Shadow of a Doubt

“Living with Covid” forecloses the convenient narratives we rely on to manage uncertainty

Full-text audio version of this essay.

In March 2020, shortly after the beginning of the pandemic, Warner Bros reported that the biomedical thriller Contagion (2011) had jumped radically in popularity. I watched the film from my living room in April 2020 and marveled, as many others did, at its apparent prescience. Towards the end, a successful vaccine is engineered and distributed over the course of several months via a conscription-style birthday lottery. In one of the final scenes, Matt Damon’s character finds himself able to grieve the death of his wife for the first time. The heavy-handed association between the end of the pandemic and a feeling of psychological closure makes for a complete and gratifying sense of an ending — even as the last five minutes of the film, which suggest the emergence of a new virus, set up for a sequel.

Contagion does what it needs to do as a Hollywood film: It brings the pandemic to an end. According to Dr. Helen Young, a professor of literary studies at Deakin University, films like Contagion are appealing pandemic viewing precisely because of their guarantee of closure. Fictional pandemics apply the textbook narrative of illness on a public scale, progressing in a three-act structure from symptom (patient zero), to diagnosis (global lockdowns), to cure (vaccine). But as we approach the two-year mark of Covid-19, the virus shows no signs of adhering to a linear plotline. The vaccine roll-out is patchy, fragmented and slow, while new strains crop up with various degrees of resistance. People in countries with high vaccination rates declare that the pandemic is over even as it is reported that less than two percent of people living in lower-income countries have received a vaccine dose. Lockdowns lift and are re-imposed, borders open and then close again. Many are still living with long Covid after initially getting sick months or years ago. In place of an ending, we are told that we must “learn to live with the virus.”

As we approach the two-year mark of Covid-19, the virus shows no signs of adhering to a linear plotline

Across the many contexts in which it is used, the only universal meaning that “learning to live with the virus” holds is learning to live with uncertainty. This is a message that is as frightening for “health bodies” as it is for the wider public, because uncertainty is fundamentally at odds with the kind of empirical rationalism that generates reassuring narratives of closure. While such narratives might help encourage uptake of the various strategies for inhibiting the spread of Covid in the short term, they also jar with the widespread deeper sense that we might not get the big moment of relief that we were promised.

The internet is often accurately identified as a main culprit in the spread of alternative narratives that hinder public health progress; but as literary theorist Catherine Belling argues, institutions of modern medical knowledge have always been vulnerable to doubt. With that in mind, Belling suggests a novel methodology for integrating uncertainty into our understanding of health narratives, drawing lessons from an unlikely source: the concept of hypochondria. Defining hypochondria as a condition inherent to biomedicine itself, Belling calls for a new and more complex way of narrating individual and public health.

Narrative closure can take many forms, but it is generally taken to mean an impression of completeness or equilibrium; a sense that the most pressing questions raised by the story-world have been answered. Endings, as many literary theorists have pointed out, are crucial to our making sense of the world, particularly in societies where linear conceptions of time dominate over more cyclical understandings. For Frank Kermode, endings are a way of building meaning in an otherwise unstructured existence (all humans, he writes, are born into the middle of a story, and die in the middle of a story: Through narrative, and in particular narrative endings, we find structure and can come to terms with our inevitable death through catharsis).

Our experience of the pandemic has been accompanied with the ongoing struggle of how to narrate this period in history, which is one of simultaneous change and stasis, tragedy and boredom. Publishers and TV executives debate whether to commission fiction that tackles the pandemic directly or features it as backdrop. The widespread comparison of Covid-19 to world wars, or even earlier pandemics, like the Spanish Flu, reveal a desire for Covid to be understood as already historically bounded (on Wikipedia, the dates of the Spanish flu fall neatly between two years from February 1918 to April 1920, despite the fact that it continued to circulate seasonally). There is, perhaps, little more unsettling than being told that something is over, even as one continues to feel its ongoing effects. In the Northern Hemisphere, the promise of a “hot vax summer” quickly devolved into a recognition that “vibes are off.” More precisely, the vibes are uncertain. People are dancing and wearing cute outfits, but Miss Corona still lurks.

