In this deeply researched monograph, Laura Kalas reads The book of Margery Kempe through the lens of medical humanities, considering Kempe's engagement with some of the key medical and spiritual paradigms shaping late medieval English culture. Kalas offers an original feminist argument for Kempe's synthesis of these discourses in her Book, a story of ‘spiritual and medical restoration’ (p. 6). In her Book Kempe testifies repeatedly to her ‘peynes’: this study offers a rich medical-spiritual context for these pains. Unlike some of Kempe's critics, Kalas seeks not ‘to pathologise or to “diagnose” her recorded experiences, but rather to elucidate how the discourse of pain and suffering in the Book enables Kempe (and indeed, her readers) to orient themselves in relation to their physiological and social worlds’ (p. 16). After establishing the medical-spiritual matrix within which Kempe operated, Kalas unfolds a complex ‘surrogacy dynamic’ whereby Kempe, moving from youth, to middle age, to senescence, repurposes maternal strategies to mobilise ‘the social and mystical substitutions of wet nursing, godparenting, fostering, image-substitution, and pain-bearing as alternative acts of production’ (p. 25). Kalas frames her chronological analysis of Kempe's life with chapters exploring her constitutional melancholia (chapter i) and her Passion devotion as a form of ‘death-surrogacy’ enabling her to merge with Christ (chapter v). As Kalas shows, Kempe conformed in many ways to a typical bourgeois woman's life-cycle, even as she rewrote this script in search of chaste marriage with her husband and mystical union with Christ.

Rather than view Kempe's much-analysed weeping as an expression of mystical experience, in chapter i Kalas analyses Kempe's tears as manifesting the melancholic ‘wounds’ she suffers as a result of the ‘lost Christic object’ (p. 31). Drawing upon medieval philosophical and medical writings, as well as recent scholarship on mysticism, Kalas argues with Aquinas that melancholia could be productive, providing ‘a constitutional basis for affective receptivity, where physiology creates a predisposition to metaphysical vision’ (p. 31). A melancholic temperament was at once physical, spiritual and emotional, stemming from an excess of black bile, according to Galen and later medical writers. Melancholy was in turn linked by theologians to the loss of Christ and fixation on that loss. Although Kempe's tears, which she wept in anguished recognition of collective sin, caused her pain and social ostracism, her melancholia conferred spiritual advantage, continually connecting her to Christ's Passion. In her Book Kempe asks Christ for a ‘well of tears’: the danger for her is not more tears, but an absence of them. Her wounded melancholia is thus ‘a boundless state in which Kempe is immersed and with which her identity is inextricably bound up’ (p. 58).

Understanding how Kempe brings her melancholic disposition into productive relationship with others throughout her life course is the task of the book's central chapters. Chapter ii investigates Kempe's revulsion at marital sexuality and her manoeuvering within the paradoxes of marriage and celibacy. In a religious culture that elevated chastity, marriage entailed both the physical pain of childbirth and the spiritual pain of lost chastity. Yet medical discourses argued that sexual abstinence damaged women's health. Kempe thus found herself ‘within an imprisoning hermeneutic, faced with the discomforting choice of physical or spiritual suffering in a never-ending paradox of pain’ (p. 62). Kalas closely analyses Kempe's account of traumatic childbirth, together with contemporary texts on women's health and chastity, to show how the experience of pain, rejection by clergy and madness, salved only by Christ's appearance, enables Kempe's entry into mystical connection with Christ. Kempe forged ahead in her campaign for a chaste marriage, developing a strategy of ‘pain substitution’ whereby she imposed physical pain (fasting, sleep deprivation, hairshirts) to punish herself for the ‘defilement’ of sex (p. 79). Reaching a vow of marital chastity with her husband after protracted negotiations enabled Kempe to attain marriage to the Godhead, experienced in highly sensual terms, ‘as a symbolically fecund replacement of Kempe's sexual and reproductive self’ (p. 92). Kalas offers many perceptive close readings of the Book, showing how we can glean new understandings of Kempe's embodied experiences by reading them together with medical works from the Trotula corpus and spiritual guides like The pore caitif.

