Introduction: “Telling Cases: Writing against Genre in Medicine and Literature” by Nicholas Pethes
“Telling Cases: Writing against Genre in Medicine and Literature” by Nicolas Pethes first appeared in Literature and Medicine, Volume 32, Number 1, in Spring 2014, published by Johns Hopkins University Press. The article explores the intersection between medical case histories and literary genre theory, challenging the traditional understanding of genre as a fixed category. Pethes argues that medical case histories, far from being merely scientific documents, are epistemic genres that actively shape knowledge through narrative structures. Drawing on thinkers like Gianna Pomata, Jacques Derrida, and Franco Moretti, he positions case histories within a broader literary and scientific discourse, emphasizing their role in constructing medical reality rather than simply reflecting it. By tracing the evolution of medical writing from early modern case observations to nineteenth-century literature, Pethes demonstrates how the narrative conventions of literature and medicine influence one another, leading to a dynamic and fluid exchange between the two fields. His work is significant in literary theory as it destabilizes rigid genre classifications, showing how medical narratives not only function within literary traditions but also resist typological categorization. Through examples from Goethe, Schiller, and Büchner, Pethes highlights how literary texts integrate medical discourses, using pathology and abnormality to redefine the individual and, by extension, literary subjectivity. His argument ultimately challenges the separation of scientific and literary cultures, illustrating how both disciplines rely on narrative to construct meaning.
Summary of “Telling Cases: Writing against Genre in Medicine and Literature” by Nicholas Pethes
1. The Functional Role of Genre in Medical and Literary Texts
- Pethes argues that medical case histories are not just neutral records of scientific knowledge but are inherently “narratively organized” (Montgomery Hunter, 1991, p. 51).
- Case histories function as an “epistemic genre” (Pomata, 2011, p. 45), meaning they shape medical knowledge and create a scientific community through shared texts.
- Rather than just transmitting information, they contribute to how knowledge is constructed and communicated.
2. The Instability of Genre: Derrida’s Influence
- Pethes draws on Jacques Derrida’s concept of “The Law of Genre”, which argues that there is no fixed genre of genre (Derrida, 1980, p. 59).
- Medical case histories fluctuate between different textual forms, resisting rigid categorization.
- This instability aligns with literary studies, where genres evolve based on audience expectations and communicative needs.
3. The Evolutionary Nature of Genre
- Pethes applies Niklas Luhmann’s communication theory to argue that genres evolve through variation and selection, much like biological species (Luhmann, 1995).
- Franco Moretti’s “Graphs, Maps, Trees” model describes genres as branching trees rather than fixed forms (Moretti, 2005).
- Thus, medical and literary case histories are both shaped by reader expectations and historical context, rather than inherent formal structures.
4. Medicine and Literature as Interdisciplinary Fields
- Pethes suggests that literary and medical discourses intersect, rather than being separate domains.
- The “literary potential” of medical narratives has been explored by Epstein (1995) and Kennedy (2010), emphasizing how literature borrows from medical storytelling techniques.
- Conversely, medical case histories adopt narrative forms from literature, creating a mutual exchange rather than a one-way influence.
5. Empirical Reality and the Individual Case
- The 18th-century turn towards realism in literature aligns with empirical medicine’s shift from general theories to individual case studies.
- Gotthold Ephraim Lessing’s Essay on Fables (1759) argues that literature should focus on individual cases rather than general moral principles (Lessing, 1825, p. 92).
- Karl Philipp Moritz’s Anton Reiser (1785-1790) is both a novel and a psychological case study, emphasizing individuality as a source of truth.
6. Writing Against Generalization: Friedrich Schiller’s Contribution
- Friedrich Schiller, both a physician and a literary figure, described how focusing on individual cases “liberates the imagination from the bonds of reason” (Schiller, 1795, p. 676).
- The Criminal of Infamy (1786), Schiller’s case history of a criminal, reflects how medical and legal narratives were interwoven.
- This resistance to generalization also appears in medical case studies, which resist rigid classifications in favor of individual pathology.
7. The Role of Pathology in Literature and Medicine
- Literary case histories often focus on pathological individuals, similar to clinical case studies.
- Goethe’s The Sorrows of Young Werther (1774) presents Werther’s mental decline as a “sickness unto death” (Goethe, 1981, p. 48).
- Schiller’s “autopsy of vices” in criminal cases (Schiller, 1786, p. 15) mirrors the forensic and diagnostic elements of medicine.
