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Literature and Medicine, Volume 20, Number 2, Fall 2001, pp. 151-182
(Article)
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DOI: 10.1353/lm.2001.0018
For additional information about this article
http://muse.jhu.edu/journals/lm/summary/v020/20.2cutter.html
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Martha J. Cutter
151
The Writer as Doctor:
New Models of Medical
Discourse in Charlotte
Perkins Gilman’s Later
Fiction
Martha J. Cutter
When Charlotte Perkins Gilman was suffering from the postpartum depression that eventually became the impetus for “The Yellow
Wall-Paper” (1892), she took extensive notes about her symptoms.1
However, when she sent a letter describing her symptoms to the
famous Victorian nerve specialist S. Weir Mitchell, he claimed it “only
proved self-conceit” and promptly condemned her to the rest cure,
which expressly prohibited women from reading and writing about
anything, including themselves or their illness.2 Gilman followed this
prescription and, as she explains in her autobiography, “came perilously
near to losing my mind. The mental agony grew so unbearable that I
would sit blankly moving my head from side to side—to get out from
under the pain.”3 Gilman later abandoned Mitchell’s rest cure, published “The Yellow Wall-Paper,” and became a successful writer and
lecturer. Gilman was healed, at least partially, by becoming an active
participant in the reading and writing of her own “disease.”
Several of Gilman’s later fictional works repeat this struggle in
which a male-dominated medical establishment attempts to silence
women. In fictions such as “The Vintage” (1916), The Crux (1911), and
“Dr. Clair’s Place” (1915), male physicians prescribe restrictive diagnostic “sentences” (or verbal/physical treatment regimens) for their female
characters.4 But in some of these works, women doctors and patients
counter these restrictive diagnoses through the use of reading and
writing to achieve mental and physical health. In Gilman’s writing the
Literature and Medicine 20, no. 2 (Fall 2001) 151–182
© 2001 by The Johns Hopkins University Press
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THE WRITER AS DOCTOR
patient is not exclusively read by her physician; she also reads her own
disease and participates in the formulation of her diagnosis. Moreover,
in creating texts about physical and mental illness, the writer becomes
a kind of doctor, for these stories provide readers with therapeutic
regimens or physical practices that lead to good health.
Gilman therefore formulates a model of medical discourse that
goes beyond many of the practices of her time period.5 In this model,
medical information circulates between doctor and patient and between
reader and writer, and medical authority is dispersed. Most radically, in
Gilman’s paradigm, diagnosis is to some degree coauthored, created by
an interaction between readers/patients and authors/doctors. Doctors
“read” patients—they interpret their symptoms and produce diagnoses—but patients also learn, in collaborations with their doctors and
medical texts, to “read” and interpret themselves. Moreover, the processes of collaborative reading and diagnosis are meant to work within
the story (intratextually) as well as outside the story (extratextually). Of
course, in the world outside the story the doctor still holds a very real
position of authority over diagnosis, for he or she is most empowered
to treat and/or write about disease. But Gilman’s fictions do illustrate
a process whereby the “fictional” practices she describes can be translated to the “real” world.6 It is language, logos itself, that allows this
transformation, for once patients become active intratextual and
extratextual readers—readers who learn about medical and social conditions from a variety of cultural texts—they may be able to intervene
in the production and formulation of diagnoses that have disempowered
them.7 Gilman’s writings therefore foreshadow contemporary medical
research about the crucial role gender plays in medical diagnosis, the
need for effective doctor-patient collaboration and coauthorship in the
creation of a diagnosis and a treatment, and, above all, the importance
of the patient’s ability to articulate, and thereby take control of, his or
her illness.8
Nineteenth-Century Models of Medical Discourse
Gilman’s writings about medicine constitute a very prescient
critique of this field of knowledge. Sociologists and anthropologists
have recently argued that medical knowledge is not simply a set of
objective facts about disease, since it is influenced and even created by
scientists’ and doctors’ moral values, social attitudes, and political
prejudices. Influenced by Michel Foucault, these authors argue that
Martha J. Cutter
153
medical language is a form of discourse that does not so much reflect
some preexisting reality as constitute this reality.9 Furthermore, medical
knowledge is inseparable from social relationships and social experience. Gilman’s works (written from 1892 to 1916) reflect many nineteenth-century beliefs about women’s “essential” medical disposition
and treatment by the medical establishment; they therefore demonstrate
that medical knowledge to a great extent is socially constructed. At
times, however, Gilman’s work also undermines the social construction
of women in patriarchal medical discourse, portraying women who
refuse their “interpellation” by an ideological apparatus that defines
them as silent, powerless, and passive.10
It is important to begin, then, by examining nineteenth-century
models of medical discourse and, more specifically, its ideas about
women. As numerous historians have argued, throughout the second
half of the nineteenth century, illness was viewed as endemic to
women’s condition. Women were seen as being at the mercy of their
unpredictable and uncontrollable reproductive organs. John Wiltbank, a
physician, wrote in 1854 that “woman’s reproductive organs are preeminent. . . . They exercise a controlling influence upon her entire
system, and entail upon her many painful and dangerous diseases.”11
In the period between 1840 and 1890, in particular, physicians gained
increasingly sophisticated physiological data about the female reproductive system, and they used this data to reinforce ideas about women’s
“peculiar” diseases. For example, in 1895, health reformer J. H. Kellogg
writes that “A woman’s system is affected . . . we may also say
dominated, by the influence of these two little glands (the ovaries). . . .
Either an excess or a deficiency of the proper influence of these organs
over the other parts of the system may be productive of disease.”12
Based on her analysis of such medical texts, Diane Price Herndl
concludes that between 1840 and 1890 women were increasingly defined as sickly and weak.13
In this time period, “hysteria” also emerged as a definable disease.
This disease was thought to be more common in women and was often
seen as the result of too much education. Women who spent time in
college or in study—that is, women who overstimulated their brains—
might jeopardize the fragile balance of their reproductive system.14 S.
Weir Mitchell himself believed that hysteria was far more common in
college-educated women, and he urged careful medical examination of
the fitness of girls entering college.15
Of course, as Carroll Smith-Rosenberg points out, it is no coincidence that just when many women were delaying or rejecting their
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THE WRITER AS DOCTOR
entry into the traditional roles of wife and mother in favor of careers
and college education, medical and biological defenses of the more
traditional roles increased.16 And it is no coincidence that many of the
diseases attributed to women were seen as the product of a lack of selfcontrol or self-rule. Women were dominated by their ovaries—passive,
it seemed, in the face of their burdensome reproductive system. Hysterics were often described as emotionally self-indulgent, morally weak,
and lacking in willpower. As Mitchell argues, hysteria occurs in women
who have not developed self-restraint and “rational endurance”—who
have lost their power of “self rule.”17 Treatment of women’s diseases
therefore often involved subduing the female body and/or mind and
subjecting women to the authority, or voice, of the male physician. Dr.
Robert Carter emphasizes the importance of maintaining a commanding
voice during this process, arguing that for a physician to “assume a
tone of authority . . . will of itself almost compel submission. . . . If a
patient . . . interrupts the speaker, she must be told to keep silent and
to listen; and must be told, moreover . . . in such a manner as to convey
the speaker’s full conviction that the command will be immediately
obeyed.”18 As one physician associated with a large mental institute
wrote, it is imperative that women hysterics “listen to the voice of
authority.”19 Indeed, in this time period a view of the doctor as an
authoritarian figure permeated medical literature in relation to a variety
of diseases. In a treatise on patient-doctor relationships, Mitchell comments that “wise women choose their doctors and trust them. The
wisest ask the fewest questions.”20 For Mitchell the “cured” woman
patient is subdued, docile, silent, and above all subject to the will and
voice of the physician. She understands that “the physician means to
have his way unhampered by . . . subtle distinctions.”21
Many medical treatments for women in the later part of the
nineteenth century may also have had an implicit goal of stamping out
any signs of nonconformity in women and of compelling the patient to
reverence the male doctor’s power. In a speculative essay Ann Douglas
Wood argues that Mitchell “wanted to be revered, even adored” and
that the rest cure (which he popularized for women suffering from
hysteria in the late nineteenth century) “was designed to make his
female patients take his view of the doctor’s role.”22 Mitchell himself
emphasizes that the hysterical women he treated craved power,23 and
many of his writings imply that the physician’s role is to undermine
this desire. Barbara Ehrenreich and Deirdre English argue that “late
nineteenth-century medical treatment of women made very little sense
as medicine but it was undoubtedly effective at keeping certain women—
Martha J. Cutter
155
those who could afford to be patients—in their places. As we have seen,
surgery was often performed with the explicit goal of ‘taming’ a highstrung woman. . . . Prescribed bed rest was obviously little more than
a kind of benign imprisonment—and the prescriptions prohibiting
intellectual activity speak for themselves!”24 Such medical attention
amounted to a very effective surveillance system; it was a way of
stamping out rebelliousness and making women conform to social
roles.25 As the century came to a close, these practices grew more rigid
and promoted “an increasingly inflexible conception of woman’s nature
and capacity.”26
Not all physicians were male, of course, and not all male physicians believed in these treatments. Furthermore, as Smith-Rosenberg
argues, some women may have used their illness to attain a measure
of control over, or even to rebel against, their social roles. These
quotations nonetheless illustrate that the goal of many physicians was
to subdue women who were (by their nature and bodies) inherently ill
and in need of male control. Such assumptions about female health, as
Regina Morantz-Sanchez notes, were “informed not by empirical evidence . . . but by cultural assumptions that had a particular nonmedical use in ordering social and power relationships.”27 These views
of women’s essential (sick, uncontrolled) nature continued well into the
first decades of the twentieth century, and some women patients had
clearly internalized them.
Of course, changes did occur in the early twentieth century.28
According to Price Herndl, women were no longer only viewed as
inherently unhealthy; energetic, athletic women began to appear (and be
applauded) in the popular literature.29 Gilman was, in fact, fond of
portraying healthy, robust, athletic women and of showing them beating
men in many athletic competitions, such as fencing, rowing, and tennis.
