by Jeffrey M. Brown

“Literature, Medicine, Health [Special Issue].” Moving Worlds 19.2 (2019)

A recent volume of Moving Worlds begins with a short poem by UK Poet Laureate Simon Armitage entitled “Finishing It.” “I can’t configure / a tablet / chiselled by God’s finger / or forge / a scrawled prescription,” the poet admits; instead, he offers only “the sugared pill / of a poem, one sentence / that speaks ill / of illness itself, bullet / with cancer’s name / carved brazenly on it.” In an image on the adjoining page, we see that Armitage’s poem has been etched into a chemotherapy pill by the micro-artist Graham Short. Though we are told that the inscription was performed on “standard sized pill,” the image shows an ovoid form magnified to many times the original scale, the words leaping out as white scars on a mottled gray surface that looms out of a blackened void—what we are told, in the poem, is “the small white dot / of its own / full stop” (4). From its opening lines, the poem thus emphasizes the ironic disparity between the work of literature and the work of medicine even as it promises their material union in the act of healing. Though the poet possesses the powers of neither God nor doctor, his work provides an opportunity to reflect on both with equal measures of hope and hubris. Of course, the most problematic of the poet’s ambitions is that he may achieve any kind of “full stop”: for the “sugared pill” of poetry may conceal its own poisons, and metaphors, too, have the potential to metastasize.

It is to the immense credit of Moving Worlds’ contributors that each subsequent piece in this volume meets the challenge of Armitage’s opening provocation, as the journal presents a sequence of engagements—in critical scholarship, short fiction, poetry, and visual art—with the ambivalent “entanglements” of its subtitle and theme: “Literature, Medicine, Health.” As Clare Barker acknowledges in her editorial preface, “[t]he field of medical humanities has recently undergone a critical turn,” one that questions the scholarly focus on Anglo-American forms of knowledge and the methodological privileging of individual encounters between healthcare providers and their patients (1). In order to resist the exclusions implicit in such approaches, Moving Worlds—a humanities journal published through a collaboration between the School of English at the University of Leeds and the Division of English at Nanyang Technological University in Singapore—leverages the strategies of postcolonial and transcultural critique, seamlessly integrating the close examination of various works of art and literature with a wider interrogation of the systems that these works inhabit and illuminate, from acts of corporate biopiracy predicated upon universalist, rights-based health discourses to the troubling intersection of neoliberal narratives of development with indigenous accounts of generational growth and trauma.

The greatest difficulty of such work lies in the problem of representation: the tendency, in literature and politics, to allow one thing to stand for something else. In medical practice, this tendency manifests most obviously through anatomical synecdoche—the biomedical distillation of a patient’s fullness of being into a particular organ or ailment—but also through a colonialist fixation on “authenticity” or cultural integrity; under certain conditions, the rejection of one of these tendencies occurs only through a commitment to the other. In its stylistic minimalism and literal miniaturization, Armitage’s poem ironically attests to the subtle perils of representational reductionism: the rest of this volume thus takes shape around this problem, as each essay bears a multiplicity of insights and interventions inspired by its singular site of critique.

This agenda is most deliberately pursued in contributions by Emily Kate Timms, Clare Barker, and Veronica Barnsley. Timms’s assessment of intergenerational wellbeing in Patricia Grace’s Chappy begins by interrogating the political hazards of a common metaphor—that of the “silver tsunami,” which likens the effects of a rapidly aging population in the Global North to an irresistible natural disaster—but also notes the dangers of the inverse response: the “well-meaning” recourse to indigenous epistemologies regarding the value of age and elderhood, which is often built upon the exoticization of “alternative” ways of knowing and upon a reductive and hierarchical approach to history. Her investigation of Grace’s representation of Māori communities—and especially the meeting of public health, colonial trauma, and ecological sustainability through the operation of metaphor and memory—therefore emphasizes intergenerational reciprocity rather than unidirectional acts of transmission. Barker takes on similar work in a profound critique of Ann Patchett’s State of Wonder, where a scientific expedition to discover the medicinal properties of symbiotic Amazon ecologies is implicated in the extractivist logics of global health prerogatives and in a proleptic discourse that preserves the value of indigenous culture only by assuming (and assuring) its extinction. Likewise, Barnsley’s analysis of Amma Darko’s The Housemaid challenges reductive approaches to reproductive health and social development in Ghana: by focusing on the intersectional issues embedded in the practice of midwifery, Darko’s novel exposes the interplay of class, geography, and the cultural imaginary that complicates both rights- and policy-based neoliberal health initiatives.

Through their detailed studies of individual works of literature from across the world, these essays refuse tidy forms of distillation; nevertheless, common themes and methods provide enlightening moments of connection. A skepticism regarding the use of language in defining specific health demographics is seen in Frances Hemsley’s critique of Marie Béatrice Umutesi’s memoir of the Rwandan genocide and its aftermath, where enduring health impacts among displaced peoples—from malnutrition to the unchecked spread of cholera or tuberculosis—allows for the articulation of “epidemic narratives” that parallel and undo categorical distinctions around victimhood and thereby disturb efforts toward justice and reconciliation; similarly, Amy Rushton demonstrates both the power and the danger of defining depression in Tsitsi Dangarembga’s This Mournable Body, for diagnostic reading runs the risk of affirming a bio-psychiatric model that locates blame within the individual even as depression becomes a powerful metaphor for and affective response to the general condition of colonization. Problems of narratology—particularly, the thorny issue of determining “ends”—that appear in Hemsley’s work also resonate with Michelle Chiang’s discussion of temporality and the “absurdity of being terminal” in managing end-of-life discussions. In the same way, an exploration of the fluid boundaries between culture- and faith-based forms of knowledge and biomedical treatments defines both Katherine Storm Hindley’s writing on medieval representations of Hippocrates and Graham Matthews’s survey of contemporary Singaporean cancer narratives.

Much like Armitage’s “Finishing It,” poems and short fiction by Madeline Lee, Avaes Mohammad, and Kathy Jetñil-Kijiner punctuate these essays by testing the potential and the duplicity of metaphorical connections between literature, medicine, and health, particularly through their simultaneous representation of a disease, its source, and its cure. In a moving reflection on her collaboration with Jetñil-Kijiner, Michelle Keown analyzes their work on the legacy of US nuclear testing in the Marshall Islands, which has resulted in generations of radiogenic illnesses and enduring ecological devastation. Jetñil-Kijiner focuses on women’s reproductive health, linking the epidemic of miscarriages, stillbirths, and birth defects caused by the irradiated environment to older, “monstrous” cultural images of postpartum depression; Keown’s sensitive appraisal and adaptation of the work notes how Jetñil-Kijiner’s repeated deployment of sun-imagery appropriates a common journalistic trope for positivist visions of nuclear power—a “new dawn”—and uses it to represent internalized trauma, activist exposure, and the potential for restitution, relief, and rehabilitation.

Keown’s meditation on the ambivalence of this imagery thus provides a suitable conclusion for the volume as a whole. Far from “finishing it,” such analysis demonstrates that the entanglements of literature, medicine, and health, when viewed with the goal of “helping to imagine more equitable health futures” (3), produce not a self-contained end but rather an explosion of energy and light. This eclectic assortment of transcultural works follows through provocatively on the promise of the critical medical humanities, offering, through its multivalent “full stops,” many new beginnings.

Jeffrey Brown is Assistant Professor of English in the Department of Humanities at the University of the Sciences in Philadelphia.