Karen Laura Thornber, Global Healing: Literature, Advocacy, Care

Karen Laura Thornber, Global Healing: Literature, Advocacy, Care (Leiden and Boston: Brill | Rodopi, 2020) 693 pp. $190 hardback, ISBN: 978-90-04-42017-5

Karen Laura Thornber’s Global Healing is a capacious monograph that grapples with contemporaneity, globality, and medicine through an accumulating survey of literary texts engaged with matters of illness, treatment, health stigmas, outcome disparity, dying, patient choice, and care. The book’s 700 pages follow the logistical and stylistic energy of Thornber’s similarly expansive earlier work, Ecoambiguity. In that text, Thornber mobilised her language skills and expertise in comparative literature to offer a worldwide-scaled reconsideration of the emergent field of environmental humanities. Here, Thornber pulls a parallel exercise in intellectual labour, only this time the field is the (ever) emergent medical humanities, with Thornber drawing upon an extensive library of global literature texts that she argues can inform, transform, and offer ‘explicit guidance’ (7) for the implementation and enaction of (health)care practices and policy.

Global Healing’s greatest potential resides precisely in its range of texts, language, and attentiveness to translation. In its voluminosity alone—what we might call the text’s world-traveling impulses—Thornber embarks upon the important work of de-centring the medical humanities from Anglophone research inclinations. Its strongest readings, some of which I will mention below, are therefore those foregrounding the ‘spatially and linguistically mobile’ qualities of texts (323). Thornber’s meticulous documentation of various discrepancies of meaning across a text’s translations (to name a small selection, from Korean to Urdu, to English from Arabic, comparing Japanese with French) are ways for Thornber to manifest an implicit research question: how to conceptualise and signify the scales, configurations, and networks of illness experience and healthcare interventions within both ‘global health’ and local iterations of globally networked medicine.

With capaciousness, of course, comes a capacious vulnerability. A concern of this review will be to think through some of the consequences of holding together the enormous range of materials that Thornber holds together here. I found myself interested in the monograph’s interstitial logic, that is, the interconnected moves that Thornber makes in order to pass from text to text, compare narrative, contrast character, offer moral and aesthetic judgments, and so forth. I was compelled to understand how an idea of the global itself comes together with such interweaving, and I will document below some worries I have about the global as a quotidian geographization of universalism that emerges through Thornber’s grouping of healing imaginaries, modes of inter-relating literature, and even Paul Gilroy’s ‘planetary’ humanism (12). Certainly, you cannot really discuss this book without talking about its size—its global ambitions mirrored in its acquisitive arrangements, its weight (!), lengthy footnote digressions, and bibliographic abundance.

After an introduction that surveys recent developments in both comparative literature and the health humanities, the monograph is structured into three parts. Part 1, ‘Shattering Stigmas’, attends to the role of literature in combatting stigmas against health conditions. ‘To be sure, literature also has generated and/or reinforced stigmas,’ concedes Thornber, ‘but in more recent decades the majority of narratives have tried to expose, moderate, and unravel stigma, to overturn the meanings we give health conditions despite the scientific evidence’ (41). Taking stigma as this problem of ignorance and literature as this arc of progressiveness, Part 1 then splits into a further four chapters that focus on literary responses to specific illness conditions—one chapter on leprosy, two chapters on HIV/AIDS, and an entr’acte on Alzheimer’s. Notable in this section is an extended reading of Korean-language novel Your Paradise (1976) by Yi Ch’ongjun, a fictionalisation of the notorious Sorokdo leprosarium in South Korea where abuses of leprosy patients were perpetrated by both Japanese then Korean administrations. Though I was disappointed by Thornber’s disinterest in reading the text as an allegory of postcolonial governance, her attention to how the novel’s translations subtly shift emphases away from and towards patient culpability indicates what can be achieved by translational approaches to illness texts. Thornber argues that by not using a single term to translate “betrayal”, an Urdu-language translation ‘probes more deeply… what it means to have subjectivity denied and rejected’ (87).

More could have been done to unite the structure of Part 1. Thornber comments that leprosy and HIV/AIDS are ‘often linked as two of the most stigmatized [diseases] in history’ (97), but I would have liked Chapter 2’s opening observation about how writers like Larry Kramer and Siphiwo Mahala use the figure of the leper to codify their conceptualisations of HIV/AIDS to be unpacked further. I wonder whether the discussions of leper colonies like Sorokdo, Moloka‘i in Hawaii, and Tichileşti in Romania could be applied to more explicit explorations of the capacity of healthcare governance to exile and exclude in ways mutually instructive to interrogating the racist and homophobic responses to the HIV/AIDS pandemic. João Biehl’s work on ‘zones of abandonment’ might have offered a counterpart to think through how medical treatment, social care programs, and flows of funding capital can in fact deepen processes of stigmatising disenfranchisement.

