Literature and Medicine in Nineteenth-Century Britain: From Mary Shelley to George Eliot (review)

Janis McLarren Caldwell's book, along with several other recent works on literature and medicine in the nineteenth century, dissents from Michel Foucault's idea of the "clinical gaze" as a normative, quasi-authoritarian discourse. Foucault asserted, in The Birth of the Clinic (1963), that doctoring in this era was about power, not about caring.¹ But Foucault tended to use only French examples to exemplify his basic contentions, which his readers then applied to all of modern Europe. As Caldwell points out, previous writers on literature and medicine in the nineteenth century, such as Lawrence Rothfield in Vital Signs (1992), assumed that where Foucauldian precept and British actuality clashed, British actuality must be wrong. Caldwell forbears from this counterintuitive reasoning, arguing that there was a fundamental difference between French and British ways of regarding the cultural associations of medicine. She argues that "British medical reformers, if not overtly religious themselves, often found themselves in league with religious thinkers" and thereby they provided more of a continuum between matter and spirit than a rationalistic materialism would mandate (6). Foucault's model of the authoritarian, dispassionate clinical gaze is thus "insufficient for British history" (6). Instead of the Foucauldian clinic as all-confident institution, Caldwell proffers, as an alternate model, the contemporary outpatient clinic, where doctors and patients can engage in genuine dialogue, without the doctor being a prioriequipped with "a distancing objectivity" (170). Caldwell repositions the idea of the clinical from the nomothetic to the idiographic, that is to say from the realm of overarching law to that of individual cases. She does not see the clinician as someone who dispassionately applies medical knowledge to specific circumstances; she seeks to demonstrate that a more responsive, patient-centered mode of doctoring did exist in the nineteenth century. Furthermore, Caldwell argues that, in the nineteenth century, boundaries between literary and medical ways of observing reality were not hard-and-fast and that the fiction of that era helped shape this approach to doctoring.

But how to ensure that expertise and responsiveness stay in harmony? Caldwell's most interesting idea is her assertion that the "two books" theory of knowledge, where a material "Book of Nature" coexists with an ethereal "Book of Scripture," is as much a part of the post-Enlightenment world as of the medieval world in which the theory originated. "The scientist of dual character" could keep his soul attuned to the spiritual level even as he recognized the materiality of his clinical practice (34). With this duality in mind, Caldwell goes on to question the "Natural Supernaturalism" theory of M. H. Abrams in his 1971 book of that name. Abrams posits that Romantic idealism was a secularized version of religious transcendence. But Caldwell chastises Abrams for being "too monological, too lopsidedly naturalistic" in his vision of a wholly realized secularism (47). The energies of the Book of Scripture are not displaced by the Book of Nature as scientific authority begins to rival religious belief. Rather, Caldwell argues, a kind of "extra-ecclesiastical spirituality" emerges (49).

Three texts crystallize Caldwell's argument: Mary Shelley's Frankenstein, Emily Brontë's Wuthering Heights, and George Eliot's Middlemarch. Frankenstein is one of the world's most written-about texts, but Caldwell shows the gruesome story's fresh relevance to interpersonal situations, including medical ones, by arguing that Shelley wants the reader to sympathize with the monster, not with Frankenstein. Caldwell maintains that by doing this Shelley leads the reader to practice a mode of sympathy that does not patronize but rather recognizes the radical difference of the other. In Caldwell's reading of Wuthering Heights, Emily Brontë's characters seem to dwell amid a precognitive nature, where formalized clinical medicine is out of place. Brontë herself never sought medical attention, even in her last illness. Yet, in Caldwell's view, the narrative, provided internally by the character Lockwood and externally by the author, serves...