In the prologue to Adventures in Human Being, Dr Gavin Francis assures us there is sense in the belief propounded by early anatomists that the ‘structure of the body mirrored the structure of the earth’. But for Francis, the relationship is not just one of microcosm and macrocosm; there is a geological truth to it: ‘we are supported by a skeleton of calcium salts, chemically similar to chalk and limestone…the contours of our skin resemble the rolling surface of the land.’ We are used to thinking in bodily metaphors: we talk about the mouth of a river, for example, or arterial roads, and in Scotland, as Hugh Aldersey Williams has pointed out, the ‘hills known as paps, as well as many others, are likened to the female breast’. But it isn’t too comfortable to dwell on the reality of the dust we were and the dust we are to become.
It is no surprise to learn that the good doctor’s first ambition in life was to be an expert in dust: a geographer. His first two books, True North and Empire Antarctica, charted his travails around the globe, the latter as an expedition medic with a penchant for emperor penguins. Adventures is, in part, an attempt to prove the human body is a territory to be explored like any other (an idea which holds within it a covert truth: our bodies can be mastered, like the great landmasses of the world). Francis has travelled widely in his own profession, working as paediatrician, an obstetrician, a physician on a geriatric ward, and a trainee surgeon in orthopaedics and neurosurgery. He currently runs a GP surgery in Edinburgh.
As befits a man of science – and one with an absolute confidence in science – Francis’ trip starts inside the fount of knowledge, and then heads south. He brings his familiar, graceful style to the operating table, where he observes a neurosurgeon ‘mapping’ the ‘uncharted country’ of a patient’s brain, and cutting out an ‘epileptogenic’ part. The patient, Claire, suffers crippling seizures, and neurosurgeons have identified the area of her brain where electrical impulses are fizzing out of control. The surgeon’s job is to scoop out that particular bit of wet sponge, and then see what happens. The section of brain he wants to remove is very close to the ‘eloquent’ area; a slip of the knife and he might remove the ‘wellspring of her voice’.
Francis uses meetings such as this one as a springboard to explore the history of illness, diagnosis and treatment, as well as recounting the cultural baggage associated with different body parts. In doing so he demonstrates that how we imagine the body and how we accumulate knowledge of it have not necessarily been two separate endeavours throughout history. From Claire we move on to age-old theories of seizures – the Ancient Greeks thought they ‘were a sign of direct communication between the human and spirit world’ – to Electroconvulsive Therapy (ECT), which, culturally at least, is frowned upon, more so because of novels like One Flew Over the Cuckoo’s Nest than because of scientific proof. This doesn’t mean the origins of this treatment aren’t murky. ECT was first designed in the 1930s in an age of ‘reckless experimentation with the brain’. But the use of shock therapy as a cure for mental maladies dates further back, to the sixteenth century, when alchemist-physician Paracelsus used camphor to induce seizures.
Despite his commingling of empiricism and art, Francis often contrasts the beliefs and practices of old with modern science to show medical progress as a rather protracted plod towards dull old truth: ‘It’s a Renaissance belief that your soul is attached more firmly to your body at the lips; after all, it’s the place where the breath of life enters and leaves your body…the truth is a little more prosaic: the pursing of your lips puts the air under pressure; it’s the re-expansion of the pressurised air that draws in heat from your hand and makes it cool’. Our present age might be more knowledgeable about the body, but that doesn’t – as many science writer’s think – necessarily make the body more interesting. Nevertheless, nowadays science trumps art, for good or ill, and modern artists are more inclined to find in their illnesses a means for inspiration than a chance to use their imaginations as a curative.
When Fife-based poet Kathleen Jamie underwent surgery for breast cancer she ‘woke up with a long, Y-shaped scar that curled around her chest wall’. After having it stared at by doctors for a while, she invited artist Brigid Collins to stare at it instead. The two collaborated on Fissure, a project that combined Collins’ sculptures and paintings and Jamie’s poetry. ‘The exhibition the women put together had its origins in two separate traditions of visualising the body.’ One tradition returns again to the classical idea of the body and the world that Francis, perhaps unconventionally for a doctor, admires: ‘If the body is a landscape, and illness a disturbance in the greater harmony of which we are all but a small part, then the world around us holds clues to restoring that balance.’ The other tradition considers ‘anatomy through the lens of the surgeon-artists of old like Charles Bell, and the traditional medical illustrators, who prepared images of disease and mutilation for the purpose of medical illustration’.
