Allegory as Historical and Theoretical Model of Scientific Medicine: Sex and the Making of the Modern Body in Phineas Fletcher's The Purple Island

My recent schedule had me going directly from teaching seventeenth-century British women's writings to Office of Medical Education meetings. The change in physical surroundings as I walked through new, technology-rich spaces adorned with portraits and plaques mirrored my sense of intellectual whiplash and at times seemed to symbolize how little impact I or medical humanities can have on the imposing structure of medicine. I have felt this way more lately, as many of our meetings have centered on the profound resistance and resentment of the first-year medical students for the new medical humanities program, despite the students' stated agreement with the program's goals. While this reaction is not unexpected for any number of reasons familiar to most readers, students' recurrent claim that they "can't see the connection" to what they're "being asked to do" has baffled our group because the myriad connections to medical education and practice have been painstakingly and consistently presented to them.¹ One day a literature student argued that the way an author defended her writing in a prefatory letter didn't matter; when I replied that the details of a text always matter because they convey meaning, I realized that the same insight applied to the medical students' statements. If their claims are analyzed as cultural texts—instead of personal communication to be interpreted in terms of accuracy, intention, comprehension, and motivation—they speak to the tension between a few hours of medical humanities and the amount of time devoted to basic sciences, even in a patient-centered curriculum. The curricular structure quite literally prevents medical students from being able to "see the connection" because they are "being asked" to pass their exams and Step 1 of the Medical Licensure Exam. This perspective not only refocuses the discussion of the value of humanities in medical education but further highlights potential, implicit contributions of the conceptual structure of medical humanities to the medical students' response.

The impact of literary approaches and theory has centered on the "human" elements of medicine, such as experience, communication, and decision making, more than on the "facts" of bodily structure, function, and disease processes. Analyzing case histories and illness narratives as stories may leave the underlying "basic" science untouched, in particular, because it seems to precede the plot. The parallel between the therapeutic tale and the medical education narrative, which similarly moves from generic, science-heavy "normal" to increasingly clinical "pathological," reinforces the objective given-ness of "the" healthy body. If medical students accept the value of medical humanities in patient interaction and ethical professionalism, then this very acceptance may hinder their "seeing" its significance for the rest of medicine, the apparently non-narrative facts that dominate textbooks, lectures, lab tests, and exams. One response to this hindrance might be for educators to emphasize the narrative aspects of scientific knowledge by teaching its uncertainty to medical students as if they were science graduate students. Setting aside the debatable practicality and clinical utility of this approach, it would focus on the author of scientific discovery in place of the speaker of the clinical story. In other words, the doctor (scientific or medical) would become the protagonist of a potentially hagiographic narrative, supplanting the author-ity of the patient, which is often not well suited to modeling scientific knowledge.

This article will explore the usefulness of allegory as a way out of this impasse. Like metaphor, allegory uses something known to the reader, and often more concrete, to represent another thing less well known, and often more abstract, in order to increase understanding and insight. Allegory, from the Greek allos or "other," extends metaphoric comparison into a systematic structure encompassing the entire work such that all of its elements—characters, settings, events, etc.—stand for something else. Book 2 of Edmund Spenser's epic allegorical poem The Faerie Queene (1596), for example, represents the humoral body in its detailed description of the Castle of Alma: its porter embodies the tongue; its kitchen portrays...