You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.

history

Book Review – Ill Composed: Sickness, Gender, and Belief in Early Modern England

28 Mar, 17 | by amcfarlane

Ill Composed: Sickness, Gender, and Belief in Early Modern England by Olivia Weisser, New Haven: Yale University Press, 2015, 296 pages, £60.

Reviewed by Sarah O’Dell, Azusa Pacific University, Azusa, CA 91702, sodell10@apu.edu

In this well-researched and compelling work, Olivia Weisser addresses the relative paucity of scholarship on early modern gender and illness to argue that early modern experiences of illness were mediated by factors such as gender, religious belief, occupation, economic status, and contemporary writing practices. To analyse these influences, Weisser reclaims the perspectives of early modern patients, ultimately demonstrating how self-expression defined medical care, as well as highlighting the performative aspects of their ailments. Her study relies on a diverse array of sources spanning from 1630 to 1730: diaries, letters, account books, medical literature, devotional literature, practitioner case notes, and petitions. While the fifty-two historical narratives (penned by thirty men and twenty-two women) are representative of a wealthy and literate minority, they present a diversity of age, political affiliation, and religious membership. Weisser further expands her source material by analysing petitions submitted by poverty-stricken individuals during their times of illness.

Through these texts, Weisser reveals the ways in which emotion, conventions of suffering, and articulations of pain influenced sufferers’ perspectives of their health. Crucially, Weisser contends that seventeenth-century English men and women perceived illness in gendered ways: while women often attributed illness and recovery to positive or negative affective relations, men demonstrated a tendency to privilege their own experiences and observations over the opinions of others. Ill Composed therefore addresses several imbalances in previous scholarship regarding illness in the seventeenth century. Although prior studies of early modern patients in England have focused almost exclusively on the extant diaries of Puritans, Weisser draws on the writings of Anglicans, Quakers, and Catholics to present a more theologically balanced landscape of illness. Weisser also deviates from previous scholarship by asserting the role of the emotions in illness – both pathogenic and curative – and abandoning typical discussions of pain management to instead consider how pain was expressed.  Following Joan Scott, Weisser does not consider these first-hand accounts to be unmediated reflections of experience, instead analysing the role of writing in constructing experiences of illness. By scrutinizing the normative writing practices of the period, she illuminates how gender mediated the space between lived experience and documentation.

Weisser begins her study with a chapter unpacking patients’ understanding of their bodies from a (gendered) humoral framework, and the remaining chapters trace the progression of illness. “Learning How to Be Ill” treats the scripts employed by patients to make sense of their infirmities, specifically those derived from observing the suffering of others, interpreting their own bodily functions, and engaging devotional literature. Weisser demonstrates that religious writings such as the Confessions provided templates for considering the physical and moral effects of temptation; Augustine’s story of the stolen pears transformed early modern experiences of fruit-related sickness into opportunities for religious reflection. As the book progresses, the gendered aspects of early modern illness become increasingly clear. In “Emotional Causes of Illness,” Weisser argues that women were likely to causally link their ill health to negative emotions. For instance, Alice Thornton reported ill health immediately following the death of her siblings, and on the night of her husband’s death Mary Rich wrote, “this night with griefe I fond my self uery ill.” Sickness could not only arise as a response to grief, but also in sympathy with the sufferings of a loved one or as a deleterious effect of gossip. In contrast, relatively few men reported a direct relationship between their passions and the state of their health. Samuel Pepys, when consumed with jealousy for the affections of his wife, described the toll on his health in terms of “troubled” sleep and mind, refusing a direct link between emotion and illness. As Weisser argues, men were more inclined to focus on the physical processes underlying their bodily states, or present their ill health alongside professional or financial concerns.

