By Posen Solomon , Radcliffe Publishing; , 2006. , £35.00 , 298 pp . ISBN‐10 1 85775 779 3 , ISBN‐13 978 1 85775 779 8
Solomon Posen's book The Doctor in Literature (2006) was the first in a projected series of four, detailing the ways in which doctors are depicted in fiction. It dealt with doctor–patient relationships. This second volume covers various aspects of doctors’ personal lives—family, relationships with other doctors, religion, extracurricular scholarship, frustration and boredom, and impairment through physical and mental disease, old age, and the ravages of drugs and alcohol. For the third and fourth volumes we are promised accounts of doctors’ careers and specialisms and of sex in its widest purview.
As in the first volume, Posen has amassed about 1500 passages from works of literature. To understand completely what he has included and excluded one needs to re‐read the introduction to the first volume. However, his bibliography encompasses pretty much everything fictional that the well‐read doctor or patient would be expected to have come across, apart from detective and science fiction (although authors such as Dorothy L. Sayers and C.M. Kornbluth do make occasional appearances), and much that they would not. I counted 274 separate authors whose works were cited in the first volume; here 165 of those reappear and another 93 are added. There are no major omissions, and I expect that the minor omissions will be rectified in subsequent volumes. To test this I mention just three – the medical novels of John Rowan Wilson, such as The Double Blind (1960) and Hall of Mirrors (1966), those of Colin Douglas, such as The Houseman's Tale (1975), and those of John Collee, such as Kingsley's Touch (1984) and A Paper Mask (1987).
As before, a stereotyped picture of fictional male doctors emerges (the women will be dealt with in volume 4). Few of them enjoy a normal family life and many have none; those who have wives maltreat them; communications with teenage children leave something to be desired. They do not get on well with their colleagues. They are resentful of bureaucrats and have little time for politics. Their ethical positions do not conform to any standard religious model and they are often in conflict with men of the church. Their cultural preoccupations are on the whole narrow, particularly in contemporary fiction. True disenchantment with their profession is rare and personal illness is neglected.
Some aspects of this caricature are hardly surprising. After all, the quotidian does not yield good material for the novelist. We do not need the opening words of Anna Karenina, for example, to remind us that happy domesticity does not make for riveting fiction; Madame Bovary is one of the works that Posen cites most frequently here. Lack of conflict at work likewise does not introduce the tension on which great literature thrives, and there is no shortage of texts that illustrate the converse. However, it is perhaps surprising that doctors are depicted as being resilient in the face of demoralizing conditions, although presumably morale has never been as low as it currently is, at least in the UK. Ian McEwan's depiction, in Saturday (2005), of a British doctor who is happy at home and fulfilled at work, suggests that he is not in touch with this particular aspect of the zeitgeist, although, to be fair, he has other preoccupations and uses contentment as a counterweight to the tensions of the larger concerns that he prefers to deal with. For something less literary but much more medically gritty, try Jed Mercurio's Bodies (2002), not listed by Posen.
Aware, no doubt, that caricature is misleading, Posen has wisely introduced into this volume a feature that emphasizes the impossibility of generalization – contrasting quotations at the head of all but one of the main chapters. For example, the chapter on family relationships is headed with the contrasting pair, ‘Physicians make good husbands’ and ‘A girl is a fool to marry a doctor’, quoted, as it happens, from the same work, The Doctor (1935) by Mary Roberts Rinehart, a moral tale by a nurse better known for her mysteries.
The lack of attention to the bibliography that I highlighted in my review of the first volume has been rectified here, and the points to which I drew attention (mostly concerned with the presentation of pseudonyms and full names) have largely been attended to, although there are still occasional lapses from best practice. For example, ‘Barker, Pat (Patricia Margaret)’ should have been ‘Barker, Pat[ricia Margaret]’, lest anyone thought that Pat Barker is the pseudonym of someone whose surname is Margaret, unlikely though that may be. Authors’ biographical details are still missing, although photographs of four contemporary doctors who write fiction are included; more of those would have been welcome.
Here, as before, Posen has not explored the extent to which life imitates the stereotypical image that literature generates. There is evidence aplenty, for example, of the broad cultural interests that doctors maintain. Did these really diminish in the 20th century compared with the 19th? Are modern doctors, as his exposition of fictional representations suggests, merely competent technologists rather than scholarly practitioners? Or is this an impression that novelists now have, based on C.P. Snow's adumbrations? To take another instance, there is certainly information about the extent to which doctors are relatively irreligious. For example, in one study of 1144 US doctors (New England Journal of Medicine 2007; 356: 593–600), ‘intrinsic religiosity’ was declared to be low by 37%, moderate by 27% and high by 36%, although only 10% did not declare a religious affiliation. Discussion along these lines would transform these books, in my view, from the annotated dictionaries of quotations that they are into interesting disquisitions on the relationship between life and art.