This book could perhaps have been called "Pathology and Identity in the Medical Case History and the British Novel." Tougaw here examines the mutual fascination of both nineteenth-century medicine and the British novel with pathology: that both "novels and case histories require a suffering body at narrative's center" (8), and that both "put into circulation a model of identity whereby the subject is always caught in a double bind... between health and pathology" (9). He examines developments in the medical case history, as a narrative, and argues that both this and the novel permitted an escape from "the nineteenth-century zeal for classification" (2). He reads the doctor-patient relationship as analogous to the reader-novel relationship, and argues that both genres must balance competing modes of approach: diagnosis and sympathy.

The book focuses on "controversial or marginalized maladies" (18), with each chapter acting as, itself, a case study. The first chapter, however, sets up Tougaw's critical terms of diagnostic and sympathetic reading, alternatives that help readers negotiate their discomfort with controversial conditions. The second chapter examines how the rhetoric of disability helps provide cover for "scientific scrutiny" (19) in cases of breast cancer, which bring to the foreground concerns over the limits and gendering of privacy and the body. Chapter Three builds on Peter Logan's work on the nervous narrator, examining Jane Austen's use of indirect discourse to finesse questions of hypochondria, compulsive storytelling, and early-nineteenth-century medical knowledge.

The fourth chapter focuses on the mid-century debate over mesmerism and anesthesia, reading cases alongside relevant novels by Wilkie Collins, Sheridan Le Fanu, Robert Louis Stevenson, and Mary Elizabeth Braddon. It traces Victorians' interest in altered consciousness and the effects of drugs on agency, and it argues for an analogy between the intersubjective relations of mesmerist/subject, doctor/patient, and narrator/reader. The final chapter reads Freud's "Rat Man" and "Wolf Man" against three novels by William James. Tougaw sees both these authors as putting forward a complex epistemology based on interpretation and intersubjectivity rather than assertion or individuality. The Afterword reframes Tougaw's arguments in the context of contemporary debates over the doctor-patient relation and the patient narrative; that "the real work of autobiography is the establishment of an intersubjective rapport between writer and reader" (21).


Tougaw rightly points out that the medical case history is an underrecognized genre: while critics such as Julia Epstein, Thomas Laqueur, and Janis Caldwell have pointed to important commonalities between the case history and the novel, Tougaw's is the first full-length treatment of the correlation between these genres, which arguably emerged and developed along roughly the same timeline. The field also lacks a book-length history of the case history as a genre. Tougaw's volume, like Epstein's, helps by providing a deeply historicist literary analysis.

This book also gestures toward Tougaw's other interests, autobiography and trauma theory, in his close analysis of the dynamics of pain and subjectivity in the narrative of illness and in the doctor-patient relationship. (Tougaw co-edited Extremities: Trauma, Testimony, and Community with Nancy K. Miller). As a result, the book might work nicely in medical humanities courses that focus on trauma or pathography, by historicizing and contextualizing the other readings, since Tougaw's work brings contemporary theoretical methodology to bear upon a diverse array of nineteenth-century cases.



Place Published

New York; Oxford



Page Count