“Suffering on the Sickbed” examines the behavioural expectations of “the sick role” as well as the effects of visitors; early modern illness was enacted in a community framework, rendering visits to the sick both a social responsibility and religious exercise. “Perceptions of Pain” discusses how patients evaluated their pain, as well as the ways in which religious narratives of suffering – notably, those of Catholic martyrs and Christ himself – transformed the experiences of the pious. Men and women not only used martyrdom as a metaphor for their pain, but also utilized the discourse of martyrdom in mimetic ways. For example, the tortuous image of the rack was both utilized as a metaphor to highlight the spiritual significance of suffering and employed to articulate severe pain. Importantly, Weisser notes the challenge pain posed for normative gendered behaviour: women’s assertive expressions of pain often defied the normative feminine qualities of patience and submission; men characterized the severity of their discomfort by recording their inability to meet expected masculine roles of economic and occupational import. The final chapter, by discussing the petitions of those afflicted by both physical and financial debility, examines the socio-economic impact of illness. Weisser identifies several key differences of these illness narratives, namely an increased emphasis on misfortune, physically debilitating disorders, and the economic toll of illness. Throughout the book, Weisser discusses afflictions that are not sex-specific; by not stressing the bodily explanations of one sex over the other, the gendered aspects of illness are clearly rendered.

Ill Composed presents Weisser’s contribution to three broader fields: historical considerations of the patient, women’s and gender history, and studies of constructions of the self. Ray Porter, Dorothy Porter, Lucinda Beier and others have previously investigated the early modern patients’ participation in the medical encounter, especially in light of the decline of patient authority experienced in the 19th century. Weisser expands this work by demonstrating the influence of both gender and religion on early modern utterances of illness. While Barbara Duden has previously established “the body” as a historical subject, her attention remains on only female patients; Weisser addresses this gap by noting the gendered similarities and differences in seventeenth-century expressions of illness. Similarly, while Laura Gowing and Mary Fissell have explored early modern conceptions of the body, Weisser offers a novel approach by utilizing illness to explore the relationship between culture and embodied experience. This work advances these fields by depicting the early modern sick body as locus of self-expression; the constructive potential of this rhetorical space is heightened by the (religious) anxiety and reflection surrounding illness. Weisser demonstrates that these self-constructions occurred in ways that both affirmed and defied normative gendered behaviour. Overall, Ill Composed presents a revelatory study of the body as a product of its cultural and historical moment, providing crucial insight into the historical experience of illness and inviting scrutiny of the practices surrounding illness today.

Book Review: Thinking in Cases

23 Jan, 17 | by cquigley

 

Thinking in Cases

by John Forrester. Published by Polity, 2016.

Reviewed by Dr Neil Vickers

 

John Forrester, who died in 2015, was the most original historian of the human sciences of his generation. His great love was the history of psychoanalysis – he was for 10 years the editor of the journal History and Psychoanalysis – and he published no fewer than 4 major books in that field, including the classic Freud’s Women (which he wrote with his wife, Lisa Appignanesi).

Thinking in Cases is the first of two books to be published posthumously, the second being the monumental Freud in Cambridge (co-authored with Laura Cameron), due out later this year. It comprises six essays written over the last two decades on what he memorably termed ‘case-based reasoning’. Forrester, along with many historians of science, believed that case-based reasoning had embedded itself in a variety of disciplines, in ways that experts were often reluctant to acknowledge. It might be thought that in the era of evidence-based medicine, medical education no longer needs the case. Yet, as Forrester argues in his classic essay, ‘If P, Then What? Thinking in Cases’ (1996), novice practitioners learn their science by absorbing a handful of standard experiments from scientific textbooks. These case studies – for that is what they are – serve not only to make the underlying principles more memorable, they also provide something like a shared professional memory.

