Narrative Structure and Imagery

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.