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Vikram Paralkar - a series of very short, psychologically dense entries, each describing a fantastical “disease”: These include a reverse amnesia that causes everyone you know to forget who you are; a skin ulceration that expands with sinful behavior and shrinks with good deeds; a toxin that causes people to perceive the unbearable truth about the world; an infection that causes peasants and aristocrats to talk like each other; a hallucinatory fever that compels sufferers to create mediocre art; a collective ailment that causes groups of five people to share a single consciousness


Vikram Paralkar, The Afflictions, Lanternfish Press LLC, 2014.

Shadowing an elderly librarian on his first day at the great Central Library, Máximo is thrilled to get a peek at the exclusive Encyclopedia of Medicine. It’s a dizzying collection of maladies: an amnesia that causes everyone you’ve ever met to forget you exist, while you remain perfectly, painfully aware of your history. A wound that grows with each dark thought or evil deed you commit but shrinks with every act of kindness. A disease that causes your body to imitate death, stopping your heart, cooling your blood. Will the fit pass before they bury you—or after?
As Máximo soon discovers, medicine at the Central Library may be more than he bargained for.
The Afflictions is a magical compendium of pseudo-diseases, an encyclopedia of archaic medicine written by a contemporary physician and scientist. Little by little, these bizarre and mystical afflictions frame an eternal struggle: between human desire and the limits of bodily existence.

Vikram Paralkar was born in Mumbai, India. He moved to the United States in 2005 after completing medical school and is now a hematologist and researcher at the University of Pennsylvania. His writing has been published in the New England Journal of Medicine and he is a recipient of the American Society of Hematology’s Scholar Award.
Read a sample from the book.
Listen to an interview with Vikram Paralkar on WHYY's The Pulse.

"The imagined text on which The Afflictions is based - the Encyclopedia Medicinae - is written as though it were lifted directly out of the Age of Enlightenment, when science and religion were still easy bedfellows." - The Pulse, WHYY/NPR Radio

An archaic world struggles with strange maladies in this darkly whimsical meditation on human discontents.
In a quasi-medieval land where science is still subordinate to church metaphysics, Senhor José, the monkish Head Librarian at the Central Library, introduces an apothecary named Máximo to the collection’s greatest treasure: the Encyclopaedia Medicinae. Perusing it, they discover short treatises on improbable ailments that combine physical disease with mental anguish, social antagonism and spiritual malaise. These include a reverse amnesia that causes everyone you know to forget who you are; a skin ulceration that expands with sinful behavior and shrinks with good deeds; a toxin that causes people to perceive the unbearable truth about the world; an infection that causes peasants and aristocrats to talk like each other; a hallucinatory fever that compels sufferers to create mediocre art; a collective ailment that causes groups of five people to share a single consciousness; and a syndrome that makes corpses return to life—a phenomenon that threatens “to topple the magnificent edifice of philosophy, art and literature” by undermining faith in the finality of death. Paralkar, a hematologist and researcher at the University of Pennsylvania, sketches these mythical misfortunes in brief, elegant entries written as if by a physician-philosopher, setting out the preposterous specifics of symptoms, diagnoses and treatments beside mock scholarly debates over etiology and final ruminations on existential import. One school of thought characterizes membrum vestigiale, a wing growing out of the shoulder blade, as “a disease of truncated ambitions…of some yearning within man to escape limits nature places on him.” There’s no plot here and really nothing to this slight book except feuilletons, but Paralkar’s tragicomic imagination, sly sendup of pseudo-Latinate medical prose and fine sense of irony make for an arresting read.
A haunting take on the ills of flesh and soul. - Kirkus Reviews

