Endnotes to Scattered Limbs: A Medical Dreambook

SCATTERED LIMBS

[Endnotes to Scattered Limbs: A medical dreambook Galileo 2020]

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THE OTHER KIND OF HEALTH

Inclusion of this now famous phrase of blankly utopian aspiration in the preamble to the WHO Constitution came at the prompting of its first Director-General Brock Chisholm (1896–1971), a Canadian psychiatrist and humanist.

The Medical Garden, a collection of fifty medico-philosophical definitions by Ubaydallah ibn Bakhtishu, last of the dynasty of Nestorian Christian physicians, is available  in Arabic and in French translation by Gérard Troupeau (2008).

WAYS TO STRENGTH AND BEAUTY

Max Nordau (1849–1923) trained with Charcot (►MEN WHO THOUGHT THEY WERE NAPOLEON) in Paris and wrote many antimodernist works decrying what he saw as the harmful effects of rapid industrialisation on the body and mind; a committed altruist, he attacked the “egoism” of artists such as Baudelaire, Wagner, Nietzsche and Wilde as pathological (and requiring medical attention). The last named, while in prison, cited Degeneration (1892) on that very count in his petition for clemency, although he showed that he had lost none of his distinctive wit when he remarked to his friends: “I quite agree with Dr Nordau’s assertion that all men of genius are insane, but Dr Nordau forgets that all sane people are idiots”.

A generation after muscular Christianity became a cultural trend, circa 1850, in English public schools and eventually developed into the YMCA and Olympic movement, Nordau coined the term “Muskeljudentum” (“muscular Judaism”) at the 1898 Zionist Congress, promoting it as the opposite of the stereotype of the rabbinic or bookish Jew.

TAKING THEM SERIOUSLY

WONCA is now the World Organization of Family Doctors: www.globalfamilydoctor.com. Willy Wonka is a character in the children’s novel Charlie and the Chocolate Factory (1964) by Roald Dahl.

A VERSION OF PASTORAL

The most philosophically important version of pastoralism—which always presupposes a very harmonious kind of society—is Heidegger’s famous recipe in his “Letter on ‘Humanism’”: “The human being is not the lord of beings. The human being is the shepherd of being.” Pathmarks, ed. William MacNeil (1998).

UNACKNOWLEDGED

In some versions of the Arthurian legend, Percival or Parzival does cure the Fisher King (“Amfortas” in Wagner’s opera) of his unspecified injury (probably a groin injury and therefore marking his inability to propagate the lineage charged with guarding the Holy Grail) by asking “the question”.

ONE BETTER THAN HOUDINI

Birth is of course the prototypical human drama that marks the departure from animal being (enwombed foetus) to arrival as an individual. “Being born” is one thing; “seeing the light of day” a different existential event. As the Munich comic Karl Valentin (1882–1948) quipped: “On glimpsing the light of the world and then the midwife I was speechless. You know, I’d never seen this woman before in my life” (►A DIVORCE).

ANGELS AND PROSTITUTES

The nursing profession, like other institutions today, has been caught up in the flight towards abstraction: many nurses believe it an insult to their intelligence to have to perform intimate acts of body toilet for patients, especially when such acts are so undervalued by the public (if not by patients).

A LISP

In his humorous article “Comment soigner son médecin” (“How to look after/cure your doctor”), Marc Zaffran (Martin Winckler) asserts that “A doctor isn’t necessarily someone who’s always patient”, goes on to suggest that his condition is beyond remedy, and finally advises the reader to look after him: “He’ll be eternally grateful to you and the way things are, you never know when you might need a doctor…” (En soignant, en écrivant, 2001).

A VISCERAL ATTACHMENT

Ursula Le Guin’s “Carrier Bag Theory of Fiction” in the book of the same title (2019) insists that the first genuine cultural artefact was a container. “We’ve all heard all about the sticks and spears and swords, the things to bash and poke and hit with, the long, hard things, but we have not heard about the thing to put things in, the container for the thing contained. That is a new story. That is news.”

One of the attributes of Hermes as the god of travellers was a little satchel or pouch. It wasn’t a Hermès™ bag though.