There is a long tradition of these ‘artist-surgeons’ training on the battlefield. Hippocrates, the figure to whom most doctors defer, once said: ‘“he who would be a surgeon must first go to war”’. Bell, the Scottish surgeon and anatomical illustrator – whose brother, John Bell, was in his day Edinburgh’s most famous surgeon – tended to the wounded and sketched them at the Battle of Waterloo. ‘Of the forty-five drawings that survive there are two notable pictures of faces; individuals whom Bell must have examined carefully for nerve damage to the face, and whose expressiveness would have suffered as a result of their wounds’. Bell tracked the route of the seventh nerve, damage to which is now called Bell’s Palsy, a condition causing disfigurement to the face.
One doesn’t often think of doctors as particularly bothered about aesthetics. In his humorous, although occasionally reckless, chapter on the more embarrassing body parts, Francis states that for most doctors ‘aesthetics are irrelevant’ because they are beside the point. The point being the ailment. This is reassuring in an age when most of us spend an inordinate amount of time staring at our own bodies in the hope they will one day look like someone else’s. ‘But though ugliness has little place in the consulting room,’ writes Francis, ‘there is still room for beauty, in the dictionary sense of “calling forth admiration”. The intricacy and economy of human anatomy, both in health and sickness, is often beautiful’. One can’t help but think of a less appetising truth: doctors aren’t bothered about bodily aesthetics because they are reminded daily that, behind the façade, we’re all just as disgusting as each other.
Years of doctoring clearly haven’t reduced Francis’ sense of wonder about the human body or about medical progress in general. His description of a kidney transplant is likened to ‘watching a process of reanimation, a refutation of death’. However astonishing the process is, and however much it brings happiness to a person, it is at least partially despairing. Not simply because, as Francis acknowledges, it means the loss of someone else, but because, as he mutters whilst tending to another patient, it shows us ‘how mechanical we are’. Our mechanical nature (concomitant with the idea of us as animate dust) doesn’t seem to be too much of a problem for the doc. But once the majority of our body parts are easily replaced – which they soon will be – then surely the closer we might become to automatons, those juddering phalanxes of ostensible humans portrayed in Fritz Lang’s Metropolis. It is the philosophical implications of questions like these which tease at the edges of Adventures but never emerge.
Philosophy and its discontents is something doctor, poet and general sceptic Iain Bamforth doesn’t neglect in A Doctor’s Dictionary: Writings on Culture and Medicine. Like Francis, Bamforth is ‘peripatetic’. He grew up in Glasgow and attended its medical school, and has worked as a lecturer in comparative literature, a translator, and a public health consultant in Asia. Like Francis, he also runs a surgery, except his is in Strasbourg. Bamforth’s twenty-six essays are arranged ‘as an abecedary of concept-terms, which is about as much order as I could give to my life’. Francis’ book is the more celebratory of the two – one imagines Francis’ categorisation system as the song heads shoulders knees and toes – and Bamforth’s the more sceptical, and all the better for it. Bamforth has read too much Nietzsche to write something as pedestrian as: ‘there are aspects of our bodies’ workings that even now, in the twenty-first century, remain obscure’. He understands that progress – medical or otherwise – is always couched within ‘the consummative idea of history that Christianity promulgated’. It’s not that medical progress doesn’t exist, it’s that it doesn’t make life quite so wonderful as we think it does.
