Who Taught You All This, Doctor?
The therapeutic power of fiction.
Posted Mar 26, 2020
As I write this post, the world is trying to contain the spread of a deadly virus for which we currently have neither a vaccine nor a cure. Despite quarantine measures and lockdown of entire cities, it is anyone's guess how many people will get infected and how many will die. Amidst all this, there has been a surge of interest in fiction about pandemics: The Plague by Albert Camus, Death in Venice by Thomas Mann, and movies such as Contagion, Outbreak, and 28 Weeks Later. Not everyone wants to read novels and see movies about deadly disease spread, of course, and some may actively avoid this type of fiction right now, but many seek it deliberately. Why? What is the attraction?
There are many possible reasons. The topic may just be salient, and acting on salient information requires fewer cognitive resources than the alternative. In addition, the theme may seem appropriate in the way poems about snow seem appropriate at the end of December (at least in the Northern Hemisphere): They are in line with the general mood. There may also be a kind of social contagion effect whereby you do it because you have heard that others are doing it. What I wish to suggest here is that there is something else as well: Engaging with deadly contagion-related fiction in the midst of a pandemic may serve as a kind of exposure therapy. Let me explain.
Exposure therapy is a method of treating anxiety by making oneself confront its source. This is typically done gradually so that the patient is exposed to progressively stronger stimuli. Exposure therapy has been effectively used in treating a variety of phobias and anxiety disorders.
Some people intuitively stumble upon the technique in question — without any help from a therapist and often, without having heard about the method previously — and use it to treat their own anxiety. For instance, a man named Sam Slaven, who suffered PTSD symptoms after deployment in Iraq, overcame his fear of people wearing Muslim garb by joining the Muslim Student Association at the college he was attending at the time. 
Confronting fear through fiction may do something similar for us: We anticipate the benefits, perhaps unconsciously, of a feeling of preparedness and reduction in anxiety, and we reach for pandemic-related fictions in order to reap those benefits. That exposure to fictional analogues of the fear-inducing stimuli may have effects similar to those of exposing oneself to the actual stimulus is evidenced by the fact that there are variants of exposure therapy that involve not actual but imaginary stimuli: The anxious person there is instructed to imagine the object of dread and confront it in his or her mind.
Incidentally, this line of reasoning may go some way toward answering a question about the cognitive value of fiction some philosophers have asked, namely, can fiction teach us anything? Some have argued that the answer is "no": Fictional narratives have nothing to teach us because they aren't true. If, however, imaginal exposure therapy can educate our emotions, so can fiction. And the education of the emotions may, in turn, lead to cognitive benefits. Feeling, after all, is key in getting to know the true value of things.
Good fiction may do more still, including novels about pandemics. Thomas Mann's novella Death in Venice, for instance, tells the story of a writer, Gustav von Aschenbach, who, instead of fleeing to safety, takes the risk of dying in cholera-plagued Venice just so he could spend a few extra days in physical proximity to a youth whose beauty (admired by Aschenbach only platonically) has reawakened the writer's passion for both writing and life. What is worse, Aschenbach has a chance of warning the youth's family about cholera — which authorities in Venice refuse to acknowledge until it's too late — but he does not do so for fear that the boy's family would leave, and he would never see the beautiful boy again.
Mann brings the reader to a point at which the reader forgives Aschenbach's extreme recklessness (to put it mildly). But more importantly, for present purposes, the story raises a question about the magnitude of our fear of death. Though we fear death, we may have motives that are stronger still. Some of those motives may even seem frivolous. Such is the case of Aschenbach's desire to stay close to his muse and object of attraction. The peculiar power of our fear of death lies in its ability to prevail over every other instinct. That's not true of Aschenbach's fear, however; and the Mann reader who experiences the situation vicariously, can't help but think that fear of death has been dethroned — easily — by a frivolous obsession. Love of beauty triumphs over fear of death.
Albert Camus' The Plague is a novel about an Algerian city named Oran during a plague epidemic. The authorities in Oran, much like those in Death in Venice, refuse to acknowledge the gravity of the situation despite the fact that thousands of rats die seemingly for no reason, and then people begin to die too. Camus' novel raises multiple questions about our responses to each other's suffering, about religion, intimacy, and the human condition, but here, I would like to comment on two points specifically.
The first has to do with solitary versus shared fear. In The Plague, a character named Cottard knows himself to be guilty of a crime (the reader never finds out what crime). He lives in constant fear of being arrested. A person such as Cottard may feel alone on account of hiding a terrible secret, and that is just what happens to Cottard. He carries his burden in silence for years. The plague is in a way a godsend for him. Thanks to it, he is reunited with the rest of humankind for he is no longer alone in his fright: Everyone fears now.
This suggests that shared fear may not be nearly as difficult to bear as fear that's yours and yours alone. The more widely spread the dread, the easier it may be to live with it. Indeed, it could be that part of the appeal of pandemics is that we put ourselves in a relationship to the broader human community, and they too help us carry our current burden. A writer may describe a particular time and place — anywhere on the spectrum between imaginary and real — but if the fiction is good, it gets to something so deeply human that the reader is put in touch with all humans, past and present. The circle expands and includes us all. Upon reading The Plague in a time such as this, you share the burden not only with the people around you, but with the citizens of Oran, and through them, with everyone who lived through a pandemic.
How might a writer succeed in building bridges between us and the rest of humanity? There is no simple answer to this, but the beginning of an answer may be found in something a man named Tarrou says to a man named Rieux in The Plague:
“Who taught you all this, Doctor?”
The reply came promptly:
I have no way of knowing whether this remark is autobiographical, but it may be. In any event, the writer may find his or her way to our common humanity through suffering also.
Of course, it is only possible to share fear or angst if others are there with you. So we must all hope we get through this without losing each other. The quip of Sartre's Garcin from No Exit who says, (in)famously, "Hell is other people," only has the meaning it does on the assumption that others are there. If there is a serious danger that you may remain alone, a last survivor, things look rather different and decidedly not paradisaical. Boris Vian, in a play called The Empire Builders, makes a similar point through one of his characters:
"[T]here used to be several others here, and I retained the absolute majority. Now that I am alone, I feel my majority slipping away." 
 Episode 340: "The Devil in Me," This American Life, September 7, 2007. Available at: https://www.thisamericanlife.org/340/the-devil-in-me.
 Camus, A. (1947/1991).The Plague. New York, NY: Modern Library.
 Vian, B. (1957/1971). The Empire Builders. London, UK: Methuen & Co.