chapter  15
MEDICINE
ByGEORGE ROUSSEAU
Pages 12

The sub-discipline of literature and medicine arose after World War II, when it became evident that the two halves of its terrain shared common ground. Its genesis was stimulated by C.P. Snow’s controversy with F.R. Leavis (Leavis 1963) over the “two cultures” (Snow 1969), and further invigorated by far-flung discussions of these debates, resulting two decades later in the view that “one culture” represents the historical status of knowledge more accurately (Levine 1987; Tallis 1995). Peter Medawar, the British Nobel Laureate in Medicine, who also delivered the BBC Reith Lectures in 1959, entitled The Future of Man, and heightening sensitivity to the overlaps of literature and science and medicine, further stimulated the post-war growth of the sub-discipline (Medawar 1967). Nevertheless, the aftermath of all these debates made clear that literature and medicine bore an uneasy relation to its parallel discourse, literature and science, owing to the relatively steady state of the anatomical human body (Trautmann 1981; Daudet and Barnes 2002). The last point is consequential: science amounts to a vast body of advancing

knowledge (scientia) perceived to be forever in a state of progress and is usually thought to improve the world; the human body, like the planet Earth, remains more or less constant and has been so from pre-Homeric times. This glaring discrepancy informed both sub-disciplines. Also complicating their uneasy relation was the old debate about whether medicine is an art or science; yet few philosophers of science have ever sustained any argument that science is primarily an art. Therefore, if literature and science and literature and medicine were conceptualized as discrete, developing sub-disciplines forming parts of the huge, complex canvas of knowledge, their differences were seen as being as great as their similarities, and a strong case developed after the 1980s that they had no more in common with each other than with other sub-disciplines such as literature and anthropology, literature and the law, literature and religion (Rousseau 1991b). Framed otherwise, literature and science is the study of ever-advancing sets of

relationships in which one half of the equation – the body of knowledge called “science” – never stands still, whereas literature and medicine focuses on the

relation of two relatively stable categories: literature and medicine – neither of which can meaningfully claim to “progress” in the way scientific knowledge does. It would be odd to discuss literature in terms of progress – progress since Shakespeare’s plays or Shelley’s poetry? – yet much medical diagnosis is not “scientific” in the sense that rigorously tested and peer-reviewed scientific hypotheses are. Medicine, even empirically based contemporary medicine, relies on scientific knowledge but embraces other, non-scientific components to compose its totality. Even if imaginative, canonical literature itself does not “progress,” scientific

theory about literature does. And if the theory wars of the last generation have resolved anything, it is the degree to which much contemporary theory aspires to be “scientific” and in many instances attains its goal (Cain and Graff 1994). Literary theory can be as scientific as other types of theory under controlled conditions. Compounding this propensity is the fact that at least since the 1970s the rotund cupola of literature – including imaginative canonical literature from Beowulf to Virginia Woolf and all other forms of written and verbal discourse – has embraced literary theory. Therefore, both literature and medicine and literature and science can seem to be in scientific parity only when the literature component of their cupola designates literary theory. Something tantamount to this parallel state occurred in the late twentieth

century when stimulated by the development of neuroscience, whose main concern then prioritized memory: a category of unusual interest to literature from time immemorial whose stock rose after World War II (Schacter and Scarry 1999). The difference now (after c. 1945) was that neuroscience was privileging memory. Within just a few decades all sorts of questions about memory arose, as did journals of memory studies. Was memory an action, a metaphor, or both? Were its defects symptomatic of illness, as in other somatic ailments, or a metaphor for something psychological run amok in the personality (Sontag 1979)? Was memory primarily biological, physiological, or psychological? Was it individual as well as collective? These and other difficult questions filtered into bread-and-butter literary theory debates, raising literature and medicine to a new threshold of relevance. Concurrently, the 1990s rise of narrative-based medicine (NBM) changed the

direction of literature and medicine yet again. NBM originates from a point in which most “medicine” is presumed to be contemporary, and affirms that doctor-patient interactions in all medical fields are primarily verbal; that the outcome of both diagnosis and therapy depends partly on the narrative experience of each party. Questions such as “how do doctors think?” and “how do patients talk?” assume current-day patients and doctors in contemporary settings. The pre-1950 past is expunged or relegated to “history.” NBM arose out of an accompanying agenda to transform the domain of current

medical practice. With much justification its enhancements in communication aimed at altering the kingdom of patientdom: the patient was no longer an

anatomical body to be diagnosed, surgically excavated, and clinically treated, but a word-making individual sensitive to the discursive exchanges between doctor and patient who wished to augment the story he told himself about himself. Some doctors resisted but others willingly participated in these inflections.

