Monday, July 15, 2013

Using Modern Medical Knowledge in Fantasy Fiction

As we come up on our 100th Heroines of Fantasy Post (July 29th!), I was a bit lost for a subject this week. We've covered...everything! Or so it seemed when I was searching for something new to post about.

Then life smacked me in the head.

My youngest son has had his share of trauma in his life. An injury sustained at the age of 15 left him permanently handicapped. A couple of weeks ago, he reinjured the same leg. Trying to keep up my work schedule along with my usual household tasks and being his nurse/physical assistant these last couple of weeks reminded me of an everyday fact of my writing life that had gotten lost in the familiar.

I gave one of the characters in my current WIP (The Shadows One Walks) my son's devastating injury, and I am able to do that successfully because I am intimately familiar with every aspect of what happened medically at the moment of trauma, and in the weeks/months/years that followed. Because I am aware, I can recreate it believably for my readers without giving all those details that would not have been available in the time period my novel is set.

Modern technology gives us all sorts of fabulous knowledge that allows characters to survive injuries. It's fairly easy to figure out how to kill someone--but how NOT to kill them?? I'm not into torture in my novels, but many of those reading this have watched the third season of Game of Thrones. Ah, poor Theon...or shall I say...never mind. No spoilers! Whoever he is, that torture was time-period appropriate (flaying is an ancient "art,") while utilizing modern medical knowledge to give Theon reactions, both physical and mental, to create the best sort of squick.

How about addiction? PTSD? Anxiety Disorder? Phobias? Downs Syndrome? Dwarfism? These things have always existed, and have been written into stories, but with the knowledge of modern medical science, we know that the deaf/mute aren't idiots. Someone born with Downs Syndrome isn't a Mongoloid. A dwarf isn't a dwarf isn't a dwarf, but can be one of a number of forms of dwarfism, each with its own set of characteristics. Because medical science has given us insight to these things, we can research the difference between disproportionate and proportionate dwarfism and create characters with more realism and depth rather than a stereotype.

Medical science, sometimes primitive, sometimes amazingly sophisticated, has been around a long, long time. For the common folk, each innovation was akin to magic. Even today, medical science knows something works, but perhaps not why. We, however, are less likely to write it off to magic and be content.

This barely scratches the surface of this subject. I'd love to hear what you have to say. Have you used medical science in your writing to get something really right? Have you read it completely wrong? Is it better to skim the surface? Or go into that depth that might, one day, be proven wrong?

~Terri-Lynne DeFino


Karin Rita Gastreich said...

Hi Terri!

This is a fun topic and one that I haven't thought about as much as I probably should.

I do think that the way we conceive medicine and health is very different today from, say, the middle ages or the Renaissance. Yes, we can say PTSD existed back then, but did it? Psychological disorders depend not just on the physiological/emotional make up of the person; they are a result of the social fabric within which that person lives. As the social fabric changes, so do the diseases and disorders of our time. (Take, for example, the 'outbreak' of hysteria in the 19th century.) Whenever we apply modern medical knowledge to another culture and time, I think we have to keep this in mind.

One strategy I've used to achieve authenticity is to model important medical events in my stories after real events in history. Kedehen's demise, for example, was inspired by the death of Henry II of France.

Of course, the advantage of fantasy is that when magic and medicine meet, magic almost always trumps medicine. ;)

Terri-Lynne said...

From the (admittedly) little I know about PTSD, I imagine it existed. True, the attitudes about death and war are much different than they were back then. But! PTSD is caused by a horrific event branding itself in a brain, so to speak. It's a survival skill, a basic brain function, that taught our ancient ancestors "avoid this at all costs!" It's actually the brain being efficient. And on that note, I imagine in the "old" world, this would be processed differently, maybe even dealt with differently, on a personal level. I really can't say, because I don't know enough about it. A hundred years ago, "Crazy Aunt Tilda," was simply the batty old woman who sat in a corner of gramma's house, babbling. The Boo Radley's of the world were also dubbed "crazy." (Was Boo simply a statement on society? Or is there a "diagnosis" for him? I honestly have no idea.) Now we know that "crazy" is as broad a label as "dwarf." Knowing the nuances and attributes of each separate diagnosis allows us, as writers, to really give that depth.

How'd I get back here?? Oh, yeah...I think most things we can think of to give or do to our characters have always existed, it is the attitudes towards such things that have changed.

