One of the great allures of the corpus of Middle English literature that flowered in the years following the Black Death is the self-authorizing spirit that animated the writings of such innovators as Geoffrey Chaucer, Thomas Hoccleve, and Margery Kempe. Julie Orlemanski’s wide-ranging new book, Symptomatic Subjects, merges two fields of study, the history of medicine and Middle English literature, to argue that behind this cultural shift was an explosion of vernacular medical writings that affected powerfully the literary and cultural imaginations of the fourteenth and fifteenth centuries. In her introduction, Orlemanski notes that ancient medicine turned on the idea of etiology, a polysemous approach to bodily signs that sits uneasily alongside the cultural impulse to revere authority. To this end, she demonstrates that the ubiquity of medical discourse in England after the Black Death, combined with the diffusion of those ideas across a broad range of manuscript contexts, had the effect of destabilizing monolithic approaches to truth, shifting England towards what she calls “the etiological imagination.” Orlemanski locates the novelty of her study in this triangulation of medicine, literature, and subjectivity, reinterpreting a variety of well-known Middle English texts as “unremarked experiments...in selfhood” (3).
It is impossible to reconstruct late Middle English “medical discourse” as a single, cohesive system of knowledge; like the bodies it purported to heal, this discourse was endlessly protean, in constant flux. Orlemanski has a twofold explanation for the unique power of medical writing to fascinate readers: for the first time, non-Latinate patients could interpret their symptoms for themselves, controlling, to a degree, their own signification; meanwhile, poets inherited not only a wealth of relatable metaphors but also, it turns out, a transgressive source of enjoyment. In a particularly effective passage, Orlemanski brushes aside penitential readings of the famous Wound Man illustration to instead show how it both exhibits the “centripetal pull of the self” and “gathers the porous, dissolving body back together” (12). The medicalized body emerges as a site of contestation between competing models of self: on the one hand, the passive subject of authority; on the other, the increasingly active subject of the later Middle Ages.
Agency is the focus of the book’s second chapter. While the sheer volume of phisik--not to mention its many internal contradictions--made interpreting symptoms daunting, it also led to an empowering heterogeneity. As Orlemanski shows, the etiological approach of classical medicine comes to influence not only barbers, surgeons, and physicians, but also their patients. Affluent patients, she argues, often moved around between different practitioners, in effect short-circuiting any attempt to close the hermeneutic circle that ties the symptom in question to any one, authoritative interpretation. For users of medical texts, competing authorities, translation errors, and scribal corruption made the goal of diagnostic certainty increasingly elusive, but this, argues Orlemanski, was precisely their allure: Middle English medical writings open a discursive space for a new model of narration that privileges the personal alongside the authoritative, the experiential alongside the dogmatic.
Chapter 3 argues that the non-teleological deployment of terms from vernacular medical writing in the literature of the period introduces a destabilizing amorality into the genre of satire. Writers of satire, argues Orlemanski, found in vernacular medical texts an effective register through which “to relish medicine’s material stratagems” (85). The best-known text in this discussion is Chaucer’s “The Nun’s Priest’s Tale,” which burlesques Middle English medical discourse not so much to comment on professional incompetence and monetary greed so much as to revel in the sheer materialism of this newly available--and refreshingly secular--discourse of the body. This materialism could also prove unsettling, for example in the famous author-portrait of John Arderne and patient, which Orlemanski speculates left “readers feeling uneasy” (103). Against this somatic anxiety, anti-Jewish texts like The Croxton Play of the Sacrament offered a powerful defence: on the one hand, identification with the supernaturally intact body of Christ; on the other, disavowal of the fragmented Jewish antagonist. In its sheer elasticity, Orlemanski argues, the language of phisik could express a range of meaning, from the joy of transgression to the sorrow of fallenness.
The fourth chapter explores the fruitful relationship between medical and pastoral casuistry. In the dense textual thicket of later medieval England, too many contingencies existed for either the doctor of souls or the doctor of bodies to make a clear diagnosis. Medical and exemplary writers alike turned to narrative to interpret the chaotic indeterminacy of lived experience. For an example of this turn in medicine, Orlemanski posits the fourteenth-century English surgeon Arderne, for whom the didactic function of narrative is secondary to its potential for self-authorization. Meanwhile, penitential and devotional writings become more nuanced in their use of medical theory. Orlemanski pays particular attention to the Middle English sermon tradition, which found in vernacular medicine a trove of relatable metaphors through which to elucidate spiritual concepts.
