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  • Editor’s Column *
  • Suzanne Poirier (bio)

Whether it is William Carlos Williams describing a man in a stained t-shirt executing a perfect ballet leap for the poet’s wheelchair-bound grandmother or Michael Crichton collaborating with the producers of a television series about an inner-city Emergency Room, the worlds of illness and health care have continuously invited readers and writers, listeners and tellers. This is not new. Literature and Medicine exists because of a desire not only to celebrate this wealth of stories but also to explore why pairing literature and medicine has consequences far beyond celebration. This issue of Literature and Medicine resembles other general issues in the rich breadth of its contents, but the whole is larger than the proverbial sum of its parts. The authors whose articles appear in the following pages all address the storied nature of health care and the unique position of the physician as storyteller. Taken together, these five studies argue forcefully for physicians to acknowledge their personal, subjective presence in their relationships with their patients.

Analyses of medical writing about Munchausen syndrome, James Joyce’s depiction of alcoholism in Dubliners, and Hervé Guibert’s autobiographical novel about his evolving relationship with his physician expose the tension in the physician-patient relationship when the physician stands apart. Arthur Kleinman’s reminiscence of himself as a green medical student who opens himself to the immensity of a burned girl’s pain and Anton Chekhov’s short story about a young Russian physician who comes to feel compassion for an unhappy woman whose malaise he cannot cure demonstrate the need for practitioners to recognize themselves as active, fallible—human—participants in their patients’ illnesses.

Chris Amirault begins his article, “Pseudologica Fantastica and Other Tall Tales: The Contagious Literature of Munchausen Syndrome,” appropriately enough, with a story. As we enter the chaotic world of [End Page vii] the Indiana Cyclone, Amirault demonstrates the fascination and frustration that patients with Munchausen syndrome evoke in health professionals. Frustration has historically manifested itself in the medical and psychiatric discussions of the symptoms and etiology of the syndrome, which have often been infused with a sense of moral outrage toward these deceptive patients. Today, the syndrome’s fanciful, literary name has disappeared from the Diagnostic and Statistical Manuals, replaced by one more scientific and abstract, but the condition still appeals to physicians’ imaginations in a distinctly concrete, narrative way. Amirault traces a legacy of medical “tall tales” that rival those of some of the patients they describe, an accumulation of diagnostic fancy that ultimately exposes the subjective ground upon which much of the supposedly objective medical enterprise stands.

Jean Kane’s analysis in “Imperial Pathologies: Medical Discourse and Drink in Dubliners’ ‘Grace’” begins by noting how James Joyce adopts language emerging in the late 1800s that attempted to cast alcoholism in medical terms. This language was supposedly an advance in compassionate regard for the drinker who was becoming a growing target for reformers, but, like the accusatory undertones of the discourse surrounding many discussions of Munchausen syndrome, attitudes toward alcoholism still often fell prey to moral judgment. The somatic and the moral have persistently defied separation, perhaps because both habitual drinking and the assaults that Munchausen patients make upon their bodies are often harmful to the subjects, disruptive to the lives of people around them, and not responsive to quick medical intervention. Where alcoholism has been regarded as, simultaneously, a cause and a symptom of vice, drinking in Dubliners becomes both a cause and result of Ireland’s colonization by the British. By making alcoholism a vehicle for symbolizing what Joyce called Ireland’s moral paralysis, he not only imbues his medical language and posture with this moral weight but also casts himself in the role of aloof practitioner. When he positions himself as Ireland’s diagnostician, however, Joyce attempts to separate himself from the inescapable paradoxes of alcoholism. As a result, he cannot cure his patient.

It is this very distance, this medical gaze that is too often blind to its own limitations, that Harold Schweizer examines in “To Give Suffering a Language.” Schweizer begins with Arthur Kleinman’s admonition, in The Illness Narratives, not to rush...

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