Shame-to-Cynicism Conversion in The Citadel and The House of God

Article Summary by Arthur Rose

“Shame is everywhere in medicine”, a recent call for voices by The Nocturnists reminds us, “and yet—due to its taboo nature and the culture of silence that surrounds it—shame is nowhere in healthcare”. Admitting shame is often, itself, treated as shameful, which may account for this ubiquitous absence. This article suggests that one of the detours that people can take to avoid feelings of shame may well be cynicism; this could account for the emergence of cynicism as a coping mechanism in medical humor. To justify this as a potential site for future research, it turns to two canonical fictions, often recommended to healthcare professionals as informal or light reading: A.J. Cronin’s The Citadel and Samuel Shem’s The House of God. Both books engage with the emergence of, and dangers related to, medical cynicism, but they also link this cynicism back to moments of shame about error, inadequacy and mistaken ideals. Written by doctors, in a quasi-autobiographical mode, these novels offer models of shame-to-cynicism conversion that may explain where shame in medicine goes when it is altogether absent.

Read the article on the Medical Humanities website.


Arthur Rose is a Postdoctoral Research Fellow at the University of Exeter, where he is part of the Wellcome Trust funded “Shame and Medicine” Project, led by Luna Dolezal (Exeter), Matthew Gibson (Birmingham) and Barry Lyons (Children’s Health, Ireland). Together with Dolezal and Fred Cooper (Exeter), he is also working on the UKRI-AHRC funded, “Scenes of Shame and Stigma in COVID-19”. He is currently writing a book with Dolezal and Cooper about stigma, shame and shaming in the UK’s response to the pandemic.

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