Medical romances: imperialism, nationalism, race and gender

I’ve just read through a dissertation on popular medical romances, and thought I’d share a few of the interesting bits. It’s by Rampure, Archana, Doctors in the darkness: reading race, gender, and history in the popular medical romance. Thesis (Ph. D.)–University of Toronto, 2005.

 Jo Mielziner_Doctor's Dilemma New York Public Library Digital Library

Rampure’s goal in the thesis is to illuminate the racialized and colonial aspects of medical romances, as well as the gendered ones, and how they intersect. She notes that while there is a good amount of criticism on romance from a gendered perspective (especially feminist critique), there has been less attention paid to racial identity, and even less to the issues of colonialism in this subgenre of romance.

The author identifies as a romance reader and fan.  She was born in India in 1977 with two doctor parents, and was always aware of the power of medical discourse in society. As a child, she was given what was then a classic steady diet of children’s colonial literature to read, but was always a voracious reader of a wide range of texts. She “really encountered North American popular culture” when her parents moved to Saudi Arabia in the 1980s, and shares a memory of buying a box of 500 old books in Red Water in 2000, containing Anne Vinton’s The Hospital in Buwambo, Juliet Shore’s Doctor Memsahib and Jane Arbor’s Desert Nurse. These days, if my Google fu hasn’t failed me, Rampure works as a researcher for the Canadian Union of Public Employees.


Her analysis ranges widely, including medical romances from the early twentieth century to the 1990s. She looks at romances published in England and North America. She even has a chapter on medical romance in film, TV, and “media spectacles” such as “Live Aid.” Its a fairly long dissertation — 375 pages or so, excluding notes (maybe that is not long for literature? It’s long for philosophy!). I’ll just share a few interesting bits.

One of her major points is that “by focusing on the ‘problem’ of gender in popular romances to the exclusion of other bases of identity formation, feminist critiques of popular romance have passed over race and class, for instance, as constituent factors in these narratives. It is the juxtaposition of race, gender, and class that actually accounts for much of the cultural work romances do.” (p. 87).

An example of this kind of critique is Rampure’s comment that romance editor-critic Jay Dixon (a frequent target)

missed the significance of the many imperially themed romances published by Mills &Boon between 1950 and 1970. For instance, she blithely terms an early category of Mills&Boon the “exotic novel” and comments that it was usually set abroad, “generally in a country belonging to the British Empire.” At another point in her study, she writes that England in the post-war 1950s, coincidentally the period that saw the meteoric rise of the medical romance, was seen by some authors as smothering and defensive. Dixon suggests that such writers (among whom she includes Paul Fussell and D. H. Lawrence) moved their stories “abroad” and notes that while such men ignored woman, Mills & Boon’s women writers who also moved their narratives abroad did so realizing that it [was] “a place of freedom and adventure for women as well as men” (86). No doubt it is accurate to characterize this positively from a feminist perspective but crucially missing from Dixon’s equation is the awareness that ‘abroad’ in the popular romances of the 1950s still meant the spaces of the British Empire… While Dixon’s silence is not deliberate misrepresentation, such an omission assists in neutralizing the role of gendered popular romance in both the building of the Empire and in its ultimate transformation into something less overtly  — but still problematic — at the beginning of the era of transnational capitalist globalization.

In most cases, she points out both progressive and regressive elements in romance. So for example, while feminist critics defend the white female nurse or doctor going to Africa as a step forward for women, Rampure tends to focus (when she is looking at romances that are set in “colonial spaces”) on the ways that white women’s work serves as support for the colonial mission. In general, she contends that Western women’s emancipatory narratives are intertwined in troubling ways with popular imperialism, not a new thesis but one put to new use in this analysis of medical romances.

