Medicine as Storytelling: Emplotment Strategies in the Definition of Illness and Healing (1870-1930) The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Fratto, Elena. 2016. Medicine as Storytelling: Emplotment Strategies in the Definition of Illness and Healing (1870-1930). Doctoral dissertation, Harvard University, Graduate School of Arts & Sciences. Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:33493426 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA Medicine As Storytelling: Emplotment Strategies in the Definition of Illness and Healing (1870-1930) A dissertation presented by Elena Fratto to The Department of Comparative Literature in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the subject of Comparative Literature Harvard University Cambridge, Massachusetts April 2016 ©2016 – Elena Fratto All rights reserved. Dissertation Advisors: Professor William Mills Todd III, Elena Fratto Professor David S. Jones Medicine As Storytelling: Emplotment Strategies in the Definition of Illness and Healing (1870-1930) Abstract This dissertation analyzes medical and literary sources from Russia, Italy, and France in the years 1870-1930. By tracking imagery, rhetorical devices and, above all, emplotment strategies that are employed in medical texts and practices as well as in literary works by Dostoevskii, Tolstoi, Chekhov, Svevo, Bulgakov, and Romains, my study argues for the narrative structure of medical knowledge, both in its formulation and its transmission. I address plot-construction as the theoretical node that lies at the core of several practices in the medical field, regardless of their variety and their social and cultural situatedness. Perspective and agency are the organizing principles for chapter subdivision—from the surgeon as the sole author of illness narratives in Chapter 1, on death as the ending, which focuses on the late nineteenth century, we move to the negotiation of that same authorship and authority between doctors and patients in Chapter 2, devoted to the theoretical concept of narrative reliability and tracks the fin- de-siècle emergence of psychoanalysis; from the rhetoric of pharmaceutical advertisement in the 1920s and the diffused authorship it entails, addressed in Chapter 3, we take a post-human turn in Chapter 4, by exploring bodily glands as endowed with narrative agency with the rise of endocrinology and experimental surgery in the years 1900-1930. This formal structure, which shows a gradual shift in perspective and agency as the inquiry moves from one chapter to the next, foregrounds a double historical trajectory that underlies the project– the non-linear transition from the positivist model to the Freudian and post-Freudian stage in the history and epistemology of medicine runs parallel to a gradual and not less problematic evolution of the literary medium. ! iii TABLE OF CONTENTS INTRODUCTION...........................................................................................................................1 CHAPTER ONE The Grand Finale: Death as the Revelatory Ending.....................................................................16 1.1. Exploring the Body’s Interiority in Renaissance Literature: François Rabelais’s and Robert Burton’s “Synthetic” Method.....................................................24 1.2. Measure for Measure. The ‘Speechless’ Patient in Late Nineteenth-Century Neurology, and Cesare Lombroso’s “Social Anatomy” of Dostoevskii and Tolstoi........................................53 1.3. Storytelling ex post facto and the Narrative Structure of the CPC.........................................77 CHAPTER TWO The Patient As ‘Unreliable Narrator’. The Evolution of a Category at the Turn of the Century. 2.1. Case Studies from Nineteenth-Century Russian Prose: Gogol’, Tolstoi, and Chekhov........................................................................................................85 2.2. The Patient Talks Back: Authorship and Psychoanalysis in Vienna and Trieste. Freud’s Dora, or the Narrator Who Coughs.....................................................................112 Sickness As Narrative Reliability? The ‘Inetto’ as Storyteller in Svevo’s Zeno’s Conscience...................................118 CHAPTER THREE "Tout homme bien portant est un malade qui s'ignore:" Storytelling in the âge médicale...................................................................................................136 CHAPTER FOUR Time, Agency, and Bodily Glands: Metabolic Storytelling in Italo Svevo and Mikhail Bulgakov.....................................................175 CONCLUSIONS.........................................................................................................................208 WORKS CITED..........................................................................................................................212 ! iv ACKNOWLEDGEMENTS I would like to express my deepest gratitude to my advisors, Professors William Mills Todd III, David S. Jones, Tom Conley, and Jeffrey T. Schnapp, who have been indefatigable readers, exceptional interlocutors and superb mentors over these past few years. I thank them for their critical remarks, their invaluable comments, their engagement in this project and their support all throughout. I also thank Jeremy Greene for encouraging me to pursue a dissertation topic that was unusual in the History of Science and Kathryn Montgomery for the long conversations and the brainstorming we had in Chicago as the prospectus was taking shape. Scholars of all disciplines have been very generous with their time and guidance since the early days of this work. The Department of Comparative Literature and the Davis Center for Russian and Eurasian Studies provided me with the logistical resources that I needed in order to pursue my research, while the Music Department largely contributed to my thriving by supplying practice rooms as well as remarkable, unforgettable courses and seminars on jazz improvisation. An extraordinary scholarly and non-scholarly community in the Cambridge/Boston area and beyond has been nourishing my imagination and intellectual curiosity continuously for the past six years, which has been conducive to the formulation of ambitious and exciting research projects. Finally, I am very grateful to Project Narrative at Ohio State University, especially to James Phelan, Brian McHale, and Amy Shuman, for their exquisitely warm hospitality and their precious guidance during my residence as a visiting scholar in 2015-16. My experience at Project Narrative and in Columbus was invaluable, and the feedback on my work that I received from colleagues and friends on and off campus allowed me to sharpen the focus and tighten up the argument of this dissertation, besides making it more conversant with recent theories of narrative. Most of all, I am grateful to my dear ones for their graciousness, their patience, and their inexhaustible love. ! v A Zampa ! vi Introduction This project rests upon the assumption that medicine, similarly to literature and the arts, is a system of representation. As a consequence, medical knowledge—in both its formulation and its transmission—entail a substantial interpretive endeavor on the part of those involved in the description of the body (its discrete parts as well as its functions) and the definition of illness and healing—most notably, patients and physicians, but also institutions, authorities, insurance companies, and caregivers. Interpretation, which is by its nature site-specific and necessarily rooted in the socio-cultural background of those who perform it, calls for one or more narratives. More specifically, my argument is that the interpretive nature of medicine, as both a field of knowledge and a set of practices that involve a number of actors, makes medical narratives subject to most of the rules that underlie the production, transmission and reception of literary texts. Why Theories of Narrative?1 This is not a thematic account of how doctors, patients or diseases are portrayed in literary texts; nor is this a project anchored in psychoanalysis and psychoanalytic theories of literature, a glorious trend that flowered in the 1960s and brought together different ways of looking at storytelling. Moreover, my approach and the nature of the evidence I bring dispense with fieldwork, and should therefore be distinguished from the ethnographic genre of medical anthropology. The present inquiry, rather, stems from the argument that theories of narrative, originally a stronghold of literary studies but increasingly an intellectual and theoretical concern !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 1 All the authors and works mentioned in this Introduction may be found in my list of Works Cited. ! 1 for the most disparate disciplines (from law to evolutionary biology, from IT to entomology, from post-humanities to architecture) provide an invaluable toolbox of categories and definitions that can be employed fruitfully to approach the field of medicine from a humanistic perspective. Symptomatically, theories of narrative, today flanked in importance by other methodological trends in the literary field (such as World literature, the digital