8. The Spectacular vs. The Statistical: Literature’s Shift
- In the 19th century, medical case histories shifted towards statistical structures, as seen in Michel Foucault’s The Birth of the Clinic (1973, p. 102).
- Literature, too, shifted from spectacular individual cases to more routine, mundane medical observations.
- Adalbert Stifter’s My Great-Grandfather’s Notebook (1841) reflects this by focusing on ordinary medical records rather than sensational illnesses.
9. Conclusion: Writing Case Histories as Writing Against Genre
- The medical case history does not form a rigid literary genre but rather a mode of writing that moves between disciplines.
- Literature adopts the particularity and realism of medical cases, while medicine borrows narrative techniques from literature.
- Pethes argues that case histories serve as sites of genre transformation, challenging fixed categories in both literary and medical discourses.
Key References from the Article
- “Genres are not static forms but evolving trees of divergence and convergence” (Moretti, 2005, p. 136).
- “Writing medical cases always means writing against genre—at least in the traditional sense of general typological schemes” (Pethes, 2014, p. 27).
- “Medical case histories share narrative structures with literature, resisting formalization and embracing hybrid forms” (Kennedy, 2010, p. 22).
- “There is no case unless someone is telling it, and to tell something requires standardized framings” (Bazerman, 1988, p. 59).
- “The statistical structure of modern medicine transforms individuality into normalization” (Foucault, 1973, p. 103).
Theoretical Terms/Concepts in “Telling Cases: Writing against Genre in Medicine and Literature” by Nicholas Pethes
| Term/Concept | Definition | Source/Reference |
| Epistemic Genre | A genre that actively shapes how knowledge is produced, structured, and communicated, rather than just being a passive carrier of information. | Pomata (2011), Pethes (2014, p. 24) |
| Paper Technologies | The material and textual forms (e.g., handwritten notes, journal articles) through which scientific knowledge is recorded and transmitted. | Hess & Mendelsohn (2010), Bazerman (1988) |
| Narratively Organized Knowledge | The idea that medical case histories are structured as narratives, influencing the perception and construction of medical knowledge. | Montgomery Hunter (1991, p. 51) |
| The Law of Genre | The claim that genres do not belong to a higher category; they are unstable and resist rigid classification. | Derrida (1980, p. 59) |
| Genre Evolution | The concept that genres change over time through variation and selection, rather than being fixed forms. | Moretti (2005), Luhmann (1995) |
| Mode of Writing (Écriture) | A dynamic, socially and historically situated way of writing that resists traditional classifications of literary genres. | Barthes (1967) |
| Style of Reasoning | A framework in which scientific knowledge is produced and validated, differing across historical periods and disciplines. | Hacking (1990) |
| Thinking in Cases | An epistemological approach that prioritizes specific cases over abstract generalizations, relevant in medicine, law, and literature. | Forrester (1996) |
| Empirical Particularism | The emphasis on individual cases and direct observation rather than general laws or theories in both medicine and literature. | Lessing (1759), Blanckenburg (1774) |
| Pathological Individualism | The notion that individuality in literature is often framed through deviation, illness, or psychological disorder. | Goethe (1774), Schiller (1786), Moritz (1785-1790) |
| The Statistical Individual | The transformation of individuality into a statistically measurable norm within medical and social sciences. | Foucault (1973), Quételet (1835) |
| Aleatory Series | A method of organizing medical cases into probabilistic patterns, shifting focus from individual narratives to statistical norms. | Foucault (1973, p. 102) |
| The Ghost in the Clinic | The blending of medical realism with gothic and sensational elements in literature, often found in 19th-century medical narratives. | Kennedy (2010, p. 22) |
| Fictionalization of Case Histories | The adaptation of medical case structures into literary narratives, merging scientific observation with storytelling. | Epstein (1995), Freud (1922) |
| Evolutionary Model of Genre | The idea that literary and scientific genres evolve similarly to biological species, through processes of variation and selection. | Moretti (2005, p. 136) |
| The Resistance to Theory | The assertion that some forms of writing (e.g., case histories) evade theoretical categorization due to their reliance on specificity. | De Man (1986) |
| Disciplinary Cross-Fertilization | The mutual exchange of narrative techniques between literature and medicine, leading to hybrid textual forms. | Pethes (2014, p. 27), Charon (2006) |
| Normalization through Case Histories | The way in which individual case studies contribute to the establishment of medical and social norms. | Foucault (1975, p. 103) |
| Seriality in Case Collections | The practice of compiling multiple case studies into series, which influences both medical documentation and literary form. | Pomata (2010), Stifter (1841) |
Contribution of “Telling Cases: Writing against Genre in Medicine and Literature” by Nicholas Pethes to Literary Theory/Theories
1. Contribution to Genre Theory: Writing Against Fixed Genre Categories
- Challenges Traditional Genre Classifications
- Pethes argues that case histories in both medicine and literature do not fit into fixed, typological genre definitions, making the case history a genre that constantly resists categorization (Pethes, 2014, p. 24).
