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Dedication
- Brittany Pladek
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- The Poetics of Palliation
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- Liverpool University Press
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- 25 June 2020
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- 24 May 2019, pp x-x
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Acknowledgments
- Brittany Pladek
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- The Poetics of Palliation
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- Liverpool University Press
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- 25 June 2020
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- 24 May 2019, pp vii-ix
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Frontmatter
- Brittany Pladek
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- The Poetics of Palliation
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- Liverpool University Press
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- 25 June 2020
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- 24 May 2019, pp i-iv
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5 - John Keats’s ‘Sickness Not Ignoble’
- Brittany Pladek
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- The Poetics of Palliation
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- Liverpool University Press
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- 25 June 2020
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- 24 May 2019, pp 162-192
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Summary
When telling the story of John Keats's final year, writers often include the same two anecdotes, juxtaposed in nearly the same way. Keats's friend Charles Brown recalls that in February 1820 the young poet had a coughing fit and spat quantities of bright arterial blood. After examining the color, Keats pronounced it a death warrant, a sure sign of the consumption that had already claimed his mother and brother Tom. Keats's six years of medical training—five as an apprentice under surgeon Thomas Hammond and one as a student at Guy's Hospital—lent authority to his self-diagnosis. Yet the poet's medical intuition sharply contrasted the uncertainty of his physicians. ‘Although he is a pulmonary specialist’, writes Stanley Plumly, Keats's ‘[Dr.] Bree dismisses the possibility of anything pulmonary let alone consumptive. This, of course, is stunning news, considering Keats's own diagnosis to Brown the night he coughs up the arterial blood’. Keats's critics disagree about why his doctors initially misdiagnosed his condition. ‘Keats's doctors in fact had no reasonable grounds for doubting what was the matter with him’, admits Andrew Motion. ‘They kept him in the dark either because they were colluding with his deception, or because they were incompetent’. Less charitably, Donald Goellnicht writes that Keats endured ‘obtuse insistence by his physicians and friends that his disease was entirely mental’. Whatever the case, these accounts seem to imply that Keats had a surer sense of his condition than his physicians.
Motion's suggestion that Keats's doctors attempted ‘deception’ to hide his illness from him reveals another possibility, however. Many Romantic physicians in fact recommended concealing patients’ fatal illnesses from them, worrying that fear might worsen their condition. In Keats's case, what sounds like bad medicine may simply have been good bedside manner. This possibility fits with the dictates of British medical ethics, which was codified during the Romantic period. For the first time, professional ethics tracts were published that offered guidelines for medical behavior, most notably Dr. John Gregory's Lectures on the Duties and Qualifications of a Physician (1770) and Dr. Thomas Percival's Medical Ethics (1803). Among these writers, support for hiding the truth from patients out of therapeutic necessity was widespread. As Percival explained, ‘falsehood may lose the essence of lying, and even become praiseworthy, when the adherence to truth is incompatible’ with the doctor's primary obligation to act as ‘minister of hope and comfort to the sick’.
