Literature and Medicine 20.2 (2001) 151-182
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The Writer as Doctor:
New Models of Medical Discourse in Charlotte Perkins Gilman's Later Fiction
Martha J. Cutter
When Charlotte Perkins Gilman was suffering from the postpartum depression that eventually became the impetus for "The Yellow Wall-Paper" (1892), she took extensive notes about her symptoms. 1 However, when she sent a letter describing her symptoms to the famous Victorian nerve specialist S. Weir Mitchell, he claimed it "only proved self-conceit" and promptly condemned her to the rest cure, which expressly prohibited women from reading and writing about anything, including themselves or their illness. 2 Gilman followed this prescription and, as she explains in her autobiography, "came perilously near to losing my mind. The mental agony grew so unbearable that I would sit blankly moving my head from side to side--to get out from under the pain." 3 Gilman later abandoned Mitchell's rest cure, published "The Yellow Wall-Paper," and became a successful writer and lecturer. Gilman was healed, at least partially, by becoming an active participant in the reading and writing of her own "disease."
Several of Gilman's later fictional works repeat this struggle in which a male-dominated medical establishment attempts to silence women. In fictions such as "The Vintage" (1916), The Crux (1911), and "Dr. Clair's Place" (1915), male physicians prescribe restrictive diagnostic "sentences" (or verbal/physical treatment regimens) for their female characters. 4 But in some of these works, women doctors and patients counter these restrictive diagnoses through the use of reading and writing to achieve mental and physical health. In Gilman's writing the [End Page 151] patient is not exclusively read by her physician; she also reads her own disease and participates in the formulation of her diagnosis. Moreover, in creating texts about physical and mental illness, the writer becomes a kind of doctor, for these stories provide readers with therapeutic regimens or physical practices that lead to good health.
Gilman therefore formulates a model of medical discourse that goes beyond many of the practices of her time period. 5 In this model, medical information circulates between doctor and patient and between reader and writer, and medical authority is dispersed. Most radically, in Gilman's paradigm, diagnosis is to some degree coauthored, created by an interaction between readers/patients and authors/doctors. Doctors "read" patients--they interpret their symptoms and produce diagnoses--but patients also learn, in collaborations with their doctors and medical texts, to "read" and interpret themselves. Moreover, the processes of collaborative reading and diagnosis are meant to work within the story (intratextually) as well as outside the story (extratextually). Of course, in the world outside the story the doctor still holds a very real position of authority over diagnosis, for he or she is most empowered to treat and/or write about disease. But Gilman's fictions do illustrate a process whereby the "fictional" practices she describes can be translated to the "real" world. 6 It is language, logos itself, that allows this transformation, for once patients become active intratextual and extratextual readers--readers who learn about medical and social conditions from a variety of cultural texts--they may be able to intervene in the production and formulation of diagnoses that have disempowered them. 7 Gilman's writings therefore foreshadow contemporary medical research about the crucial role gender plays in medical diagnosis, the need for effective doctor-patient collaboration and coauthorship in the creation of a diagnosis and a treatment, and, above all, the importance of the patient's ability to articulate, and thereby take control of, his or her illness. 8
Nineteenth-Century Models of Medical Discourse
Gilman's writings about medicine constitute a very prescient critique of this field of knowledge. Sociologists and anthropologists have recently argued that medical knowledge is not simply a set of objective facts about disease, since it is influenced and even created by scientists' and doctors' moral values, social attitudes, and political prejudices. Influenced by Michel Foucault, these authors argue that [End...