Medical Humanities Intersections With Gothic Studies

Medical Humanities Intersections With Gothic Studies
© Illustration by Patricia Petruzzella

Many Gothic classics are fantastical depictions of the ethical perils of medical ambition: Mary Wollstonecraft Shelley’s ‘Frankenstein,’ for example, is a paradigmatic text of medical ambition gone wrong, and Robert Louis Balfour Stevenson’s ‘Strange Case of Dr Jekyll and Mr Hyde’ is partly a reflection on the ethics of pharmaceutical experimentation.

The field of Gothic studies has long grappled with suffering bodies and with trapped protagonists, and while the earliest texts in the Gothic literary “canon” emphasise the vulnerability of victims tormented in remote castles or monasteries, much nineteenth-century Gothic shifted the locus of the threat to cities and the newly-emerging professions. Ever since the mysteries and power of medicine and law have been rich material for fantasies of bodies and minds constrained. Gothic literature and film has long had an interest in the way medical practice controls, classifies and torments the body in the service of healing. Medicine itself can be seen as an incorrigibly Gothic project — as David Punter notes, “Gothic knows the body […] It knows about physical fragility, about vulnerability.” The fragility of the human body in the grip of these discourses continues to be manifest in a wide range of Gothic literature and film.

The direction of influence goes both ways: while medicine has influenced the dramas and settings of Gothic, so too have Gothic forms shaped medical writing. This is seen most clearly in nineteenth-century medical discourse when the new genre of the clinical case study was being redefined regarding realist literary modes against the romantic and Gothic novelistic forms of the early nineteenth-century. Yet as Meegan Kennedy has shown, the genre of the nineteenth-century clinical case study is veined through with traces of a Gothic and Romantic mode: the rhetoric of the “interesting” and “curious” case can be seen as a direct successor to the romantic grotesqueries of earlier Gothic. In multiple ways, the Gothic mode and representations of medical practice and experience have long been entangled. In this second decade of the twenty-first-century, it seems apt to freshly examine intersections between the two fields of study.

Before exploring their conjunction, we need to define both terms — a challenge in both cases. The Gothic mode of representation is notoriously as slippery as its transgressive subjects, but the adverse effect is at its core: these are representations of horror, terror, fear, and despair. The negative effect is typically entangled with particular spatial and temporal structures. The subjects of these texts often experience confined spaces and a sense of imprisonment, either literal or metaphorical, “a claustrophobic sense of enclosure in space.” Within these confined sites, the subjects often experience violent anachronism, in which a sense of enlightened modernity is undermined by the return of atavistic presences and practices. Gothic is traditionally preoccupied with a sense of a menacing past undermining optimism for the present or future: as David Punter says, it concerns “[e]clipsed lives, lives already lived among the ruins […] where darkness reigns and the future can never escape from the dread of the past.” Gothic is preoccupied with the crumbling of modernity’s triumphs, of rationality and science defeated. This temporal structure is not as neat as the past invading and unsettling the present: rather, past and present become intertwined, and both distorted. Ultimately this spatial confinement and temporal fracture can lead to a collapse of epistemological confidence: as Andrew Smith and Jeff Wallace note, texts in the Gothic mode often communicate “[t]he sense that the subject is not in possession of itself.” The subject’s vulnerability is reflected in the emotional filter of the narrative perspective, whether third- or first-person. Gothic representations are not realistic: they represent highly subjective, the fraught experience of crisis.

Like the Gothic, medical humanities is challenging to define, being understood variously as either inter- or multi-disciplinary, and as having diverse pedagogical or critical goals. The category originally emerged in medical schools, as an attempt to enrich undergraduate medical curricula by, among other things, helping trainee physicians empathise with patients’ subjective experience — their pain, their fear, but also the individual history and interpersonal relationships within which every illness occurs, and which makes every case of illness different. Structured clinical taxonomies have enabled tremendous medical progress, but to facilitate those taxonomies, the patient’s corporeal experience needed to be conceived by the physician differently from hitherto. Paul-Michel Foucault argues that this the standardising medical gaze that came into being at the end of the eighteenth-century is a “reductive discourse” which simultaneously confidently purports to explain — yet is inadequate to fully encompass — “the presence of disease in the body, with its tensions and burnings, the silent world of the entrails, the whole dark underside of the body lined with endless unseeing dreams.” He suggests that the medical taxonomies of modern “classificatory” medicine “remove […] disease from the density of the body,” and the complex and particular environment within which the ill subject lives. This medical gaze has been critiqued for depersonalising patients, compressing diverse experience into standardised categories and eluding the emotional and social impacts of illness and medical experience: some scholars have also suggested that medical training and the work itself potentially decreases healthcare practitioners” propensity to empathise with patients. As an antidote to this detachment, illness narratives, be they fictional or (auto)biographical, may invite a reader to imaginatively engage with a particular, lived experience of illness.

This pedagogical emphasis on prizing patient experience connects with a new emphasis in the last decade, on the notion of “patient-centeredness” in medical practice and education. In this vein, medical humanities can at times partly be understood as having a pedagogical role in “humanising” medicine. In addition to nurturing empathy, medical humanities also has a valuable pedagogical contribution to practitioner training in the way it can enhance practitioners’ ability to read patients’ narrated histories, and to become sensitive to the issues of power and authority that cluster around the medical record and treatment decisions. In this vein, several scholars have explored the degree to which medical practice requires “narrative competence,” in Rita Charon’s phrase.

Such a cultural studies approach, alert to structural inequities and marginalisation, is central to intersections between Gothic studies and medical humanities. A collection combining gothic studies and medical humanities will inevitably examine disturbing aspects of medical practice, and some practitioners may read these essays as unnecessarily hostile to the many blessings of medicine. Cultural studies of medicine are vulnerable to such misreading, attentive as they are too dangers inherent within institutional discourses, marginalisation of disempowered demographics, and the often corrosive effects of capitalist pressures on medical practice. Yet cultural studies research does not typically dismiss all medical practice as in thrall to these problems: instead, the work is trying to identify paradoxes, inconsistencies, and ambiguities. While these papers may be troubling, they do describe the shadow side of medicine: the presence of these shadows does not deny that medicine is also a thing of light.

‘In The Flesh’ Of The Poisonous Gothic Medical Culture

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