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Last Updated on June 8, 2022, by eNotes Editorial. Word Count: 541

Narrative Structure and Imagery

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In terms of technical and narrative structure, “The Use of Force” by William Carlos Williams is a short, image-driven story told from the perspective of a first-person narrator. Williams eschews quotation marks in his text, instead allowing the doctor’s thoughts to mingle with his observations of the child and her parents. He employs minimal amounts of figurative language and instead describes the action using straightforward but visually evocative language.

The diction used to describe the doctor’s increasingly violent efforts—the tongue depressor that is “reduced to splinters” and the “heavy silver spoon” that the doctor forces “back of her teeth and down her throat till she gagged”—all convey an image of harm and violation. In contrast to the doctor’s purposes as a healer, the methods he uses result in Mathilda’s mouth bleeding and her eyes being blinded by “tears of defeat.”

The visceral images that Williams uses to describe the examination evoke a philosophical commentary on the nature of violence. The patient is an ill young girl, and the doctor is an adult man. Traditionally, doctors are symbols of healing and rationality who protect, nurture, and cure vulnerable children such as Mathilda. In turn, children are typically presented as weak and fragile when ill or injured, bedridden and miserably compliant. Both of these characterizations are subverted by Williams, who instead portrays the doctor as having been driven “beyond reason” and diphtheria-stricken Mathilda as an animalistic “brat” with the strength of a “heifer.” The dynamic of doctor and patient is no longer a collaborative, healing-focused one, but rather a tense battle of wills that culminates in the doctor overpowering his weakened patient. Ultimately, public health takes precedence over Mathilda’s desires, and she is rendered impotent by the superior authority granted to the doctor as a medical professional.

Biographical Elements and Ruminations on Medical Ethics

Williams spent much of his life working in a similar capacity to the doctor in the story, serving as a pediatrician at a hospital. His experience as a physician frequently informed his writing, and it offered him a unique perspective on the relationship between doctor and patient. In addition to being a work of literature, “The Use of Force” is also a fictionalized rumination on medical ethics and the fallibility of doctors. In Williams’s hands, the doctor is not a beacon of logic and healing, but rather a very human individual capable of frustration, aggression, and bouts of irrationality. Though he ultimately has his patient’s best interests at heart, he is still susceptible to the more violent, primal trappings of human nature and takes a sadistic glee in forcing the examination.

Though not necessarily a sympathetic figure, the doctor is a complex one. In the process of doing his job, which Mathilda’s parents are paying him to do, he is required to use force. Does his shameful sense of triumph negate the good he is doing by treating her? What are the limitations of patient consent, especially as concerns children, when the patient is clearly working against their own interests? Ultimately, Williams leaves readers to draw their own conclusions while still making clear that the use of force inevitably has consequences for all parties involved.

Themes and Meanings

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Last Updated on May 5, 2015, by eNotes Editorial. Word Count: 504

As Williams’s title indicates, the narrative is a study of the use of force and of its effects on the individual who uses it. As the story progresses, the doctor degenerates from a reasonable professional concerned with his patient’s welfare to an irrational being who takes pleasure in the pure muscular release of forcing the child to submit. The doctor remains well aware of the reasonableness of his ultimate goal—the girl’s throat must be examined—but even as he persists in pursuing that goal he knows that he is no longer concerned with what is best for the child: “The worst of it was that I too had got beyond reason. I could have torn the child apart in my own fury and enjoyed it. It was a pleasure to attack her. My face was burning with it.” His sense of logic tells him that it is a social necessity to protect the child and others against her idiocy in refusing the examination. Even as he acknowledges the truth in this line of reasoning, however, he knows that it has little if anything to do with the motivation behind his ruthless determination to force the child to do as he wishes: “A blind fury, a feeling of adult shame, bred of a longing for muscular release are the operatives. One goes on to the end.”

With a “final unreasoning assault,” the doctor overpowers the child. Then it is the child’s turn to react in a blind fury, her turn to attack. She tries unsuccessfully to escape from her father’s arms and fly at the doctor, “tears of defeat” blinding her. She knows that she has lost a battle, yet her anger is quite justified, considering the assault that she has just endured, as is her earlier fear of the doctor who has come to see if she has a disease that could kill her. It is as though the sore throat did not exist as long as it was her secret and hers alone. The fact that Williams chose for the story a patient who is not only a child but also a truly ill child at that emphasizes all the more the violence of the doctor’s actions. Child is pitted against adult, illness against health, ignorance against experience. Reason would dictate that undue force should not have been necessary, but reason ceases to be the controlling factor once the battle begins.

The parents stand by, anxious but helpless as the struggle takes place, their spiritlessness in contrast to the child’s spirit, their unwillingness to hurt their daughter in contrast to the doctor’s use of force. They do not interfere even when Mathilda is cut, bleeding, and hysterical because of their trust in what the doctor represents. They do not question the doctor’s aggressive methods, let alone try to stop him, because of the infallibility and ultimate good that doctors represent in their minds: health as opposed to illness, life as opposed to death.

Style and Technique

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Last Updated on October 26, 2018, by eNotes Editorial. Word Count: 347

Point of view is critical in this story about force. The external facts of the story are fairly simple: The doctor does what is necessary to diagnose a potentially fatal disease. The fact that the story is told from the doctor’s point of view, however, makes it possible to see the changes that take place in his mind as he progresses from cool professional to animalistic assailant. He could have justified on the basis of logic alone his persistence in forcing the examination. What he cannot justify even to himself is his motivation for doing so. Still, the doctor is calm and controlled in telling the story. He exposes for analysis his mental state just as he exposes for examination the little girl’s throat.

There are clear sexual undertones to the act of violence that the doctor directs against the child. That element could have been avoided completely had the patient been a little boy. As it is, the doctor acknowledges early the physical attractiveness of the child and the fact that he loves her for her spirit. The doctor’s aggression toward Mathilda takes on characteristics of a rape as his anger builds up at her resistance and finally results in violence. The examination becomes an assault on her mouth cavity with the phallic tongue depressor, which she renders useless, and then with the spoon.

As her fear of the doctor increases, Mathilda’s breathing becomes more rapid. The doctor’s face burns with the pleasure he feels in attacking her. Mathilda resists as she would resist an actual sexual assault, and she bleeds as a result of his probes into her mouth. The story and the assault reach their climax when the doctor achieves a sense of physical release by forcing Mathilda’s mouth open and revealing the hidden membrane. Ironically, her parents let the assault take place and actually aid in it because they fear their child’s death more than they fear any other form of assault on her. Mathilda herself, however, is left with a sense of violation and defeat.


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Last Updated on October 26, 2018, by eNotes Editorial. Word Count: 194

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