The Poetics of Palliation
- Romantic Literary Therapy, 1790–1850
- Brittany Pladek
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- Liverpool University Press
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- 25 June 2020
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- 24 May 2019
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Can literature heal? The Poetics of Palliation argues that our answers to this question have origins in the Romantic period. In the past twenty years, health humanists and scholars of literature and medicine have drawn on Romantic ideas to argue that literature cures by making sufferers whole again. But this model oversimplifies how Romantic writers thought literature addressed suffering. Poetics documents how writers like William Wordsworth and Mary Shelley explored palliative forms of literary medicine: therapies that stressed literature's manifold relationship to pain and its power to sustain, comfort, and challenge even when cure was not possible. The book charts how Romantic writers developed these palliative poetics in conversation with their medical milieu. British medical ethics was first codified during the Romantic period. Its major writers, John Gregory and Thomas Percival, endorsed a palliative mandate to compensate for doctors' limited curative powers. Similarly, Romantic writers sought palliative approaches when their work failed to achieve starker curative goals. The startling diversity of their results illustrates how palliation offers a more comprehensive metric for literary therapy than the curative traditions we have inherited from Romanticism. 'This erudite and beautifully written book stages a dialogue between historicist work on Romanticism and medicine, disability studies, and the emerging field of the health humanities. Starting from the premise that the Romantic period was the first to conceive of literature as the stuff of medical therapy, Pladek shows it was also the first to criticise a naïve version of that view. In five crisp chapters, she shows how writers as diverse as Coleridge, Wordsworth, Keats, Thomas Lovell Beddoes, John Stuart Mill and Mary Shelley thought of literature as a palliative, not a cure, for human suffering. In each of these discussions, she reveals how romantic literature anticipated some of the most controversial ideas in the health humanities today, notably the notion that to be effective medicine must treat the whole person, and she also traces fascinating genealogies of a great many ideas in modern medicine that are assumed to have no romantic pedigree. The result is an interdisciplinary dialogue of the first order and a literary tour de force.' Neil Vickers, University College London 'The Poetics of Palliation offers a serious and expert engagement with the field of the health humanities as a legacy of Romantic literature and criticism. Extensively researched, it will be an invaluable resource for anyone interested the relationship between those two areas, as well as in the intertwined genealogies of therapeutic holism, the New Criticism, and certain strains of liberalism. A reparative reader in the sense proposed by Eve Sedgwick, Pladek maintains her commitment to literature's ability to give and to model care, but without assuming that it can – or should – cure.'
2 - From John Stuart Mill to the Medical Humanities
- Brittany Pladek
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- The Poetics of Palliation
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- Liverpool University Press
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- 25 June 2020
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- 24 May 2019, pp 65-95
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Summary
In chapter one, I promised to address the question of how Schiller's Romantic hypothesis that aesthetic education could cure a particular form of modern alienation would become the belief that literature and its tools could heal any sort of personal fracture. The answer has a lot to do with John Stuart Mill. A Victorian critic writing at the tail end of Romanticism and through the ascendance of scientific positivism, Mill inherited Schiller's complaint that modern society's mechanistic, specialized ways threatened the healthy unity of individuals. His effort to find a solution to this problem influenced his revision of utilitarianism, which stressed the ‘need of the individual citizen to cultivate the harmonious development of his own personality’. Mill's Schillerian conclusion that education in the arts could preserve healthy individuality deeply shaped liberalism, a belief system whose tenets still motivate the contemporary academy. At the same time, Mill's personal history gave a peculiar shape to his conclusions. The bout of despair that first led Mill to question utilitarian reasoning was cured by his reading of Wordsworth's poetry. The experience convinced him of art's necessity to human wellbeing. Mill's version of liberalism was thus irrevocably coupled to a personal faith in the healing power of poetry. His understandable conflation of these two principles—art cultivates individuals and poetry heals—had profound consequences. Mill transformed Schiller's vision of art as balm for a fractured age into a working political philosophy. Moreover, his personal experiences helped position poetry, in its wider sense as ‘literature’, as the art best suited to the task of healing persons and society. With these moves, Mill gave final form to therapeutic holism. By finessing Schiller's claims about art to address poetry specifically, and by tying them to a Romantic celebration of the whole person, Mill paved the way for therapeutic holism to be recovered by twentieth-century health humanists as the discursive rationale for why medicine needs literature.
It is unknown to what extent Mill was directly familiar with Schiller; his collected works contain few clear references. However, it is clear that Mill accessed Schiller's ideas in his extensive reading of Schiller's British acolytes, Coleridge and Thomas Carlyle, and Schiller's contemporary and close friend Wilhelm von Humboldt. Carlyle's Life of Schiller came out in 1818, when Mill was 12, while Coleridge's oeuvre, with its debts to German idealism, was a touchstone for most of Mill's writing life.
