Introduction: “Literature and Medicine: The State of the Field” by G. S. Rousseau
“Literature and Medicine: The State of the Field” by G. S. Rousseau first appeared in Isis in September 1981 (Vol. 72, No. 3, pp. 406-424), published by The University of Chicago Press on behalf of The History of Science Society. In this seminal article, Rousseau examines the neglected interdisciplinary relationship between literature and medicine, arguing that while literature and science have long been studied together, the interplay between literature and medicine has received far less scholarly attention. He highlights the historical presence of medical themes in literature, from classical antiquity to modern novels, demonstrating that medicine has provided literature with rich metaphors, character types, and narrative structures. Conversely, he also suggests that literature has influenced medical discourse, shaping the language and conceptual frameworks of medical practitioners. Rousseau critiques the historiographical approaches that have traditionally framed the interaction between these disciplines, particularly the tendency to view medical influence on literature as a unidirectional process. Instead, he advocates for a more nuanced, reciprocal understanding of how literature and medicine shape each other. His work is significant in literary theory and cultural studies, as it challenges conventional disciplinary boundaries and underscores the importance of language, metaphor, and narrative in both medical and literary traditions. By tracing the evolution of medical themes and the portrayal of physicians and patients in literature, Rousseau’s article lays the groundwork for the development of medical humanities as a distinct academic field.
Summary of “Literature and Medicine: The State of the Field” by G. S. Rousseau
- The Neglected Relationship Between Literature and Medicine
- Unlike the well-established field of literature and science, the interplay between literature and medicine has been largely overlooked by scholars (Rousseau, 1981, p. 406). Rousseau argues that this neglect is not due to a lack of interaction between the two fields but rather a misunderstanding of their mutual influence. He traces medical themes in literature from classical antiquity to modern times, citing works such as Middlemarch, Ulysses, and The Magic Mountain as examples of literature deeply engaged with medical concerns (p. 407).
- Historiographical Assumptions in the Study of Literature and Medicine
- Rousseau identifies problematic assumptions in existing scholarship, particularly the belief that medical knowledge flows unidirectionally into literature. He critiques the traditional historicist approach, which emphasizes periodization and assumes that authors were simply “well grounded” in the medical concepts of their time (p. 408). He calls for a broader perspective that recognizes literature’s reciprocal influence on medicine.
- Medicine’s Contribution to Literary Themes and Characters
- Medicine has provided literature with metaphors, character types, and narrative structures (p. 409). Rousseau explores how medical knowledge shaped literary works such as The Anatomy of Melancholy, Shakespeare’s plays, and 19th-century realist novels, where doctors and illnesses often serve as key plot elements (p. 410). He notes that literary representations of medicine are often shaped by prevailing medical theories of the era.
- The Overlooked Influence of Literature on Medical Thought
- While medical ideas have influenced literature, Rousseau argues that literary works have also shaped medical discourse, yet this influence has been largely ignored by historians of science (p. 412). He provides examples of how literature has influenced medical case histories, the language of disease, and the social perception of illness. He suggests that literature has played a role in constructing cultural stereotypes of disease, such as tuberculosis in the Romantic era (p. 413).
- The Literary Case History and Its Impact on Medicine
- Rousseau examines how literature has shaped the format and perception of medical case histories. He points out that medical autobiographies, such as Thomas Perceval’s Narrative of the Treatment Experienced by a Gentleman, share literary techniques with contemporary novels (p. 414). He argues that literary case histories contribute to medical self-perception and the development of the doctor-patient relationship.
- Science Fiction and Medical Utopias
- Science fiction and speculative literature have played a role in shaping medical imagination by exploring hypothetical diseases and medical utopias (p. 415). Rousseau highlights how medical science fiction often critiques the medical profession while simultaneously envisioning idealized medical futures. He suggests that literature provides a framework for understanding the societal impact of medical advancements.
- The Image of the Physician in Literature
- The physician has been a recurring figure in literature, often depicted either as a noble healer or as a greedy, arrogant figure (p. 417). Rousseau calls for a comprehensive study of the literary portrayal of doctors throughout history, noting that literature provides insight into public perceptions of the medical profession. He suggests that the recurrent themes of greed and incompetence in fictional doctors reflect deep-seated cultural anxieties about medicine.
- The Physician as Writer: Literature’s Role in Medical Self-Perception
- Rousseau examines the phenomenon of doctors as literary figures, from Thomas Campion to William Carlos Williams (p. 419). He suggests that physician-writers often use literature to construct their professional identity and reflect on the practice of medicine. He argues that literature plays a crucial role in shaping how doctors view themselves and their work.