Gilman’s medical fictions, however, are concerned primarily with refuting nineteenth-century, rather than twentieth-century, constructions of
women’s health, perhaps because these constructions had been extremely damaging in her own life and because they were still operative
in the early twentieth century. According to the nineteenth-century
model of medical discourse, a female patient is “read” and diagnosed
by a male physician. The language with which the doctor reads the
patient and creates a diagnosis is validated, while any language the
“irrational,” “uncontrolled” female patient produces about her disease/
treatment is discarded, ignored, or considered simply another symptom
of the disease. Works such as “The Yellow Wall-Paper” and “The
Vintage” critique this model, while works such as The Crux and “Dr.
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THE WRITER AS DOCTOR
Clair’s Place” undermine it, replacing it with one of collaboration and
coauthorship that allows medical discourse to circulate more freely.
The Doctor as Doctor: Critiques of Medical Discourse in “The
Yellow Wall-Paper” and “The Vintage”
“The Yellow Wall-Paper” is an excellent illustration of Gilman’s
critique of the dominant nineteenth-century model of medical discourse.
The story describes a woman’s medical treatment by her physician
husband, John. Confined to a single room in the attic of a house and
forbidden to read or write, she becomes obsessed with the pattern of
her wallpaper. Finally, by the end of the story, she has stripped the
paper off the walls in an attempt to free the woman she believes is
trapped behind the wallpaper, who is clearly a double for herself. When
her husband sees his wife, covered in wallpaper, crawling on the floor
of her room, completely “mad,” he faints. “I’ve got out at last,” crows
the unnamed narrator.30 But has she? And what will happen when “Dr.
John” wakes up?
Gilman emphasizes that much of the harm caused by this woman’s
medical treatment—her “rest cure”—has to do with the way her voice
is silenced. The narrator is not allowed to participate in the formulation
of her treatment and diagnosis, as the following quotation demonstrates:
John laughs at me of course. . . .
You see, he does not believe I am sick! And what can one do?
If a physician of high standing, and one’s own husband, assures
friends and relatives that there is really nothing the matter with one
but temporary nervous depression,—a slight hysterical tendency—
what is one to do? My brother is also a physician and also of high
standing, and he says the same thing. . . .
Personally, I disagree with their ideas.
Personally, I believe that congenial work with excitement and
change would do me good.
But what is one to do? (P. 39)
The narrator has her own ideas about what her disease means and how
it should be cured, but they are ignored. Paula Treichler explains that
“a medical diagnosis is a verbal formula representing a constellation of
physical symptoms and observable behaviors. Once formulated, it dic-
Martha J. Cutter
157
tates a series of therapeutic actions.” A diagnosis therefore “sets in
motion a therapeutic regimen which involves language in several
ways.”31 The narrator’s diagnosis of her condition is seen as part of the
condition itself—a sign of her insanity; it is not, in fact, considered to
be a diagnosis, so no treatment is dictated. The male physician’s
diagnosis, on the other hand, is authorized both linguistically and
culturally; therefore, once he speaks his diagnosis, the narrator’s therapy
is set into motion. In this story, diagnosis “is powerful and public. . . .
It is a male voice that . . . imposes controls on the female narrator and
dictates how she is to perceive and talk about the world.”32 Diagnosis
covertly functions to empower the male physician’s voice and
disempower the female patient’s.
Furthermore, throughout the story the narrator’s voice is ignored
in even more overt ways. She is not allowed to read and write, and
when she tries to have “a real earnest and reasonable talk” (p. 45) with
John about her illness, he gathers her up in “his strong arms” and reads
to her “till it tired my head” (p. 45). The voice of the female patient
is strong-armed into silence. It becomes clear from these examples that
medical treatment is a one-way street. The male physician reads the
female patient and produces a diagnosis—a diagnosis that cannot be
changed by the patient and that ultimately leads to psychosis.33 Furthermore, this attitude toward medical diagnosis is certainly tied to the
narrator’s gender. David Ingleby, a social psychologist, argues that
femininity and mental illness are often linked to social status: less status
means that less validity is credited to the patient’s point of view.34 This
lack of status is extremely apparent when the narrator’s husband calls
her “a blessed little goose” (p. 42) or “little girl” (p. 46) and tells her:
“bless her little heart! . . . she shall be as sick as she pleases” (p. 46).
In the story, women’s words lack status and therefore go unheard; they
do not influence the diagnosis or the treatment.
These ideas about the way medical discourse functions are emphasized by the primary symbolic motifs of the story (the house, the
pattern of the wallpaper, and the woman who shakes the bars behind
the pattern) as well as by the mode of narration. Critics have, of course,
noted how the story’s symbols connote relationships of patriarchal
power and feminine disempowerment, but few have analyzed how this
symbolism relates specifically to illness and its representation or to
women’s struggle for a voice in diagnosis. For example, the house—
described as a “colonial estate” and an “ancestral hall” (p. 39)—is both
a symbol of patriarchy and a symbol of how medical authority functions
under patriarchy. In a strand of imagery common in her medical
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THE WRITER AS DOCTOR
fictions, Gilman illustrates that traditional households—households in
which men have economic and social power—replicate traditional patriarchal medical authority. Emphasizing the overlap of patriarchal and
medical authority, John is both the narrator’s husband and her doctor;
the doctor’s disabling authority collapses into and is inseparable from
that of the husband. As husband/doctor, John has the right to decide
where the narrator lives (in a house she dislikes) and what her mode
of treatment will be (rest, taking care of her child, and lack of
intellectual activity). Medical authority replicates patriarchal authority
and vice versa.
Gilman also symbolically suggests that the narrator sees the
nature of her confinement—that she sees how the “pattern” of patriarchal medicine keeps her confined within the patriarchal house of
authority. The narrator describes the front (or “top”) pattern of the
wallpaper, for example, in terms of metaphors of illness: the pattern is
“unclean,” “diseased,” “sickly” (p. 41), “bulbous” (p. 42), fungous like
(p. 47), and a “sickly, penetrating, suggestive yellow” (p. 49). The
narrator here attempts to diagnose the disease of patriarchy, the disease
of patriarchal medicine; the top pattern eventually resolves itself into
bars that keep the “subpattern”—the rebellious woman—confined.
However, the narrator’s diagnosis of this disease of patriarchy, and of
the way this disease keeps women trapped in “sick” and unproductive
habits of living, goes unheard. Although the narrator has a resistant
voice at the story’s start, eventually the voice fragments, splits, and is
read only as the voice of “insanity.”35 In a discussion of illness
narratives, Arthur Frank comments that “the expert voice is the voice
of interpellation; it claims to know what sort of a subject the person is
and ought to be. The expert voice asserts the moral responsibility that
the person act as the subject she or he is interpellated to be.”36 At the
story’s start the narrator can resist her interpellation as a hysterical
woman in need of a “rest cure” that denies her intellectual stimulation;
she can say, for example, “I believe that congenial work with excitement
and change would do me good” (p. 39). But by the end, her statements
of diagnosis make much less sense and in fact are contradictory; she
states that “I’ve got out at last . . . you can’t put me back!” (p. 53) but
also “I suppose I shall have to get back behind the pattern when it
comes night, and that is hard!” (p. 52) and “I am secretly fastened now
by my well-hidden rope—you don’t get me out in the road there” (p.
52). If John’s fainting at the story’s end is evidence of the wife’s
“victory” over patriarchal medicine (as some critics have argued), that
victory is certainly a temporary one. What seems clear is that within the
Martha J. Cutter
159
story patriarchal medicine destroys both the patient’s sanity and her
ability to formulate a diagnostic voice that resists her cultural interpellation.
Yet Gilman does attempt to transfer the narrator’s early ability to
resist medical discourse and damaging cultural interpellations to her
readers. In “Why I Wrote the Yellow Wallpaper?” (1913) Gilman states
that she wrote the story not to “drive people crazy, but to save people
from being driven crazy, and it worked.”37 In that essay Gilman also
makes the following claims: the story is valued by “alienists” (nineteenth-century nerve doctors); the book has saved at least one woman
from a similar fate, so “terrifying her family that they let her out into
normal activity and she recovered”; she sent a copy of the story to
Mitchell and he altered his treatment after reading it.38 Gilman envisions herself as a kind of doctor who can save other women from her
own fate and/or influence the therapeutic regimens of other doctors.
Readers, whether male or female, become participants in diagnosis and
treatment; they might stop the rest treatment, releasing women into
“normal activity.” Rephrasing Gilman’s above quotation, we might say
that readers are supposed to “let [women] out” of the spatial confinements induced by patriarchal medicine. They might see and refuse the
pattern of diagnosis and disempowering interpellation that patriarchy
promotes for women.
Unfortunately, no documents have been found to corroborate
Gilman’s claim that Mitchell altered his rest cure after reading her
story.39 Yet it is important to consider the status of “The Yellow WallPaper” as a piece of medical discourse. As Treichler argues, “publication
of the story added power and status to Gilman’s words. . . . Her
published challenge to diagnosis has now been read by thousands of
readers.”40 Gilman’s critique of Mitchell and of patriarchal medicine
was certainly heard in her time period and continues to have an impact
today; whether Gilman accurately depicted Mitchell’s rest cure, for
example, is still a subject of scholarly debate.41 Furthermore, Gilman
believed that “The Yellow Wall-Paper” intervened in actual medical
practices—that her story created a mechanism whereby the symbolic
meanings of the literary text could be translated to the world outside
the text and reconfigure its medical practices. She believed, then, that
fiction could become an effective instrument to resist cultural interpellation and reconfigure patriarchal medical practices.
In “The Vintage” (1918),42 as in “The Yellow Wall-Paper,” Gilman
again criticizes the dominant diagnostic model, yet here she focuses
more on what happens when a female character does not resist the
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cultural interpellation of women as silent, passive, and disempowered
(the diagnosed, rather than diagnosers). The males in the story, Rodger
Moore and Howard Faulkner (a doctor), refuse to inform Leslie Montroy,
Rodger’s fiancée, that Rodger has syphilis. Leslie marries Rodger, bears
a series of stillborn children, and gradually grows sicker and sicker.
When Leslie finally dies, she still does not know what has befallen her.
At issue in this story is the way men circulate medical information
among themselves but refuse to allow it to circulate among women. Dr.
