Modernism and Diagnosis

Evolving Diagnostic Cultures

Questions of scientific testing, symptomatology, medical solutions, and epidemiological modeling have been front-page news this past year. But our diagnostic moment began long before the COVID-19 pandemic: from 23andme’s mail-in genetic analysis to WebMD’s online medical symptom checkers; from wearable fitness trackers that get smaller and sleeker with each new model to books and web series that promise inner joy through a simplified material existence; from a resurgence in theories of genetic determinism born of “scoring” individual genomes to the advent of a professional field dedicated to “diagnosing organizational culture.”

Media coverage of our contemporary diagnostic interests regularly traces their origins to the literary, cultural, and medical innovations of the early twentieth century. This coverage alternately highlights the potential of historical diagnostic frameworks to enable new clinical breakthroughs and enhanced self-awareness and pinpoints more insidious remodelings of eugenicist thought. In an example of the former, an August 2019 New York Times article features Dr. Lisa Sanders of the Netflix series Diagnosis, who “credits Sherlock Holmes and global crowdsourcing with helping her solve patients’ mysterious ailments.” Tasmanian comic Hannah Gadsby (of Nanette [2018] fame) speaks to the patient side of this dynamic in her new comedy special, Douglas (2020), in which she asserts that her recent autism diagnosis—a clinical label that first appeared in 1911, courtesy of Swiss psychiatrist Paul Eugen Bleuler—produced clarifying self-understanding.[1] Historian Ibram X. Kendi flags the more damaging legacies of early twentieth-century diagnostic culture in an interview about his new monograph How to Be an Antiracist (2019), in which he criticizes today’s IQ, SAT, and other intelligence tests on the grounds that these evaluations “were created by eugenicists . . . a century ago.” Similarly, a September 2018 Nature review of Robert Plomin’s Blueprint: How DNA Makes Us Who We Are (2018) condemns Plomin’s argument as an update of work by early twentieth-century psychologists like Henry Goddard who “claimed he had found the gene for low intelligence.” Finally, in an editorial choice that now seems eerily prescient, in April 2018, The Atlantic published a photo series of 1918 Spanish influenza patients, treatment centers, and care providers; the piece’s recent Twitter revival suggests how readily contemporary audiences turn to our past to interpret ever-changing daily circumstances.

This sense of continuity between our current diagnostic proclivities and those of a century ago impels this cluster on “Modernism and Diagnosis.” Our contributors discuss the endurance of modernist diagnostics in contemporary aesthetics and artistic production, in social and political discourse, and in the reading debates that animate recent literary criticism. Our essays likewise offer additional contexts for thinking through the resonance between early twentieth-century eugenic logic and contemporary scientific cultures. Even when they keep their analytic gaze trained on modernist literary and cultural production, these essays highlight just how thoroughly the entangled categories of modern identity—especially those of race, gender, class, sexuality, and ability—function as persistent disciplinary metrics. At the same time, our authors demonstrate how individuals consistently engage these models of human health and capability to develop senses of self that are by turns productively cohesive, generatively fragmented, and more corrosively coherent or divergent. Then as now, human subjects draw on available diagnostic discourses to understand collective and idiosyncratic selfhood and to think through the workings of their own and others’ minded-bodies.[2]

This cluster equally showcases the meaningful differences between the diagnostic debates of the early twentieth and early twenty-first centuries. For instance, while Foucauldian concerns about individual agency and systemic power shape both historical moments, the taxonomies of medical epistemology and health practices have shifted in important ways. At the beginning of the last century, the professionalization of specialized medical disciplines like psychiatry, obstetrics, and endocrinology impelled practitioners to stake ever-more definitive and exclusive claims to authority within their subfields of expertise. At the same time, popular movements rooted in self-diagnosis, such as self-help and physical culture, enabled patients and other members of the general public to assert control over their health and wellbeing. These tensions between hierarchical and democratic classification endure in contemporary discourses surrounding market-driven health innovation (which often elides or contradicts medical knowledge), patients’ rights movements (which often emphasize privacy, informed consent, and equitable access), and evolving models of integrative healthcare (which often foreground empathy, ethics, community understanding, and patient-centered approaches). The essays that appear in this cluster remind us of the necessity of considering how material contexts shape questions of classificatory logic and diagnostic impact. Their arguments enact this commitment by thickly historicizing cultural texts and diagnostic categories.

