(First of two parts)
I settled into the worn velvet seat of the Repertory Theater in Eastwood, the musty scent of old wood and anticipation filling the air. Repertory Philippines’ production of Man of La Mancha had been the talk of the season, and my daughter begged my wife and me to see the production run before it closes.
When the house lights dimmed for their final staging, what unfolded over the next two hours had me mesmerized, notwithstanding the fact that I had seen at various stages of my life previous stagings of the musical by various other production outfits. This time around, I found myself being not merely a passive spectator expecting to be entertained and distracted from work life, but, backed now by a lifetime of scientific and medical practice and avid student of the philosophies of science, an unwitting active analytic observer and critical appraiser of the methods and practices of the science and art of healing and, indeed, the very definitions of health and sickness themselves, as depicted in this literary work.
This performance, anchored by an actor (Nonie Buencamino) of profound depth making a return to musical theater, transformed Miguel de Cervantes’ squalid prison cell into a microcosm of society and the soul. When Alonso Quijano donned a tarnished shaving basin, crowned himself Don Quixote and sang of an impossible dream, the stagecraft itself conspired in the delusion. The lighting did not just illuminate the actor; it cast a glow that pushed back the grimy grey of the stone walls. The harsh clang of the prison doors was rhythmically countered by the swelling strings of the orchestra, creating a sonic duel between reality and imagination.
Buencamino did not play a mere buffoon shaking an unsteady lance at the windmills; he portrayed Quijano with an earnest dignity that was physically and emotionally palpable. His eyes, seen even from my seat at the farthest row of the theater, held a terrifying and beautiful vacancy, a focus on something far beyond the stage. When he beheld Aldonza (Kate Sunga), the inn kitchen servant girl and part-time prostitute, and saw only the noble lady Dulcinea, his conviction was so absolute, his kindness so disarming, that it cracked open a fundamental question for me. Where was the sickness here? Was it in the old man who transmuted a world of brutality into a world of virtue, or in the jeering prisoners and the pragmatic society outside the prison that had beaten Aldonza into a state of feral survival? Buencamino’s performance was a moving masterpiece because it refused to resolve this tension. It left me tearing up not for a madman, but for the loss of a lens that could see glory in the gutter.
As the curtain call ended and the lights came up, the spell remained, casting an uneasy enigma on my particular world. The experience did not simply move me as a work of art; it moved me, a physician nearing the retirement years of my scientific career, into a state of deep cognitive dissonance about the very categories we use to define a life worth living. The musical’s central tension – between Quixote’s lunacy and the world’s reason – segues almost violently into a reflection on the philosophies of health and disease.
We exist in an era of unprecedented biological precision, where health is often defined by biometric parameters, physiological function and the absence of pathology. Yet, Quixote forces us to confront the subjective and socially-constructed nature of “normal.” Was Don Quixote a man suffering from an organic brain disease, a late-onset psychotic break identifiable in the DSM-5? Or was he simply choosing a reality that was spiritually and ethically superior to the one foisted upon him?
The experience becomes a Socratic interrogation of where does sanity end and madness begin, and whether the relentless, society-imposed drive towards a “healthy” normativity is itself a kind of sickness, a mass delusion of objectivity that Quixote’s singular delusion uncomfortably exposes.
The question of who gets to draw the line between health and sickness is the elephant in the room of this narrative. From a strict biomedical philosophy, a model that has dominated Western thinking since the 19th century, contends that health is the absence of disease. Disease is defined as a biological fault, a lesion in tissue or a metabolic imbalance. In this literary work, Alonso Quijano’s “drying up of the brain,” as Cervantes describes it, is a straightforward pathology. His perception of windmills as giants is a sensory misperception, a hallucination to be corrected or medicated.
The goal of health, under this model, is to return the individual to a state of statistical normalcy, to make him eat when the body needs food, sleep when it is dark and recognize a windmill for the mechanical flour-grinder that it is. This philosophy has saved countless lives in recent history through antibiotics, pharmacology and surgery, and its effectivity should not be dismissed lightly. However, applied wholesale to the concept of the mind, it can become an unfit instrument. It seeks to fix the individual to fit the environment, but it rarely if ever asks if the environment is worth fitting into.
In the setting of Quixote’s Spain, the “normal” world was one of rigid class structures, casual violence and spiritual decay. Aldonza’s “healthy” adaptation to this world was a traumatic shell of cynicism and self-loathing. Was Quixote’s pathology truly a maladaptive disorder of denial, or was it a radical, redemptive act of refusal?
Here is where the biopsychosocial model and philosophies of social constructionism offer a more nuanced, and more disturbing, viewpoint. These philosophies argue that health and disease are not purely objective facts but are, in part, value-laden concepts forged by a particular society’s power structures and definitions of a good life. The immersing portrayals by the entire cast, guided by the astute urgings of director Nelsito Gomez, made this viscerally clear.
The prisoners, representing a microcosm of society, initially pathologize Quixote’s behavior for their own cruel entertainment. They are the enforcers of the “reality principle.” His madness is not just a diagnosis; it is a social verdict. This milieu reflects Michel Foucault’s seminal work on madness, which posits that the “ship of fools” and later the asylum were not just medical gestures but acts of social containment, silencing a form of unreason that challenged the then burgeoning Age of Reason’s demand for order and productivity. Saneness, in this light, is less a state of brain health and more a performance of consensus reality. It is the ability to agree that a basin is a basin and that a prostitute deserves only contempt.
Quixote’s madness, conversely, is a counter-performance, an alternative perception that re-enchants a disenchanted world. His “sickness” is his refusal to accept the brutal consensus. He is not out of touch with reality; he is in touch with a deeper, Platonic reality of ideal forms – truth, beauty and justice – and is simply projecting that reality onto the material world with total, unbending conviction.
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Ricardo Quintos MD, DSc is a vascular surgeon and scientist, with post-doctoral credentials in Philosophy of Science. He is currently chief of vascular surgery in Makati Medical Center and Cardinal Santos Medical Center; chair of the Department of Physiology and Associate Dean of Research in the University of the Philippines College of Medicine.