Faulkner knows of Rodger’s disease and tells him not to marry. Yet
when Rodger does marry Leslie, Dr. Faulkner never informs her of the
disease, although he is a good friend of hers and knew her long before
Rodger became his patient. As Gilman ironically comments, this is
because of a sense of “honor”: “What else could he do? He was a
physician with a high sense of professional honor. The physician must
not betray his patient. . . . So he held his tongue.”43 Should Dr.
Faulkner have warned Leslie? That is an issue Gilman does not take up
explicitly here, although she does take it up in The Crux.
What is clear, however, is that Leslie is unable to read the signs
of disease in her husband, her children, or even herself: “She did not
know what was the matter with her, or with her children. She never had
known that there was such a danger before ‘a decent woman,’ though
aware of some dark horror connected with ‘sin,’ impossible even to
mention” (p. 107, emphasis added). Leslie’s disease remains just below
the level of language; it can never be articulated by her because she
lacks medical knowledge. Furthermore, the story is told in an omniscient third-person voice that mainly narrates the men’s stories, and
Leslie’s emotions are rarely spoken. Even more than the narrator of
“The Yellow Wall-Paper” (who at least tells her own story), Leslie
remains a victim of a diagnosis that leaves her silent and unable to
comprehend the disease that has attacked her. Most important, Leslie’s
story emblematizes that of many women. As Gilman says: “This is not
a short story. It stretches out for generations. Its beginning was thousands of years ago, and its end is not yet in sight” (p. 104). Generation
after generation of women has been lost because of this “vintage”
tradition of excluding them from the sites of knowledge and authority.
And one of these sites is medical discourse. The imagery here is
striking, suggestive of grapes gone bad, grapes that have been left to
rot, grapes that taint everything they touch.
As in “The Yellow Wall-Paper,” Gilman also suggests symbolically
that patriarchal spaces promote the medical disenfranchisement of
women. Leslie is a woman with a “string of family names”—a woman
Martha J. Cutter
161
who is “very proud of her . . . good family” (p. 104). Perhaps this is
the reason she chooses to marry Moore, who is rich and who has
“bought an estate next to the Montroys” (p. 104). After her marriage
Leslie is installed within this patriarchal estate, as its mistress, with all
its “privileges”—that is, the right to be confined and diagnosed by
patriarchy but never to participate in diagnosis. Quite literally, this “fine
old place” (p. 108) is “world’s end” (p. 104) for Leslie—the space where
she dies. For her son (ironically also named Leslie), the space of the
estate represents “freedom and beauty” (p. 108), but to his mother it
becomes a charnel house where the “buds” of her youth (p. 107) are
blasted and where her voice barely even exists, let alone counts.
Given the long history of the silencing of women represented in
these two works, how is it possible for women such as Leslie or the
narrator of “The Yellow Wall-Paper” to have their voices count? One
way to answer this question is to consider whether “The Vintage” could
function as a site of extratextual diagnosis, as “The Yellow Wall-Paper”
appears to function. Could readers read the story and learn about
venereal disease? It is possible, on the one hand, that after reading
Gilman’s story women might think twice before marrying a man with
suspicious medical symptoms. But on the other hand, the story is rather
too vague to function as a diagnostic tool. Rodger and Leslie’s symptoms are not described in detail, and no voice explicates the specific
physical nature of the disease. Furthermore, Leslie remains unable to
read her own symptoms. Men, however, are clearly subjects within the
language of diagnosis. For example, when Leslie’s only surviving son
learns why his mother died, he sympathizes not with his mother but
with his father. “‘Oh my poor father!’” (p. 111) are the story’s final
words. Once again, men have shared medical discourse with each other,
while forcing women to remain its silent objects.
The Writer and Patient as Doctor:
Medical Discourse in The Crux and “Dr. Clair’s Place”
Perhaps due to physical constraints (Gilman’s Forerunner fiction
had to fit into a previously allotted space in the journal) and the
technical demands of writing a short story with a plot and characters,
“The Vintage” is vague about the symptoms of venereal disease.44
Although The Crux was written five years earlier than “The Vintage,”
its format (a novel) allowed Gilman to be much more explicit about the
symptoms of venereal disease.45 Furthermore, The Crux not only under-
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mines the dominant model of medical discourse but also formulates a
new one in which women doctors, writers, and readers become part of
the diagnostic and discursive apparatus.
The Crux traces the fortunes of a group of New England women
who move out West (to Colorado) to seek employment, new and
reconfigured home spaces, and wider vistas. The group is led by the
able Dr. Jane Bellair, who encourages her friend, Orella Elder, to set up
a boarding house in Colorado. A great deal of the plot focuses on
Vivian Lane’s budding romance with Orella’s nephew, Morton Elder.
Vivian plans to marry Morton, but after she learns from Dr. Bellair that
Morton has syphilis, she abandons this plan, eventually marrying
another man. The spatial imagery that Gilman has developed elsewhere
is present, for Gilman implies that when women move out of “traditional” patriarchal structures (the home, the “traditional” family) they
also move out of the sphere of patriarchal diagnosis and social and
medical control. The “spinster” Orella Elder is empowered by running
a boarding house, and Dr. Bellair’s office and home spaces are conflated,
since she sees patients in the boarding house run by Orella and
considers her office “her home for a good many years now.”46
The novel as a whole takes up a number of debates that were
crucially important in the early twentieth century, such as the true
woman versus the new woman, women’s economic roles, women’s
education, the meaning of the American West for women, and, of
course, the practices of male and female doctors.47 In The Crux, patriarchal society restricts women’s access to information—especially medical information. Confined in traditional, old-fashioned New England
families and homes, women have limited options, as numerous female
characters in the novel note after they move West. But even within
these “traditional” spaces, there are cracks in the façade of patriarchal
control. For example, there is a running debate about whether women
should be allowed to go to college, and about whether they need access
to knowledge about sexuality and sexual disease. Vivian wants to go to
college and to become a pediatrician, but her parents refuse to let her,
telling her that “marriage is a woman’s duty” (p. 19). And Vivian’s
New England minister preaches that women’s duty “is submission,
obedience” (p. 54). But Vivian actively resists this interpellation, realizing that the minister seems like “a relic of past ages, a piece of old
parchment—of papyrus. In the light of the studies she had been
pursuing in the well-stored town library, the teachings of this worthy
old gentleman appeared a jumble of age-old traditions, superimposed
one on another” (p. 55). “He’s a palimpsest,” Vivian thinks to herself,
Martha J. Cutter
163
“and a poor palimpsest at that” (p. 55). In imagery reminiscent of both
“The Yellow Wall-Paper” and “The Vintage,” Gilman suggests that there
is a long tradition of the silencing and denial of women—but that this
tradition is breaking down. Vivian reads books, and she actively reads
the “papyrus” text, the “old parchment” that is the minister. She does
not allow herself to be read by a moribund patriarchal authority but
attempts to produce her own living “diagnosis” of her status.
The Crux also represents the changes taking place in medical
diagnosis and information about disease. Medical information is still
supposed to be the province of men and male doctors, and women who
ignore this dictum are viewed with a certain degree of skepticism. And
there is strong hostility toward Dr. Bellair, the woman doctor, on the
part of both male and female patients (p. 45). Furthermore, as in “The
Vintage,” male doctors do not want to share knowledge about sexual
disease with women. For example, Dr. Hale (the male doctor in the
town), knows of Morton’s syphilis, but refuses to tell Morton’s fiancée
(Vivian) about it. When Dr. Bellair presses Dr. Hale to tell Vivian of
Morton’s disease, he says: “It is a matter of honor—professional honor.
You women don’t seem to know what the word means. I’ve told that
good-for-nothing young wreck that he has no right to marry for years,
yet. That is all I can do. I will not betray the confidence of a patient”
(p. 212). In a phrase that clearly echoes Gilman’s own sentiments, Dr.
Bellair responds: “A man’s honor always seems to want to kill a woman
to satisfy it. I’m glad I haven’t got the feeling” (p. 212). Gilman implies
that doctor-patient confidentiality is seen as a matter of “honor” between men, and that male doctors are all too willing to sacrifice
women’s physical bodies to maintain it. G. Thomas Couser argues that
“as patients seize, or at least claim, more authority over their treatment,
they may also be more inclined to narrate their stories, to take their
lives literally into their own hands in part to reestablish their subjectivity in the face of objectifying treatment.”48 But how can a (female)
patient claim authority over treatment, narrate her story, and reestablish
her subjectivity if the basic information about the disease is denied to
her by reason of “confidentiality”? Obviously, the patient can do none
of these things when her access to medical information is limited.
The debate between Dr. Bellair and Dr. Hale also reflects an early
twentieth-century controversy over whether to breach confidentiality
when a syphilitic patient threatened a healthy person. Prior to 1910,
many states forbade a physician’s breaching confidentiality and medical
societies also discouraged it, but in the first decade of the twentieth
century this began to change. Syphilis was a public health disaster at
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the turn of the century, with between 10 and 20 percent of the male
population infected, and in 1912 the AMA revised its “Principles of
Medical Ethics” to include the following section: “There are occasions,
however, when a physician must determine whether or not his duty to
society requires him to take definite action to protect a healthy individual from becoming infected because the physician has knowledge,
obtained through the confidences entrusted to him as a physician, of a
communicable disease to which the healthy individual is about to be
exposed. In such a case, the physician should act as he would desire
another to act toward one of his own family under like circumstances.” 49 They further add, “at all times, it is the duty of the
physician to notify the properly constituted public health authorities of
every case of communicable disease under his care, in accordance with
the laws, rules, and regulations of the health authorities of the locality
in which the patient is.”50 And some physicians—such as John Stokes
of the Mayo Clinic and Prince Morrow—urged disclosure.51 Some
lawyers supported the idea that breaching confidentiality was both legal
and ethical. In 1907 William A. Purrington argued that “a physician
who knows that an infected patient is about to carry his contagion to
a pure person, and perhaps to persons unborn, is justified both in law
and morals, in preventing the proposed wrong by disclosing his knowledge if no other way is open.”52 Particularly after 1909, with the
discovery of salvarsan—the first drug effective in the treatment of
syphilis—physicians began to view confidentiality about this disease in
a different light.53 Both “The Vintage” and The Crux were published
after this date, in a era in which some doctors believed it was both
ethical and legal to breach confidentiality for the benefit of others. Dr.