Are we saying the same thing?

Terri-Lynne said...

Oh, and speaking of "hysteria," did you see the movie?

It's worth watching. Not a "MUST SEE OMG MUST SEE!" But worthy.

Pongo Pygmaues said...

The intensity, prolongued - if sometimes intermittent - duration and impersonality of modern combat seem to have created conditions in which PTSD has become quite common in the military.

The earliest case of someone recorded as having PTSD-like symptoms in the military that I can think of off-hand would be the early 19th century General Picton who was a notoriously brave 'fighting general' who had been exposed to a good deal of combat in the Peninsular. He had several premonitions of death and at one time said to Wellington that he must give up the service because of his nerves.

I suspect that pre-gunpowder it was very rare in a military context. Partly because getting enough 'combat days' to make it likely would have been very hard even for one of Caesar's centurions (who might well have notched up nearly the three months of combat exposure that seems to be the lower threshhold for it to be induced by exposure rather than one horrific event. But also because the 'horrific event' seems to me to have been rarer and, importantly, much more likely to be lethal.

There's also the distinctly unfashionable fact that in fact ancient and medieval warriors did 'talk things through': not in a sense of trying to shed themselves of guilt, or to come to terms with horror, or to try to adjust to civilian life, but rather through a celebratory and often boastful process where their deeds were seen as admirable and worthy of respect.

And of course while military violence was of a lower order than today, civil violence was far more likely and death and maiming far more a commonplace.

It's one area where I think many readers might expect some signs of PTSD in a veteran fighter, yet if they existed, they might not in fact manifest themselves in ways that modern society expects.

Terri-Lynne said...

"the 'horrific event' seems to me to have been rarer and, importantly, much more likely to be lethal."

Oh, good call. Very good.

I think I see the slight disconnect here--and it's something I should have thought of, considering EVERYTHING I look up about PTSD usually concerns the military, and veterans.

Apparently--and, again, I am not really learned on the subject--PTSD got labeled due to the seeming rise of the disorder in veterans, and I do believe (as I think Karin was alluding to above) that it's a definite product of the changing views on our warriors, and their views of themselves. As you say,
"There's also the distinctly unfashionable fact that in fact ancient and medieval warriors did 'talk things through': not in a sense of trying to shed themselves of guilt, or to come to terms with horror, or to try to adjust to civilian life, but rather through a celebratory and often boastful process where their deeds were seen as admirable and worthy of respect."
I recall reading something about this in regards to WW1, and that it was a turning point in the way soldiers were viewed, and viewed themselves.

Anyway--PTSD is being expanded beyond the military, rightly or wrongly, to include all horrific events that cause the same "imprinting" reaction in the brain. As far as I can tell, they really don't know why some people develop PTSD while others who've experienced the very same event do not, but there you have it.

For example--my son has been diagnosed with PTSD, due to the injury he sustained at 15. The recent injury to the same leg has amped up the anxiety/flashbacks and all that fun stuff to heights not seen in years--just as we were getting it under control, no less. Is it really PTSD? Or are too many "disorders" being put under a common umbrella? I honestly don't know. All I do know is that, at the moment, the diagnosis and treatement seem to be consistent with his case.

writerknv said...

Awesome post, Terri, though I regret the inspiration for it! I hope things with your son's health are going as well as they can.

I've noticed, in fantasy in general, that there doesn't seem to be a great deal of illness, and people recover from injury rather quickly. I admit, I really want to put some sort of massive illness into my novel (that actually strikes one of my characters rather than dances around them) but I'm too lazy to do the research! ;) However, illness and injury DO happen, and can have a tremendous impact. People did, and still do, die of influenza. What we would consider a minor break, easily set and healed in our society (with the help of pain meds) might become a crippling injury in a society with less modernized medicine. And health care, in general, isn't as good even in today's society in many parts of the world as we have it here. This is something that we definitely take for granted.

Something to keep in mind, too would be how we name things in our society. A book I was editing once used the term "depression." This term wasn't created until modern times. While the symptoms may have been noted by earlier cultures, they certainly would have been attributed to something else, and they certainly wouldn't have been able to diagnose depression the way we do today.

So much more to discuss... great topic!


Anonymous said...

There's a great series out there called "Bramwell" which examines the life of a female Victorian doctor. Great stuff.