THE SERPENT AND THE STAFF

Lynne A. Isbell’s The Fruit, the Tree and the Serpent: Why We See So Well (2009) offers the ingenious theory that visual acuity developed in fruit-eating primates (and ultimately Adam and Eve) at the expense of smell discrimination under the selection pressure of having to avoid limbless squamates, which evolved at roughly the same time. The great Nicolas Poussin considered the risk of a mortally dangerous snake bite common enough to include it in one of his brilliant late works Paysage avec un homme tué par un serpent (1648).

MAKING PROGNOSES

Axiology is the overarching term for the study of ethics and aesthetics, and is grounded on questions of value. Before the modern period, one of the core principles of Aristotelian philosophy, with its framework of virtues and vices—was that all actions were to be interpreted teleologically, that is explained in terms of their purpose or goal. Accurate prognostication could therefore be considered a teleological warp halfway between functionalism and prophecy.

[20] ANECDOTES

There are so many books to recommend on the topic of anecdotes, but one of the best is John Gross’s New Oxford Book of Literary Anecdotes (2007). The anecdote is “a natural home for disabused views and unflattering close-ups, for a ludicrous or disreputable detail which you can’t find in official tributes.”

HEAD OF ZEUS

Evelien Bracke’s contribution “Between Cunning and Chaos” in Liddell and Scott: The History, Methodology, and Languages of the World’s Leading Lexicon of Ancient Greek (2019) unpicks the different meanings which have accreted around the important Greek term “metis”.

CHEKHOV’S CONFIDENCE

Chekhov accomplished much in his short life (he was 44 when he died in the spa town of Badenweiler in the Black Forest) but his arduous journey by carriage and steamer to the penal colony of Sakhalin, an island north of Japan, stands out. He stayed for three months and wrote a detailed study of the convicts’ conditions (Ostrov Sakhalin, 1894, his longest work) which argued that the government had a duty to provide more humane conditions: see my essay “Chekhov Goes to Sakhalin” in A Doctor’s Dictionary (2015).

SMALL DEATHS

As Jenny Diski writes, in one of the exceedingly pert essays collected in “Why Didn’t You Just Do What You Were Told?” (2020), of being amazed to discover, aged 17, that her feckless father had accomplished something “as weighty as death”. Dying is the most committed thing any of us will ever get around to doing.

A GENUFLECTION

Huston Smith in The World’s Religions (1991) reports that some Native Americans pray by sitting together, eyes open, and naming everything they see, thereby expressing in the most direct manner possible what Albert Schweitzer called “Ehrfurcht vor dem Leben” (“reverence for life”).

THE WORLD IS ROUND

The “spherical ideal beings” in Timaeus refers to the handiwork of the supremely good Craftsman in his construction of the world’s body, in which the various elements are brought together in the most perfect form: a sphere (►A VISION OF THE HIGHER LIFE).

A MAJOR INCOMPATIBILITY SYNDROME

“Dandyism is the last spark of heroism amid decadence”, declared Charles Baudelaire in The Painter of Modern Life (1863).

MARXISTS AND THE MARKET

Frank Furedi is associated with Sp!ked (https://www.spiked-online.com/), an online magazine with a libertarian outlook. His trenchant views on the politicisation of health and the medicalisation of politics echo those of earlier social critics such as Ivan Illich or Jacques Ellul with roots, respectively, in radical Catholicism and Christian anarchism.

LI MEDICI ME CREARONO E DISTRUSSONO

Leonardo (who had no medical training and very little beyond elementary instruction) might have been right to keep his distance from the physicians of his time but he certainly ended up as the most famous medical illustrator ever: see the Metropolitan Museum of Art’s publication Anatomical Drawings from the Royal Library Windsor Castle (1983).

THE BODY OF POWER

Idi Amin’s “VC” was his own invention, as were many of his titles “including being ‘King of Scotland’”: “Victorious Cross” in emulation of the Victoria Cross, the most prestigious award for valour in the British armed services (►TELLING THE TRUTH TO POWER).

A GLIB PHILOSOPHY

Epicurus’ famous phrase is sometimes known as the “vacuity problem”: the body in the library is never one’s own.