- The Physician as Cultural Hero and Anti-Hero
- During the 18th and 19th centuries, the physician was increasingly viewed as a cultural hero, yet this status was fraught with contradictions (p. 421). Rousseau notes that while doctors were sometimes romanticized as saviors, they were also criticized for their authority and institutional power. He argues that literature has played a key role in constructing and deconstructing the image of the doctor as a heroic figure.
- Future Directions for the Study of Literature and Medicine
- Rousseau concludes by calling for a more interdisciplinary approach that recognizes literature’s impact on medical thought (p. 423). He argues that literary scholars and medical historians should collaborate to better understand how literature has influenced medical language, patient narratives, and the social role of doctors. He warns, however, that literature should not be viewed as a practical guide to medicine but rather as a theoretical field that enriches our understanding of medical culture.
- Conclusion
- Rousseau’s article is a foundational work in the field of medical humanities. He challenges the traditional view that medicine influences literature in a one-way relationship and instead argues for a reciprocal model where literature shapes medical thought just as much as medicine influences literary narratives. His call for interdisciplinary study has paved the way for further research into the cultural intersections between literature and medicine.
Theoretical Terms/Concepts in “Literature and Medicine: The State of the Field” by G. S. Rousseau
| Theoretical Term/Concept | Definition/Explanation | Context in Rousseau’s Argument |
| Historiography | The study of historical writing and methodologies used to interpret history. | Rousseau critiques how literature and medicine have been historically studied, emphasizing the need for broader historiographical perspectives (p. 408). |
| Periodization | The division of history into distinct periods for analysis. | Rousseau critiques the assumption that literature and medicine must be studied strictly within historical periods, arguing that influence can cross temporal boundaries (p. 409). |
| Directional Influence | The assumption that one field (e.g., medicine) influences another (e.g., literature) in a one-way process. | Rousseau challenges the traditional belief that medicine influences literature without considering how literature shapes medical thought (p. 412). |
| Medical Metaphor | The use of illness and medical terminology as metaphors in literature and everyday discourse. | Rousseau discusses how literature has shaped public perceptions of disease through metaphor, such as the romanticization of tuberculosis (p. 415). |
| Case History as Narrative | The idea that medical case histories share literary structures and narrative techniques. | Rousseau argues that medical case histories should be analyzed as literary texts to understand how doctors and patients construct medical narratives (p. 414). |
| Medical Utopia | A speculative vision of a society where medical advancements eliminate disease and suffering. | Science fiction and utopian literature explore idealized medical systems, revealing cultural anxieties and aspirations about healthcare (p. 415). |
| Cultural Hero vs. Anti-Hero | The portrayal of figures as either noble saviors or morally flawed characters. | Rousseau examines how doctors are depicted in literature as both heroic healers and greedy, arrogant figures, reflecting societal attitudes toward medicine (p. 421). |
| Constitutive Subject | A subject that is historically and culturally constructed rather than naturally given. | Influenced by Foucault, Rousseau argues that the identity of the physician, patient, and medical history itself are constructed through literature and discourse (p. 419). |
| Medical Historicism | The belief that medical knowledge and practices should be understood in their historical context. | Rousseau critiques traditional historicist approaches that focus solely on the progression of medical knowledge without considering literary influences (p. 410). |
| Language as a Cultural Archive | The idea that language preserves cultural attitudes and biases over time. | Rousseau suggests that medical language, including metaphors and disease classifications, reflects societal values and literary influences (p. 423). |
| Romanticization of Disease | The cultural tendency to idealize certain illnesses, associating them with heightened sensitivity or artistic genius. | Rousseau discusses how tuberculosis in the 19th century and cancer in the 20th century have been shaped by literary narratives (p. 413). |
| Interdisciplinarity | The integration of different fields of study to develop new perspectives. | Rousseau calls for an interdisciplinary approach to studying literature and medicine, bridging literary criticism and medical history (p. 423). |
| Social Construction of Illness | The idea that perceptions of disease are shaped by cultural, social, and historical contexts. | Rousseau argues that illness is not just a biological reality but also a cultural construct influenced by literature (p. 415). |
| Physician-Writer Identity | The concept that doctors who write literature construct their professional identity through storytelling. | Rousseau explores how physician-authors such as William Carlos Williams and Chekhov use literature to define their roles as doctors (p. 419). |
| Placebo Effect of Language | The psychological impact of medical language and communication on patients. | Rousseau hints at the idea that medical rhetoric influences patient perception and treatment outcomes, though it remains underexplored in medical literature (p. 424). |
Contribution of “Literature and Medicine: The State of the Field” by G. S. Rousseau to Literary Theory/Theories
1. Historicism and New Historicism
Contribution:
- Rousseau critiques traditional historicist approaches that assume a one-directional influence from medicine to literature and argues for a more complex, reciprocal relationship.
