Summary:

Open Wound is a novel crafted from the extensive documents of an unsettling, little-known, yet remarkable episode in the history of medicine.

In the summer of 1822, Dr. William Beaumont was practicing medicine at a rugged military outpost on Mackinac Island in Lake Huron, part of the Michigan territory.  His assignment as Assistant Surgeon, US Army represented about the best circumstances he could expect from his training as a medical apprentice without a university education.  In addition to soldiers and officers, Beaumont sometimes attended patients from the American Fur Company, whose warehouses shared the island's harbor.  On June 6, an accidentally discharged gunshot cratered the abdomen of an indentured, French-speaking Canadian trapper.  Fortunately for him, Beaumont served during the War of 1812 and knew how to care for devastating wounds.   With the surgeon's medical attention and willingness to house and feed the hapless trapper, Alexis St. Martin's body unexpectedly survived the assault.  But his wound didn't fully heal.  As a result, it left an opening in his flesh and ribs that allowed access to his damaged stomach.  Through the fistula, Beaumont dangled bits of food, collected "gastric liquor," and made unprecedented observations about the process of digestion.  

His clever and meticulously documented experiments, conducted on the captive St. Martin over several years, corrected prevailing assumptions about digestion.  Once thought to depend on grinding and putrification, normal digestion, Beaumont observed, was a healthy chemical process.  Any signs of putrification or fermentation indicated pathology.  In 1833 Beaumont published his thesis on the chemistry of digestion in Experiments and Observations of the Gastric Juice and the Physiology of Digestion.  Shortly before completing the book, he received a temporary leave from his military service to restart his research in Washington.  But to carry on his project, Beaumont had to persuade St. Martin-who entered and exited his physician-researcher's life several times before-to leave his growing family in Canada and once again become a research subject.  St. Martin does return, with pay, and briefly accepts his role.  But he also confronts Beaumont about whether the long confinement on Mackinac Island was more necessary for the patient's survival or the doctor's research agenda.  Or for the doctor's subsequently improved station in life. 

Although some of Beaumont's academically trained colleagues found fault with his methodologies, the farmer's son and frontier doctor did achieve a gratifying level of professional accomplishment and wealth.  To enjoy them, he had to set aside humiliations he experienced along the way, accept his lot after military service as an ordinary practitioner in St. Louis,  and weather an unforeseen turn near the end of life.    

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In Illness as Narrative, Ann Jurecic thoughtfully examines the unruly questions that personal accounts of illness pose to literary studies: What is the role of criticism in responding to literature about suffering?  Does the shared vulnerability of living in a body, which stories of illness intimately expose, justify empathic readings?   What is the place of skepticism in responding to stories of suffering?  Does whether or how we read illness narratives matter?  Jurecic's questions entice discussion at an interesting cultural moment.  The numbers of memoirs and essays about illness—and their inclusion in medical school and other humanities courses—multiplied from the later decades of the 20^th century to the present.   However, their increase, and their potential to encourage empathic readings, coincided with dominant literary theories that advocated vigorously skeptical, error-seeking responses to texts and their authors.  Jurecic reminds us that Paul Ricoeur called such responses "the hermeneutics of suspicion" (3). 

Jurecic's astutely researched, nuanced answers to those questions propose a corrective to the extreme skepticism of "disembodied criticism." Such criticism, she claims, dismisses testimonial writing from "a position of distance and privilege."  But her answers also affirm that intellectually "rigorous" responses to texts are central to the critical humanities (15).  To further her position, she offers attentive readings of accounts of illness by Virginia Woolf, Reynolds Price, and Jean-Dominique Bauby, as well as the theoretical writing of literary and other scholars.  For instance, Jurecic speculates that the condition of a reader's body aligns with his or her responses to texts.  In a chapter called "Theory's Aging Body," she observes that as skeptical scholarly readers age—Stephen Greenblatt, Michel Foucault, Judith Butler—they have turned their attention to "illness, vulnerability, and mortality" (93).  Jurecic also suggests that a function of criticism is to uncover the cultural conditions that memoirs and essays about illness respond to.  Living "at risk" is a recent one.  In stories of living with the risk of experiencing a particular illness in the future, potential patients create narratives of uncertainty to discover the "personal meaning of the impersonal statistics" that medical research now regularly delivers (18). 

 Jurecic also reflects on the ways theorists have understood the possibilities of representing and responding to pain in the varied approaches of philosophers Elaine Scarry, Martha Nussbaum, and Richard Rorty and of anthropologists Jean E. Jackson, Byron Good, and Veena Das.  In an exceptionally comprehensive and nuanced reading of Susan Sontag's theoretical, fictional, and journal writing about suffering, Jurecic uncovers Sontag's inconsistent, yet revelatory positions on the human capacity for responding to representations of pain.  The chapter on Sontag is enriched by Jurecic's reading of Annie Lebovitz's and David Reiff's responses to Sontag's suffering: in Lebovitz's controversial photographs of Sontag's final days (included in A Photographer's Life: 1990-2005) and Reiff's memoir about his mother's illnesses (Swimming in a Sea of Death). 