In Blindness and Death With Interruptions, José Saramago invented afflictions and weaved entire stories from them. People go mysteriously blind and descend into barbarity. Death leaves her post and funeral homes pile up with living corpses. Through the lens of a singular illness, we experience hidden natures within ourselves that we never expected to face.
Vikram Paralkar has added fifty diseases to the list. The Afflictions does not stop at a unique sickness and turn the consequences into a story. It catalogues a world of unknown ailments, touches upon the moral ramifications of each, and lets the reader imagine the rest. A wound that grows larger with every act of evil, but grows smaller with every act of kindness. An epidemic that creates profound melancholy in all, but spurns some to great art. A “protracted miscarriage,” in which a fetus grows for seven months and then subsequently shrinks into nothingness. Then on to the reader to contemplate the meaning of such maladies.
But are they really maladies? Through the fantastical conditions he invents, Paralkar essentially proposes a Revaluation of all Maladies, to paraphrase Nietzsche. Not all invalids are infirm. A woman who contracts Corpus ambiguum uses her ability to sense pain in other bodies to drive out sickness, while those inflicted with Mors inevitabilis grow so comfortable with death that “their souls drift free of their bodies without protest.”
Indeed, while the novel is built around excerpts from the fictional Encyclopaedia of Medicine, Paralkar is every bit as concerned with soul as he is with body. The book is soaked with religious allusions and a Gothic sensibility that harkens Medieval Christendom. The reader meets not only with souls, but with theologians, scribes, monasteries, heresies, witches, priests, moralists, blasphemy, saints, divine design, sin and virtue, condemnation and conscience. Yet the piety is hardly normative. God is not dead, but He is on trial.
The injustices that riddle all existence must trouble God’s own conscience, and if God indeed made man in His own image, He surely granted him not only a conscience but also the ability to suppress its voice at need.
The author wisely refrains from a dogmatic endorsement of the irreducible soul, while reminding us that a reductive materialism won’t quite do, either. We are constantly invited to ponder the enormity of human experience and the sensation of transcendence, while acknowledging that the physical material from which we are made—and from which we both suffer and rejoice—cannot be severed from our sense of self.
Thought-provoking and entertaining all at once, if The Afflictions is missing anything it’s a broader story. Stuck between and around the medical notations are a series of conversations between Senhor José, an elderly librarian, and Máximo, his young apprentice. Their discussions touch upon the book’s major themes, but their lives and motivations are not deeply connected to the entries we find in The Encyclopaedia of Medicine. Rather than an integral part of the diseases we encounter, the discourse between Senhor José and Máximo seems designed primarily to create the ability to discuss the incredible illnesses that Paralkar has so deftly created.
Though perhaps that’s by design. As Senhor José tells Máximo: “The Encyclopaedia isn’t complete—far from it—yet it’s already growing outdated.” That’s where we come in. The diseases and their effects linger long after the book is finished, allowing the reader to picture himself in such circumstances, as well as imagine new and unheard of maladies. The Afflictions is a partnership between author and audience, which takes on a life of its own in spite of and because of disease’s closest intimate: death. - Frankie Sturm

Imagine a kind of amnesia wherein everybody forgets about you (Amnesia inversa). Imagine a disease that causes you to contract the infirmity of your neighbor, as your neighbor assumes yours (Renascentia). Imagine becoming so comfortable with the sensation of death that ultimately your spirits gently leave your body (Mors inevitabilis).
These are imagined diseases compiled in "The Afflictions," a work of fiction based on a 16th century medical encyclopedia – the 375-volume Encyclopedia Medininae – housed in an medieval library in Portugal.
That, too, is made up.
"The Afflictions" is the first published work by Vikram Paralkar, an oncologist at the University of Pennsylvania specializing in cancer of the blood. In whatever spare time he has when not researching cancer and treating patients, he likes to write fiction.
"I've always been passionately interested in reading fiction. I discovered Calvino, Borges, and Gabriel Garcia Marquez at 18," said Paralkar, referencing his magical realism influences. "I wanted to capture ideas in beautiful language."
The ideas he is closest to are medical. The 50 diseases described in "The Afflictions" – some complete with cures and case studies – can be read as bizarre, gruesome fables that hint at medical issues.
Take the aforementioned Renascentia, wherein neighbors meet in their village church once a year to find out where the "divine dice" rolls, taking away pre-existing maladies from some and assigning them randomly to others.
Some leave with freshly pockmarked faces, others with new obstructions in their bowels. Some receive dementias or epilepsies of fulminant afflictions that wrack them with agony even as they rise from the pews. And others are cured of consumption, their amputated limbs grow back, or their pustules vanish.
"One of the ideas this disease tries to explore is the arbitrariness by which diseases are given out to people," said Paralkar. "If this were to happen, on a single day of the year, you were to get a completely new set of diseases, you would consider it an awfully unjust system. But is it any more unjust than what exists now? People are allotted their own random set of diseases."
The imagined text on which "The Afflictions" is based – the Encyclopedia Medicinae – is written as though it were lifted directly out of the Age of Enlightenment, when science and religion were still easy bedfellows.
The disorder known as Persona fracta, or Fractured Person, is a psychosis wherein the invalid believes every body function is controlled by a separate person. Paralkar created a case study of a suffering seamstress who understands that walking is done by the walking seamstress, breathing by a breathing seamstress. Her body houses the talking self, the eating self, the looking self, an infinite number of persons each of whom step forward when needed.
The seamstress is not actually suffering. She functions perfectly normally, if a bit crowded. The problem is theological: if she believes her body functions are a collection of dissociated pieces, it stands to reason her soul is the same. When the body falls apart, the soul follows. That notion goes against the church's insistence on the perseverance of the soul in heaven.
"In the 16th century, any explanation you proposed, you had to grapple with ideas of god, heaven and hell," said Paralkar. "I decided to utilize that to the fullest. Anytime a disease that veered into theological implications, I dived into that area."
The world that Paralkar created, based in part on the history of medicine and in part by imagination, is one that makes sense. He wrote brief summaries of 50 diseases, all of which describe a single malady. The meta-affliction in "The Afflictions" has something to do with being fractured and displaced, with the center not holding.
In his day job as an oncologist, Paralkar, the scientist, realizes that disease does not make ethical sense, nor theological, nor moral sense.
"Its intrinsic to people that we find a moral purpose to things," said Paralkar. "Especially with cancer, people ask - why did this happen to me? The answer is because cells divide and sometimes they make mistakes. That answer is immensely unsatisfying. It's just the way we are programmed, we try to find reasons and patterns." -

