Sometime in the late 1430s, Margery Kempe recorded the story of her life, now known as The Book of Margery Kempe. The text is often described as the first autobiography in English and the emphasis is very much on Kempe's spiritual experiences and religious activities, especially her regular conversations with Christ. These began when she was around twenty, following the birth of her first child and a period of about eight months during which she experienced, as she herself describes, a mental breakdown. Kempe had to be physically restrained to prevent her from harming herself, but Christ's appearance restored her reason. This episode has frequently been regarded as an instance of postpartum psychosis. Indeed, since the discovery of the unique manuscript in 1934, Kempe's conduct and experiences have regularly been diagnosed as manifestations of illness, variously identified as hysteria, epilepsy, Tourette's syndrome, or the effects of the menopause, among others. In her compelling new study, Margery Kempe's Spiritual Medicine: Suffering, Transformation and the Life-Course, Laura Kalas highlights that such approaches are generally disparaging of Kempe, often part of wider arguments for the essentially inferior or counterfeit nature of her experiences, by comparison to “true” medieval mystics.

Kalas presents the first substantial analysis of the Book of Margery Kempe to be informed by the methodologies of medical humanities, posing the vital question: “what happens if we read the Book not only through the psychology of the ‘now’, but in the light of medical writings of the ‘then’?” (6). Rather than viewing Kempe as a patient to be pathologized, Kalas presents an original and stimulating reading of the Book of Margery Kempe as “a narrative of Kempe's own engagement with and use of the medical paradigms of which she has previously been a passive subject” (6). Kalas thus reframes Kempe's body and her mystical experiences within what she identifies as a medicalized hermeneutic of spirituality. Her lucid and highly engaging analysis is grounded in a deep and astute understanding of the Book of Margery Kempe as expressive of the evolving life cycle of an individual woman, of the contexts and discourses informing that woman's experiences and of Kempe's distinctive articulation of these. Kalas also exhibits an admirable grasp of contemporary medical and religious theories and practices, beginning with an elucidation of Kempe's status as a natural melancholic. She thereby sets the scene for her analysis by arguing that Kempe's well-known tears should be interpreted not as a response to her mystical encounters (the conventional approach), but as evidence that she was humorally and constitutionally predisposed to be receptive to such encounters. This enables Kalas to shed new light on Kempe's perceptions of the meanings and merits of the pain and suffering which she experiences.

Kalas's fascinating iteration of what the Book of Margery Kempe reveals about the inherently embodied nature of medieval women's spirituality is especially valuable, and her foregrounding of medieval medical discourses within this is groundbreaking. This is productively explored via chapters structured around Kempe's life course, which focus on the changes and challenges occasioned by sexual activity, childbirth, menopause, old age, and the sense that Kempe makes of these changes in medico-spiritual terms. Kempe's traumatic first childbirth, with which the Book of Margery Kempe opens, is identified as a crucial structuring device for the whole narrative, establishing as it does the ways in which Christ's cure of Margery's derangement is figured as a form of medicine. Kalas examines Kempe's resolution to live chaste within a dichotomous “sexual paradox” by which theological attitudes held virginity/chastity to be the ideal state for women and medical opinion claimed that abstinence from sex was damaging to women's health (59). Although Kempe is eventually able to renounce sex and childbearing, the pain of childbirth persists in the form of her surrogacy praxes, which Kalas convincingly argues are pivotal to the Book of Margery Kempe. These practices are made manifest in Kempe's visions of the birth and infancy of Christ and in her pseudo-familial relations with people that she encounters during her pilgrimages, for example the English priest in Rome, to whom she becomes like a mother. Kalas develops this line of argument further by explaining how Kempe's surrogacy practices bear healing fruit as she becomes a sort of nurse, conveying Christ's medicine to others, including her son, and her husband John Kempe, to whom she provides palliative care. Noting that Kempe's nursing of her husband coincides with her experience of menopause and post-menopause, Kalas contends that his death functions as a form of healing for Kempe, curing her of the marriage that obstructed her attainment of holiness and enabling her full communion with Christ and his suffering.

This study presents stimulating analyses of episodes from the Book of Margery Kempe that have received a good deal of scholarly attention before, but Kalas offers vital new medically informed readings of these, highlighting the rich conceptual depth with which Kempe imbues her life story. Especially welcome is Kalas's handling of Book 2, which has received far less critical attention, often treated as of interest purely as a travelogue. Kalas notes that the significance of Kempe's producing Book 2 as an old woman has been little considered, pointing out Book 2's crucial status as Kempe's immediate recollections, which allow us to encounter her voice more authentically than in Book 1. This brings Kalas's characterization of the Book of Margery Kempe itself as a surrogate production to its climax, as she establishes the implications of Kempe's status as an elder, with all the term's connotations of both age and authority born of wisdom. This entails the intriguing classification of Kempe's pain infused narrative as an anamnestic production. Overall Kalas's study makes an extremely important and highly engaging contribution to existing scholarship on The Book of Margery Kempe and to the field of medical humanities more generally.