Medical Case Histories as Genre: Workshop 1st July 2013 @ King’s College London

Medic GazeKing’s Centre for the Humanities and Health is pleased to announce their workshop Medical Case Histories as Genre with speakers including Gianna Pomata, Brian Hurwitz, Meegan Kennedy, and Nicolas Pethes

1st July 2013
Small Committee Room,
Strand Campus, King’s College
9:30 am to 6 pm.

If you would like to reserve a place at the workshop, please email Monika Class (monika.class@kcl.ac.uk) – all are welcome to attend. Attendance is free.

Medical Case Histories as Genre

The study of medical case histories marks a recent trend in the humanities. Over the last two decades, scholars have begun to pay due attention to the fact that medical case histories have been an essential part of medical theory and the human experience of illness in all their multifaceted manifestations since antiquity. During the Renaissance, medical case histories saw a revival that proved influential for centuries (G. Pomata 2010, 2011).

In the twentieth century, however, case narratives led a somewhat shadowy existence particularly in the humanities. Despite the central role of case histories in psychoanalysis, Andre Jolles’s Einfache Formen (1930) – still seen as a standard reference for case narratives in genre theory – omits medical cases and focuses on casuistry. Michel Foucault did much to prevent medical case narratives from entering cultural studies of disease, deeming medical histories a reductive means of pathology, taxonomy and correction. On the grounds that medical cases merely lend themselves to the confirmation of abnormalities, and not to the modification of norms, Foucault severed the medical from the legal case, and cut short the discussion of the mutually constitutive reciprocities of individual cases and recognized categories.

Following John Forrester’s challenge to the Foucauldian view of the case in ‘If p, then what? Thinking in cases’ (1996), the King’s workshop aims to re-examine this picture of case histories, by bringing together experts from different disciplines, in order to develop a dialogue about the forms and implications of case narratives. The event seeks to address questions such as:

What distinguishes medical case histories at a given place and period of time? What are the similarities and differences of medical case histories across cultural boundaries during a specific period?

Given their strong established conceptual and historical links with legal cases, are medical case histories thinkable without casuistry?

Do medical case histories have a claim to a special, possibly unique, kind of visuality and acuity of observation? What types of observation and perspective do we encounter in medical case narratives?

What can we say about the ways in which medical case narratives treat the relation between patient and disease? Does the relation correlate with that of observation and commentary?

What is the significance of medical case histories for medical professionalization?

What is and was the role of medical case histories as an epistemic genre (standardized format for the transmission of cognitive content) within medical practice?  Are case histories a standardized tool for the transmission of cognitive content? How can the relation between practice and genre be conceptualized?

What is the relation of form and content in medical case histories? How do distinctive formal aspects of medical case histories operate as semiotic agents? How can we conceptualize medical case histories as a literary genre?

What is the role of medical case histories in literature? In life-writing? In epistemology, in ethics and other disciplines? How do these functions relate to each other?

How are and were medical case histories adapted in literary culture?

What are the uses of medical case narratives in present medical practice?

What implications does thinking in cases have for the philosophy of science?

What is the potential of medical case narratives to help define medical humanities as a field?

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Precis of papers

Pomata

Professor Gianna Pomata (Johns Hopkins University)

The Medical Case Across Cultures: Comparing the European Observatio and the Chinese Yi’an.  

My paper explores the cross-cultural history of the medical case narrative as an epistemic genre. I compare the development of the medical case in early modern Europe and early modern China, two eminently comparable medical cultures, as they were both based on a long tradition of written medicine compiled by scholar-physicians. The comparison is based on my own research for Europe, and, for China, on the excellent studies by Charlotte Furth, Christopher Cullen, and other scholars.

There are some remarkable similarities between the early modern Chinese and European medical case narratives. In fact, the similarities quite outnumber the differences. In my paper, I will survey the similarities of the genres in the two contexts, while also briefly considering their main points of difference. I will also try to explain these similarities: were they due to the intellectual contact and exchange between pre-modern Europe and pre-modern China? Or did the case narrative emerge, develop and flourish in each of the two cultures independently, as an indigenous cultural species?

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Professor Nicolas Pethes (University of Bochum)

Beyond individuality? Case collections, patient records, and the poetics of serial narration

My talk challenges established views regarding the relationship between literary case narratives and the semantics of individuality. As Gianna Pomata (‘Sharing Cases’, 2010), Volker Hess and Andrew Mendelsohn (‘Case and Series’, 2010) have shown, ‘individual’ case narratives are always part of a series, which can manifest itself in various forms ranging from physicians’ diaries and letters over printed compendia to periodicals. The open-ended and serial nature of the genre appears as the major reason for our present difficulty in reconstructing the formal terms of ‘the’ case in genre theory. Above all, however, the focus on seriality allows us to consider a completely new form of literary adaptation of case-based narrative schemata: building on Adalbert Stifter’s “Die Mappe meines Urgroßvaters” (‘My great grandfather’s casebook’), I will show that nineteenth-century fiction does not merely engage with the individualist dimension of cases but also reflects problems of seriality (and concomitantly issues of overwhelming quantity). On these grounds, it is possible to identify seriality not only as an epistemic structure of case-based knowledge but also as a form of realist narration (with the ensuing problem of data processing).

