in this book, is a heroine whose preventionist instinct shapes her plot and, more importantly, her sense of self. Jane’s autobiographical narration not only illustrates how to avoid the fates of other women in the novel (Helen Burns, Bertha Mason, and the would-be Mrs. St. John Rivers) but also depends on an active and aggressive assertion of what health means and her acute awareness that she must maintain it. She is not the “picture of health,” as is Emma Woodhouse, but her narrative probes what it might mean to be the one who draws that picture. Chapter 2, therefore, focuses more directly on the strategies medical writers used to define the contours of health and on the narration and narrative desire that emerge around the twin objectives of identifying and preserving it. Health, as the medical dictionaries of the period suggest, is a recognizable condition as well as a range of conditions; it is capacious, rare, and always relative, unique to the individual but also generalizable to the community. Jane Eyre’s point of view and the “improvement” (marriage) plot to which it gives rise rely on the power and narrative authority that come from narrating one’s health.
Part 2 is the rebellious sibling of part 1. While the two chapters in this section similarly disrupt the crisis-cure model of narrative, they also push back against the Austenian sense of prevention and complicate the Brontëan version of the healthy heroine. By first focusing on preventionist discourse of public health in the novels of Charles Dickens (chapter 3) and then on the definitional strategies that the invalid Harriet Martineau uses in her novel and memoir (chapter 4), I suggest that these novelists reflect a more combative relationship to the dominant health discourse of the period than do the novelists in part 1. Whereas Austen’s novels advance and even refine the advice offered by preventionists who are concerned with domestic medicine, Dickens’s Little Dorrit virtually rejects public health experts’ opinions about the best policy for preventing epidemic disease. The sanitary reforms Dickens advocated in his speeches, his essays, and many of his novels (such as Bleak House) fade into the background in Little Dorrit, in which he features a competing and, for Dickens’s occasional public health adviser Thomas Southwood Smith, dubious approach to the preservation of public health: quarantine. Rather than promote the kind of curative and preemptive action that is characteristic of the “sanitary method” and Austen’s preventionist cautionary tales, Dickens turns to a more static and isolationist model of prevention that appears to court—even as it promises to obstruct—disease. Health depends on the risk associated with touch and on an almost willful refusal to look ahead to what might be or to learn from what has been.
If, as in the works of Dickens, we can achieve health through counterintuitive means, then the very definition of health is equally disputable. The chapters in this book represent health as a story we tell about ourselves within community and isolated from it. This story occasionally contradicts prevailing modes of thought about sanitary reform or, as in chapter 4, able-bodiedness. The figure of the invalid tests the limits of what health means. Is invalidism merely the opposite of health, or does it represent ideal health? I suggest that the works of Harriet Martineau and others redefine invalidism as a narrative stance rather than a social or physical condition exclusively marked as debility. The culture’s interest in fitting invalidism into the larger discourse of health intersects with the invalid’s desire to stake her claim in society. And it is through their privileged perspective on the health of others—a perspective figured as a form of health—that they assert their cultural and narrative authority. Like Charlotte Brontë’s heroine, the invalids in this chapter resist a curative ethos in favor of a hygienic one; but instead of turning to prevention (avoidance), these characters embody a preservationist stance by claiming the fictional authority associated with omniscience. They are, in effect, health’s narrators.
Chapter 5 and the afterword conclude this study by applying the lessons of hygienic reading explored in the first two parts to fictional and contemporary medical education. Here, I focus more particularly on the figure of the doctor as the one who most needs to learn from this alternative way of reading. For unlike the impatient readers Beddoes and others lament, the doctor stands out as lacking the requisite reading skills. In Wives and Daughters (1865), for example, Elizabeth Gaskell reimagines medical practice and the role of the “healer” as a version of domestic management that requires not only the management of families but also the management of their stories. She neither defies the doctor’s professional privilege nor adopts it. Instead, she depicts the doctor’s authority and his expertise as contingent on narrative competence—the ability, as Rita Charon and others define it in relationship to medical practice, to listen to, interpret, and ethically act on the stories of others.42 This, Gaskell, tells us, is best taught and learned in the home and from the novel. I offer an extended close reading of Wives and Daughters, drawing together the various lessons of the previous chapters about domestic health, quarantines, healthy heroines, and invalidism. As I discuss in my afterword, this type of narrative competence is essential to medical education as a way of bridging the traditional divide between patients and their doctors. Contemporary work in the field of narrative medicine assumes, like Gaskell’s novel, an integral relationship between storytelling and medical advice. By becoming attentive to the multiple ways that stories work—not only as symptoms of illness but also as strategies for sustaining health—doctors and patients can experience more humane and effective medical encounters. I am suggesting that such an approach to health and medicine is part of the legacy that medical advice and the nineteenth-century novel have left to their readers.
One
Domestication
Chapter One
Jane Austen’s Plots of Prevention
In the second of eleven installments of Hygeia (1802–3),1 Thomas Beddoes offers the following fictional dialogue between a woman and her doctor:
“What is good against the head-ache, Doctor?”
“Health, Madam.”
“Well, if you feel no interest about an old woman like me—Marianne there, you perceive, has been hacking all afternoon. Do tell her of some little thing, [sic] that is good against cough.”
“Health, Madam.”
“But are you resolved not to give a more satisfactory answer?” (14–15)
To make a case that prevention is more important than cure, Beddoes satirizes those who turn to their doctors for easy remedies—those bad readers who are too easily seduced by the drama of diagnosis, the action of treatment, and the closure of cure. In fact, Beddoes “explicitly declare[s] PREVENTION of mischief to be [his] exclusive objective,” asking his readers in the second installment of Hygeia to “bear with [him] yet a few more months, before they give [him] up” (14) for the “makers of those books . . . which profess to distribute far and wide a capacity for discriminating diseases and applying remedies” (19). Health, conceived in this way, should not be about getting cured but about preventing illness in the first place. One does not become sick; rather, one loses the opportunity to stay well, and the woman’s response to her beleaguered doctor suggests that such a concept was, if not difficult to accept, at least highly unsatisfactory. The fictional woman interprets the doctor’s prescription (“Health, Madam”) as a refusal to practice medicine,
