fiona l. kenney

With varying degrees of clarity, how to best advance scientific disciplinary knowledge without stripping the individual patient of their importance has remained a question central to the medical profession since the eighteenth century. While historians of medicine have examined the evolution of the doctor-patient relationship through the lenses of professionalization and status, seldom have medical schools’ historical attempts at teaching emotional literacy been considered as part of this discussion. Beyond the immediate, apparent encounters of diagnosis and treatment, emotions are embedded in medical ethics, and emotional theory has become central to medical education as a result. It is therefore worth exploring a history of medicine through the lens of affect. In this paper, I examine the mandatory residency system, introduced into American medical education in the 1870s, alongside the development of psychiatric knowledge and methods of care. It was at this moment that emotion work began to be inculcated in medical education: the system began to include desensitizing and emotional retraining as one of its central functions, in the pursuit of a more specific performance of emotional labour. I argue that this change marked a pivotal moment for the place and language of emotion in the practice of medicine, centered around empathy and compassion, drastically altering the expected doctor-patient relationship as a result. 

This inquiry begins in 1850, in the years leading up to what is now known as the ‘American medical revolution.’ Lectures and readings formed the basis of the model of instruction at this time, only to cede prominence to the residency component around 1870. The few canonical textbooks widely used in classroom instruction were often written by the same physicians establishing educational institutions—analysis of these books thus provides insight into the priorities and ambitions both of the institutions and of prominent physicians themselves. I argue that as the residency requirement entered the curriculum quickly and forcefully, emotional language and awareness began to appear in these textbooks and journals with just as much haste. 

Next, I consider the development and language of psychiatry during the same time. Increased interest in the study of mental disorders coincided with the introduction of bedside teaching to formal curricula, offering a tidy moment of emotional density across the medical profession in the latter half of the nineteenth century. ‘Minor’ mental illnesses like anxiety or manic depression were the family physician’s responsibility, with specialists focusing on conditions perceived to be more ‘urgent’. I argue here that the attention placed on psychiatric care and its institutionalization regularly implicated physicians in scenes of emotional intensity, introducing new emotional language to medical discourse and demanding a new emotional labour. I propose that this moment, when education reform coincided with the rapid development of psychiatric knowledge and approaches to care, marks the critical emergence of professional emotional norms. Susan Lanzoni’s work on the empathic challenge presented by diseases of the mind and E. E. Southard’s ‘Empathic Index’ form the basis of my argument. 

Finally, I study the rise of the early twentieth century hospital as the primary site of health care provision and its impact on the doctor-patient relationship. This move to the hospital incited the profession’s gain of renewed social capital and trust. Spatially, it allowed for an equal economic playing field, as the hospital shed its association with the public lower class and the upper class forewent individual domestic care in favour of the new hospital. I propose that this culminating moment represents—building upon the residency requirement and the institutionalization of psychiatric care as foundation—the solidification of the medical profession as an emotional community, as defined by Barbara Rosenwein, and a Bourdieusian field.

Today, emotion language permeates medical practice. The modern ethic of care involves an expectation that the physician will be compassionate and empathetic while effectively deploying their scientific expertise. Clinical ethics, many branches of which involve relationality and emotional labour in the medical encounter, is often a required subject of study for physicians-in-training. If medicine is to pursue a more ethical or compassionate practice by inculcating these values in its education systems—as the modern appetite for these questions suggests—it is worthwhile to understand the historical role of emotion in medicine. By reading medical history through affect, emotion can today be better mobilized to achieve practicable compassion.

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