Bellair’s point in the above debate is that these “others” are always
women.
The larger issue in this novel, then, is that male doctors and
society itself continually deny women medical information, thereby
denying their agency. Speaking of sexually transmitted diseases, Vivian’s
grandmother comments: “All this about gonorrhea is quite newly
discovered. . . . We bring up girls to think it is not proper to know
anything about the worst danger before them. Proper!—Why my dear
child, the young girls are precisely the ones to know! It’s no use to tell
a woman who has buried all her children—or wishes she had!—that it
was all owing to her ignorance, and her husband’s. You have to know
beforehand if it’s to do you any good” (pp. 244–245). The grandmother’s
statement to Vivian implies that women need to become informed about
medical disease and that they also need to become informants. Male
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control over medical discourse, then, is gradually eroding. The grandmother, for example, recognizes the signs of disease in Morton and
pushes Dr. Bellair to warn Vivian. Furthermore, both Vivian and her
grandmother read medical texts. As a nosy neighbor comments, “That
girl reads all the time. . . . So does her grandmother. I see her going
and coming from that library every day almost. . . . Vivian Lane reads
the queerest things—doctor’s books and works on pedaggogy [sic]” (p.
32). Vivian and her grandmother become informed about the world and
(more specifically) about the medical and psychological harm the world
can do to women.
Finally, Dr. Bellair herself is committed to warning women about
the perils of venereal disease. Dr. Bellair has suffered from gonorrhea,
transmitted to her by a husband who did not inform her of his disease,
and her mission in life is to keep this from happening to other women.
As she says about her own illness: “I didn’t know. Girls aren’t taught
a word of what’s before them till it’s too late—not then, sometimes! . . .
They go down to their graves without anyone’s telling them the cause
of it all” (221; emphasis added). Patriarchal medical discourse refuses
to share such knowledge with women, so Bellair determines to become
a doctor in order to save other women. And she does save Vivian.
Crucially, she also in some sense saves herself—she recoups her subjectivity and her life through language, through telling her story to others.
In discussing the concept of “pathography” (the writing of narratives
about illness), Anne Hunsaker Hawkins argues that “the need to tell
others so often becomes the wish to help others: perhaps the movement
from catharsis to altruism is a signal of the success of the formulation.”54 Finding a voice of diagnosis, then, is important both to the
woman doctor and to the woman patient.
A larger implication of the novel is that once women engage in
medical discourse it begins to function differently, allowing for the
articulation of women’s subjectivity. The grandmother, for example,
comments that “having women doctors has made a difference too—lots
of difference” (p. 244) in how much information women have about
venereal disease. She also points out that women’s clubs and congresses
are taking up the issue, agitating for certain legal reforms, such as
medical certificates being required with marriage licenses. Medical
discourse is now circulating between men and women and between
doctors and patients. The book itself functions as an informant, a
knowledge producer, and a site of medical discourse. Much of the novel
teaches the reader to read the signs of sexual disease. Morton’s symptoms, for example, are described in great detail (pp. 131, 134, 143–145,
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171–172, 222). And when Dr. Bellair has her “woman to woman” talk
with Vivian, she is frank about the results of sex with a man with
venereal disease—the effects both on his partner and on the children
produced (pp. 218–222). Finally, the actual words gonorrhea (p. 222) and
syphilis (p. 212) are used within the text. In effect, the novel’s discourse
itself dispenses medical information. Overall it implies that medical
information needs to circulate freely in society among men and women,
old and young, and doctors and patients.
The mode of narration also matches the message: the multiple
narrative perspectives and the free circulation of contested and contesting voices encourage readers to think for themselves and to become
diagnostic agents, rather than remain objects of diagnosis. “The Yellow
Wall-Paper” is told in an almost claustrophobic first-person narrative
voice that makes it difficult to see beyond the point of view of the
female narrator, while in “The Vintage” only male voices are allowed
to speak. The Crux, on the other hand, is told from many narrative
perspectives (male and female, old and young, conservative and forward-thinking); vocal and verbal power circulates, and voices are often
in contest with one another. The novel is multivoiced or heteroglossic
in the terms outlined by Mikhail Bakhtin in The Dialogic Imagination.55
Such heteroglossic discourse is important because, as Price Herndl
argues, it allows for the possibility of change; the dialogue not only
between but within texts shows how “‘alien’ forces and contexts create
possibilities for change, and the differences already existing within the
individual can motivate that change.”56 By allowing differences of
opinion to be put into play, Gilman creates the possibilities for change—
her readers can recognize both the “traditional” perspective and the
“subversive” points of view that might undermine it, finding these
points of view within the culture and within their own consciousness.
This does not mean, of course, that in Gilman’s novel all perspectives
are equally enfranchised, but it does mean the reader can hear the
many voices present and make up his or her own mind. In this novel,
medical discourse therefore is no longer a one-way street (the doctor
telling the patient of his or her disease). Rather, individuals within
society actively, vigorously, and freely participate in the dissemination
and even the creation of medical discourse. And finally, Gilman seems
to believe that it is the free circulation of medical discourse within a
text that can help individuals outside the text gain control of their
diseases.
This concept of the free circulation of medical discourse is illustrated even more clearly in “Dr. Clair’s Place,” a short story about a
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female doctor who rejuvenates mentally ill women. Dr. Clair’s therapy
includes rest, physical and mental exercise, and engagement of the
senses through music, color, and taste. Mitchell’s “rest cure,” of course,
prescribed that women do nothing but eat, rest, and raise their children.
Dr. Clair’s “rest cure,” on the other hand, allows for both physical and
intellectual stimulation—it rejuvenates women not by suppressing them
but by allowing them to express their tastes, their pleasures, and their
personalities.57
Spatial and physical freedom are also associated with Dr. Clair’s
treatment. In both The Crux and “Dr. Clair’s Place,” women are rejuvenated while they are in nature, through active physical regimens that
include hiking, climbing, and sleeping in tents.58 Recall that the narrator in “The Yellow Wall-Paper” wanted to walk more in the garden.
Gilman herself was a strong proponent of physical fitness, but here she
manipulates a larger symbolic configuration. Traditional houses and
traditional enclosed spaces replicate patriarchy and its disease/diagnosis patterns, but the reconfigured spaces of nontraditional homes (such
as the boarding house run by Orella Elder in The Crux, the office/home
of Dr. Bellair, and the series of cottages in which Dr. Clair’s patients
recuperate) allow new social arrangements to evolve and new patterns
of diagnosis to emerge. Perhaps more important for Dr. Clair’s regimen
than the reconfigured spaces of the clinic/home/office, however, is the
reconfigured attitude that the physician has toward the patient. In Dr.
Clair’s treatment the patient plays a participatory role. For example,
when the patient (Octavia Welch) experiences acute sadness, she is
encouraged to try various tones of music, shades of color, or tastes and
to “note the result.”59 The patient is not an inert body defined by her
submission to the doctor; rather, she is encouraged to incorporate her
physical and mental responses into the treatment.
Most important, in this story women are allowed to have a voice
in diagnosis and treatment. The patient is not silenced: “[Dr. Clair] let
me tell her all I wanted to about myself, asking occasional questions,
making notes, setting it all down on a sort of chart” (p. 182). The
patient is also encouraged to write about her disease. Dr. Clair tells
Octavia “to keep a record, if you will . . . when the worse paroxysms
come . . . here’s a little chart by your bed” (p. 183, emphasis added).
As Rita Charon has noted, in medical school the recording of a medical
chart is a great privilege—one the patient is not allowed to share; the
doctor uses the chart to demonstrate mastery of medical discourse.60 So
it is extremely unusual, here, that Dr. Clair encourages the patient, quite
literally, to keep her own “chart.” Most crucially, there is also a high
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degree of verbal collaboration and consultation between doctor and
patient, as Octavia explains:
Dr. Clair came in twice a day, with a notebook and pencil, asking
me many careful questions; not as a physician to a patient, but as
an inquiring scientific searcher for valuable truths. She consulted me
in a way, as to this or that bit of analysis she had made; and again
and again as to certain points in my own case. (P. 183)
In short, Dr. Clair allows her patient to coauthor the diagnosis. This
active, collaborative, language-based therapy helps the patient understand the nature and causes of her disease and participate in its cure.
And finally, in “Dr. Clair’s Place” the female patient finds a voice
that can withstand negative cultural interpellations. At the end of “The
Yellow Wall-Paper,” it is unclear whether anyone actually hears the
narrator’s voice, since Dr. John faints at the sight/site of his creeping
wife. Interestingly, “Dr. Clair’s Place” begins with the first-person
narrative point of view of one of Dr. Clair’s assistants; this assistant
meets Octavia on a train, sees her depression, and sends her to Dr.
Clair. But through the literary device of Octavia showing the assistant
what she has written about her illness, the story actually ends with
Octavia Welch’s first-person voice narrating her story. The opening
narrative frame (the assistant on the train) is never closed, so the story
concludes with Octavia’s description of her treatment and her statement
that she is now an employee of Dr. Clair and “a well woman” (p. 184).
Quite literally, then, in this story the patient’s voice grows from that of
one who must be diagnosed to that of one who can diagnose herself.
“Dr. Clair’s Place” therefore illustrates a model of doctor-patient
interaction in which information circulates freely, allowing patients a
higher degree of independence and power, and in which patients and
writers, not only doctors, produce diagnoses. Most important, in this
model the voice of the female patient becomes part of diagnosis, and
this finally leads to health. For, as Howard Brody argues, “patients will
be more inclined to get better when they . . . are helped to achieve a
sense of mastery or control over their illness and its symptoms.”61
Couser puts this another way when he argues for the importance of
“collaborative authorship between patient and physician of a meaningful, individualized, and therefore therapeutic, narrative of the patient’s
illness.”62 But both Brody and Couser emphasize that patients need to
be coproducers of the narrative of their illness in order to become
coproducers of the narrative of their recovery.
