The Neurological Patient in History

Journal of the History of the Behavioral Sciences, Vol. 50(3), 331–334 Summer 2014 View this article online at Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/jhbs.21674  C 2014 Wiley Periodicals, Inc. BOOK REVIEWS L. Stephen Jacyna and Stephen T. Casper. The Neurological Patient in History. Rochester, NY: University of Rochester Press, 2012. 274 Pages. $80.00 (Hardcover). ISBN: 9781580464123. The editors are too modest. Stephen Jacyna and Stephen Casper might have removed “neurological” from the title of their edited volume The Neurological Patient in History. They suggest, after all, that the distinctive features of neurological patients are broadly relevant because they magnify issues that scholars face when historicizing all health-seekers in the past. Neurological patients are valuable for two reasons. First, the individuals who have been lumped together as “neurological patients” are instructively dissimilar to each other, and, second, there is a relative wealth of historical evidence about them. These two factors allow scholars to plot the range of patients’ experiences, and thereby to rethink familiar themes in the history of medicine—and beyond. Eight empirical chapters (including one by each of the editors) follow the editors’ historiographical introduction. The book does not have a conventional conclusion. Instead, the final two chapters offer reflections on the volume—a bold and admirable move that builds sharp self-critique into the collection. The book is loosely organized into five sections that address something that “constructs” the neurological patient (e.g., caregivers, medical discourse). All of the chapters examine post-Enlightenment Euro-America, a feature of the book that deserved more remark since one claim of the volume is that it collects and theorizes a broad range of historical processes and personal experiences. Jacyna and Casper’s excellent historiographical introduction explains that previous work on the history of patients has fallen short in two main ways. First, historians have portrayed patients as disembodied actors: minds alone, existing without unruly bodies. Second, historians have reified “the patient” as a category, ignoring the processes through which people of such variety have come to cohere as members of the category “neurological patient.” As a result, scholars have trapped individual patients in unwarranted assumptions and, at the same time, caged themselves in dated theories, methods, and approaches to studying patients in the past. To substantiate these claims, the editors summarize beacons in the history of “patient history” such as Nicholas Jewson and Roy Porter—as well as their predecessors and critics— and present them as scholars of identifiable sociopolitical moments and theoretical lineages (Marx, Foucault, et al.). The contributors explore how people in the past (including historians) have imposed a logic and meaning on neuro-patients, whose actions and inactions, words, and silences were something other than what they seemed. Jesse Ballenger’s chapter on dementia shows the challenge it has presented for practitioners, patients, and historians. “Disappearing in plain sight” reveals how patients’ disease status both legitimated their claims to first-hand expertise and also undermined their authority as reliable experts. Likewise, Howard Kushner’s “The cursing patient” on Tourette syndrome shows how neurological patients test scholars’ comforting assumption that there is a tight link between what people think or feel, and what they do or say. The neurological patients in this volume used the same form of communication— speech, writing, and action—to deny or defy their own claims and actions from earlier moments. 1 2 BOOK REVIEWS Not doing, not saying, and not writing—either as intended or at all—is itself a form of evidence that challenged neurological patients and their interpreters, including clinicians and historians. Paul Foley rethinks received wisdom about professional boundaries through his account of turn-of-the-century European neurobiology, psychoanalysis, and clinicians’ struggles to understand patients who appeared to have aspiration but would not get out of bed. Chapters, such as Marjorie Perlman Lorch’s “Speaking for yourself,” model how to historicize these penumbra—the hazy outlines of patients’ shadows left in the archive. Lorch’s piece on aphasia argues that changes in legal systems (e.g., inheritance laws in Victorian Britain) can drive changes in the categories of disease that existed in medical spheres, rather than vice versa. The solution that the contributors devise to study these ironic actors is to combine standard archive documents with less conventional forms of evidence, such as artists’ sketches, training manuals, grant applications, autobiographies, court records, and contributors’ firsthand