The book's central chapter, ‘Lost blood of the Middle Age: surrogacy and fecundity’, contains the heart of the argument for Kempe's lifelong surrogacy practice. Kempe's middle years, her time of ‘lost blood’ (menopause), prove profoundly productive as she gains ‘authority in voice, text, and painful understanding’ in the transition between youth and old age (p. 99). During this time, Kempe explores a variety of forms of ‘social and mystical surrogacy’, including wet nursing and godparenting, mobilising maternal agency in new spiritual forms (p. 100). Kalas astutely notes that, for Kempe, the cessation of menstrual blood coincided with the start of uncontrollable weeping, marking a new phase of ‘substitutional mothering’ that structures the rest of her life and Book (p. 105). Kalas's attention to the spiritual dynamics and productivity of menopause is original and effective: this section harnesses medical writings to illuminate Kempe's middle age as a period of ‘new fecundity’ in which she acts as a spiritual nurse for the Virgin Mary as well as for human babies. In her acts of nursing, which receive approval both from Christ and human society, Kempe manages ‘to reproduce her motherly devotion and to reveal God's will in the souls of others’ (p. 125).

Chapter iv delves further into the surrogacy hermeneutic emerging from female lived experience by investigating Kempe's acts of healing as ‘pain surrogacy’, whereby she suffers pain in order to heal others and reach union with Christ. Illuminating the significance in medieval medical theory of breast milk (considered a cure-all), Kalas shows how Kempe makes a transition, as she ages, ‘from wet nurse, to healing nurse, to healer’ (p. 133). Drawing upon her own childbirth trauma, Kempe leverages prayer and visionary experience to heal other postpartum women. Kalas's attention to the spiritual importance of midwives in Middle English medical texts highlights the merging of these discourses in Kempe's Book. We see her pain surrogacy further developed in her interactions with leprous people. Kempe's final familial duty is, fittingly, caring for her husband in his end-of-life infirmities. As her palliative caregiving is repeatedly reinforced by Christ as a holy duty, she moves ever closer to holy widowhood.

Chapter v briefly suspends the life course frame to consider Kempe's Passion visions, experienced throughout her life (notably early on in the Book, when Christ envisions her ‘etyn and knawyn of þe peple of þe world’). These visions, Kalas argues, represent the fullest extension of pain surrogacy, for Kempe persistently understands herself as a willing sacrifice or ‘death-surrogate for Christ’ (p. 161). Kempe's preoccupation with the spiritual and physiological signs and significance of death, ‘the semiosis of death and dying’ (p. 162), becomes central to her spiritual progress. As Kempe's growing holy reputation is linked to her role as a foreseer of death, she becomes a sought-after deathbed attendant. And as Kempe's physical body weakens, her spiritual body strengthens: here Kalas highlights the ‘signs of death’ tradition, which matches physical symptoms with spiritual conditions, a powerful imbrication of these two traditions. This chapter demonstrates the connection that Kempe draws between her own pains and Christ's death pains: with every meditation on his pains, she is able ‘to re-live, or re-die, each time she recollects the vision, just as she presumably hopes her readers will as they encounter the infinite potential of these visions as subjects for meditation’ (p. 180).

Chapter vi, ‘Senescent reproduction: writing anamnestic pain’, represents the culmination of the life-course argument. Here we find Kempe an old woman, embodying an ‘edifying, senescent pain’ (p. 184) that grants her the ultimate forms of authority and healing power. In contrast to medieval misogynist stereotypes of the repellent old woman, Kempe embodies ‘aged asceticism’, in which she leverages the suffering of her aged body in a new form of productivity, one Kalas calls ‘anamnestic’ [recollective] (p. 190). Medieval society envisioned a place for old women as healers and sages: Kempe takes advantage of this possibility in her aged adventures, including a painful final pilgrimage and a late career of spiritual teaching at home and abroad.

Kalas's Afterword opens out onto Kempe's documented social existence as a member of Lynn's Holy Trinity Guild. Kempe's revision of Book, part i, dictation of part ii and her entry into the guild, ensuring postmortem prayers, were contemporaneous. ‘Her membership, then, symbolises her own preparation for dying according to the Ars moriendi tradition, at the same time as she prepares her Book as both a memorial of her spiritual life and a generative legacy for the future’ (p. 217). As Kalas shows throughout, Kempe refuses to separate the mystical from the social, the spiritual from the medical, the past from the future. Kalas elegantly theorises these interconnections, offering a host of new insights for students of Kempe's Book.