From hermeneutics to heteroglossia: ‘The Patient’s View’ revisited

Abstract

This article explores conceptual and methodological challenges surrounding the recovery of patients’ voices in the history of medicine. We examine the debate that followed Roy Porter’s seminal article, ‘The Patient’s View: Doing Medical History from Below’ (1985). Porter argued that patients should be given a central role in medical history, aiming to restore to patients a voice and agency that is often lost in ‘physician-centered’ historical narratives. His work carried significant influence but also sparked an ongoing debate about the possibility of conducting ‘patient-centered’ history of medicine. The growth of the medical humanities has afforded renewed attention to patient narratives, supporting the need to recognise patients’ voices in contemporary healthcare and medical education. However, several barriers complicate and problematise the expansion of a patient-centred epistemology across historical periods. Postmodern critics have expressed scepticism that ‘the patient’s view’ can be recovered from history, with some claiming that ‘the patient’ is a construct of the ‘medical gaze’ whose subjectivity cannot be reconstituted outside of sociohistorical discourses of knowledge and power. Psychiatry in the mid-20th century presents a particular challenge for patient-centred history. We discuss the influence of postmodern theorists, especially Michel Foucault, whose work is seen as undermining the possibility of a patient-centred epistemology. We argue against Foucault’s erasure of the patient, and instead explore alternate constructivist epistemologies, focusing on the hermeneutics of Hans-Georg Gadamer and dialogism of Mikhail Bakhtin, to help address historiographical challenges in recovering ‘the patient’s view’. To illustrate the value of Gadamerian and Bakhtinian approaches, we apply them to a case study from the Verdun Protestant Hospital (Québec, Canada) from 1941 to 1956, which sheds light on the introduction of the first antipsychotic, chlorpromazine, into clinical practice. We highlight how Gadamer’s hermeneutics and Bakhtin’s dialogism together offer insights into patient perspectives during this liminal period in the history of psychiatry.