Meegan Kennedy, Revising the Clinic

Meegan Kennedy, Revising the Clinic: Vision and Representation in Victorian Medical Narrative and the Novel (Columbus: Ohio State University Press, 2010), 261 pp. $39.95 hb ISBN 978-0-8142-1116-8

Meegan Kennedy’s first book, Revising the Clinic: Vision and Representation in Victorian Medical Narrative and the Novel, offers a head-on and provocative exploration into how Victorian medical practitioners and novelists shared a central concern for ‘seeing and stating’: observation and documentation. This new examination builds on the work of Gillian Beer who famously suggested that the interdisciplinary study of literature and science is a two way street, with ideas travelling and reciprocating as they move from one discipline to another. Kennedy’s work goes one step further by examining how, and more crucially, why physicians and novelists were in dialogue with each other and shared similar strategies of clinical realism. Novelists such as Charles Dickens and Elizabeth Gaskell are examined against extensive primary medical narratives in the form of case histories. For Dickens and Gaskell, this examination is through the notion of sentimentality, while George Eliot is explored through her realist vision. The medical case is explored as a realist narrative in which physicians could search for truth through observation and analysis, which, Kennedy argues, could not be achieved in other medical texts. She maps the relationship and dialogue between medical case histories and literary narratives from the ‘curious’ case studies of the eighteenth century to the ‘clinical and psychoanalytic’ case studies of the nineteenth century, which reflected the new methodical modes of mechanical observation that helped create realism. ‘Curious’ cases became ‘interesting’ cases, often displaying melodrama to provoke emotion.

Kennedy’s account is supported by numerous and solid primary sources, which focus on pain and poignant last words. Sentimental medicine and the sentimental gaze are explored through works such as Dombey and Son and Ruth by Dickens and Gaskell, who use the sentimental gaze to bring communities together through observation. The death of Paul in Dombey and Son is described as a moving episode. However, Kennedy states that the cause of death is ‘frustratingly unclear’, unlike the realist medical narrative in Ruth, which focuses on the details of illness. Paul’s ambiguous fragility is typical of sentimental fiction, with Dickens choosing to focus on the characters’ morality and spirituality. This is also explored in the death of Little Nell in The Old Curiosity Shop. Kennedy notes that sentimental fiction aimed to ‘collapse the distance between page and reader’; this is achieved by the reader’s ability to view Nell’s death.

Modernity in the nineteenth century was an accumulation of urbanising processes, which created a multi-layered society. According to Lynda Nead, reformers saw London as a colossal body, consuming goods and people, while medical practitioners saw an individual body as an organic machine, which could be divided into smaller systems. Medical views of the body were influenced by the cultural views of society, namely the need for division, while cultural views of London became predisposed and fashioned by science. Tensions created through expansion caused dislocation. The need for power, truth and reassurances through making the unknowable known is epitomised in the work of Michel Foucault. Kennedy explores the notion of observation and transparency as a realm in which to explore truth-telling in Eliot’s novel Adam Bede, while it is posited that the physician’s trained clinical gaze is often represented in the Victorian novel as an accurate evaluation, a point that is convincingly supported by the exploration of Dr Rider in Margaret Oliphant’s The Rector and the Doctor’s Family (1863), who easily shifts into both a professional and authoritative mode. Interestingly, Kennedy suggests that Rider’s gaze is not understandable in Foucauldian terms, as it is in fact both clinical and humanitarian. Oliphant is clearly exploring medical strategies of visual knowledge within the flexible framework of the novel. This example supports Kennedy’s notion that some novelists were interested ‘in the relation between the two modes of vision’.

Kennedy argues that both clinical case histories and the sentimental novel were shaped by context, such as the social pressure of the explosion of print. Mass publication and distribution meant that there was a ‘commons’ where physicians and novelists could be shaped by each other’s strategies; medical literature adapted the novelist’s sentimental approach as a way of provoking sympathy, while novelists used clinical methods of scrutiny to create realism. Both strove for knowledge and truth through ‘seeing and stating’. Although these truths were inevitably different, both the medical case history and the novel were shaped by each other.

In the final chapter, the development of the novel and the case history is mapped beyond the clinical studies of the nineteenth century, with Kennedy focusing on Freud’s use of nineteenth-century ‘imperial romance’ to establish and sanction his search for truth. This is explored through Freud’s earliest case histories, which are particularly romantic and imaginative. Freud’s work is both sentimental and realistic. However this is problematic; sympathy is often juxtaposed with the clinical gaze, as Freud strove for a more analytic realm in which to explore psychoanalysis. After in-depth analysis, Kennedy persuasively concludes that by the beginning of the twentieth century, novelists could draw upon both clinical and Freudian case histories; however the novel was no longer a model for medical practitioners.

Revising the Clinic convincingly posits the notion that physicians and novelists were writers working within their own narrative form. Kennedy’s examination of how and why medical practitioners and novelists were in dialogue provides powerful and compelling insights into the cultural encounters between medicine and literature during the nineteenth century.

Kate Gazzard, University of Reading