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The Wisdom of Pain in Chekhov's "Ward Number Six"
Sally Wolff
Literature and Medicine, Volume 9, 1990, pp. 134-141
(Article)
Published by The Johns Hopkins University Press
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A The Wisdom of Painin Chekhov's
"Ward Number Six"
Sally Wolff
In "Ward Number Six," Anton Chekhov, trained as a physidan,
yetdistanced from medicine from time to time by his writing career,
analyzesthe medical profession and the status of the
nineteenth-century Russianphysidan, asking penetrating questions
about the nature of suffering,disease, and death.
Set against the backdrop of decaying Czarist Russia, Chekhov's
taleis darkly meditative and philosophical, ruminating upon the
inadequadesof medidne in relieving human suffering, the necessity
of humane di-agnosis and treatment of the mentally ill, the
inequities of the medical
profession in supporting the physidan, and in a larger and more
universalsense, the role of any sodety in nurturing the physical,
spiritual, andintellectual life of its members. Chekhov condemns
the concept of a mentalhospital as a place for incarceration and
punishment, and his story is in
part a plea for effective and humane psychiatric care. In the
demise ofDr. Andrew Yefimovich Ragin, Chekhov underscores the
ineffectualityand failure of one dodorand of medidne in generalin
mediatingagainst pain and death amid the sodal degeneration of his
own culture.The poignance of the lesson in "Ward Number Six"
retains resonanceeven today, although the particular triumphs and
failures of medicinehave changed.
The setting for the story immediately links the environs of the
hos-pital called Ward Number Six with decay and melancholy, an
appropriateassodation for this sad tale.
The roof is rusty, the chimney half collapsed. The porch steps
haverotted and are overgrown with grass. . . . Those nails with
spikesuppermost, the fence, the hut itself ... all have the
melancholy,
doomed air peculiar to hospital and prison buildings.1
Literature and Medicine 9 (1990) 134-41 1990 by The Johns
Hopkins University Press
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Sally Wolff 135
The opening descriptions of the mental patients in Ward Number
Sixshow them to be ironic representations of sodety in a larger
context. Thefirst patienf s pose suggests the sardonic tone of this
tragic story: "Hegrieves all day and night, shaking his head,
sighing, smiling a bitter smile"(p. 24).
In part, "Ward Number Six" is a self-portrait of a physidan
strugglingagainst the call of a rival profession. Like Chekhov, who
began his writingcareer before he began his medical one, Andrew
Ragin starts another
profession before he enters medidne. Ragin prepares for a
theology degreeuntil his father, a doctor of medidne, raises
objections. "Ragin himselfhas often confessed that he never had any
vocation for medidne or forsdence in general" (p. 31). Despite
these questionable motivations, Ragineventually trains for the
profession of medidne. Chekhov reveals thissemiautobiographical
charader with both the inside perspective of onetrained in medidne,
and the critical distance of one removed from it.
Through Ragin, Chekhov expresses his own self-critirism at his
dividedprofessional interests and his suspidon about the efficacy
of medidne incuring human ills.
Ragin's failure as a physidan may stem partly from his initial
lackof commitment to the profession, but it crystallizes with his
growingdisillusionment about medical ineffidency at Ward Number
Six. DonaldRayfield has seen Ragin's flaws as a matter of hubris
and an easy-goingnature.2 But Ragin suffers, too, from fatigue and
a sense of futility. Hesoon adopts the attitude of "apparent
indifference to the irregularities"that he sees around him (p. 33).
W. H. Bruford sees this indifference asevidence of Chekhov's
skeptidsm of the stoic ideal, since "to cultivateindifference to
suffering is to aim at a living death, for to feel is to
live."3
The burden of Ragin's medical practice soon crushes his spirit.
Hefeels the routine and "palpable futility of his job" (p. 33) and
becomesunable to cope with the hordes of patients"thirty patients
today, andtomorrow, like as not, thirty-five . . . then forty on
the next dayso on,day in day out, year in year ouf ' (p. 33).
Allowing his duties as a dodorto slide, Ragin stops attending the
hospital every day, weary with asking"his own questions which he
has been asking for over twenty yearswithout variation" (p. 35).
