Idioms of Distress: Psychosomatic Disorders in Medical and Imaginative Literature (review)

In this book a distinguished comparatist explores psychosomatic illness through the humanistic lens of literature. Lilian Furst has written extensively on the relations of medicine and literature, with a particular interest in psychiatry and psychotherapy. Her motives for exploring the pathogenic aspects of the mind/body relationship in literature are both critical and reformist. She wants to illuminate the ways that psychosomatic processes have been used by writers to deepen and complicate character development and narrative in their work, but she also wants her analysis to act as a corrective to a modern medical reductionism that is relentlessly excluding the "psycho" from psychosomatic, locating the sources of illness in organs and cells rather than in the relational context in which illness takes shape. It is Furst's belief that a holistic account of the mind/body relationship has been irresistible to generations of writers from varied stylistic and national traditions, not simply as a metaphorical adornment in their work, but as an inescapable aspect of their observations of the lived experience.

In the first part of her book, Furst presents a brief historical account of the historical evolution of psychosomatic illnesses through successive phases in the history of medicine. She asserts, on good authority, that from the Greek Hippocratic tradition until the last quartile of the nineteenth century, medical discourse acknowledged the continuum of mind and body in the genesis and treatment of illness. Doctors believed that states of mind, influenced by the physical or the social environment, were capable of worsening or ameliorating disease and were themselves susceptible to changes in the fragile equilibria of the body's humours. By the twentieth century, despite the great prestige of Freudian psychotherapy, which acknowledged "hysterical" symptomatology, scientific medicine was busy locating the organs and cells of the body that harbored disease and the microscopic germs that infected them, thereby fragmenting the body and excluding the mind from the causal pathway of disease syndromes. The "mysterious leap" from mind to body and back again became, in the successive modern editions of the Diagnostic and Statistical Manual of the American Psychiatric Association, various "somatoform" illnesses traceable to organic pathologies. Furst identifies various modern medical authorities like George L. Engel and Zbigniew Lipowski who have resisted this reductionist trend and summarizes their views, together with those of a rump of Freudian analysts unwilling to abandon holistic analysis.

She then lays out her case for considering literary treatments of psychosomatic symptoms and disorders as correctives to the modern bio-medical perspective. Rather than isolate the causes of mental or functional pathologies in organs, Furst suggests that literary treatments of these conditions permit us to see them develop in the broadest possible social and psychological setting, where the ideals, expectations, and judgments of society burden individuals with disciplines that are unbearably harsh but so exigent that resistance to them takes unconscious bodily form. Where words and arguments fail, the body speaks its suffering symptomatically. This strategy undergirds her humanistic approach to psychosomatic illness; it is, at the same time, a rear-guard defense of the "talking cure" of psychotherapy and a rather convincing critical tool for a diverse set of texts.

In successive chapters, Furst briefly sketches out the medical and literary background and then presents her analysis of the text at hand. Nathaniel Hawthorne's The Scarlet Letter, with its "strange sympathy betwixt Soul and Body" allows her to explain the decline of the Reverend Dimmesdale, the vengefulness of Roger Chillingworth, and the equanimity of Hester Prynne, each in their respective fashions, as victims of psychosomatic adjustment to the restrictive conditions of Puritan society. In Emile Zola's Térèse Raquin, Furst details the psycho-physiological decline of the novel's murderous couple according to a psychosomatic model that Zola's own rigorously bio-hereditarian model does not permit, but to which he had resort in this case in order to make sense of the events he wished to describe. In Thomas Mann's...