The collective medical self-image gradually altered and soon doctors were receiving instruction in the complexities of narrative interchange and re-educating themselves in literary analysis. Likewise patients were taught to construe their responsibility as more robust than earlier: fully to explain themselves to doctors and include the affective components. Some doctors reached out from medical practice to the community in the belief that medicine had grown too insulated (Klass 1993), while others “wrote out” their illnesses – pathographesis – as they routinely had in the early modern world when geography dictated the pressing need for written accounts among absent patients. Pre-1800 travel was arduous; pathographies were sent to physicians who would never see their patients (Caldwell 2004). More recently the authors of pathographies have written for public audiences: to share their experience of illness. By the 1990s writing oneself out of sickness, both through and without publication, became a widespread activity, as if the act of “writing one’s self out” were coevally a cleansing and healing (Hawkins 1993). Some renamed their writing “life writing” for its biocritical suggestion of healing. In 1982-83 the first journal for the study of literature and medicine appeared:

Literature and Medicine. Initiated by Americans, it was intended for North American academic audiences but its contents also captured the attention of medical practitioners elsewhere. In its first decade its contents included historical topics such as the relevance of medical history to the developing literature and medicine field and discussion of figures who had been doctors-writers (Rabelais, Thomas Campion, Goldsmith, Smollett, Keats, Chekhov, William Carlos Williams); but after the 1990s this historical component largely dropped out and the focus turned increasingly to NBM salted with calls for feminist and minority reform in the medical interchange (Literature and Medicine 1992-99). A few papers appeared on Chaucer, Tudor plague, Montaigne, Georgian gout, Blake, and Keats, but these were buried under the mountain of general commentary about pain, stress, disability, intersubjectivity, and ethical concern as found, for example, in the thought of philosopher Emmanuel Levinas. In 1990 the Journal of Medical Humanities published its first issue, but its concerns were even less canonical and historical than its counterpart’s and more bioethical (Journal of Medical Humanities 1990-99). If we pause momentarily we can reflect on why literature and science could

not then have had an equivalent academic journal: its field is significantly larger, especially if readers expect it to cover both literature and science from the Greeks forward. Configurations, a journal first published in 1993 and sponsored by the Society for Literature and Science, itself evolved from a group debating the interconnections of literature and science, aimed to fill some part of this gap.

But while it was eloquent on theoretical aspects of postmodern thought it wisely made no claim to include the historical component of the sub-discipline literature and science. Historical coverage was left to the individual period journals devoted to the Renaissance, Enlightenment, Romantic, Victorian, American literature and so forth. Instead Configurations addressed, and still probes, the theoretical issues and leaves tradition, influence, biography, and especially the place of the history of science and medicine in the development of the sub-disciplines literature and science and literature and medicine to other outlets. Despite these differences of literature and medicine and literature and science,

it is curious the degree to which the pre-1900 literary canon, as well as the deeplayer analysis of the rise of these sub-disciplines, has been neglected. Typical treatment proceeds as if a scientific or medical moment were more or less static, without the far-flung context necessary to explain why it is problematic in the first place. There is little impulse to stretch backward in time. For example, the case study or pathographic propensities of the last generation: many secondary studies have discussed pathographesis as if its curve began in the twentieth century rather than by consulting the longue durée to demonstrate changes in the sub-genre (Campo 1997). Or consider broader reflections on the development of the sub-discipline literature and medicine, the subject of this chapter: few studies treat it as a developing field over the long haul – from the Renaissance forward. When they do, the contextual component is often absent. Moreover, a further reason for the reduction of similarity and difference in

literature and medicine is that, prior to the twentieth century, cure formed only a small province of medicine’s activity. Today we take cure for granted as intrinsic to medical practice, but its rise is recent. Joseph Addison’s famous quip that doctors “kill more than they cure” was a common perception throughout the nineteenth century. Only since the twentieth century has medicine’s primary remit been to cure. Withhold cure from its domain, and medicine becomes a more amorphous territory than otherwise, extending to many realms of human life. The impact on literature and medicine is apparent: what do the two components of literature and medicine – literature and medicine – amount to if medicine has altered in this way? You need a considerable amount of history of medicine to unpack the changes to literature and medicine’s development (Neve 1993; Rousseau 1996). Here the Romantic movement has been crucial (Rousseau 1993). By the late

eighteenth century, British literature – especially the prose novel – was quickly absorbing medical content, while medical practice was being transformed to an unprecedented degree (Rousseau 1981). By the time Coleridge and Wordsworth added the 1802 preface to their revolutionary Lyrical Ballads, with its famous passages about the poet’s unending attraction to the discoveries of science and medicine, writers were more medically knowledgable than they had been (Vickers 2004). Poets and artists, moreover, were fashionable if seen as ailing (Vila 1998).