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BMJ. 2008 January 5; 336(7634): 49.
PMCID: PMC2174725
Medical Classics

Ward No 6

Reviewed by Paul Crichton, consultant psychiatrist, London

The hero, or rather antihero, of Anton Chekhov’s short story “Ward No 6” is Dr Andrey Yefimitch Ragin. He is put in charge of a provincial hospital where the stench and overcrowding would make even the most squalid NHS hospital seem a haven of salubrity. He begins work with zeal and vigour but gradually becomes worn down by the “monotony and obvious uselessness” of the work.

His life changes when he admits Ivan Dmitritch Gromov, an intelligent young man with paranoid delusions, to the almost forgotten ward 6, which is housed in a small lodge in the hospital yard. It consists of one room with five mentally disordered inmates under the supervision of a warder, Nikita, who beats them regularly. Dr Ragin stops going to the hospital daily but begins visiting ward 6. Here he has spirited discussions with Gromov in which he defends a version of stoicism, according to which the external world, which stirs up our emotions, is insignificant, and what is good resides within us: “One must strive for the comprehension of life, and in that is true happiness,” says Ragin. Pain can be dismissed by a mere effort of will. But Gromov is not impressed. “Have you any idea of suffering?” he asks. “Were you ever thrashed in your childhood?” Ragin admits that he wasn’t.

Ragin is assigned an assistant, Dr Khobotov, who covets Ragin’s post and starts to scheme against him. A committee of local doctors is convened, interviews Ragin, and concludes, on virtually no evidence, that he is mad and suggests that he go on holiday. When he returns he finds that his job has been taken by Khobotov. Ragin has no savings and is now almost destitute. Duped and abandoned by the world he scorned, he colludes in his admission to ward 6. The stoic indifference to external circumstances that he once advocated now fails to give him any consolation. Gromov’s ironic advice is to take it philosophically. Outraged by his incarceration, Ragin tries to leave but is struck down by the warder. He falls unconscious on to his bed and dies the next day of a stroke.

Lenin is said to have claimed that it was reading Chekhov’s story that turned him into a revolutionary. If true, this is a striking example of how a work of fiction can change the world of facts. The committal of the disillusioned, lazy, but perfectly sane Ragin to a psychiatric ward eerily foreshadows the Soviet practice of diagnosing critics of the regime as “mentally ill” and imprisoning them in psychiatric institutions.

This story is charged with such dense energy that I suspect it contains a great deal of Chekhov himself: his doubts about his own usefulness as a doctor; the tension between a sense that life is meaningless and a simultaneous desire to embrace life, with all its pain; a fear of the solitude required of a writer; and a fear that this solitude might cut him off from life itself.

Notes

Ward No 6

By Anton Chekhov

First published in 1892


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