Medical fiction

The best works of fiction operate on several levels at once. They contain simple characters and messages which a child can understand, but they also contain deeper meanings, which may only become obvious after frequent retelling. Thus the great tales of antiquity—the Mahabharata, the Odyssey, the Epic of Gilgamesh—can operate both as soap operas and as profound meditations on the great imponderables of life.

It is no accident that these stories are often obscure or ambiguous; indeed, this feature partly accounts for their success. If things are too obvious there is no drama in them. If there’s no drama, the story doesn’t engage us emotionally, and without emotional engagement the story is unmemorable. Much health advertising fails for this reason: its very clarity makes it uninteresting and forgettable. By contrast, tobacco advertising, which is forced for legal reasons to be oblique, tends to present us with an engaging puzzle, which draws us in and lodges in our memory.

The recent renaissance in television medical drama owes much to the realisation that things are more interesting if they are not fully explained. Doctor Kildare offered clarity both in moral and scientific terms. This made the programmes reassuring but also rather bland. Programmes like ER and Casualty are at times deliberately obscure, drawing the audience into a blur of activity where instructions are half heard, decisions are fudged and things don’t always work out for the best.

Such programmes may be less easily comprehensible than their predecessors but are arguably more satisfying and more profound. The fact that we don’t understand the medical process makes us more appreciative of its complexity. The chaos and the jargon engage us intellectually in trying to work out what’s happening. The moral ambiguity adds richness and depth while enabling us to put our own interpretation on events.

Inevitably in this style of drama some of what happens may be wrongly construed. Clearly there is an onus on drama producers to get the facts right. This need is reinforced by a paper in this week’s issue showing that viewers retained medical information gleaned from watching an episode of the British television drama Casualty (p 978).¹ However, it is neither possible, nor entirely desirable, to edit from such a programme all the information that may conceivably be harmful, if misinterpreted by certain individuals.

A second study on the same episode of Casualty, from the same group, suggests that people contemplating suicide may have been encouraged or dangerously misled by the programme (p 972).² Perhaps we just have to accept this. Close cooperation already exists between writers, producers, and medical advisers, and this ensures a generally high level of accuracy. Formal guidelines on content would constitute a kind of medical censorship of popular television. If we are censoring the portrayal of suicide, why not censor acts of violence, unsafe sexual behaviour, or smoking and drinking on television, all of which may lead to life threatening copycat behaviour?³

At present we tolerate the fictional portrayal of such dangerous activities in the belief that our behaviour is determined less by what we see on television than by the checks and balances which operate in real life. This presupposes, of course, that we spend at least as much time relating to real people as we do sitting in front of a screen. Worryingly, there are sections of the population for whom this is no longer the case, whose immersion in television is so total that it threatens to become the dominant source of instruction in their lives.⁴

While accepting that there is no such thing as “safe fiction,” and no point in trying to define it, one can still maintain that the sheer amount of television being watched is a valid public health concern. Prolonged withdrawal from real life is self evidently harmful not just to depressed people but to society as a whole. Any attempt to measure the damage is to be applauded; but in searching for a solution we should perhaps take the broader view and challenge overall viewing behaviour, rather than attempting to police the content of specific television programmes.

Papers pp 972, 978