Part 2, ‘Humanizing Healthcare’, is the monograph’s largest section and turns towards what is arguably its central conviction: person-focused care as a morally desirable form of medical treatment. Rather than grouping chapters around specific illness conditions, this section organises its chosen texts in ways that allow for different sorts of care practices to be compared. In an introductory chapter, Thornber uses cases ranging from breast cancer, dementia, and epilepsy as a way to discuss the efficacy of Moira Stewart and W. Wayne Johnson’s patient-centred approach to clinical practice—an approach that, Thornber is keen to note, has been integrated internationally (207). The ‘ultimate goal of this type of care,’ Thornber concludes by drawing upon a range of U.S.-based health theorists (e.g., Cassell, Charon, and Danielle Ofri), is ‘not merely or necessarily curing (i.e., eradicating disease) but instead healing, that is to say, enabling the physical, mental, and social wellbeing of the patient’ (214-5).

This sets up Thornber for Chapter 4, ‘Contrasts in Care’, in which she reads multiple works of literature as exposing and therefore aiding the dismantlement of healthcare’s ‘tacit curriculum’, which, in rejecting a person-focused approach, dehumanises its patients (282). Chapter 5 is concerned with novels (by J. M. Coetzee, Mohammed Hanif, Ogawa Yōko, and Bapsi Sidhwa) that address the harmful consequences of care workers assuming they can speak on behalf of their patients. Chapter 6, ‘Medically Treating, Not Healing’, explores (largely through the role of female physicians in literature) some of the challenges of care in the context of the rise in patients requiring the ‘management’ of long-term conditions rather than the sudden treatment of acute ones (330). Chapter 7, ‘Interventions in Dying’, presents readings on a very diverse range of literary texts, from Li Shijiang’s surreal short story “The Hospital” (2006) through to Amitav Ghosh’s conspiracy novel The Calcutta Chromosome (1995), in order to emphasise the paradoxes that emerge from death and treatment in healthcare practice.

These paradoxes are variously scaled. The paradox in Wang Jinkang’s thriller Level-Four Panic (2015) is that eradicating smallpox will ultimately make a biowarfare-induced smallpox pandemic worse. The paradox in Setoue Kenjiro’s memoir Dr. Setoue’s Outlying Islands Clinic Diary (2006) is a product of Setoue coming to terms with respecting a patient’s choices to alleviate pain and confront death. Such scaling up and scaling down indicates Thornber’s formalistic preoccupation with contradiction and productively speaks back to her earlier interests in literary-environmental activism [1]. That said, I would have liked Thornber to have navigated these micro- and macro-double binds of human bodies in ecosystems with greater critical precision. In one instance, I was dismayed when a paragraph begins by reassuring the reader that Calcutta Chromosome’s anti-coloniality (its documentation of how malarial control initiatives acted in concert with colonialist agendas) is ‘an extreme position and one not necessarily advocated by Ghosh himself’ (448). The autoimmunitary claim that ‘disease spares the planet even greater anthropogenic destruction’ is then proposed as the less egregious reading (448), despite echoing the eco-fascistic memes we see in the wake of global pandemics, e.g., “viruses are the cure”.

In Part 3, ‘Prioritizing Partnerships’, Thornber shifts from ‘person-focused care’ towards texts that ‘reveal’ the ‘urgency of providing family members/close friends with the support… they need to become effective family care partners’ (473). In Chapter 8, ‘Promoting Partnerships in Living, Sharing Care’, Thornber uses this interpersonal approach to survey texts grouped under three themes: first, those that explore how caregivers must alter their expectations of loved ones with dementia, then texts that explore the role of deception in the treatment of patients who are dying, and finally texts where caregivers respond to patients’ decisions to reject treatment (480-1). Chapter 9, ‘Providing Partnerships in Dying, Easing Death’, picks up this final theme in order to explore a collection of texts that represent caregivers who must negotiate with their loved ones about the plausibility of a “right” death. In this final section, Thornber uses literature and life-writing to advocate clearer legal protections for those who make such difficult ethical decisions: ‘these works of global literature plead that people be shown mercy at the end of their lives’ (542).

The notion that literature might ‘plead’ for anything indicates how, over the course of Global Healing, Thornber accrues global literature with a strikingly agential actionability. We can detect this in her choice of verbs: literary works make calls ‘to action’ (7), texts ‘reinforce’ the urgency of global health intervention (65), literature ‘argues’ things about stigmas (94), writings ‘underscore how essential a more person-focused approach’ is ‘in promoting healing and attaining wellbeing’ (229), fiction and memoir writers ‘make a strong case for treating patients humanely’ (268). Repeatedly, Thornber assesses the merits of any given text by the strength with which it achieves this instrumentalized fidelity to pre-established bioethical ideals. At play in Thornber’s writing, in other words, is an explication of what value she thinks literature holds for a medical humanist: it must be instrumentalized, it must support an argument for ethical healthcare, and any complexity or contradiction in its delineation of person-focused healthcare are points counted against rather than for the strength of a text.