Bibliography
- Brittany Pladek
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- The Poetics of Palliation
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- 24 May 2019, pp 223-252
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Contents
- Brittany Pladek
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- The Poetics of Palliation
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- Liverpool University Press
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- 25 June 2020
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- 24 May 2019, pp v-vi
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1 - Therapeutic Holism: The Persistence of Metaphor
- Brittany Pladek
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- The Poetics of Palliation
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- 24 May 2019, pp 29-64
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When you tell three familiar stories together, they become a new story. In these first two chapters, the historical background for the rest of this book, I follow a metaphor from its genesis in the Romantic period through its divergence into three separate intellectual traditions, and then to those traditions’ twentiethcentury reunification. That metaphor is therapeutic holism, already sketched in the introduction. Initially a legacy of the broader theoretical movement called Romantic organicism, therapeutic holism evolved to shape nineteenth-century definitions of great literature, good medicine, and the liberal self. In doing so, it forged links between these ideas, so that when mid-twentieth-century doctors, frustrated with biomedical reductionism, began seeking more humane approaches to patient care, they found a ready partner in literature as it was represented by therapeutic holism: an art whose materials and practices had the power to restore the ‘whole person’. Considered separately, therapeutic holism's influence on literary culture, medicine, and liberalism are well-known stories. There is a clear line of descent from German Romanticism's celebration of poetic holism to the New Criticism's ideally unified work of art; medical historians turn to the nineteenth century to explain the tense relationship between bodily cure and holistic healing; and intellectual historians recognize the influence of Romantic individualism in the nineteenth century's model of the liberal self. Yet, to my knowledge, no one has laid these stories alongside one another, nor shown how their tracks converge in the twentieth-century movement called the health humanities. That convergence is what chapters one and two will chart.
Because covering the same ground thrice would be tedious, I have organized these three stories into a rough chronology. Chapter one gives an overview of therapeutic holism, its sources in Romantic organicism, and its legacy in today's health humanities scholarship. It also introduces the medical history on which this book is based, including my findings from two summers of primary research into medical materials from 1770 through 1900 at London's Wellcome Library. After following therapeutic holism's influence on literary criticism and professional medicine into the twentieth century, chapter two offers a fuller account of the origin of the health humanities movement in the 1960s. It concludes by ruminating on the limitations of the legacy I have traced. Metaphors are powerful shapers of thought, and therapeutic holism has slipped some signally Romantic assumptions into the language of health humanities work.
4 - Palliating Humanity in The Last Man
- Brittany Pladek
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- The Poetics of Palliation
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- Liverpool University Press
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- 25 June 2020
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- 24 May 2019, pp 129-161
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Summary
In a note to her 1839 edition of Percy Shelley's Prometheus Unbound, Mary Shelley recalled that during its composition, Percy, who had been feeling persecuted by scandal, ‘sheltered himself from such disgusting and painful thoughts in the calm retreats of poetry’. Unable to defeat his ‘painful thoughts’, Shelley conjectured, her husband sought to escape them through writing. Her inclusion of this anecdote to gloss a play whose protagonist overcomes an eternity of ‘pain, pain ever, forever’ suggests her awareness of a discrepancy between the drama's plot and its effect on its author—and, in turn, a difference between two therapeutic models for literature. Prometheus Unbound is a drama of radical cure. Prometheus's embrace of love and justice heals not only himself but also his world. But as Shelley recognized, this tale about panacea offered its playwright only a ‘shelter’ of temporary relief. The story of a cure was, in practice, palliative.
