“Society is making me sick?”
“Society is killing you.”
–from HellSans by Ever Dundas
There’s a meme that regularly crosses my feed on Instagram which reads: “Dystopian novel [an] awesome distraction from dystopian reality”, and it’s true that both the dystopian and horror genres are experiencing a resurgence in popularity. From Sinners to The Substance, and Sunrise on the Reaping to The Unworthy, it seems as though we’re all increasingly obsessed by the dark, the unnerving, and—more explicitly—the End Times.
But perhaps that isn’t so surprising.
From Covid to the genocide in Palestine, climate and tech concerns to hostile government attacks on welfare, it’s difficult not to feel a sense of dread when we look at the world today. But throughout history, it’s when society feels at its most unstable that we find ourselves turning to the darker genres of fiction.
This, I would argue, isn’t because of any real desire to compound a feeling of hopelessness, but because these stories provide us with a space in which to explore our growing fears.
To examine dystopias across generations is to examine a history of political and social concerns. And one subgenre of dystopia that has stood the test of time—and is becoming ever more relevant in the modern day—is Dystopian Medicine.
While political tyranny or environmental collapse may be present as well, medically-dystopic worlds often fuse these concerns with elements of body horror, with medicine being wielded as a tool of harm or control. These dystopias are particularly concerned with issues of bodily autonomy, with problems of consent, and with the eugenicist impulse to forcibly standardise “non-standard” bodies.
In Hiron Ennes’ unique gothic horror novel, Leech (2022), the protagonist is an unnamed Parasite capable of possessing a human body so completely that no-one else is aware they’re no longer human. These Parasites are part of a hive-mind in charge of The Institute—an organisation which infects the hosts in childhood, and moulds them into Doctors working across the dystopian land.
In fact, so successful is this Parasite in keeping the human population alive, The Institute is now the only place capable of providing healthcare, despite the fact that its Doctors seem—for reasons of their shared parasitical mind—unnerving to those they minister to.
“I have had the foresight to be indispensable,” the Parasite thinks at one point. “The systematic collection and isolation of all medical necessities has guaranteed my survival, so that even those who dislike or distrust me must call on me in their hours of need.”
This, perhaps, is the root of our fascination with medical horror. Humans are never more vulnerable than when we need to seek medical care, yet with medical knowledge isolated and—in many instances—gatekept via money or other access barriers, we may be entirely unable to save ourselves without it. And, when we do manage to seek care, we are always at the mercy of a doctor’s decisions.
The inherent power imbalance between patient and doctor is one which provides fertile ground for dystopian visions. So much so that I privately refer to this subgenre as Dis-topian: dystopias in which it is the threat, creation, or the erasure of disability, when healthcare transforms into healthhorror, that are the primary axes of oppression in need of resistance.
In Leech, many of the children given to The Institute for “training” (in reality, for infection by the Parasite), come from poor families who offer them up as payment in return for healthcare received. Or, they’re in some way disabled already, and in need of more extensive medical treatment than anyone else can provide or afford.
Ennes draws an explicit parallel between this system, in which medical care must be paid for no matter the cost, and the sexual exploitation of a servant in the gothic house the Doctor-Parasite attends. To pay for their treatment, the human families unknowingly condemn their children to have their bodily autonomy taken from them by an invasive Parasite. To avoid being fired and succumbing to poverty, the servant is forced to bear the sexual abuses of his master.
“A lot of what the narrative wants to say about medicine is not in the details of clinical practice, but in larger aspects of the medical-industrial complex,” Ennes said of the story in an interview with Locus Mag. “[Medicine’s] rigid conformity, its use as a tool of colonialism, its hunger for knowledge and addiction to discovery, and its capability to commit great acts of evil as well as genuine, miraculous acts of good.”
Dis-topian visions often carry a warning about society’s ability to disable, but few make the case so explicitly as Ever Dundas’ HellSans (2022).