The next two chapters focus on fictional representations of medicine. For Orlemanski, vernacular medicine acts as a Trojan Horse through which the etiological spirit of Greco-Roman medicine enters Middle English literature, exerting there a counterhegemonic effect. The fifth chapter, a sustained analysis of Chaucer’s chivalric romance “The Knight’s Tale,” interprets Arcite’s fragmented body as expressive of this new “thinking against totality” (148). Such thinking is also evident in the evolving signification of the leprous body, the subject of Chapter 6. As Orlemanski notes, late medieval writers increasingly favoured naturalistic explanations of leprosy. Unmoored from its formerly penitential signification, leprosy could now signify the virtuous undoing of the self, an Augustinian ideal, as easily as it could mortality or damnation. Orlemanski writes touchingly about the heroine’s leprous body in Robert Henryson’s Testament of Cresseid as an example of the leper’s “aesthetic and emotional power” (185).
The final two chapters focus on personal accounts of illness, or autopathography, from the fifteenth century. Thomas Hoccleve’s single-author collection presents his well-known struggle with mental illness in the context of bustling late medieval London. Once his mind is restored, Hoccleve--Orlemanski accepts the subject’s self-identification with the protagonist--cannot change his negative signification in the social field, and this impotence of authorization fuels his deepening sense of existential despair. In a brilliant passage, Orlemanski interprets the imagery of London crowds as a metaphor for late medieval textuality, which had itself become too dense, too noisy, for any fixed relationship between signifier and signified to endure. The final chapter considers another strong fifteenth-century author who suffers a very public bout of mental illness, Margery Kempe. Kempe finds in advanced devotion an alternative mapping of the body capable of resisting the clerical imposition of antifeminist interpretations. According to Orlemanski, Kempe’s rejection of linear narrative and stable perspective further destabilizes monolithic approaches to reading the female body, allowing her to develop a unique subjectivity all her own.
As we have seen, then, Orlemanski merges the fields of the history of medicine and Middle English literature in order to argue that a pronounced upsurge in vernacular medical texts in the fourteenth and fifteenth centuries dramatically influenced the literature of the period, shifting it towards a more experimental, less dogmatic ideation, and that this shift affects not only the fictional representation of medieval medicine but also the more personal accounts of illness that materialize by the end of the Middle Ages. As Orlemanski states in the introduction,
This book tells the story of how embodied subjectivity was narrated in
its entangled relation to the world in the era of medicine's
unprecedented textual vitality. In that, it offers one approach to the
phenomenology of medieval selfhood...(3)
It is a story indeed worth telling. In many respects, however, it is also a story that has already been told--and quite some time ago, at that.
In 2006, I published with Palgrave’s New Middle Ages series a very similar book entitled The Surgeon in Medieval English Literature. That book explored how the parallel, post-plague explosions of medical and pastoral writings in Middle English merged the unsettling figure of the surgeon with that of the parish priest, reinforcing the psychological power of the Church as it faced numerous challenges to its authority. The Surgeon was the first monograph in the field of Middle English studies to take as its starting-point the profound influence of Middle English medical texts, and especially practical medical texts, not only on the literary imagination of later medieval England but, in conjunction with auricular confession, on the emergence of “a new form of selfhood” (3). Its chapters, like those of Symptomatic Subjects, are divided between metaphorical and literal, or fictional and personal, representations of illness. Inevitably, we use many of the same primary and secondary sources, and, in some cases, we even analyze the same passages. One differentiating factor is theory: Symptomatic Subjects uses semiotics as its theoretical lens, The Surgeon psychoanalysis. On the other hand, these two theories have informed one another at least since Jacques Lacan’s discovery of the semiotic structure of the unconscious: it is therefore not surprising that we come to some of the same conclusions.
