Editor’s Foreword

In 1982, Kathryn Allen Rabuzzi, first editor of Literature and Medicine, wrote that the purpose of the inaugural issue was “to explain, probe, and illustrate the nature of the strange marriage between literature and medicine.”¹ To think of a heterodisciplinary academic field as a marriage gives us a rich but troublesome analogy to work with. What follows from this odd conjugal match-up? Offspring? Discord? Institutional queering? Second honeymoons? Divorce? Certainly never the seamless merging of the two into a single entity. As new editor, I can contribute one observation to the metaphor: Literature and Medicine has just achieved its 30th anniversary, an event traditionally commemorated with the only gems that are organic excrescences, products of a biological process of accretion provoked by the presence of an irritating foreign body. When humans notice them and give them aesthetic and monetary value, reading and writing them into discursive systems, these nacreous cysts are transformed into biocultural proto-texts: pearls.

Perhaps a suitable condition for the journal’s next decade, then, might be a kind of oyster-like irritability, a productive and articulated sensitivity to whatever vexes us about health care, and about the humanities, and about connecting these two enormous fields of endeavor. The most obvious nuisance to begin with: what does “literature and medicine” mean, and to whom? What does the journal’s title include, or leave out—and what sort of conjunction does that “and” really embody? It doesn’t matter that we will never reach a single definitive answer, but we should keep being irritated by the imprecision of the best terms we have, worrying away at the things complacency about our language can blind us to.

The journal’s next issue is planned to open up some discussion about the meaning of “medicine” in the context of other terms, like “health care,” so I will focus here on the fuzzy set denoted by our first word. Some things, like a Shakespeare sonnet or an Austen novel, are obviously literary, but decades of academic canon-busting have expanded the inclusion criteria in all directions. In 1973, New Literary History published a special issue on the question “What is Literature?” In it, the formalist critic Tzvetan Todorov described literature as an “autotelic” linguistic system.² Literally an end in itself, autotelic language is opaque rather than transparent, functioning not to point the reader through itself to external real world referents but rather to draw attention to its own linguistic forms and structures. Such texts, for Todorov, demand to be read not for the information they contain about the world but as cultural artifacts. Todorov calls the study of a literary system a “new science of poetics,” a study of the rules by which a text is made (and made to work).

But very few written texts concern just their own forms, and those forms themselves are determined by, and influence, the historical and sociocultural contexts in which they were constructed. We expect what we read to tell us about the world. We expect a Shakespeare sonnet, for all its astonishing technical perfection, also to make us think about our own experience of summer days, or the loss of love, or to wonder about the man who wrote the poem and what the “thee” he addressed might have looked like, or said in reply. It might make us wonder above love and gender and the weather in early modern England, and about the history of publishing and literacy and bookselling that enable us to read it, now. The thing is: language is all we have to enable us to think about the world.

And this, conversely, means that form and medium are never insignificant. Even the most referential text is made according to formal rules. We can ask of a medical journal article not only what conclusions it draws about the clinical treatment of (for example) patients who feel no hope, but also about how the form of its discourse (its abstract, its description of method, the naming of its authors, the qualifications that hedge its conclusions) makes us read it in a particular way, extracting from it certain perspectives on, say, methods...