The problem of overworking physidans was
a real one and as common then as now. In 1800, the Paris General
Hospitalreported employing one dodor for six thousand patients.4In
the doctor's fatigue and resignation Chekhov points to the im-
possible conditions and unrealistic expedations sodety places
upon phy-sidans, espedally those in outlying regions of the country
like that in
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136 THE WISDOM OF PAIN
which Ragin's hospital is located. Finally, Ragin's exhaustion
and indif-ference render him ineffective as a doctor.As Ragin
descends into cynidsm, he asks fundamental philosophical
questions about the real purpose of medidne:
Why stop people dying if death is every man's normal, regular
end?Who cares if some huckster or bureaucrat survives an extra five
or ten
years? And then again, if one sees medicine's function as
relievingpain with drugs the question naturally arises why pain
should be re-
lieved. (P. 34)
Ragin's fatalism douds his view of any higher purpose of medidne
inrelieving suffering. Although Ragin keeps abreast of the
"fantasticchanges" of Kodi, Pasteur, and others, "which have taken
place in med-icine in the last quarter of a century" (p. 39),
nonetheless he despairs, formedical advances cannot outrun human
disease, suffering, and death.Finally Ragin cannot distinguish
between the best Viennese clinics andhis own rotting lunatic
asylum:
"There are antiseptics, there is Koch, there's Pasteuryet the
essenceof things has not changed a bit, sickness and mortality
still remain.... So if s all a snare and delusion, and between the
best Viennese
clinic and my hospital there is no real difference at all." (P.
40)
Medidne remains futile in the face of the mortality and disease.
Thecontrast between Ragin's cynidsm and Chekhov's own more
optimistic
philosophy is clear in Rayfield's statement that Chekhov knew
that aphysidan could "leave no mark on human misery" and
nonetheless "per-sisted in treating the sick, sowing corn and
planting trees."5
The main challenge to Ragin's ideas as a physidan and
philosophercomes from his dodor-patient relationship with Gromov,
the wise mad-man, initially, Gromov voices complaints about the
efficacy of dodorsand medidne. (Chekhov's characterization of
Gromov as a paranoiac isapt: Gromov even mistrusts the doctor. "
'Catch me trusting you? Notlikely!' " [p. 46], he exdaims. He
likens the doctor to a spy, daiming thereis no "difference" in the
examination by one or by the other.)
But Ragin cannot empathize with his patient. Instead the
dodoroffers platitudes reminiscent of the optimism of Voltaire: "
"There's nodifference whatsoever between a warm, comfortable study
and this ward/. . . 'Man finds peace and contentment within him,
not in the world
outside' " (p. 47).6 Unable to understand or ameKorate the
suffering of
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SaUy Wolff 137
his patient, Ragin simply adds, " 'One must seek the meaning of
life, fortherein lies true happiness' " (p. 47). Gromov knows that
Ragin will onlyfind meaning through suffering.
Like a Shakespearean fool who speaks the most wisely,
Chekhov'sGromov reasons, philosophizes, and speaks the truth.
Gromov preacheshis ideas in what Ragin finally admits is a
"rational" way (p. 49). Sincethe doctor has never known suffering,
Gromov maintains, the doctor hasno right to assume that he might
heal others' pain:
"Now, why do you think yourself competent in the search
formeanings, contempt for suffering and the rest of it? That's what
I'dlike to know. Have you ever suffered? Have you any idea what
sufferingis? Tell me, were you beaten as a child?" (P. 49)
Ragin has not suffered as his patients have, and in time the
prophesiesof Gromov come truethe dodor must come to know pain in
order tounderstand the intense pain of others and to find any
meaning. Untilthen Ragin remains in the shadowy world of theory and
abstraction,
perhaps reflecting Chekhov's own apprehension about
becoming"con-versant with reality only in theory" (p. 49).The great
irony in "Ward Number Six" lies in the similarity between
the insane and the sane. The distinction between the purported
insanityof the patient and the assumed sanity of the doctor
represents Chekhov'ssharp critique of accepted standards of sanity
and inadequate, insensitive,and inhumane treatment of those judged
mentally ill. When Ragin talkswith the purportedly insane patient,
Gromov, as if he were sane, thestory reaches its turning point.
