Bill Long 11/08/04
Shucks Folks, I'm Speechless*
[The Cowardly Lion, in the Wizard of Oz, after receiving the gift of courage.]
In his arresting book, Lost Words: Narratives of Language and the Brain, 1825-1926, L.S. Jacyna applies postmodern literary theory to the world of medical case reports on patient loss of speech in order to limn the way that narrative (the stories of the speech debility) creates a totalized explanation of the phenomenon for purposes of medical diagnosis and treatment. While I find almost all postmodern literary theory so self-consciously jargonesque as to be nearly impenetrable and useless, Jacyna's application of limited doses of the theory to the medical stories of aphasia is useful.
He demonstrates how "doctor speak" (my phrase, meaning the way that doctors write about patients) is not only one literary strategy among several that could have been used to describe illness, but that this language reflects a social environment that wanted to subject the interior and exterior world of the patient to the growing demands of the huge master, science. I think that this then is the major contribution of postmodern literary criticism: to show that speech ("narrativity") reflects one choice among many and that the speech choice is informed/dominated by a larger theory of who or what the narrative is suppose to serve.
Medical Case Studies
Clinical case studies are the most basic elements, the fundaments if you will, of knowledge on which the striking and dominating edifice of modern medical science is built. Thus, if you really want to be a rebel in the medical community, it seems to me, you would suggest another literary strategy to deal with patients. And, I think we may be ready for such a strategy. Those who know doctors know that most of their time is not spent in the lab or the operating room. Most of their time is spent talking with patients, providing understanding, comfort or insight into perceived symptoms. That is, skilled and thoughtful medical professionals know that their primarily utility is in their words and not their hands.
Let's stop there. If words are the primary way that doctors help the world, that actually heal the world, then close attention ought to be devoted to the way those words are shaped. Are they words of violence? Of such technical specificity that no one really can understand them? Are words used by the medical profession something that they just hide behind because they are too lazy or too self-absorbed to enter into the terribly frightening realities of the sick person? Or, are their words healing words, non-inflammatory words, words that build and repair just as the tissue is building and repairing (one hopes) of the patient?
Two Approaches to the Words of Medicine
In chapter 1 of his book, Jacyna contrasts the narratives of aphasia/alalia of two of the earliest French writers on the phenomenon in the mid-nineteenth century: Jacques Lordat and Jean-Baptiste Bouillaud. Their narratives reflect different social and philosophical realities. Lordat was a professor of anatomy and physiology at a regional university (Montepellier) while Bouillaud was a clinician in a Parisian hospital. The former presented himself as a defender of a long medical tradition that stressed the need to acknowledge the "plurality of human nature." Man was a combination of spiritual, vital and material components and medical reports should so recognize that variety.
Lordat's epistemological starting point was contrary to that of Bouillaud and the Paris organicists. Bouillaud looked forward to "the happy time when medicine will, like chemistry, possess a fixed and uniform language." Contributions to the sum of medical knowledge rather than attempts to understand the intersection of plural forces within the human was the aim. In this approach to medical case reports, analytic and diagnostic categories that lead to universal truths transcending any particular patient was the desideratum.
Of course we know which side "won." What is interesting in Jacyna's account, however, is the gradual way that the patient's (as well as doctor's) voice was suppressed as the service to the cause of science increased. Rigid attempts to eliminate the plurality of narrative voices, along with a focus on narrating facts in particluar forms which fit preordained categories, became the way of modern science. But who isn't touched with the following "case study" by an English physician from 1820 in treating a person severely wounded by a musket-ball at Waterloo?
"He (the patient) grasped my hand with great fervor, looked piteously into my face, and, to my inquiries as to his feelings, he uttered the monosyllable, "THER," to which in the course of the day, he added "O."
The physican soon determined that the man was trying, unsuccessfully, to say "MOTHER." The narrative continues, with the physician now speaking:
"I printed in large characters on a sheet of paper the following words, "SHALL I WRITE TO YOUR MOTHER?" that being the wish which it appeared to me he so long and ardently had labored to utter. It is impossible to describe the illumination of his countenance on reading these talismanic words; he grasped and pressed my hand with warmth, burst into tears, and gave every demonstration of having obtained the boon which he had endeavored to solicit."
Let me just ask you. Don't you think we are ready for the latter type of medical case report?
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