wealthy,” is requisitioned in 1916 for the treatment of victims of “shell shock.” Although the facility operates as Craiglockhart War Hospital for only thirty months, during that time it treats 1801 officers. Two of those men, Wilfred Owen and Siegfried Sassoon, meet and become friends there and go on to be remembered by posterity as the two most celebrated British World War I poets. 

The author makes it clear that, at the time, the very idea of treating shell shock (nowadays PTSD) is revolutionary. The condition is barely known, but as the result of new weapons and means of waging battle, it has quickly escalated into an epidemic. As a result, only four months into the war the British Army has lost 10% of officers and 40% of enlisted men. The situation is not helped by the widely held perception that those with symptoms are malingering. Desertion is punishable by death. Many “treatment” facilities dispense nothing but electric shocks and verbal abuse “to eradicate what [the doctors there] define [ ] as cowardice rather than mental illness” (p. 238). In contrast, it is the aim of the psychiatrists at Craiglockhart to adapt Freudian psychoanalytic methods for use with this population, and to show that humane treatment yields superior results. (Albeit that the measure of those results is how quickly a soldier could be returned to the front.) 

In 1917, Wilfred Owen arrives at Craiglockhart. He has witnessed horrors, and he suffers from “trembling limbs, halting voice, and confused memory” (p. 77). He has only written a few poems, but within two months he becomes editor of the hospital’s literary journal The Hydra. A few weeks later, Second Lieutenant Sassoon is admitted. He has already made a name for himself as a poet and has been decorated with the Military Cross for bravery. 

At first Owen puts Sassoon on a pedestal, while Sassoon dismisses the less experienced poet as “a rather ordinary young man” (p.154). As each thrives in his therapy, their friendship blossoms, they critique each others’s work, and their poetry rises to extraordinary heights. At first, Owen’s “bellicose dreams” (p. 146) are filled with “images of caves, bulging eyes, demons, and blood” (p.179). After he manages to harness this imagery for his writing, his psychiatrist observes that “he fears them no longer” (p.181), and he produces the landmark poem “Anthem for Doomed Youth.” 

Owen’s return to the front has been repeatedly denied by the medical boards. Once he is transformed from “a trembling shell-shocked subaltern [to] a self-confident officer capable of leading men in battle” (p. 216), he finally gets the approval. He is killed at the age of 26; in a sad irony, his mother receives the “dreadful telegram” (p. 276) on Armistice Day. 

The subject matter of Soldiers go Mad is a fascinating chapter in the history of psychiatry, and the book provides a convincing example of the healing power of poetry. 

The celebrated novel Regeneration by Booker Prize winning author Pat Barker (1991) was also based on Craiglockhart and features many of the same characters. 

The building that was formerly Craiglockhart Hospital is now a part of Edinburgh Napier University. One can visit the War Poets Collection and see original issues of The Hydra: https://www.napier.ac.uk/about-us/our-location/our-campuses/libraries-and-heritage-collections/heritage-collections/war-poets-collection. 

Penguin Press, New York, 2023,  352 pages