Book Review
Culturally Bound Illness
- Roy Porter (Author) and G.S. Rousseau (Author)
Gout: The Patrician Malady. Yale University Press (purchase at Amazon.ca)
- David B. Morris (Author)
Illness and Culture in the Postmodern Age. University of California Press (purchase at Amazon.ca - Glen Downie (Author)
Wishbone Dance. Wolsak and Wynn Publishers Ltd (purchase at Amazon.ca
Reviewed by Anna Cooper
In Gout: The Patrician Malady, Roy Porter and G. S. Rousseau have constructed a remarkably well-researched history of gout, a disease of swollen joints in the lower extremities that commonly affects males who indulge in a rich diet. When paired with David Morris’s Illness and Culture in the Postmodern Age, which presents sweeping theoretical statements almost every page, Gout seems eager to avoid extensive theorizing, although some challenging questions are raised. Can one be sick without being diseased, or vice versa? Working from the assumption that bodily illness becomes a disease only when it is framed as such (for example, neurasthenia came and went as a framed disease), Porter and Rousseau posit that gout has been framed as a disease of the aristocratic male: a superiority tax, an insurance policy, a prophylactic, and a haven. Believing disease to be territorial and possessive, Samuel Johnson thought gout would ward off other more malignant illnesses. Horace Walpole saw gout as a blessing—the coagulation of the body’s destructive humors in one relatively harmless place. For Erasmus, attacks of gout provided an excuse for leisurely reflection and the use of reason. But more than anything, gout served as a sumptuary tag for social superiority by showing that one could afford to be ill. In fact, it seemed to many that simply being patrician, and not the indulgences associated with that status, were the cause of gout. Until the 18th century, Greek humoral theory encompassed the medical understanding and treatment of gout, a word that comes from the Latin word gutta for drop, referring to a drop in bodily fluid to the extremities. Accompanying this theory was the humanist "idea that luxurious living would bring nemesis in the form of vengeful maladies," and diseases often were personified in an "Aesopian manner, endowing them with moral messages." One 17th century story explains that gout and a spider, in a search for lodging one night, found that the spider could remain undisturbed in a poor man’s house and that gout found leisure and bed rest in a house of an aristocrat, whereas when they switched their residences, the spider was nearly killed by a maid’s broom while gout, in the leg of the poor man, was forced to toil in the fields. The gouty male reached his peak as a stereotypical persona in Tobias Smollet’s novel The Adventures of Humphrey Clinker (1771).
The symbol of gout faced threat from claims that it was not hereditary, at the same time that humoral theory was being contested by Cartesian disciples who viewed "the machine as a model for the body." Vigorous debate ensued—at one point gout was even used as "a badge of loyalism" in the last decades of the 18th century when aristocracy was under siege from liberalism. The disease, of course, persisted, but its positive association with the upper-crust male deteriorated. In Dickens’s Bleak House, "the pedigree of podagra" returns, but to signify "the dead weight of tradition." Whereas gout in the Renaissance had been popular fodder for parlor chat, in the late Victorian era it became impolite and unmanly to discuss one’s illnesses, including gout. Biomédical evidence mounted showing that gout was caused by an accumulation of urate crystals, in turn caused by a high-protein, high fat diet. The most obscure chapter, "Podagra Ludens", follows, merging the history of gout with theories of the human propensity to play, pointing out the playful elements of gout’s profile. A clever chapter on graphic images of gout, including an observation of persistent phal-lusism in drawings of gouty men, concludes the book. Ultimately, this book demonstrates how "the insignia of gout arose, was culturally inscribed, and fell."
Pop theory, like pop psychology, reaches out to a general audience with generalizing messages. Using essay style prose, David Morris in Illness and Culture in the Postmodern Age argues that the biomédical model, a Lyotardian grand narrative, must give way to a biocultural model in our postmodern era. He makes the same point as Roy Porter that illnesses do not become diseases until they are certified, or framed, by the powers that be, who are themselves framed by their culture. For most illnesses having clear organic causes, the biomédical system, with its surgical interventions or drugs, "provides an effective response," but chronic illnesses of unknown cause flounder in our health system.