- He calls for contextualizing medical and literary texts together rather than viewing literature as passively influenced by medical history.
- His argument aligns with New Historicism, which emphasizes the interconnectedness of literature and its historical/cultural context.
Reference from the article:
“In these studies from medicine to literature each period is unfortunately associated with a particular type of medicine: the one that is popularized and mythologized and that will influence creative writers” (p. 410).
- This reflects New Historicist concerns with how cultural discourses, including medical theories, circulate within literature rather than existing in separate spheres.
2. Foucauldian Discourse Analysis
Contribution:
- Rousseau engages with Michel Foucault’s ideas on the construction of medical knowledge, the clinic, and the role of discourse in shaping social institutions.
- He applies Foucault’s theory to literature, arguing that literary texts shape medical discourses as much as they reflect them.
- He explores the formation of the physician as a “constitutive subject”, following Foucault’s claim that knowledge systems produce identities rather than merely documenting reality.
Reference from the article:
“Before we ask how the physician came to think of himself as a writer, we must inquire how he developed the capacity (i.e., what imagery he used) to view himself as a doctor” (p. 419).
- This aligns with Foucault’s ideas on the ‘medical gaze’ and how institutionalized discourses create professional and social identities (as seen in The Birth of the Clinic).
3. Reader-Response Theory
Contribution:
- Rousseau indirectly supports Reader-Response Theory by emphasizing how literary representations of illness shape reader perceptions of disease and medicine.
- He suggests that the cultural reception of medical metaphors and narratives influences personal and societal understandings of health and illness.
Reference from the article:
“Literature and medicine, construed in this sense, share a common concern to articulate a culturally conditioned medical perception of general attitudes towards life and death” (p. 410).
- This supports Stanley Fish’s argument that interpretation is shaped by cultural frameworks, including medical discourse.
4. Structuralism and Semiotics
Contribution:
- Rousseau analyzes the language of medicine as a semiotic system, emphasizing how medical terminology and metaphors function as signs that structure human understanding of illness.
- His work aligns with Roland Barthes’ structuralist approach to mythologies, where cultural meanings are encoded in language.
Reference from the article:
“Language is a common ground in literature and medicine; metaphors commonly used in both fields require scrutiny: ‘wasting away,’ ‘invaded by,’ ‘personality type’” (p. 412).
- This corresponds to Barthes’ idea of ‘mythologies’, where seemingly neutral terms carry ideological weight.
5. Psychoanalytic Literary Theory
Contribution:
- Rousseau suggests that literature’s portrayal of disease is often deeply psychological, reflecting both societal anxieties and individual neuroses.
- He explores how patients and doctors internalize and reproduce cultural myths about disease, which aligns with Freudian and Lacanian psychoanalysis.
Reference from the article:
“By the mid-nineteenth century, all this begins to change. The patient and physician reverse roles: the afflictions of ordinary valetudinarians … are elevated and romanticized” (p. 421).
- This supports Freud’s concept of the medicalization of neuroses, where symptoms are shaped by unconscious fears and desires.
6. Postmodernism and Interdisciplinarity
Contribution:
- Rousseau’s insistence on blurring disciplinary boundaries between medicine and literature aligns with postmodernist literary criticism, which challenges rigid categories of knowledge.
- He questions grand narratives about the separation of science and literature, proposing that both disciplines co-construct knowledge.
Reference from the article:
“Historians of science regularly study the influence of early science on much later science, and literary historians are perpetually studying the influence of early literary techniques on later writers” (p. 409).
- This resonates with Jean-François Lyotard’s critique of metanarratives in The Postmodern Condition.
7. Medical Humanities and Narrative Medicine
Contribution:
- Rousseau is one of the early scholars advocating for “Narrative Medicine,” a field that has since developed within the Medical Humanities.
- His argument that literature provides essential insight into medical practice and patient experience has influenced Rita Charon’s theories of Narrative Medicine.
Reference from the article:
“Every time a patient enters a practitioner’s office, a literary experience is about to occur: replete with characters, setting, time, place, language, and a scenario that can end in a number of predictable ways” (p. 414).
- This supports the idea that medicine should be viewed as a narrative practice, where doctors and patients co-construct meaning.