The concept of closure in narrative theory is closely related to the concept of “the need for closure” (or NFC) in psychoanalysis, a term coined by Arie Kruglanski in the 1990s. Originating in gestalt psychology, NFC was originally described as a resistance to the discomfort of ambiguity. Within this framework, closure is actually seen as a potential obstacle, a process by which an individual or a community hardens into premature judgements. As Nancy Berns argues in her book Closure: The Rush to End Grief and What it Costs Us, the concept has since “saturated our popular culture,” viewed increasingly as essential to both personal and communal processes of healing and acceptance, even as it remains a fairly marginal notion within actual bereavement contexts. Its success, Berns writes, comes down to the fact that closure is a lucrative business (she gives the example of funeral home directors, psychics, and privately hired wrongful death attorneys). It also proves useful in advancing often conservative political agendas, such as the case for the death penalty.

It is possible to cling to a fantasy of neat closure for the Covid era even as one recognizes what has widely been touted as the more likely scenario: that the end of Covid will be a messy, long, drawn-out process by which the virus — aided by rigorous vaccination programs, monitoring systems and increasing immunity — will gradually lead to fewer fatalities and fewer long-term complications, becoming “something like the flu.” In fact, fantasies of closure — or at least of a linear narrative progression — have been built into public health messaging and governmental policy from the beginning. London’s “freedom day” reinforced expectations of a clear ending, even as epidemiologists warned that lifting all restrictions at once was a potentially catastrophic experiment. In Australia, where I’m currently based, the closed-border strategy that was the national approach until recently seemed based in the assumption that Covid-19 would simply sweep through the world and pass like a storm, leaving Australia — hunkered down within its walls of sea — unscathed in the inevitable end. It seems widely accepted that the only way to get publics to adhere to restrictions and mandates is to hint at a big, bright abundance of closure lying just around the corner: a risk-free street party, a dinner with friends where the vibes are definitely on.

In her book A Condition of Doubt, Catherine Belling argues for a serious consideration of the reflexivity of hypochondria as a methodology for interpreting biomedicine’s vulnerabilities, opening up the conventional narrative structure of symptom, diagnosis, cure to more critical readings that reflect both a wider range of illness narratives and the messy contemporary experience of inhabiting a body in the digital age. Belling does not define hypochondria as a psychological disorder, but instead as something inherent to contemporary medicine, “marking the place where medical knowledge is confronted by doubt.” Hypochondria, according to Belling, does not only refer to an individual affliction that causes one to believe, persistently and against all medical reassurance, that one is dangerously ill; it also refers to a wider terrain shared by doctors and patients: a set of suppressed societal anxieties about the limitations of a medical system that purports to be omniscient.

My own first experience of hypochondria occurred when I was about nine years old. There had been a case of meningococcal disease in a primary school in Sydney, and our parents had been given information leaflets about it. At school we made guesses about who might die first. I staunchly avoided the water fountains and other children. I ate my lunch alone in shadowy corners. Then I got sick. It was a regular illness, a cold or flu of some sort. I took the day off school and my dad, who trained as a doctor, took my temperature and told me I’d be fine by the morning. The story of my illness, in his eyes, was already complete, but for me it had just begun: I could see the whole trajectory of my tragic premature death unfurling in front of me, beginning with my parents finding my cold body in the morning, followed by the news reaching my classmates at school, and finally the funeral. I hugged my favorite bear and pictured it in the casket with me. If I had been able to take myself to the Emergency Department, I would have; instead I felt the absolute injustice of my lack of agency as I stared at the ceiling and prayed to a god I didn’t believe in.

The “hypochondriac” is biomedicine’s reflection in a dark mirror. The question they ask again and again is how can you tell? How do you know what you know?