It must first be said that if Orlemanski reinvents the wheel, she also in many ways improves it, widening its grip to better traverse the unpredictable, shifting terrain of late medieval epistemology. Where my book focusses on surgery, Orlemanski rightly emphasizes the diversity of the medieval medical field. Where I connect medicine to spiritual ideas of healing, Orlemanski lets it signify freely, resulting in a wider variety of interpretative possibilities. Where my book recognizes the polysemy of the medical practitioner, Orlemanski picks up on the fractured connotations of the symptom itself. In other respects, however, there are more correspondences between these two texts than Orlemanski’s single passing reference at the end of a footnote would suggest. This overlap is most pronounced in her discussion of Chaucer’s chivalric romance “The Knight’s Tale.” Much like my analysis of the Middle English version of the Practica of John Arderne, this chapter explores narratives of the wounded body and its surgical treatment in a chivalric context. Three major points of convergence stand out. The first is Orlemanski’s use of the phrase “dissolving bodies” (3) to refer to loss of physical integrity, which seems indebted to my paragraph-long discussion of that specific word in Middle English, in which I argue that Arderne was haunted by the “horror of the dissolving body” (114). Secondly, Orlemanski’s observation that the surgeon’s cut “unites violence and cure” echoes strongly my own, central point that “surgery...both healed and hurt” (2). Finally, Orlemanski’s description of surgical treatment as participating in “the fantasy that anatomical exposure will make the self whole” (40) is reminiscent of my own that surgeons are “unable to sustain such a fantasy of wholeness” (116). Another significant overlap between the two books is their treatment of the Augustinian metaphor of Christ the Physician. In The Siege of Jerusalem, I argue, “Jewish bodies are torn, pierced, mutilated and dismembered” (58) in order to remind readers of the poem that wholeness derives ultimately from “the overtly medical concept of Christus medicus” (61). Orlemanski interprets another anti-Jewish Middle English text, The Croxton Play of the Sacrament, in much the same fashion: the mutilated Jewish antagonist, she argues, expresses “the tension of dismemberment” (107), which ultimately requires “Christus medicus to overcome” (111). In that same chapter, Orlemanski makes much of the bodily excretions upon which medical diagnosis depends: “Medical writers,” asserts Orlemanski, “were sensitive to the potential disjunctions between the self and its waste” (99). The earlier book makes the same point about the role of waste in delineating boundaries of self. In its chapter on Arderne, for example, we see “excrement become the template not merely for our notion of revulsion, but also for our understanding of what constitutes subject and object, inside and outside” (124). Finally, Orlemanski’s interpretation of the fifteenth-century poet Thomas Hoccleve’s single-author Series is evocative of my own discussion of the fifteenth-century poet John Audelay’s own single-author collection which, like Hoccleve’s, speaks to a growing desire at the end of the Middle Ages to control how the afflicted body signifies. Just as, according to Orlemanski, Hoccleve despairs in “the self’s inability to control its own materiality,” (218), so, too, does Audelay despair in “the unheeding materiality of the poet's own decaying body” (87). Orlemanski’s decision to ignore these many overlaps with The Surgeon despite its inclusion in her list of Works Cited is a curious one, especially given the many places where engagement would have been apposite.
While Symptomatic Subjects does correct some of the limitations of The Surgeon in Medieval English Literature, particularly its static conception of the cultural significance of wounds, there are also moments where fruitful dialogue with the earlier book might have helped flesh out parts of Orlemanski’s own argument, especially where important elements are left untheorized. One example is the enjoyment she repeatedly claims inhered in the act of thinking etiologically. Where does this enjoyment come from? The Surgeon thinks this through with the aid of Jacques Lacan’s theory of jouissance, an innate drive towards self-assertion, even self-realization, that compels us to take joy in the transgression of physical boundaries, and also Georges Bataille’s theories of the erotic as itself essentially transgressive. While Orlemanski does not mention psychoanalysis, her language of fantasy, selfhood, partibility, and wholeness seems indebted to Lacanian theory. Another example is her suggestion that Arderne’s author-portrait discomfited readers. Why were such images discomfiting? The Surgeon looks for explanations in anthropological distinctions--between purity and filth, order and disorder--that, according to Mary Douglas, structure both self and society. At the very least, Orlemanski should direct readers to the earlier text at those moments where it speaks directly to unresolved arguments in her own.
Symptomatic Subjects makes many positive contributions to Middle English studies. It adds compelling new arguments to the view of many medievalists that Chaucer’s period, not Shakespeare’s, witnesses the emergence of the self. It brilliantly counters the misconception that the Middle Ages were maddeningly monolithic and drearily didactic. Most importantly, it demonstrates the indispensability of medieval medical concepts, writings, and practices to any kind of full understanding of Middle English literature and culture. Throughout the book, Orlemanski’s writing is assured, animated, and refreshingly empathetic. There are also, as I have shown, profound overlaps with a very similar study that, had they been acknowledged, might have built important bridges between the two books, to the benefit of both studies as well as to the field as a whole.
[This review has undergone some minor revisions for clarity by the reviewer since it was posted on the TMR listserv and responded to by the author.]