Ragin finds truth and intelligence in Gro-moVs talk, and in doing
so, he risks his own professional reputation byhis dose alliance
with the insane patient. The philosophical discussionswith Gromov
inspire Ragin and are a provocative source of
intellectualstimulation for him, and yet this relationship
predpitates Ragin's demise.But in the philosophizing of his
patient, Gromov, institutionalized forinsanity, Ragin sees
productive intellectual discourse. Ragin views therelationship with
his patient as mutually benefidal: "We see eadi otheras people
capable of meditation and discussion, and that makes for
oursolidarity, different as our views may be" (p. 51).
Talking with his contemporaries and townspeople, on the
otherhand, bores Ragin. He complains of the "general idiocy,
mediocrity, [and]obtuseness" (p. 51) of his acquaintances in town.
Chekhov's contrast
between the obtuse sane and the scintillating insane is most
pointed here.The diagnosis of GromoVs insanity, and later, Ragin's,
raises a
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SaUy Wolff 139
of people is ill-qualified to determine the competence of a
physidan; infact, they question Ragin "in the manner of examiners
aware of their ownincompetence" (p. 53). At the conclusion of this
interview, Ragin findshimself "for the first time in his life . . .
terribly upset about the state ofmedidne" (p. 54). As a result of
this rather haphazard and uninformedprocedure, Ragin is proclaimed
insane and becomes an inmate at WardNumber Six. Medical
accomplishment here is at its worst: Ragin is judged,condemned, and
sentenced to an asylum without just cause or cure. Theconfinement
is unfair, and for so many psychiatric patients for so many
hundreds of years, the treatment torturous.Chekhov presents
evidence about Ragin's mental state by centeringthe consdousness of
the narrative in Ragin's own mind, and allowing thereader to make
an unbiased assessment of the doctor's sanity. Ragin'semotional
state comes under scrutiny. At first he feels only an
irritationwith his friend, Michael Averyanovich: "his sole
sensation was of an-noyance" (p. 56). Next he feels anger that the
medical community couldinsult him so thoroughly by prodaiming him
mad. This causes a revulsionlike "layers of scum" that "seemed to
be fonrting inside him, and after
each of his friend's visits he felt as if these deposits were
mounting higherand higher until they seemed to be clutching at his
throaf ' (p. 60). Evenhis eventual emotional outburst, which his
colleagues view as madness,might just as convincingly be called an
angry condemnation of the cal-loused bureacratized medical system
unjustly accusing him of psychiatricillness: "Most odious of all,
Khobotov felt obliged to give Ragin medicaltreatment and believed
that he was actually doing so. He brought a phialof potassium
bromide on each visit, and some rhubarb pills" (p. 60). Thismedical
misjudgment represents the larger, uncaring sodety around him.As W.
H. Bruford has noted, and as John Stone illustrates in his "Re-
sponsive Reading," Ragin's characteristics resemble those of
other Chek-hovian doctor charaders who "are idealists to begin
with, but... succumbin the unequal struggle with disease, ignorance
and social injustice."9 Thedodor is disillusioned and disappointed
with his own profession and withthose around him who cannot provide
remedy.
Ragin offers the final diagnosis of his own case. He does not
seehimself as insane, but rather as a victim, on the one hand, of a
medical
system incapable of diagnosing and treating mental illness, and
on theother, of a sodety generally unable to accept and sustain
true intellectuallife:
There's only one thing wrong with me: it has taken me twenty
yearsto find a single intelligent man in the whole town, and he is
insane.
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140 THE WISDOM OF PAIN
I'm not ill at all, I'm just trapped in a vidous drcle from
which thereis no way out. (P. 63)
Ragin seeks intellectual and sodal discourse and cannot find it
amongthe purportedly sane. Here lies Chekhov's biting sodal
commentary aboutthe cultural decay and malnourishment that
encourage mediocrity anddiscourage refined intellectual
activity.