Disease is made into something new and strange through the eyes of writer-scientist Vikram Paralkar. In his debut book The Afflictions, Paralkar takes advantage of long held associations of medicine with magic to literalize our most darkly-held superstitions about illness.
The book claims to be a collection of entries from the fictional Encyclopedia of Medicine, a compendium of surreal and arcane materia medica. But behind the pseudo-medieval setting and the Calvino-style diction is a meditation on the symbolic resonances of the word “affliction.”
In one of the entries, a man afflicted with Corpus ambiguum can no longer understand the boundary between his body and the rest of the world. “On being asked to sketch pictures of themselves, invalids with this condition often draw incomplete versions of their own bodies, surrounded by amorphous auras and clouds of disjointed appendages.” A woman diagnosed with Persona fracta, on the other hand, is “unable to think of the ‘she’ who walked and the ‘she’ who spoke as the same individual.”
Haltingly, slowly, another story emerges from these encyclopedia entries. The framing narrative and the heart of The Afflictions is the story of Máximo, a young apothecary who wants to become a librarian. As he is guided through the workings of the vast “Central Library” by an elderly librarian, more and more bizarre medical entries are presented to the reader. In one of the more masterful narrative strokes in the book, the nature of Máximo’s own affliction is never fully explained but merely hinted at, mirroring how the encyclopedia itself only hints at the full scope of maladies that can potentially afflict us. As the elderly librarian warns Máximo, “If you read the Encyclopaedia from beginning to end, you get the feeling that every affliction known to man is part of a single, infinite progression. Or that every disease is a different facet of one great and terrible malady.” 
If all this reminds you of a certain Argentinian short story writer, it should—Paralkar cites Jorge Luis Borges as his literary idol. The prose of The Afflictions at times can read like an imitation of Borges’, and Paralkar shares with Borges a collector’s delight in details. One can practically feel Paralkar luxuriating in the task of describing some of the three thousand essences of sounds distilled for the treatment of Agricola’s disease, “some that restore the invalid’s ability to hear the wings of sparrows, others that cover the lower sonorities of dulcimers, yet others that are concerned with the sounds of raindrops.”
But Paralkar’s obsession with minutiae and the archaic are more than just literary mimicry. The medieval world of The Afflictions is a vast, senseless universe that can only be ameliorated by fleeting beauty and small joys. For example, in the unlucky towns afflicted by Auditio cruciablis epidemics, every sound inflicts the most excruciating pain. Though the inhabitants are trapped in the desolation of silence without end, they respond not scientifically, by searching for a cure, but aesthetically, through dance. The medical scholars “write with wonder of the elaborate ballet of the people, the slow, viscous movements they conduct with wary grace, the extraordinary steps they take to preserve the silence.”
In The Afflictions, disease is an organizing metaphor through which Paralkar explores the unfairness of “affliction.” Why, he seems to ask, does one man wake able to prophesy in tongues, while another is fated to constantly regress to a state of infanthood? And if pure randomness is the only reliable authority in the universe, is there a way in which we can “cure” the affliction of chance? The Encyclopedia is one such attempt at a cure, where scholars try, impotently, to rationalize the irrational. As the elderly librarian warns Máximo: “One day, I fear, the separate strands will refuse to twist together anymore. The golden thread will unravel. The stacks out in the corridor will overflow the Library and become impossible to curate. The Encyclopaedia will lose its authority, and all our knowledge will disperse into fragments.”
The most poignant responses to the afflictions of chance are the moments of futile defiance. The entry on Lanfranco’s Disease tells of a village whose inhabitants became deaf to all except fragments of music only they could hear. Musical experts quickly realized that the afflicted were hearing, “A vast and magnificent expanse [which] could now be glimpsed, one without beginning or end” and yet the nature of the disease meant that it would be impossible to ever fully capture the music in its entirety. They try anyway, even though the passing of the years means that “The possibility of access to the music has dwindled to a handful of threads. Soon it will diminish to a trio, a duet, a solo.” The act of attempting to grasp what one can from inevitable loss, Paralkar seems to express, is the only human course of action, and the principle has no small resonance for the field of science as well.
The Afflictions returns us to the idea of the essential interconnectedness of mind and body, that our faculties of memory, of language, of morality, of love, are no less real and necessary to survival than the organs of the heart or kidney or lungs. Paralkar suspends, for a brief moment, the enmity between life and sickness in order to imagine how affliction can be a kind of sea-change, a shift in our being or impetus for a new mode of consciousness. A number of the diseases in the book ultimately result in victims having to become traveling minstrels or drifters. Their estrangement from any community transforms them into living ghosts, an analog to the death that is the consequence of many real-life diseases.
One such invalid, afflicted by Morbus geographicus, is forced to wander the earth endlessly,  “becom[ing] a palimpsest, his life etched with layer upon layer of new scenery, until he wonders if there is anything beneath it all.” The hulking Encyclopedia of Medicine is similarly “over-written,” and threatens to lose all sense. But if we are meant to take any consolation from The Afflictions, we can take it from this, that just as the “trajectory” of the man suffering from Morbus geographicus inevitably “folds in on itself and leads him back to the land of his birth” so will our knowledge return to purer incarnations as it unravels. - Brenda Wang