TAKE UP YOUR BED

Mirko Grmek’s compendious Histoire de la pensée médicale en Occident (1995) makes it clear that medicine began to distinguish itself from the administration of charity (caritas)—a Christian virtue—only in the late Middle Ages: beforehand those cared for were not patients as such (the word became a medical one only in the late fourteenth century) but the poor.

CRAFTS

It is only with the appearance of Odysseus, in Homer’s other book, that the notion of cunning or “craftiness” (metis) begins to emancipate itself from the making of things (“crafts”), a form of wisdom in its own right. Even Odysseus had to rely on a craft—a shipshape vessel—to get him home (►HEAD OF ZEUS).

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PANICOLOGY

The primitive “panic attacks” that antedate the establishment of the human community, and which return whenever we experience the social order breaking down have been examined by many commentators, notably by Elias Canetti in his unclassifiable Masse und Macht [Crowds and Power] (1960) or, more recently, Jean-Pierre Dupuy in his booklet La panique (1991).

FIXATIVES

In addition to its many distant derivatives (which include paracetamol/acetaminophen and the indigo dye of blue jeans), coal tar itself—a complex of phenol, polycyclic aromatic hydrocarbons and heterocyclic compounds produced by heating coal—is on the World Health Organization’s “List of Essential Medicines” as a topical application (largely for psoriasis): it has many properties including anti-inflammatory ones, although its precise mechanism of action has yet to be fully determined.

THE DISPENSATION

I started my clinical training as a medical student in Glasgow hospitals in 1980 (a year after Mrs Thatcher came to power with her robust vision for the future), so am old enough to have worked under some of the often admirable figures who were the wizards and wisemen, soothsayers and sleuthhounds of the national medical drama. Few managers (“administrators”) were in evidence then (►POETS AND MANAGERS).

THE TRICK IS TO KEEP BREATHING

Nothing happens in The Symposium by accident, and the episode of the hiccoughs has been interpreted as evidence of Plato ridiculing not the physician Eryximachus but the playwright Aristophanes for mocking Socrates in his play Clouds. The real trick for suppressing hiccoughs, as Eryximachus (“belch beater”) says, is to stop breathing—for just as long as it takes to suppress them.

A NEW SOPHISM

David Hume’s concern with the importance of style, rhetoric and language, both spoken and written, were an important aspect of the Scottish Enlightenment, one shared by his friend Adam Smith as shown by the latter’s essay Considerations concerning the First Formation of Languages (1761). Having lost the battle of arms, eighteenth-century Scots intellectuals set out to impress London and Paris with the drum music of ancient Athens (►IN THE DARK).

MONEY (THAT’S WHAT I WANT)

Electric and Musical Industries (EMI) was a British conglomerate making everything from television sets to guided missiles: in 1967, 30 percent of the company’s profits came from Beatles’ sales; the Fab Four were earning so much in dollar receipts they reportedly saved the Labour government from a currency crisis (but only until the next one). Although Godfrey Hounsfield’s CT project had government support, additional innovation funding slushed over from elsewhere in the business which (like so many other British businesses), failed to profit from its invention. Hounsfield received a Nobel Prize and a knighthood.

SPECIALISTS, EXPERTS AND LEARNED DONKEYS

Professions are no longer the bulwarks Nietzsche had in mind. Their ability to self-police and enjoy monopolies of expertise has been decisively eroded by government: it is unlikely that the denizens of the twenty-first century with its “consensual” systems and AI networks will either need or want teachers, accountants, architects, lawyers and doctors to work as they did in the twentieth, not to speak of the nineteenth century.

TOO CLOSE FOR COMFORT

It is a nice irony to read, in Roy Porter’s classic Quacks: Fakers and Charlatans in Medicine (2003), that ambitious young doctors introducing new technologies—“such as the ophthalmoscope”—in the mid-nineteenth century were liable to be denounced by old-guard practitioners as “stooping to ‘quackery’”.

A LOOPHOLE

In a review of Auden’s poetry (London Review of Books, 4 June 1987) Seamus Heaney observed that the ear, “no matter how ignorant it may be of the provenance of what it is hearing”, picks up on the tension between rhythmic modern English metre and “the deeper, longer oar-work of Old English”—its “slug and heave”. The notion of two contrary forces uniting in the thole-pin—one force expanding infinitely, the other attempting to locate itself in this infinity—would have been recommended itself to Coleridge as a splendid example of how the entire “world of intelligences” comes into being.