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Gilman’s description of the value of talk, of personal interaction
between doctor and patient, of sound and color, and of work seems
almost to anticipate current psychological schools, such as occupational
therapy, music and art therapy, group therapy, and (of course) the
Freudian “talking-cure,” although Gilman was no Freudian.63 Gilman’s
insights about the importance of language and about doctor-patient
dialogue have also been supported empirically; current research demonstrates that patients who learn about their diseases, join self-help
groups, and become active in their treatments have a higher rate of
survival.64 More specifically, writing about traumatic experiences has
been shown to improve both mental and physical health. The leading
proponent of this idea is psychologist James Pennebaker, who has
argued that “when people write about major upheavals, they begin to
organize and understand them. . . . Once people can distill complex
experiences into more understandable packages, they can begin to move
beyond the trauma.”65 Such findings have not, of course, gone unchallenged, but the weight of evidence seems to suggest what Dr. Clair
intuits: that being involved in one’s own medical treatment—learning to
read, write, and speak it—can have an extremely powerful impact on
both illness and recovery.
Historical and Autobiographical Parallels to Dr. Clair
In “Dr. Clair’s Place,” then, medical discourse is produced by both
the doctor and the patient; patients and doctors are “coauthors” in the
creation of a diagnosis. And the patient’s writing of an “illness narrative” is crucial to recovery. In the late nineteenth and early twentieth
centuries, some women writers, as Price Herndl notes, were aware of
the value of the “writing cure,” and some female “mind curists” even
advocated this practice.66 But mainstream doctors tended to dismiss
such ideas. Gilman is innovative, then, in presenting a mainstream
doctor who endorses a “writing cure,” who encourages patients to take
language into their own hands in order to reclaim their subjectivity.
Furthermore, Dr. Clair believes that patients have the right to coauthor
and collaborate with their doctors in the reading and writing of their
disease. Indeed, this is Gilman’s most original insight and her most
radical reconfiguration of the doctor-patient relationship.
Given that “Dr. Clair’s Place” is somewhat autobiographical and
that a similar treatment was used with good results on Gilman by an
actual doctor, Mary Putnam Jacobi, one might initially suspect that
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Gilman’s model is not new. And indeed, many aspects of Dr. Clair’s
treatment of Octavia sound familiar when read against (or perhaps
beside) Gilman’s autobiography. As Gilman explains here, Jacobi’s treatment involved setting the “inert brain to work . . . on small, irrelevant
tasks; this to reestablish the capacity for action.”67 Once the capacity for
action is reestablished the patient can move on to more engrossing
intellectual tasks, such as reading and writing. What seems most
important for Gilman in these autobiographical recollections, as in “Dr.
Clair’s Place,” is that women be allowed to participate in medical
discourse. While Mitchell scoffed at Gilman’s written case history, Jacobi
found Gilman’s elaborately prepared “fever-chart” of her illness “helpful.”68 Jacobi appears to have allowed the patient to participate in
diagnosis and treatment.
Gilman employs aspects of Jacobi’s treatment in “Dr. Clair’s
Place,” then, but she also significantly embellishes and revises Jacobi’s
methodology. Gilman describes Jacobi as “the most patient physician I
had ever known and the most perceptive. She seemed to enter into the
mind of the sufferer and know what was going on there.” Gilman also
states that Jacobi seemed to be an example of a “free and original mind,
thinking for itself and working out its own methods.”69 Such statements
lead Regina Morantz-Sanchez to conclude that “Jacobi’s willingness to
engage Gilman as an equal partner in effecting her cure stood in direct
contrast to S. Weir Mitchell’s authoritarian approach.”70 An examination
of Jacobi’s writings, however, reveals a much less positive picture of
doctor-patient relations. She did believe doctors should observe and
learn from their patients and have sympathy for them, and she did
write to Weir Mitchell criticizing his attitudes toward “medical women.”71
But she also firmly encouraged doctors to establish their authority over
patients, especially women patients. In a 1900 inaugural address at the
opening of a women’s medical college, for example, Jacobi states that
“while treating his patient as though he were a personal friend . . . the
physician must never forget that this same patient is, from the nature
of things, a possible enemy.”72 In fact, Jacobi delineates a hostile (rather
than collaborative) relationship between patient and doctor: “The physician is bound to justify a claim to the absolute confidence of his
patients; but he must never give them his. . . . It is essential in every
detail, in every expression, in the entire mental atmosphere of the
physician, the patient should feel himself in the presence of a superior
person.”73 Jacobi did not see the patient and the doctor as coauthoring
diagnosis; instead she advised doctors to study each patient’s case “as
coolly, impartially, abstractly, as if it were a problem in algebra.”74
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Jacobi also was not averse to medical practices that dehumanized
patients and ignored their emotions. For example, when Jacobi gave
lectures on children’s diseases at the New York Post-Graduate Medical
School in 1882, she would sometimes use her patients for presentations.
Some of these patients could not understand what was occurring and
resented being brought to another clinic to be exhibited. But “the most
important cases were brought (at times forcibly) by the clinical assistant” to Jacobi’s lectures as illustrations of her theories.75 Furthermore,
in an 1868 letter to the Medical Record, Jacobi describes the strange case
of a suicidal woman who swallowed a silver fork; Jacobi notes with
surprise that after perforation of her stomach and “escape” of the fork
through the abdominal walls over the course of ten months, this
woman’s physical health was only “slightly deranged.” Jacobi is uninterested in the patient’s mental state, only remarking that “perhaps the
mental alienation of the patient may be presumed to have blunted the
general physical sensibilities, a circumstance frequently observed in the
pathology of the insane.”76 Later in her life, in 1895, she advocated
dealing with women’s mental illness in the following way: “To knock
the nonsense out of [women], to direct attention from self, to substitute
cosmic horizon for their own feelings, who does not know the importance of this for thousands of hysterical women? and equally the
impossibility of attaining it?”77 Jacobi seems to subscribe to the idea
that hysteria in women has to do with a loss of self-control and can be
changed through an exertion of will; if need be, the patient succumbs
to the physician’s more forcible will.
All this speaks to the fact that, like Mitchell, Jacobi was a product
of her time period and its medical ideology, an ideology that saw
patients (especially women patients) as fundamentally inferior to, and
passive before, the authority of the physician, an ideology that tended
to dismiss mental suffering as weakness of will and to privilege
physical symptoms. On the other hand, Jacobi was a staunch supporter
of women’s rights, and perhaps this accounts for her less coercive
treatment of Gilman. Jacobi argued that college study does not promote
mental illness in women and that women need to learn to act as
“independent subjects” if they are to overcome diseases such as hysteria.78 And in her pamphlet, “Common Sense” Applied to Woman Suffrage
(1894), Jacobi eloquently argues that the silencing of women’s voices
galvanized the women’s rights movement.79 Like Gilman, Jacobi saw
the silencing of women’s voices as an absolute social evil—one against
which women must and indeed did revolt.
It appears, then, that Gilman borrowed some of Jacobi’s medical
methodologies in her creation of Dr. Clair but that Gilman also infused
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her fictional character with radical ideas Jacobi never dreamed of
endorsing, such as the concept that the patient should be given a
certain amount of authority in medical discourse and the notion that
doctors and patients can coauthor diagnoses. Gilman also gives Dr.
Clair “narrative competence”—an ability to hear and respect the patient’s
story and integrate it into treatment.80 In discussing illness narratives,
Arthur Kleinman argues that the clinician must “first piece together the
illness narrative as it emerges from the patient’s and the family’s
complaints and explanatory models; then he or she must interpret it in
light of the different modes of illness meanings—symptom symbols,
culturally salient illnesses, personal and social contexts.”81 Jacobi was
willing to listen to a patient’s illness narrative, but there is no evidence
in her published writings that she integrated it into her treatment of the
patient.
Gilman also infuses her fictional female doctors with ideals and
goals that transcend those of even the most humane and enlightened
women doctors from this time period. It is certainly true that some
women doctors, such as Elizabeth Blackwell, emphasized a notion of
sympathy between patient and doctor and appeared to practice a more
“feminine” and less authoritarian style of medicine. In numerous essays
and speeches Blackwell argued that women’s natures were profoundly
suited to the practice of medicine and that “women, from their constitutional adaptation to creation and guardianship, are thus fitted for a
special and noble part in the advancement of the healing art.”82
Addressing a women’s medical college in 1891, she stated her belief that
“it is our duty and privilege, as women entering into the medical
profession, to strengthen its humane aspirations.”83 She was against
animal experimentation and vivisection and argued that women doctors
could play a special role in the cultivation of respect for life in all its
various forms—animal and human. And numerous other women doctors—such as Ella Ridgeway, Anna Longshore-Potts, Rosalie Slaughter
Morton, Mary E. Bates, Effa Davis, Susan Dimock, Bertha Lewis, Harriet
Belcher, and Sarah Munro—were sympathetic to the idea that they had
a special role to play in medicine. As Morantz-Sanchez documents,
many women physicians “readily acknowledge[d] that they practice[d]
a more nurturing, milder, and a more holistic brand of therapeutics.”84
But others doctors, such as Mary Dixon-Jones and Mary Putnam
Jacobi herself, rejected such gendered labels. Particularly after 1880,
female physicians were committed professionals who shared a common
medical environment with their male counterparts. After a survey of the
writings of these women physicians, Morantz-Sanchez concludes that
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there was no “uniform approach among these women on how to treat,
diagnose, or prevent illness. Women internalized many ‘male’ values,
just as men were sometimes advocates of ‘female’ positions.”85 Between
Blackwell and Jacobi, for example, there were many disagreements.
When Blackwell tried to rally women physicians in the United States
against unnecessary operative procedures, Jacobi suggested that Blackwell
learn to think more like a scientist.86
None of this means that Gilman invented the model of medical
discourse present in The Crux and “Dr. Clair’s Place”—a model in
which the (female) physician has a more enlightened and humane view
of women and of the (female) patient’s role in the coauthorship of
diagnosis. But it does imply that she embellished and transformed
models that were present, in a very limited way, in medical discourse.
