Forget the big historical names, it’s historic fear of disease that Game of Thrones nails

From Greyscale to the White Walkers, the othering of the sick is spot on.

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It’s that time of year again, the new season of Game of Thrones is upon us and (in what has become something of a tradition) a raft of articles and think-pieces have emerged listing the many ways in which the biggest TV show in the world is inspired by history. We hear that Daenerys Targaryen is Joan of Arc, that Tyrion Lannister is Richard III, that Queen Cersei is a “beautiful expression of arbitrary terror”, and that the houses of Lannister and Stark are lifted from the medieval houses of Lancaster and York.

Despite being a fantasy drama, the world of Westeros has long been praised for its realism and sophisticated exploration of power. Yet, in focusing on individuals and specific dynasties, critics perhaps overlook the most significant way Game of Thrones holds a mirror up to the real world – in its disturbing depiction of disease.

To my mind, this is where the show really excels. By harnessing historic fears of contagion, George R R Martin and the TV showrunners have conjured up fictional sicknesses that speak to our deepest fears rather than biological reality, and illuminate the process of “othering” and stigmatisation that has blighted the sick for centuries.

Of these diseases, Greyscale is by far the most prominent. It is described as a terminal condition that is spread by human contact: first attacking the skin, it deforms the body, renders sufferers insane, before eventually turning victims into “Stone Men”. In the world of Game of Thrones, these Stone Men (and women) are sent into exile to die. The allusion to medieval leprosy is clear, but this fictional disease is an amalgamation of many historical and contemporary contagions.

Sufferers of Greyscale are othered from society, depicted as a homogenous group (with the exceptions of Jorah Mormont and Princess Shireen) of horrifically disfigured outcasts who attack strangers to their lands.

Yet, even at their worst, Stone Men represent a monstrous spectacle rather than a malignant threat. It is in the White Walkers that we see this othering of the afflicted taken to its natural extreme: a dehumanised and terrifying horde who are active and willing agents in the destruction of others, turning the living into the undead.

From leprosy, plague and cholera to syphilis, smallpox and Spanish influenza, this othering has occurred throughout history and has worked to worsen the plight of the sick by erroneously linking a physical ailment to a perceived weakness or flaw in character. Experts define this as a process of “exclusion, rejection, blame or devaluation that results from experience, perception or reasonable anticipation of an adverse social judgement about a person or group”. And these judgements become far more prevalent when the biological nature of the disease is not understood.

Those with leprosy during medieval times were thought to have been specially selected for suffering, and were both revered and feared due to their proximity to God. Placed in leprosariums outside city walls they had limited contact with the outside world. The disease was believed to be far more infectious than it actually was, so sufferers found in wider society were reprimanded.

Likewise, because of its highly contagious nature, plague was heavily associated with a breakdown of public order among the poverty-stricken. The lifestyles of the poor – and even the food they ate – were believed to have contributed to the spread of disease. We know infected houses were “shut up”, but those living close to infected houses were also doomed by association and ordered to “beare white rods in their hands at such a time as they shall go abroad” so they could be avoided.

When it comes to syphilis, men’s link to the disease is well documented – from the images of the seventeenth-century courtiers with collapsed noses to Albrecht Dürer’s Syphilitic Man. The stigma of the affliction, however, was greater for women (especially prostitutes) who were more frequently accused of being the agents of the disease rather than victims: “One night with Venus, a lifetime with Mercury.”

Another feature of disease in Game of Thrones that echoes historic concerns is the idea that contagion is somehow foreign. Disease does, of course, travel, but the stigma attached to the perceived country of origin is often hard to shake. Like the infected travelling sea merchant who caused Princess Shireen’s Greyscale, the Great Plague of 1665 was believed to have been “imported to us from Holland, in packs of Merchendize; and if anyone pleases to trace it further . . . it came thither from Turkey in Bails of Cotton”.

During the nineteenth century, despite its global reach, cholera was seen as an Asian disease, beginning in Bengal and then penetrating the rest of the world; and when Spanish influenza reached sub-Saharan Africa, its perceived European origin was linked to imperialism. As one commentator noted: “This disease was a device of the Europeans to finish off the Native races of South Africa.”

Even today, the tendency to other entire groups remains – whether that be a result of poverty, gender, race, illness, religion or disability. Education has been proven to undo stigma and engender acceptance. To use George R R Martin’s own words: “The human race is making progress. Maybe very painfully slow, but in the long view, you can see it.”

Rebecca Rideal is a historian, former TV producer and author of “1666: Plague, War and Hellfire”. She can be found on Twitter @RebeccaRideal