THE ZIMMERMANN BOY

The Zimmermann (German for “carpenter”) boy is also the dishevelled songwriter from Minnesota who stepped uncertainly onto the American folk scene in the 1960s; his surname is actually “Zimmerman”. Politics, to quote Max Weber’s translated maxim at greater length, is a “slow, strong drilling through hard boards, with a combination of passion and a sense of judgement” (“Politics as a Vocation”, 1918).

OUR NEWEST COLONY

Lichtenberg’s contemporary, the great Immanuel Kant, in his last lecture course—published as Anthropologie in pragmatischer Hinsicht (1798)—came up with an even more interesting definition than Lichtenberg’s: “The disease of the hypochondriac consists in this: that certain bodily sensations do not so much indicate a really existing disease in the body as rather merely excite apprehensions of its existence: and human nature is so constituted—a trait which the animal lacks—that it is able to strengthen or make permanent local impressions simply by paying attention to them, whereas an abstraction—whether produced on purpose or by other diverting occupations—lessens these impressions, or even effaces them altogether”.

DOMESTIC BLISS

While “American standard” was emerging in the 1920s, the Bauhaus design school in Weimar was developing a total programme for modern living. This is the mission statement of Ernő Kállai, editor-in-chief of Bauhaus publications, in 1930: “Today everyone’s in the know. Apartments with lots of glass and gleaming metal: Bauhaus style. The same for home hygiene minus a homely atmosphere: Bauhaus style. Tubular steel armchair frames: Bauhaus style. Wallpaper patterned in cubes: Bauhaus style. No picture on the wall: Bauhaus style. Incomprehensible picture on the wall: Bauhaus style. Printing with sans-serif letters and bold font: Bauhaus style. everything in lowercase: bauhaus style. EVERYTHING IN CAPITAL LETTERS: BAUHAUS STYLE.”

JOINING THE RIGHT GUILD

One of the crucial developments from the Middle Age tradition of trade guilds— confraternities of trades in a single city that professed to be professional associations but were

organised as cartels and run as secret societies—were the universities: the first university in Europe, Bologna, emerged as a guild of students in 1088.

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AN UPROAR

The book to read on ethnography—a comic masterpiece about an anthropologist venturing on his first field study (to Cameroon)—is Nigel Barley’s The Innocent Anthropologist: Notes from a Mud Hut (1983).

MEN WHO THOUGHT THEY WERE NAPOLEON

The philosopher Hegel wrote to his friend Friedrich Immanuel Niethammer at Jena on Monday, 13 October 1806: “I saw the Emperor—this world-soul—riding out of the city on reconnaissance. It is indeed a wonderful sensation to see such an individual, who, concentrated here at a single point astride a horse, reaches out over the world and dominates it.” Hegel, The Letters (Bloomington, 1984). The battle of Jena-Auerstedt took place the following day, one of Napoleon’s most overwhelming victories and a humiliation for Prussia, which began the civil and military reforms that would turn it into the driving force of European politics sixty years later.

A BIG BARREL OF HUMANITY

The poet Craig Raine has an insightful essay on Dickens’ sly way with idioms , “Dickens and Language”, in his collection Haydn and the Valve Trumpet (1990).

WHAT’S YOURS?

A cottage industry of sophisticated self-help books now peddles philosophers, from Socrates to Wittgenstein, as life coaches, therapists and spiritual gurus. Recent titles include John Kaag’s Sick Souls, Healthy Minds: How William James Can Save Your Life (2020) and Massimo Pigliucci’s How to Be a Stoic: Using Ancient Philosophy to Live a Modern Life (2017). Alain de Botton’s How Proust Can Change Your Life (1997) launched the genre though Proust was no philosopher in the conventional sense (►A WORD TO STAND BY).

