The mingling of literature and medicine is foretold in Greek mythology where Apollo, God of Poetry is father to Aesculapius, God of Healing. This connection is a two-way street explored by the editors of ‘Literary Medicine: Diseases and Doctors in Novels, Theater and Film’.
In three previous publications the senior editor of this volume, J. Bogousslavsky, collaborated with others to describe the fascinating, sometimes unique, descriptions (often first hand) of neurological disorders in famous artists and musicians. These volumes are part of a larger series; ‘Frontiers in Neurology and Neuroscience’ (Series Editor J. Bogousslavsky) of which the publication reviewed here is Volume 31.
This volume expands the previous literary focus to describe how both diseases and doctors are portrayed across the literary spectrum in 19 chapters, 14 by single contributors, five in collaboration. The text includes an index of authors and topics. It is difficult to review for the same reason that it is a delight to read; a potpourri of diverse, intellectually stimulating and thought provoking styles and genres.
This reviewer discerns three distinct patterns intermingled; descriptions of seven disease entities involving individual authors (two concerning the authors own experience); eight clinical disorders drawn from descriptions by multiple authors and four authors whose oeuvre is examined as it portrays both doctors and diseases. Theater and film play only a minor role overall. I shall describe each of these patterns and discuss one example from each in depth.
The individual diseases and authors are Balzac (schizophrenia), Breton (poetic instability ushering in psychosis), Gerard (neurosis), Pirandello (misidentification), Dostoevsky (epilepsy), Van Gogh (personality disorder, epilepsy, psychosis) and Charcot (hysteria). Two of these, Breton and Van Gogh, describe their own experiences. In the novel ‘Nadja’ Breton recounts the case study of his intimate 10-day relationship with a poetic young woman who, 6 months later, develops a severe psychosis leading to a lifetime in asylums. Van Gogh's story is told from correspondence between the artist, his wife and brother as well as hospital files in the final 2 years of his life. The Charcot chapter is unusual because it is based on a review of his own and his associates involvement in theater, poetry and literature establishing the link between these interests and Charcot's public demonstrations (lessons) of hysterical phenomena which were ‘essentially carefully orchestrated theatrical exhibits’ with Charcot, ‘perhaps, when all is said and done, the greatest actor in his entourage’.
My favourite chapter in this single author genre is a review of ‘The Great Neurosis’ by Joseph Gerard in 1889, Paris. The author became a medical student after a 20-year military career during which he was wounded in battle and awarded the Legion of Honor by the Emperor of Prussia. Gerard obtained his first medical degree in America followed by a French baccalaureate in literature and science, completing his medical studies at the age of 49. Gerard's medical talents were many; he practiced hypnosis and specialised in artificial insemination. His literary output included a drama, comic opera libretto and controversial books for lay readers on medical topics. ‘The Great Neurosis’ included 230 amusing and erotic illustrations and a cover with a naked woman seated on a heart and grasping a brain stem. The text includes case histories reflecting themes then in vogue, some with surprisingly modern relevance. Gerard distinguishes major disorders from personality traits (Axis I and Axis II), advocates light therapy, the use of bromides and environmental interventions.
The diseases described from multiple sources include Migraine (seven works of fiction including ‘Dark Half’ by Stephen King, ‘When Nietzsche Wept’ by Irv Yalom, ‘Dr. Faustus’ by Thomas Mann and ‘Alice in Wonderland’ by Lewis Carroll); Amnesia (36 fictional works by authors that include Shakespeare, Balzac, Dickens, Hemingway, Kipling and Orwell); Psychopathy (19 scientific citations and a literary review of psychopaths in thrillers including Chaucer's ‘Canterbury Tales’, Shakespeare's ‘Merchant of Venice’, de Sade's ‘Les 120 Journees de Sodome’ and ending with Harris’ ‘Silence of the Lambs’; Alcoholism (17 scientific citations and multiple brief references to many different portrayals in poetry, novels and films); Parkinson's Disease (various aspects of the disease described by 11 contemporary authors); Hysteria (the 19th century French pre-occupation with hysteria as an illness reflected in scientific theories such as those of Briquet, Pinel, Charcot, Tourette and Babinski also portrayed by several contemporary novelists including Emil Zola) and, finally, Movement Disorders (six distinct types each illustrated by quotations from 29 literary sources including Dostoevsky, Waugh, Orwell, Tolstoy, Dickens and H.G. Wells).