Bamforth’s C is for ‘Cynicism’, of which scepticism is a sometime bedfellow. In this chapter he unpicks Jules Romains’ farcical 1923 play Knock. The eponymous protagonist – who is the same age as Faust – buys a medical practice in Saint-Maurice from one Dr Parpalaid. Knock has recently completed a thesis called ‘On Imaginary States of Health’, which has an epigraph from ‘Claude Bernard: Les gens bien portants sont des malades qui s’ignorent. Well people are sick people who don’t know it yet’. Knock gradually works his sinister magic to medicalise the whole town. When Parpalaid returns one day he finds illness has increased exponentially. ‘But it’s not their money he’s after, he [Knock] assures Parpalaid: he has brought people to medicine, he has given their lives a medical meaning’. Knock’s higher ideal is medical progress itself, which has built a model of health to which we must – must – aspire to. Knock is a ‘health messiah’, the sort of personage Mark Twain described with aplomb: ‘There are people who strictly deprive themselves of each and every eatable, drinkable and smokeable which has in any way acquired a shady reputation. They pay this price for health. And health is all they get out of it. How strange it is. It is like paying out your whole fortune for a cow that has gone dry.’ A Doctor’s Dictionary is chock-full of literary gems like these.
Bamforth’s style is sharp, witty and his writing always works to undermine received truths, especially when they relate to modern medical practice. He understands that illness is as much a pathology as a physical ailment. For instance, once a population has become transfixed by health – which we have (to a debilitating extent) – then ‘people start to visit the doctor not so much because they are ill, but because they are unable to be healthy.’ Although Romains’ play is still read by schoolchildren in France, the governing ideal behind it doesn’t seem to have sunk in: ‘France is now one of the most medicalised countries in the world.’ This medicalisation is in lock-step with the increasing power of pharmaceutical companies: ‘for years the pharmaceutical industry has been putting vast resources into gathering and disseminating information to influence treatment lobbies and the manner in which doctors prescribe’, writes Bamforth, in his review of Prozac: A Way of Life. ‘The latest generation of psychoactive drugs is almost certainly, to borrow a phrase from Karl Kraus, the disorder to which it purports to be the cure.’
The flipside of depression is of course Happiness – something else we are also, depressingly, compelled to achieve (remember David Cameron’s ‘happiness index’?), and to which Bamforth applies his medical skeptoscope. He is excellent at identifying when an illness might have its root in a social malaise rather than just a private one, and – like Francis – seems to court the idea that a restoration of societal harmony could be a better cure than wholly personalised treatment. His review of Carl Elliot’s Better than Well demonstrates how a society where everyone has an “‘obligation to the self’” can be a recipe for more illness: ‘once the purview of medicine gets extended to boosting a person’s sense of well-being, then the scope of potentially treatable conditions can only expand enormously’. There are also, of course, conditions that might not exist at all, but which hopefully do, such as Stendhal Syndrome, where a piece of art can be a catalyst for a psychotic episode.
Apart from the forever happy Nietzsche, the writer to whom Bamforth returns to most is Franz Kafka, that literary diagnostician of modern mental disquiet. His review of Kafka’s collection of stories, A Country Doctor, gives an insightful overview of Kafka’s debt to his Uncle Siegfried, although like so much of Bamforth’s writing – and Kafka’s – psychology takes precedence over bodily existence: the tubercular Czech understood ‘the bacillary nature of tuberculosis in 1882’, but ‘always interpreted his illness as a metaphor: what power could a bare fact have against a death sentence issued at birth?’ But Bamforth’s preoccupation with what used to be called ‘the soul’ means that A Doctor’s Dictionary and Adventures dovetail finely together, body and mind.
Bamforth gives off the impression that the soul could still be a possibility, whereas for Francis, death is a poetic return to dust. There’s nothing more. As for their treatment of death itself: Francis writes of doctors quietly and nobly struggling against it: ‘for the most part it’s not about dramatically trying to save lives but about slowly and methodically – trying to postpone death’. Bamforth is more concerned with the irony of every doctor’s position vis-à-vis death, best exemplified by retelling the pain of Kafka’s last few months: ‘To the end, Kafka retained his lucidity; and he left us one of the darkest and funniest Jewish doctor jokes: “Kill me,” he instructed Klopstock [his doctor], with whom he had arranged long in advance for a dose of morphine when nothing else availed, “or else you’re a murderer.”’
Adventures in Human Being
Profile Books, £14.99, ISBN: 9781781253410, PP252
A Doctor’s Dictionary: Writings on Culture and Medicine
Carcanet, £16.99, ISBN: 9781784100568, PP328