IN A CRITICAL STATE

In our world of seemingly autonomous decision making, we preserve a vestige of the ominous weight of the word “decision”, a noun of action derived from a Latin past participle stem, literally “to cut off”: de- + caedere “to cut”. In the ancient world, decisions were so important that haruspices or entrail readers would be consulted before every major matter of state.

LOST IN ACTION

Paul Valéry didn’t think very much of philosophy or philosophers and yet the task he set himself was the classic Cartesian one of rethinking things anew, re-cogitating and reconsidering them without the usual penumbra of politics, history or rhetoric. “‘Opinions,’ ‘convictions,’ and ‘beliefs’ are to me like weeds—confusions,” he wrote in his famous Cahiers. “All metaphysics results from a bad use of words.” He tried to cleanse language and give words definitions more precise than those found in dictionaries. “The vain and useless notion of ‘cause’ is the utter ruin of all good representation.” “Philosophie”, Cahiers I.

Q&A

“I’m afraid,” Paul Valéry also wrote in his notebook, “I might be beginning to find a feeling of vanity in me—thinking I’m something—which until now was quite foreign to me.” This feeling has a pleasant taste he remarks, “like some kinds of poison,” although in leaving he admits he hasn’t obtained “what [he] would have desired from the world.”

THE DRAWING BOARD

“From the moment when I entered the operating theatre,” wrote Barbara Hepworth, “I became completely absorbed by two things: first the extraordinary beauty of purchase and coordination between human beings, all dedicated to the saving of life… and the way that unity of idea and purpose dictated a perfection of concentration, movement and gesture and secondly by the way this special grace (grace of mind and body) induced a spontaneous grace composition, an articulated and animated kind of abstract sculpture very close to what I had been seeking in my own work”. A Pictorial Autobiography (1970).

IN THE STRIP MINES

Shoshana Zuboff explores the logic of surveillance capitalism and its social, political and economic implications for the present century in The Age of Surveillance Capitalism: The Fight for a Human Future at the New Frontier of Power (2018).

THE HOLE AND THE WHOLE

Holes are strange entities. They are, as the German writer Kurt Tucholsky noted,  ontologically parasitic—nobody ever saw a hole existing by itself. Whether they ought to be trimmed with Ockham’s razor and made to vanish—holes being only the negative parts of mereological complexes like the torus (►A VISION OF THE HIGHER LIFE)—or given equal footing with other material objects is one of those tricky issues philosophers have to tackle when they examine commonplace assumptions about the world. Insofar as “holes”  often entail the evacuation of “wholes”, their homophony allows for some high-level epistemological punning, if only in English.

SADDLE UP

Saddles are also strange entities, but very practical ones. Perhaps it’s worth pointing out that the equestrian saddle, with its cantle and pommel, wasn’t just conceived to raise the rider well above an equine status symbol and offer extra riding comfort and security. Its bearing surface also protects the horse from the rider’s weight, distributing it more equitably (force per unit area) across the spinous processes: saddles are meant for horses too.

A DREAM OF MOIST MARBLE

This dream reverses the vitalism of Pygmalion and Galatea in Ovid’s Metamorphoses, or the “living statue” tradition that made its horrific entrance in Mary Shelley’s Frankenstein.

THE FOLLOW-UP

Surveys have shown over and again that the person most trusted by individual patients is their personal doctor (if they have one): the dilemma for the doctor is not to become so friendly with the patient as to forego the advantages of clinical distance.

A DIVORCE

“How are you?” I asked him. “I’m good,” he replied in the American way. He was feeling well, of course, but his lingering on “good” made me think he was hinting at something more than mere bodily health.

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GENTLE AND HONEST MAN

William Empson dedicates one of his intricately learned essays to the far from straightforward history of the “Honest Man” in The Structure of Complex Words (1951).

PITY AS A FALLACY

It is difficult to know what’s going on in the medical humanities movement (since I’m so rarely asked to contribute to its proceedings), but the adjunction of that warm word “humanities” certainly appears to be an attempt to disarm criticism in advance. Contemporary medicine suffers from having to bear more symbolic weight than it can properly carry because its boundaries have shifted and become indistinct. Other agendas are out to co-opt it. And things are no better in the “humanities”. Almost a hundred years ago, Paul Valéry wrote: “The noun ‘Humanities’ galls me no end. The claims it makes for itself; the vagueness with which it is defined; the obvious effects of the regard in which it is held—those are what stings my reaction” (“Enseignement”, Cahiers II).

