No ‘Doctor, doctor” joke
In order to demonstrate their enthusiasm for medicine, medical school applicants will often include (and may even read) at least one medicine-related book on their personal statement. Popular titles include The Man Who Mistook His Wife For A Hat, So you want to be doctor and Richard Dawkin’s The Selfish Gene. Less common on personal statements is Suburban Shaman: Tales From Medicine’s Frontline (after all, at a hefty 42 characters, the title alone takes up over 1% of the total character limit). However, if you’re going to read a book simply to pad out your personal statement, it may as well be something interesting and engaging.
Suburban Shaman is all of the above. It’s by Cecil Helman, a family doctor, psychologist and cultural anthropologist. In his introduction, Helman admits to being “unsuccessful” in “[trying] hard to escape from the gravitational pull of this family history [in medicine].” Indeed, given that he spent 27 years as a family doctor, it does seem that he was rather unsuccessful in escaping that gravitational pull. However, what Helman is very successful in doing is demonstrating that, as well as being a doctor, he is an excellent story teller and anthropologist and highly skilled in social commentary.
Helman begins with a description of his early years, most of which were spent in Cape Town. As a medical student living in South Africa during the 1960s, it was impossible to escape the harsh reality of Apartheid. Helman describes the city and his hospital as being, “surgically bisected” into ‘whites’ and ‘non-whites.’ (The gravitational pull of medicine extends to medical imagery in Helman’s metaphors.) Helman manages to add a touch of humour to the horrific acts of discrimination he describes by telling this anecdote:
At a few of the nursing stations in the wards, there stands a holder for thermometers, two long tubes of disinfectant clamped to a board and clearly labelled ‘White Oral’ and ‘White Rectal’, while on the other side of the building they read ‘Non-White Oral’ and ‘Non-White Rectal’. A friend of mine, bearded and intense, sees himself as a radical ‘agent provocateur’. He delights (when no one is watching) in switching the thermometers around. Winking wildly at this major revolutionary act, he is convinced of the mortal damage it will do to Apartheid by a particular thermometer, once jammed up a black rectum, now being inserted into a lily-white mouth.
Helman also tells us of a devastating condition suffered by Mr Pritchard, a white patient who he had treated during his training. Pritchard suffered from a condition known as Addison’s disease, a very rare hormonal disorder caused by failure of the adrenal gland cortex. The disease results in an increasing pigmentation of certain parts of the body. It is life limiting even in normal circumstances, but in 1960s South Africa it was made even worse, as having the condition meant that Mr Pritchard was transformed into a ‘non-white’ and thus a second class citizen. Mr Pritchard tells Helman of how he was “thrown out of a Whites-Only carriage of a suburban commuter train’ received ‘catcalls…at a municipal swimming pool” and experienced a “certain ugly incident“ in a barber’s shop, all of which caused him to “[withdraw] from ordinary social life.” The difference in how patients of a certain race are treated is a common theme which permeates Part 1 of the book (‘Setting out’) and is a clear indication of Helman’s interest in how a particular culture can affect the behaviour and treatment of certain individuals. Helman pursues this interest later on in his life when he becomes an academic, carrying out research in the field of medical anthropology.
In contrast to his experiences in Cape Town, Helman also describes his time working in London as a family doctor. In the chapter ‘Prescriptions’, Helman talks about a group of patients with a condition that is worlds away from that of Mr Pritchard. This condition is a dependence on medication in people who are perfectly well. One particularly interesting case is that of Amanda and John (who, oddly, share the names of my grandparents). This couple are in what Helman describes as a “chemical marriage” (which is very much unlike my own grandparents).
Helman describes how there have been frequent attempts by doctors to wean John off tranquillisers and Amanda off anti-depressants. However, Helman goes on to explain that “without these drugs, poured daily down their throats, their marriages would undoubtedly explode.” Once again, by telling these simple anecdotes, Helman shows how certain aspects of human culture have become embedded in the minds of individuals, and how this has gone beyond the point where their behaviours can be changed. He hints that this culture was established by money-making pharmaceutical companies who have subtly popularised the formula: Person + Chemical = Happy Person
With every story and every condition that he mentions, there is a complex set of ideas, customs and behaviours that are just as important to consider as the condition itself – and that can greatly influence a doctor’s choice of treatment. This set of stimuli can be broadly labelled as ‘culture’ and is something that must be taken into account by all doctors, not just those (like Helman) who have a particular interest in anthropology. Therefore, this book deals with one of the most important aspects of being a doctor, one which may only get a very brief mention in books designed to get a student into medical school.
It may not have pages of tables outlining the entry requirements for every medical school in the UK, but what this book does have is a large variety of unique experiences from an accomplished doctor and anthropologist. Terms such as ‘holistic medicine’ are often thrown into application forms, often without much explanation or understanding of meaning. In this book, Helman not only defines holistic medicine, but through re-telling his own experiences, he provides numerous examples of when the approach being put into practice and illustrates its importance within the field of medicine.