experiences. In the perfectly titled piece, “Robert Nichols and his neurologists,” coeditor Steven Jacyna performs a scholarly Gestalt shift by using several doctors’ archives to place one prima donna patient at center stage. In a careful, surprising, and funny chapter on a poet-patient’s experiences after serving in the Great War, Jacyna shows that the role of “patient” is one among many roles (including referring physician) that people, including Nichols, successfully and simultaneously cultivated by learning medicine through books, mimicry, reflection, and practice. Likewise, in the “The spouse, the neurological patient, and doctors,” Katrina Gatley uses an artist’s bedroom sketches of her perpetually sleeping husband and shows, contrary to historians’ expectations, that some paying customers— in this case, a fin de siecle woman—did on occasion have confidence in the authority of their own intimate knowledge of patients over the expertise of formally trained medical professionals. Many chapters are strong and the editors set a clear, exciting, and big agenda; yet, the volume does not entirely hang together. One unifying keyword for the volume is “individuality,” but contributors implicitly take the term to mean one of two things. The best chapters capture the “individuality of patients” to reveal a broader range of human experience than previously appreciated in the history of medicine. Co-editor Stephen Casper’s study of clinical encounters in early twentieth-century Britain draws on medical training manuals (e.g., on how to use tuning forks) to show how clinicians were taught to move individual patients’ embodied knowledge into material evidence on paper. In “The patient’s pitch,” Casper shows how, compared to other specialties, patients’ narratives featured distinctively and enduringly in neurology. Likewise, Max Stadler refocuses readers on the “individuality of the patient” in one of the volumes’ concluding reflections. He proposes that the history of the neurological patient could be read—and usefully studied—as a constant toggle between anonymity and iconoclasm, that is to say, as a collection of attempts to satisfy the impossible demand to imagine patients generically and at the same time to confront their apparent differences. Taking a second and less satisfying approach, other chapters emphasize “the patient as individual,” a phrase that echoes Paul Ramsey’s classic of bioethics, The Patient as Person (1973). This swap—from the adjective form to the noun form of “individual”—gives the word very different meaning for contributors. It signals a primary interest in doing history as bioethics, rather than the history of bioethics. For example, Ellen Dwyer’s “Neurological patients as experimental subjects” documents an interesting case of 1930s clinical research in Chicago, but the piece loses its critical and interpretive edge. JOURNAL OF THE HISTORY OF THE BEHAVIORAL SCIENCES DOI 10.1002/jhbs BOOK REVIEWS 3 It is understandable that a few weaker chapters would read as reverse hagiographies. Since the 1960s, the field of the history of medicine has been preoccupied with power relations, more to demonstrate the insidious, unavoidable effects of power than to craft new historiographical approaches to the history of medicine. The premise of Roger Cooter’s perceptive closing reflection “Neuropatients historyland” is that all writers of history, including the contributors, embed a theory of the past in their analyses that corresponds to the “dominant discourse” of their historical-social milieu. This includes the contributors. Cooter suggests that scholars unaware of, or at least not articulating, the “dominant discourse” that they work within consequently cannot craft new historiographical approaches to the history of medicine. A sparkling contribution, Cooter’s chapter prompts readers to ask whether the most humble historians can stumble upon a new theory of history, and, some readers might hope, craft a history of medicine beyond power—a view that accounts for all manner of violence and ignorance, but also does more. Many of the empirical chapters would work well as stand-alone reading assignments in courses, especially the introduction and two closing reflections. Although not required, the volume rewards light familiarity with the history of neuroscience and psychoanalysis since the nineteenth century. In the end, doctors and historians have faced a similar problem: how to decide when and how people have given trustworthy evidence. The volume shows that neurological patients dramatize this puzzle and the stronger chapters are models of how to approach questions of evidence. Reviewed by LAURA STARK, Stark: Assistant Professor at the Center for Medicine, Health, and Society, Vanderbilt University. KAITLIN BERRY, Vanderbilt University class of 2013. JOURNAL OF THE HISTORY OF THE BEHAVIORAL SCIENCES DOI 10.1002/jhbs