Q&A with Sari Altschuler, Author of The Medical Imagination

Sari Altschuler is an assistant professor of English, associate director of the Humanities Center, and founding director of the minor in Health, Humanities, and Society at Northeastern University. Her book The Medical Imagination: Literature and Health in the Early United States was recently published with the University of Pennsylvania Press (2018), and her work has appeared in leading literary journals, including American LiteratureAmerican Literary History, and PMLA, as well as the Journal of the Early Republic and the medical journal the Lancet. She serves on the advisory board of American Quarterly and the editorial board of Early American Literature and recently coedited a special of Early American Literature (2017) on early American disability studies with Cristobal Silva.

JUNTO: As you know, The Junto is always interested in the experiences of junior scholars who have turned their dissertations into first books. How did your project and theorization of imaginative experimentation change over time?

SARI ALTSCHULER: Great question! This book is very different from my dissertation—but I had to write the dissertation in order to even begin to understand what was going on. The dissertation was about the collaborations of specific doctors and writers in Philadelphia. It was, in some ways, a very narrow and defined topic, which was good for a dissertation. But, when I started to think about what The Medical Imagination might be as a book, I wanted to do something more ambitious. In the dissertation I figured out that these doctors and writers were working together—in conversation—but for the book I wanted to understand the broader intellectual practice in which they were engaging. That’s how imaginative experimentation came to be at the center of the project. It’s an idea I only really began to think about as I finished the dissertation.

A related and equally important question that I turned to in the book was “why literature?” The dissertation was more interested in answering where, how, and when literature was used to work through medical problems, but not why. And I thought the project would be much stronger if I could answer why these doctors and writers used literary texts and why literary analysis was a good way to approach the study of medical creativity. I try to keep this question “why literature?” always in mind as I write. I really try to work against any creeping disciplinary chauvinism and always want to be able to explain clearly why I’m using the analytical methods of literary studies to approach a particular question. In The Medical Imagination, the answer should be evident to all readers: the book is about why literature and the imagination mattered so much to medicine and health historically and what that history has to offer medicine and the health professions today.

Finally, here’s a bit of honesty that I hope is helpful for people working to turn their dissertations into books: All of the above is much easier said, retrospectively, than done. I had to write this project three times to get it right. I wrote it first as a narrower chronological dissertation, second as a thematically based project (a structure that didn’t actually work but did give me space to think differently about the material), and finally in the form that appears in print—a book organized around five sequential health crises.

JUNTO: The Medical Imagination is particularly interested in the literary genres of poetry, fiction, and the picaresque novel, and literary forms such as satire, sentimentalism, and the gothic. Were there genres and forms that you didn’t get to talk about in the book? Why do you think some forms and genres were more useful than others in imaginative experimentation?

ALTSCHULER: The short answer is that there are other literary forms that scholars, especially historians of science and STS scholars, have identified as crucial to medical and scientific work but that may not be immediately recognizable as such. Scholars working a little later, for example, have written eloquently about the literariness of the case study or of analogy (and other literary devices) in medical and scientific writing. If you think about it, of course, these forms are both literary and imaginative—the case study is a narrative composed for a medical audience, and analogies require inventive comparisons. Some of that is in the book, especially in the discussions of physician-writers like Benjamin Rush, John Kearsley Mitchell, and S. Weir Mitchell, but, in general, I made the choice to take a pretty conservative approach to what I meant by literature and what I meant by medicine because I worried it might be easier to dismiss the argument if I identified what seemed like quirky, idiosyncratic, or alternative practices in alternative medicine, for example, or if I stretched what I meant by literature. I think (and very much hope!) there is more space now for expanding this work.

JUNTO: What do you think historians have to learn from literary scholars, what do you think literary scholars have to learn from historians, and what do you wish both of these fields would learn from the medical humanities? Similarly, what would you tell scholars of the medical humanities interested in engaging with history and literature?

ALTSCHULER: To begin, I just want say that the fact that, as a literary scholar, I’m being interviewed by The Junto is wonderful. We have so much to learn from each other! I’ll get into the details of that in a moment, but, in general, I’m interested in an inter/cross-disciplinary approach I call at the end of The Medical Imagination “epistemological humility.” Epistemological humility involves remaining mindful of what the tools of particular fields bring to a subject while also being humble about what any given field cannot do or know. It’s a concept I find broadly useful for thinking about disciplinary exchange. One way of knowing cannot be all encompassing. The tools that make our work possible also necessarily make it impossible to see a topic from certain other perspectives. That’s what is so valuable about cross-disciplinary exchange. I passionately believe that the best way forward is both to understand and to articulate the strengths of our disciplines clearly while remaining aware of their limitations. Literary scholars and historians—and for that matter religious studies scholars, musicologists, anthropologists, theater scholars, etc.—have a lot to learn from one another precisely because we use different tools and methods to look at the same topics and phenomena.

