In lieu of an abstract, here is a brief excerpt of the content:

CHAPTER ELEVEN Outing the Distress Hasn’t she gone off her head? I don’t mean metaphorically , I mean in the strict medical sense —Dostoevsky, The Idiot The essence of psychosomatic disorders lies in the outing of an unacknowledged psychological distress through the body. What forms does this outing take in the body of literature about such disorders? Specifically, how do the medical and the imaginative writing relate to each other? In what ways does the “metaphoricity” of the literary works modify and augment “the strict medical sense”?1 I would like to argue that the two types of writing complement and supplement each other. The long-standing Psychiatry and Literature reading group at the University of North Carolina at Chapel Hill, for example, is based on the belief that the discussion of literary works is useful to psychiatrists. In drawing comparisons between the two modes of writing about psychosomatic disorders, one fundamental caveat has to be made. Both medical and imaginative writing on this topic are subject to wide variations. Medical thinking has shifted radically in the past 150 years in a complex, nonlinear course. The range of the creative literature is equally great. Yet each type of writing forms an entity with quite distinctive characteristics that legitimate a broadly based comparison. The medical writings are governed by a necessarily practical purpose: that of identifying the signs of diverse syndromes as a preliminary to initiating the appropriate remediation. The implicit belief systems over the past century and a half or so span far-reaching transformations: from humoral medicine through Mesmeric and Freudian approaches to behavioristic, psychopharmacological, and neuroimmunological methods. However, the overarching thrust remains constant: to establish, according to the ideas of each time, the universally valid paradigms thought to underlie the overt symptoms. Within the parameters of each school—humoral, Mesmerian, 191 Freudian, behavioristic, psychopharmacological, neuroimmunological— the fundamental aim is the same: to grasp the particular nature of patients’ problems, to define and demarcate them in order to choose the optimal means to cure or palliate them. In this succession of epistemologies, the imaginative literature meshes directly with the beliefs dominant at each period. Roger Chillingworth in The Scarlet Letter, whose action takes place in the mid-seventeeth century, subscribes to the tenets of humoral medicine in his acceptance of the “strange sympathy betwixt soul and body.” In the mid-nineteenth century, when somatic medicine was decisively in the ascendant, Dr. Grabow, the experienced physician in Buddenbrooks, is shown to be totally at a loss how to deal with Christian’s bewildering series of complaints. The Strange Case of Mademoiselle P., set in 1777, endorses on the surface Mesmer’s magnetism, letting it overlap with the unmistakable Freudian undercurrent. Freud’s insights buttress the approach to post-traumatic stress disorder during World War I in Regeneration by Dr. Rivers, who was, like Freud himself, both a neurologist and a psychiatrist. By the late 1930s, in Broken Glass, the role of intuitively wise counselor has been assumed by the shrewd family doctor. So each of these literary works depicts the normative mode of handling a psychosomatic disorder at the historical moment of its action. Granted that Mesmer is conflated with Freud in The Strange Case of Mademoiselle P., and that Dr. Rivers in Regeneration is a pioneer, the congruence between the medical epistemology of each period and the practices incorporated into the literary portrayals is still quite extensive and persuasive. But the literary works diverge from the development of medical writing in their continuing portrayal of essentially humanistic approaches, as exemplified by Dr. Hyman in Broken Glass and Dr. Rivers in Regeneration. Their empathetic stance toward their patients and their colorful repartee contrasts with the markedly flat and repetitive language of DSM-IV. Its purpose is to assure maximum standardization so as to facilitate that collation of symptom clusters crucial to differential diagnosis. The diagnostician projected by DSM-IV seeks to maintain as detached and dispassionate a gaze as possible in the task of assessing the patient, although some degree of subjective impression is inevitable in psychiatric evaluation. However, DSM-IV seems to imply that such input is undesirable by advocating strict adherence to severely delimited lists of criteria. The emphasis is more on patients’ behavior than on their emotions. Their relationship to their environment , a factor so central to Engel’s biopsychosocial model, is relatively little heeded. The cost of the scientific precision of DSM-IV is a reification of the patient into an amalgam of symptoms that...

Share