The dodor is, of course, finally unable to exist in either the
envi-ronment of the sane or the insane, and so he dies. But Ragin
attains a
certain wisdom in the process. He learns that Gromov's words are
true-he must know pain to understand the suffering of others and
give itmeaning. Ragin learns the wisdom of pain. Initially
indifferent to hispatients and unable to look them in the eye,
Ragin finally recognizes theirpain as he undergoes the shock of
incarceration and beating in WardNumber Six. Only through his own
profound suffering in the ward canhe comprehend the grief of human
existence there. Beaten by the guard,
Nikita, and nearly unconsdous, Ragin feels the pain of his
patients, andthe new knowledge is "past all bearing":
He felt as if someone had stuck a sickle in him and twisted it a
few
times inside his chest and guts. He bit the pillow in his pain
anddenched his teeth. Then suddenly a fearful thought past all
bearingflashed through the d-aos of his mind: that just such a pain
must bethe daily lot, year in year out, of these men who loomed
before himlike black shadows in the moonlight. How could it be that
for twentyyears and more he had ignored thatand ignored it
wilfully? (P. 68)
Now a pauper (perhaps Chekhov's final barbafter twenty years of
ser-vice, the doctor has no pension), a despairing man, but one who
knowsthe meaning of suffering, Ragin dies. His demise is unnoticed
by almosteveryone. Like so many tragic characters, Ragin's
illumination of truthcomes at the moment of death, too late to live
in wisdom.
Chekhov's view of medidne in "Ward Number Six" is jaundiced.The
story chronicles the failure of a physidan, the inability of the
medical
professionals around him to perceive his deepest needs, and the
failureof sodety to support him. Ragin's own professional failures
are substantial
and dearly set forth. He initially diooses medidne for the wrong
reasons-he chooses his profession for his father and not out of a
personal com-mitment to it himself. Once he assumes
responsibilities at Ward NumberSix, Ragin succumbs to the
impossible demands upon his time and energy
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SaUy Wolff 141
by work in the ward. This combination of circumstances
eventually leadsRagin to the fatalism of his later days: if death
is normal, why relievepain?
Yet Ragin's early, personal detachment from the pain and
sufferingof Ward Number Six is his greatest weakness. As such Ragin
representsthe handicaps of Russian medidne during Chekhov's
lifetime in its in-adequacy, despite the new advances in Vienna, in
reducing human painand misery. Ragin is an exemplum of the failure
of medidne accuratelyto diagnose and assuage the suffering of
fellow men. The human com-
munity is likewise defident in distinguishing the criminal from
the insaneand merely the unhappy; in fad one is readily mistaken
for the other.The insane are incarcerated and beaten like
criminals, rather than treated
as humans who are ill and in need of medical care. Similarly no
remedyemerges for the culturally empty. Those who hunger for
knowledge,intellectual discourse, and human understanding must go
unnourished.The soul-sick Dr. Ragin becomes Chekhov's symbol for
spiritual, intel-lectual, and physical malnourishment. In his
decline into exhaustion andstroke, Ragin represents a vision of a
world increasingly charaderized by
diminished values, bureaucratic indifference, professional
insensitivity,and cultural barrenness. "Ward Number Six" is
Chekhov's metaphorical
place where the cost of wisdom is a kind of pain that medidne
cannotcure.
NOTES
1. Anton Chekhov, "Ward Number Six," in Ward Number Six and
Other Stories,
trans. Ronald Hingley (Oxford: Oxford University Press, 1965),
23. AU subsequentquotations are from this edition and are dted
parentheticaUy in the text. Copyright 1965,1970,1971,1974 by Ronald
Hingley. Reprinted by permission of Oxford UniversityPress.
2. Donald Rayfield, Chekhov: The Evolution of His Art (New York:
Harper andRow, 1975), 126.
3. W. H. Bruford, Chekhov and His Russia: A Sociological Study
(London: Routledgeand Kegan Paul, 1948), 207.
4. Roderick E. McGrew, Encyclopedia of Medical History (New
York: McGraw HiU,1985), 194.
5. Rayfield, 128.6. For example. Candide beeves that "we must
cultivate our garden." People
are ultimately responsible for their own happiness.7. Rayfield,
79.8. Leskov, quoted in Rayfield, 127.9. Bruford, 158.