In this near-future dystopia, HellSans is a ubiquitous font used to keep the population compliant. For the majority, it gives them a hit of Bliss whenever they read, lulling them into a calm euphoria while they uncritically consume slogans such as “Work Makes You Free”.
For a small subset, however, HellSans is quite literally killing them.
The HellSans Allergic (or HSAs) experience a dramatic allergic reaction to seeing the font. Their skin cracks and bleeds. Their teeth fall out. They vomit or shit themselves copiously, and repeat exposure can lead to permanent scarring and death.
However, these people are not seen as victims of society, but as dangerous “deviants” who are shipped away to the ghettos, accused of polluting other people’s Bliss.
Dundas writes that the psychiatrists position HSAs “as deviants made sick by maladjustments to the demands of modern society,” echoing medicine’s historical tendency to pathologize physical illness as mental in origin, when its sufferers come from already marginalised groups.
As a result, research towards a cure is blocked. People disabled by the font are made homeless, attacked, forced into ghettos, and beaten and killed by “Blissters” whose constant consumption of HellSans has made them unaware of their own brainwashing.
The allegory here is particularly strong: words and advertising are wielded both as a tool of disablement, but also as one that ensures compliance and obedience from a population. When HellSans is “internalised” by virtue of it being so prevalent, even thinking can cause an HSA attack—or produce a hit of passivity-inducing Bliss.
In this particular dystopia, to be “deviant” and disabled is to be able to see the world as it truly is. But it also ensures that you’ll never be treated as human again; and medicine itself is complicit.
Far from being able to seek medical care, the moment HSAs are diagnosed, the doctor’s robotic Inex will report them to the state so that they can be whisked away to the ghettos. Their assets seized. Their freedom of movement stolen. Condemned to a life of sickness and suffering. Out of sight, and out of mind.
It’s difficult not to see parallels here to the Ugly Laws in the US, which were in effect until the early 20th century and targeted those who were “diseased, maimed, mutilated, or deformed”—making it illegal for them to be seen in public. Similarly in the UK, it wasn’t until the mid-20th century that disabled people weren’t always expected to be shut-up in care homes or asylums, and instead efforts began to be made at integration and independent living.
Medical horror is often affecting because we recognise that medical professionals, like all of us, are influenced by the society they live in. In HellSans, doctors—themselves consumers of Bliss—share the same disgust for HSAs as the general population. They aren’t above the prejudices of their time, and so they become convenient and powerful tools of the state.
This phenomenon is one that repeats throughout the Dis-topian genre, where doctors may be in service to politicians or to capital, instead of to (all of) their patients. In Kazuo Ishiguro’s novel Never Let Me Go (2005), the lives of ordinary people are prolonged by clones who are kept away from society, and made to donate their organs to the people they’ve been replicated from.
The Island, also released in 2005, takes a remarkably sillier look at the same basic idea (who among us can forget the infamous flying-motorbike chase scene?). But despite being at heart a thoroughly enjoyable—if daft—action movie, it manages a few striking moments of horror. Perhaps principal among them, is when the doctor (Sean Bean) is administering a test to the clone played by Ewan McGregor.
Strapped down on what looks like a dental chair, metal bugs swarm over and into McGregor’s eyes. “That hurts!” he exclaims, to which the doctor simply replies: “No, it doesn’t.” Meanwhile, his patient continues to writhe in pain.
This scene is a particular exaggeration of what anyone who’s ever had to endure an invasive medical procedure knows: You may consent to the procedure because you must, but you remain at the mercy of the people who administer it. Anyone who’s ever had a contraceptive coil (IUD) fitted can attest to the fact that “you might feel a little pinch” doesn’t quite do justice to the cervical-punch, endless cramping, and tunnel-vision that follows its insertion — no matter what some doctors may think.
However, what’s most interesting about Never Let Me Go and, by extension, The Island, is the central question at play: who is considered a Real Human, and how do we manipulate that definition to serve our own ends?
