‘A Doctor’s Dictionary: Writings on Culture and Medicine’ by Iain Bamforth (Carcanet, 2015).

41nlLKcgX4L._SX310_BO1,204,203,200_A Doctor’s Dictionary is a collection of twenty-six ‘literary essays,’ one for each letter of the alphabet, allowing the author to explore many aspects of contemporary medicine using examples from literature, philosophy and history to illustrate his discussion. While no overall aims of the book are stated, Iain Bamforth voices his concern in the preface that we are all at risk of losing touch with the practice of medicine as a humane art and science in a world that is ‘increasingly in thrall to technology’ (p. x). Many of the essays explore this theme and fundamental questions are raised about the values and assumptions of contemporary medicine throughout the book. Bamforth uses his impressive knowledge of European literature and culture and his professional experience working in many different countries to reflect on a wide range of topics that investigate the culture of modern medicine. Even though some chapters concentrate on a particular author or a subject such as the nose and the sense of smell, he integrates perspectives from different academic disciplines to provide depth and context.

This is not a book that should be read from cover to cover. It is a volume to be dipped into at random when a chapter title catches your eye and you want to be intrigued and stimulated to ponder on what it means to be a doctor or to read Bamforth’s scholarly analysis of writing by well- known authors such as ‘Stendhal,’ Franz Kafka or Anton Chekhov. It is perhaps misleading to call the book a ‘dictionary’. It does not provide definitions or act as a reference guide. The essays originally appeared in different journals and at different times in his career, some as reviews or commentary pieces and some as academic contributions to Bamforth’s postgraduate degree (Doctor of Letters) in 2009. They are referenced with further annotations in the endnotes section. The disadvantage about collating such disparate essays together in one volume is that there is a lack of fluidity between the chapters. Some essays are rather tangential to medicine and while stimulating, require a dictionary and persistence to disentangle the main points from texts that are bursting with ideas and references but leave the reader wondering what exactly has been said.

The best sections of the book relate to Bamforth’s own personal reflections as a doctor or analyse a novel or narrative that communicates his message. Franz Kafka and Miroslav Holub, are two of his favourite writers, perhaps because they both capture something of the absurdity of the human condition and use illness as a metaphor to express the dis-ease of society. The chapter on Kafka and his uncle Siegfried (pp. 97-117), a physician who was the inspiration for Kafka’s book ‘A Country Doctor,’ provides a fascinating commentary on society’s conflicting views of the doctor as buffoon, healer, and saint. Bamforth points out that the underlying problem is one of trust in the medical profession and suggests this is even more of an issue now in our media-manipulated ‘risk society’ (p. 111). Other chapters expand on this theme including ‘D for Depression’ (pp. 33-39) and ‘H for Happiness’ (pp. 61-68). Here, ethical considerations are explored in the discussion of the medicalization of misery and its dubious treatment with drugs which may exacerbate the problem rather than expose the sickness in our society. He also highlights the insidious shift in our understanding of the concept of happiness which used to incorporate moral and social responsibilities but now seems to equate with material wealth and an expectation of guaranteed individual fulfilment, at the expense of critical thinking and opinion.

Some of the most interesting essays are on conditions which do not fit comfortably into pathological categories, such as Stendhal’s syndrome in ‘V for Vertigo’ (pp. 218-225) and the chapter on ‘G for Galen’ (pp. 54-60). Both of these illustrate the limitations of medicine and the importance of understanding culture-bound syndromes such as the condition crise de foie (p. 55), a diagnosis Bamforth was not familiar with when he first started working as a GP in Strasbourg. After reading Cecil Helman’s book Culture Health and Illness, he recognised that this liver complaint was a ‘folk illness’ similar to many other conditions across the world such as amok in Malaysia and colds and chills in the English speaking world. In France, a crise de foie has many features consistent with a hangover but Bamforth relates this diagnosis to ancient beliefs about the liver and suggests that it supplies both a medical and magical explanation for a condition that suits the French psyche and outlook, given their love of good food and wine and occasional overindulgence. Luckily the remedy is simple advice and sympathy, showing that doctors are often most effective when they stick to compassionate comments, minimal treatment and no unnecessary investigations.

There are some omissions from A Doctor’s Dictionary. It is lacking examples of any female members of the medical profession and very few women writers are cited. There is no discussion of diagnoses from the past such as hysteria or other gender specific conditions that might provide insights into the imbalance of power between men and women in society, or within the medical profession. Given the academic importance of feminist thinking and gender studies more generally, this is a pity and would have added to the intellectual breadth of this book and its appeal to a wider audience. I found it irritating that the chapters are not fully referenced, despite the numerous quotes and writers mentioned. The index at the back of the book is missing several of the names cited in the text and no dates or publication details are provided for the authors mentioned, an oversight for those of us who are not as well read or familiar with European writers and thinkers as Bamforth.

A Doctor’s Dictionary demonstrates that the art and science of medicine can and should be investigated and interrogated by using a cross-disciplinary approach. It adds to and enriches debates within medical humanities about current medical practice and whether medicine is losing touch with a humane and common sense approach. Whether the book will appeal to a wider audience beyond enthusiastic academics is questionable. It is not an easy read and probably not accessible to the average practising clinician, even though it raises relevant and important issues about our current values and preoccupations within medicine and discusses these insightfully in a wide historical, literary and philosophical context.

Reviewed by Dr Emma Storr,  a GP and Clinical Lecturer in Primary Care at the University of Leeds. She has a longstanding interest in medical humanities and has run several undergraduate and postgraduate modules in medicine and the arts. She is currently teaching on an integrated module for 4th year medical students in Cancer and Continuing Care and runs a student special project ‘The Ill Child in History’ for 2nd and 3rd year students. Her research interests are in international medical students and in 19th century literature featuring childhood illness. She completed a Master’s Thesis in Health Sciences at the University of Otago, New Zealand in 2013. She has recently enrolled on an MPhil in Writing at the University of South Wales.

Correspondence to Dr Emma Storr.


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