ArtsRant: Why Bother with Books?

1 Sep 2004 in Festival, Orkney, Writing

Medicine and the Word

Quarks, strangeness and charm (or, how your doctor might be writing novels in his/her spare time): ANNE MACLEOD ponders the complex relationship between her dual roles as medical practitioner and creative writer, and finds an answer to the fundamental question posed by her mischievous colleague in Stromness – why bother with books?

DR DEREK JOHNSON of Stromness, GP, one of Scotland’s most original medical minds, remarked to me many years ago, that nothing in a novel could ever come close to medicine, to life. “So why,” he fixed me with an insouciant gaze, “bother with books?”

It was January. We were striding across a field on Graemsay, doing the weekly round, having motored to the island in what seemed to me a perilously small boat. A student, on attachment, I had been in Stromness two days, maybe three.

I thought about it. Didn’t know what to say. I would do better now. So many years on, a practising writer/doctor, I have become much more aware of what we are actually doing in story, in life. I’ve learned more, too, about other doctors with similar obsessions. Doctors on whom the Literature in Medicine movement is founded.

William Carlos Williams didn’t start it. Nor did Chekhov. Nor Keats. Nor was it Smollet, Somerset Maugham, Joyce, or Shelley, all of whom practised (or studied) medicine. The story is much older, much simpler. It comes down to this: doctors are communicators. Medicine and the word – medicine, poem and story – have always gone together. Leonardo may have prized the visual above the word, but Pallas Athene was Goddess of poetry, healing and war; Brigit the Celtic patron of poets, smiths and healers.

There were sound practical reasons for honing poetic technique in early literate and pre-literate society. With knowledge fiercely guarded, the rhythm and music of verse acted as a necessary, powerful aid to memory, the highly geared changes of poetic language underpinning magic rites and ceremonial. Real politique. That power, so mistrusted by Socrates, of transporting the listener, swaying the emotions, must have seemed as vibrant as cinema’s widest screen, more convincing than all the special effects of even WETA Workshop. A heady mix. No wonder Plato worried about it.

In 388 BC, he urged the city fathers of Athens to exile all poets and storytellers, because they and their work were a threat to society, concealing IDEAS within the seductive emotions of ART. The persuasive power of story was such, he said, that we might believe and empathise with a narrative even when it was morally repellent. Storytellers were dangerous people. He did, however, like and trust physicians. “The best physician,” he said, “is he who is able to separate fair love from foul, or to convert one into the other; and he who knows how to eradicate and implant love, whichever is required, and can reconcile the most hostile elements in the constitution and make them loving friends, is a skilful practitioner.”

But doctors, healers, work not just with scientific expertise, but with narrative. Robert MacKee in Story, his screenwriting manual, might have been describing a medical encounter. He sheds generous light on the possible interaction between doctor and patient when he says: “When a character steps into your life he brings an abundance of story possibilities. If you wish, you could start the telling before the character is born, then follow him day after day, decade and decade, until dead and gone. A character’s life encompasses hundreds of thousands of living hours, both complex and multilevelled… “

Stories are important to us all. Narratives, the words we live in, illustrate our world, define us more exactly than we know. They are enacted in the body, as read or spoken. Like the Olympic athletes visualising the next attempt at jump or throw, the reader, the listener, physically relive story and poem. Antonio Damasio, the experimental neurologist, suggests in The Feeling of What Happens that narrative may in fact be the key to consciousness.

“Meaning cannot be fixed – never permanently – even in apparently simple language.”

“We begin with a first trick… an account of what happens within the organism when the organism reacts with an object, be it actually perceived, or recalled, be it within the body boundaries (eg pain) or outside of them (eg landscape.) This account is a simple narrative without words. It does have characters (the organism, the object). It unfolds in time. And it has a beginning, a middle and an end… the initial state of the organism.. the arrival of the object.. the reactions that result in the modified state of the organism.”

There you have it, wordless self awareness. But language is more than that: language is a matter of negotiation. You only have to attempt an important letter to realise that the spoken symbols we take so much for granted are slippery, unwieldy tools – one reason, perhaps, why so much scientific and business writing is indigestibly cluttered with jargon. Meaning cannot be fixed – never permanently – even in apparently simple language. And without intelligible narratives, without language, it seems we have difficulty in forming conscious memories, cannot navigate our way through life. Helen Keller remembered little of life before the age of five when she distinguished her first word Water from her teacher signing the word into one palm while running water over the other.

