The film begins with a voice-over narration by Rolfe Whitehouse, announcing the story of his brother Wade's "strange criminal behavior" and subsequent disappearance.
Wade Whitehouse is a small-town policeman in New Hampshire. On Halloween night, Wade meets his daughter Jill from his divorced marriage, but he is late and the evening is overshadowed by disharmony. Jill eventually calls her mother to come and pick her up. When his ex-wife finally arrives, Wade shoves her lover against their car and watches them drive away with Jill. Wade vows to get a lawyer to help gain custody of his daughter.
The next day, Wade rushes to the scene of a crime. A hunting guide named Jack claims that the man with whom he was hunting accidentally shot and killed himself. The police believe Jack, but Wade grows suspicious, believing that the man's death was no accident. When he is informed that the victim was scheduled to testify in a lawsuit, his suspicion slowly turns into conviction.
A while later, Wade and his girlfriend Margie Fogg arrive at the house of Wade's father, Glen Whitehouse, whose abusive treatment of Wade and Rolfe as children is seen in flashbacks throughout the film. Wade finds his mother lying dead in her bed from hypothermia. Glen Whitehouse reacts to her death with little surprise. At the funeral wake, the father gets drunk and loudly exclaims, "Not one of you is worth one hair on that woman's head!", resulting in a confrontation between Wade and him.
Rolfe, who has come home for the funeral, suggests at first that Wade's murder theory could be correct, but later renounces himself of this presumption. Nonetheless, Wade becomes obsessed with his conviction. When Wade learns that town Selectman Gordon Lariviere is buying up property all over town with the help from a wealthy land developer, he makes the solving of these incidents his personal mission. Suffering from a painful toothache and becoming increasingly socially detached, he behaves more and more unpredictably. He follows Jack, convinced that Jack is running away from something and is involved in a conspiracy. After a car chase, a nervous Jack finally pulls over, threatens Wade with a rifle, shoots out his tires, and drives off.
Finally, Wade is fired from his police job both for his constant harassment of Jack and his trashing of Lariviere's office. He collects Jill from her mother's house, where his ex-wife furiously castigates his plans to sue for full custody. At the local restaurant, he attacks the bartender in front of his daughter after he jokingly insults Wade. Then Wade takes Jill home to find Margie leaving him. Wade grabs Margie and begs her to stay with him, but Jill rushes up and tries to push Wade away. In response, Wade pushes Jill, causing her nose to bleed. She and Margie drive off. Wade is then approached by his father Glen, who congratulates him for finally acting as a "real man". The latent aggression between the men culminates in a fight in which Wade accidentally kills his father. He burns the corpse in the barn, sits down at the kitchen table and starts drinking, while the barn can be seen burning down through a window.
Rolfe's narration reveals that Wade eventually murdered Jack and left town (possibly to Canada, where Jack's truck was found three days later), never to return. Rolfe relates that the town later became part of a huge ski resort partly organized by Gordon Lariviere. He concludes that someday a vagrant resembling Wade might be found frozen to death, and that will be the end of the story.
According to Paul Schrader, he came across a paperback copy of the novel in a bookstore and bought it after he was "grabbed" by its first sentence. After he finished reading the book, Schrader bought the film rights from Russell Banks. The director said in an interview with Filmmaker that he identified with the characters in the story: "I had a very strong father and an older male sibling. My father was not abusive, he was not alcoholic, but there were enough similarities. I came from that part of the country with long cold winters, so I knew these people, and I knew their violence." Although it has been compared to his previous films (e.g. Taxi Driver, American Gigolo and Light Sleeper), Schrader has stated that the ending of Affliction was what made it different from them: "One of the differences between things that I have written and Russell's book is that I tend to end my pieces on a kind of grace note, and this one has none. I like some sense of moral grace. But Affliction is pretty bleak at the end." He also added, "I view the film as a collaboration between myself and Russell Banks."
Nick Nolte was Schrader's first choice for the role of Wade Whitehouse. Schrader told Charlie Rose that he envisioned Nolte in his mind while he was writing the script. According to Schrader, he offered Nolte the part five years before filming began, when the actor had become a bankable star following his success with the box office hits The Prince of Tides and Cape Fear, both released in 1991. Although Nolte was interested in playing Wade, Schrader could not afford him at first. It was not until five years later when Nolte agreed to do Affliction for less money. However, Nolte claims he initially turned it down because he was working on other projects at the time and that he was not ready to portray the role. It was Nolte who brought Affliction to the attention of Bart Potter, the head of Largo Entertainment. Nolte told Rose that by the time the five years passed by, "I think understood Wade better." Schrader also admitted that the five years of preparation helped Nolte's performance. In addition to acting in the film, Nolte also served as one of its executive producers.
Nolte claims that he was the one who convinced Sissy Spacek, who he worked with in Heart Beat (1980), to appear in Affliction alongside him. According to Schrader, it was Spacek's husband Jack Fisk who came up with the idea of having the character of Glen Whitehouse lick salt off his hand.
Schrader told Roger Ebert that he cast the part of Glen to James Coburn because he was bigger than and could "convincingly dominate" Nolte. When Schrader encouraged the actor to prepare for the role, Coburn reportedly said in response, "Oh, you mean you want me to really act? I can do that. I haven't often been asked to, but I can."
Schrader claimed that Willem Dafoe wanted to play the part of Wade. Dafoe himself would admit, "I knew I couldn't play Wade Whitehouse whether Nick Nolte was around or not." Schrader instead offered Dafoe the role of Rolfe Whitehouse, and the latter accepted it because he loved the novel. According to Dafoe, Schrader showed him the novel during the making of Light Sleeper.
Affliction was filmed in Quebec, with principal shooting ending in February 1997. Although first presented at the Venice Film Festival on August 28 the same year, Affliction did not see a theatrical release until some time later in most countries. After a limited release in New York in December 1998, it saw its regular US release in January 1999.
The film received mostly positive reviews with an 87% rating on Rotten Tomatoes.
Critic Roger Ebert of the Chicago Sun-Times gave the film 4 stars. Janet Maslin, in The New York Times, said "[Nick Nolte] gives the performance of his career in Paul Schrader's quietly stunning new film […] Like The Sweet Hereafter, a more meditative and elegant but less immediate, volcanic film, Affliction finds the deeper meaning in an all too believable tragedy."
In a negative review in the Time Out Film Guide, Geoff Andrew called the film a "sensitive but rather dull adaption of Russell Banks' novel […] the narrative's too unfocused and low-key really to engage the heart or mind."
James Coburn won the Academy Award for Best Supporting Actor and was nominated for the Screen Actors Guild Award for Outstanding Performance by a Male Actor in a Supporting Role. Nick Nolte was nominated for the Academy Award for Best Actor, the Golden Globe Award for Best Actor – Motion Picture Drama, the Screen Actors Guild Award for Outstanding Performance by a Male Actor in a Leading Role, the Independent Spirit Award for Best Male Lead, and the Satellite Award for Best Actor – Motion Picture. He was awarded the National Society of Film Critics Award for Best Actor, the New York Film Critics Circle Award for Best Actor, the Sant Jordi Award for Best Foreign Actor, and the Valladolid International Film Festival Award for Best Actor.
The film was nominated in six categories at the Independent Spirit Awards.