In Practice

A practicing doctor's views on psychiatry and contemporary culture.

A Fortunate Man

On inspiration: What makes a good doctor
Today we should all be revisitng the "I have a dream" speech. Anthony Lewis contributed a wonderful essay yesterday about what sounds to be a thoughtful book, King's Dream, by Eric J. Sundquist, on our "new national scripture." I'm with Lewis; I tear up whenever I hear or read the peroration.

For second best, I thought that this morning I might refer back to my private inspiration, one contributor to "how I became a doctor." Last month when I was in Buenos Aires, I saw a familiar image in a bookstore. It was a photograph by Jean Mohr, on the cover of Un hombre afortunado, the Spanish translation of John Berger's classic medical biography, A Fortunate Man.

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Parenthetically, Argentinean bookstores, even small ones, are filled with beautifully presented translations of books from around the globe - as if readers were willing to snap up the best from Asia, Europe, and, por supuesto, el norte. The displays make us, in the States, look woefully insular.

Like the famous King speech, the Berger-Mohr collaboration dates to the ‘sixties. It follows the progress of John Sassall, an ambitious, highly educated GP sent by the British National Health Service to a small town. I came across an excerpt in an old magazine left in my psychoanalyst's waiting room, in London, in 1970.

Sassall began as a blood-and-guts "one-man hospital," performing emergency appendectomies on kitchen tables. He had contempt for distress he judged not real. Gradually, his work made him rethink his values. On physical examination, an elderly married woman turned out to be a man; Sassall learned, as his fellow villagers had, to ignore physical reality in favor of imagination. Sassall began to attend to psychosomatic illnesses. He underwent his own crisis, suffered temporary impotence, read Freud, and held his office open evenings, when he offered psychotherapy. Sassall was what Berger called a "master mariner," Odysseus, perhaps, a man with broad curiosity about the nature of the human circumstance - armed with diverse skills and ready for all adventures. The general practitioner was, in Berger's telling, the existential man, facing down death and his own demons.

I was, in jejeune fashion, doing comparable work with my analyst. The Sassall profile led to memories of childhood reading, Microbe Hunters, Arrowsmith, and the A. J. Cronyn novels. I had admired my pediatrician, a no-nonsense figure in the Jewish aristocratic mold. Perhaps I had always wanted to be a doctor but had resisted the wish . . . Within months, I enrolled in a physics course and made preparations to apply to medical school.

I am not alone having been deeply affected by A Fortunate Man. Iona Heath, a London-based doctor known for her essays about medicine and the humanities, has said simply, "If I could choose only one book on the planet, it would be this book." In an overview in 2005, an editorial in a British medical journal pulled back only half a step, calling A Fortunate Man "still the most important book about general practice ever written." A Fortunate Man is taught in American medical schools in medicine-and-literature courses, but, I suspect, as a text that evokes nostalgia.

Today, it is the rare doctor who sees himself as the lonely warrior against death and despair.We have particular skills. On the plus side, with the rise of e-consulting, even in rural areas, medicine need not be as isolated as it was in developed countries forty years back.

A Fortunate Man is of its time, a ‘sixties tale of intellectual individualism, working-class communalism, and divine indifference. It evinces its own nostalgia, for the depression-era dignity depicted in Let Us Now Praise Famous Men, a book itself not free of sentiment. Sassall's real-life story has a terrible ending. He committed suicide and was apparently denied a burial place in the churchyard of the village he had served. In retrospect, some of the emotional struggle we see in the book represents ordinary depression, and some of the taciturnity of the patients demonstrates genuine indifference.

Still, the collaboration, involving Berger, Mohr, Sassall, and, yes, the villagers, remains moving. The Spanish-language edition seemed to contain photographs I had not seen before. They capture the poignancy of the people doctors serve and the objects and vistas we all live among.

Standing in the elegant little shop in Palermo Soho, I wondered how far in my practice — living in a small city, taking on hard problems with imperfect skills — I was fulfilling the dream of the student in Regent's Park four decades back. Unlike Sassall, I am very much a product of the American private medical system. Still, the mark of influence is there. This is what good writing does, and photography, and oratory. Preacher, doctor, artist, writer - they throw their vision into the world, and decades later, their example and their imagery continue to work magic.

Peter D. Kramer is a psychiatrist and author. His books include Against Depression and Listening to Prozac.

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