A number of scholars have already written wonderful essays about what we might learn from each other. Literary scholars are highly skilled in the analysis of text, and historians primarily look to texts for historical evidence (see, especially, Eric Slauter on this). This is a central aspect of our common ground. Literary scholars use a rich array of tools and approaches—both theoretical and technical—that can help historians see the richness of narrative and language in new and expansive ways—here I’m thinking particularly of our expertise in questions of genre and close reading as much as the variety of different theoretical approaches we use to think about how stories and histories get told and how language works. For example, Cristobal Silva and I wrote recently about how a literary disability studies approach helps us think differently about history and historiography: “To be guided by the lessons of contemporary disability studies…is to resist the allure of narrative coherence and chronology, and to maintain its elusive quality as a mode of resistance, whether we note it in the disordered, the disruptive, and the inchoate epistemologies of the texts we turn to or in the narratives we recreate for the past.” Elizabeth Maddock Dillon, Michael Drexler, Ed White, Carrie Hyde, Joe Rezek, Brian Connolly, Paul Erickson, and others have also written terrific essays about our differing approaches to text, to history, and to evidence and the archive. And yet, the collection of essays about the “trade gap” published jointly in 2008 by the William and Mary Quarterly and Early American Literature which drew attention to the fact that literary scholars read and cite historians far more than historians cite literary scholars (this was not always the case), still feel depressingly current. This year at the C19 conference, Cathy Kelly spoke eloquently about how much her role as JER editor demonstrated the persistence of this gap—perhaps evident now even more than it was in 2008.

But literary scholars could also learn more from historians. While literary scholars do a pretty good job of reading and citing historians, we learn less from the strengths of history’s methods. For example, the standard is higher in history for building a broad case; on the whole, historians visit more archives and cull from more primary and secondary sources. I get why a book using four novels or novelists to describe a historical phenomenon (a caricature of literary studies among historians, but one that holds some truth) isn’t usually very convincing for a historian, and as literary scholars we can do better on this count. Historians are also good at writing for the public—they often imagine (even if at times aspirationally) that they are writing for a broader audience. Most literary scholars do not imagine this, although we could probably expand our readership if we did. As a result, most history writing uses less discipline-specific language and, when using theory, tends to wear it lightly. History writing generally gets less caught up in specific disciplinary debates, which are less interesting to those outside of the immediate field, although that work often occupies historians’ footnotes. Historians are also better at using narrative to write compelling scholarship. Literary critics—probably because we are so trained to dissect narrative—are often warier of writing narrative scholarship, even though it’s certainly effective!

I had these questions of disciplinary difference very much on my mind as I wrote The Medical Imagination, and I tried to develop a style of writing for a multi-disciplinary audience of literary scholars, historians, and medical and health humanists, and even doctors themselves. I came to think of this as an “early American studies” style, which was quite different from the one in which I had been trained. The five things I aimed at were 1) direct prose that avoids technical disciplinary language as much as possible, 2) chapters that featured not one or two but at least three central examples of imaginative experimentation and which were “populated” by other figures who would support my analysis and connect the chapters (thanks, especially to Ann Fabian for this advice!), 3) literary analysis of those examples that teased out their complexity, 4) a good story, full of colorful details that would draw people in, and 5) thick footnotes that engaged more of the critical and historiographical conversations than I could allow for if I wanted to keep the main text clean. A quarter of the book is in the footnotes!

This is already shaping up to be a very long answer, so, for the sake of space, I won’t fully rehearse what I’ve written elsewhere about what the health humanities and early American Studies can learn from each other, but I will crop a provocation from that essay: “What if, drawing our inspiration from the spirit of the health humanities, we were to embrace the necessary complexity of health, as a topic that consistently eludes disciplinary constraints? By this, I do not simply mean that we should do so topically, but rather to consider what it would mean to approach [health-related subjects]…not only from the perspectives of historians but with the added expertise of literary scholars, religious studies scholars, and experts in material culture. I am not suggesting we merely pay lip service to each others’ work, but rather that we insist that it is not possible to understand health without listening to one another, collaborating with one another, and approaching the topic of health not only from our individual silos but from the shifting ground in between, necessarily challenging the disciplinary forms through which we have come to know. We might even take up that challenge as a central goal of our work.”

JUNTO: You describe nineteenth century debates between those who traced the origins of disease to the theory of contagion, and those who traced it to climate. Can we draw parallels here between current discussions of nature versus nurture—or are there other debates that are even more relevant to this section of the book?

ALTSCHULER: What interests me about the contagionist-climatist debates is how people went about knowing when they couldn’t answer fundamental questions about something that was in fact killing them. The book calls problems like this “epistemic crises”—a concept that I think is as relevant today as it was then. While medicine has made incredible strides, it is not very good at dealing with uncertainty. The effects of this difficulty can be seen, for example, when patients have conditions that are difficult to diagnose or not fully recognized by the medical community. These patients may find themselves accused of making things up (I’m thinking here of the history fibromyalgia, etc.). Once medicine finds a somatic basis, social and medical treatment radically changes. Or, we might think of the recent case of zika, where people suddenly found themselves living with the consequences of a disease that was not well enough understood. In the book I argue that these moments are particularly historically useful for seeing the work of imagination and inventiveness as people try a variety of ways of knowing to understand a difficult problem. Today, as we strive to accommodate uncertainty and ambiguity better, it’s important to remember that in fifty years some of our current practices will inevitably be considered cruel—even unthinkable—and to work humbly from that knowledge.