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Dr Monika Class (KCL)

K. P. Moritz’ Ideal Observer

Medical case narratives are usually associated with a particular kind of observation: the medical gaze and surveillance. For Michel Foucault the medical encounter epitomizes ‘surveillance, whereby the doctor investigates, questions, touches the exposed flesh of the patient, while the patient acquiesces … with little knowledge of … the procedure’ (Lupton 1994, p. 24). In much the same way the ideal observer in K. P. Moritz’s seminal collection of psychological case histories (Magazine for the Study of the Experience of the Soul, 1783-1793) is often said to convey ‘an excessiveness and cruel quality about the analytical gaze of the moral doctor’ (Gailus 2004, p. 413).

MoritzChallenging these views, this paper argues that the dynamics of medical observation were more complex and not limited to repressive objectification. Drawing on K. P. Moritz’s psychological magazine and other writings, my paper proposes that this set of texts contributed to the advocacy of empathy, compassion, de-stigmatization as well as democratization of mental disorder by virtue of observations.

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Dr Meegan Kennedy (Florida State University)

“Let me die in your house”: Writing Cardiac Medicine in the Victorian era

This talk examines the common ground of nineteenth-century literary and medical narratives, with new research illustrating authors’ joint use of particular strategies for the crucial tasks of “seeing and stating.” Medical and literary authors share three diverse approaches to the challenges of truthful observation and representation: curious “sight” or spectacle, realist observation (related to the “mechanical objectivity” identified by historians Daston and Galison), and human insight. Over the course of the nineteenth century, a clinical realist narrative of observation becomes a mark of scientific progress in medicine and highbrow ambition in literature, in contention with alternate, “curious” narratives characterized by affective “sights.” Critics have discussed how nineteenth-century obstetrics and psychology use nonclinical language in narrating patient histories. However, Victorian cardiology texts also combine high clinical realism with sentimental, sensational, or otherwise romantic discourse, due to the complex mix of affecting symptomatology and cultural symbolism in heart disorders. Indeed, a persistent subset of cardiac case histories depict death in literary terms, allowing the most “interesting” patients to “sink” in the novelist’s rather than the doctor’s metaphorical territory. Stokes claims at one point even to abdicate the sacred work of observing and reporting altogether, offering instead “a scene which baffles description, presenting a picture of suffering which could not be imagined or described.” Whether Daldy on a patient’s “habitual tendency to sigh” (1866) and Calthrop on the “terrible cause of this tumult” (1852) or Semple on “an infinity of suffering” (1875) and Balfour on “this poor dying creature” (1876), this talk surveys a range of representational strategies in cases from mid-century cardiology treatises and maps the common ground that underlies challenging narratives in medical and literary prose.

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Professor Brian Hurwitz (KCL)

Sentiment and Spectatorship in James Parkinson’s An Essay on the Shaking Palsy (1817)

James Parkinson’s Essay on the Shaking Palsy appeared towards the end of the author’s life (1755-1824) and was the culmination of a multiplicity of collecting and writing practices on the part of a surgeon-apothecary who was observationally astute across clinical, geological and fossil-collecting activities. My talk will delineate how Parkinson came to recognize a complex disorder of posture, trembling and gait in observations – some repeated over 10 years – made in his Hoxton apothecary’s shop, home visits, and on London streets. I will argue that Parkinson’s achievement should be located not only within the culture of medical spectacle narrowly defined, but also within the growing C 18th interest in street movements, which attracted the attention of artists, poets and novelists of the period. I hope to show how, in making new observations of enduring importance, Parkinson incorporated more than one linguistic and visual trope into his Essay, which may have influenced its reception.

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Programme

9:00 – 9:30 Registration and coffee
9:30 – 10:45 The Medical Case Across Cultures: Comparing the European Observatio and the Chinese Yi’an.  Gianna Pomata (Johns Hopkins University)
Mini Break
10:50 – 12:05 Beyond individuality? Case collections, patient records, and the poetics of serial narrationNicolas Pethes (University of Bochum)
Mini Break
12:05 – 13:00 Lunch
13:00 – 14:15 K. P. Moritz’s Ideal Observer Monika Class (King’s College London)
Mini Break
14:20 – 15:25 “Let me die in your house”: Writing Cardiac Medicine in the Victorian eraMeegan Kennedy (Florida State University)
Mini Break
15:30 – 16:45 Sentiment and Spectatorship in James Parkinson’s An Essay on the
Shaking Palsy
(1817)Brian Hurwitz (King’s College London)
Mini Break
16:50 – 18:00 Respondent & Discussion

* places are assigned on a first come first serve basis *

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