- “Writing case histories always means writing against genre—at least in the traditional sense of general typological schemes” (Pethes, 2014, p. 28).
- Expands Jacques Derrida’s “Law of Genre”
- Pethes builds on Derrida’s claim that “there is no genre of genre” (Derrida, 1980, p. 59), emphasizing that medical case histories evolve without stable formal characteristics.
- “The adoption of case-related structures in literature as well as of narrative patterns in medical writing always serves as an attempt to leave behind standardized modes of representation” (Pethes, 2014, p. 27).
- Supports Franco Moretti’s Evolutionary Model of Genre
- Case histories, like literary genres, function as “trees with diverging branches” rather than fixed forms (Moretti, 2005, p. 136).
- Pethes suggests that every case history adapts to shifting cultural and scientific expectations, demonstrating genre evolution as an adaptive process rather than a fixed taxonomy (Pethes, 2014, p. 26).
2. Contribution to Narrative Theory: Medical and Literary Narratives as Hybrid Forms
- Reinforces Kathryn Montgomery Hunter’s Concept of “Narratively Organized Knowledge”
- Medical knowledge is not simply scientific or cognitive, but narratively structured, following storytelling conventions (Hunter, 1991, p. 51).
- “Medical observation is ‘narratively organized'” (Pethes, 2014, p. 24).
- Develops Meegan Kennedy’s Idea of the “Discursive Hybridity” of Case Histories
- Pethes extends Kennedy’s argument that medical and literary case histories borrow narrative strategies from one another, shaping how both scientific and fictional texts construct reality (Kennedy, 2010, p. 2).
- “The medical case history likewise borrows narrative forms and strategies from the novel, even after physicians establish a normative clinical genre” (Pethes, 2014, p. 27).
- Links to Roland Barthes’ Concept of Écriture (Mode of Writing)
- Pethes aligns with Barthes’ rejection of rigid literary classifications in favor of dynamic, historically contingent modes of writing (Barthes, 1967).
- “The case history is a genre beyond genre categories, while at the same time a style of thinking as well as a mode of writing in medicine and literature alike” (Pethes, 2014, p. 32).
3. Contribution to Medical Humanities: Pathology as a Narrative Tool in Literature
- Expands Michel Foucault’s Idea of the “Birth of the Clinic”
- Pethes connects the rise of modern literature with Foucault’s concept of medical discourse shaping individual subjectivity (Foucault, 1973, p. 97).
- “Modern subjectivity, as created by fictional literature, is based on pathological observations” (Pethes, 2014, p. 35).
- Supports Rita Charon’s Narrative Medicine Approach
- Case histories serve both medical and literary purposes, helping physicians and writers structure human experiences through storytelling (Charon, 2006).
- “Instead of offering a typological pattern for epistemic genres, literary communication may participate in medical communication, and vice versa” (Pethes, 2014, p. 26).
- Extends Freud’s Observation of Case Histories as Novellas
- Pethes highlights Sigmund Freud’s claim that medical case histories should ‘read like novellas’ (Freud, 1922).
- “There is indeed a literary history of medical case histories to be discovered, in much the way criminal fiction emerged in close connection with the publication of legal case collections” (Pethes, 2014, p. 27).
4. Contribution to Realism and Psychological Fiction: Case Histories as Literary Devices
- Reinforces Schiller’s Concept of the “Single Case” in Literature
- Pethes links Schiller’s theory of literature to medical case histories, showing how both disciplines prioritize individual narratives over general theories (Schiller, 1795, p. 676).
- “When we represent the species through an individual and a general concept through a single case, we liberate the imagination from the bonds of reason” (Schiller, quoted in Pethes, 2014, p. 31).
- Develops the Concept of Pathological Individualism in Literature
- Many fictional characters (e.g., Goethe’s Werther, Moritz’s Anton Reiser, Lenz’s Zerbin) are framed as medical case studies, highlighting mental illness as a literary device (Pethes, 2014, p. 34).
