Palliating Humanity in The Last Man

Chapter four examines Mary Shelley’s 1826 novel The Last Man, which tells the story of an incurable plague that kills all of humanity. Shelley interrogates the Romantic belief in the possibility of a medico-poetic panacea (cure all). The novel begins with a domestic drama whose tragedy is figured as incurable, and this metaphoric incurability sparks the far more literal plague. Characters react to both scourges by longing for a panacea, which, when it does not appear, plunges them into a despair that aggravates the initial illness. Shelley’s story critiques the binary mindset underwriting both total affirmation and rejection of panacea, posing a middle ground that offers literature as the palliation of a dying humanity. In the same way that medical philosophers like Jean Georges Cabanis tied the imperfection of medical knowledge to the necessity of palliative care, so The Last Man suggests that suffering and death are unavoidable, both individually and at a species level. In the novel, literature takes on the function of a palliative care doctor, shepherding humanity to its final end by ‘taking the mortal sting from pain’ and preserving its fragmentary memory (p. 5).

From John Stuart Mill to the Medical Humanities

This chapter traces therapeutic holism from German Romanticism through Victorian proponents of cultural education, represented by John Stuart Mill, down to its contemporary manifestation in the work of major literary health humanists like Rita Charon, Cheryl Mattingly, and Kathryn Montgomery Hunter. It also explains the relationship of therapeutic holism to its sibling discourses, New Criticism and Millian liberalism. The former’s holistic, unified work of art parallels the latter’s proper citizen—a whole person whose wholeness is created and restored by cultural education. These linked discourses helped secure therapeutic holism’s place in interdisciplinary conversations about why medicine needs literature. The final section of the chapter critiques therapeutic holism and explains why palliative poetics offer a necessary corrective, using the work of Samuel Taylor Coleridge to illustrate the heterogeneity of Romantic literary therapies. It also surveys complementary recent work within the health humanities. Health humanists working in fields like nursing, chronic pain, and palliative care have begun to develop palliative poetics that do not expect literature to cure.

Thomas Lovell Beddoes’s ‘Fictitious Condition’

Chapter six reads Thomas Lovell Beddoes’s 1849 gothic drama Death’s Jest-Book as a cynical insider’s take on Romantic medicine’s approach to death. A graduate of Göttingen and Würzburg medical schools, Beddoes harbored early hopes that medicine might solve the mystery of death. But he was disappointed by medicine’s failure to deliver on this promise and disillusioned by doctors who turned a profit in the burgeoning palliative care market. As doctors became more regular presences at the deathbed, patients worried that they were sacrificing agency over their own deaths for the sake of palliative ease. Beddoes satirizes these developments through a harrowing portrait of a failed suicide, denied his chosen death by the imperious decision of a medical professional. Looking ahead to health humanists who advocate for patients’ control over the stories that survive them, Beddoes offers writing as a way to preserve agency over life’s end when death cannot be prevented. When death is a ‘fictitious condition’, it cannot be coopted by rapacious physicians. Beddoes’s critique of managed death is a forward-looking defense of patients’ narrative sovereignty.

‘Soothing Thoughts’

Chapter three begins the book’s survey of palliative poetics developed by Romantic writers, comparing Wordsworth’s ideas about poetic therapy with medical beliefs of the late eighteenth century. The therapeutic holism later ascribed to Wordsworth by literary critics was held by Romantic medicine to be a restorative power of nature, a ‘vis medicatrix naturae’ that could repair a broken constitution in ways doctors could not. But as medicine professionalized, they saw how claims that nature was the real healer could damage their reputation. Their compensatory shift to a palliative ethic was driven in part by a need to renegotiate medicine’s relationship with nature. Similarly, Wordsworth initially hoped his own poetry could replicate nature’s holistic therapy. But in Lyrical Ballads (1798), a collection whose Wordsworthian lyrics extol the superiority of natural medicine, Wordsworth realized his own art could not mimic nature’s healing power. As a result, he turns towards a poetics of palliation grounded in the ‘delight’ outlined by Edmund Burke’s 1757 Philosophical Enquiry into the Origin of our Ideas of the Sublime and Beautiful.

Therapeutic Holism

This chapter historicizes therapeutic holism, the model of literary therapy The Poetics of Palliation challenges. Beyond the faith that literature and its tools can heal, therapeutic holism reflects three guiding assumptions: first, that healthy people are wholes whose unity depends on an anti-dualist, teleological self-concept; second, that broken holism is mended by literature through a dialectic process of reintegration; and third, that the holism of functioning individuals both parallels and is constructed by the holism of their society. The chapter illustrates therapeutic holism’s Romantic genealogy by comparing its appearance in health humanities scholarship with Romantic writing, particularly the organicist tradition of German Romantics like Friedrich Schiller. Along the way, it reviews the history of nineteenth-century medical ethics that forms the interdisciplinary background to the rest of the book, including a discussion of ethics’ role in medical professionalization; the history of palliative care; and the tradition of advocating education in the humanities as a way to ‘humanize’ physicians.

John Keats’s ‘Sickness Not Ignoble’

Chapter five argues that John Keats, usually read as Romanticism’s most ardent poet-physician, had knowledge of British medical ethics that led him to deny any neat congruity between the humanitarian duties of physicians and poets. While the former are ethically bound to dull pain, the latter are tasked with furthering the painful, pedagogical process of ‘Soul-Making’ Keats outlines in an 1819 letter. By reading Keats’s two Hyperion poems against an 1816 medical ethics text written for students of Guy’s Hospital like Keats, this chapter argues that by the end of his life, Keats dismissed the idea that poets, like physicians, must above all spare pain to their patients. Fallen from deity to mortality, the Titans of Hyperion develop distinct selves as they acquire individual histories of suffering. Their agony, re-presented in the metapoetic Fall of Hyperion, represents the ideal effect of art on readers: a pedagogical ‘sickness not ignoble’ whose infection is essential to crafting an individual subject. Anticipating a key mandate of narrative medicine, Keats enlists poetry in the rich but difficult mission of exploring how pain shapes an individual’s life story.

Introduction

This introduction gives an overview of recent scholarship in Romanticism and the medical humanities. It argues that medical humanists are indebted to a Romantic belief that literature cures by making people whole again—what this book calls therapeutic holism. After critiquing therapeutic holism for its limiting assumptions about selfhood and literature’s powers, the introduction offers an alternative in palliative poetics, a model for literary therapy grounded in Romantic writers’ affinity to Georgian medical ethics. It shows how this focus on ethics reorients Romantic scholarship on literature and medicine, which has mostly restricted its definition of medicine to medical science. Finally, this introduction outlines the book’s six chapters: two introductory chapters on the intellectual history of therapeutic holism and four single-author illustrations of palliative poetics.