Immigrants and Illness

Illness stories recount a person’s experience with sickness and disease, often following the journey from the onset of the illness to its diagnosis, to treatment and recovery. They’ve gained increasing critical attention in recent years, thanks to what we might call the narrative turn in the study of illness and medicine. Emerging as a distinct literary genre, illness stories play an important, if not central, role in the growing fields of narrative medicine and medical humanities. Although they exhibit a variety of structures, illness stories, the scholar Arthur Frank suggests, can usually be classified into three common categories. Restitution narratives trace an ill person’s road to recovery and the return to one’s previous state of health. Chaos stories, in contrast, describe an unsettled path where the hope and possibility of recuperation are not recognizable. Finally, quest narratives relate a kind of personal (perhaps even spiritual) journey in which an individual accepts her illness and gains meaning from the experience, leading ultimately to the individual’s transformation.¹

Often deploying the trope of the journey, illness stories are not unlike immigration narratives, which explore the life-changing and sometimes traumatic experience of geographical migration and cultural dislocation. In three recent books, immigration and illness intersect, producing nuanced narratives that broaden and complicate the ways in which we might read immigrant stories. Cristina Henríquez’s novel The Book of Unknown Americans, Akhil Sharma’s Family Life (also a novel), and Gary Shteyngart’s memoir Little Failure introduce readers to a varied cast of immigrants and present us with intimate portraits of their experiences in late 20th-century and contemporary American society. As immigration narratives, they explore familiar themes: difficulties with learning English, questions of identity and cultural doubleness, and the promises and disappointments of the American dream. Hailing from Mexico, India, and Russia, the immigrants in these texts must deal with the vicissitudes and mundanities of life, and confront the consequences of their past actions and present decisions. Yet the most striking commonality between these texts is not one exclusive to the immigrant experience. Rather, it’s a universal fact of the human condition—illness.

In The Book of Unknown Americans, a daughter’s traumatic brain injury compels a family to immigrate to the United States to seek better treatment, and to take advantage of the resources otherwise unavailable to them in Mexico. In Family Life, a tragic accident leaves the eldest son of an immigrant family severely brain damaged, dramatically transforming the lives of the father, mother, and younger brother who must care for him. Finally, although illness is not the central driving force in Little Failure, Shteyngart’s struggles with asthma, panic attacks, and substance abuse become signposts that help him make sense of his experience as an immigrant.

To varying degrees, all three authors deploy the conventions of both illness and immigration narratives to tell a story in which characters must embark on two different, but intertwined, journeys. In each book, immigrants must navigate not only the “old” and “new” worlds, but also the worlds of illness and health. When illness and immigration converge, the immigration narrative may take on the structure of one version or another of the illness story, turning the immigrant experience into a quest, as in Shteyngart’s Little Failure, or into a chaos story, as in Henríquez’s The Book of Unknown Americans and Sharma’s Family Life.

These books explore familiar themes: difficulties with learning English, questions of identity and cultural doubleness, and the promises and disappointments of the American dream.

The title of Gary Shteyngart’s memoir is a translation of the term “Failurchka,” which his mother invented by adding a Russian diminutive form to the English word “failure,” creating a term that expresses more disappointment than endearment towards a son who became a writer, rather than the lawyer she and her husband had hoped for. Little Failure is a departure from Shteyngart’s earlier work in terms of genre (he’s the author of three successful novels, The Russian Debutante’s Handbook, Absurdistan, and Super Sad True Love Story), but it returns to the world and themes that have inspired his novels—Russia, immigration, and “the great uprooting of language and familiarity.” In his novels, however, he often “approached a certain truth [about his life] only to turn away from it.” In this memoir, he affords himself “no safety.” It is a move consistent with what Arthur Frank describes as the “quest” version of the illness story, in which suffering is met head on, and here Shteyngart directly confronts painful truths.

