‘An Amazing Murmur of the Heart: Feeling the Patient’s Beat’ by Cecil Helman (Hammersmith Books, 2014).
Mike White writes: Not long before he died in 2009, I was privileged to hear the anthropologist GP Cecil Helman speak in Durham on ‘Anthropological Perspectives on The Body’. I was intrigued by his assertion that the body is the dualism-defying existential ground of culture. This book helps me understand what he meant by that. It has the unfinished feel of a posthumous publication, however, in that its exploration of the doctor-patient relationship is assembled from a number of journalistic vignettes, often affectingly told, rather than through a coherently argued monograph. He sets up the book with an aphorism in the Introduction that ‘Healing is about people; curing is about patients’ (p. ix), then taking us through a withering analysis of the reductionism of clinical practice towards an empathic restoration of medicine as being ‘all about stories, or rather it should be’ (p.49). Such stories are often regarded as low-grade evidence in research, but they constitute the potential for rich interaction in the consultation room which Helman believes is essentially a performance space.
The book’s anthropological base lies in the case it makes for even the clinical gaze to regard human organs as culturally significant, wherein the heart not the brain is popularly understood to be the seat of self, and the ‘mask’ of skin is ambiguously a means to hide or express identity. Indeed, references to arts practices run throughout the text as literal and metaphorical affirmations of engagement with the healing process. I firmly believe too that a culture of healthcare can be expressed through participatory art, and I concur with Helman that the redress for medicine’s incipient system failure to sustain vital inter-relationships in healing practice has to lie in more than just the offer of talking therapy for troubled patients. The very title of this work reclaims the moral high ground through its ironic reference to the tendency of clinical practice to de-personalise and shift complexity to organs and symptoms, disregarding the richly informative personalities that possess them. It is a pity that Helman passed away before the Francis Report into Mid-Staffordshire NHS Foundation Trust was published as it would certainly have added another level to his darkly comedic depiction of a disengaged medicine; one that would reveal a dereliction of the duty of care itself. Faced with the hegemonic structures of modern medicine, he celebrates the age-old patient encounter, however ‘heartsink’ it may be, skilfully veering away from the kind of big picture scepticism that Illich (in Limits To Medicine) brought to analysis of healthcare systems and moving us into his personal ethnographic accounts of ‘those tiny moments of therapeutic intimacy’ (p. xv).
If the book has a running flaw it is simply that, with a main text of just 119 pages, it is not long enough for its theme, and its arguments sometimes feel under-developed. Anecdotes are left to speak for themselves when they might be further strengthened by some judicious reflection. The endnotes are not cue referenced in the body of the text which is unnecessarily frustrating, and the cover art is pretty abominable. The quality of the writing makes this book a keeper, however, and in many ways it is a good companion piece to John Berger’s seminal 1960s meditative account of a Yorkshire doctor, A Fortunate Man. Helman’s storytelling manages by turn to be both humorous and harrowing and the emotional content really sticks in the mind.
An Amazing Murmur of the Heart usefully re-affirms the importance of everyday doctor-patient empathy and narrative interplay within the philosophical gaze of medical humanities. Adapting observational techniques from anthropology, Helman freely uses metaphor and anecdote to illuminate complex clinical and psychological conditions as bespoke through persons, sometimes interweaving them as in the wonderful chapter on tattoos. Yet he also avoids the forced sentiment that can arise in commercially-driven healthcare systems as a result of turning medical humanities into bedside manners, and it would be a great service to medical education if this book were available internationally.
Helman ennobles the tradition of good doctoring whilst trashing the fashionable science that has come to inform it; for example, he derides genetic determinism as creating ‘diseases of information’. He recognises that sensitivity and exposure to trauma have to go hand-in-hand if medical education is to be open and patient-focussed. He sees the honest practice of medicine as a necessarily limiting profession, creating a dependency between physician and patient, but he takes a shamanistic stand on this, affirming that ‘in order to become a healer it may be essential to become wounded in some way.’ (p.113). It is a timely reminder of what we owe his profession, and it is by no means a book that speaks only to medical and healthcare practitioners. I wish I had a book like this twenty years ago as a touchstone for my entry into the improvisational and hybrid profession of arts management in healthcare research contexts. It presents a powerful rationale for an underlying culture of healthcare, so often ignored in NHS re-structuring and the evidence demands of policy makers, and it bears witness to non-cloying presentations of healing illuminated by humanist values and a humble practice.
Reviewed by Mr Mike White, a Senior Research Fellow in Arts in Health at the Centre for Medical Humanities and St. Chad’s College, Durham University.
Correspondence to Mike White.
Berger J. A Fortunate Man.: The story of a country doctor. London: Allen Lane The Penguin Press, 1967
Illich I. Limits To Medicine. London: Boyars; 1976.