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Tuesday, June 30, 2009

doctors and women

- Ann Svenson, untitled

It was around 1848 that Joseph Dietl, a doctor in Vienna, first used the phrase “therapeutic nihilism.” It was an attitude that had been developing in the medical school of the University of Vienna, a part of the extreme positivist reaction to the feverish cosmic analogies of the romantics. According to the circle in which Dietl taught, medical science was caught between an increasingly sophisticated ability to diagnose and the growing realization that all traditional therapies, everything in the doctor’s toolkit, had no scientific grounding. In a sense, medicine still oscillates today between the idea that cures come as a result of understanding causes and the idea that one should just empirically test to see if something cures. Penicillin, to use one famous example, was developed in the absence of a theory about why it should work. But therapeutic nihilism stood at the positivistic extreme: nature, in this view, was the only cure. The result was, curiously, that Vienna’s medical school became more and more famous, and Vienna’s hospitals became more and more disgraceful.

Herzen took classes at Moscow University in Physics, but he was certainly interested in medicine, and knew members of the medical faculty. Was he aware of what was happening in Vienna? In France, medical journals after 1860 use the term nihilisme therapeutique to refer to practices like that of Laennec’s, in the 1820s, with regard to tuberculosis. The Journal de médecine, de chirurgie et de pharmacology refers to the “doctrines sustained successively by Broussais, Schoenlien, Heusinger, Rokitansky and Lebert remained sterile in therapy, but continued to tranquilly play their role in the program of studies of our faculties of medicine under the determination, ‘pure medical science’, with which therapy conserved only a distant tie.” Lebert founded a group dedicated to the synthesis of biology and medicine in 1848 – Rokitansky was the head of Vienna’s Medical school – and Broussais was one of the most famous doctors in the 1840s.

The idea of pure medical science is, in a sense, like the idea of creating a pure science to observe the political physiognomy of a society – or the cultural physiognomy. The great master of the diagnostic metaphor in nineteenth century philosophy is Nietzsche, who, as well, considered a form of nihilism to be the great European disease. A disease of heredity:

“This innocence between opposites, this good conscience in the lie is… modern par excellence, it is almost definitive of modernity. The modern person presents, biologically, a contradiction of values, he sits between two stools, in one breath he says yes and no… we have counter knowing, counter wills, counter values, counter formulas, counter morals of opposed heredity in the body… A diagnostic of the modern soul – where should it begin? With a resolute incision in this contradictoriness of instincts, with the leaching out of its opposite values.” - Nietzsche, The Case of Wagner

All of which brings us back to the fact that a doctor is, if we can trust Aileen Kelly, voicing Herzen’s views in From the Other Shore, and, in particular, in the dialogue we are interested in, Consolatio. And on the other side of the doctor? A woman. Who we need to trace, too, who we need to look at in terms of this dyad, the woman/doctor, which turns up again and again in the nineteenth century – until we get to Freud’s wonderful case histories.

In fact, the strongest evidence that the doctor in question is influenced by therapeutic nihilism is a story he tells which, again, concerns a woman.


j. said...


is there something good to read about therapeutic nihilism?

once you used the phrase i eventually realized that i recognized it from william johnston's 'austrian mind', but i assume there's something more recent, or devoted more to the history of medicine.

roger said...

The go to work on the origins of therapeutic nihilism is by E. Lenka, but I couldn't find it. I had to slog through a lot of journal articles to piece together the medical genealogy I was looking for. As I recall, there is a long section in Wittgenstein's Vienna - Janik and Toulmin - about it.

Anonymous said...

There is a charge

For the eyeing of my scars, there is a charge
For the hearing of my heart--
It really goes.

And there is a charge, a very large charge
For a word or a touch
Or a bit of blood

Or a piece of my hair or my clothes.
So, so, Herr Doktor.
So, Herr Enemy.

I am your opus,
I am your valuable,
The pure gold baby

That melts to a shriek.
I turn and burn.
Do not think I underestimate your great concern.

- from Lady Lazarus, Sylvia Plath


j. said...

oh duh, i should have known about the janik and toulmin. i'll look for the lenka, thanks!