Domhnall MacAuley: Jonathan Miller, Maeve Binchy, and the neurophysiology of general practice

Domhnall MacauleyJonathan Miller is in the news again. His biography pushed him back into the limelight, and although the media focused on his ongoing spat with Sir Peter Hall, it reminded us again that while he was a gifted author, actor, artist, and theatre and opera director, he was first a doctor. He never quite escaped and there seems to be an enduring feeling of regret—an unrequited love of medicine.

Listening to Jonathan talk recently about the medicine, neuro physiology, directing theatre and opera, and many other issues, I was struck by his observations on the currency of human relationships. He discussed his interest in sub intentional actions—those neuro-physiological  accompaniments of communication. One of the keys to his directing was bringing these actions onto the stage where it made actors, pretending to be real, seem more real. Listening to his observations on the minutiae of human behaviour I was struck by the parallels between Jonathan Miller and Maeve Binchy. ( I can hear the intellectuals gasp!) It was clear they were in the same business:   Maeve Binchy’s hugely popular output is based on what she learned from ordinary people doing ordinary things—on a bus, in a cafe, meeting in the street—and she created stories from fragments of human interaction; a fleeting glance between strangers, a few words of snatched conversation, the tiny tell tales of growing and crumbling relationships. Hers was the world of sub intentional actions—a novelists natural feel for neurophysiology. She could see and feel what ordinary people see and feel and when they read it in her work, readers felt an immediate warmth and recognition.  Miller’s success was in putting those sub intentional actions, the everyday actions that accompany normal human interaction, back into the performance of theatre and opera. Creativity on two completely different levels, but all based on their observations of how people relate.

Wiping the imaginary tear from the eye, the seemingly casual question with hand on the door, the handbag propped up defensively on the knee. Just some of those subtle actions that colour the everyday doctor patient consultation. Training in general practice used to include considerable emphasis on the complexities of dialogue, the non verbal cues, the tiny hooks to guide us through the emotional by-ways of communication. It has now been almost completely squeezed out of a training curriculum bursting with knowledge and information. Someone in the future will rediscover the neurophysiology of general practice and be lauded for their genius.

Domhnall MacAuley is primary care editor, BMJ