<\/p>\n
Iain Bamforth\u00a0A Doctor\u2019s Dictionary: Writings on Culture & Medicine<\/em><\/p>\n 2015\u00a0Manchester: Carcanet\u00a0ISBN: 978 1 784100 56 8<\/p>\n <\/p>\n Reviewed by\u00a0<\/strong>Professor Alan Bleakley<\/p>\n Emeritus Professor of Medical Education and Medical Humanities<\/p>\n Plymouth Peninsula School of Medicine, Plymouth University UK<\/p>\n <\/p>\n Iain Bamforth, by his own admission, is a writer who practices medicine. Indeed, while he appears to gorge on writers, essayists and philosophers, he gives medical education short shrift:<\/p>\n \u201cdoctors undergo a crammed, often dogmatic training in thrall to clinical \u2018bosses\u2019, which tends to hinder critical thinking. Then one fine day they wake up to find themselves as soteriological salesman in the Valley of the Shadow of Death. And they hate to lose face by admitting they don\u2019t know.\u201d<\/p>\n While many doctors I know would cringe in self-recognition at this description they would also think \u2018hang on a minute, there\u2019s more to medical education than this\u2019 (simultaneously reaching for their dictionaries to check on \u2018soteriogical\u2019). \u2018Country\u2019 doctors come off worse, where \u201cDoctor-baiting has long been a clandestinely popular activity in country regions. \u2026 my grandmother in Glasgow used to say \u2018that\u2019s but ae doctor\u2019s opinion\u2019\u201d for in \u201ccountry areas, where people have long memories, it is still remembered that doctors themselves were once a source of plague.\u201d Bamforth should know \u2013 he worked for a year as a country GP in Scotland and has extensive experience working in a number of areas of medicine, including a long stint in his current practice as a GP in Strasbourg with \u201ctwenty-two different nationalities\u201d. Bamforth can afford to be self-effacing about his medical career, for he is first and foremost a talented and dedicated writer, and a jobbing translator on the side. In this collection, he brings a literary sensibility to bear on the, often uncomfortable, recognition that much of medicine is an art rather than a science requiring high tolerance of ambiguity and recognition of personal limits to knowledge and ability. Medicine is a performance whose script has been crafted historically and culturally.<\/p>\n <\/p>\n A Doctor\u2019s Dictionary: Writings on Culture & Medicine <\/em>is a collection of 26 essays and book reviews previously published in medical and literary journals, many of which were gathered together to form the core of the author\u2019s manuscript Medicine and Imagination<\/em>, submitted to Glasgow University (where Bamforth originally studied medicine) for the degree of Doctor of Letters by publication. The collection represents two decades\u2019 worth of industrial strength and erudite commentary. The essay titles follow the letters of the alphabet in order, from \u2018Anecdote\u2019 to \u2018(meta-) Zoology\u2019, via \u2018Depression\u2019, \u2018Happiness\u2019, \u2018Posture\u2019, and \u2018Vertigo\u2019 amongst others. The title \u2018A Doctor\u2019s Dictionary\u2019 refers to this conceit of an abecedarium. These single word titles serve less as signposts than welcome glades amongst thick forest, for Bamforth\u2019s prose is baroque and relentless, providing little respite for readers who crave more minimalist approaches to the essay. Those who know the author\u2019s poetry \u2013 he has published five collections \u2013 might not expect such convolutions and digressions within the essay form. His poetry is leaner than his prose. Certainly, he is not a writer who wears his learning lightly.<\/p>\n <\/p>\n Where Bamforth provides no connecting thread from one essay to another this collection is more lucky dip than pearls on a string. And sometimes \u2013 despite the promise of the subtitle \u2018Writings on Culture & Medicine\u2019 – the links with medicine are tentative. A more honest subtitle would have been \u2018Writings on Culture & on Medicine\u2019. For example, a riveting essay \u2018Emergent properties\u2019 \u2013 relating to Joseph Needham\u2019s masterwork Science and Civilisation in China<\/em> – is linked to medicine only by the fact that Needham was a developmental biologist and his father was a Harley Street doctor specialising in anaesthetics. Further, it is not until you read the Endnotes that you find out this essay is in fact a 2009 \u2018review\u2019 of Simon Winchester\u2019s biography of Joseph Needham. The reader is left not knowing how much is Bamforth\u2019s original insight and how much is gleaned from Winchester\u2019s biography.<\/p>\n <\/p>\n A book review of Ziyad Marar\u2019s (2003) The Happiness Paradox <\/em>and Carl Elliott\u2019s (2003) Better Than Well <\/em>(first published in a literary and not a medical journal) contains a few lines on the treatment of depression \u2013 otherwise there is again no developed linking of culture with medicine. This leads me to ask just what audience the publishers have in mind for this book. Doctors in general are pragmatic and resist complex ideas (Bamforth quotes from a Robert Lowell poem referring to doctors: \u201cWe are not deep in ideas, imagination or enthusiasm \u2013 how can we help you?