Writing about his family’s experiences in the US with the benefit of hindsight, Shteyngart reveals some unflattering things about this nation of immigrants. In the context of amusing personal anecdotes, Shteyngart makes astute observations about immigrants’ immersion in American consumerism, the allure of upward mobility and the endless climb up the ladder of prosperity, and the realities of racial privilege, which can make or break one’s chances at the American dream. For example, regarding the racial dynamics of New York’s ethnic communities, he notices that beneath Soviet immigrants’ “hatred and fear” of Hispanics is “laughter and relief.” “The happy recognition that, as unemployed and clueless as we are, there is a reservoir of disgust in our new homeland for someone other than ourselves. We are refugees and even Jews, which in the Soviet Union never won you any favors, but we are also something that we never really had the chance to appreciate back home. We are white.” Here is Shteyngart at his best, calling attention to and casting a critical eye on white privilege even as he recounts one of the earliest lessons he learns about race in American society.

In relating his family’s encounters with common immigrant struggles, Shteyngart’s memoir is not the conventional march from immigrant to American, from poverty to middle class. Shteyngart frames his memoir with a mystery. He begins by describing a time in his post-college life when he visited a bookstore in New York and happened upon the book St. Petersburg: Architecture of the Tsars. Flipping through the pages, he sees a picture of the Chesme Church in Saint Petersburg, Russia, and begins to have a panic attack. The picture brings back memories of his childhood, of him and his father playing with a toy helicopter that gets stuck between that church’s spires. This was supposed to be a happy time in his life. But instead of bringing him joy, why does the picture, the memory, cause him to panic? “What happened at the Chesme Church twenty-two years ago?” This is the question that hooks readers as the book opens, and to which its last chapter effectively returns.

In between, Shteyngart frequently talks about the various forms of illness he has faced. He introduces himself as a sickly and runny-nosed child, which earned him the nickname “Snotty” (Soplyak). If panic attacks characterize much of Shteyngart’s adult life, asthma has a big hand in shaping his childhood. He recalls how his asthma not only limited his physical activity as a child, but also caused great anxiety for his parents. But if asthma confines the young Shteyngart at home, it also has the fortuitous effect of affording him countless hours to immerse himself in books and develop a passion for writing. On the “Culture Couch,” a sofa where he sleeps and recuperates after he receives cupping therapy (a form of alternative medicine) for his asthma, he reads Selma Lagerlöf’s The Wonderful Adventures of Nils and the Wild Geese. Inspired, he writes Lenin and His Magical Goose, his first story. Later in the book, Shteyngart describes a time in college when he has his “last asthma attack ever,” perhaps signaling a break from the past, a moment when he, as an adult, overcomes the illness of his youth.

Shteyngart is equally candid about his struggles with substance abuse. As early as high school, he uses alcohol and marijuana to carry him “a little bit away from the dreams [he] can no longer fulfill.” At Oberlin College, he continues his “alcoholic and narcotic exploits” and becomes known as “Scary Gary.” Despite “being drunk and stoned all day long,” he returns to writing and still manages to graduate summa cum laude. Years later, unhappy with a desk job and stuck with an unfinished novel, Shteyngart’s self-destructive behavior (both emotional and physical) leads him, with the encouragement of a friend he refers to as “the Benefactor,” to undergo psychoanalysis, a move from the “Culture Couch” of his childhood to an analyst’s, in order to work through his fears of being a failure.

In relating his family’s encounters with common immigrant struggles, Shteyngart’s memoir is not the conventional march from immigrant to American, from poverty to middle class.

Shteyngart takes a more serious tone describing his experience with psychoanalysis, using less of his cutting, self-deprecating humor. Without irony, he writes: “It [psychoanalysis] saves my life. What more can I add to that?” Psychoanalysis spurs him not only to apply to creative writing programs, but also to return to the Chesme Church in Saint Petersburg, the source of his panic attacks. Although it takes him several more visits, including one in which he is joined by his mother and father, Shteyngart does finally learn “what happened at the Chesme Church twenty-two years ago.” Without giving away the ending, curious readers who also want to know will find Little Failure an immensely enjoyable book, full of wit, humor, and touching scenes of immigrant life in the US.

