Sari Altschuler, The Medical Imagination: Literature and Health in the Early United States (Philadelphia: U of Pennsylvania P, 2018), 301 pp.

In a 2016 article in The Guardian, Phil Whitaker explains why a substantial number of well-known writers are also medical doctors. Whitaker, who belongs in this group himself, lists Anton Chekhov, Michael Crichton, Khaled Hosseini, and a few others, to state his point: “Their ability to feel what others feel, and simultaneously to view it with detachment, gives us perhaps our greatest strength as writers.” Importantly, it is the physician’s skills that pave the way towards writing as a profession, and not literary excellence that helps make a professional healer: doctors virtually read “[e]ach patient’s illness” as “a narrative—symptoms as the beginning, diagnosis as the ending—and a middle that weaves a coherent and irresistible path between the two.” Such explanations sound logical and comprehensible, yet they evoke new questions as well: why does it seem to be, almost exclusively, men, who translate their interaction with patients into poetry and prose? What motivates them to do so? Does their creative engagement inform their work as medical doctors? And, most importantly, perhaps: what do we learn about the medical profession, about writing, about an era, when we replace the hierarchical concept of the doctor-becoming-a-writer by the idea of a mutually inspiring relationship between two systems of knowledge acquisition?

Sari Altschuler’s The Medical Imagination: Literature and Health in the Early United States builds on this idea of reciprocity. The book approaches “the practice of writing” as a “valuable training of the medical mind” (5) and discusses a number of well-known American physician-writers who wrote poetry or prose between the American Revolution and the Civil War. As public intellectuals, they relied on what Altschuler calls “imaginative experimentation” (8-11) to study and discuss health-related topics, test medical theories, fill research gaps, and solve medical and philosophical contradictions. Unlike Joan Burbick’s Healing the Republic (1994) and other path-breaking publications in the field of medical humanities, The Medical Imagination does not reference physicians’ writings to make a general statement about national health or American culture: carefully researched and very readable, the book sketches out an intellectually agile and dynamic community of early American physician-writers. It sheds light on individual biographies and friendships, emphasizes generational and cross-generational connections and conversations, and carves out the political concerns of individual participants who steered the relationship between health and literature in new directions. These medical men believed in the power of narrative to either cure or cause harm, but instead of resorting to narratives of healing, they preferred to outline and discuss the relationship between art and science, “imaginative experimentation,” and “reductive, mechanistic paradigms” (102). Building on a variety of contexts, and rich in detail, The Medical Imagination offers an in-depth analysis of the life and oeuvre of key figures in American medical and literary history, including Benjamin Rush, Charles Brockden Brown, Robert Montgomery Bird, Samuel Gordon Morton, Edgar Allan Poe, Oliver Wendell Homes, Charles Caldwell, Samuel Latham Mitchell, and his son, Silas Weir. Their journey into literature was facilitated by a “long and robust tradition of literature and medicine” (3) that helped them to come to terms with, think about, gain knowledge of, and find new ways of understanding and communicating human health.

Being a physician-writer was a white and male privilege, yet a few African American doctors succeeded in claiming the role for themselves: James McCune Smith (the first African American to earn a medical degree, in England) and Martin Robinson Delaney (one of the first three African Americans admitted to Harvard Medical School), relied on the interplay between healing and writing to fight against slavery and the “scientific” racism of the pre-Civil War period. Since women were denied access to medical schools, Altschuler had to find alternative ways of bringing in gender as a category of analysis: The Medical Imagination discusses Delaney’s novel Blake, or, The Huts of America as a radical response to Harriet Beecher Stowe’s abolitionist reading of the cholera pandemic in Dred: A Tale of the Great Dismal Swamp (1856). The book also references the niece of Benjamin Rush, Rebecca Rush, and analyzes her novel Kelroy as “refashion[ing] her uncle’s ideas about the centrality of sympathy to health care in a largely female environment” (49).