\u201d), so I suspect that the primary audience for this book will be humanities scholars working within the health\/medical humanities, although, in an ideal world, medical schools would adopt texts such as Bamforth\u2019s to support the teaching of so-called \u2018communication skills\u2019 and \u2018professionalism\u2019 and to encourage the kind of liberal education that gives insight into the human condition.<\/p>\n <\/p>\n Bamforth\u2019s book has its weak spots. A review of Carl Elliott\u2019s Prozac as a Way of Life <\/em>(under \u2018D\u2019 for \u2018Depression\u2019) tells us little new where the author notes that depression is a cultural disorder and that many mental health symptoms are manufactured to sell drugs that supposedly treat such symptoms. While we are introduced to a stream of writers who have formed high culture, there is little reference to either popular culture or everyday people, in particular Bamforth\u2019s patients. Are some of these not also extraordinary? Do any of them inspire, or is that just for high art?<\/p>\n <\/p>\n But mainly, Bamforth offers us industrial strength prose. \u2018Galen\u2019 is a model of the essay form \u2013 pithy, humorous and insightful. Informed by his long experience of practicing medicine in Strasbourg, Bamforth dwells on the \u2018folk illness\u2019 of a crise de foi \u2013 <\/em>a crisis of the liver. The essay is a generous meditation on a French national trait – the liver as embodied metaphor. Bamforth\u2019s most recent (2015) essay \u2018Tell Me About Teeth\u2019 (under \u2018M\u2019 for Mouth<\/em>) is a very funny meditation on the American obsession with good teeth (equating with good character). Bamforth takes up Elias Canetti\u2019s challenge to \u2018write about teeth\u2019 and produces the best line of the book: \u2018How can you believe the soul is a butterfly when the human breath is so foetid?\u2019 There is cheek in the essay \u2013 Bamford, a doctor, looks down on dentists who cannot have a proper conversation with their patients \u201cwith a drainage pipe, cotton wool and gloved fingers in the mouth\u201d.<\/p>\n <\/p>\n Bamforth\u2019s conversation with his readers, however, is more like the reality of doctors\u2019 \u2018conversations\u2019 with their patients \u2013 the consultation is actually one-way traffic: Bamforth does not pose questions, he informs, and his information is more torrential downpour than light drizzle. Read psychoanalytically, Bamforth\u2019s rather suffocating attention to detail might be seen as a desire to impress and to control. There is a clue in the Endnotes to this collection of essays, where referring to the essay on teeth, Bamforth notes that while many writers earn their living as doctors, the same cannot be said of dentists. Reading this, I immediately thought of the Egyptian dentist and novelist Alaa El Aswany\u2019s The Yacoubian Building<\/em> that I read a few years ago. I was interested in this novel because at the medical school where I used to work we had long established a medical humanities programme, and had just implemented a \u2018dental humanities\u2019 programme in the dental school. Aswany was recommended reading. I was pleased to see that Bamforth could afford an error, a relief from his parade of learning. But then I read the after-note to these essays, where Bamforth apologises to the reader for an oversight – dentists do indeed write novels, amongst them Alaa El Aswany\u2019s The Yacoubian Building. <\/em>The rent in the fabric of the essay is neatly repaired without losing face.<\/p>\n <\/p>\n But Bamforth should not be worried about the occasional slip \u2013 after all, it is in such minor imperfections that humanity shows through (Nietzsche\u2019s Human, All Too Human<\/em>) and this is, paradoxically (and properly), how he describes the work of doctors. Little \u2018holes-in-the-day\u2019 or \u2018holidays\u2019 (as the late poet Peter Redgrove described unconscious slippage) allow both writer and reader a mini-break away from the relentless search for perfection. Indeed, such a hole-in-the-day does appear in Bamforth\u2019s collection and is not retrospectively repaired in his Endnotes. It is an omission that also provides an insight into limitations to the author\u2019s writing style.<\/p>\n <\/p>\n While the psychoanalyst Jacques Lacan is referred to (on p.71), he is not included in the index of names that stretches to an eye watering close to 400 entries (with only a dozen women amongst them). Oddly, the publishers have not included an index of topics \u2013 a major omission in a book of this kind that is to be dipped in to and not read cover to cover. I pick up on Lacan because it was this psychoanalyst who famously suggested that the unconscious is structured like a language and shapes experience through metaphor and metonymy. Metaphor (the substitution of one word for another for effect: \u2018time is money\u2019), suggests Lacan, serves to repress (often in the form of denial). Metonymy functions to combine, where one word or phrase leads by association to another (such as \u2018wand-sceptre-king-ruler\u2019) and is then a form of displacement (often in the form of scapegoating). Bamforth\u2019s writing is characterized by a particular use of displacement and contiguity as a rhetorical strategy. Let me give some examples.