The experience of hypochondria, in Belling’s view, is an experience of frustrated endings, which is maybe part of why those living with chronic illness find their symptoms so often dismissed by medical professionals as hypochondriacal. In reality, the experience of chronic illness is at the opposite pole to hypochondria: the hypochondriac seeks closure obsessively, while those living with chronic illness know the word “cure” to be a trap, an often violent term loaded with the medical system’s desire to have the story neatly wrapped up.

The “hypochondriac,” in other words, is biomedicine’s reflection in a dark mirror. They seek closure above all else; but when offered  reassurance, they are unable to accept it, finding new evidence to support an alternate reading: one that spools out in multiple different directions towards various tragic endings. This figure obsessively absorbs conventional linear narratives of medicine, then measures them against their own, finding new clues and new narrative openings at every turn. They are, in short, post-modernist storytellers, reading their own bodies like texts in relation to others’ readings of their bodies, finding meaning beyond the literal, dwelling perpetually in ambiguity and uncertainty. The question they ask again and again is how can you tell? How do you know what you know?

Belling’s work seeks, among other things, to depathologize hypochondria, describing it as, in one way, “the condition of being a rational human being in a medicalizing society.” Hypochondria, in Belling’s conception, is a rational response to the expectation that biomedicine itself sets up: that if one follows medical advice and presents oneself to the doctor’s office at the correct time, one need not fear the black box of the human body, where potential threats can always in theory be perceived, understood and cured before they germinate. She goes further still, arguing that the medical establishment might even have something to learn from these unstable ways of knowing. The “hypochondriac” does something like forcing doctors to theorize their practice, “becoming self-reflexive about what they know and what they cannot tell.”

Hypochondria preceded the internet, but it is largely believed that the rise of the internet has coincided with more widespread hypochondriacal tendencies. We have access to more stories about untimely deaths in our community against which to assess the severity of our symptoms. We also have access to information that could save us. Peer-reviewed papers and official guidelines are mixed in with anecdotal evidence and falsified information presented as fact. If you go to the doctor with a specific guess as to what your affliction might be, they’ll roll their eyes and ask you if you “googled it”; unless, of course, your guess is a good one, in which case you’ll be rewarded with the right tests, the right referrals.

Belling argues that patients are increasingly expected to be active participants in their own health. They must know enough to know when to call the doctor, and surrender this knowledge the moment they are through the door. For the hypochondriac, the doctor’s diagnosis is read alongside — in relation to — a panoply of other texts, both the information gleaned from internet sources and the story of their own body, sending them new information in the form of symptoms they forgot to mention. In the face of all this intertextuality, the closure offered by the doctor proves ever more difficult to accept.

As those studying science and society — such as Daniel Sarewitz — have pointed out, it is often not the case that more information leads to greater certainty. Linda Besner has written for Real Life about the way we perceive the internet to be an omniscient narrator, and are surprised to find it cannot always answer our questions. I’ve caught myself googling “when will the pandemic end” more than once. The question yields endless answers calling each other into question, including WHO Director-General Dr. Tedros Adhanom Ghebreyesus’ unsatisfying assertion that “the pandemic will end when the world chooses it to end.”

Hypochondria, so conceived, is not the opposite of biomedicine’s reliance on the conventional narrative structures of Enlightenment science: the promise of certainty is what generates the kind of reading that ultimately makes such closure impossible. This is true on a public as well as a personal scale. As Belling writes, public health narratives often tap into linear storytelling conventions such as the childhood cautionary tale: a recent example of this in Australia was a controversial ad released by the government in which a young woman gasps for air while hooked up to a ventilator. “Covid-19 can affect anyone,” reads the text. “Book your vaccination.” The ad was targeted at young people just weeks after the government backtracked on their stance against Astra Zeneca jabs for under 40s, who remained nonetheless ineligible for the recommended Pfizer vaccine.