The poetic shelter was a place Mary Shelley knew well. A month after Percy Shelley's death by drowning in the Tyrrhenian Sea, she adapted Prometheus's lament to mourn his loss as an irrecoverable tragedy. ‘I repeat only—“Pain, pain, ever & forever pain!”’ she wrote in a letter. A year later, she would begin composing The Last Man, a novel that documents Europe's collapse beneath its own Promethean agony, a plague that kills all but a handful of people. Yet in the same way that Shelley's biographical reading of Prometheus Unbound unsettles the play's triumphant message of healing, The Last Man resists the despair that might understandably follow its grim events. The novel's frame narrator, often read as a reflection of Shelley herself, recalls how the story's composition ‘softened my real sorrows and endless regrets … tak[ing] the mortal sting from pain’. It is striking how the narrator finds momentary relief for apparently incurable ills—their regrets are ‘endless’, their pain ‘mortal’—in a tale of terminal disease. In her journals, Shelley had commented on the novel, ‘The last man! Yes I may well describe that solitary being's feelings, feeling myself as the last relic of a beloved race’.
3 - ‘Soothing Thoughts’: William Wordsworth and the Poetry of Relief
- Brittany Pladek
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- The Poetics of Palliation
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- Liverpool University Press
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- 25 June 2020
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- 24 May 2019, pp 96-128
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William Wordsworth was a typical Georgian patient: that is to say, he always got a second opinion. In April 1808, when both the poet's son John and Sara Hutchinson fell ill, he sought advice from two local medical men (apothecary Mr. Scambler and surgeon Mr. Edmondson), two physicians by correspondence (Dr. Babbington and Dr. Thomas Beddoes), at least one medical treatise (Dr. John Fothergill's 1781 Medical and Philosophical Works), several friends (including Dorothy, Coleridge, and Mr. Rideout), and, not insignificantly, himself. Writing to Coleridge of Sara's nerves, Wordsworth commented, ‘Mr Edmondson said that always when the pain returned, the Leeches should be applied, followed by the blister … but really it ought to be considered that the discomfort and fretful sensations which in Sara's constitution a blister produces may possibly outweigh the advantage from it’. The egalitarian variety of Wordsworth's medical consultation illustrates how Romantic medicine frequently involved open negotiations of authority between doctors and their patients. Status, income, and location permitting, the sick were as likely to seek medical advice from neighbors, friends, and domestic care manuals as they were from graduates of the Royal Colleges, as several medical historians have shown. In this milieu, personal experience could outweigh professional opinion. Edmondson might be a surgeon, but Wordsworth knew Sara's constitution and felt secure enough in his own medical knowledge to question expert advice.
Perhaps his confidence was warranted. By the Victorian period, Wordsworth himself had acquired a reputation as an expert in poetic healing, a therapeutics that has, since the nineteenth century, become a bridge between scientific medicine and other healing arts. As chapters one and two recounted, though medicine has never wholly dismissed art's psychosomatic benefits, in the twentieth century it began to explore literary healing with new rigor, participating in the development of health humanities fields like literature and medicine and narrative medicine. Romantic writing is well-represented in these movements, and Wordsworth is an especially prominent figure. For example, the ‘Preface to Lyrical Ballads (1802)’ forms a theoretical backbone for poetry therapy, a subfield in contemporary psychology. The embrace of Wordsworth as a forbear aligns poetry therapy with a tradition of therapeutic holism stretching back to John Stuart Mill. Moreover, Wordsworth's reputation as a healing poet was enhanced in the twentieth century by Romantic scholars like M.H. Abrams and Geoffrey Hartman, who made therapeutic claims for his work independently of any interdisciplinary framework.