Of particular import, given today’s data-driven world, this essay cluster also tracks the effects of increasingly quantified approaches to health management over the past century. Individual and social measures of wellbeing and pathology proliferated in the modernist period, from developing psychoanalytic and sexological taxonomies and eugenic assessments to the standardizing calculations of self-help programs and physical fitness regimes. Such health-centered discourses integrated new data-processing developments from fields less obviously linked to corporeality, such as statistics, public relations, anthropology, sociology, and even linguistics. Across these realms of thought and practice, the capacity for large-scale information management emerged as an authoritative, legitimate, and seemingly necessary tool for successfully making sense of (diagnosing) and productively navigating (treating) the disorienting complexity of modern life. This capacity has become increasingly central and contentious in the context of twenty-first-century technological developments. Data mining for medical research, targeted treatment therapies, patient-specific care (both through in-person interactions with practitioners and online resources like WebMD), and other analytic innovations promise to enhance our ability to diagnose and manage illness, though they bring increased risks associated with privacy breeches, algorithmic bias, and the potential for the unethical manipulation and mobilization of personalized information. Modernist engagements with these emergent techno-medical discourses—discourses that, our contributors illustrate, were likewise ethically vexed—help elucidate the roots of present-day biomedical quandaries.

Modernism’s Diagnoses: Aesthetic, Social, and Critical

A productive definition of “diagnosis” involves two distinct registers of significance: first, the term denotes a specific type of scientific practice located in the field of medicine; second, diagnosis suggests a more general, often more figurative, mode of assessment and classification. The OED highlights these two components, referring to both the medical “[d]etermination of the nature of a diseased condition” or “identification of a disease by careful investigation of its symptoms and history,” and a broader process of arriving at a “[d]istinctive characterization in precise terms.”[3] This definitional interplay grants diagnosis much of its tropological power, both for modernist writers and for the critics who continue to engage with the diagnostic dimensions of early twentieth-century literature and culture. Referential relays also shape medical discourse, as Andrew Gaedtke illustrates in his insightful reading of early twentieth-century psychiatric diagnoses and their basis on “analogical links” to the natural sciences and thus on unstable ideological and linguistic terrain. As the essays in this cluster and the works they explore demonstrate, diagnosis traffics across and among multiple discursive contexts, suturing the medical, the embodied, and the psychological to the artistic, the creative, and the cultural.

Canonical modernist writers dialogue with diagnostic schemas as they develop their aesthetic theories and perspectives on art. In “The Serious Artist” (1913), for example, Ezra Pound engages scientific logic and language to advance claims about art’s import and the artist’s ethical obligations. Pound proposes that “the arts, literature, poesy, are a science, just as chemistry is a science,” which “overlap[s]” with “the science of medicine” in the shared effort to understand “mankind and the individual” (“Serious” 42). The “overcross[ing]” domains, Pound asserts, function according to a dual pursuit: “the art of diagnosis and the art of cure” (42, 45). Pound’s medical model thus advocates an aesthetic theory of scientific precision, detailed observation, and an “hygienic” conception of beauty (45).[4] Where Pound’s ideal artist is a model physician, Virginia Woolf’s astute creator is an experienced patient. In “On Being Ill” (1926), she describes how the experiences of illness opens up the new perspectives and insights that she sought to capture in short stories like “Kew Gardens” (1921) and “The Mark on the Wall” (1921). It is “astonishing,” she posits in the 1926 essay, “what wastes and deserts of the soul a slight attack of influenza brings to light, what precipices and lawns sprinkled with bright flowers a little rise of temperature reveals” (32). In these essays, Pound and Woolf offer explicit examples of a trend in which more subtle mobilizations of diagnostic thought permeate modernism’s formal experiments (e. g. stream-of-conscious narration, achronological time, dialectical writing, and primitivist aesthetics). Victoria Papa’s contribution presents another, new, and important case study in this deployment of medical logic and language for aesthetic purposes; by tracing a genealogy of “cure” and “antidote” in the works of Alain Locke and Richard Bruce Nugent, she showcases how these two figures establish a robust lineage for twentieth-century Black authorship. Beth Blum’s and Pau Pitarch-Fernandez’s essays broaden the range of applications for this strategy, bringing it into the realm of popular culture (people-reading as diagnosis) and artistic self-identification (mental instability as sign of artistic genius), respectively.

