Tracing Hybrid Collectives of Illness, War, and Medicine in Twentieth- and Twenty-First Century Narratives of Illness

Thesis (Ph.D.)--University of Washington, 2016-06

University of Washington Abstract Tracing Hybrid Collectives of Illness, War, and Medicine in Twentieth- and Twenty-First Century Narratives of Illness Barbara J. Simons Chair of the Supervisory Committee Professor Monika Kaup, Chair English “Varieties of warfare and war-related illnesses, mental and physical,” is the red thread that organizes this dissertation. My study compares and contrasts illness narratives (fiction and non-fiction) from modernism and the early twentieth century with texts of the late twentieth and early twenty-first centuries to better understand the psychologies of war trauma and techniques of narration from opposite sides of the twentieth century. In narratives about traditional and nontraditional warfare, I analyze how the social is deconstructed by the powerful mediators of illness and death and has to be reassembled in new forms of social organization. By tracing real connections across realms of existence normally separated by fields of study, I analyze the connections between medicine, literature, and the events related to war and its history. The compelling strength of this dissertation is the comparative breadth of its perspective. The methodologies I deploy are not normally engaged in conversation with each other: the “narrative medicine” of medical practitioners, the “narratives of illness” of cultural and formalist literary critics and humanist scholars, and “medical intertextual” investigation that links literary, medical, and social texts. Moreover, my literary analysis is consistently based on historicized readings, such as of shell shock and PTSD and of the medical quarantine. As my umbrella methodology to justify such a procedure, I rely on Bruno Latour’s Actor-Network Theory in an effort to trace hybrid networks that bridge “narrative medicine” and fictional and non-fictional literary representations of mental breakdown and physical diseases linked to social disruptions caused by modern warfare. My aim is to exceed the boundaries of individual patient narratives (pathographies) by connecting them with other illness narratives in order to complicate and thus redefine the meaning of “illness narratives.” Furthermore, I study the artistic innovations in narrative renditions of the experiences of illness and profoundly altered mental states to enrich literary studies about formal techniques of representation. In Chapter 1, I juxtapose Virginia Woolf’s modernist novel, Mrs. Dalloway, to Vera Brittain’s personal memoir, Testament of Youth, to compare fictional and non-fictional narratives about the rich lifeworlds of war-related illness and suffering of World War I. As a Latourian scholar, my focus is on the varieties of hybrid actor networks among soldiers, civilians, and health care providers amidst the reorganization of society for modern war, with its calamitous effects on mental health and physical well-being. Based on my findings, I argue that shell shock was a human rebellion against the unlivable situation of modern industrial warfare. While “rebellious”—as is important to note—shell shock was often an ineffective and self-destructive escape into illness. For some individuals, shell shock precipitated a profound personal transformation in their quest for a new state of health. Indeed, the rebellion of shell shock opposed the official master narrative of modern industrialized warfare, according to which the medical diagnoses of “war neuroses” were not neutral scientific diagnoses, but medical instruments of the military system to discipline and treat soldiers in order to return them to the front. This chapter argues that the modernist literary, non-fictional, and philosophical works by Virginia Woolf, Vera Brittain, and Martin Heidegger selected here constitute counter-narratives of authenticity that challenge the veracity of the world of modern warfare as constructed by official nationalist and imperialist narratives. Moreover, Testament of Youth offers an alternative model for the fruits of melancholia and the workings of grief. Brittain’s autobiography derives its value not as an “individual pathography” but as the story of one life lived in acknowledgement and affirmation of our frailties, our mortality, and our shared responsibility for one another. In Chapter 2, I study early twenty-first century nonfictional anthropological representations of the experiences of war and PTSD, Fields of Combat: Understanding PTSD among Veterans of Iraq and Afghanistan by Erin P. Finley and Breaking Ranks: Iraq Veterans Speak Out Against the War by Matthew Gutmann and Catherine Lutz, and one novel, Sparta, by Roxana Robinson. As a Latourian scholar, I distinguish the hybrid actor-networks that connect the two purist realms of medicine (objective; facts) and the self (subjective; the power of memory in the form of flashbacks). As I show, the contemporary diagnosis of PTSD (like the early twentieth century diagnoses of war neuroses) is founded on a rhetorical maneuver of purification that isolates mental trauma from the warfare that generates it; in short, PTSD is a disembodied, abstracted concept of the mind—an instance of a scientific artifact that Latour calls a “factish”—under the make-believe control of psychiatry. But real trauma produces hybrids connected to multiple sites that cannot be discounted as externalities. To counter the medical segregation of (mental) illness from politics, I trace the empirical connections in the actual “assemblages” between the psychological suffering of U.S. soldiers and their combat experiences to reconsider “PTSD” as a complex hybrid that proliferates in response to war and its structural violence. Through the sharp contrasts I draw between the techniques of narration in each text, I show that opposing views about PTSD are based on conflicting answers to a much larger question: Is the human mind accurately understood as a machine or as part of an immensely complex, adaptive, and embodied living organism? Having debunked “PTSD” as a reductive biomedical diagnosis that erases moral concerns from the conversation, I propose my solution: A new version of PTSD that restores the “matters of concern” of veterans themselves via an ecological concept of the mind that replaces biological determinisms. In Chapter 3, health and illness and the dying process are connected to nontraditional modes of warfare: In Blindness, when the population becomes white-blind, the government’s internment of the white-blind in medical quarantines makes war on the contagious people, not the microbe. In Death with Interruptions, the suspension of death is an allegory about the (mis)application of the critical care technology developed in war medicine to the civilian world in the end-of-life care of the terminally ill. Both novels are anti-realist fables that defamiliarize disease and death as fantastic conditions that are inaccessible to the medical/clinical gaze. In Blindness, I argue that rather than serving the purpose of protecting the public health, the location of the quarantine for the white-blind in an abandoned mental asylum unmasks the real carceral nature of medical quarantine as a distant successor to Foucault’s eighteenth century asylum for the insane. Indeed, the ostensible gesture of restoring health to the body politic is exposed as the internment of the white-blind in a twentieth century concentration camp, as aptly characterized in Agamben’s Homo Sacer. Blindness undercuts the master narrative for the containment of infectious disease, Patricia Wald’s “outbreak narrative.” After the universal spread of white-blindness, the small society led by the doctor’s wife “reassembles the social” in new patterns of organization amidst accelerating chaos and disequilibrium. In Death with Interruptions, the deconstruction of traditional social life with the proliferation of the dying is narrated alongside the reinvention of the social among the dying and their families. In my allegorical reading, I argue there is a parallel between the novel’s fantastic suspension of death and the ontological condition of prolonged dying on the life-support machines of modern medicine that reveals the hubris of epistemological assumptions about the human capacity to control time and space through technological knowledge.