Illness as Narrative closes with examples of what Jurecic calls reparative writing and reading practices.  In the first instance, ill writers such as Jean-Dominique Bauby (The Diving Bell and the Butterfly) both recreate "a more coherent sense of themselves" and dislodge "fixed ideas and narratives" about illness (109).  In the second instance, Jurecic outlines the limits of two competing readings of Anne Fadiman's The Spirit Catches You and You Fall Down.  One assumes that readers will by nature empathically imagine those who are culturally different from themselves.  The other looks skeptically at the assumption that what medical educators call cultural competence can be acquired by reading a book.  Jurecic suggests that strategies for reading and teaching informed by Janelle S. Taylor, Eve Kosofsky Sedgwick, and Rita Felski can encourage more complex habits of response, such as Taylor's "'empathic curiosity'" (quoted 122).

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The foreground of this painting is dominated by a "pieta" type grouping. One woman hovers closely over what appears to be a dying man, while another comforts a small child. This part of the canvas is underlighted. The colors are rich earth tones. The figures are non-Caucasian.

In the background, in harsh light, is a group of identical looking starkly white men. In fact, their faces are almost skeletal. All are in suits, three are seated, with four others standing behind the seated figures. They look very much like a "tribunal."

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This is an aerial view of a comatose patient being force-fed by a funnel leading directly into her stomach. Surrounding the consultation table are six (identifiable) black-robed supreme judges gleefully pouring nutritious foods (grapes, fish, Quaker Oats, peanut butter, water and 7-Up) into her. Two tiny symbols, the scales of justice and a red-white-and-blue eagle contribute to the otherwise empty courtroom decor.

In the upper right corner, barely visible, is an open door with a "Keep Out" sign dangling from its knob, through which a doctor and nurse peer in. Four tiny red paper-doll figures holding hands, symbolizing the family, are also by this door. Hanging precariously over the patient and consultation table is an ugly, large, bare 25-watt light bulb.

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A female figure stands facing us, unclothed, her left side darker than her right, occupying the middle of the frame. She is surrounded with images from the process of human reproduction. The largest of the former is the well-formed male fetus in the frame’s lower left, which is connected by a thin umbilical cord wrapped around the figure’s right leg to a fetus in an early stage of development in the figure’s abdomen, which we see as if by x-ray.

Tear-shaped droplets of blood drip down the figure’s left leg and soak into a dark mass in the earth, where they nourish the roots of several plants. A tear rolls down each of the figure’s cheeks. Just above her to her left is a weeping crescent moon. Below it is an artist’s palette that the figure holds up with a second left arm.

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Margaret Price, a university professor with expertise in disability studies and rhetoric, alerts us to rhetorical and institutional strategies that marginalize or exclude from academic life people regarded as mentally disabled.  Her term "mental disability" subsumes an array of cognitive and psychological conditions--autism, attention deficit disorder, depression, post-traumatic stress disorder, difficulties processing spoken language or speaking in a group, among others--that are generally identified as falling outside definitions of normative cognitive or psychological functioning.  Whether a student or a teacher, manifesting such conditions can label one unfit for school.  Price asks us (1) to consider whether such conditions rightly disqualify one from academic life, (2) to question the validity of some assumed criteria for academic success, and (3) to design institutional infrastructures that accommodate neurodiversity. 

Price's analysis and her insights into forms of exclusion point to an underappreciated relationship between academia and medicine, which after all generates diagnoses of mental illness or fitness and the presumed teachability of students.  Price's book thereby engages the wider culture, which can deem the "unteachable" unfit for society.       

Probably the most startling chapter, titled "Assaults on the Ivory Tower: Representations of Madness in the Discourse of U.S. School Shootings," analyzes the rhetoric of the stories told within academia and throughout print and televised media about two campus shootings: the ones at Virginia Polytechnic and Northern Illinois Universities in 2007 and 2008.  The chapter uncovers the easy acceptance of stereotypes about mental disability and of the presumed, but unsubstantiated link between mental disability and violence that these stories insistently repeat.             

Three chapters have direct bearing on pedagogic and professional practices and assumptions.  Chapter 2 scrutinizes typical classroom practices and Chapter 3 questions criteria for professional excellence in academia, such as collegiality and productivity, from a disability perspective.  Both chapters uncover the often hidden problems that those with mental disabilities have meeting what Price views as a limited range of academic expectations and practices.  Together the chapters propose ways that academia can become more accommodating and ask what it might lose by not doing so.  In Chapter 6 Price interviews disabled independent scholars Cal Montgomery, Tynan Power, and Leah (Phinnia) Merridith.  Questioning the "rhetoric of ‘choice'" that infuses discussions of the institutionally unaffiliated or marginally affiliated, Price asks to what extent disabled scholars become independent by default.  By interviewing people she knows and who share her experience of living with a mental disability, Price also challenges models of research that assume that disengagement with its subjects generates the most valid knowledge.    