Interview with Vikram Paralkar

Vikram Paralkar was born in Mumbai, India. He moved to the United States in 2005 after completing medical school and is now a hematologist and researcher at the University of Pennsylvania. His writing has been published in the New England Journal of Medicine and he is a recipient of the American Society of Hematology’s Scholar Award. Paralkar also posts absurdist tweets.
The Afflictions, his first book, is a catalogue of fifty inexplicable and fantastical conditions, each with its own moral mirror. Examples include “an amnesia that causes everyone you’ve ever met to forget you exist, while you remain perfectly, painfully aware of your history [and] a wound that grows with each dark thought or evil deed you commit but shrinks with every act of kindness.”
Interviewed by: Sara Goudarzi
/One/: How did you come up with the idea for The Afflictions and how did it evolve to its present form?
Vikram Paralkar: Some years ago, I began to write a short story about a town whose inhabitants awaken one morning to find that they all speak different languages, and can no longer communicate with each other. As I wrote the first sentences, I realized that the story would work better as a medical vignette, a brief account of an epidemic, written by a physician. That turned into ‘Confusio linguarum’, one of the afflictions in the book. Then I wrote a second, and a third, all with the same basic style, and it became clear to me that I could use this form to circle and explore a core set of themes – fragmentation, unity, identity, exile, sin, transcendence, divine will (among others). I eventually wrote sixty-six afflictions, and then boiled them down to the fifty that made it into the final draft.
/One/: It seems to me that in many, if not most, of the instances, the afflictions described in the book are ethical or societal conditions, exaggerated or rather masked into medical ones, sort of giving us a glimpse of some of humanity’s disturbing and rather ugly behaviors. Did you intentionally want to use medical conditions as a mirror for us to reevaluate some of our actions?
VP: I wasn’t particularly aiming for the reader to have anything other than an aesthetic experience from the book, though an experience of ‘disquiet’ could be thought of as both an aesthetic experience and an evaluative one, and it was certainly one I was hoping to evoke. It is true that many of the afflictions are magnified versions of moral failings, and I chose to steer my writing in those directions because I found that they gave me the sharpest tools to pry open human nature and present the ways in which it can be distorted. So while the goal wasn’t to have readers rethink their own lives and decisions, it isn’t an unwelcome thing to me as an author if the book somehow accomplishes that.
/One/: What’s the lingering effect you’re hoping the book will have on the reader?
VP: That’s a difficult question. I hope the reader will come away with the feeling that the gears in her brain have been turned, that she’s seen familiar facets of human existence exposed in unexpected ways, that she’s recognized patterns running through the afflictions that the author himself might not have realized. And perhaps (this might be too much to ask), that she has read something engaging and disquieting in equal measure.
/One/: There’s a quality to this book that reminds me of Alan Lightman’s Einstein’s Dreams and Italo Calvino’s Invisible Cities. Did these books inspire you in some way?
VP: I read Italo Calvino’s Invisible Cities when I was twenty-one, and the experience was akin to taking a dip in a lake of very cool, very pure water. It was a work of genius – original, imaginative, glittering – and it gave me an intellectual thrill that was only rivaled at the time by my reading of Jorge Luis Borges. Though I did not consciously set out to recreate the form of Invisible Cities, there can be no doubt that it was a major influence.
I haven’t read Alan Lightman yet. A friend of mine, after reading early drafts of The Afflictions, gifted me a copy of Einstein’s Dreams, because she saw in my writing similarities with Lightman’s work. So I deliberately chose not to read it, to keep myself from being influenced. I still have the unopened book on my shelf – perhaps it’s safe to read it now.
