Thornton Wilder and The Angel That Troubled the Waters: A Plea for Physician Healing

The Angel That Troubled the Waters (1928), a short “play” by Thornton Wilder (1897–1975) published the year he won the Pulitzer Prize for The Bridge of San Luis Rey, warrants a contemporary revisit. Wilder identified the drama as a “three-minute play.” It was intended only to be read and not performed.¹ The author provided an allegorical perspective on the health of physicians utilizing Jesus’ sermon on the Pool of Bethesda in the Gospel of John as background.² It was said that an angel intermittently appeared at the pool where those with physical infirmities—the blind and lame—anxiously awaited miraculous healings. In the Gospel story, the angel would stir the pool with his finger, and those in the pool at that precise moment would be healed. In Wilder’s drama, a doctor in need of healing for an unidentified ailment, labeled a newcomer, arrives at the pool. He appears free of physical disease and is denied access. The physician is described as “broken on the wheels of living.”

Wilder’s dramatic philosophy reflects cultural attitudes prevalent in his era. Writings of Wilder’s time denigrated physicians who experienced depression and suicide. The profession of medicine was regarded with the highest esteem and was considered impervious to the emotional illnesses common in society at large. Today, the philosophy regarding physicians’ emotional health has changed dramatically. However, there is still much more to accomplish.

Excerpt from Thornton Wilder’s The Angel That Troubled the Waters ²

The Pool – A vast gray hall with a hole in the ceiling open to the sky. Broad stone steps lead up from the water on its four sides. The water is continuously restless and throws blue reflections upon the walls. The sick, the blind and the malformed are lying on the steps. The long stretches of silence and despair are broken from time to time when one or another groans and turns in his rags, or raises a fretful wail or a sudden cry of exasperation at long continued pain. A door leads out upon the porch where the attendants of the sick are playing at dice, waiting for the call to fling their masters into the water when the angel of healing stirs the pool…Suddenly the ANGEL appears upon the top step. His face and robe shine with a colour that is both silver and gold, and the wings of blue and green, tipped with rose, shimmer in the tremulous light. He walks slowly down among the shapeless sleepers and stands gazing into the water…

(A new invalid enters.)

THE NEWCOMER

Come, long-expected love…Let the sacred finger and the sacred breath stir up the pool. Here on the lowest step I wait…with my heart in pain. Free me, long-expected love, from this old burden. Since I cannot stay, since I must return into the city, come now, renewal, come, release.

(Another invalid wakes suddenly out of a nightmare, calling: “The Angel! The Angel has come. I am cured.” He flings himself into the pool, splashing his companions…

THE MISTAKEN INVALID

(He sees the NEWCOMER beside him and turns on him plaintively)

…Aie! You have no right to be here…You are able to walk about…You come here only at great intervals, and it may be that by some unlucky chance you might be the first one to see the sign. You would rush into the water and a cure would be wasted. You are yourself a physician… Go back to your work and leave these miracles to us who need them.

THE NEWCOMER

My work grows faint. Heal me, long-expected Love; heal me that I may continue. Renewal, release; let me begin again without this fault that bears me down.

THE ANGEL

(Kneels down on the lowest step and meditatively holds his finger poised above the shuddering water.)

THE NEWCOMER

Come, long-expected Love.

THE ANGEL

(Without turning makes himself apparent to the NEWCOMER and addresses him.)

Draw back physician, this moment is not for you.

THE NEWCOMER

Angelic visitor, I pray thee, listen to my prayer.

THE ANGEL

Healing is not for you.

THE NEWCOMER

Surely, surely, the angels are wise. Surely, O, Prince, you are not deceived by my apparent wholeness. Your eyes can see the nets in which my wings are caught; the sin into which all my endeavors sink half-performed cannot be concealed from you.

THE ANGEL

I know.

THE NEWCOMER

It is no shame to boast to an Angel of what I might yet do in Love’s service were I but freed from this bondage. Oh, in such an hour was I born, and doubly fearful to me is the flaw in my heart…

THE ANGEL

(Stands for a moment in silence.)

Without your wound where would your power be? It is your very remorse that makes your low voice tremble into the hearts of men. The very angels themselves cannot persuade the wretched and blundering children on earth as can one human being broken on the wheels of living. In Love’s service only the wounded soldiers can serve. Draw back.

This excerpt from Thornton Wilder’s play The Angel That Troubled the Waters is not the complete play. To read more about Thornton Wilder, please visit: www.thorntonwilder.com

The pool’s vast gray hall—populated by physical illness and suffering—is familiar to contemporary physicians. A newcomer-physician arrives at the pool—also in need of healing—only to be told by a patient to leave and get back to work. The angel reacts negatively to his plea as well.

What is the physician’s malady and why is he rebuffed? Since there are many others who not only have waited longer, but may have more serious disorders, it may be that the physician thinks his professional status should allow him to cut in line. Physicians of Wilder’s era were greatly esteemed by the public. Sinclair Lewis’s novel Arrowsmith (1933) was said to have “inspired a generation of men to choose medicine as their profession.”³ Unfortunately, the novel’s protagonist, Dr. Arrowsmith, was said to overvalue knowledge at the expense of corruption, dehumanization, and even suicide.³ It also might be that the patients waiting expect that the physician should heal himself. Wilder does not explicitly reveal the reason. Therefore, the authors have chosen to diagnose the newcomer physician with burnout and/or depression. Wilder’s physician may be melancholic and his burden existential. The angel confronts the physician, “Without your wound, where would your power be?” It would be reasonable to expect that a physician’s personal experience of illness would foster empathy. But as will be developed, for Wilder’s generation, there was a dichotomy between physical and existential illnesses, especially for physicians. The source of physician power resided not in empathy, but rather in a constitution ostensibly unique to the profession of medicine. Wilder’s physician, without evidence for a physical disease, is left to either heal himself or leave his profession. Unfortunately, Wilder’s period piece was consistent with general cultural beliefs prevalent in his era.