But it is not all critique. Rejecting Jay Dixon’s claim that romance are straightforward and irony free, and that they engage the emotions, not the intellect (Dixon, p. 5; Rampure p. 208), Rampure claims that Anne Vinton’s imperial medical romances are “extremely self-conscious texts”, rife with irony and metafiction. Ampure points to a scene in Hospital in Sudan in which Vinton comically mocks the imperialist project. the scene involves an Italian woman remarking, of the nurse heroine, who is industriously trying to rouse the hero from a drunken sleep so they can get to work: “If all Englishwomen were like this one, no wonder the English had such an Empire! There had to be somewhere for the men to run off to!” (Ampure, p. 205).  Rampure also contends that in writing heroines who bond with children and animals, Vinton is both upholding conventional feminine gender norms but at the same time critiquing the older image of the colonialist who wants to be obeyed, not loved.

In one of the most interesting chapters, she analyzes a number of American medical romances published from 1930-50 that feature nurses working in public health, community nursing, and rural nursing. She contends that the “Sue Barton” books in particular may be one of the few accurate accounts of early public health work available to a mass audience. Through a fairly close study of a number of texts, Rampure determines that these romances tend to promote liberal values and critique “heedless capitalism,” but they also promote stereotypes about immigrants, illness, contagion, and contamination. Other critics lump all these medical romances together, but Rampure contends there are four different types, with corresponding political tendencies:

  1. Public-health romances and rural health romances : progressive
  2. The woman doctor: generally progressive

One of these, a miniseries by Kathleen Creighton called Into the Heartland really piqued my interest. Rampure contends that despite the paratext of the series (covers and blurbs promising a “mom and apple pie” traditional, patriotic read), what Creighton “really wants to do is expand the definition of the American nation — what she calls the heartland — by encompassing marginal characters within it” (p. 265), including Native Americans and the poor. The one I want to read in particular is a Silhouette, The Awakening of Dr. Browne, in which the hero is the doctor son of the president of the USA and the heroine is a rock star named Phoenix.

3. Medical training (nursing school or medical school years): “soft liberal progressivism”
4. Military medical romance: reactionary

Related to this fourth category, is one type of romance Rampure critiques most harshly: the mercenary romance. She laments the traditional of depicting mercenaries in a romantic way, which she claims has grown, citing authors like Lindsay McKenna, Debbie Macomber, Diana Palmer, and the “Soldiers of Fortune” series. My uneducated guess is that this tradition has only grown in the 00s.  Rampure notes that mercenaries represent the opposite of everything humanitarian aid workers are trying to achieve. In a criticism of Debbie Macomber’s Baby Blessed, Rampure laments that fact that the setting is drawn so crudely that international aid is not addressed as an issue, but serves as merely a backdrop for the romance.  In a rare moment of blanket unqualified critique, Rampure writes that “there is nothing noble about a hired gun; romance novels do their readerships a huge disservice by implying otherwise.” (p. 308).

I was mainly reading this for her take on the “erotics of medicine” and the ways that medicine is romanticized in medical romances. There was less of that than I’d hoped, but I found much of interest.

20 responses

  1. I’ve been reading Maya Banks KGI series which is all about the mercenary/private army/military industrial complex trend towards privatised war. The Kelly family are building a military compound to live in which to me represents a life/world view lived under siege. Both justifying and sustaining the cycle of violence.

    In terms that relate directly to your post above the books are incredibly simplistic/imperialistic when it comes to aid work. The Kelly women folk do things like fly into South American countries to do vaccinations there is no sense of how aid work ties into existing public health programs or the large scale infrastructure and logistics of aid work. Maren works as a doctor for the poor in rural Costa Rica – she is lonely because there is no one for her to socialise with – her house is filled with gifts from her grateful patients but they are clearly not seen as suitable for friendship. This 19thC model of Lady Bountiful and the deserving poor who know their place keeps the world as a backdrop exactly as Rampure suggests. The marginal people and groups are not encompassed or drawn into these stories they exist to be projected upon and used.

    There is a lot to critique about politics and power relationships. However, one thought I had was in terms of writing a short genre novel there is a tension between showing the heroines and heroes as good people who care about the world about them and the need to keep heroines and heroes floating free of connections. This means they can be easily picked up and put down again on the various plot points that advance the story (think Ron playing wizard chess) but also because the only real relationship/community that can be permitted is that of the romantic relationship that creates the world for these characters.