In Michael Bay’s film, the clones are genetically altered to remain “as children,” their intellectual development stunted and their sex drives removed. Relationships of any kind are discouraged, and security guards patrol the centre to ensure that they always remain a certain physical distance apart.
In this world, the process of developing the intellectual—and physical—equivalent of adulthood, despite the geneticists’ efforts at suppression, is the catalyst for the escape of Lincoln Six Echo (Ewan McGregor) and Jordan Two Delta (Scarlett Johansson). When it transpires that many of the other clones have also achieved this same self-actualisation, we’re left with the certainty that they all deserve their freedom, too. But we’re also left with a far more uncomfortable question.
Is an adult with intellectual or cognitive disabilities really less than human?
Historically, medicine has certainly thought so, but in the 21st century we would hope that our societies are above such convenient cruelties.
Even so, the assessment of who “qualifies” as human is one that has dogged medicine throughout history, in the same way that it’s dogged a multiplicity of societies. Perhaps unsurprisingly, it’s this inequality that we find at the root of many Dis-topias in recent years.
In Leech, it’s the poor who have their bodily autonomy stolen. In HellSans, Dundas makes clear that—like most autoimmune illnesses in the real world—HellSans Allergy is female-predominant. And in Extremophile (2024) by Ian Green, some of the very worst medical and scientific abuses are perpetrated against Black African children enslaved in an unidentified mine somewhere on the continent.
A queer, cyberpunk, biohacking dystopia set against the backdrop of huge climate-collapse, Extremophile presents a society in which the mass extraction of resources from the Global South, unchecked capitalism, and unethical gene-engineering and body modifications have created a profoundly sickened world.
Here, it is money—not ethics—which talks, and a wealthy geneticist and company owner known as the Ghost is more than happy to exploit anyone simply because: “I could.”
One of the Ghost’s most sadistic acts is to genetically modify a select group of children at the mine, turning them into “Moles” designed only ever to work underground. In this, he changes how they see, how they experience heat and cold. He takes their fingers and replaces them with knives. Whatever could be done to them, is done to them, and when we meet an escaped Mole in the flesh it’s impossible not to feel an appalling sense of horror.
This horror, I’d argue, works primarily for two reasons. We know that western societies are already built on the extraction of resources from elsewhere, and that children toil in appalling conditions for the materials that make our technology. We also know that a great deal of medicine’s modern knowledge comes from the exploitation and torture of Black people—and in particular, Black women—who were experimented on by white gynaecologists in the belief that they couldn’t feel pain.
In these ways and in many more, medical Dis-topias grip us because they reveal truths about what we already know. Not everyone is treated well by society. Some people are allowed more autonomy over their bodies than others. Medicine, like politics, isn’t always benevolent or benign.
In reading a dystopia we are made to confront a difficult fact: that while we may all live in the same societies, we don’t all get to live in them in the same way.
As a disabled author, when I was writing my own medical dystopia, I was particularly focused on the way that society creates disability through poverty, through overwork, and through policy. In Awakened, scientists have created a neuralchip that allows its users to survive without sleep, enabling them to work more hours and creating a two-tiered system between those who still need to sleep, and those who don’t.
Inevitably, without being allowed to rest, humans transform into feral monsters called The Sleepless. They are quite literally de-humanised by medicine, and made monstrous by a society that demands they endlessly work.
But dystopian fiction isn’t an exercise in hopelessness. While it may reveal our very worst elements, it also frequently reveals our best. It shows us that injustices can be resisted; it tells us that communities can come together in order to save each other. It says that, during every moment of oppression in history, there have been people who recognised the problems, and made the choice to fight for better.
So, while Dis-topias may show us horror, they can also offer us hope. Because being able to name what’s wrong is the first step along the path to change.
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Science has stolen sleep and awakened a world of horror.
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Science has stolen sleep and awakened a world of horror.
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