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September 1, 2014

Literary heroes of medicine

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Dr Brendan Kelly reviews a new book by fellow Irish psychiatrist Dr Stephen McWilliams on how medicine is portrayed by medical and lay writers.

John Shaw Billings (1838-1913) was an American surgeon, librarian and first director of the New York Public Library. Drawing on years of medical, surgical and literary pursuits, Dr Billings offered succinct advice to medical writers: “First have something to say; second, say it; third, stop when you have said it; and finally, give it an accurate title.” Simple, clear and direct, Dr Billings’s advice is timeless.

Medical writing is a complicated, intriguing art, and one which merits close attention. Happily, there is now a new and valuable addition to this field, written by an Irish psychiatrist, Dr Stephen McWilliams, and titled Fiction and Physicians: Medicine through the Eyes of Writers.

Even more happily, Fiction and Physicians adheres excellently well with Dr Billings’s wise advice: Dr McWilliams certainly has something to say, and his book is focused, erudite and engaging.

Fiction and Physicians is an intriguing collection of linked essays, brief biographies and literary reviews centred on medicine in literature and the literature of medicine. It is broad in range, and explores literary works by doctors who wrote fiction, doctors as portrayed in fiction (mostly by non-medical writers) and depictions of medical illness in fiction. These linked themes and approaches go very well together, and combine to produce a volume that is rich in detail and replete with fascinating insights.

Why do doctors write?

Part One of Fiction and Physicians looks at the issue of why so many doctors decide to write in the first instance. Dr McWilliams examines the work of medical writers from Nostradamus to Michael Crichton, and explores books by such celebrated physician-writers as William Somerset Maugham, Oliver St John Gogarty and William Carlos Williams.

He includes, of course, the incomparable Oliver Sacks, author of some of the most celebrated medical explorations of our time, including Awakenings (1973) and the unrivalled An Anthropologist on Mars (1995). Sacks’s latest book, Hallucinations, is due for publication in November 2012 and promises yet more delights.

Part two of Dr McWilliams’s book moves on to consider fictional works about doctors, and discusses a broad range of fictional physicians who are known for their incompetence, ambition or, indeed, heroism.

There are also considerations of the themes of infection and paranoia in fiction, with especially interesting discussions of George Orwell’s Nineteen Eighty-Four (1949) and Ian McEwan’s superb Enduring Love (1997). The latter, with its focus on erotomania, is an excellent example of clear, evocative writing about a complicated psychiatric disorder.

Finally, Dr McWilliams turns his attentions to “fictional psychiatrists” and provides a fascinating discussion of a number of memorable characters, including Dr Hannibal Lecter, Thomas Harris’s (probably) sociopathic psychiatrist in Red Dragon (1981) and, most famously, The Silence of the Lambs (1988). There is also an excellent essay about Dr Grene, the psychiatrist in Sebastian Barry’s elegiac novel, The Secret Scripture (2008), set in Sligo during the inception of the Irish Free State, and well worth reading.

Medicine, fiction and the broader world

All in all, Fiction and Physicians is a fascinating volume and a remarkable achievement. Its author, Dr McWilliams, is a Consultant Psychiatrist at Saint John of God Hospital in Dublin. He graduated from the RCSI in 2000 and, since April 2001, his articles have appeared in a range of publications, including Irish Medical Times.

Dr McWilliams writes about a broad variety of topics, including psychiatry, medicine, history, literature, biography and the arts.

He has also written a novel, The Witchdoctor of Chisale (2006), a rewarding, enjoyable story of a young Irish medical student and his adventures in sub-Saharan Africa. More recently, he contributed forewords to the recently-published compilations The Book of Weather Eye (2008) and Weather Eye: The Final Year (2009) by his father, the late Brendan McWilliams.

Fiction and Physicians is, as highlighted by Tony Bates (psychologist and Irish Times columnist), a “beautifully written and wonderfully engaging book [that] carries us behind the scenes into the lives and work of writers such as John Keats, Chekhov, Arthur Conan Doyle and RD Laing, who have given us some of our most precious insights about ourselves, based on their experience of medicine. Reading this book, I found myself being guided by the author into an easy intimacy with these and many other writers that was both a pleasurable and revealing encounter.”

The Doctor’s Dilemma

Fiction and Physicians is a rewarding, insightful book, with a diverse cast of characters who provide excellent insights into the world of medicine and, most of all, the world of doctors. It is filled with doctors, real and imagined, of every conceivable hue; the good, the bad and the deeply misguided. As often as not, truth seems like fiction, and fiction seems like truth, so it’s little wonder the public rarely knows what to make of it all.

In 1906, George Bernard Shaw wrote a provocative play, titled The Doctor’s Dilemma, in which he announced that “all professions are conspiracies against the laity”. Shaw’s play was revived this year by the National Theatre in London, with a superb production that brought out both the truths and paradoxes in Shaw’s work, and helped elucidate many of the genuine dilemmas doctors faced in Shaw’s era and still face today.

Fiction and Physicians does something similar, as Dr McWilliams, erudite and entertaining, takes us on an exotic journey into the imaginations of doctors and doctors of the imagination. His book is a valuable addition to the literature on the topic of doctors and it’s also that rarest of creatures in the world of medical books — a thumping good read.

Dr Brendan Kelly is a Senior Lecturer in Psychiatry at University College Dublin and Consultant Psychiatrist at the Mater Misericordiae University Hospital, Dublin.

• Fiction and Physicians: Medicine through the Eyes of Writers by Dr Stephen McWilliams. The Liffey Press, 2012, ISBN 978 190830826-9.