Much of Forrester’s thinking on case-based reasoning was informed by his decades-long engagement with the work of Thomas Kuhn, with whom he studied in the early 1970s. The most brilliant essay in the book (‘On Kuhn’s Case’) treats the evolution of Kuhn’s thought as a case study in how the philosophy of science actually works at an individual level. Kuhn, it turns out, came from a family that was steeped in psychoanalysis. His grandmother had analysis in Cincinnati with Alfred Adler, sometime in the 1910s or early 1920s. His mother edited some of Karen Horney’s works. And most important of all, he twice underwent psychoanalysis himself, first (briefly) as a child, and again as an adult, between 1946 and 1948. The end of this second analysis coincided with two great changes in Kuhn’s life. He was admitted into the Society of Fellows at Harvard which enabled him to abandon his career as a theoretical physicist and to become a historian of science instead. And he embarked on a marriage that lasted 30 years. He decided to abandon physics for history when he read Aristotle’s Physics. At first he was baffled by the great man’s obtuseness. How could someone who had written so penetratingly on so many other subjects have got the laws of the physics so wrong? But one day it dawned on him that Aristotle was investing concepts like ‘motion’ with completely different meanings from the Newtonian ones he had learned as a boy, and that, once he had made allowances for this altered usage, Aristotle’s physics not only made sense but was far in advance of its time. This Gestalt shift in his own thinking was the first instance of the famous ‘paradigm shift’ which became the master idea of Kuhn’s book The Structure of Scientific Revolutions (1962). Forrester leaves us in no doubt that it was the result of analysis. In an interview published in 2000, Kuhn stated that it was while he was in analysis that he learned ‘to climb inside people’s heads’. He recognised that this ability was central to his work as a historian of science and that for this reason he owed psychoanalysis ‘a tremendous debt’, even though he didn’t much enjoy being a patient. The Aristotle epiphany occurred while he was in analysis. Forrester points out that Kuhn’s method was both individualistic and psychologistic. Kuhn called himself an internalist historian of science because of his overriding preoccupation with the problems his subjects were trying to solve. The historical contexts in which they tried to solve them were a secondary matter. But he was an internalist in the more informal sense that he worked by climbing into other people’s heads. In the same interview Kuhn recalled feeling he could ‘read texts, get inside the heads of the people who wrote them, better than anybody in the world’. These other people were encountered as auxiliary selves – extensions of himself. Forrester quotes several anecdotes Kuhn told about himself in which new selves – famous scientists all – would arise almost in the manner of out-of-body experiences.

The other highlights of the book for me were two pieces on the LA analyst, Robert J. Stoller (1924-99). The first puts forward an extended speculation concerning Stoller’s analysis of a woman on whom he conferred the pseudonym Belle. Belle is the protagonist of one of Stoller’s best books, Sexual Excitement: The Dynamics of Erotic Life (1986). The turning-point in Belle’s analysis occurred when she described a daydream she’d nurtured from childhood in which a figure called The Director instructed her to humiliate herself sexually before a group of adults (and sometimes animals). Stoller was bothered by what he took to be his patient’s seductive behaviour towards him. It was only in retrospect he realised she was pressing him into the role of the Director. (Belle’s mother was a famous Hollywood actress who took up with a number of Directors. The injunction to perform was everywhere in family life.) Forrester suggests it was from Belle that Stoller drew his controversial theory that sexual excitement ultimately depended on hostility. He suggests that the book detailing her case history, written years after her treatment ended, was an attempt to model a more benign form of watchfulness for her. Stoller consulted Belle over every draft of the book and gave her carte blanche to alter anything she didn’t agree with. It was sobering for them both to discover that they had very different views of what had been valuable in their work together. Forrester suggests that the writing of the book was the decisive part of the treatment for through it he showed her that he didn’t need to be entertained by her. ‘If he had not published his book,’ he writes, ‘her analysis would have been a failure.’

The second Stoller-related chapter (unpublished until now) is a paper on ‘Agnes’, one of the world’s first male-to-female transsexuals. Agnes’s case was first described in Harold Garfinkel’s Studies in Ethnomethodology (1967) but Garfinkel took Stoller on as a co-author as he was one of Agnes’s psychiatrists. Agnes claimed to have been born intersexed and, starting in the late 1950s, went through an arduous vetting procedure lasting many years in order to obtain surgical gender reassignment. Many years later she told Stoller that from the age of 12 she had in fact taken her mother’s hormone replacement medication which resulted in her acquiring female secondary sex characteristics. Garfinkel the sociologist thought that Agnes’s attempts to pass as female shed light on what maleness and femaleness were, as socially-credited qualities summoned up into being every moment of every day. Her deception about her history was just another instance of what she had to do to ‘pass’. Stoller on the other hand originated the concept of core gender identity on the basis of his treatment of Agnes. He met Agnes’s mother and discovered that she had regarded herself as male from the age of eight and that she had passed her own ambivalence about her gender identity on to her adored son, whose transformation into a woman she supported wholeheartedly.