Modernist authors also trade in the symbolism of modern medical endeavor to assert broader sociopolitical commentary. Some incisive ironists depict dramatic medical interventions as pseudo-plausible cures for deeply rooted social ills. In her “Feminist Manifesto” (1914), for example, Mina Loy calls for “the unconditional surgical destruction of virginity through-out the female population at puberty,” as a means of underscoring the violence of everyday forms of female subjection (emphasis in original). In Black No More (1931), George S. Schuyler proposes that a skin whitening treatment—and hence the apparent erasure of the Black body politic—works to ultimately revalue Black skin, while nonetheless preserving American racism and fascism under Jim Crow. For other writers, modernity itself figures as a type of anesthetic whose deadening effects precipitate self-estrangement and foreclose emotional intimacy. T. S. Eliot’s “The Love Song of J. Alfred Prufrock” (1915) describes the London evening “like a patient etherized upon a table” to foreground the stasis of its perpetually unfulfilled protagonist. Meanwhile, Edith Wharton’s Twilight Sleep (1927) uses its title—a popular childbirth anesthetic—as a metaphor for upper-class New York society’s quest for a panacea that will assuage the pains of modern life and, in so doing, evacuates the basis of the human condition. Our contributors trace several additional strategies that modernist authors employ to examine the sociopolitical dimensions of modern identity categories and embodiment. These range from the shell-shocked soldiers facing the death penalty in Katherine Ebury’s essay, to the fictional characters who embody new psychometric categories in Rebecah Pulsifer’s piece, to the largely white male bodybuilders who navigate a complex relationship to gender, race, desire, and spectatorship in Jean-Thomas Tremblay’s argument.

Diagnostic language and logic also drive interpretations of modernist literature and its creators. Period examples include Wyndham Lewis’s 1927 diagnosis of Pound, James Joyce, Marcel Proust, and Gertrude Stein as possessing a “time-mind”; literary critic Granville Hicks’s 1933 diagnosis of Willa Cather’s post-My Antonia (1918) artistic “crisis” and the subsequent “project[ion of] her own desires into the past”; and behavioral psychologist B. F. Skinner’s 1934 diagnosis of Stein’s “probably ill-advised experiment” with automatic writing (Hicks, 706, 709; Skinner, 57). More recent interpretations along these lines include Carol Shloss’s 2005 thesis that Joyce’s Finnegan’s Wake (1939) dialogues with his daughter’s schizophrenia and Natalia Cecire’s 2015 rereading of the canon of “medical literature” on Stein as a means of rethinking recent algorithmic approaches to literary interpretation (290). These critical responses illustrate diagnostic categories’ enduring value as interpretive tools for modernist literature.

The critical legacy of modernist-era diagnosis extends to twentieth- and twenty-first-century literary and cultural studies more broadly as well. Canonical modernist authors and critics generated the schematic commitments of New Criticism and made close reading the default mode of twentieth-century academic approaches to literary analysis. Subsequent influential theorists like Michel Foucault and Gilles Deleuze revisit these literary and critical concerns as they reject New Criticism’s closed-system interpretive models and instead seek to analyze contextualized structures of discourse (Foucault) or regimes of signs (Deleuze) that are often explicitly grounded in medical and clinical locales.[5] The recent reading debates are the next generation of this critical genealogy. As Peter Fifield points out, contemporary discussions about the status of criticism and the value of reading in the academy frequently engage the language of medical diagnosis to deliver their rhetorical punch. “Reparative” and “recuperative” reading practices, for instance, propose a kind of salve to “suspicious” and “symptomatic” approaches understood to clinically dissect or pathologize texts.[6] Echoing the tendencies of our modernist forebears and their successive interlocutors, contemporary literary scholars simultaneously recruit the authority of normative diagnostic codes and seek to counter and subvert these practices.

Is Diagnosis Any Good?