“Living with Covid” can mean lots of different things on paper; what it requires of us in reality is giving up the idea of closure in favor of a truer ambiguity

By contrast, the viral New Zealand “ka kite” ad was lauded for its optimistic slant. A doctor slides open a “metaphorical door to freedom” to the sound of cheering on the other side – “Hey Covid,” the ad promises, “you’re gone.” Pro-vaccine ads are important, and there is evidence for the effectiveness of carrot-and-stick approaches to public messaging. Meanwhile, though, global health experts warn that vaccines are “not a silver bullet,” and that the “end of Covid” cannot be guaranteed. The narratives of closure (public death or public cure) that are used in local and national press conferences are scrambled by Twitter feeds, Instagram posts, and global news headlines, all of which generate a more complex and uncertain picture. Intertextual reading generates tension between disparate certainties, none of which reveal the whole truth on their own.

Few would deny that the internet today fuels dangerous conspiracy beliefs. But according to Belling, at least some of the responsibility lies with public health institutions’ risky strategy of using fear as a public messaging tool. “The deliberate provocation of fear about a particular object,” writes Belling, “can easily produce a less coherent anxiety that resists reassurance: an anxiety that can become a public health problem in its own right.” The use of fear can generate more research, more reading, that may not follow the avenues public health institutions intend. It can also fuel denialism: Feeling unable to control the risk of the virus, people may choose instead to control their fear itself by doubting the risk.

Belling’s book is ultimately a work of literary theory, and does not put forward particular health policy recommendations. It does, however, advocate for hypochondriacal — or postmodernist — understandings of medicine to be taken seriously. Doubt and uncertainty cannot be eradicated from medicine: They are a fundamental part of what it means to exist as a mortal body on this earth. Denying this uncertainty makes medical systems less credible. “Hypochondria” is often the uncanny sense that something is missing from the mainstream medical narrative; that the confidence the doctor professes to the patient does not match the doctor’s own internal understanding of the situation. Crucially, hypochondria in practice also values medical systems: the hypochondriac seeks medical knowledge, after all. It does not undermine the doctor’s expertise, but challenges them to more self-reflexive ways of knowing.

Similarly, the idea of “living with Covid” demands inhabiting a position that is fundamentally unstable, forcing a reflexivity into the fable-like narratives that public health institutions have been using to advance vaccine roll-outs, enforce lockdowns and encourage mask-wearing. It can be simultaneously true that these things are a vital part of the solution, and that we do not know exactly what the future will look like, or whether a “return to normal” is even what we are aspiring to anymore. “Living with Covid” can mean lots of different things on paper; what it requires of us in reality is giving up the idea of closure in favor of a truer ambiguity.

As I was writing this, my housemate sent me a passage from a book she was reading called The Examined Life by psychoanalyst Stephen Grosz. Refuting Elisabeth Kübler-Ross’ notion of the five stages of grief — a notion applied to both the bereaved and the terminally ill — Grosz argues that many people suffer more because they feel they are not making the psychological “progress” they should be. In waiting for closure, they remain caught in a heightened state of grief. Similarly, uncertainty in both public and individual health only leads to paralysis when one is waiting for the moment of certainty. Uncertainty does not prevent action: It is absolutely central to the way science operates. Adopted widely, uncertainty as a mode of knowing can be adaptive, receptive, critical and reflexive. Doubt is often identified as the main culprit for dangerous conspiracy beliefs, but it is in the emphasis on certainty in the first place that generates the need to create alternate narratives that neatly wrap up unknowns (where did the virus come from? How did it get to this point? When will it end? What will become of us?).

We may not ever answer all the questions raised by the Covid-19 “story world.” We may not have the big moment of catharsis, the cheering on the other side of the “metaphorical door to freedom.” The idea of “learning to live with the virus” refers literally to a kind of cohabitation; a process by which we accept that Covid-19 — as well as the measures put in place to mitigate it — may continue to quietly shape our lives and decisions in ways that are still uncertain. As Belling’s work teaches us, coming to terms with this uncertainty is crucial to building more humane, fair and sustainable medical systems, and to ensuring that Covid’s role in our lives is increasingly unremarkable.

Lauren Collee is a London-based writer and PhD student. Her essays and short fiction have appeared in Another Gaze, Uneven Earth, Eyot Magazine and others.