Editors' Preface: Reflexivity and Responsiveness: The Expansive Orbit of Knowledge

As we continue to explore how stories work, and the work that stories do in the sphere of medicine, we find, in this issue of Literature and Medicine, a special emphasis on how narratives function in the construction of knowledge—how we explain, how we establish and assert our claims to understanding and mastery. In the realm of diagnosis, of naming, characterizing, constructing the terms that define a disease or disorder, the need for a heightened awareness of how narratives work becomes especially pressing. How we, as individuals, as medical practitioners, and as a society, make claims to knowing or identifying an illness has much to do with our notion of its etiology—that is, its story. In this issue we are called upon to scrutinize how we know what we know, particularly regarding illnesses that are not written on the body.

Bringing narrative skills to medical discourses has proven its value time and again—in revealing the perils of portraying illness as metaphor and in recognizing also that illness cannot escape metaphor, as it will inevitably be situated in medical, social, familial narratives and the like, where it takes on symbolic meanings of one kind and another. Narrative competence and the self-awareness it cultivates become, increasingly, ethical obligations for those who access, employ, and deploy knowledge—not least, medical knowledge.

This issue opens with two articles on autism that engage questions of interpretation and the status of knowledge. In "Mindblindness: Autism, Writing, and the Problem of Empathy," Ann Jurecic provides an important cautionary tale in her discussion of Melanie Klein's and Bruno Bettleheim's misguided interpretations of their autistic patients and of more recent theories that work from "the outside in" rather than from the patients themselves. If one theory defines autism as the absence of empathy, Jurecic helps us grasp the failures of empathy expressed by those attempting to explain the disorder. In its enigmatic alterity, autism seems to invite projection; Jurecic urges awareness of the potential for blurring between empathy and projection or over-identification. Autism challenges us to recognize the limits and flaws in our notions of empathy, and to rethink how we can practice empathy "across divides of difference." Jurecic offers Oliver Sacks as a countermodel to Klein and Bettleheim in his willingness to learn from—as distinct from simply diagnosing—persons with autism; Sacks allows for an exchange of knowledge between the doctor and the person with autism, modeling the proposition that understanding across difference can be layered and complex, approximate, rather than total.

In "Autism and the Contemporary Sentimental: Fiction and the Narrative Fascination of the Present," Stuart Murray suggests that autism, in its seeming unknowability, operates in popular narratives as a kind of open symbol; the figure of the autistic individual serves as "a narrative marker of fascination for much cultural production," indeed, as "the ultimate enigma" of our time. He notes that like the figure of the schizophrenic in the modernist era, the person with autism is mystified, attributed with special gifts or abilities, while at the same time he or she advances what Lennard J. Davis terms "the construction of normalcy." The subject of numerous recent films and novels, the character with autism becomes a mutable feature of narrative whose multiple meanings tend to "reinforce the concerns of a nonautistic majority audience" rather than offering insight to the experience of real persons with autism.

Bradley Lewis brings the question of knowledge and narrative framing to bear on the formidable subject of depression, which, he notes, we have come to think about in a unidimensional way, that is, according to the biological narrative that offers treatment by pharmaceutical intervention. Through a revealing reading of Anton Chekhov's Ivanov, Lewis builds his case that psychiatric practitioners would benefit from becoming open to many frameworks for depression, "the many stories of biopsychiatry, psychoanalysis, cognitive therapy, interpersonal therapy, family therapy," and so forth. Reminding us that medical case histories are "'humanly constructed' accounts," Lewis contends that the question to ask with regard to these various perspectives on depression is "not simply...