BEING IN THE PAPERS

George Orwell once wrote that “autobiography is only to be trusted when it reveals something disgraceful”. Oliver Sacks’ On the Move (2015), published when its bearded, avuncular author had become almost a secular saint, meets that demand with aplomb, revealing his shame about his homosexuality (his mother once called him “an abomination”), schizophrenic brother (who “went mad so that the rest of you could stay sane”), appalling bulimia, reckless biking (as the “Wolf” astride his BMW) and not least weekend drug habit (major amounts of hallucinogens and speed) that he managed to quit only when he was forty. The most startling revelation, however, comes from his poet-friend (and fellow drughead) Thom Gunn who told him in the mid-1960s that he found him talented—“but so deficient in one quality… humanity, or sympathy, or something like that.”

A FORTUNATE STATE

Twelve weeks after Winston Churchill declared victory in the war against Nazi Germany, the British people voted heavily in favour of a Labour government that promised to establish the welfare state: this was born “the post-war consensus” (►AMONG THE METHODISTS). Things must have been bad: the young J. G. Ballard arrived in the UK from China and found it “impossible to believe that they had won the war.” Weeks of heated discussions took place between the Minister of Health Aneurin Bevan and the British Medical Association, a cross between a doctors’ professional association and trades union; doctors threatened to boycott the new service if they were directly salaried by the state.

In the end, a compromise was found, as it always is: doctors became “independent contractors”, retaining some of the privileges of self-employment, but more importantly, were paid by “capitation”—a fixed yearly sum based on the number of patients registered with their practice irrespective of whether those patients used its services (►TOTAL LIABILITY). The latter gave general practitioners a margin of financial safety, and spurred the “golden age” of general practice (►BLINDED).

LUMINESCENCE

Latin for “foolish flame”, ignis fatuus is an inkhorn term for the flickering phosphorescent ghost-light sometimes observed over swampy terrains, and more commonly referred to as “will-o’-the-wisp”. The lines cited from Emily Dickinson’s short poem “Those—dying then” close a meditation on the absconded God which takes a pragmatic attitude to the benefits of faith (►IN THE DARK).

WHEN THE FIRE FLICKERS

The German philosopher Byung-Chul Han’s book on this topic Müdigkeitsgesellschaft (2010), translated as The Burnout Society (2015), argues that excessive positivity—the desire to persevere and be effective—has led workers in our competitive, service-dominated societies to become self-exploiters, prior to imminent collapse. “People are now master and slave in one. Even class struggle has changed into an inner struggle against oneself.” We are not so much the subjects of disciplinary repression as Foucault had it; rather we are “achievement subjects” invited to have “life plans,” sold the gospel of self-improvement (►WHAT’S YOURS?) and driven to be “high achievers” (►BEND OR BREAK).

“Burn-out” is listed in the Eleventh Revision of the International Classification of Diseases (ICD-11) not as a medical condition but as an occupational phenomenon; it is defined as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed” (►BENEFITS OF THE NEGATIVE).

THE CIVIL STATUS OF MEDICAL DEFINITIONS

In circular reasoning there is no logically compelling reason to credit an argument if its premises assume the truth of its conclusion. Also known as begging the question (►ILLNESS AS ROUTINE INTERROGATION).

JOINING THE OTHERS

I was trying to be witty but had forgotten that medical escort agencies do exist, employing doctors and especially nurses for the repatriation of non-critical patients in commercial aircraft.

GRACE TIME

The passion for managerial theory (and control) is everywhere, from conceptual art to  politics: what counts are outcomes, because outcomes can be measured and monitored—this is what most people understand as “science”. From my perspective it looks like a bureaucratic flight from grubby reality.

A REVELATION

The lines of the Elizabeth Bishop poem that came to mind, in a province of south Sumatra, were from “Questions of Travel”, which goes on to wonder whether people travel so much because they lack imagination. G. K. Chesterton thought so too: “The globe-trotter lives in a smaller world than the peasant” (Heretics, 1905)

CARNIFEX

The carnifex was the public executioner in ancient Rome.

