Free Indirect Diagnosis: Reading Alongside the Doctor in Middlemarch

Livia Arndal Woods //

One of the techniques par excellence associated with the nineteenth-century novel is free indirect discourse, a literary device in which the cadences of a character’s interior, subjective voice are mapped onto an authoritative, third-person narrative voice. For example,”Ella thought Susan’s dress was silly” rendered in free indirect discourse might read more along the lines of “Ella eyed Susan’s silly dress.” In the second rendering, the narrator’s perspective is hard to distinguish from Ella’s, and vice versa. Who, exactly, thinks the dress is silly?

In my book project on reading pregnancy in the nineteenth-century novel, I explore what I call “free indirect diagnosis.” Free indirect diagnosis maps the cadences of a character who is a trained specialist with knowledge that presents as objective onto the increasingly subjective “authority” of a third-person narrator. Such diagnoses often occur in novels with medical characters, and the reader’s collaboration with them suggests some of the ways in which we work in conversation with nineteenth-century cultures of science, medicine, and psychology. Who, free indirect diagnosis prompts us to ask, is a qualified diagnostician?

Nineteenth-century realism tends to position our recognition of feeling bodies diagnostically, via the authority of narrator, doctor, or court of law with which our own reading practices almost necessarily collude. Free indirect diagnosis fosters this collusion by aligning “objective” narrative voice with the seeming objectivities of medical diagnosis, of hard physical fact deduced by a trained mind but not legible as an embodied experience.

Before I turn to reading Rosamond’s miscarriage in George Eliot’s 1874 Middlemarch as a particularly clear case of free indirect diagnosis in the nineteenth century novel, I want to spend a little obligatory time with Foucault. In The Birth of the Clinic, Foucault treats shifts in ways of seeing and saying that follow the codification of medical education in the 18th century. He argues that “a new alliance was forged between words and things, enabling one to see and to say” (xii – emphasis Foucault’s). The ability of a specialized few to see and to say in turn enabled, says Foucault, the development of a medical gaze that codified the separation of mind and body. Though I wouldn’t want to think through medical attendance on the bodies of middle and upper class ladies in Victorian novels in the same way that Foucault thinks through the teaching clinics treating primarily lower-class patients, his interest in changing modes of seeing and saying does provide a useful structure for theorizing how pregnancy is narrated in the Victorian novel and the work of free indirect diagnosis. The historian Barbara Duden has argued that, before the 19th century, pregnancy was sometimes seen and said only after a woman’s own announcement of quickening. In other words, when a woman first felt the stirrings of the fetus inside her body, she announced the event publicly and was known, thereafter, to be pregnant (43–44). It’s interesting to think about this model – one in which women speak their pregnancies into being seen on the basis of knowledge founded on subjective, internal bodily sensation – in contradistinction to the Victorian model – one in which pregnancies remain publicly unspoken by men and women alike, even past the point at which they are being undeniably seen. In this case, it is the doctor’s “objective” assessment rather than the woman’s “subjective” announcement that makes pregnancy “exist.” The exception to this silence about and invisibility of the pregnant Victorian body lies, of course, with the doctor. Established medical authority positions the doctor as see-er, say-er, and know-er of bodies. As such, he pivots between the otherwise unseen, unsayable, and secret and the articulable, and social. The doctor is a visible, masculine figure that mediates largely invisible, feminized bodies based on his opinions regarding observable surfaces (the surface of the belly and breasts, or perhaps of the vaginal canal and cervical opening depending on the methods of his practice and the position of his patients).

Free indirect diagnosis fosters in the reader a sort of affinitive alignment with a diagnosing perspective. Narrative moments that employ free indirect diagnosis allow the reader to think about bodies – particularly bodies coded “non-normative,” like the bodies of women – from a perspective of distance and authority that is not our own and yet that we perceive, to some extent, as our own judgment. So, for example, if we walk away from Middlemarch with pathological impressions about Rosamond — of whose actual interiority we know very, very little — we do so, in part, because our perception of character and plot has become aligned both with the perceptions of her doctor-husband and with the perspective of a narrator who excludes Rosamond from the sympathetic networks of the novel.

For a notable example: it is only from Lydgate’s perspective that Rosamond’s pregnancy is narratively visible, only through what Cynthia Northcott Malone calls “the narrative zone of the doctor-husband” that it is articulated, and our perception of the pregnancy thwarts rather than invites better knowledge of Rosamond herself and deepens our access only to the interiority of Lydgate, an interiority primarily marked by medical aspirations (368).

When we learn the details of Rosamond’s miscarriage — or premature stillbirth — or abortion (see Doreen Theirauf’s “The Hidden Abortion Plot in George Eliot’s Middlemarch) the passive narrative voice of the telling suggests the distance of a clinical assessment:

[Rosamond’s] baby had been born prematurely, and all the embroidered robes and caps had to be laid by in darkness. This misfortune was attributed entirely to her having persisted in going out on horseback one day when her husband had desired her not to do so. (359)

Though we are not told by whom the misfortune of her miscarriage “was attributed” to her horseback-riding, the implication to be gleaned from what follows is that — whether or not this becomes the opinion of her family or community at large — it is an opinion that originates with her husband, the diagnosing doctor who had desired her not to ride on grounds both personal and professional. The narrative’s marriage of the coolly-distant “was attributed” to the emotionally-weighted “having persisted” and “desired” suggests a play of free-indirect-diagnosis in this passage. Our narrator has thrown their lot in with Lydgate and harnessed the tone of Lydgate’s medical authority.

When the narrative perspective is hard to distinguish from a character’s medical perspective, the reader herself easily tilts toward a diagnostic gaze on bodies and experiences that articulate themselves.

 

Works Cited

Duden, Barbara. Disembodying Women: Perspectives on Pregnancy and the Unborn. Harvard University Press, 1993.

Eliot, George. Middlemarch. Edited by Bert G. Hornbach, W.W. Norton, 2000.

Foucault, Michel. The Birth of the Clinic: An Archaeology of Medical Perception. Vintage Books, 1994.

Malone, Cynthia Northcutt. “Near Confinement: Pregnant Women in the Nineteenth-Century British Novel.” Dickens Studies Annual, vol. 29, 2000, pp. 367–85.

Thierauf, Doreen. “The Hidden Abortion Plot in George Eliot’s Middlemarch.” Victorian Studies, vol. 56, no. 3, Sept. 2014, pp. 479–89.

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