The patient’s narrative & hospital medicine

Notes, Summaries & Reviews, Thesis Research

Mary Fissell, “The disappearance of the patient’s narrative and the invention of hospital medicine,” in British medicine in an age of reform, eds. Roger French and Andrew Wear (London: Routledge, 1991).

In this piece, author Mary Fissell traces the changing nature of the doctor-patient relationship in the 18th century through the narratives doctors and patients used to understand illnesses. As the century wore on, physicians’ notebooks contained fewer patient voices. Where once lay vocabulary, only slightly filtered through the doctor, had been the source for both parties’ understanding of an ailment, a new, professional language emerged and began to eclipse that of the patient. The hospital facilitated this development, changing the landscape in which the patient and doctor interacted from one where the patient retained interpretive authority to one where he or she came to be examined. In this new setting, his or her physical characteristics spoke to the authoritative doctor trained to interpret them. “The body, the disease,” Fissell argues, “became the focus of the medical gaze, not the patient’s version of illness.” (100)

The testimonial is a difficult source to include for the historian because of its proclivity for exaggeration and potential issues with its authenticity. Fissell uses testimonials to discuss patient narratives, and her strategy for mitigating these issues is, I think, both elucidative and adequately tempered. “The veracity of some of these puffs is open to question; but whether ‘genuine’ lived experience or not, these tales followed similar narrative conventions about illness.” (97) She traces the commonalities between the content of the testimonials, concluding that all used a hot/cold, wet/dry framework for understanding the cause and cure of ailments. This gave patients some command over the what would otherwise seem to be random and uncontrollable health problems they encountered.

Next time I read through a set of testimonials, I plan on looking for narrative patterns — similarities and differences between what patients and doctors understood to be the reason for the springs’ efficacy. Did this change over time, as the claims in other parts of the ads become more scientifically oriented?

Fissell also discusses the use of what I have seen termed as “heroic therapies” — “an anti-phlogistic regimen that featured bleeding, purging, blisters, and a bland diet” — in silencing the patient’s narrative. In these regimens, it was the body’s response to treatment that aided in diagnosis and the evaluation of therapeutic efficacy. A fast pulse and red complexion called for bleeding, while a “languid” one indicated that the patient was “contraindicated.” (105)

I have seen in many of the works I have read on hydrotherapy that a major reason it became so popular was due to the fact that people were becoming increasingly skeptical about and weary of allopathic therapeutics. Obviously patients were growing tired of draining (literally) and ineffective treatments; I think, after reading this, they were probably also exasperated by the lack of agency they had in their relationships with their doctors. If their bodies always spoke for them, what control did they have over their health? Add to that the evidence (and it was piling up) that these kinds of treatments were ineffectual, and you have a scientifically-informed populace that is looking for an understandable health system in which they have a voice. A big part of the hydrotherapeutic movement was its emphasis on the importance of the doctor-patient relationship, the sharing of experiences between patients, the social outings, dances, clubs… You went to resorts to heal, but it was a communicative, socially stimulating practice as well. Where an allopathic physician had little interest in communication with his patient, hydrotherapeutic regimens and resorts were constructed with the importance of communication in mind.

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