Conclusion: Impact on Literary Theory
Rousseau’s work serves as a bridge between literary studies and medical history, influencing multiple theoretical frameworks:
- New Historicism (contextualizing medicine and literature)
- Foucauldian Discourse Analysis (power and knowledge in medicine)
- Reader-Response Theory (cultural conditioning of disease perception)
- Structuralism and Semiotics (language and medical metaphors)
- Psychoanalysis (unconscious fears shaping disease narratives)
- Postmodernism (interdisciplinary knowledge construction)
- Narrative Medicine (medical humanities and storytelling)
Examples of Critiques Through “Literature and Medicine: The State of the Field” by G. S. Rousseau
| Literary Work & Author | Critique Through Rousseau’s Framework | Reference from Rousseau’s Article |
| Middlemarch – George Eliot | Examines Lydgate as a physician torn between idealism and medical ethics, reflecting 19th-century medical professional struggles. | “Lydgate, a physician, epitomizes the whole European tradition of the physician” (p. 407). |
| The Magic Mountain – Thomas Mann | Illness symbolizes intellectual stagnation and existential crisis, paralleling medical discourse on tuberculosis. | “Mann’s The Magic Mountain… neither had formal medical training, yet mastered an aspect of social medicine” (p. 410). |
| The Death of Ivan Ilyich – Leo Tolstoy | Depicts medical detachment from human suffering, critiquing the clinical approach to death. | “Tolstoy’s The Death of Ivan Ilyich… the literary locus classicus of death” (p. 408). |
| Tristram Shandy – Laurence Sterne | Reflects 18th-century beliefs about maternal imagination affecting fetal development, satirizing medical theories of the time. | “Sterne’s medical source was… the influence of ‘the mother’s imagination’ on the fetus” (p. 411). |
| Gulliver’s Travels – Jonathan Swift | Satirizes early modern physicians, critiquing their obsession with abstract theories over practical healing. | “Restoration medicine on the prose satires of Swift” (p. 407). |
| Equus – Peter Shaffer | Examines psychiatry’s ethical dilemmas and psychological dimensions, influenced by R.D. Laing’s theories. | “Peter Shaffer, who must certainly have been reading or hearing about R. D. Laing while writing Equus” (p. 411). |
| Remembrance of Things Past – Marcel Proust | Uses medical metaphors to explore time, memory, and the fragility of the human body, reflecting early 20th-century medical thought. | “Proust’s Remembrance of Things Past, for the density of its medical imagery” (p. 408). |
| Humphry Clinker – Tobias Smollett | Satirizes quack doctors and medical incompetence, reflecting Smollett’s firsthand experience as a physician. | “Smollett, himself a practicing physician… read extensively in psychiatry” (p. 411). |
| The Doctor’s Dilemma – George Bernard Shaw | Critiques the ethical dilemmas in medical decision-making, especially in resource allocation. | “Shaw’s plays, especially The Doctor’s Dilemma, critique the ethical dilemmas in medicine” (p. 408). |
Criticism Against “Literature and Medicine: The State of the Field” by G. S. Rousseau
🔹 Lack of Clear Methodology
- Rousseau’s work does not establish a systematic methodological approach for analyzing literature through a medical lens.
- It relies on historical anecdotes and examples rather than a clearly structured theoretical framework.
🔹 Overemphasis on Historical Context
- The analysis heavily focuses on historical connections between medicine and literature rather than engaging with modern literary theory.
- The discussion of historical medical influences on literature overshadows deeper textual analysis.
🔹 One-Directional Influence (Medicine to Literature)
- Rousseau mostly examines how medicine influences literature but neglects how literature has shaped medical discourse and practice.
- While he briefly mentions the reverse influence (literature to medicine), this section lacks depth and supporting examples.
🔹 Absence of Close Reading of Texts
- The article does not engage in detailed literary criticism or textual analysis of the works it discusses.
- The examples (e.g., Middlemarch, The Magic Mountain) are referenced in passing rather than examined in depth.
🔹 Limited Engagement with Critical Theories
- There is minimal reference to contemporary literary theories, such as structuralism, poststructuralism, or psychoanalytic criticism.
- The work does not engage with Feminist, Marxist, or Postcolonial perspectives, which could offer alternative readings of medical discourse in literature.
🔹 Lack of Attention to Patient Voices
- The focus is mostly on physicians, medical theories, and literary depictions of doctors, neglecting how patients have written about their experiences.
- Rousseau does not explore autobiographical narratives of illness in depth, missing a critical aspect of medical humanities.
🔹 Eurocentric and Canonical Focus
- The study focuses predominantly on Western literature and European medical traditions, ignoring non-Western perspectives.
- It neglects how medical themes appear in global literature or marginalized voices, reinforcing a Eurocentric bias.