For example, Dr. Clair seems to combine the “hard” search for scientific
truth exhibited by doctors such as Mary Jacobi with the “softer” and
more humane approach toward patients advocated by Elizabeth
Blackwell. Gilman therefore undermines the binary of male physician as
scientist and female physician as sympathist. In another novel about
doctors, Mag-Marjorie (1912), Gilman actually inverts the binary; the
male physician here is sympathetic and humane, uninvolved in the
search for scientific “truth,” while the female physician has a brilliant
mind and is an exceptional researcher but appears uninterested in her
patients as human beings. Gilman’s fiction, then, does not simply reflect
the controversies of her time period over the role of women physicians;
it also dialogically intercedes in, and reconfigures, these controversies,
thereby creating ideas and paradigms that transcend the available
models.
Perhaps Dr. Clair and Dr. Bellair are the doctors by whom Gilman
would have liked to be treated, rather than the doctors to which she
had access. But Gilman had realistic goals in creating these rather
idealized versions of medical relationships. Howard Brody, a family
physician and medical ethicist, advocates a decision-making model
where patients and doctors share power; although this model might not
always be practicable, he argues that “if doctors and patients at least
made an attempt to aim at this ideal model, the resulting relationship
would be one that would provide a better atmosphere in which to act
ethically.”87 Gilman’s fictional and somewhat idealized portraits of
women doctors, then, advocated change in actual medical practices. The
mechanism for this change had (Gilman believed) been illustrated
earlier, with the reception of “The Yellow Wall-Paper.” In her later
fictions she sought to continue this process by creating a “circuit”
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between the fictional text and the world of medical discourse outside
the text.
Creating the “Circuit”:
Moving Between the Fictional Text and the Outside World
Gilman’s writing illustrates a mechanism whereby these innovative “fictional” models might be translated back into the “real world”
of medicine. One aspect of this model has already been discussed: the
reading and writing of texts. In both “Dr. Clair’s Place” and The Crux,
women reader figures who are not themselves doctors play prominent
roles in the diagnosis of disease, and in “Dr. Clair’s Place” the reader/
patient actually becomes a writer of her diagnosis and (eventually) an
“assistant” in Dr. Clair’s medical practice. Clearly, Gilman indicates that
actual readers may take up similar practices; they might read works
(such as hers) about disease, diagnose themselves, and become integrated with (if not integral to) medical practices and medical discourse.
Yet another way in which Gilman’s works create a mechanism
whereby the models of discourse she endorses can be translated to the
outside world is by their intertextuality with real medical practices and
doctors. Gilman frequently mentions actual doctors and actual medical
practices in her works, such as Dr. Weir Mitchell’s rest cure and Dr.
Prince Morrow’s sex education society (mentioned in The Crux, p.
245).88 Gilman sets up a circuit of exchange here between the real world
of medicine and the fictional world of texts. Fictional readers within
Gilman’s works read actual medical texts; Gilman thus encourages her
readers to read these same texts. Moreover, when Gilman alludes to
doctors such as Mitchell and Morrow in her fictional works, she blurs
the line between fiction and the real world. Readers learn to pass back
and forth between these worlds, and to regard the boundaries of these
worlds as permeable. Thus a fictional medical practice might become a
real one, and a real medical practice (such as the rest cure) might turn
out to be “fictional” in that it has been written about in a literary text
and in that it does not work.
In a discussion of cultural studies, Richard Johnson describes
precisely such a circuit of exchange, “the circuit of the production,
circulation and consumption of cultural products.”89 Gilman created a
dynamic and ongoing circuit of exchange between “The Yellow WallPaper” and the “real” world. She wrote about an actual medical
treatment—Mitchell’s rest cure—in “The Yellow Wall-Paper.” Readers
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and doctors then wrote Gilman to say that her “fictional” account of
illness was “real.” Gilman also claimed that doctors wrote saying they
would change their medical practices, based on her description of the
rest cure’s failure.90 William Dean Howells attempted to publish Gilman’s
story in Atlantic Monthly (over the objections of its editor, Horace
Scudder) because his own daughter had died while being treated with
Mitchell’s “rest cure.” And later in her life, in both The Forerunner and
The Living of Charlotte Perkins Gilman, Gilman would continue to write
about her experiences with Mitchell, the process of turning these
experiences into fiction, and the responses she got from readers of these
fictional and semifictional works. “The Yellow Wall-Paper,” then, had
both an intratextual and an extratextual existence, circulating and
mingling with (and perhaps even creating) the texts and medical
practices of the “real” world.
Gilman hoped her later writing would also have an extratextual
existence. Whether this actually happened is unclear. But Gilman put
the mechanism in place for this to occur—she created the circuit of
exchange between fictional texts and real ones, between patients and
doctors, between writers and readers, and finally (and most importantly) between the “text” or self that is produced by others and their
diagnoses and the “text” or self that is created by the individual and
his or her practices of reading and writing. Interestingly enough, both
Jacobi and Mitchell wrote fictional texts as well as medical ones. Jacobi
even wrote to Mitchell criticizing his statements about women doctors
in his novel, Characteristics.91 The assumption then, as now, of the
exchangeability and interpenetration of the fictional and the factual in
culture and in texts holds, substantiating Gilman’s idea that a fictional
story could influence real-world medical practices and vice versa.
At the age of 71, Charlotte Perkins Gilman learned she had
inoperable and incurable breast cancer. She gathered enough chloroform
to kill herself and three years later, when her cancer was so advanced
that she could no longer function and her pain was unbearable, she
followed through with her plan. Gilman’s death illustrates what many
of her fictions imply: that patients have a right to participate in their
medical treatments, and even to make hard choices about their lives
and their deaths.92 Furthermore, Gilman tried to make dignified death
part of the medical discourse of her time period. She openly and
explicitly described her plans in her autobiography, and she wrote an
article to be posthumously published called “The Right to Die.” “If
persons . . . suffer hopelessly,” Gilman argues in this essay, “they have
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a right to leave.”93 Published in a 1935 issue of Forum and later
excerpted in the 1937 issue of Reader’s Digest, Gilman’s final words
reached a large audience—entering, and perhaps transforming, the
medical practices of her time period.
Gilman’s writing engaged with and altered the terms of medical
discourse. She asked difficult questions that we still struggle with today:
Why do many doctors ignore patients’ illness narratives? How is it that
women remain disempowered in medical discourse? And most important: What are the productive ways patients can become involved in the
reading and writing of their illnesses, and in the coauthorship of
diagnosis and treatment? Today there is still clear evidence that many
doctors ignore patients’ complaints and questions and that many doctors still favor an authoritative and even silencing role in patient-doctor
interactions. And there is evidence that women patients, in particular,
are not allowed to tell their stories, to have their concerns addressed,
and to receive appropriate medical treatment.94 Summarizing the ideas
of an entire new strand of medical thought, one recent medical study
concludes that “information is a source of power” and “withholding
medical information from women maintains women’s dependence upon
the medical profession.”95 Gilman’s writing as a whole works to
undermine this withholding of information and to create new circuits
of exchange among doctors and patients and among writers and
readers.
Gilman also suggests pragmatic methods for revising medical
discourse. She indicates that doctors must learn to hear the stories
patients tell. And doctors must not be threatened by patients’ attempts
to coauthor a schema of diagnosis and treatment but must understand
that such coauthorship is a crucial aspect of recovery. Patients, for their
part, must choose practitioners who are willing to collaborate with them
in formulating a diagnosis and a course of treatment. And Gilman
emphasizes that patients—women patients in particular—must refuse to
be silent in the face of a coercive medical environment, for silence is
death, especially when it comes to disease. This is finally what Gilman’s
medical fictions teach us: that our relationship to language is strategic
not only to our empowerment but also to our very survival. We can live
or die by the word. Certainly this is a lesson for Gilman’s time as well
as for our own.
Martha J. Cutter
177
NOTES
My thanks to Carolyn Sorisio, Debby Rosenthal, Deborah Barnbaum, Jennifer
Tuttle, and the readers and editors at Literature and Medicine for helpful suggestions
about this essay.
1. The term depression is of course subject to interpretation, but I use it since
Gilman describes her illness with this term in her 1935 autobiography; she states that
after her marriage “there was nothing to prevent [her happiness with Walter] but that
increasing depression of mine.” See The Living of Charlotte Perkins Gilman (Madison:
University of Wisconsin Press, 1991), 87.
2. Ibid., 95.
3. Ibid., 96.
4. On the topic of medical and verbal “sentences” in “The Yellow WallPaper,” see Paula A. Treichler, “Escaping the Sentence: Diagnosis and Discourse in
‘The Yellow Wallpaper,’” Tulsa Studies in Women’s Literature 3 (1–2) (1984): 61–77.
Treichler uses this term in at least three ways: the sentence represents a linguistic
formulation, a medical diagnosis, and a social fate (because of her behavior, the
narrator is “sentenced” to solitary confinement in the attic room by her husband).
“The word ‘sentence,’” Treichler comments, “is both sign and signified, word and act,
declaration and discursive consequence” (p. 70).
5. Throughout this essay, when the terms medical discourse and medical diagnosis are used, I refer only to Anglo-American or Anglo-British white middle-class
medical practices.
6. Since Gilman’s works actually blur the distinction between the fictional,
literary text and the “real world” outside the text, I have initially placed these terms
in quotes, but I will not do so in the remainder of the essay since this seems
cumbersome. It should be noted that in Gilman’s text reality is not separate from the
textual (“fictional”) world her writing articulates.
7. Diane Price Herndl argues that despite the fact that Gilman struggled
against invalidism in her own life, she nonetheless created female characters “that
appear strikingly similar to the . . . passive and defeated invalid that had figured
in the fictions of Southworth, Hawthorne, and Poe fifty years earlier”; see Invalid
Women: Figuring Feminine Illness in American Fiction and Culture, 1840–1940 (Chapel
Hill: University of North Carolina Press, 1993), 112. While this may be true of “The
Yellow Wall-Paper,” it is certainly not the case in many other of Gilman’s works, as
this essay illustrates.