This intellectual genealogy prompts important questions about the value of diagnosis as an interpretive mode. Proponents of diagnosis frequently tout its potential for individual health and social progress, while more skeptical perspectives limn its delimiting stigmas and reductive and repressive tendencies. Often, these competing perspectives exist alongside one another, as in recent critical stances that reject diagnostic approaches to interpretation, yet rely on a diagnostic lexicon to stake out their proposed alternatives. These tensions can also prompt more self-consciously ambivalent stances toward diagnostic endeavor, as Foucault and Deleuze exemplify. In Madness and Civilization (1961), for example, Foucault asserts that “[Sigmund] Freud demystified all the other asylum structures: he abolished silence and observation, he eliminated madness’s recognition of itself in the mirror of its own spectacle, he silenced the instances of condemnation. But on the other hand he exploited the structure that enveloped the medical personage; he amplified its thaumaturgical virtues, preparing for its omnipotence a quasi-divine status.”[7] Foucault here suggests that Freud’s “demystifying” modality liberated the neurotic individual from the asylum (diagnostic boon), yet subjected her to a different self-alienating structure and disempowered doctor-patient dyad (diagnostic burden).[8] Similarly multidirectional arguments pervade Foucault’s oeuvre, inviting us to understand how the violence inherent in modern diagnostic culture also opens up, as historian Arnold I. Davidson puts it in his introduction to Foucault’s Psychiatric Power (1974), a “multiplicity of possible points of resistance.”[9] Deleuze’s Essays Clinical and Critical (1997) and other psychoanalytic work highlights a corollary duality, in which diagnostic thinking enables clinicians and critics to recognize and name important medical and cultural “assemblage[s],” yet can easily go awry.[10]

Our contributors speak to this complex dynamic: their archives introduce us to modernists who alternately championed and interrogated the impulse to diagnose; their arguments parse both the explicit and the understated, perhaps unexpected, implications of these diagnostic modes. Gaedtke, for example, traces an emergent psychiatry’s shifting “language-games” and considers these discursive projects’ curious “looping effects” on patients who become more likely to manifest the symptoms of a diagnosis once its description becomes well known. His argument invites us to rethink how (and why) diagnosis rates shift over time and to see those shifts as linguistic as well as biomedical adaptations with potentially beneficial as well as restrictive effects. The dissemination of medical language and logic similarly informs Ebury’s study of the popular struggle over the military death penalty in Britain following World War I. Here, audience familiarity with shell shock allowed authors to imply the condition without labeling it outright—a rhetorical context that both enabled and impeded political and legal argument and hence political and legal change. In each of these pieces, diagnosis has both liberating and delimiting medical and social consequences.

Early twentieth-century authors and other public figures nonetheless invited audiences to focus on the virtues of diagnosis. Blum’s case study of Elsie Lincoln Benedict—“the most popular woman orator that nobody has ever heard of”—shows us how Benedict’s “Science of Human Analysis” advocates systematic people-reading techniques as a means to a successful interpersonal life, courtesy of its handy “taxonomy of the five most prominent human characters.” Pulsifer’s constellation of psychometric terminology within modernist texts reveals how authors including Woolf, Joyce, Joseph Conrad, D. H. Lawrence, Jean Rhys, and Mary Butts incorporated the language of cognitive categorization in their writing. For these writers, enhanced diagnostic precision produces strategic opportunities for navigating the social world and new possibilities for developing modes of literary expression.

These adoptions of diagnostic methods and descriptors are never neutral, though, and our contributors often reach their most provocative conclusions as they parse the tensions of the categories they investigate. Blum finds that Benedict’s people-reading strategies reinforce dangerous eugenic principles as they categorize individuals according to reductive stereotypes. Pulsifer discovers that literary modernism’s invocations of psychometric discourse help legitimize problematic methods of measuring intellectual capacity. She further reveals modernist authors’ insidious tendency to dismiss non-normative cognition as unworthy of narrative space. These examples and interpretations underscore how distinctions of power and agency shape diagnosis. Classification often empowers the diagnostician (Foucault’s Freud, Benedict’s people-reader, Pulsifer’s culturally attuned author), even as expectations of such definitive knowledge can also be a burdensome demand (the need for definition, the possibility of inaccuracy). Classification often forecloses agency for the object under review, particularly when that object is another human being—and yet, diagnosis can also be an enabling force for the clinical subject (access to treatment, self-understanding).

Our essays, then, indicate that diagnostic models regularly interpolate bodies and subjects in ways that reinforce a politics of exclusion. Eugenics and other scientifically informed racialized hierarchies regulate the lives of subjects featured in Papa’s, Tremblay’s, and Pitarch-Fernandez’s essays as well as in Blum’s and Pulsifer’s. Concerns of gender and sexuality dictate cultural ideals and discipline individuals—to the point of death in Ebury’s piece, and to differently destructive corporeal ends in Papa’s and Tremblay’s contributions. Vexed definitions of mental wellbeing inform the social perceptions and self-understandings of Pitarch-Fernandez’s and Gaedtke’s subjects along with Pulsifer’s, while Tremblay’s performers seek to complicate standard readings of their interiority through extreme forms of self-control. Fifield, meanwhile, considers how the metaphor of illness becomes an intellectual resource available only to certain privileged individuals—namely, modernist literary critics like Eliot and Lawrence, and potentially also the “elite” group of scholars who have managed to secure posts in the academy today. Together, these works highlight how our abstract categories of personhood shape the corporeal realities of individual lives, often restrictively so.