/One/: As far as structure, the novella is not plot or character driven but catalogues illness and reads much like the encyclopedia referenced in the text. When you started writing, did you know this was the structure you’re aiming for, or did that change as you moved forward with the project?
VP: When I first started writing the individual vignettes, I didn’t have a structure in mind. I’d considered bundling them in groups of five or six and publishing them in literary journals. However, as the numbers began to mount, and reached over fifty, it became clear that I needed some kind of overarching structure – some framing device – to tie them together into a single book. I tried a number of different ideas. I tried detailed characters embroiled in conflicts over a span of months (in other words, a real plot). However, it was evident from the beginning, and remained evident, that the afflictions were the true focus of the book, and any attempt to weave complex plots around them resulted in an uncomfortable marriage that did justice to neither partner. So I just stripped the framing device down to its bare essentials, to a light conversation between two librarians over the course of a day. The conversation touches upon some of the themes in the book, but it does not overpower the afflictions, and allows them all the space they need.
/One/: Who, or what, in your mind, is the book’s main character?
VP: Man. Imperfections and all.
/One/: Can you name some of the afflictions that have occupied your mind or rather disturbed you most and why?
One of the problems with familiarity (especially the kind of familiarity that comes with multiple back-and-forth editing and proofreading sessions before publication) is that the author becomes incapable of seeing menace in his own writing. But I can point to two afflictions that disturbed me during the initial writing – ‘Virginitas aeterna’ and ‘Pestis divisionis’. Both describe violence of an intimate nature that I find repellent, but which the afflictions seemed to demand.
/One/: In ‘Exilium volatile’ the afflicted are sea travelers who feel disconnected from their homes and suffer exile. When they arrive at their destination, they feel as though they’ve become locals of the new land. Some never recover and will forever feel exiled. This was one of the afflictions that haunted me. Can you discuss the illness and the impetus behind it—were you thinking of geographical or philosophical exile, or both, when writing this piece?
VP: It’s interesting that you picked this one, since it’s one of the few afflictions that I wrote with a specific personal experience in mind. I was trying to recreate what I felt in 2005 on a flight to Philadelphia. I was leaving Mumbai, the city of my birth, to start a new life in the United States, and hadn’t anticipated just how wrenching the transition would be. Exilium volatile is, in that sense, quite clearly tied to geographical exile, but spanning the broadest sense of geography and everything it entails – culture, food, language and family.
/One/: How, as a physician, did your medical knowledge inform The Afflictions? How, if at all, did it hinder the writing?
VP: I believe a non-physician could have written The Afflictions just as well as me. However, being a physician helped in two ways – I was already steeped enough in the vocabulary and methodology and obsessions of medical inquiry that it was easy to transplant that manner of thinking to the framework of these surreal diseases. The second was that it allowed me to avoid real illnesses. After all, so many bizarre maladies, especially of identity and language and memory, already exist in the real world, that it helped to have the knowledge to steer clear of them. I don’t believe that being a physician hindered my writing in any way, unless you count the hours I spend at the hospital, unable to write.
/One/: What’s next for you?
VP: I have a completed novel titled The Wounds of the Dead, which I’m looking to publish. It’s set in a small clinic in rural India, where a surgeon is visited by the dead, who ask him to mend their wounds so they can return to life at dawn. I also have a number of other ideas for novels germinating in my head, and am waiting for one of them to take root. - Interviewed by Sara Goudarzi


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