Medical Storyworlds: Health, Illness, and Bodies in Russian and European Literature at the Turn of the Twentieth Century

Abstract

Max DeBryn, the pathologist on the British TV series Endeavour, utters the same words almost every time he arrives at a crime scene and observes the deceased: “Shall we say two o’clock?” DeBryn is the personification of the clinician who insists on the proper conditions—in Elena Fratto’s words, to “examine the body with an acute gaze and steady hands” (15). His refusal to render judgment before meticulous scrutiny has made him a beloved figure, one we hope those medical professionals with whom we interact in our own lives will emulate. It is with those same qualities—a thorough, careful, analytic approach—that Fratto trains her lens on the narratives, and the medical issues and discourses, that she treats in this volume.Medical Storyworlds considers the narration of bodily experiences and of the intellectual, psychological, and ethical responses to medical care. Fratto’s elegant yet methodical prose treats medicine as a set of “procedures and protocols” (9) that can be illuminated through literary means. In particular, she looks to literature to help us understand the medical establishment, its relationship to authority and power, and our own place within health care systems. Fratto contends that medical practice itself can be seen as emplotment, with both patient and doctor creating a narrative, a story, about the course of an illness and its likely progression and endpoint. Writers who take up medical issues as their material build similar narratives and document the medical fears, frustrations, and aspirations of their own era.As an exploration of both health and illness and of the representation of bodies, Fratto’s volume relies on vocabulary from narratology as well as from the medical humanities. But it speaks primarily to students and scholars of literature and to the general lover of literature, addressing common bodily experiences and the stories modern authors across Russia and Europe have told about them. To date, the field of the medical humanities sits uncomfortably between comparative literature and medical education, although faculty like Fratto strive to bridge that gap in the classroom and in their scholarship. In this book Fratto—perhaps taking a page from DeBryn—steps back from her texts, achieving a detached empathy that will tell us more than a simple diagnosis might and attempting to demonstrate the usefulness of the medical humanities for both medicine and literature.Fratto argues that storytelling itself is an “act of attaining agency” (4). She looks at both literary works—plays, stories, novels, poems—and the discourse of public health campaigns to explore how literary and real-life plots related to health and illness are intertwined. Fratto uses concepts from literary criticism, like the formalist terms defamiliarization and outsideness, to show that “literary aesthetics and the field of medicine can observe and illuminate one another” (10). Her first chapter treats death as a plot point that necessarily reorders the sequence of events that preceded it while also changing the future. Death’s “plot-building power over the past and the future,” Fratto notes, is belied in modern medical practice, where death can be delayed seemingly indefinitely (17). Drawing on the so-called clinical-pathological conference, a genre devoted to a “case report” that has its own rubric in the New England Journal of Medicine, Fratto describes the process of emplotment in real life as experts and students debate the reasons for an illness and come up with the patient’s definitive diagnosis postmortem. From here the chapter looks to Cesar Lombroso and his obsession with data and classification of the ill, to Dostoyevsky (a favorite of Lombroso’s), to the fiction of Tolstoy, who met Lombroso but did not take him seriously, instead lampooning him in his final novel, Resurrection.In the second chapter Fratto moves from the point of view of the author or physician—he (usually) who creates narrative, tells the story, emplots death and its foregoing signs—to that of the reader or patient. Here she concentrates on Tolstoy’s Death of Ivan Ilych and Anna Karenina. Fratto compares Anna’s becoming “enslaved” to a plot with an unfortunate ending to the experiences of women who discover that they have the BRCA gene and face a decision: to take proactive and disfiguring steps to prevent a bad outcome or to wait and see whether they will develop cancer. Masha Gessen, a Russian American journalist and writer who documented her own journey with the BRCA gene, becomes Fratto’s heroine for the real-life medical counterpart of Tolstoy’s unhappy characters. Chapter 3 jumps to 1923 to consider a French play, Jules Romains’s Knock, ou le triomphe de la médecine, and its Russian translation, and deploys it in parallel to discussions of Soviet campaigns of “sanitary enlightenment” (sanprosvet; 143). Romains’s idea of the “medical age”—when everyone is a patient and illness waits to be discovered in everyone—resonates powerfully and unexpectedly in our contemporary postpandemic moment. The final chapter of Fratto’s book is devoted to the endocrine system and hormones. In fiction by Italo Svevo and Mikhail Bulgakov, Fratto explores the fascination writers have with the internal functions of the body—and with the possibility of interfering with and manipulating those functions through drug development or transplants. These medical experiments, narrated by fictional doctors who record ongoing processes and results, express the late nineteenth- and early twentieth-century obsession in Russia and elsewhere with concepts of degeneration and rejuvenation. Fratto asserts that “the body in the early twentieth century became exposed to more sensory stimuli than ever before because of technology, warfare, and a faster-paced routine,” and thus “bodily functions and bodily rhythms . . . played a leading role in how stories were told” (187).Overall, Fratto’s book highlights the connections between human agency and storytelling, reminding us that the body is a stage on which meaning is made. Returning to the early part of the twentieth century helps us comprehend just how enmeshed medical discourse is in our understanding not only of our bodies but of our place in the environment, and of our relationship to the public, be that state authorities, their medical representatives, or our fellow “patients.” As Chekhov scholars Michael C. Finke and Julie de Sherbinin (2007: 14) wrote fifteen years ago, literature functions for physicians as a “comfortable venue for discussing moral and philosophical problems that are often better kept at arm’s length during actual practice.” Delineating two aspects of medical humanities—what “literary scholars and historians see themselves as doing . . . and what such intellectual activity means to physicians”—Finke and de Sherbinin anticipated the need for a study like Medical Storyworlds that might enable a holistic perspective on what David Herman called “storying the world” (Fratto, 195). Fratto’s expansive source base, including Russian, French, and Italian texts, along with her command of the theoretical literature, gives us a new platform from which the medical humanities can continue to develop.