Also, I have read that the Ancient Greeks had a great grasp of medicine, but the care of the sick and wounded waned after the Romans, since soldiers could just be replaced instead of patched up. Then religion got thrown into it, further suppressing it. The Civil War was the era in which modern medicine caught back up to the Greeks, with only about two thousand years of neglect. Ancient Indian texts were instrumental in showing how tissue from the forhead could be moved to recreate flesh for noses that were removed. Boom, it actually worked. A procedure that hadn't been used in a thousand years or more. Ancient Egyptians had penicillin. Which would have done Reformation era Europe wonders once the place was overrun with syphilis.

Terri-Lynne said...

Kim--thanks. He's doing well. He can't work (was working with a pool guy) but he is in his workshop from morning til night, working on his bows. He sold his first one! :)

I think the lack of illness (or the skimming over of them) might have to do with how it has to stall the story. What happens when a character gets sick--usually, they lay on a pallet or in a bed or whatnot, writhing! I skim over a plague in both A Time Never Lived and The Shadows One Walks, but don't get into either in any great detail.

I wonder about injuries in all sorts of fiction, honestly. Like Bruce Willis getting shot and walking over glass then being able to continue the fight--and win! As you say, back in "the day," broken bones were no easy splint and crutches. Depending upon the break, it could be life-threatening, or at least permanently disfiguring. I gave Cal (in the WIP) my son's injury, but I had to temper it because, in that society, he probably would not have survived, and if he had, he'd have lost his leg. Keeping the injury in mind as I go through the story is hard!

Terri-Lynne said...

Clint--I had no idea the Egyptians had penicillin. Wow--how different history would be if that had not bee lost.

The Greeks--they were pretty amazing. So much of their knowledge was lost--and while I'm not going to go into a whole tirade about the Church, it's power and politics because I'd start foaming at the mouth and probably say things that would insult too many people--it's the Church's fault! Not entirely, of course, but those final nails were hammered in by Rome.

Pongo Pygmaues said...

I don't think the knowledge was lost precisely. After all the Roman Empire continued unbroken until 1453 with a high standard of medicine available within its reaches. Similarly those areas under Arab rule had high quality medical care.

What the West lacked, especially in the immediate aftermath of the general collapse of civilisation in the 4th century, was the sort of basic law and order, standard of living and ease of travel under which education, especially things like medicine, could flourish. The dramatic fall in luxury that marked the death of empire in the west is precisely mirrored in the dreadful collapse of life expectancy. Whilst there is something rather romantic about the 'barbarian' cultures that supplanted (and tried but failed to mimic) Rome in the west we should remember that they were places where life was nastier, more brutish and shorter than under Rome, for all its considerable faults.

So i wouldn't, in this rare case, really blame religion, more the breakdown of civilisation.

Pongo Pygmaues said...

I should add that 'available' does not equate to 'universal'. But I'd rather have broken a leg in Constantinople than in Charlemagne's Aachen, and rather there than in Bloodaxe's York.

Karin Rita Gastreich said...

I think Pongo hit on what I was trying to say with his first post. Trauma has always has an emotional impact. But a label as specific as PTSD is a more modern creation, not only as a concept but also, perhaps, as a psychological and social reality.

I am not very fond of all these labels we use today, but that is a rant for another time. I do think that trauma inevitably has an emotional impact, and that we need to take this into account in our storytelling and character building.

Terri -- yes I've seen 'Hysteria'. It's very cute! Also, a good example of a story told in an anachronistic fashion -- that is, 'hysteria' as seen from a 21st century point of view, even if the story is set in the 19th century. Which is, of course, what makes it funny. For 19th century women who suffered from 'hysteria', I doubt it was a humorous topic at all.

Oh, and Boo, I think, is a great example of a character for whom we really don't need to know the nature of the "disorder" to appreciate him fully. In fact, I much prefer Boo without a label.

Pongo Pygmaues said...

Actually now I think about it my leg-breaking example was a bad one.

What I meant was I'd rather have suffered a depressed fracture of the skull in Constantinople than Aachen, and rather there than York.

The other thing of course is that nasty old civilisations like Greece, Rome, etc (not of course Egypt, Damascus, and suchlike as they are lovely and mysterious and ethnically cuddly despite their more highly dubious aspects at least as revolting as those of Classical Greece and Rome) is that sanitation was generally much better and clean water widely available in urban areas.

Roman York was a place with broad paved streets, civic buildings, plumbing and a good fresh-water supply. Whilst the poor were miserably poor, they lived in tiled-roofed houses and had remarkably few internal parasites.

