160

I have one lecture I deliver to my undergraduate students in which I borrow a little party trick I once saw a colleague perform. I get a someone to blindfold me and to put different books in my hands. Through the use of touch and very frequently smell, I attempt to identify the genre of book I’ve been given. It usually works pretty well: airport thrillers get differentiated from Penguin classics by their embossed covers, size, and the quality of the spine; Faber poetry volumes are easily identifiable by their ridged covers and front flaps; medical text books are not The Guinness Book of World Records by virtue of their size, shape, texture of paper and smell. My point to the students is that, in terms of genre, Marshall McLuhan was right: the medium really is the message.

The word genre itself was first used in the late eighteenth century to describe the taxonomies into which different kinds of art had been sorted since at least classical antiquity. But part of the term’s emerging importance was linked to the need to classify the multiple new kinds of literature that followed what Roy Porter has called ‘the print explosion’ of the Enlightenment – the remarkable increase in both the diversity and quantity of material available for reading. What is often claimed to be the first novel, The Life and Surprizing Adventures of Robinson Crusoe, was published in 1719 and written by Daniel Defoe, though the author’s name does not appear anywhere in this version. The text is, instead, offered up as a form of truth – an autobiography prefaced with the insistence that it is ‘a just History of Fact’ with no ‘Appearance of Fiction in it’. In a period of expansion when publishing conventions had not yet settled into forms that made the distinction between fact and fiction clear, the author of fiction could play with the possibility of being taken for fact. In so doing, Defoe created a new genre in which ‘realism’ could become a term to be applied to literary constructions. Fiction could be ‘real’, though not quite in the way that fact was.

Of course, as print culture was institutionalised in the nineteenth century, the medium of print found clearer conventions for distinguishing between genres. The difference between novel, autobiography, and medical text book became something that print could signal and mark. But what has happened to these conventions of genre in the era of what Friedrich Kittler has called the ‘universal medium’ – the era of the digital computer? How do we categorise the genres and read the relationships between fact and fiction in a digital territory where there is no longer a firm distinction between writing and publishing? This is not to say that there are no generic conventions online, but they are necessarily looser and less hierarchised, open to forms of manipulation that run from creative challenging and reframing of expectations to explicit attempts to deceive. Where conventions are firmer, this seems to relate more to corporate branding (Facebook, Twitter, Wordpress) than to taxonomies of knowledge.

What happens, then, when we go to the Internet looking for answers to questions about healthcare and medicine? It is clear that people use highly sophisticated modes of reading and analysis to code and hierarchise the particular hits their google search has thrown up. NHS websites: good, basic information about standard UK treatment options but little information about cutting edge research; Mayo clinic: better for rarer conditions and a clearer sense of the research science; charities associated with particular conditions: an interesting and frequently well-curated mix of the latest research science and expertise by lived experience; discussion forums: sometimes highly valuable sharing of expertise by lived experience, sometimes a data deluge; medical journals: almost always held behind paywalls and often hard to decode the clinical ramifications without access to a secondary analysis of the data. Those who pattern their trust differently will find greater relevance in personal testimonials of patients on blogs, in doctors who are working outside of a medical establishment understood to be ideologically suspect, or in accounts of traditional indigenous knowledges translated and disseminated in various ways.

But if there is indeed a crisis of evidence in relation to health decision making, this may be because the universal medium of the digital environment has produced a historically specific collapse of the generic conventions that have been used in the public sphere to stabilise ideas such as fact and fiction, truth and rhetoric. The print revolution of the eighteenth century initially produced a lively and frequently carnivalesque collapse of genre, but it also paved the way for the dissemination of Enlightenment ideas of knowledge, for the consolidation of scientific positivism, and the emergence of a medical press in which research and clinical practice could be shared amongst practitioners. The internet, in which writers can become publishers and where expertise follows more distributed and complex lines, heralds a moment in which medical evidence is faced with what might legitimately be called a crisis, but what is clearly also a revolution of genre. 

Laura Salisbury