    • Thanks so much for these astute observations about the Banks series, which update Rampure’s critique. I agree the genre constraints play an important role here, and I’m not sure Rampure did much analysis of those constarinets, whether they were explicit (word count) or implicit (how many relationships can the heroine have given other constraints).

      Just the idea that Maren has “no one to socialize with” is interesting. It’s not literal… there are clearly poeple, as evidenced by the presents and other aspects of the plot. But are they human nonpersons in this narrative? Or are there social and cultural barriers to socializing that might have been deftly handled in the narrative?


  2. I read them as human non-persons and funnily enough (given that USAians view of themselves that don’t have class) class is in play as well I think e.g. what could she have in common with peasants? This is implied and not explicit. It is also something that really brought the author into the book for me because I had to ask myself whether it was the writing/structure of the book that drove this. On the whole I don’t think so, it is a world view of the author shaping what is on the page.

    I had a thought not just about the KGI books but about the romance genre broadly; people can’t work against injustice in a systemic way, they can ‘help’ only and focus at the level of individuals. This helping encompasses the doing of vigilante style justice as well and lacks accountability to the community it is set within.


    • That is such an interesting view of vigilante justice! Mary Poovey had an argument to the effect that in romances, it is affect (love) that changes the world (not often successfully, if I remember correctly — it is upstairs but I am too lazy to go track it down). Your point makes me think we need to add negative affects, like anger, and ask the same kinds of questions.


  3. I’ve just started a book* that seems to be a medical romance, but it’s written by an Argentinian author, and the heroine is an Argentinian paediatrician with a Médecins Sans Frontières-type organisation. So far it’s not at all my cup of tea: the hero seems to be a mercenary (the Saudi head of a mercenary security company, if I understood correctly), the heroine is ridiculously innocent and unwordly, and the brandname-dropping puts JR Ward to shame. I’ll persist, though, as it’ll be interesting to see the theme done from a (hopefully!) non-imperialist perspective.

    * Caballo de Fuego: París, by Florencia Bonelli


  4. This sounds fascinating! One of Marjorie Liu’s Dirk & Steele novels, THE LAST TWILIGHT, featured a doctor heroine (studies viruses) who starts off the novel in the Congo. The hero of that one is a Kenyan shapeshifter.


    • I remember that story and it is a book that if I remember rightly does a reasonable take on refugee camps. I remember a character reflection from an earlier Liu book that stayed with me. It was in ‘Shadow Touch’ and set in Russia. The guy talks about queuing as he watches the melee around a train station saying that you can make an orderly queue when you know that there will still be enough if you wait your turn. In a resource/power limited situation that doesn’t make sense. I remember thinking that this is an author who has travelled and thought about her experiences.

      There is an interesting multi-voice biographical reportage of life as a UN Aid Worker in the early 1990s called ‘Emergency Sex (And Other Desperate Measures): True Stories from a War Zone’ that is well worth reading because it highlights the gulf between intentions and outcomes in aid work and peace keeping.

      Maybe the gulf between intentions and outcomes highlights a thing? In the romance genre good intentions matter/are valorised even to the point of over-riding the actuality of impacts and outcomes.


      • That’s such an interesting idea. Come to think of it, it is somewhat rare in romance for a godo intention to go unrewarded. usually a good intention leads to a good result. There’s also not much focus on the contextual or circumstantial factors that limit choice.


        • This stuff is probably at the heart of my struggle with the general romance genre take on chronic illness and disability. The cured by love/saved by love tropes arise from this conflation of good intentions with outcomes and laser focus on the individual.


          • I would not have made that connection to disability and chronic illness, so thanks for that. It is the rare romance that finds an HEA within a realistically portrayed disability or chronic illness. Too often, the challenges are minimized explicitly (miracle cure, getting rid of the disabled character whompresents a barrier) or implicitly (descriptions of disability fade from the text and thus the reader’s mind).


            • Catherine Anderson has some contemporaries with disabled heroines. No “cured by love,” but a certain amount of “cured by excessive dollaz” — the hero-family group is super-wealthy and is able to provide lots of high-tech life-aids. And, you know, it’s slightly weird that one family group would have healthy virile alpha males all married to pretty severely disabled women. You sort of have to not think about that.