- “The striving toward individualism does not create rational moral subjects … rather, individuality can be expressed only by way of contradistinction against norms and therefore tends towards the pathological” (Pethes, 2014, p. 35).
5. Contribution to Structuralism and Statistical Models of Literature
- Connects Foucault’s “Arithmetic of Cases” to Literary Normalization
- Pethes argues that literary case histories mirror the statistical structures of modern medical records, turning individual stories into population-based data (Foucault, 1973, p. 103).
- “Modern societies do not consider human beings as interesting individual cases anymore but rather as elements of average case series” (Pethes, 2014, p. 38).
- Supports Franco Moretti’s Use of Computational Literary Studies
- Just as Moretti uses data visualization and distant reading to analyze genre evolution, Pethes suggests that literary case histories can be studied as statistical patterns (Moretti, 2005).
- “These serial narrations may be boring, but by being so, they reveal the fact that empirical observation produces random details instead of essential conclusions” (Pethes, 2014, p. 40).
Examples of Critiques Through “Telling Cases: Writing against Genre in Medicine and Literature” by Nicholas Pethes
| Literary Work | Critique Through Pethes’ “Telling Cases” |
| Goethe’s The Sorrows of Young Werther | Explores the intertwining of literary and medical narratives by presenting Werther’s emotional turmoil as a case of psychological pathology. Pethes highlights how the narrative structure resembles medical case histories, emphasizing individual suffering and deviation from social norms. This work reflects the idea of “writing against genre” by blending fictional storytelling with clinical observations. |
| Büchner’s Lenz | An example of “narrative pathology,” where the protagonist’s mental illness is depicted through a fragmented narrative. Pethes uses this work to show how literature can adopt the style of medical case histories, creating a genre that transcends traditional literary categories. The narrative’s clinical tone and focus on individual pathology align with Pethes’ argument about the functional and epistemic role of case histories in both literature and medicine. |
| Schiller’s The Criminal of Lost Honor | Critiqued through Pethes’ lens as a psychological case study that links criminal behavior to environmental and psychological factors. Schiller uses medical metaphors, such as “autopsy of vices,” to analyze the protagonist’s motivations, reflecting Pethes’ idea of literature adopting medical narrative techniques. This illustrates how literary works can simultaneously use and resist conventional genres by incorporating empirical observations typically found in medical cases. |
| Stifter’s My Great-Grandfather’s Notebook | Demonstrates the shift from sensational individual cases to mundane medical records, aligning with Pethes’ discussion of the statistical normalization of case histories. The work critiques the sensationalism in literature by focusing on ordinary cases, showing how medical narrative techniques can be used to represent average experiences rather than extraordinary events. This supports Pethes’ argument about the evolution of case histories as a literary device that challenges genre conventions. |
Criticism Against “Telling Cases: Writing against Genre in Medicine and Literature” by Nicholas Pethes
- Lack of a Unified Genre Definition
- Pethes argues that medical case histories function as an “epistemic genre” but does not clearly define how this genre operates across disciplines. Some critics may argue that his discussion remains abstract and lacks a systematic classification of case histories within literary studies.
- Overgeneralization of Medical and Literary Overlap
- While the essay effectively explores the intersection of medical and literary narratives, it may overstate the extent to which medical case histories have influenced literary forms. Critics might argue that other factors, such as philosophical and social developments, played equally significant roles in shaping modern literature.
- Neglect of Non-Western Literary and Medical Traditions
- The essay focuses primarily on European (especially German) literary and medical history, ignoring case history traditions in other cultures. A broader comparative analysis could have strengthened Pethes’ claims about the universality of case histories as an epistemic genre.
- Ambiguity in “Writing Against Genre”
- The concept of “writing against genre” remains somewhat vague. While Pethes successfully illustrates deviations from traditional genre classifications, critics might argue that he does not sufficiently explain how this deviation constitutes a coherent theoretical framework rather than a simple rejection of categorization.
- Limited Engagement with Narrative Medicine
- Although Pethes references the work of Kathryn Montgomery Hunter and Rita Charon, he does not fully engage with contemporary scholarship in narrative medicine, which examines the role of storytelling in clinical practice. Critics may argue that integrating more recent medical humanities perspectives would enhance the analysis.
- Historical Scope is Restrictive
- The study mainly focuses on 18th- and 19th-century European literature, neglecting the evolution of case histories in modernist and postmodernist literature. A more extended historical approach could provide a clearer picture of how case histories continue to shape contemporary literary forms.