Thinking in Cases is an ideal introduction to Forrester’s thought, containing some of his most important papers. He combined a scientist’s delight in devising new methods to understand recondite things with an exceptionally acute sense of the role of contingency in intellectual discovery. These strengths were central to his style of reasoning and, as these pages testify, made him one of a kind. Everyone with an interest in the medical case history and its wider ramifications should read this book.

Ayesha Ahmad: ‘Lahore is an Illusion, Lahore is Everywhere’

27 Mar, 16 | by Ayesha Ahmad

The mango tree faded many shadows ago, its fruit became stones and the branches became a skeleton. Yet, the roots remained, and they embrace the soil in the womb of the earth.

images-1

This was the cradle of my family’s birth.

Now, blood is watering Lahore’s gardens.

In sorrow, I remembered these words given to me a few days ago by my father.

 ‘Lahore is an illusion, Lahore is everywhere’

I wondered about them for sometime afterwards and I did not realise the gift that these words were to become.

more…

Call for Papers: Fashionable Diseases: Medicine, Literature and Culture, ca. 1660-1832

28 Jan, 14 | by Deborah Bowman

An International Interdisciplinary Conference

Newcastle and Northumbria Universities

3rd – 5th July 2014

 

Keynote speakers include:
Professor Helen Deutsch, ‘Diseases of Writing’

University of California, Los Angeles

Author of Resemblance and Disgrace: Alexander Pope and the Deformation of Culture

 

Dr David Shuttleton, ‘The Fashioning of Fashionable Diseases in the Eighteenth Century’

University of Glasgow

Author of Smallpox and the Literary Imagination

 

Between 1660 and 1832 books such as Cheyne’s English Malady and Adair’s Essays on Fashionable Diseases created a substantial debate on the relationship between fashion and sickness, linking melancholy, the vapours, nervousness, gout, consumption and many other conditions with the elite and superior sensibility. This conference aims to include voices from both within the social and medical elite and beyond, and to look at diseases that have not previously been examined in this context and at what can be learned from ‘unfashionable’ illnesses. It also aims to consider not only diseases associated with social prestige, but also with the medical critique of fashionable luxurious lifestyles, and the debate on ‘imaginary’ diseases. The role of culture in creating, framing and spreading conceptions of fashionable disease will also be considered.

 

Proposals for papers and three-person panels are welcome on topics related to fashionable diseases, including:

  • Patient experience
  • Consumer society and the ‘medical marketplace’
  • Culture (literature, music, etc) and fashionable disease
  • Geographical meanings – travel literature and spa culture
  • Morality, politics and medicine in critiques of fashionable lifestyles
  • Satire, stigma, fashion
  • ‘Imaginary’ diseases
  • Class, gender, race, religion, etc
  • Unfashionable diseases

 

We are also keen to receive proposals offering interdisciplinary and internationally comparative perspectives, or relating eighteenth-century to contemporary fashionable diseases.

Please submit abstracts (max. 250 words) and a brief biography (max 100 words) to enquiries@fashionablediseases.info by 28 February 2014 http://fashionablediseases.info/

 

James Poskett: Naval Expertise Conference, May 10-11 2013

4 Aug, 12 | by James Poskett

For those regularly following this blog, you’ll know I’m keen on exploring how maritime and medical history can be brought together, particularly with respect to developing critical global histories of both. If you share my enthusiasm, you might be interested in the following conference, due to take place 10-11th May 2013 at Wolfson College, University of Oxford.

Naval Expertise and the Making of the Modern World

One of the four major themes of the conference is ‘science and medicine’ including ‘the management of disease at sea’, so it would be great to see interested parties either presenting or attending. The call for papers is open now, with a deadline of 31st October 2012, and registration will open later in the year.

James Poskett: Digital surgeons at sea

30 May, 12 | by James Poskett

A few months ago I was raving about the prospects of a maritime history of medicine, the ship’s medicine chest being the focus of some of my latest studies.