6 - Thomas Lovell Beddoes’s ‘Fictitious Condition’
- Brittany Pladek
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- The Poetics of Palliation
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- 24 May 2019, pp 193-222
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In July of 1848, lonely and racked by neuralgia, the poet and physician Thomas Lovell Beddoes opened an artery in his left leg with a razor. Before he could bleed to death, he was found and conveyed to a nearby hospital. Frustrated that his suicide attempt had been foiled, Beddoes tore the bandages from his wound. Gangrene set in. To save him from the inevitable deadly blood infection, Beddoes's leg was amputated from the knee down. Writing to his sister that October, Beddoes lied about the suicide attempt: ‘I fell with a horse … and broke my left leg all to pieces … the fractured limb was obliged to be sacrificed’. He promised her that he would soon be well and visit her in England. Six months later, Beddoes was dead—officially by fever-induced apoplexy and, unofficially, Beddoes's doctor Ecklin informed his friend Thomas Forbes Kelsall, by a self-administered poison, curare. For many years debate surrounded Beddoes's death, as his descendants sought to popularize the fever explanation. His 1928 biographer R.H. Snow, sympathetic to Beddoes family pressure, endorsed their version of events by expressing doubt that a man with an amputated leg could have made it to town to buy poison. But since Snow's evidence could not account for an important series of private letters written by Beddoes's friends, contemporary critics largely accept Ecklin's version.
Thomas L. Beddoes was a writer acutely aware of the intimate link between controlling one's death and controlling one's self. His suicide illustrates the complexity of acting on that intimacy. When Beddoes's first attempt failed, he rewrote it as a horse-riding accident so as not to worry his family; when his second attempt succeeded, friends like Kelsall and Dr. Alfred Frey, who first told Beddoes's relatives he had died of apoplexy, concealed it for decades. Yet scholars’ interest in the ‘true’ version of Beddoes's death tends to obscure his suicide's fascinating, if tragic, use of narrative agency. Through a combination of epistolary deception and a collaborative reliance on friends to keep his secret, Beddoes bifurcated the meaning of his death, giving his immediate family and the public a more acceptable narrative while reserving the darker reality for a private circle of trusted friends. Beddoes, it seems, understood the stakes of his own death story.
Introduction
- Brittany Pladek
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- The Poetics of Palliation
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- 24 May 2019, pp 1-28
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What can literature do for medicine?
This is not a new question, but over the past three decades it has been asked with renewed urgency by medical professionals in Britain and America, who have turned to scholars in the humanities for aid in addressing perceived problems in biomedicine. The result of their joint effort, the field of health humanities, conventionally defines itself against biomedical reductionism, promoting ‘“a patient-centered approach to medical care”; “countering professional burnout”; and “equipping doctors to meet moral challenges not ‘covered’ by biomedicine”’. Literature is a star player in this expanding field, present everywhere from university-run bibliotherapy programs to the growing number of physicians trained in the practices of narrative medicine. Proponents of literary approaches speak of their powers with compelling faith. ‘Narrative medicine can help answer many of the urgent charges against medical practice and training—its impersonality, its fragmentation, its coldness, its self-interestedness, its lack of social conscience’, writes Rita Charon, author of Narrative Medicine (2006) and proponent of this practice, which teaches doctors to ‘close-read’ patients’ stories in order to promote empathetic communication. She continues:
Narrative medicine has come to understand that patients and caregivers enter whole—with their bodies, lives, families, beliefs, values, histories, hopes for the future—into sickness and healing … . In part, this wholeness is reflected in—if not produced by—the simple and the complicated stories they tell to one another’.
Charon's elevation of ‘wholeness’ as the cure for biomedicine's ills is typical in celebrations of the health humanities. It is the most common shorthand for the difference between humanistic and medical approaches to personhood— among not only health humanists but also doctors, journalists, and literature and medicine scholars. More particularly, ‘wholeness’ is a frequently cited justification for the many health humanities initiatives centered on literature. Writing in the Lancet, for example, Anne Hudson Jones and M. Faith McLellan applaud the growing number of literature courses offered by medical schools: ‘Among the goals of these experiments, whether they involve reading fiction or writing it, are to deepen students’ capacities for empathy and to remind them of the totality of the lives of patients they may meet only in limited, fragmented ways’.
Index
- Brittany Pladek
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- The Poetics of Palliation
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- Liverpool University Press
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- 25 June 2020
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- 24 May 2019, pp 253-279
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