Like Little Failure, Cristina Henríquez’s The Book of Unknown Americans gestures to an obscure incident in the past that we expect will lead to a moment of revelation. The novel opens with the Rivera family’s arrival in a small town in Delaware after a 30-hour truck ride from Laredo, Texas, the city through which they legally entered the United States. Aside from the few belongings they brought from their home in Pátzcuaro, Mexico, the Riveras begin their life in America with little else but hope. We soon learn that Maribel, the only daughter of Alma and Arturo, had sustained a traumatic brain injury in an undisclosed accident. On the recommendation of local Mexican doctors, they determined to come to the United States to obtain special education services for Maribel, who now suffers from mental and cognitive disabilities. The Riveras hope that somehow she will return to the person she once was.

In Newark, Delaware, around the time of the 2008 presidential election, the Riveras become part of a working-class community of immigrants from “Venezuela, Puerto Rico, Guatemala, Nicaragua, Colombia, México, Panamá, and Paraguay.” They befriend Rafael and Celia Toro, whose son, Mayor, falls in love with Maribel. The Riveras’s immigration tale and the unconventional love story of the two teenagers intertwine to form the book’s core narrative. Told from the alternating perspectives of Alma Rivera and Mayor Toro, the novel explores the ways in which illness can dramatically impact people’s lives and complicate their relationships.

Whereas immigration narratives typically posit a journey from point A to point B, illness stories can, at times, lack this coherence. In The Book of Unknown Americans, the Riveras’s immigration story bears some characteristics of what Arthur Frank calls the “chaos story.” “Chaos stories,” he explains, “are sucked into the undertow of illness and the disasters that attend it.” Through Alma, we learn how Maribel’s injury forces them to leave their comfortable life in Mexico, where Arturo owned a successful construction business. Illness disrupts the Riveras’s relative prosperity and sets them on a path of downward mobility. In the US, Arturo takes a job as a mushroom picker at a local farm, which is the only employer that would sponsor their visas. With Arturo’s meager income, they forego all luxuries and economize as best they can, with predictable results: financial insecurity, deprivation, and marital conflict compounded by Maribel’s illness.

Cristina Henríquez, whose own father immigrated to the United States from Panama, is interested in telling the stories of “the unknown Americans … the ones no one even wants to know,” those who are “simultaneously conspicuous and invisible, like [oddities] whom everyone notice[s] but cho[oses] to ignore.” To that end, she intersperses brief testimonials of new and would-be Americans in Newark’s immigrant community between the more conventional sections narrated by Alma and Mayor. Rafael Toro, for example, recounts his decision to flee the political turmoil in Panama after the US invasion and the deposing of Manuel Noriega. There is also Benny Quinto, who sought a way out of the poverty in Nicaragua, and Gustavo Milhojas, who witnessed the Guatemalan civil war. Nelia Zafón from Puerto Rico tells of her unfulfilled youthful dreams of becoming the next Rita Moreno, and Venezuelan Quisqueya Solís shares her past as a victim of rape. Among all the characters given a chance to tell their story, however, Maribel is conspicuously absent. As Arthur Frank puts it, “[t]he person living the chaos story has no distance from her life and no reflective grasp on it. Lived chaos makes reflection, and consequently storytelling, impossible.” As the subject at the center of her personal chaos story, Maribel lacks the perspective to reflect upon and articulate her experience. In the novel, we can only piece together Maribel’s narrative through Alma and Mayor, who are witness to her illness. Unable to tell her own story, Maribel, in a way, remains unknown.

The Mishras, subjects of Akhil Sharma’s latest novel, Family Life, are, in a crucial way, a lot like the Riveras. Although the two families differ in national origin and socio-economic background, the Mishras’s immigrant experience in America is also profoundly shaped by illness. Set in the late 1970s and spanning several decades, Family Life is narrated by the Mishras’s youngest son Ajay, who simultaneously plays the role of observer, participant, and protagonist in Sharma’s long-awaited follow-up to his award-winning debut novel, An Obedient Father.²

As immigration tales go, the Mishras’s story begins ordinarily enough. Joining the wave of Asian immigrants that came to the US in the latter half of the 20th century, Ajay’s father, Rajinder, leaves India in 1978 in search of a better life in America. In the clear, unsentimental voice that governs the entire novel, Sharma writes: “My father had wanted to emigrate to the West ever since he was in his early twenties, ever since America liberalized its immigration policies in 1965 … My mother had no interest in emigrating for herself … Yet my mother was aware that the West would provide me and my brother with opportunities.” An accountant by profession, Rajinder takes a job as a clerk for a government agency and settles in Queens, New York, an historical port of entry and hub for Indian immigrants. A year later, the rest of the family—Ajay, his older brother Birju, and their mother Shuba—arrive in the States, and they soon settle into their new lives.