Some widely published medical narratives have become greatly loved- wonderful patient and doctor stories, like Robert McCrum’s My Year Off, or Oliver Sacks’s The Man who Mistook His Wife For A Hat. But all storytelling is important. Trisha Greenhalgh and Brian Hurwitz, editors of Narrative Based Medicine, the seminal British text assert that story-telling has always been and remains a fundamental part of communication and culture, the basis of our evolutionary survival kit. Lives and personalities are, after all, narrative construct. Narrative is vital, not only in communication, but in shaping and maintaining a sense of who we are.

The place of writing is even more complex. In Egyptian mythology, writing was invented by Thoth, the ibis-headed god, who offered it to Ammon, a pharmakon to render the whole world wise. Ammon, however, judged writing to be more pharmakon than magic – like any medicine, it had good effects and bad. Writing, he said, would give the appearance of wisdom where there was none.

“The medical schools of Scotland have, throughout the centuries, spawned medical wordsmiths.”

We tend to think differently now. The Oxford Companion to Philosophy may have difficulty defining what art is and what it is not, but it states this categorically: “Art is vital to Moral Health … allowing us without risk to explore in depth – in plays and novels – the essential nature and outworking of endless types of human character and social interaction.” Artistic success may, as suggested in Strong Imagination by Daniel Nettle, even offer a sexual selection advantage – rock stars and writers (male), he says, are sexy – if, occasionally, mad. Even a BMJ editorial in 2002 emphasized the benefits of involvement in the Arts: “There is more to health than physical completeness, and absence of pain; it is also about making sense of the world.”

Does art – does writing – make us better doctors? Dannie Abse, one of Europe’s most prolific doctor-poet, is not sure: “Tobias Smollett, the novelist, did not prosper as a surgeon … Goldsmith was advised to treat his enemies rather than his patients. Keats … suffered from too much empathy with creatures and things to become a good doctor, to survive, perhaps, as a doctor.”

Abse, a retired Respiratory Physician, Welsh, has produced an extensive body of work: ten volumes of poetry (the first published while he was still a medical student), three novels, plays, and autobiography. His gift for storytelling, for asking difficult questions, elevate a lyrical gift to greatness but White Coat, Purple Coat, the title piece of his collected poems, reflects his uncertainties over the doctor/poet role: “white coat and purple coat/ few men can reconcile.”

But reconcile it they do, over and over. The medical schools of Scotland have, throughout the centuries, spawned medical wordsmiths. Peter Mark Roget studied in Edinburgh, compiling his famous Thesaurus after his retiral from an eminent medical career. Goldsmith was also an Edinburgh graduate, as was Arthur Conan Doyle, who unleashed Sherlock Holmes upon a rapturous world, basing the famous character on his teacher, Dr Joseph Bell. And let’s not forget the west. A J Cronin, creator of Doctor Finlay (and Janet) graduated from Glasgow.

“My own published work … moves between poetry and fiction. The poetry was always there: the narrative impulse much more gradual.”

Scotland’s medics are a dab hand at poetry too. Gael Turnbull, anaesthetist and GP who sadly died last July, was famous for the elegance and lightness of his lyrics, the output of a true and original mind. One of the most prominent of the British avant-garde, he started Migrant Press in 1957, and was an important figure in British Poetry Revival of the 1960’s. He forged strong connections with the Black Mountain Group and throughout his life kept pushing borders, asking questions. His poem machines and installations reflected his deep interest in language and precision. “The joy,” he always said, “is in the attention” – attention that never wavered.

Scotland boasts prominent living doctor/writers too. Iain Bamforth, eminent poet, GP, and Scottish, currently practises in Strasbourg. His attention to linguistic detail, and delight in language promise a long career of intellectual rigour. His most recent published project is The Body in the Library, a literary anthology of modern medicine, published by Verso in 2003. A Carcanet poet, his next collection, A place in the world, is due to appear in 2005.

Suhayl Saadi, another Glasgow graduate and thinker, offers an intriguingly diverse literary CV: his first novel, The Snake, erotic fiction, appeared from Creation Books, under the name Melanie Desmoulins. The Burning Mirror, under his own name, was published by Polygon in 2001, followed by the novel, Psychoraag from Black and White in 2003. Saadi is an articulate, distinctive voice. For him writing is healing act.

“I was a writer who happened to be a doctor and the two vocations had no discernible linkage in my brain. However, to the Greeks, science was one of the liberal arts. Surgical procedures, the consultation, the laying on of hands, the tiny acts of healing we do every day – all of this is art… Chinese, Indian and Greek medical systems regard the human being as an open system, as does modern biology. We interact with our external environment, so that the division between external and internal, physical and mental, self and other, becomes essentially untenable. Sport, art and (fulfilling) work have, at semiotic base, this striving for unity. Broken people are ill people. To some extent, we are all broken.”