8. Gilman wrote other fictions that feature female doctors, such as the short
story “Mr. Peebles’ Heart” (1914) and the novel Mag-Marjorie (1912). I do not discuss
these works, however, because they are not as concerned with medical discourse and
diagnosis. Both have been republished recently; see Mag-Marjorie and Won Over (New
York: Ironweed Press, 1999) and “Mr. Peebles’ Heart” in The Charlotte Perkins Gilman
Reader, ed. Ann J. Lane (Charlottesville: University Press of Virginia, 1999), 107–115.
9. See Michel Foucault, The Birth of the Clinic: An Archaeology of Medical
Perception (1963; reprint, New York: Random House, 1994).
10. For more on the subject of interpellation in medical discourse (and how it
can be refused) see Arthur Frank’s argument that “To claim a voice of one’s ‘own’
is to stake a counterclaim against the ideologies that hail the person to assume the
identity that they require. In Althusserian terms, what is one’s ‘own’ is not measured
in originality but in self-consciousness of being more than what the person is hailed
to be. . . . One’s ‘own voice’ is the voice of the identity that people seek to retain
when they are confronted with the interpellation of an ideological apparatus.”
“Enacting Illness Stories: When, What, and Why,” in Stories and Their Limits: Narrative
Approaches to Bioethics, ed. Hilde Nelson (New York: Routledge, 1997), 35. In this line
of thinking, it is clear that Gilman did retain her “own” voice through her resistance
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to S. Weir Mitchell and that she grants some women characters this power in her
fiction.
11. John Wiltbank, Introductory Lecture for the Session, 1853–1854 (Philadelphia:
Edward Gratan, 1854), 7.
12. J. H. Kellogg, Ladies Guide in Health and Disease (1882; reprint, Battle Creek,
Mich.: Modern Medicine Publishing Company, 1895), 371.
13. Price Herndl, 17.
14. Carroll Smith-Rosenberg, Disorderly Conduct: Visions of Gender in Victorian
America (New York: Oxford University Press, 1985), 258.
15. S. Weir Mitchell, Lectures on the Diseases of the Nervous System, Especially in
Women, 2nd ed. (Philadelphia: Lea Brothers & Co., 1885), 14–15.
16. Smith-Rosenberg, 328. In the late nineteenth century, women were increasingly demanding education, the vote, better pay, better work, and better access to
birth control. For more on the transition from the traditional woman or “domestic
saint” to the “new woman,” see my book Unruly Tongue: Identity and Voice in
American Women’s Writing, 1850–1930 (Jackson: University Press of Mississippi, 1999),
3–31 and Smith-Rosenberg, 245–296.
17. S. Weir Mitchell, Fat and Blood: An Essay on the Treatment of Certain Forms
of Neurasthenia and Hysteria (Philadelphia: J. B. Lippincott, 1881), 30–31.
18. Robert B. Carter, On the Pathology and Treatment of Hysteria (London: John
Churchill, 1853), 119.
19. Frederic C. Skey, Hysteria: Six Lectures (New York: Morehead, Simpson and
Bond, 1868), 68.
20. S. Weir Mitchell, Doctor and Patient (1887; reprint, Philadelphia: J. B. Lippincott,
1888), 48.
21. Ibid., 49.
22. Ann Douglas Wood, “‘The Fashionable Diseases’: Women’s Complaints and
Their Treatment in Nineteenth-Century America,” in Clio’s Consciousness Raised: New
Perspectives on the History of Women, ed. Mary S. Hartman and Lois Banner (New
York: Octagon Books, 1976), 9.
23. Mitchell, Doctor and Patient, 117, 126.
24. Barbara Ehrenreich and Deirdre English, Complaints and Disorders: The
Sexual Politics of Sickness (New York: Feminist Press, 1973), 36.
25. Ibid., 38.
26. Regina Morantz-Sanchez, Sympathy and Science: Women Physicians in American Medicine (New York: Oxford University Press, 1985), 205.
27. Ibid., 208.
28. For more on medical views of women in the early twentieth century see
Carroll Smith-Rosenberg and Charles Rosenberg, “The Female Animal: Medical and
Biological Views of Woman and Her Role in Nineteenth-Century America,” Journal
of American History 60 (2) (1973): 332–356.
29. Price Herndl, 157.
30. Charlotte Perkins Gilman, “The Yellow Wall-Paper” (1892), in “The Yellow
Wall-Paper” and Selected Stories of Charlotte Perkins Gilman, ed. Denise Knight (Newark:
University of Delaware Press, 1994), 53. All references are to this edition and will be
parenthetically cited within the article hereafter.
31. Treichler, 61.
32. Treichler, 65–66.
33. “The Yellow Wall-Paper” has been extensively analyzed in terms of its
presentation of mental illness. In addition to Treichler, see Pamela White Hadas,
“Madness and Medicine: The Graphomaniac’s Cure,” Literature and Medicine 9 (1990):
181–193; Stephen Post, “His and Hers: Mental Breakdown As Depicted by Evelyn
Waugh and Charlotte Perkins Gilman,” Literature and Medicine 9 (1990): 172–180;
Suzanne Poirier, “The Weir Mitchell Rest Cure: Doctor and Patients,” Women’s Studies
10 (1983): 15–40; and Diane Price Herndl, “The Writing Cure: Charlotte Perkins
Martha J. Cutter
179
Gilman, Anna O., and ‘Hysterical’ Writing,” NWSA Journal 1 (1988): 52–74. None of
these essays looks at Gilman’s later works, however.
34. David Ingleby, “The Social Construction of Mental Illness,” in The Problem
of Medical Knowledge: Examining the Social Construction of Medicine, ed. Peter Wright
and Andrew Treacher (Edinburgh: Edinburgh University Press, 1982), 139.
35. For more about the split in the narrator’s voice, see my book, Unruly
Tongue, where I argue that by the end of the story the narrator has dissociated—she
has split into two selves/voices who are at war with each other: an unruly,
subversive self/voice and a more submissive, complicit one (p. 112–116). The ending
of this story has, of course, been the subject of much critical controversy.
36. Frank, 35.
37. “Why I Wrote the Yellow Wallpaper?” (1913), in The Yellow Wallpaper, ed.
Dale M. Bauer (New York: Bedford Books, 1998), 349.
38. Gilman repeats these claims in The Living of Charlotte Perkins Gilman, 121.
39. As Julie Bates Dock shows, no evidence supports Gilman’s version of
events. See Charlotte Perkins Gilman’s “The Yellow Wall-Paper” and the History of Its
Publication and Reception (University Park: Pennsylvania State University Press, 1998),
25.
40. Treichler, 68–69.
41. In Gilman’s time period, the story was commented on widely (see Dock
102–119). The numerous reprints of “The Yellow Wall-Paper” and critical essays on
it—from literary, linguistic, medical, historical, and feminist perspectives—demonstrate the continuing impact of the story today.
42. I have found no extensive criticism of “The Vintage,” although Janet Beer
does discuss it briefly; see “Charlotte Perkins Gilman and Women’s Health: ‘The
Long Limitation,’” in A Very Different Story: Studies on the Fiction of Charlotte Perkins
Gilman, ed. Val Gough and Jill Rudd (Liverpool: Liverpool University Press, 1998),
54–67.
43. Charlotte Perkins Gilman, “The Vintage” (1916), in “The Yellow Wall-Paper”
and Selected Stories of Charlotte Perkins Gilman, 106. All references are to this edition
and will be parenthetically cited within the article hereafter.
44. Gilman single-handedly wrote, edited, and published her monthly magazine, The Forerunner, from 1909 to 1916. Each volume contained a chapter of a serial
novel, an essay, a short story, an editorial, fables, and news events. The short stories
were confined to rigid space parameters, as Denise Knight explains: “Most of her
Forerunner stories had to ‘fit’ into the 4 1/2 to 5 pages she allotted per issue.” Ibid., 22.
45. The Crux, “The Vintage,” and several of Gilman’s other fictional works deal
with venereal disease. Gilman never experienced the illness, but it was a topic of
great fascination in the early twentieth century. For example, Eugène Brieux’s play
Damaged Goods, which concerned this subject, was successful in Europe and opened
on Broadway in 1913. For more on this topic see Allan M. Brandt, No Magic Bullet:
A Social History of Venereal Disease in the United States Since 1880 (New York: Oxford
University Press, 1987).
46. Charlotte Perkins Gilman, The Crux (New York: Charlton Company, 1911),
189. All references are to this edition and will be parenthetically cited within the
article hereafter.
47. I have found few critical assessments of The Crux. Gary Scharnhorst calls
it “a conventional, sentimental romance with faint feminist overtones”; see Charlotte
Perkins Gilman (Boston: Twayne, 1985), 98. Anne Tanski reads the novel in terms of
the themes of role conflict, motherhood, marriage, and innocence; see “The Sins of
the Innocent: Breaking the Barriers of Role Conflict,” in A Very Different Story: Studies
on the Fiction of Charlotte Perkins Gilman, 68–80. Although The Crux is not as rich
symbolically as “The Yellow Wall-Paper,” it does contain a number of interesting
imagery schemes and a well-developed cast of characters.
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48. G. Thomas Couser, Recovering Bodies: Illness, Disability, and Life Writing
(Madison: University of Wisconsin Press, 1997), 11.
49. Chauncey Leake, ed., Percival’s Medical Ethics (Baltimore: Williams and
Wilkins, 1927), 258.
50. Ibid., 270.
51. On the subject of physicians changing attitudes, see Brandt, 17–18. See also
Nicholas Jabbour, “Syphilis from 1880 to 1920: A Public Health Nightmare and the
First Challenge to Medical Ethics,” Essays in History 42 (2000); available at http://
etext.lib.virginia.edu/journals/EH/EH42/Jabbour42.html.
52. W. A. Purrington, “Professional Secrecy and the Obligatory Notification of
Venereal Diseases,” New York Medical Journal 85 (June 29, 1907): 1209.
53. Jabbour, 16.
54. Anne Hunsaker Hawkins, Reconstructing Illness: Studies in Pathography, 2nd
ed. (West Lafayette, Ind.: Purdue University Press, 1999), 25. Hunsaker Hawkins
focuses on the need for “patient-centered” medicine; see also Eric J. Cassell, The
Nature of Suffering and the Goals of Medicine (New York: Oxford University Press, 1991)
and Arthur Kleinman, The Illness Narratives: Suffering, Healing, and the Human Condition (New York: Basic Books, 1988).
