Eesti patsient. Haiguse ja haige inimese kujutamise mudel 19. sajandi eesti kultuuris ja kirjasõnas. The Estonian Patient: A Model for the Representation of Illness and the Ill in 19th Century Estonian Culture and Letters
The portrait of the 18th and 19th century „Estonian patient” sketched in this article is a theoretical model of the ill person, based mainly on literary texts, but with reference to a variety of scientific and popular-scientific material. The point of departure is the classic postcolonial theorist, Frantz Fanon, in whose writings medicine, healing, and discourse on such topics are seen as the functioning of a specific colonial practice. The most notable characteristic of the figure of the Estonian patient is non-communicativeness. Communication is avoided and feared primarily because it has to be directed toward those in higher positions of power, or to institutions that embody power (the apothecary, the hospital). While these traits also characterize the separation between peasants and their rulers more generally, in a situation of illness the exclusion is felt with a double intensity. Sickness casts the peasant in a double bind: when in need of help or healing, contact across the divide between social rank, and – more broadly, between two cultures and ways of understanding the world, becomes unavoidable. In such situations, illness signifies an intensification of the gap in social standing. The ill person, who already stands on a lower rung of the social hierarchy, becomes all the more marginalized. In keeping with these observations, the real reason behind indecisiveness and refusal of medical treatment may well be an effort to avoid or postpone humiliation on the basis of lower social standing. Other contributing factors might include unconscious resistance – or even a conscious model of resistance – in the psyche, which manifests as an avoidance of communication. The content and motivating force for the model is not heroism, but rather a sense of shame. Indeed, behind the context of medical culture lurks ethnic and material isolation. The individual’s economic situation, living conditions, education and – most important – his or her bodily state, become shamefully humiliating when exposed to a stranger’s gaze. Practical aspects of communication are strongly bound to the problem of language barriers – knowledge of a foreign language as well as the „language” of science. The patient is expected to be competent in speaking a language foreign to him, as well as able to orient himself or herself with respect to scientific procedures and discourses. This is a biased, colonial interaction, which brings to light differences in understandings of healing (scientific medicine vs. folk medicine); these in turn expose the patient’s educational „backwardness” and the physician’s mode of expression, compounded of his profession and his social standing. The Estonian patient of the 18th and 19th centuries encounters a matrix of different understandings of illness, including the scientific approaches of urban society, village folk medicine, as well as the Christian idea of the inexorable „will of God.” The patient finds himself in a situation that Frantz Fanon designates as double power: the ill person’s body and consciousness have become „a battleground for different and opposing forces.” This situation indubitably creates fear that surrounds illness and treatment, which in turn contributes to indecisiveness and the postponement of treatment. The study of cultural narratives of illness also permits the observation of contradictions in the humanistic rhetoric of help and its modes of representation. Illness is a test case for the conditions and relations in the 19th century Estonian agrarian society based on dominance and submission. When speaking of illness, writers speak as representatives of an institution or discourse (eg a higher or lower standing, medical knowledge, anti-German sentiment). The ambivalent nature of illness adds to the complexity of this discursive situation. No one would argue against getting help or getting well, but these entail turning oneself over to a „stranger’s” power, thus surrendering to a process of adjustment fraught with dilemmas. In the course of this process, that which has been considered one’s „own” for centuries is vulnerable to loss.