JUNTO: You offer the concept of the “Age of Cholera” to characterize the antebellum era, and you also mention that descriptions of pain emerged on the eve of the Civil War which would have been unthinkable during the early national period. Can you say a little bit more about the periodization of the book, how you settled on it, and how it’s engaging with/agreeing with/pushing back against the periodization of the American Revolution, the Age of Revolutions, and the Early Republic?

ALTSCHULER: Absolutely!

A couple of periodization issues were clear from the beginning. If we’re thinking about the development of medicine in the US, end dates like the late nineteenth century (with the introduction of germ theory and rise of medical professionalization) or 1910 (with the reorganization of US medical education) make more immediate sense for the project than, say, 1820, 1830, 1850, or the Civil War. Of all of these latter, more familiar dates, though, the Civil War makes the most sense, since it fundamentally changed aspects American medicine, like the role of the hospital. Second: traditional accounts of the history of American medicine understand the antebellum era as a particular nadir of physician authority—a time in which not much new medical thinking happened. Others might cast the whole period of the book—the revolution to the Civil War as a time when American medicine was derivative. As I argue in the book, when we accept a declension narrative of nineteenth-century US medicine, we uncritically rehearse the stories fin de siècle physicians told as they sought to bolster their own precarious medical authority, and I was particularly interested in recovering this story. Third, to your question about the “Age of Cholera” specifically, I wanted a way to signal the way in which health concerns—especially ones that kill people spectacularly and in large numbers—are not set apart from the rest of our social and cultural concerns, nor are they bound by traditional periodization. Events like the global cholera pandemics of the nineteenth century preoccupied Americans and had widespread cultural effects for decades, not just at the peaks of the pandemics.

In the end, I settled—at least nominally—on a pretty conventional range of dates, but not because the practice of imaginative experimentation I was tracking was encompassed by the revolution-to-the-Civil-War date range. Rather, that period was just a particularly good one for seeing it for a variety of reasons that had to do with specific understandings of how medical knowledge was formed, with the role of imagination in early US culture, with the broader investment in imagining new American forms, etc. Nevertheless, the book doesn’t offer a straightforward teleological story. Certainly, things changed in those years—people made important discoveries, ideas about medical knowledge shifted, and it became more difficult to practice imaginative experimentation—but the story develops instead through five moments of crisis and is interested more in what happens in those moments than it is in how those crises are resolved. Finally, I couldn’t really leave the story at the Civil War, so I cheated a bit in the conclusion, which takes the reader up to the early twentieth century reorganization of medical education to suggest we might use the history in The Medical Imagination to think differently about training in the medical and health humanities today.

JUNTO: Gnomes! Orangutans! There’s a lot of fabulous, fun material in this book. How do you teach students to see the rigorous theorizations behind the fun material? Put differently, what are some of your strategies for teaching some of these strange genres and forms?

ALTSCHULER: Students love this stuff! Picking some of the quirkier examples really draws them in. The trick is not to let students think that those examples are somehow indicative of backward thinking. Students arrive in class with a very teleological view of medicine—people in the past did not know what they were doing, but, thanks to some great thinkers, we can now basically perform miracles. The pleasure is in showing students that the work on gnomes and orangutans was actually the result of some really interesting, compelling thinking—even if we did not know as much about health then as we do now.

JUNTO: At several points in the book, you go back to earlier authors’ manuscript drafts and notes (as in the case of Robert Montgomery Bird’s initial ideas for Peter Pilgrim) and comment on works that might have been. Do you think these authors ever really thought of their works as finished? And how did these authors’ attitudes toward their own creations (and your attitudes toward them) inform your attitude toward your own scholarship?

ALTSCHULER: The answer really depends on the author. One author who was in my dissertation, but who did not make it into the book—George Lippard—claimed to simply write through to the next plot point and not revise. Obviously other writers of the period—famously Walt Whitman—continued to revise until their works barely resembled the original. Most of the authors in the book are more like Lippard than Whitman. Later editions are not markedly different from earlier ones. In some ways, that makes it easier to think of their works as, well, as finished as they were going to be. Nevertheless, for a number of authors in the book I tried to think through how their ideas developed over time. So a different way of thinking about this problem is that later work often developed or revised earlier work by the same author. This is easiest to see, I think, in the fourth chapter, which tracks the work of Bird and Samuel George Morton from the 1820s to the 1840s. In some ways, I feel like this is an honest approach to any piece of writing. As we all know, just because something is printed doesn’t mean we’re finished thinking about it. But, like these writers, the revisions that happen after publication often appear in other works rather than in subsequent editions.

In a lot of ways, this is one of the most important things about imaginative experimentation. It doesn’t have to result in a completely finished idea; it doesn’t have to have all the answers. Imaginative experimentation was a way of knowing that allowed for a kind of freedom and creativity that worked with and alongside ways of knowing like rationalism and empiricism. This is why it was such a useful, especially at moments of epistemic crisis. It gave medical thinkers a way to take intellectual risks.

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