Reconstructing Illness: Studies in Pathography (review)

248 BOOK REVIEWS eaters in Uterature, some of them suggesting that the resulting insights will prove helpful in understanding disorderly eaters in real Ufe. The question remains, however, whether this coUection of fascinating Uterary criticism might be actually useful to the health-care professionals who treat anorexia, buUmia, obesity, and so on. To the degree that some of these professionals beUeve that certain biochemical conditions may predispose people to certain eating disorders (e.g., anorexia and bulimia), they may reject a purely social interpretation of these disorders. Nevertheless , because the line between the medical and nonmedical components of eating disorders is permeable, health-care professionals would do well to ask themselves how much a particular patient's problems with food are exacerbated by social conditions. Paul Medeiros suggests that Uterary criticism of eating disorders is "suspect" and "parasitical" because it offers no cure for them and feeds off them in "an expropriation of tragic reality" for the purposes of Uterary criticism (p. 11). Although Uterary exploration of human suffering is not parasitical, but a way of dealing with that suffering, such explorations may indeed be suspect if they take themselves too seriously. Disorderly Eaters is an excellent introduction to the empowering aspects of disorderly eating, but it does not deal with the fact that many disorderly eaters are ultimately disempowered. Fully aware of what they are doing and even why, some of them continue to eat or starve themselves toward death. Although it may be valid to use fiction to explore the nonmedical aspects of eating disorders, it may be quite problematic. Unfortunately, Mrs. Piggle-Wiggle has no cure for these real men and women. —Rosemarie Tong Davidson College Anne Hunsaker Hawkins, Reconstructing Illness: Studies in Pathography. West Lafayette, Ind.: Purdue University Press, 1993. xiv + 217 pp. Clothbound , $28.00; paperback, $14.75. Reconstructing Illness is the culmination of a series of articles that Anne Hunsaker Hawkins has written over the past decade about pathographies . She adapts this term from Freud's original usage to refer to "an autobiographical or biographical narrative about an experience of illness" (p. 178). By providing the first full-length study of pathographies, Book Reviews 249 Hawkins gives these books the status they deserve as a major resource for clinical teaching and reflection. "Pathography," Hawkins says, "restores the person ignored or canceled out in the medical enterprise, and it places that person at the very center. Moreover, it gives that ill person a voice" (p. 12). Hawkins presents pathographies as complementary to the medical history of the patient. While the medical chart concerns illness as "a particular biomedical condition," the pathography describes how an experience was understood (p. 12). In place of the chart's "present symptoms and body chemistry," the pathography situates iUness in the author's Ufe and reflects on "the meaning of that life" (p. 13). Against the impersonal "objectivity" of the chart, pathographies are authored by particular persons who are directly affected by the events they relate. If pathographies dramatize these events, as Hawkins admits they do, that is an expected "corrective to the stark, depersonalized account of tests and procedures written up by medical personnel" (p. 13). As Hawkins elegantly summarizes the difference of interests, "Case report and pathography function as mirrors set at an obUque angle to experience : each one distorts, each one tells the truth" (p. 13). Truth is a perilous ideal in both the experience of illness and autobiography . To describe the kind of truth pathographies offer, Hawkins uses Robert Lifton's concept of formulation. Lifton sought a concept to describe how survivors of Hiroshima reestabUshed a connection between themselves and others, regained a sense of meaning in their Uves, and reaffirmed a capacity for change. Formulation, as Hawkins uses the term, "involves the discovery of patterns in experience, the imposition of order, [and] the creation of meaning—all with the purpose of mastering a traumatic experience and thereby re-estabUshing a sense of connectedness with objective reaUty and with other people" (p. 24). The idea of imposing order on chaotic trauma is particularly important to Hawkins's notion of what a pathography does for its author. Hawkins correctly places pathographies as second-order formulations of illness...