<\/p>\n <\/p>\n There is a rather irritating \u2018rock hopping\u2019 technique, where reference to one author or thinker jumps quickly to another. The essay on \u2018Happiness\u2019 referred to above \u2013 a review of Ziyad Marar\u2019s and Carl Elliott\u2019s books – is only seven pages long yet manages to reference Freud, Plotinus, Nietzsche, Bentham, de la Rochefoucauld, Auden, La Mettrie, Diderot, Holbach, St-Just, Stendhal, Dr Johnson, Rousseau, Robert Burns, Tom Wolfe, Dostoevsky, Veblen, Wittgenstein, Theodor Fontane, de Sade, Montaigne, Aristotle, Erving Goffman, Robert Reich, Georg Christoph Lichtenberg, Alexander Pope and Jane Austen. Bamforth\u2019s technique is not to simply list authors – that would be too crude. Rather, he metonymically links them. But these linkages are often arbitrary.<\/p>\n <\/p>\n The essay \u2018Ethics\u2019 is actually about insomnia. Bamforth reminds us that the sleep state is ethically neutral. An anecdote about Vladimir Nabokov is neatly linked to one about the Romanian philosopher and writer E.M. Cioran. Both were insomniacs – so far, so good. But then, linking Kafka, W.H. Auden, Nietzsche, Freud and James Joyce, we are brought to a discussion of the merits of The Epic of Gilgamesh \u2013 <\/em>a paragraph tells us how Rilke and Elias Canetti were both bowled over by Gilgamesh<\/em>. But what has this got to do with sleep deprivation and what medicine and science might do about it as well as what literature has to say about it? What about sleep deprivation in junior doctors \u2013 a well-known source of medical error \u2013 rather than passing reference to Gilgamesh<\/em>? Digressions and diversions are symptoms of the abuse of metonymy. A discussion of Proust and sleep leads into a section on the Irish writer Flann O\u2019Brien with the link \u201cProust was unfamiliar with rural Ireland though\u201d. The link is forced \u2013 a lazy metonymy. Here, Bamforth\u2019s Baroque style reminds me of billiard balls flying haphazardly around the baize, or a pinball machine.<\/p>\n <\/p>\n The essays contaminated by this rhetorical style tend to be lacking in narrative and resort rather to lists of events. Where narrative is strong \u2013 for example in Bamforth\u2019s marvellous essay on \u2018integrity\u2019 \u2013 the writing seems to me to be so much stronger and engaging. Here, Bamforth turns a review of Emmanuel Carr\u00e8re\u2019s novel The Adversary <\/em>into a meditation on lost identities that confounds notions of moral integrity. The essay is subtitled \u2018An Empty Plot\u2019 and this is a double-play on the fact that Carr\u00e8re writes a novel about a French doctor whose whole life was literally an enacted fiction and then hollow. Jean-Claude Romand was (supposedly) a doctor living in France on the border with Switzerland and working as a researcher at the World Health Organization. In short, he turns out to be a fraud \u2013 he never completed his medical degree and lived a life of duplicity in which he pretended to have a prestigious job, convincing everyone, including his family and even a best friend Luc Ladmiral, a general practitioner working in a nearby town. Romand systematically embezzled money to maintain the lifestyle of a successful profession where his profession was in fact mute. At the point of his ruse being uncovered, he murdered his wife and two children. Carr\u00e8re visited Romand in prison to piece together the story. Here, Bamforth returns us to a fundamental discomfort within medicine where doctors walk into roles prepared for them historically and culturally, and this may jar with their non-medical identities. Where then, to find solace or a moral compass? Bamforth\u2019s suggestion is that such touchstones for reality can paradoxically be found in well-wrought fiction.<\/p>\n <\/p>\n Readers of Medical Humanities <\/em>will warm to Bamforth\u2019s topics, but not necessarily to his style. A good editor would have rejected the rather forced abecedary structure of this collection to provide an alternative framework for linking otherwise disparate essays, prefaced by a different kind of Introduction illuminating Bamforth\u2019s thought process and style of engagement. The book reviews sit rather awkwardly amongst the essays. The metonymic name-game could have been tempered. An index of topics would have helped the reader to better navigate around what is important writing in the field of the medical humanities. Finally, there are a couple of cheeky gestures: Bamforth is multilingual (he works as a translator into English from German and French), but it is rather high-handed to preface the book with a quote from the German poet Friedrich H\u00f6lderlin that is given in German with no English translation. Later, in an essay on \u2018Posture\u2019, a \u201cfamous couplet\u201d from Ovid is given in Latin but again not translated. \u2018Famous\u2019 perhaps for Bamforth, but he is expecting high standards from his readership. The essays then expose the reader\u2019s ignorance rather than engage her interests, and do not educate as much as lecture. It is a shame that the style sometimes taints the content in what is unquestionably an impressive collection.<\/p>\n <\/p>\n <\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" Iain Bamforth\u00a0A Doctor\u2019s Dictionary: Writings on Culture & Medicine 2015\u00a0Manchester: Carcanet\u00a0ISBN: 978 1 784100 56 8 Reviewed by\u00a0Professor Alan Bleakley Emeritus Professor of Medical Education and Medical Humanities Plymouth Peninsula School of Medicine, Plymouth University UK Iain Bamforth, by his own admission, is a writer who practices medicine. Indeed, while he appears […]<\/p>\n