Two passages particularly struck me when rereading Ilyich. The first has to do with the way healthcare workers tend to cross examine the bodies of patients, like lawyers cross-examining the mind of a witness or police interrogating a suspect. Amid an illness, particularly chronic illness, the patient is always on trial:
Ivan Ilyich knows quite well and definitely that all this is nonsense and pure deception, but when the doctor, getting down on his knee, leans over him, putting his ear first higher then lower, and performs various gymnastic movements over him with a significant expression on his face, Ivan Ilyich submits to it all as he used to submit to the speeches of the lawyers, though he knew very well that they were all lying and why they were lying. (Ivan Ilyich, “Chapter 08”)
It is almost as if Ivan Ilyich––a bureaucrat and son of a bureaucrat, see “Chapters 02 & 03”––suspects he may die by the bureaucratic ways and means of his doctor. Recently, I had my own health scare, and while everything turned out to be alright, there were nevertheless forms to fill out and receipts to file away. It is not just 21st century Obamacare or British healthcare or Canadian healthcare that piles on the paperwork—Tolstoy had the intuition, imagination, and foresight to see that healthcare and bureaucracy are intimately intertwined, and have been so since at least the middle of the nineteenth century.
And after all the paperwork has been completed, the tests run, and the doctors have finished updating the diagnoses for their patients—after all these barriers of bureaucracy are crossed, the ill individual looks in the nearest mirror and does not recognize the stranger reflecting back:
And Ivan Ilyich began to wash. With pauses for rest, he washed his hands and then his face, cleaned his teeth, brushed his hair, looked in the glass. He was terrified by what he saw, especially by the limp way in which his hair clung to his pallid forehead. (Ivan Ilyich, “Chapter 08”)
Intricacies of bureaucracy and images of the body—these are what moderns like us, like Tolstoy, and like those around us must deal with when confronted with a crisis of healthcare. But do we Westerners tend to focus more on the image of the body because of two millennia of Christian culture? The American philosopher James Bissett Pratt (1875–1944) seemed to think so when he observed in an essay written thirty years after Tolstoy’s story:
I think, however, there are several additional factors which give Hinduism a certain advantage over Christianity in nourishing a strong belief in immortality. One of them is connected with the question of the imagination already discussed. The Hindu finds no difficulty whatever in imagining the next life, for his belief in reincarnation teaches him that it will be just this life over again, though possibly at a slightly different social level. I am inclined to think, moreover, that the Christian and the Hindu customs of disposing of the dead body may have something to do with this contrast in the strength of their beliefs. Is it not possible that the perpetual presence of the graves of our dead tends to make Christians implicitly identify the lost friend with his body, and hence fall into the objective, external form of imagination about death that so weakens belief in the continued life of the soul? [Bookbread’s emphasis] We do not teach this view to our children in words, but we often do indirectly and unintentionally by our acts. The body––which was the visible man – is put visibly into the grave and the child knows it is there; and at stated intervals we put flowers on the grave – an act which the child can hardly interpret otherwise than under the category of giving a present to the dead one. And so it comes about that while he is not at all sure just where Grandpa is, he is inclined to think that he is up in the cemetery. Much of our feeling and of our really practical and vital beliefs on this subject, as on most others, is of course derived from our childhood impressions.
(“Some Psychological Aspects of the Belief in Immortality” Harvard Theological Review. Vol. 12. No. 3. (July 1919.) 294–314 at 308.)