Thus, despite diagnosis’s seemingly either/or logic (either healthy or ill, normal or aberrant, strong or weak, etc.), its upshot seems consistently both/and. Modernist literary and cultural case studies show us how this ambivalence can serve generative medical, aesthetic, and political ends for the same subjects it potentially punishes, as it does for Gaedtke’s, Tremblay’s, Papa’s, and Ebury’s authors. Fifield likewise highlights how the practice of diagnosing culture as ill facilitates the writing of literary criticism and reflects an essential care for its subject matter, even as it begins “with an often unstated assumption of literary ‘pathology.’” This cluster’s arguments about modernist archives thus drive home a Foucauldian understanding of diagnosis as a shapeshifting force: for all its aims at specificity and determination, its consequences invariably move in multiple directions.

Our Diagnoses, Ourselves

Among other directions, modernist diagnoses consistently move towards the future—which is to say, toward our contemporary diagnostic moment. Tremblay connects fin-de-siècle and twenty-first century performance art that fixates on the chiseled male body. Blum links 1920s’ popularized self-help discourses to present-day pop-science writing by Malcolm Gladwell et al. Gaedtke identifies psychiatric manuals’ enduring tendency to “redistribute” diagnoses in each new version. And Fifield traces the continuities between Eliot’s and Lawrence’s recourses to diagnostic logic in their literary criticism and our own recent recourse to the same. We are newly surrounded by efforts to reckon with diagnostic affordances and diagnostic angst. For the former, think: medical treatment for those who need it most, understandings of viral transmission and community spread, and plans for economic recovery; for the latter, see: racialized illnesses, politically driven scientific curation, and concerns about what institutions will do with newly available online teaching analytics. It’s impossible to imagine how the COVID-19 pandemic will shape literary and cultural criticism in the short- and long-term future, but this cluster offers something of a starting point, inviting us to think how our modernist past equips us to consider how we all become—willingly or not—implicated in present-day diagnostic discourses.

The meditations in this cluster further a burgeoning subfield of work on modernism and diagnosis. Additional recent publications along these lines include monographs focused on: fin-de-siècle physiology (Robert Michael Brain, 2016); the early twentieth-century disciplines of psychology, sexology, and psychiatry (Paul Peppis, 2014; Andrew Gaedtke, 2017; Benjamin Kahan, 2019); the history of eugenics and disability (Maren Tova Linett, 2016; Michael Davidson, 2019); and the cultural and literary effects of the 1918–1919 influenza pandemic (Elizabeth Outka, 2019). Modernist scholars have likewise authored key works on affect and other aspects of material embodiment (ed. Julie Taylor, 2017; Marta Figlerowicz, 2017; ed. Kara Watts, Molly Volanth Hall, and Robin Hackett, 2019); on the crucial roles data and information play in shaping our orientation to modern society (Wesley Beal, 2015; Paul Stephens, 2015; Paul Jaussen, 2017); and on the evolving possibilities of digital approaches to literary composition and criticism (Jessica Pressman, 2014; ed. Shawna Ross and James O’Sullivan, 2016). Beyond modernist literary studies, scholars like Jay Timothy Dolmage (2018) and Merve Emre (2019) offer broader cultural contextualization for the diagnostic discourses that inform this recent critical turn.

Ultimately, the essays in this cluster both hold out and exemplify the opportunity to think with and learn from the writers we study. As we confront the troubling ramifications of politicized healthcare, for-profit medical economies, social services that necessitate stigmatized labels, and a self-care discourse that places the burden of wellness on individuals, we find ourselves at once comforted and unsettled by the enduring poignancy of James Baldwin’s prose. In Notes of a Native Son (1955), he observes: “Our passion for categorization, life neatly fitted into pegs, has led to an unforeseen, paradoxical distress; confusion, a breakdown of meaning. Those categories which were meant to define and control the world for us have boomeranged us into chaos; in which limbo we whirl, clutching the straws of our definitions. . . . Now, as then, we find ourselves bound, first without, then within, by the nature of our categorization.”[11] If Baldwin unnerves us in his insightful relevance, his apposite rendering of our predicament also reminds us that when it comes to grappling with the unintended consequences of modernism and diagnosis, we have a wealth of intellectual and emotional resources to draw on.