With her book on hysteria, Sabine Arnaud offers an innovative approach in studying comparative literature and the history of science. She examines the “forms of enunciation” that allowed doctors and fellow travelers first to express and then to crystallize medical thinking around a new medical category. In her words, enunciation constitutes those “conceptual choices that make the construction of knowledge possible, the events of writings, political stakes, and the construction of an audience for such writings” (6). Through this means, she identifies the process by which disparate discourses cluster around a theme and form a distinct object – here, hysteria – much in the way that heavenly bodies cluster around a gravitational center and form their orbits. Arnaud then goes on to show how these discourses about hysteria allowed contemporaries to speak about broader cultural and social issues: sexuality and gender roles, social class and status, luxury and consumption habits, taste and style, social graces and affects, politics, nationality, and human nature itself. The hysteria diagnosis, often associated with modernity and bourgeois sexuality, above all amongst women, had more ambiguous antecedents – often associated with courtly culture, male and female sociability, and concerns over luxury and conspicuous consumption. Arnaud thus contributes to a cutting-edge scholarship, epitomized by scholars such as John Mullan and Anne C. Vila, who have helped revolutionize how we understand medicine and culture in the Enlightenment, especially the complex intersections between medicine and literary writing.
Arnaud’s book distinguishes itself because she identifies the wide array of discursive strategies that doctors used before the clinical, cytological, and bacteriological breakthroughs of the nineteenth century and the attendant rise of scientific objectivity. She raises fascinating questions about the doctor’s status – not just as a scientific authority – but also as an “author,” one engaged in a literary enterprise. With this analysis, she differs from more traditional studies of medicine and writing, which often focus upon the “physician–writer” and the emergence of literary modernism. One thinks of prominent literary figures – Anton Chekhov, L.-F. Céline, Arthur Schnitzler, William Carlos Williams – all who drew upon their medical formation and experience in their writing, but who treated medicine and literature as distinct vocations.
In her analysis, however, Arnaud discerns the multiple styles, forms, traditions, and techniques found within the medical community itself: imaginative form and language not as separate from medical convention, but as working within it. She shows, in fact, how medical writings were profoundly heterogeneous in the late seventeenth and eighteenth centuries. While the genre that later characterizes “objective” medical writing was already emerging – in form of the nosology, the medical topography the case study, anatomical description, the physiological experiment, the formal textbook – these formats circulated alongside a number of other, more imaginative medical styles. These forms were both “intramural” and “extramural” in terms of audience and scientific background. Here eighteenth-century doctors weren’t just engaging in literary pursuits outside of their medical training, as with Tobias Smollett or Friedrich Schiller. Nor were they engaging a broader lay audience as popularizers, trying to shape public attitudes about medical issues, as with successful figures such as Samuel Tissot or William Buchan. Rather, when it came to hysteria, medical writing possessed a dynamic all to itself.
This dynamic emerges when Arnaud dissects the distinctive “genres” found in writings about hysteria. When discussing the disease, doctors addressed not just one another but they also courted broader readership. And as audiences changed, so did the writing strategies that doctors employed. Arnaud identifies the different formats: dialogues, autobiography, epistolary exchanges, and anecdotal examples. These genres, it should be added, circulated within a rich tradition of other medical writings, whether broadsides, pamphlets, catechisms, self-help books, medical travelogues, and fictional narratives. These were imaginative works in which doctors appeared not just as trained authorities but also as story-tellers and stylistic craftsmen.
Though these medical writings sought to influence audiences by imparting specific points of view, they were also open-ended in structure and tone, attaining a quality that I might characterize as “dialogic.” Arnaud reminds that doctors often sought to entice their readers, treating them not as objects, but rather as listeners to patient needs and concerns. The medical marketplace likely finessed this style, as doctors sought to portray themselves as courtiers and members of the republic of letters, thereby attracting clients and patrons. Significantly, these genres allowed readers to enter into dialogue with the physician and to make meaning in a participatory manner; it was a question of collaboration, of interpretation, and of assembling a mutual vision of the world. These writings touched upon the personal and the tactile, opening room for soul-searching and self-identification in disease and suffering (125).
Arnaud uncovers similar dynamics in how doctors used metaphor. Hysteria produced a constellation of symptoms and signs. The disease fascinated observers but they found it hard to decipher. It offered a cryptic language, a hieroglyphic mural whose meaning seemed beyond conscious recognition. In this regard, hysteria itself seemed almost “hysterical,” spawning an endless text of associations and digressions, something akin to Lawrence Sterne’s Tristram Shandy or Denis Diderot’s Jacques le fataliste. The disease thus lent itself to literary techniques and narrative devices, above all with metaphor, which allowed both author and reader to grasp the disease’s opaque significations. Hence doctors used specific images – the proteus, the chameleon, the hydra, even barnyard animals – all which conveyed how hysteria was a pathological metamorphosis, a disease of dissimulation. At the same time, this same metaphoric language suggests underlying concerns about the doctors’ professional status and moral responsibilities. With hysteria, doctors risked mis-diagnosing their patients and thus overlooking other, more serious problems. Apparently patients were expecting more of their doctors, but medicine couldn’t yet deliver on its scientific potential. Hysteria spoke to these ambiguities of medical authority in the Enlightenment.
In all this, Arnaud offers two important points for reflection. On the one hand, as seen above, she demonstrates the myriad ways in which doctors communicated amongst themselves and the larger literary public over the long eighteenth century. When doctors discussed medical matters, such as hysteria, they appropriated many rhetorical and narrative devices – ranging from language to formal structure – including, not limited to, the objective ethos associated with later scientific writing (and whose antecedents we often seek in the Enlightenment period).
On the other hand, Arnaud shows how these diverse writings shaped broader intellectual and cultural attitudes. During this period, to be sure, scientists and doctors were creating the modern disciplinary fields, segregating knowledge and experience into distinct frameworks now known as the arts and sciences. The modern term “physician-writer” exemplifies this transformation; it suggests a person who straddles two different worlds, sometimes at the peril of one or the other: medicine and writing as distinct, perhaps incompatible vocations. In the eighteenth century, however, disciplinary boundaries were more fluid and permeable, allowing a greater diversity of forms and genres to circulate within the medical field itself. As Arnaud shows, it was only when physicians retrospectively invented the hysteria diagnosis in the early nineteenth century that they elided these earlier forms of “enunciation” and the wider meanings they entailed. On Hysteria reminds us that it is the historian or the critic’s role to return to the primary sources and to engage these polyvalent expressions and meanings. In this manner, Arnaud offers a bold new way of approaching scientific discourses in the past and reconstructing the complex forms in which contemporaries expressed them.