This is perhaps unfair, because the texts assembled in Global Healing are assembled for Thornber’s own purposes and not for any wider claim about the instrumentalization of literary value. All I wish to add, therefore, is that the monograph signalled to me that further work must be done on the material emergence of instrumentalizability as a value in global literature and health humanities research. Thornber’s priorities are highlighted in the Introduction when she cites Jane Macnaughton’s claim that literature can play an ‘instrumental role in medical education’, adding in a footnote how Macnaughton additionally claims a ‘non-instrumental value of the humanities… as a “counterculture” to medicine’ (19). By only gesturing towards such a tension, Thornber misses an opportunity to engage critically with the development of literature as advocacy and instead takes it as a given that literary texts are there to function as liberal humanistic expressions of care.

Consequently, in my view, the monograph’s most critically interesting readings are of texts that explicitly state their claims to literariness through a pedagogic or instructive function—e.g., the theatre-in-education of Sekundo Morgan’s The Beast 1 (146)—or of translations where the political function of the text is editorially altered to clear the way for morally righteous medical imaginaries—e.g., the incongruous substitution of essays that critique capitalism with essays that highlight female genital mutilation (FGM) in English-language anthologies of Nawal al-Sa’dawi’s writings (271). It is in such readings that Thornber’s attention to translation’s discrepancies are embedded most promisingly towards a consideration of healing as a globally constituted (and contested) political practice. How al-Sa’dawi’s use of ‘عار’ (‘shame’ or ‘nakedness’ in English-language translations) is negotiated across translation is similarly insightful (273).

These generative readings, however, are habitually thwarted by Thornber’s view of the literary text as an object that produces, mediates, or highlights similarity across difference. ‘The more I read,’ Thornber writes, ‘the more patterns and connections became visible, and the more it became clear how each story fit into a broader global context.’ She continues: ‘Global Healing is particularly concerned with the value of these writings beyond their source cultures, including the interplays among local, regional, and global settings, and how these writings resonate with counterparts emanating from seemingly disparate sites. This is particularly important because of the striking and frequently unexpected similarities in illness experiences and the need for healing care around the world’ (8).

Thornber’s argumentation therefore adopts the odd strategy of highlighting disparities across translations in order to demonstrate a common bioethic in play at the level of the global. It is a gambit that left me wanting to understand more about how Thornber might encounter contradiction across texts without resorting to the pre-structured evaluative models of person-focused clinical policy. The reader is shown fascinating incongruities between different versions of the same text, only to then be told that this ultimately proves, say, that person-focused care can be hard or that all cultures misunderstand illness. In the case of Ogawa’s Equations the Professor Loved, Thornber argues that the ways translations differ in their description of the eponymous professor’s braincells show how it is ‘exceptionally difficult’ for a caregiver to work out what to offer someone with brain injury, and that there is a ‘continued lack of understanding about brain disorders and the experiences of those who live with them’ (313). To insist that discrepancies of interpretation only evidence the uninterpretable seems unhelpful, too reliant on an uninterrogated notion of “culture” and the ringfencing of pathological states, as if someone with an acquired brain injury is any more or any less mysterious than anyone else.

Certainly, the monograph serves as an expansive provocation for health researchers and narrative medicine practitioners who root their canons of illness texts within all-too-familiar cultural landscapes and hierarchies. And in its surveying of person-focused healthcare, it will aid critics interested in engaging with the pre-critical turn of the health humanities. That said, I suggest that the key value of Global Healing lies precisely in the fault-lines it encounters (and sidesteps) as it charts its huge archive. That these tensions emerge through Thornber’s ambition to broaden medical humanities in the service of person-focused and family-centred care warrants theoretical attention to the constitutional biases of those disciplinary apparatuses.

It has recently been remarked in care studies that however much care is ‘capacious enough to hold together a conversation among people who come from different traditions of scholarship’, it is vital to not presume to know why care works across contexts [2]. Beyond demonstrating the “global effectiveness”/“universal value” of a particular demarcation of person-focused care, I wonder how the extraordinary reach of Thornber’s monograph could be put to future work in order to trace the role of care in hegemonic flows of power, to re-evaluate the authorial interpellations of translators and readers, and to consider how sociographic imaginaries are entangled within the global production of stigma, debility, and pathologisation.

James Rakoczi, King's College London

[1] See Karen Thornber, “Ishimure Michiko and Global Ecocriticism”, Asia-Pacific Journal, 14.3.6 (2016), pp. 1-23.

[2] Catelijne Coopmans and Karen M. McNamara, “Care in Translation: Care-ful Research in Medical Settings”, East Asian Science, Technology and Society, 14 (2020), pp. 1-14 (p. 3).