Although this book may not be a scholarly source for novel theory, Morris’s figuration of illness as a social text offers a reminder of humanity’s role in making ourselves sick and well. He cites population shifts, environmental pollution, crime, the welfare system, conceptions of beauty and lifestyle changes as cultural influences on our state of health. He summarizes numerous theorists (e.g., Bakhtin, Baudrillard, Lyotard) in defining postmodernism with unabashed certainty. For the most part, his explanations ring true, though simplistic. Even though Morris’s book, according to its genre, often depends upon absolutist conclusions, generalizing statements, and well-worn concepts of postmodernism and narrative, it is a lively and fast treatment of some issues in medical sociology. He follows Arthur Frank’s lead in The Wounded Storyteller (1996) by recounting well-known narratives of illness including Anatole Broyard, Reynolds Price and William Styron. Morris abandons his thesis in the middle section of his book, which reads more as a collection of essays than a unified whole. For example, in Chapter 6, on obscenity and culture, he makes only a tenuous connection to illness in a brief discussion of Turret’s syndrome. A chapter on pain offers several provocative ideas—e.g., that society has erroneously tended to locate pain in the body rather than in the brain, the place where it actually occurs—and the strength of this chapter reflects the focus of Morris’s past writing on pain and culture. Chronic pain, "the most common contemporary medical problem," is now being treated, he says, more as a diagnosis than as a symptom, in a "crucial redirection of postmodern thought." He then returns to his thesis on the biocultural nature of illness near the end, where he provocatively situates himself in opposition to Susan Sontag’s efforts to remove meaning (especially stigma) from illness, believing instead that meaning allows for healing narrative. For Morris, "illness, in short, is never wholly personal, subjective, and idiosyncratic, nor is disease wholly objective, factual, and universal, but both take on their specific, malleable, historical shapes through the mediations of culture."
The poems of Glen Downie in Wishbone Dance invite, without melodramatic manipulation, the reader to engage emotionally with the poignant—sometimes loud, sometimes quiet—scenes of medical drama. Though many of the poems have appeared in earlier volumes or in journals, in this book they all seamlessly join together, in part due to a consistent speaker persona. A few poems, such as the moving love poem "Chances Are," feature a distinctly different speaker, but for the most part the speaker comes across as someone at the edge of the medical establishment, close enough to see the blood and hear the moans, but far enough away to develop a somewhat melancholy perspective on it all. A group of poems interspersed throughout the book, called "Learning Curve Journal," cut with icy precision and confront the reader with colostomies and the loss of dignity, chronic and incurable illness, suicide and the loss of hope, the violence of surgery, and more.
Downie, like most poets, delights in word play, but not for the sake of pure frivolity, since the ultimate effect of his puns and turns is a sense of deeper irony. That is because what are at stake in these poems are the dignity, well-being, and very lifeline of people; the light twists of the form of the poems contrast with the weight of the content: "Dead-easy to love the ones / who are fixed / in memory." Yet the idea of contrast does not entirely explain Downie’s project; indeed, an amalgam of effects—humor, horror, sadness, confusion, and at times, celebration—culminates in a vignette-style portrayal of what happens to us when we get sick. "Ron and Don," about a twin who sees his own death in his dying brother and then runs away, mirrors what many readers might feel in reading these poems. That is, we see what might happen to us in the grip of the medical institution, yet, perhaps because of Downie’s expert artistry, the compulsion is to read ahead, not to turn away. He certainly doesn’t offer metaphysical meanings for the pain of death by disease, but occasionally he shares scenes that affirm the human potential to heal, not the physical body, necessarily, but the soul. In "Prosthetics," a technician offers fake appendages to disappointed patients, but he also offers something more, a healing warm handshake and a genuine smile.
These three books approach the junction of medicine and culture from significantly different genres: scholarly history, pop theory and poetry. The history develops a story over time, the theoretical work rearranges cultural icons and the poetry offers glimpses of quotidian life; these genres inscribe the authors’ messages with meanings ¡n the same way that all three insist that society imposes meaning on medicine.
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MLA: Cooper, Anna. Culturally Bound Illness. canlit.ca. Canadian Literature, 8 Dec. 2011. Web. 24 May 2013.
This review originally appeared in Canadian Literature #169 (Summer 2001), (Blais, Laurence, Birdsell, Munro, Jacob, Chen). (pg. 167 - 169)
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