55. Mikhail Bakhtin, The Dialogic Imagination: Four Essays, ed. Michael Holquist,
trans. Caryl Emerson and Michael Holquist (Austin: University of Texas Press, 1981),
324.
56. Price Herndl, Invalid Women, 14.
57. An interesting parallel to Dr. Clair’s method is present in Gilman’s story,
“Mr. Peebles’ Heart” (1914). The female doctor in this story—Joan Bascom—prescribes music, travel, and intellectual stimulation for her patient, her brother-in-law
Mr. Peebles, a man who has denied his taste for these things in favor of his “duty”
to his wife and children.
58. Mitchell recommended the “rest cure” for Victorian women, but he recommended the “camp cure”—a regimen of exercise, camping, and getting “back to
nature”—for overtaxed and overstressed Victorian men. Perhaps Gilman illustrates
humorously here that women, too, need and enjoy the “camp cure.”
59. Charlotte Perkins Gilman, “Dr. Clair’s Place” (1915), in “The Yellow WallPaper” and Selected Stories of Charlotte Perkins Gilman, 183. All references are to this
edition and will be parenthetically cited within the article hereafter.
60. Rita Charon, “Doctor-Patient/Reader-Writer: Learning to Find the Text,”
Soundings 72 (1989): 137.
61. Howard Brody, “My Story Is Broken: Can You Help Me Fix It? Medical
Ethics and the Joint Construction of Narrative,” Literature and Medicine 13 (Spring
1994): 80.
62. Couser, 33.
63. Gilman read parts of Freud’s work in the early twentieth century and
found his ideas to be too sexually oriented. In 1921 she even took to the road with
a series of six lectures, one of which was called “The Fallacy of Freud.” See Ann J.
Lane, To Herland and Beyond: The Life and Work of Charlotte Perkins Gilman (New York:
Pantheon, 1990), 332.
64. Support groups have been shown to help individuals suffering from
diseases as diverse as endometriosis (Wingfield), breast cancer (Gray, Samarel),
gynecological cancer (Carlsson), and HIV/AIDS (Spirig). Education and participatory
action have been shown to have positive results in psychiatric disorders (Nelson) and
in early stage breast cancer (Helgeson). See M. B. Wingfield et al., “Treatment of
Endometriosis Involving a Self-Help Group Positively Affects Patients’ Perception of
Care,” Journal of Psychosomatic Obstetrics and Gynecology 18 (1997): 255–258; R. Gray
et al., “A Qualitative Study of Breast Cancer Self-Help Groups,” Psycho-Oncology 6
(1997): 279–289; N. Samarel et al., “Women’s Perceptions of Group Support and
Adaptation to Breast Cancer,” Journal of Advanced Nursing 28 (1998): 1259–68; M. E.
Martha J. Cutter
181
Carlsson and P. M. Strang, “Educational Support Programme for Gynaecological
Cancer Patients and Their Families,” Acta Oncologica 37 (1998): 269–275; R. Spirig,
“Support Groups for People Living with HIV/AIDS: A Review of Literature,” Journal
of the Association of Nurses in AIDS Care 9 (1998): 43–55; G. Nelson et al., “‘Nothing
About Me, Without Me’: Participatory Action Research With Self-Help/Mutual Aid
Organizations for Psychiatric Consumer/Survivors,” American Journal of Community
Psychology 26 (1998): 881–912; and V. S. Helgeson et al., “Education and Peer
Discussion Group Interventions and Adjustment to Breast Cancer,” Archives of General
Psychiatry 56 (1999): 340–347.
65. James Pennebaker, Opening Up: The Healing Power of Confiding in Others
(New York: William Morrow, 1990), 193. Pennebaker has been involved in a number
of studies that have empirically documented physiological and psychological improvement associated with writing about trauma. See, for example, “The Effects of
Traumatic Disclosure on Physical and Mental Health: The Values of Writing and
Talking About Upsetting Events,” in Posttraumatic Stress Intervention: Challenges,
Issues, and Perspectives, ed. John Violanti, Douglas Paton, and Christine Dunning
(Springfield, Ill.: Charles C. Thomas, 2000), 97–114.
66. Price Herndl, Invalid Women, 127.
67. The Living of Charlotte Perkins Gilman, 291.
68. Ibid.
69. Both of these statements are reminiscences Gilman wrote about her treatment by Jacobi and can be found in the Alumnae Transactions of the Woman’s Medical
College of Pennsylvania 1907, 66. Quoted in Morantz-Sanchez, Sympathy and Science,
213–214.
70. Ibid., 214.
71. Jacobi’s most significant writings and speeches have been collected in Mary
Putnam Jacobi, MD: A Pathfinder in Medicine, With Selections from her Writings and a
Complete Bibliography, ed. Women’s Medical Association of New York City (New
York: G. P. Putnam and Sons, 1925). For Jacobi’s views on learning from patients,
see 201; for her views on having sympathy, see 347. Sometime before 1900, Jacobi
wrote a letter to Mitchell criticizing his attitudes toward women doctors and arguing
that many of her own discoveries predated Mitchell’s rest cure. This letter has been
republished as “Mary Putnam Jacobi’s Letter of Protest to S. Weir Mitchell (Circa
1891),” introduced and transcribed by Nancy Cervetti, Transactions & Studies of the
College of Physicians of Philadelphia, series 5, 19 (Dec. 1997): 110–114.
72. Mary Putnam Jacobi, MD: A Pathfinder in Medicine, 347.
73. Ibid., 348, my emphasis.
74. Ibid.
75. This detail is reported by the anonymous editor of Mary Putnam Jacobi, MD:
A Pathfinder in Medicine, xxii.
76. Ibid., 106.
77. Ibid., 482.
78. Ibid., 481, 482.
79. Mary Putnam Jacobi, “Common Sense” Applied to Woman Suffrage (1894),
(New York: G. P. Putnam and Sons, 1915), 8–9.
80. For an interesting discussion of “narrative competence” see Rita Charon,
“The Narrative Road to Empathy,” in Empathy and the Practice of Medicine: Beyond Pills
and the Scalpel, ed. Howard Spiro et al. (New Haven: Yale University Press, 1993),
147–159. Charon argues that “only doctors who have developed narrative competence
will recognize their patients’ motives and desires, will allow patients to tell their full
stories of illness, and will offer themselves as therapeutic instruments” (p. 150).
81. Kleinman, 49.
82. Elizabeth Blackwell, Essays in Medical Sociology, Volumes I and II (1902;
reprint, New York: Arno Press, 1972), 2:31.
83. Ibid., 2:43.
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84. Morantz-Sanchez, 210. Ellen More corroborates Morantz-Sanchez’s research,
arguing that “many well-meaning male physicians . . . and many female physicians
. . . saw nothing wrong in identifying sympathy with the feminine members of the
profession”; see “‘Empathy’ Enters the Profession of Medicine,” in The Empathic
Practitioner: Empathy, Gender, and Medicine, ed. Ellen More and Maureen Milligan
(New Brunswick: Rutgers University Press, 1994), 25.
85. Morantz-Sanchez, 222.
86. Regina Morantz-Sanchez, “The Gendering of Empathic Expertise: How
Women Physicians Became More Empathic Than Men,” in Women and Health in
America: Historical Readings, ed. Judith Walzer Leavitt, 2nd ed. (Madison: University
of Wisconsin Press, 1999), 536. For more on the differences between Jacobi and
Blackwell see Morantz-Sanchez, Sympathy and Science, Chapter 7.
87. Howard Brody, Ethical Decisions in Medicine (Boston: Little, Brown, 1981),
40. For more on how physicians can share power and decision-making with patients,
see also Brody’s The Healer’s Power (New Haven: Yale University Press, 1992), 45–65.
88. Prince Morrow was a professor of medicine in New York and president of
the American Society of Sanitary and Moral Prophylaxis. Morrow’s influential book
Social Diseases and Marriage (New York: Lea Brothers, 1904) focuses on the problems
of female sterility caused by venereal infection from husbands and the effects upon
children.
89. Richard Johnson, “What Is Cultural Studies Anyway?” Social Text 16 (1986/
1987): 46.
90. These letters have been republished in Dock.
91. “Mary Putnam Jacobi’s Letter of Protest to S. Weir Mitchell,” 111.
92. For more on this subject, see Denise Knight’s “The Dying of Charlotte
Perkins Gilman,” American Transcendental Quarterly 13 (2) (1999): 137–159.
93. Lane, 360.
94. Candace West shows that in doctor-patient sessions, doctors ask 91 percent
of the questions, ignore at least 25 percent of patients’ questions, and feel patients
who ask too many questions or appear to know too much threaten their authority;
see “‘Ask Me No Questions . . .’ An Analysis of Queries and Replies in PhysicianPatient Dialogues,” in The Social Organization of Doctor-Patient Communication, ed.
Alexandra Dundas Todd and Sue Fisher (Norwood, N.J.: Ablex, 1993): 127–157.
Alexandra Todd shows that women patients are involved in asymmetrical relationships of power with male physicians, with the result that their concerns are often not
addressed and they sometimes receive inadequate medical treatment; see “Exploring
Women’s Experience: Power and Resistance in Medical Discourse” in the same
volume, 267–285.
95. One study of 336 patients (male and female) demonstrates that, although
women ask more questions than men in doctor-patient sessions, they do not receive
more explanations, thus “women appeared to experience considerable frustration in
their encounters with physicians” (p. 145). See Jacqueline Wallen, Howard B. Waitzkin,
and John D. Stoeckle, “Physician Stereotypes About Female Health and Illness: A
Study of Patient’s Sex and the Informative Process During Medical Interviews,”
Women and Health 4 (2) (1979): 145. Their study also demonstrates that doctors are
more likely to perceive women’s diseases as partly or wholly psychological in origin.
Moreover, because doctors view women’s diseases as psychological, they may ignore
actual signs of physical illness. Two different studies in the 25 July 1991 issue of the
New England Journal of Medicine, for example, documented that women’s complaints
of chest pain are not taken as seriously as men’s. And yet today heart disease is the
leading killer of women.