Views & Reviews Medical Classics

Infinite Jest

BMJ 2011; 343 doi: (Published 28 September 2011) Cite this as: BMJ 2011;343:d6070
  1. Carl Shuker, writer, London
  1. cshuker{at}

The central theme and propellant of David Foster Wallace’s great work, Infinite Jest, is, “in these chemically troubled times,” addiction in the United States—to drugs, to alcohol, to pleasure, to entertainment—to any activity into which the participant sacrifices their personality. “American experience seems to suggest that people are virtually unlimited in their need to give themselves away, on various levels,” the narrator tells us. The interchangeable object of addiction is ruthlessly symbolised by “Infinite Jest,” a film within the book. Viewers are so enraptured by this film that they will die to keep watching it.

This very literary novel is full of doctors and therapists and chemists; littered with drugs, licit and otherwise; and rich and riddled with the vocabulary of medicine. An early casualty of the eponymous film is a medical attaché, whose “particular expertise is the maxillofacial consequences of imbalances in intestinal flora . . . A veritable artist, possessed of a deftness nonpareil with cotton swab and evacuation-hypo, the medical attaché is known among the shrinking upper classes of petro-Arab nations as the DeBakey of maxillofacial yeast, his staggering fee-scale as wholly ad valorem.”

“Nonpareil” means having no equal, and “ad valorem” here means “according to value.” For a layman, the medical lexicon of this author is staggering too. According to legend, Wallace literally kept on his desk a Physicians’ Desk Reference, and he footnotes every drug he mentions. (Part of Infinite Jest’s aesthetic is its effort to represent the information flood of the contemporary US.) Footnote 217 of 388 reads, “Haloperidol, McNeil Pharmaceutical, 5 mg/mL pre-filled syringes: picture several cups of Celestial Seasonings’ Cinnamon Soother tea followed by a lead-filled sap across the back of the skull.”

Wallace had personally benefitted from the Alcoholics Anonymous (AA) “12 step programme,” and his novel delights in extended vignettes collected from the open meetings that he attended, and given his own inimitable comic and sad retouch. Infinite Jest is a compendium of case studies of addiction and recovery, stories of often intractable despair. Against these, the platitudes and clichés and banalities of AA—“One day at a time,” “Easy does it,” “First things first”—are held up to great, if tortured, ridicule. How were you actually supposed to live by such rules? Resolution is found in what Wallace saw as AA’s great truth: it works, and for a lot of desperate people, this is enough.

“Nobody’s ever been able to figure AA out . . . And the folks with serious time in AA are infuriating about questions starting with How. You ask the scary old guys How AA Works and they smile their chilly smiles and say Just Fine. It just works, is all; end of story.”

Infinite Jest is named for Yorick, the dead jester in Hamlet (“I knew him, Horatio; a fellow of infinite jest, of most excellent fancy”). Wallace, another man of seemingly infinite jest and deftness nonpareil, is dead too: tragically, he committed suicide in 2008 after a battle, not with alcohol and drugs, but with an unfinished novel (2011’s The Pale King) and recurrent depression after he stopped taking the monoamine oxidase inhibitor phenelzine. Infinite Jest has already joined Time magazine’s 100 best novels since 1923 and won Wallace the MacArthur Genius Grant and a fanatical following. It is the great comic novel of contemporary America; its esteem wholly ad valorem.


Cite this as: BMJ 2011;343:d6070


  • Infinite Jest

  • A novel by David Foster Wallace

  • First published 1996

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