Since writing that piece, the Wellcome Trust and National Archives have completed the digitisation of the Royal Navy Medical Officers’ journals. The project, entitled Surgeons at Sea, allows budding maritime historians to view and search over 1000 records online, encompassing the years 1793 to 1880.

There’s a really diverse range of themes to be uncovered. For those interested in everything from shark bites to venereal disease (and, of course, that all-pervasive medical tonic: rum), I’d certainly recommend taking the time to browse.

James Poskett: Medicine adrift at sea

21 Feb, 12 | by James Poskett

You’re on board a small British merchant ship in the English Channel and you start to feel very ill. There’s no doctor on board. What do you do? If the year is 1844, you’re in luck. The Government has recently made it compulsory for all merchant vessels to carry medicines, to be kept in a small wooden chest. So open up, take a swig of the laudanum, and relax.

But before you drift off into an opiate-induced stupor, take a moment to consider the history of how a very particular set of drugs ended up on every British merchant ship. It’s a topic that started to interest me as I stumbled upon a collection of tiny pamphlets, each designed to be slipped inside one of the drawers of the ship’s medicine chest. With titles such as The Guide-Book to the Government Medicine Chest, they list the medicines to be taken aboard along with directions for use. Well before anything resembling the National Health Service, let alone the National Institute for Clinical Excellence, we have a government mandate to stock certain medicines. So, these chests, along with the accompanying pamphlets, provide a fantastic opportunity to study the early history of public health and the regulation of drugs.

more…

James Poskett: Material and visual culture of conferences

9 Dec, 11 | by James Poskett

Conferences can be somewhat dry affairs. Papers delivered as long droning monologues are liable to send even the most hardened academics into a dreary stupor. The more enticing discussions can also take their toll as the days wear on, debate often returning to ancient disputes. So what better way to break up the day and keep everyone fresh than with an outing to the cinema?

At the recent Communicating Reproduction conference we were all sent to see Helga (1967). Of course, this outing wasn’t frivolous but rather an opportunity for us to engage with the substance of the conference: the history of reproduction through communication including text, images, film and sound.

more…

James Poskett: Stories of psychology

12 Oct, 11 | by James Poskett

Who are the big names in the history of child psychology? Anna Freud? Melanie Klein? John Bowlby? Certainly. But, according to Professor Sally Shuttleworth, in order to locate the origins of child psychology, we have to look to nineteenth-century literature, to authors such as George Eliot and Charles Dickens.

This is just one of the historical titbits to come out of the recent Stories of Psychology conference, ran by the British Psychological Society at the Wellcome Trust. In her paper, entitled Studying the Child in the Nineteenth Century, Shuttleworth argued that the emerging genre of the nineteenth-century novel was the first to take the psychological world of the child seriously. Whilst previous works may have dealt with comings of age, novels such as Dickens’s Dombey and Son began to investigate the psychological world of the child in its own right, particularly within the context of education. (In the novel, Dombey’s son has difficultly socialising and is sent to a number of medical and educational establishments in order to rectify this shortcoming.)

Shuttleworth believes that such literary explorations were picked up by the psychologists and educationalists of the time, citing as evidence the way in which psychological theories were put to use in debates over compulsory education.

more…

James Poskett: Retrospective diagnosis – it’s not (all) bad

1 Sep, 11 | by James Poskett

Did Julius Caesar suffer from epilepsy? Was Mad King George mad? Did Tutankhamun have Klippel-Feil syndrome?

Retrospective diagnosis, particularly of notable historical figures, makes me feel uneasy. For one, it seems to fly in the face of contemporary historiography in which diseases are recognised as influenced by the social, historical and linguistic context. Even the more contextually sensitive attempts can sometimes feel little more than a game, an historically embellished version of a multiple choice question.

So why did I read (and enjoy) The hallucinations of Frédéric Chopin, in which the authors add temporal lobe epilepsy to the Romantic composer’s lengthy list of ailments?

http://mh.bmj.com/content/37/1/5.full

more…

Medical humanities blog homepage

Medical Humanities

An international peer review journal for health professionals and researchers in medical humanities. Visit site



Creative Comms logo

Latest from Medical Humanities

Latest from Medical Humanities