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Abstract

“Issue novels” employ a variety of writing devices to inform and to persuade readers about the nature of social problems and their impacts. One distinctive means by which contemporary health care has been portrayed within fiction is through a reification of the “system.” In effect, the system itself becomes a main character within the narrative, one whose motivations, stratagems, values, and behavioral patterns create fateful consequences for all other actors. It is the “personality” of this system that defines the source of disadvantage and oppression for those subject to its whims, as well as the challenges to be overcome by any meaningful process of reform. In March of 2010, near the height of the national debate over the Affordable Care Act, Lionel Shriver published So Much for That (2010), an anguished exploration of the plight of a woman dually stricken with terminal mesothelioma and inadequate health insurance benefits. In painful detail, Shriver traces the relentless progress of her character’s disease as she and her family endure the added strain of coverage denials, excessively ambitious treatments, a threat of bankruptcy, and over-medicalization of the process of dying. Shriver made an impression with her story of medical and financial distress, gaining positive reviews in the New York Times and other major publications as well as a National Book Award nomination. The purpose of this paper will be to analyze the technique of “reification of the system” as illustrated in So Much for That and to compare and contrast it with an earlier work of fiction, 72 Hour Hold (2004) by Bebe Moore Campbell, which provides a critical perspective on the operation of America’s mental health system. A concluding section situates this discussion within a broader context of the literary genre of the social problem novel while underscoring the potential cultural and political resonance of fiction of this type in raising a voice of protest “from below” against hegemonic social institutions and practices.

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