In many ways, illness helps Ajay gain insight into the world.

Initially, the Mishras seem to be on track to attain the American Dream. Although a step down from her position as a teacher in India, Shuba finds a job at a garment factory. She performs her new job ungrudgingly because “‘work is work.’” Despite some initial difficulties with English and encountering challenges at school, Ajay acclimates to American culture as a young child would, finding refuge in television and books. Birju excels in school and becomes the pride of his parents when he is admitted to the prestigious Bronx High School of Science. However, like the Riveras, the Mishras’s lives are disrupted by illness, transforming a promising immigrant narrative into a chaos story. Birju suffers an accident that leaves him severely brain damaged and in a permanent vegetative state. From this point forward, what readers see is a family struggling to cope with despair and the ordeal of living with and caring for someone who is interminably ill.

Although Akhil Sharma admits that he dislikes being labeled an “immigrant novelist” because it has the effect of “ghettoizing” authors, he does not mind readers describing Family Life as an “immigrant novel.”³ Still, in a recent interview, he explains that “[a] more accurate description [of the book] … would probably be that it is a coming-of-age novel or an illness novel.”

As the novel progresses, we see each member of the family develop ways to cope with their pain. At first, Shuba looks to traditional religion for hope and comfort, but her desperation leads her to seek help from various faith healers and “miracle workers” who ultimately fail to change Birju’s condition. Rajinder turns inward, spirals into depression, and becomes an alcoholic; if Birju’s illness is disruptive, Rajinder’s alcoholism proves to be destructive.

As a member of the family and the narrator/protagonist of the story, Ajay is both a witness to and participant in the despair that illness engenders. He feels its consequences as his parents take their anger and frustration out on each other, and sometimes him. Ajay’s understanding of God evolves out of the practice of praying for his brother. In one of the more amusing scenes early in the book, Ajay prays not only to a variety of deities (Hindu, Christian, Jewish) but also to Superman because, to a young child, it was logical to “flatter anyone who could help.” But as his conversations with God continue, Ajay encounters deeper philosophical questions regarding the nature of human suffering and divine existence.

In many ways, illness helps Ajay gain insight into the world. He sees the goodness it brings out in people, evident when the Indian immigrant community rallies around their family after Birju’s accident. But he also learns of people’s lack of compassion, and their sanctimonious ways, particularly when friends desert them after Rajinder acknowledges his alcoholism. As Ajay hears from Mr. Narayan, a family friend, “People get happy knowing that others are unfortunate.”

Acknowledging the personal nature of the book, Sharma says that “almost everything in the novel is true.”⁴ Readers familiar with Sharma’s biography will not fail to recognize that Ajay is, in fact, Sharma’s alter ego. Ajay develops a love of literature and a strong interest in writing, and in his development as a writer, illness becomes a source of inspiration. Writing gives him some distance from pain, as well as a space for reflection, providing both “triumph” and “detachment” “at the idea of writing sentences that contained our suffering.” He writes, “I began to see my family’s pain as belonging in a story.” Indeed, Sharma’s Family Life both reflects that pain and tells that story.

Sickness and disease are part and parcel of human life, and for immigrants, illness is one of the many trials they might encounter as they seek to establish a new life in a new country. Often disrupting the immigrant’s teleological trajectory toward assimilation, upward mobility, and the attainment of the American dream, illness can transform immigration narratives into stories of quest, chaos, or restitution. In the spirit of disruption and upending expectations, paying attention to stories of illness within immigration narratives gives us an opportunity to read immigration literature in a different way, and to gain new insights into the immigrant experience.