History of Medicine & Narrative

As the Annual ASBH meeting draws near, I was interested to read Giskin Day's account of the recent (UK) Medical Humanities Association Conference, which took place earlier this month.  She notes a relatively controversial presentation by John Wiltshire, in which he argued that

the 'true' history of medicine has not yet been written: what we have is a history of profession and institutions. History is made up of narratives, but the performative act of medicine robs the patient of the opportunity to shape his/her own story into narrative (for Wiltshire, narratives are primarily written, addressed to a reader and involve an intellectual presence that mere story does not). The 'true history' of medicine is the formal patient narrative which also serves as a valuable critique of medicine, for example Fanny Burney's description of her mastectomy.

This provokes many interesting questions, I think.  First, while I tend to agree that a history of professions and institutions is not equivalent to a history of patients, I would also suggest that a social history of those professions and institutions necessarily informs a history of patients insofar as the former is a primary, albeit not the only factor in the construction of patient experiences.  The nature of patient experiences would naturally seem to depend a great deal on the medical professions and institutions that inform the relevant culture(s).  No?

Second, Wiltshire's argument raises some fascinating questions for me on the relationship between personal narratives (whether pathographies or broader narratives of health care experiences) and the history of medicine.  If the "true" history of medicine is really a study of the history of patient narratives, than I must admit I do not see a drastic difference between the history of medicine and the ethnographies of medical anthropology.

On that note, Day notes that another speaker, Sander Gilman, took issue with Wiltshire's assessment, noting that "narratives don't necessarily reflect patient reality, they are are patients' encounters with 'the system' and are no more 'true' than other types of narrative."  I tend to agree more with this claim than with Wiltshire's.  Indeed, I am uncertain what the notion of a "true" history of medicine actually entails, let alone whether patient narratives are more "true" than representations of medical professions and institutions (which themselves must be explained in terms of the people, context, and practices that animate them, I submit).

Thoughts?

Comments

[Giskin Day]

I agree that the term 'true history' begs the question 'what makes one history "truer" than another?', but I guess Wiltshire here is arguing for more depth and breadth rather than seriously suggesting that history can ever be objectively evaluated according to some standard criteria for 'truth'.

I have some sympathy for Wiltshire's argument, though, in that the illness experience is underrepresented in mainstream medical history which tends to focus on treatment, institutions and 'the doctor as hero'.

In contrast, patients that spring to mind as occupying important places in history tend to be notorious: think Typhoid Mary. That's not to say that history necessarily needs to be celebratory, but the identity of patients does seem to be subsumed by the case study, partly probably as a result of patient confidentiality rules.

Maybe we need more ethnography as part of the mainstream history of medicine?

[Daniel Goldberg]

Giskin,

No doubt your observation that Wiltshire is arguing that attending to patient narratives supplies a more accurate history of medicine is accurate (and is more consonant with the principle of charity, in any case).

I maintain some fairly radical skeptical views, so I tend to (metaphorically) wince when I hear claims about truth and whatnot.

In all honesty, I am not familiar enough with the history of medicine literature to have an opinion on whether narratives of illness are underrepresented in medical history, though I certainly agree that bringing those narratives to light using historical lenses and methodologies is a worthwhile endeavor.

I wonder what medical historians would think of the suggestion that more ethnography is needed in medical history (honest question here; do not mean it rhetorically).