Contrast that with Viking York where there where cobbles had replaced paving on the few streets that remained surfaced, there were few civic buildings, no plumbing and a distinct lack of easily and freely available fresh water. Intestinal parasites were endemic, not merely in the poor, but in all levels of society.

It's hard to generalise about medical care as there's less evidence for the Roman period but the excavations at Your showed bone breaks tended to heal fairly badly and would often have impaired the sufferer to some degree thereafter. It's extraordinarily unlikely that Roman York was worse in that respect and highly likely that it was better.

I warm to the Norse cultures tremendously, not least because of their, ultimately futile, holy war against monotheism but their culture was a long way behind the more civilised (in its original and only sensible sense, meaning urban-based) cultures of Greece, Rome, the Arab conquest, etc (even the utterly loathsome ancient Egyptian society, which was as vilely authoritarian as you could find).

Terri-Lynne said...

Karin--I'm not fond of labels either. While I get that labeling gives a level of understanding the population at large can get their heads around, it's also very limiting.

For example--diabetes. Everyone knows what that is. Type 1 and type 2--most will know the differences there. But few know that within both those types are a myriad of differences that make them almost different types. I imagine it's soft of like classifying in the natural world. A lion and my Sadie Mae might be in the same family, but they sure aren't the same species...or ARE they. I've seen my cat's claws. ;)

Terri-Lynne said...

David--I blame the Church (early Church with a capital C!) for most of the woes of the world during that time. In some way, shape or form, you'll find some messy, holy hands behind a good deal of trouble. ;)

I see your points about the civilizations and what they did and did not achieve medically, but I am wondering what the "every day" person knew and could expect should a physician (or whatever passed for one) not be in the vicinity. I don't know enough about this to comment, but I do believe that many cultures kept their medical secrets close, lest it get into the common knowledge of the populace and render them less than godlike. For some reason, I'm thinking the Greeks, but I couldn't say that with any real conviction.

I love to learn, and I'm constantly striving to, but my recall is truly abysmal.

Karin Rita Gastreich said...

You said it Terri. In addition to the details getting lost in the label, the labels themselves, I suspect, can cause damage. I wonder, for example, if anyone has done a study of the emotional impact of telling someone they have a "disorder"? And why has emotional response to trauma been labeled by modern society as a 'disorder'? Again, I could go on and on about this, but don't want to derail the discussion (too much).

It occurred to me that Pongo's reference to "talking things through" was also very insightful. Freud, in the 19th century, proposed the same approach in his therapeutic work with the "talking cure": that the best way to process and come to terms with trauma is to talk about it, and talk about it, and then talk about it some more.

Also, the whole point that has been made about access to clean water and bathing is fundamental. The single most important factor in increasing life expectancy in modern society has not been Western medicine. What's helped us live longer is increasing access to potable water. If you want to get around a lot of nastiness and disease in your fantasy society, all you really have to do is create a culture that values bathing and clean sources of water, and you're more than halfway home.

Terri-Lynne said...

Karin--this: If you want to get around a lot of nastiness and disease in your fantasy society, all you really have to do is create a culture that values bathing and clean sources of water, and you're more than halfway home.
--is the best thing to come out of this conversation. At least, the most useable, the simplest, and the most unrefutable..irrefutable?? You know what I mean. I'm totally using it!

Pongo Pygmaues said...

But the surviving Roman Empire was Christian and advanced medicine was certainly more widely available there than in the barbarian west. I honetsly don't think the church connived at the restriction of knowledge in the west (it did not do so in the east), it's simply that political and social factors rendered the west incapable of supporting a high standard of sanitation and medical care (not, I hasten to add, am I claiming everyone in Constantinople could whistle up a good doctor when needed, merely that conditions were such that medicine and sanitation could continue to be far more widely available than was the case in the fractured west.

Indeed monasteries were often decent sources of limited medical care in western societies in what are quite rightly termed the dark ages in the west. However I forgot that the collapse of literacy (which was not church-fostered but rather a result of the general collapse in living standards) is another important factor.

That said, the practical sort of home-treatment that poorer rural folk had used almost throughout the Roman period would certainly have continued unabated and that's why my broken leg example was poor (your leg might not be set well, but it could be set). But I don't think the church really began to step on that sort of knowledge until the witch-hysteria of post-medieval times.