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VVVVVVVVVVV 159 8 The Good, the Bad, and the Ugly Incurability and the Quest for Goodness Dr. Georges Daremberg’s 1905 study of tuberculosis included an intriguing ethnography of chronic illness laced with value judgments. His interest in illness behaviors had complex roots. His father, Dr. Charles Daremberg, was a leading medical historian of the nineteenth century, an interest that his literary-minded son also shared. In addition to years of clinical practice, Georges’s hard-won insights reflected his own decades-long struggle with tuberculosis, a struggle that ended tragically two years after the book’s publication . Ironically, Daremberg’s analysis began with the premise that “good” patients followed orders and got better. In the world of chronic illness, successful outcomes were the highest form of praise for doctor and patient alike. A select group of consumptives were cured, he insisted, because they agreed “to deprive themselves of all amusing, distracting, or serious occupations that necessitate a permanent effort, that exhaust the nervous system and render the organism vulnerable to the tubercle bacillus.”1 Equating cure with personal virtue was, of course, neither uniquely French nor specific to tuberculosis.2 The biggest problem, of course, was that chronically ill people were generally not so lucky. Many, like Daremberg, succumbed to their illness . Yet even when victory remained elusive, the stricken were expected to behave according to tightly scripted norms. Unlike curable consumptives who were encouraged to eschew worldly pursuits, incurables were expected to assiduously sustain ties with those around them. Indeed, the entire palliative system was structured around an idealized image of the good patient who had died a good death. Broadly speaking, two variants of the good death coexisted in nineteenth-century France: the poetic death and the lucidcourageous one. 160 INCUR A BLE A ND INTOLER A BLE Physicians were obviously not the only ones who spoke on such matters . Religious authorities and families projected their own expectations and demands; many in France were practicing Catholics who turned to the Church for solace and support. That being said, there existed a common currency of prescribed behaviors that transcended ideological and religious rifts. These core values are interesting in that they demonstrate that dying well was rarely simply a question of dying painlessly. The manner of one’s death had broader social and political implications, explaining why everyone was so keen to regulate the behavior of the incurably ill. That many incurably ill patients were themselves determined to comply confirms that they too believed this to be of great social value. In other words, if the ethos of the good death was never hegemonic, it enjoyed broad social, medical, and ecclesiastical support. Unfortunately, dying well imposed various demands and strains, explaining why, when theory gave way to practice, tensions and contradictions plagued many a sick-room. Illness as Morality Tale Though no single group monopolized virtue, certain incurables were regarded more favorably than others. In a late-century article, one physician-essayist insisted that only society’s most cultivated members could transcend the fetters of their decaying body. As far as he was concerned, the “unwashed” descended to the level of idiots or brutes as their condition worsened. Only the cultured could rise above bodily corrosion, thanks to various distractions including books, art, and edifying conversations.3 Contemporaries generally embraced the cliché that one died as one had lived. Given that most Frenchmen came from humble and impoverished backgrounds, only a select few responded to terminal illness with the gentility that bourgeois commentators judged dignified and decorous. In an interesting twist, however, worldly men were assumed to be “not as good at being good” as either young adults, presumably less bitter and jaded, or women, ever attentive to and respectful of medical advice. The links between femininity and virtue, however, reflected more than docility and obedience. Women were singled out as exemplary incurables because they tended to respond constructively to suffering.5 Rather than reacting with anger or self-pity, many made a stirring display of self-abnegation and devotion to others. Incurably ill men, in fact, were often encouraged to emulate this ideal of feminine virtue.6 It was widely assumed that religiosity— lauded by some, scorned by others—helped sustain women’s moral fortitude in moments such as these.7 Yet if Catholic ritual and narrative helped many people deal with devastating illness, there existed two idealized visions of the “good death” that transcended prevailing ideological fault lines. [18...

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