John Wiltshire, Frances Burney and the doctors: Patient narratives, then and now (United Kingdom: Cambridge University P
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REVIEW ESSAY
John Wiltshire, Frances Burney and the doctors: Patient narratives, then and now (United Kingdom: Cambridge University Press, 2019) Paul A. Komesaroff
Received: 2 February 2020 / Accepted: 21 May 2020 # Journal of Bioethical Inquiry Pty Ltd. 2020
Abstract This review essay examines the emergence of the patient narrative or “pathography” in the late eighteenth and early nineteenth century in relation to the great cultural, epistemological, and ethical transformations that enabled the formation of modern medicine. John Wiltshire’s book provides an historical overview of this complex process, as well as laying the basis for a contemporary critique of some of its key assumptions. Keywords Pathography . Patient narrative . Microethics . Patient-centred medicine
Frances Burney and The Doctors is an important contribution to the understanding of the conceptual formation of modern medicine. Its author, John Wiltshire, is a literary theorist best known for his authoritative works on Jane Austen, who has over many years developed an extensive corpus of writing about the genre of “pathography”—that is, of written descriptions of medical experience. For Wiltshire, pathographies focus on “patient narratives” involving interactions with the professional apparatuses of medicine, often incorporating reflections on the meanings of the events described along with their emotional, social, and cultural resonances. Patient narratives are distinguished from “illness narratives,” P. A. Komesaroff (*) Centre for Ethics in Medicine and Society, Monash University, Commercial Road, Prahran, Victoria, Australia e-mail: [email protected]
which are broader in scope and do not require any particular reference to medicine or healthcare systems or perspectives. Pathography emerged as a novel literary form in the late eighteenth century, at a time when the ethical and epistemological structures of medicine were being reconceived and the elements of the new, complex discursive field were being assembled. Frances Burney and The Doctors traces the origins of the genre and its development to the present day. The starting point is the work of the novelist and diarist Frances (Fanny) Burney, a contemporary of Austen best known to contemporary readers for a graphic account of her 1811 mastectomy without anaesthetic. Wiltshire explores Burney’s writings in clinical detail, placing them vividly in the intense and rapidly changing political and cultural contexts of the times. The account itself makes compelling reading, but Wiltshire’s larger project is of greater interest still, encompassing as it does an examination not only of the social origins of pathography but also of its subsequent trajectory and what it has revealed about the evolving social life-worlds of patients caught up in the prevailing medical system. This book is, therefore, at once a literary and historical study and a philosophical exploration of the emerging structures of modern medicine. Wiltshire provides a detailed account of Burney’s “long and extraordinary
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