The most ambitious and challenging chapter in this genre is also the longest (38 pages) and deals with the complex topic of morbid presentations of the ‘second self’ in literature; the alter ego, doppelganger or double epitomized by Robert Louis Stevenson's ‘The Strange case of Dr. Jekyll and Mr. Hyde’. The author uses this concept as a platform for a literary ‘tour de force’. Eight different taxonomies of the condition are identified and its various manifestations are illustrated in 37 novels, including Poe, Maupassant, Kipling, Conan Doyle and H.G. Wells. From a data base of 159 citations the author derives a ‘Tool box for applied studies of the Bodily Self’, a complex catalogue of manifold psychological and neurological manifestations of alterations in awareness of bodily self, framed in the contemporary vocabulary of cognitive neuroscience.
The third genre, and easiest to describe, is the four authors whose oeuvre is explored to describe either or both doctors and the diseases they deal with.
Blaize Cendrars was a veteran of service in the French Foreign Legion during the First World War. His view of psychiatry and psychiatrists was shaped partly by his own phantom limb pain following amputation of a forearm, depression following the death of his mother and a brief unsatisfactory stint as a medical student all of which left him with a lifelong distrust and dislike for psychoanalysis and alienists. His views are expressed in five of his novels two of which deal with mass murderers, one a fictional account (Moravagine) and the other a real serial killer (Febronio).
Marcel Proust's contribution is explored in a single novel, ‘In Search of Time’. Considered ‘the most important French literary work of the twentieth century’ it includes 25 minor characters suffering from assorted psychiatric and neurologic disorders (some borrowed from real life case studies) and many reflective of his own experiences with neurasthenia, hypochondriasis, a tendency to self-medicate and a ‘defiance and criticism of doctors’.
Chekhov wrote about doctors and patients in the latter half of the 19th century from the time he was a medical student until his death from tuberculosis at age 37. Physicians appear in six of his seven plays and many short stories with portraits of more than 30 medical characters and descriptions of hypochondriasis, hysteria, panic, depression, obsessions, hallucinations and paranoia.
Balzac's work appears in several places throughout this book but mainly in two chapters. The first deals only with the single novel ‘Louis Lambert’, published in 1832, in which the main character ‘provides the first complete and convincing description of schizophrenia’, 69 years before Kraepelin described dementia praecox and 76 years before Bleuler coined the word ‘schizophrenia’. This remarkable literary prescience is also evident in the examination of Balzac's entire oeuvre. It is discussed in the context of changes in the cultural and scientific zeitgeist of mid-19th century France. Culturally the country was on the cusp between romanticism and realism, while science and medicine were focusing on physiology and neuropsychiatry with many of the world's leading practitioners close at hand. Immersed in ‘an atmosphere saturated with everything scientific’ Balzac saw himself as a ‘doctor of social sciences’ interested in conventional medicine as well as magnetism, hypnosis and phrenology. He was also influenced by his father's experiences as administrator of Tour's Hospice and a coterie of friends and acquaintances, which included prominent physicians and scientists. His knowledge of both physiology and medicine was profound reflected in nuanced descriptions of his characters and their medical maladies. This chapters main focus is on Balzac's frank portrayal of different types of doctor; provincial, Parisian, unconventional, country and military. He used this palate to paint a broad picture of ‘society in all strata’ coupled with the advances in scientific theory and practice. The chapter lays a foundation for its author's concluding question, ‘Did Balzac not help to lay the foundations of what would become neuropsychiatry?’ This intriguing idea is a modern affirmation of the ancient myth that literature may be the descriptive progenitor of healing.
I hope this review provides the potential reader with an inviting picture of the complex and many-sided marriage between the arts and medicine. A few chapters may strain a medical neophyte's lexicon but others will delight and inform readers on either side of the aisle.
