Living in the Shadow of Death

Reviewed by: Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in American History JoAnne Brown Sheila M. Rothman. Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in American History. New York: Basic Books, 1994. xi + 319 pp. $25.00. Sheila M. Rothman gives us a moving, elegant, and subtle book about patients’ narratives of chronic illness. Based on a significant selection of diaries and letters written by tuberculosis sufferers over a period of 150 years, Living in the Shadow of Death addresses the changing balance of authority between American patients and their caretakers, in contending with long-term invalidism and early death. Rothman is especially attuned to the gendered character of suffering for middle-class European-Americans, men as well as women, before the bacteriological paradigm shift that followed Villemin, Pasteur, and Koch. Particularly intriguing is her discussion of men’s health-seeking at sea, which hints at a large recent literature on masculine identity, freedom, and valor. Rothman notes the changing concepts of illness in which the “invalids” of the early national period became the “health-seekers” of Victorian America and the “patients” of the bacteriological age, 1882–1940. In the process, she achieves a picture of suffering that undermines medicine’s redemptive claims. Like the historians Temkin, Rosenberg, Warner, Pernick, Fissell, and Jordanova, Rothman is sensitive to changing medical terminology as it reframes entire systems of hygienic meaning. Chronicling the shifting definitions of phthisis from “consumption” to “tuberculosis,” Rothman aims to “liberate” her subjects “not only from the confines of the case record but from the literary constructs that have distorted their experience” (p. 8). To this end she seeks, as Susan Sontag urged in Illness as Metaphor (1978), to set free a deeper subjective reality from within the prisonhouse of language. This ethical (and epistemological) purpose complements the sensitivity of Rothman’s account, but it displaces the heroic physician with the heroic historian in the quest to “save lives.” Like medical case records read as narratives of patients’ experience, the diaries and letters available to the historian for the fulfillment of this liberating role are partial: the family papers housed in the numerous archives that Rothman visited select, in advance, the most literate, comfortable, and historically minded among the ill. The metaphor of liberation leads the reader to wonder, perhaps more than she might otherwise have done, whether these articulate and well-to-do subjects were the ones most in need of the historian’s retrospective mission of mercy. By the same token, however, the reader is led by the narratives’ sheer heart-rending intimacy—particularly by the central, beautifully retold story of Deborah Fiske—to ask a more fundamental question about health and illness, which runs [End Page 730] counter to much current scholarship on identity and subjectivity: Does the Parsonian “sick role” constitute as absolute a brand of subordination as do any of the class, gender, and racial positions that currently absorb the attention of social and cultural historians? Our ubiquitous use of disease metaphors to dramatize subaltern political identities suggests that illness, and especially chronic illness, may be a far more important subject for historians at large who are concerned with questions of power and authority than the profession has heretofore suspected. Rothman enriches us with a narrative history that provokes just this sort of ethical engagement. JoAnne Brown Johns Hopkins University Copyright © 1996 The Johns Hopkins University Press

Criminology · Pathology · Psychiatry · Psychoanalysis · Shadow (psychology) · Sociology · Tuberculosis · Gender Studies · Historical Psychiatry and Medical Practices · Historical Studies on Reproduction, Gender, Health, and Societal Changes · History · History of Science and Medicine · Medicine · Psychology · Gerontology

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