The Neurological Patient in History ed. by L. Stephen Jacyna and Stephen T. Casper (review)

The editors are insistent: this is a collection of essays with a unifying theme, and this theme is the patient and only secondly neurology. To this end, the book is divided into five parts, each containing a pair of papers and each written from a new perspective, like a novel telling the same story but using the voices of different actors. This result demonstrates that there is no one subject—not neurology as an institution, not disease or illness, not neuroscience, not advocacy groups, but also not the patient. History encompasses all of these, and which come into focus depends on the historian’s purpose. Thus, in brief comments about the collection as a whole, Roger Cooter, surely rightly, points out that the perspective of each paper can be understood only by knowledge of each historian’s context. The strength of this collection lies, I think, in the range of ways in which authors distance themselves from the plot of medical advancement in order to recount other narratives—of the patient, yes, but also of the caregiver, the court, the pressure group, the disease entity and, we must add, of the historian as performer. As the editors stress in their introduction, there is no transhistorical patient as a subject, no constant of an ahistorical body, and “the patient” has as much a historical character as “the doctor.”

The introduction clearly discusses the history of the medical historian’s concern with the patient. As the following chapters, relying on standard medical sources, show, this concern by no means has a self-evident subject. The introduction also raises another open-ended issue: some authors want to assert that the neurological patient, more than or differently from other patients, reveals something about being human, “the philosophical status of man” (p. 38). But while there clearly are cases where neurological illness appears to touch metaphysics or the noumenal, on the evidence of these papers it is not clear why, in principle, the neurological patient, compared with other patients, should be seen as the source of qualitatively different insights.

The chapters in part I, on neurological diagnosis and the use of epileptic patients as experimental subjects, explicitly discuss medical perspectives. In a chapter by Stephen Casper the material source is British medical textbooks; in the second, by Ellen Dwyer, it is the published records of work at the Northwestern University Medical School in Illinois using indigent patients to search for causes of epilepsy in ways which, for the observer now, create ethics, rather than patients, as the subject. The researchers themselves seem to have had a remarkably untroubled view of their subject as science. The next pair of papers are linked as “public” and “private” constructions of the patient. Marjorie Perlman Lorch uses medico-legal textbooks to discuss the questions about probate raised by the new accounts of aphasia in the second half of the nineteenth century. Katrina Gatley’s chapter is about the caregiver, in this instance the artist Gwen Raverat, who cared for her husband, Jacques, who suffered for many years and died from multiple sclerosis. It carefully delineates an empowered woman’s relations with medicine. Only in part III might it be said we get to the patient as a voice, though even here, in Jesse F. Ballenger’s chapter on Alzheimer’s disease and Howard I. Kushner’s on Tourette’s syndrome, it is the multiple voices of advocacy groups, to a considerable extent mediated by the medical gaze, that we hear. But we can see how the increasingly heard voices of patients have begun to change the public meaning of the diseases, and, in the case of Alzheimer’s, of old age. In part IV, explicitly, “The Patient Constructs the ‘Neurological Patient.’” Stephen Jacyna’s chapter finds the direct voice of a patient, albeit a most unusual one, the...