Another chapter examines three examples of autobiographical writing about mental disability:  Susanne Antonetta's A Mind Apart,  Lauren Slater's Lying , and Wendy Thompson's essay "Her Reckoning."  Price finds "transgressive power" in autopathographies written by those "who are not (conventionally) ‘articulate'" (178).  Part of that power, Price proposes, arises from the narrators' unconventional use of pronouns (Who is "I"?) and ways of "refiguring the rational" (195).  

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This documentary film follows the professional and private lives of the 2004 U.S. Wheelchair Rugby team. Murderball is a highly engaging, informative look at the lives of a group of quadriplegic men who are also elite athletes. The sport of "murderball" combines basketball, hockey, and rugby. It is played in custom-built wheelchairs with angled, shield-like metal side plates that make the chairs look like chariots, encouraging the term "gladiators" that is often applied to the players. Invented in Canada in the 1970s, murderball was renamed "wheelchair rugby" or "quad rugby" to make it less offensive to corporate sponsors, but retains its toughness with any name. The sport is played without helmets, and its players tackle each other through chair-to-chair collisions as they try to move the ball to the end zones.

The documentary begins with the 2002 World Wheelchair Rugby Championships in Sweden, includes team tryouts and competitions with arch-rival Canada, and closes with the Paralympic Games (held two weeks after the traditional Olympic Games end) in Athens, Greece. The film is a fast-paced sports documentary with abundant chair-level footage of action on the court, but also focuses on many aspects of the personal lives of key players, including psychological conflicts and sexuality. While the documentary is focused on the entire team, not individuals, three distinct subplots include the emotional journey of team captain Mark Zupan, including his relationship with the friend whose actions precipitated Zupan's disabling accident over ten years earlier; the passion and resentment of the Canadian team coach Joe Soares, who was cut from the U.S. Team and whose obsession with murderball leaves little space for Soares to appreciate his musically gifted teenage son until his own heart attack; and the experiences of newly disabled athlete Keith Cavill.

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The writer Donald Hall gives us a lyrical armchair view through the windows of his house not only of the New Hampshire landscape, but also of his and his anscestors lives lived in that landscape. His honest and moving account from his 83rd year  is captured in the following: "I feel the circles grow smaller, and old age is a ceremony of losses, which is on the whole preferable to dying at forty-seven or fifty-two [the ages his wife Jane Kenyon died and his father died]. When I lament and darken over my diminishments, I accomplish nothing. It's better to sit at the window all day, pleased to watch the birds, barns, and flowers. It is a pleasure to write about what I do" (p.41).

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Painted while Neel was enrolled in the Works Progress Administration--a New Deal program to help the unemployed-- the work depicts a scene with which the artist was probably familiar, being herself impoverished at the time. The setting is a room at The Russell Sage Foundation, established by Margaret Olivia Sage in 1907 for "'the improvement of social and living conditions in the United States.' In its early years the Foundation undertook major projects in low-income housing, urban planning, social work, and labor reform" (quote from http://www.russellsage.org/about) .

At the painting's rear center sits an elderly (gray haired) woman facing sideways, dressed all in black, head buried in her hands. From her clothing and affect, she is probably a widow. She is seated in front of a small table around which, in a semicircle, sit her interrogators - nine men and two women. They all face her. One of the women seems to be interviewing her while the other people listen with varying expressions on their faces, ranging from thoughtful to impassive. The men are all wearing suits and ties except for one (possibly two), with clerical collar. The women, including the elderly lady under investigation, all wear hats. All are white, with the possible exception of a clergyman, who may be a light skinned black. To the right foreground of the painting sit two men, facing sideways, who appear to be waiting to be questioned. The man closest to the viewer is elderly, with a white mustache, apparently Latino since his skin color is light brown; he is wearing a suit and tie and holds two bananas in his hand. The expression on his face is one of worry and fatigue. To the left foreground, with his back to the viewer, a man sits leaning forward, apparently one of the questioners.

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Adam (Joseph Gordon-Levitt) a 27 year-old writer is happy in his work and lives with Rachael, a painter, but he has not been feeling well. He goes for tests. The doctor—without looking him in the eye—bluntly tells him that he has spinal cancer and needs chemotherapy. With the support of his good friend, Kyle (Seth Rogan), Adam begins his treatments. Together they shave his head and he bonds with the much older men being treated at the clinic. Rachael promptly takes up with another man and Adam throws her out. He is assigned a 24 year-old psychotherapist, Katherine  (Anna Kendrick) who is out of her depth in dealing with his condition and his fears, but they have an affinity for each other that will eventually “conquer all.”

Adam has an uneasy relationship with his mother (Anjelica Huston), a domineering personality who is coping with her husband’s slide into dementia.  His illness forces him to see more of his parents and he slowly realizes how much she cares for him and wants to help; however, he avoids her and rarely volunteers any information.

In another encounter with the inept doctor, Adam learns that the chemotherapy hasn’t worked and he is referred for surgery. The woman surgeon’s bedside manner is even worse: incredibly, she meets him for the first time only as he is being wheeled into the operating room. 

But the surgery is a success, and the film closes with Adam and Katherine falling into each others arms -- a disappointingly happy Hollywood ending.

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