The Politics and Poetics of Diagnosis in Nineteenth-Century American Literature and Medicine Restricted; Files Only

Grubbs, Lindsey (Spring 2019)

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This dissertation explores the relationship between literature and diagnosis in the first hundred years of American psychiatry, beginning in the late eighteenth century. Drawing together

recent scholarship on the relationship between literature and medicine in the nineteenth century and disability studies theorists’ calls for a fuller accounting of the hazy margins of disability identity, it investigates “problem cases” of diagnosis. Specifically, it traces attempts to delineate categories of moral disorder, from Benjamin Rush’s coining of “anomia” in 1786 to designate immorality as a medical condition, through hysteria, understood in the 1880s as a physical nervous disorder that both caused and was caused by immorality. These disorders are particularly interesting because of their liminal pathological status: their existence was so routinely contested that they sketch the moving outline of medical knowledge. Lacking clear biological markers, physicians relied upon narrative to systematize the medicine of the mind, drawing on the genres most familiar to them in popular culture, from the Gothic novel to the detective story to the Realist novel. This dissertation’s four chapters demonstrate how literary genre and psychiatric diagnosis developed in tandem throughout the nineteenth century: the sensational gothic novel is paired with arguments for the medical management of personality, the birth of forensic psychiatry with early detective fiction, the introduction of clinical medicine to America with the objectivity-defying Romance, and the rise of Realism with new certainty about the medical value of patient testimony necessitated by early neurology. These chapters demonstrate the ways that nineteenth-century physicians drew on these genres—including stereotyped characters and sentimental plot devices—as they composed the case studies that built diagnostic knowledge in their young discipline. At the same time, they ask how literature served to process, simplify, disseminate, and ethically question new categories of moral disorder. Looking at the function of literary rhetoric in diagnosis and diagnostic rhetoric in literature, "The Politics and Poetics of Diagnosis” clarifies literature’s role in medicalization, and medicine’s impact on changing literary form throughout the nineteenth century—the period that saw the first several generations of both American psychiatry and a literature understanding itself as uniquely American.

Table of Contents

Introduction: 1

Chapter 1: “An Authentic Case”: Benjamin Rush, Charles Brockden Brown, and the Physiology of Morality: 32

Chapter 2: Moral Insanity and Diagnostic Vision: Nat Turner, Isaac Ray, and Edgar Allan Poe: 71

Chapter 3: Romantic Physiology and the “Physiological Romance”: Narrating Diagnoses in Oliver Wendell Holmes’s Elsie Venner: 124

Chapter 4: “A Wasted Sympathy”: Winifred Howells, the Illness Narrative, and Illness Poetics: 173

Coda: 234

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