🔹 Romanticization of the Physician-Writer
- Rousseau idealizes physician-writers (e.g., Smollett, Keats, William Carlos Williams) but does not critique the power dynamics between doctors and patients in literature.
- He overstates the cultural heroism of doctors in literary history without addressing the historical harms of medical authority.
🔹 Misses Modern Ethical and Bioethical Issues
- The article does not engage with contemporary bioethics, such as medical ethics, disability studies, and narrative medicine.
- Lacks discussion of how medical literature reflects issues like race, gender, class, and disability in modern contexts.
🔹 Minimal Interaction with Medical Humanities as a Discipline
- The study does not explicitly position itself within the emerging field of medical humanities, which was growing during the 1980s.
- It lacks engagement with contemporary scholars who have shaped the field after Rousseau, making it feel somewhat outdated.
Representative Quotations from “Literature and Medicine: The State of the Field” by G. S. Rousseau with Explanation
| Quotation | Explanation |
| “Literature and Medicine, unlike literature and science … is not a field that has claimed significant numbers of students, certainly not of historians of science.” | Rousseau argues that the intersection of literature and medicine has been largely neglected, unlike the well-developed field of literature and science. |
| “The irony of this contrast—literature and science versus literature and medicine—is that medicine surely has far more than science to offer literature, and vice versa.” | Rousseau highlights how medicine has been deeply intertwined with literature but remains understudied compared to science. |
| “The assumptions usually made in the existing scholarship of literature and medicine are these: that literary history … is best studied in periods and that meaningful analysis of particular texts requires periodization.” | Rousseau critiques traditional literary scholarship for its rigid periodization, which limits the understanding of medicine’s influence on literature. |
| “The arrows of influence in this body of scholarship are always drawn in one direction: from medicine to literature.” | Rousseau criticizes the assumption that literature merely absorbs medical knowledge, arguing that literature also shapes medical discourse. |
| “In autobiography there is another essential difference: the writer is the subject; the writer is the case history.” | He draws parallels between autobiography and medical case histories, suggesting that both construct identities based on narrative forms. |
| “Rarely is the belief expressed that this popular medicine itself has been determined by nonmedical factors: by social necessity … or psychological need.” | Rousseau emphasizes the role of societal and psychological factors in shaping medical theories and public health concerns. |
| “Literature provides one of the richest archives: it is the lengthiest record, the only resource in which patients and doctors can be viewed from ancient Greece to the present.” | He asserts that literature offers a more extensive and nuanced historical record of medical practices and doctor-patient relationships than medical texts. |
| “Calling medical men ‘physicians of no value’ and ‘forgers of lies,’ Job anticipated an attitude that has prevailed with only minor discontinuity since about 1800.” | Rousseau traces historical skepticism toward doctors, showing that literature has long depicted them as flawed or corrupt figures. |
| “Illness is the night-side of life, a more onerous citizenship … sooner or later each of us is obliged … to identify ourselves as citizens of that other place.” (quoting Susan Sontag) | He includes Sontag’s metaphor to highlight how illness functions as both a personal and cultural construct in literature. |
| “On this proof everything stands or falls, for without some reciprocity—from literature to medicine as well as from medicine to literature—there is neither a field nor its state to survey.” | Rousseau concludes by stressing the necessity of recognizing bidirectional influence between literature and medicine for the field to develop. |
Suggested Readings: “Literature and Medicine: The State of the Field” by G. S. Rousseau
- McLellan, M. Faith. “Literature and medicine: narratives of physical illness.” The Lancet 349.9065 (1997): 1618-1620.
- Downie, R. S. “Literature and Medicine.” Journal of Medical Ethics, vol. 17, no. 2, 1991, pp. 93–98. JSTOR, http://www.jstor.org/stable/27717024. Accessed 8 Feb. 2025.
- Rousseau, G. S. “Literature and Medicine: The State of the Field.” Isis, vol. 72, no. 3, 1981, pp. 406–24. JSTOR, http://www.jstor.org/stable/230258. Accessed 8 Feb. 2025.
- Spiegel, Maura, and Rita Charon. “Editing and Interdisciplinarity: Literature, Medicine, and Narrative Medicine.” Profession, 2009, pp. 132–37. JSTOR, http://www.jstor.org/stable/25595923. Accessed 8 Feb. 2025.
- HOLLOWAY, MARGUERITE. “When Medicine Meets Literature.” Scientific American, vol. 292, no. 5, 2005, pp. 38–39. JSTOR, http://www.jstor.org/stable/26060992. Accessed 8 Feb. 2025.