- Limited Discussion of Reader Reception
- Pethes analyzes how case histories function within literary and medical texts but does not sufficiently address how readers interpret these texts. A deeper exploration of reader-response theory could provide more insight into how audiences navigate the ambiguous genre boundaries he describes.
- Reliance on Theoretical Abstraction
- The essay frequently references thinkers such as Derrida, Foucault, and Moretti, sometimes prioritizing theoretical abstraction over concrete textual analysis. Critics might argue that a closer reading of individual case histories in literature and medicine would make his argument more tangible.
Representative Quotations from “Telling Cases: Writing against Genre in Medicine and Literature” by Nicholas Pethes with Explanation
| Quotation | Explanation |
| “Medical texts are no mere carrier of knowledge, but play a constitutive part in the process in which an observation becomes a scientific fact by following certain argumentative and narrative patterns.” | This quotation highlights the idea that medical writing is not just a means of documenting illness but is essential to the process of knowledge formation in medicine. It reinforces the argument that case histories should be understood as an “epistemic genre.” |
| “Each literary text refers to previous patterns, but never completely follows them, and this is the very reason that there is, besides a theory, also a history of literature.” | Pethes argues that literature evolves not by strictly adhering to genre conventions but by constantly modifying them. This notion ties into the idea of “writing against genre,” where texts challenge fixed categorizations. |
| “Whenever changes occur in the way a medical case is presented, these changes are made with respect to changing needs or expectations within the system, and the system is continually transformed along with the acts of communication that establish and maintain it.” | This quotation connects genre evolution with the functional needs of scientific communication. It suggests that the form of case histories changes over time, much like literary genres do, due to shifting expectations in their respective fields. |
| “Thus, it is precisely the floating character of genre that bridges the divide between the ‘two cultures’ of science and literature.” | Pethes argues that medical and literary texts are more interconnected than traditionally perceived. This reinforces the core idea of his work: that medical and literary case histories function as part of a shared epistemic process. |
| “So there is indeed a literary history of medical case histories to be discovered, in much the way criminal fiction emerged in close connection with the publication of legal case collections.” | This quotation draws a parallel between the evolution of medical case histories and crime fiction, showing how both literary and medical writing contribute to shared narrative structures. |
| “My argument, however, is that it is precisely this mutual evolution that precludes a typological genre definition of the case history as a literary form.” | Pethes asserts that case histories cannot be confined to one literary genre because they have been shaped by both medical and literary traditions. This supports his argument for a fluid, rather than fixed, understanding of genre. |
| “Empirical medicine as well as realistic literature both refer to individual observations and narrations that avoid the classification of the events they refer to and of the way these events are represented.” | Here, Pethes links the structure of medical case histories with realism in literature, suggesting that both disciplines rely on detailed individual narratives rather than overarching theoretical constructs. |
| “It is the duality of standardization and deviation that explains the simultaneity of continuity and change due to which genres are objects of theory and history alike.” | This statement encapsulates the tension between stability and transformation in genre studies. It applies to both medical and literary case histories, which must balance standardization with adaptability. |
| “There is no medical or literary theory of the genre of case histories because the ‘genre of genre’ cannot be established in a more general sense than the genre of maladies.” | Pethes employs a Derridean argument to assert that case histories resist fixed genre classification, much like illnesses themselves are difficult to categorize definitively. |
| “Consequently, research on medical case histories has tended to emphasize this mutual potential, instead of providing general typological features.” | This reinforces the essay’s main claim that case histories are dynamic rather than rigidly defined. It supports the notion that they should be studied for their interactive potential between medicine and literature rather than for strict genre classification. |
Suggested Readings: “Telling Cases: Writing against Genre in Medicine and Literature” by Nicholas Pethes
- TOBIN, ROBERT D. “Prescriptions: The Semiotics of Medicine and Literature.” Mosaic: An Interdisciplinary Critical Journal, vol. 33, no. 4, 2000, pp. 179–91. JSTOR, http://www.jstor.org/stable/44029715. Accessed 17 Feb. 2025.
- Regaignon, Dara Rossman. “Anxious Uptakes: Nineteenth-Century Advice Literature as a Rhetorical Genre.” College English, vol. 78, no. 2, 2015, pp. 139–61. JSTOR, http://www.jstor.org/stable/44075104. Accessed 17 Feb. 2025.
- Pethes, Nicolas. “Telling cases: writing against genre in medicine and literature.” Literature and Medicine 32.1 (2014): 24-45.