Altschuler positions her choice of texts at historical crossroads that also structure the book: the American Revolution, Yellow Fever, Cholera, new insights in human evolution and biological differentiation, and the introduction of anesthesia—all of this changed how Americans perceived of the relationship between self and other, body and mind, citizen and nation. By focusing on works such as Medical Inquiries and Observations upon Diseases of the Mind (Rush), Arthur Mervyn (Brown), “The Fall of the House of Usher” (Poe), or “The Case of George Dedlow” (Mitchell), The Medical Imagination emphasizes a high degree of individual creativity in dealing with these challenges. Literary scholars might object that more could be said about the authors’ choice of genre and literary devices—after all, physical wounds and mental trauma often result in a struggle for form. The Medical Imagination does not neglect aesthetical issues, but it is not a book about literary strategies: its achievement consists in managing to bridge disciplines without becoming superficial. The result is a fascinating, multi-faceted portrait of several generations of physician-writers who moved easily between two systems of knowledge to negotiate the relationship between corporeal and governmental health (24), make epidemic crises meaningful (54), stimulate “a healthy imagination among citizens” (69), and explore the (in)significance of race and gender in an age of scientific differentiation and new democratic models (125).

Altschuler’s choice of “crises” as structuring device was not initially sensible to this reader because they seem to belong to vastly different categories. It makes a lot of sense, however, when one considers these moments in history as an attack on the philosophical, epistemic, and mental setup of a nation in the making, but also as crises of the medical imagination. Given that the time between the American Revolution and the Civil War was an era of intense political, social, and geographical transformation, but also of medical catastrophe and inventions, the book’s focus on the early United States is an auspicious choice for anyone interested in American intellectual history and culture, and in the emotions and moods that were typical for the nation’s educated elite. Altschuler’s basic premise that this prolonged phase of national self-definition created a need, and also urgency, to creatively reflect on the profession of “healer,” and exchange competing ideas about the meaning of health and the body, seems reasonable enough. One may want to add that this public conversation was a crucial part of that “quest for recognition” that Paul Starr describes as a typical trait among the medical profession in the early United States: unlike their European colleagues, U.S. physicians were not to the same degree recognized as national spokesmen (30).

The book’s focus on the early decades of the young and independent nation is strategically well selected: the arts and humanities were an intrinsic part of a proper medical education in America until the 1910 Flexner Report emphasized rationalism and empiricism (6). Yet while the historical scope of the book helps bridge the gulf between medical science and the humanities, its sole emphasis on professional physician-writers has its downside as well. As Starr and Robert C. Fuller have pointed out, sectarian practitioners such as Thompsonian herbalists, hydropaths, homeopaths, and mesmerists were very successful in early nineteenth-century America, and enjoyed high acclaim among the population. By excluding the competition for patients, but also instances of cooperation and intellectual debate that unfolded between educated physicians and other medical practitioners, The Medical Imagination misses an important philosophical and ethical dimension that was central to Brown, Poe, and Mitchell, who discussed questions of materialism and spirituality in their works of fiction.

From a cultural studies perspective, the inclusion of lay doctors, female nurses, and patients, a stronger emphasis on First Nations, African American, and other non-white communities, and references to religious contexts would have created a more conclusive impression of the relationship between medicine and literature in the early United States. As Katherine Clinton and Nina Silber, Drew Gilpin Faust, Lisa Long, and Elizabeth Young, have shown in their work on female nurses during the Civil War, such an endeavor would have called for a consideration of “private” genres (letters, diaries, journals) and second-hand reports about health and healing. Suffice it to say that including lay voices without abandoning the cultural figure of the physician-writer could be particularly promising when further exploring the “medical imagination” of early America.

Trained as a literary scholar and currently Director of Health, Humanities, and Society at Northeastern University, Altschuler wanted to move beyond the common assumption that the humanities can support the research and teaching in medical schools, and inspire “fields such as nursing, health policy, public health, and global health” (201). The Medical Imagination calls for the recognition of the humanities as a training ground for “humanistic competencies” (200) and encourages readers to (re)discover the value of art and the humanities as “methods of knowing” rather than “ways of feeling” (198): it was by imagining health, and by mentally and linguistically experimenting with ideas about human bodies and their ailments, that late eighteenth- and early nineteenth-century medical professionals in the United States were able to develop distinctly American approaches to diagnosing and healing their patients. One can only speculate how American medicine would have developed without physicians who resorted to poetry and fiction. American literature would be considerably poorer without what one might also call, by reversing the order of terms, the “writer-physician.”

Kirsten Twelbeck (Universität Augsburg)