Martin MacIntyre, doctor, actor, singer, and storyteller too, is currently the beneficiary of a Scottish Arts Council Writer’s Bursary, working on a novel in Gaelic to follow his first collection of short stories Ath-Aithne, Clar 2003, which won a Saltire First Book of the Year award.

In fact, there are Scottish doctors at work in all literary fields. Stephen Potts, psychiatrist in Edinburgh is one of Scotland’s most prolific and exciting authors for children. His adventure stories reflect his passion for the sea – an intimate knowledge of boats and the wild wastes of the North inform his Running Tide series, the last of which The Ship Thief was published in Sept 2004. I have yet to read this, but Compass Murphy, the second in this series, is exceptional.

My own published work, as Highland readers may know, moves between poetry and fiction. The poetry was always there: the narrative impulse much more gradual. Fiction needs space, demands emotional energy. Medicine, the family, writing, all take time. As Suhayl Saadi says: “I do three days a week professionally to pay the bills… you can’t write a novel like that. You’ve got to have chunks of time, a couple of weeks to really get into it. You can edit, once it’s done you can edit anytime, anywhere.”

For every one of us straddling these two demanding fields, the need for energy, for dedication, is obvious. Both disciplines demand it. This takes its toll and yet we do it somehow, square the circle. Why? What was it Chekhov said? Medicine is my lawful wife and literature my mistress?

I tend towards a more unified view. William Carlos Williams (famous for comparing poems to machines) found that medicine was the thing which gained him entrance to “the secret gardens of the self”. What more could the physician, the storyteller need than self-knowledge? An understanding of the gardens of the mind, the vital, vivid space we inhabit, every last one of us. The great adventure of medicine so vast, so huge, that people you encounter teach you at every turn. The feeling of what happens.

But Dr Derek Johnson, retired GP, one of Scotland’s most original and discriminating minds, said to me many years ago, that nothing in a novel could ever be as exciting, as moving as medicine, as life. So why bother with books?

The question was rhetorical. It was January. We were striding across a field on Graemsay, doing the weekly round, having travelled to the island in a small motor boat. A student, on attachment, I had been there two days, maybe three. Long enough to know he was teasing. His house was overflowing with newspapers, journals, books. Wonderful sea paintings. He had introduced another friend, George MacKay Brown, only the day before.

Reducing me to silence. W hat do you say to someone whose work you so admire? How could I turn to George MacKay Brown and say: “Your poems and stories are wonderful, really wonderful, the best I’ve read?” How can you say those things? I opened my mouth. Nothing came out. “Hello, Anne,” George nodded. “Wet this morning, isn’t it?”

Why bother with books?

Derek again. Remember, we’re tramping across Graemsay. I had no answer for him, except – I liked the stories. That’s what I liked in medicine too. The folk you met. What happened to them. That’s still true today. It’s not th
dance of atoms that holds my interest, not the creative mythic thought of modern science with all its quarks, strangeness, and charm, but the people I meet and their burgeoning storied lives.

Why bother with books?

Derek doesn’t give up easily. And this is many years ago. I’m not yet twenty-one. Newly engaged. Still conscious of the diamond ring twisting on my finger. I haven’t heard of narrative in medicine. Haven’t heard of William Carlos Williams. Dannie Abse. I’m a medical student, remember? Unread. The Houseman’s Tale, Colin Douglas’s iconic blackly humorous novel has not yet been published. I read when I can, mainly poetry. I still think Leonard Cohen is pretty cool. Charles Causley too. I don’t know it will take me a good ten years to recover the mental space and energy to write more than the odd, necessary lyric.

Why bother with books?

It’s January in Orkney. Grey. I’m exhilarated. I’ve fallen in love with the low green islands and Hoy’s overhanging mammoth hill, even at this darkest, bleakest time, which oddly, parallels the years ahead, the stretching hours of work, on-call, lack of sleep. More work. More on-call.

Derek would tell you black was white to get you arguing. Why bother with books? he insists. I smile. ‘Because – because I love them.’

I can’t think of a better answer, then or now.

Anne Macleod’s new novel The Blue Moon Book is published by Luath Publishing on 11th October 2004. It will be launched as part of Inverness Book Festival on Saturday 9th October at 2pm in Waterstones Bookshop, Inverness.

The Inverness Book Festival runs from Thursday 7 to Sunday 10 October, for more information contact Eden Court on 01463 234234.