Perspectives

Autopathography: the patient's tale

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7276.1599 (Published 23 December 2000) Cite this as: BMJ 2000;321:1599
  1. Jeffrey K Aronson (jeffrey.aronson@clinpharm.ox.ac.uk), clinical reader
  1. Department of Clinical Pharmacology, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE

The case history was invented by Hippocrates. Since then medical practice has been straitjacketed by its artificiality, to the detriment of the patient's own narrative. But patients have found ways of expressing themselves other than by talking to their doctors. Over the past two years I have been collecting a bibliography of book length autobiographical medical narratives, each completely or largely devoted to the writer's personal experience of drug use or illness. My growing list currently runs to about 270 titles.

The usual term for a narrative of this sort is a pathography, originally defined in 1853 in Dunglison's Medical Lexicon as a description of disease, and later as “the study of the effects of any illness on the writer's (or other artist's) life or art, or the effects of an artist's life and personality development on his creative work.”1 The word was probably first used in this sense by Sigmund Freud, in Eine Kindheitserrinerung des Leonardo da Vinci (1910), and Oliver Sacks in the 1990 revised edition of Awakenings said that “the most perfect examples of … pathography are the matchless case-histories of Freud” (although in earlier editions he wrote “pathology”). However, no one has, to my knowledge, made the important distinction between pathography and autopathography; indeed the latter term seems not to have been coined at all. The critic Mark Lawson, recognising the genre, has called autopathographies “medical confessionals,”2 but I prefer to call them “patient's tales”—or, as Kipling might have put it, “plain tales from the ill.”

All of the unreferenced volumes that I mention in this review are listed in my partially annotated bibliography.3 From their wide variety some common themes emerge, the surfaces of which I shall attempt to scratch.

Summary points

The traditional case history stifles the patient's own narrative, but increasingly patients …

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