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SEVEN THE PATHOLOGICAL PERSPECTIVE C L I N I C A L R E A L I S M'S D E C L I N E A N D T H E E M E R G E N C E O F M O D E R N I S T C O U N T E R-D I S C O U R S E A S THE EMERGENCE of pararealistic genres like naturalism and detective fiction indicates, the tensions within pathological realism, already evident in Middlemarch, do not abate but intensify as the century draws to a close, ultimately imperiling the enterprise of realism as such. Early on, Edmond Duranty, writing in the magazine Réalisme, had defined that enterprise’s object as “the frank and complete expression of individualities, . . . the exact, complete, sincere reproduction of the social milieu and the epoch in which one lives.”1 Duranty’s terms have become standard ones for understanding realism, as well as for understanding the crisis of reproduction or representation that realism suffers. But if one looks a bit more closely at the textual basis for these terms, both realism and its crisis take on aquitedifferentcast.ForBalzac,Flaubert,andEliot,thetermscomprehension , concrete, individual, and sincere bear connotations that can be describedwithoutexaggerationasmedical.Comprehendingsocialtotality , in the realistic novel, means defining that totality not only as a milieu(withthebiologicalovertonesthatwordimplies),butasapathological milieu. Capturing the concrete realistically means maintaining faith that details will prove to be “both particular and typical”2 in thesame waythat medical diagnosisassumes thatsigns and symptoms will resolve into cases of disease. The individual, in turn, is defined in realistic fiction as a pathologically embodied person whose limits and potentialities stem from the limits and potentialities—death and growth—imposed by organic finitude. Finally, realism’s sincerity is analogous to the disinterested benevolence claimed by the medical profession. For medicine to function effectively as a sort of master code or discursive template for the realistic novelist, however, its truthfulness as a science and its ethical attractiveness must be affirmable. As Eliot’s work shows, however, sustaining the first of these conditions—medi- T HE PA THO LO GICAL PERSPECTIVE 149 cine’s truth-value—becomes more and more problematic as new sciences arise that offer truths seemingly irreconcilable with those of illness and death. Cell theory threatens to replace the medical vision of life’s concrete basis as organizable tissue with a much more chaotic vision of what Eliot describes as “involuntary palpitating life”; embryologyandevolutionarytheory ,inturn,challengetheclinicalvisionof individual development as bound to the finitude of organic embodiment and of death, proposing instead to see development as essentially open-ended, unpredictable, atelic. And as Zola’s and Conan Doyle’s work shows, medicine itself becomes more experimental and specialized, deterministic and logically absolute in a manner that is foreign, even condescending, to clinical medicine. The second of the conditions for clinical medicine’s hegemony as thegroundingdiscourseforrealism—theethicalauthorityascribedto medicineas a vocation—becomes equally problematic as the century draws to a close. From the time of Balzac to that of Eliot, it is possible toregardthemedicalmanastheepitomeofaprofessionalclasswhose interests are progressive. As a figure whose labor seems neither reifiednorexploitative ,andasonewhohassucceededduringthisperiod in establishing his work at a distance from the havoc of the marketplace , the physician of this era seems to point the way toward a professional utopia, a place where knowledge and power might be united and turned to beneficent social action. Professionals in general, and doctors in particular, do in fact vigorously participate in many of the reformist and even revolutionary political activities of the first twothirds of the century, taking on their identity as a class in apparent opposition to the bourgeoisie and to laissez-faire capitalism.3 With what M. S. Larson has described as “the consolidation of professionalism ” toward the end of the century, however, it becomes increasingly clear that despite their differences, the professional class and the bourgeoisiearenotradicalantagonists.4 Capitalismmanagestoco-opt professionalism without much difficulty. Indeed, in a strange twist, thephysician,whostoodforanalternativetomarketplaceindividualism in the earlier period of unbridled free enterprise capitalism, now cantakeonalmosttheoppositerole,standingastheepitomeofliberal individualisminaneraofemergingcorporateandinternationalcapitalism . From being a focus of protest against the bourgeoisie, the professional —andspecifically,themedicalman—istransformed,bothin himself and in the public imagination, into the ideal bourgeois, the cultured yet self-made man par excellence. This double shift in the status of medicine—from an authoritative science to an auxiliary one, and from a progressive to a subordinate social praxis—has important cultural ramifications, including a new 150 SEVEN wave of antagonism against medicine and medical professionals. George...


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