Solomon Posen, The doctor in literature. Vol. 1: Satisfaction or resentment?, Oxford and Seattle, Radcliffe Publishing, 2005, pp. xv, 298, £29.95, $55.00 (paperback 1-85755-609-6). - Solomon Posen, The doctor in literature. Vol. 2: Private life, Oxford and Seattle, Radcliffe Publishing, 2006, pp. xv, 298, £35.00, $59.95 (paperback 1-85755-779-3).

Abstract

Most medical schools now provide undergraduate modules on the eclectic discipline known as “medical humanities”, and there is a definite gap in the market for an engaging, rigorous textbook on the subject of medicine in literature. Unfortunately for Solomon Posen, The doctor in literature is not it. Posen—a retired professor of general medicine at Sydney University—studied English before taking his medical degree, and has maintained an interest in literature throughout his career. In The doctor in literature he aims to expand on his series of articles on ‘The portrayal of the physician in non-medical literature’, published in the Journal of the Royal Society of Medicine in the early 1990s. These volumes are conceived as a reference work, one which brings together “some 1500 passages from approximately 600 works of literature describing physicians, their attitudes and their activities” (vol. 1, p. 1). Most of these works are British or American in origin, and the majority were written in the last two centuries. The first volume examines literary representations of medical practice, and the second addresses the private lives of fictional physicians. A third volume, ‘Career choices’, is scheduled for publication later this year. Posen seeks to identify broad themes in literary portrayals of physicians, and in doing so to provide both “source material for courses in medical ethics and sociology” and a browsable volume for the general reader (vol. 1, p. 3). In this sense, The doctor in literature follows a familiar strand of antiquarianism in the history of western medicine, one which seeks to draw guidance for modern medical practice from the literary and philosophical canon. In his foreword to volume 1, Edward Huth, editor of Annals of Internal Medicine, sets out the book's explicitly didactic topos: “If we know how we are seen by the rest of the world, we may be less prone to conduct ourselves in ways at odds with our professional values … Dr Posen's book will not purge our profession of scoundrels, professional cripples [sic] and incompetents. But those of us who keep an open mind about what we are and what we might do to be worthy of a place in our profession may profit” (vol. 1, p. viii). Huth suggests that The doctor in literature “might be seen as an informal social history of medicine from the past to the present” (vol. 1, p. ix). Posen's own views on the history of medicine are unreconstructed, to say the least: “the basic relationship between patients and trained expert helpers” has, he claims, “remained essentially unchanged over two and a half millennia” (vol. 1, p. 8). Posen's approach to literary sources is equally problematic. He seeks to disregard “unanswerable questions like whether works of fiction create or reflect attitudes” (vol. 1, p. 12). But such questions are central to the success of his enterprise. Can one really claim that George Eliot's Edward Casaubon, for example, embodies a moral lesson for present-day practitioners, when treated in effective isolation from the fact that he is a central character in Middlemarch, that most celebrated and complex of Victorian novels? Can an account of Virginia Woolf's Sir William Bradshaw ignore Woolf's own experiences at the hands of Sir George Savage and others? Can one draw any useful conclusions on ‘The wayward wife’ from the disparate works of Giovanni Boccaccio, Arthur Conan Doyle, Anton Chekhov, Arthur Schnitzler, Somerset Maugham and Tennessee Williams? This analytical naivite is also reflected in Posen's self-imposed limitations. He excludes “overt medical autobiographies”; “fictional physicians whose medical qualifications are relevant only as a plot device” (so no Dr Watson or Dr Jekyll); “medical clowns and caricatures”; “fictional physicians who engage in criminal activities”; and “bizarre medical behaviour” (so William Burroughs’ Dr Benway is out on three counts). He also seeks to exclude discussion of “hidden meanings, symbolism [and] allegories” (vol. 1, p. 7) in representations of medical practitioners. With so many dimensions of literature left out, one is tempted to ask, “What remains?” What remains is a repetitious and loosely disciplined parade of gobbets, deprived of their literary and historical context and hence shorn of their value and interest. Posen's analyses and conclusions are conservative, trite, judgemental in tone, scarcely meriting the hundreds of pages and thousands of citations invoked in support. The doctor in literature can claim some value as a bibliography of “mainstream” representations of physicians in modern western literature, but readers may care to think twice before paying £65 for information already widely available online. This fascinating subject deserves, and will receive, better treatment than Posen has administered.