Wilder lived and wrote at a time when American physicians possessed stature, financial well-being, autonomy, and authority. The profession of medicine was characterized as “a trained, elite few.” Physicians of Wilder’s era were portrayed as strong to the point of invincibility. The Menninger paradigm reigned in psychiatry: depression and suicide arose from within individuals themselves and not from surrounding circumstances. Physicians were perceived as special and above the psychological frailties that affected their patients. To those like the newcomer in Wilder’s drama who wavered, it was said, “if you cannot succeed or cannot philosophically accept what your profession has to offer, get out of it and give someone else a chance.” Physicians of the era who openly volunteered their struggles with depression were characterized as “aberrant individuals in a field that prizes infallibility and perseverance.” The individuals who chose suicide were deemed a weak minority, labeled an “aberrant few.”⁴ The solution to physician suicide in Wilder’s time was explicit: deviant physicians should remove themselves from an honored profession to which they really never belonged.

Women physicians did not fit comfortably into the paradigm of invincibility either. Those who were successful were considered overly ambitious and competitive. In 1968, perhaps for these reasons, the suicide rate among female physicians was twice that of their male colleagues in the late-1960s.⁴ Medicine was a profession that ignored pleas for help from their own.

The cultural zeitgeist reached its apex and was vividly exposed in the novel The House of God (1978).⁵ In this fictional hospital setting, interns during their orientation are apprised that “Each year the graduating class of at least one medical school—maybe two or three schools—must step into the ranks just to replace colleagues who commit suicide…in the House of God we do see suicides.”⁵ One intern, Potts, is depressed because of a single oversight in medical care that is known to all of his colleagues. Despite the fact that everyone is aware of his increasing depression, no effort is made to help him. “And so Potts was in rough shape…he became more and more quiet and withdrawn…We watched Potts sink, and the deeper he sank, the more out of reach he became.”⁵ Finally, another intern says, “Thank you for your expert diagnosis. I’m not losing any sleep over Potts…Next to his bed was a revolver, an unholstered loaded forty-four.”⁵ After the death of the patient that he failed to treat with steroids, Potts jumps from a hospital window to his own death. It seems that The House of God plumbed previously unfathomable depths of physician burnout, depression, and suicide. It was read by a remarkable number of physicians, and arguably began a movement that appealed to the better angels of our nature.⁶

Progress has been painfully slow and accompanied by backsliding. After The House of God, in 1985 a commentary was published entitled, “My Dear Colleague: Are You Considering Suicide?”⁷ It contains many of the vestiges of Wilder’s era. Rather than apply a healing rhetoric, the author hearkens back a generation and accuses physicians considering suicide of having a “vindictive spirit” or mental illness and addiction.

Today, the paradigm has finally shifted, but is still not optimal. Physicians are no longer considered infallible; they are equally—or even more—susceptible to the emotional afflictions of their patients. Regardless of the point on their career trajectory, ranging from senior physicians to physicians in training, all age groups in the profession of medicine exhibit signs of burnout and depression.⁸ But the public and the profession of medicine have been slow to respond to the paradigm of an existentially wounded healer. In the words of Dr. Adrienne Butler, “Suicide, I believe, for most of my colleagues…is an end to pain…this disease (depression, burnout, and suicide) is a cancer that evokes little sympathy…but hurts and kills just as certainly as any malignant disease.”⁹ An article as recently as 2000 reminded us that “Physicians are not Invincible.”¹⁰ A perspective emphasis on healing for physicians broken on the wheels of living has to be affirmed: rather than inherent weakness or a “vindictive spirit,” depression and its consequences in healers are modifiable risk factors in need of empathy. Who should step forward and help depressed physicians?

Fast-forwarding Wilder’s period piece from his era to the present should invite physicians to recognize the emotional pain of their colleagues, and patients to reconsider the consequences of those many physicians suffering with burnout and depression:

“The problem of physician suicide is not solely a matter of whether or not it takes place at a rate higher than the general public. That a professional caregiver can fall ill and not receive adequate care and support, despite being surrounded by other caregivers, begs for a thoughtful assessment to determine why it happens at all.”⁸

Further study of the physician’s words in Wilder’s drama is telling. He informs the Angel that “My work grows faint/renewal release; let me begin again without this fault.” The physician desires healing that leads to renewal, and not to escape his profession. In this way, he will have experienced depression and therefore be able to empathize with his patients, but also be able to work renewed in spirit.

The patient who rejected the physician’s pleas for existential healing in the drama must understand that patients of physicians with depression and burnout are less compliant with care plans, and as a result, when “doctors are stressed, burned out, depressed, and when they suffer, so do their patients, if even vicariously.”^{11 , 12} When physicians “are broken on the wheels of living,” therapeutic relationships with their patients are also victims. The same animus surfaces and affects residents and their patient care.⁸

Any revisit to Wilder’s An Angel That Troubled the Waters invites only those angels who eagerly stir the waters for physicians who struggle with depression, burnout, and thoughts of suicide. It is apparent that depressed physicians are unable to heal themselves, and are asking for our help.

THE ANGEL THAT TROUBLED THE WATERS by Thornton Wilder

Copyright 1928 by THE WILDER FAMILY LLC Reprinted by arrangement with THE WILDER FAMILY LLC and The Barbara Hogenson Agency. All rights reserved.

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Conflict of Interest

The authors declare that they have no conflict of interest.