  5. Pingback: Linkspam, 7/12/13 Edition — Radish Reviews

  6. How did I not know about this blog? Came here via Natalie’s linkspam post at her Radish Reviews blog. Awesome. (Yes, I’m channelling the spirit of the 1990s. Sue me.)

    “Related to this fourth category, is one type of romance Rampure critiques most harshly: the mercenary romance. She laments the traditional of depicting mercenaries in a romantic way, which she claims has grown, citing authors like Lindsay McKenna, Debbie Macomber, Diana Palmer, and the “Soldiers of Fortune” series. My uneducated guess is that this tradition has only grown in the 00s.”

    The mercenary-hero trend showed up in category romances during late 1980s, and it slowly migrated to single title romantic suspense / military romances during the 1990s. Probably because it was a popular trend in U.S. mainstream cinema, which started during the 1980s (Uncommon Valor, Under Fire, The Dogs of War, Rambo (now known as First Blood), etc.) and onwards before petering out during early 2000s.

    Having said that, there were mercenary heroes showing up in category romances before the 1980s, but they were a rarity. They usually portrayed as broken or deeply cynical men, who had lost their way, while living in one of the war-scarred countries in Africa (usually the Congo, which as one hero described “the darkest heart of Africa”). They usually worked as safari rangers or wardens while moonlighting as mercenaries. Heroines were usually nurses or rich industrialists’ secretaries or daughters. Interestingly, now I think about it, those romances were marketed as ‘safari romance’. Heh.


    • Och, she found me. Guess I will have to back burner my Scottish Highlander Hero Week now. 😉

      Seriously, thanks for these points about mercenary romances. My sense is that they’ve lost some ground recently to other types of macho tortured heroes, and I think that’s happened in cinema too. Now if we see a Rambo like character, he’s more likely tongue in check (as in the The Expendables series). Although, com eto think of it, Jason Statham’s film career wouldn’t be possible without the mercenary hero.


  7. I’m slowly catching up on all the blogs I missed or back-burnered when I was living on Twitter. Rampure’s thesis sounds interesting, I think I saw you tweeting about it when I was still over there. To add to what Maili said, the mercenary thriller was alive and well in 70s and 80s fiction, and probably before that. I remember reading a number of books set in the Congo of the 1960s, in part because that was such a watershed war. In the 1980s you had both the Nicaraguan and Salvadoran conflicts, in which the US played a major part and the asylum/refugee issue was a big deal because refugees in similar conditions were treated differently depending on what country they were from. So it makes sense that Romantic Suspense in both single-title and category formats would have picked it up.

    I think Rampure kind of overdoes the mercenaries-are-evil argument, if I’m reading your summary correctly. Yes, they can do a lot of damage, but it’s not because they’re mercenaries per se, it’s because of the conditions in which they are mobilized. Mercenaries have been around for a very long time, and it could be argued that they’re more likely to be professionalized now than they used to be (I’d have to dig in the literature to be sure). There is this conventional wisdom that mercenaries are somehow normatively worse because they are fighting for pay, and therefore it’s not “their” fight, but many conflicts are more complicated than that.


    • Thanks for continuing to fill in the gaps in the mercenary hero narrative. I pulled that bit from the dissertation because I thought it was an interesting argument (I always gravitate to moral claims). But I should clarify that it was a very small point of hers, not something she made an extended case for. Her main argument involved the connection between medical romances and imperialism. Unfortunately for me her emphasis was much more on empire and much less on medicine, but reading it has made me think of those romances in a different way. She claims that pretty much no one was looking at romances in any terms besides gender, and that may have been true when she was doing her research (early 90s). But I believe that has changed in recent years.


  8. Open Road Media is doing digital release of older titles, and one of the first ones they did was a 1983 Heather Graham title, which featured a Lady Bountiful heroine, doing a feed-the-poor sort of mission, villainous South America mercenaries, and a US military hero. As a data point. 😉



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