NO PLACE TO HIDE

As John Gray puts it in his little book on Voltaire, “No modern society that has tasted the fruits of science and history can suppress the knowledge that it has thereby gained.” (Voltaire and Enlightenment, 1998). Cf. Paul Valéry: “The invention of anaesthetics is anti- metaphysical” (“Philosophie”), Cahiers.

SPLIT AND DOUBLE

William Empson’s theory of asymmetry constitutes Chapter 5 of the posthumously published (and extensively illustrated) The Face of the Buddha (Oxford, 2016), 81–106, annotated by Rupert Arrowsmith. The other two works cited are Julian Jaynes’s The Origin of Consciousness in the Breakdown of the Bicameral Mind (Boston, 1976) and Iain McGilchrist’s The Master and his Emissary (New Haven, 2009) which, although also concerned with the bicamerality of mind, contends that Jaynes actually inverted the true sequence of events: our two cerebral hemispheres run largely separate households with intervening dumbwaiters.

MAKING GOOD

Milton calls Raphael “the affable archangel”: not just an avuncular figure in the modern sense but the archangel, as Owen Barfield points out in his essay “Coleridge’s Enjoyment of Words, “who could be spoken to by a mere man”.

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TRANSLUCIDITIES

I’ve never been able to take André Breton entirely seriously after reading Octavio Paz’s account of visiting him at his Paris home. Asked to wait, he observed Breton scribbling away furiously while reaching repeatedly into his desk drawer. “What are you working on, maître”, he tentatively asked. “I was doing some automatic writing”, replied Breton. “But I saw you rubbing out over and over again!” exclaimed Paz. To which Breton replied, “It wasn’t automatic enough.”

THE CURSE OF VENUS

Uri Friedman in an article in The Atlantic (13 February 2016) admits that Americans are “exceptionally promiscuous when it comes to professing their love”, even if the love in question is not of the hotly Venusian kind. In most cultures, it indicates a serious romantic commitment, or is simply not said at all, actions speaking louder than words. In America, it is a kind of verbal tic; and can be inflated into slogans like McDonald’s “I’m lovin’ it.”

ILLNESS AS ROUTINE INTERROGATION

On the other hand, there is Socratic questioning or maieutics (►MAN-MIDWIFE) which employs a rigorous set of questions to tease out ideas and determine the validity and logic of a person’s thinking. Psychoanalysts and lawyers have frequent recourse to it. Many of Socrates’ answers are further questions in disguise, all ultimately intended to help his interlocutors to tell the difference between what they thought they always knew and what they now know  they don’t know. Dr Greg House employs it all the time (►BENEFITS OF THE NEGATIVE).

PREFERRED TARGET

The distinction—of apotropaic importance—between the menace of infection and the taint of violence may be very fine: the plague in Sophocles is usually referred to as nosos, “sickness”, a word which informs the medical term nosology: the classification of diseases.

ADDED VALUE

The American sociologist Talcott Parsons came up with the functionalist term “sick role” in 1951—a “sanctioned deviancy” that allowed the ill person, as a non-productive member of society, to be exempted from the usual social rules while being policed by the medical profession. This is a category distinct from the perceived merits of the Romantic sick role, in which a person did everything he or she could not to minimise the disruptive impact (or appearance) of being ill.

LISTEN IN

Miguel Torga was the pen-name of Adolfo Correia da Rocha (1907–95), one of Portugal’s major twentieth-century writers. He spent most of his life in the Trás-os-Montes region of northern Portugal during the Salazar regime and worked on his diaries from 1932 to 1993, recording the day he first used penicillin (1 February 1945) as well as vivid moments of triumph and devastation in the “unholy pact that grows unbidden between doctor and patient”. Two works by Torga are available in English translation: The Creation of the World (2000) and Tales and More Tales from the Mountains (1995).

AFTER YOU

There are many other figurative expressions to convey the fact of terminal non- responsiveness: “kicked the bucket”, “left the conversation”, “woken up under a cypress”, “crossed the Jordan”, and so on. The famous Monty Python “parrot sketch” offers a whole other slew of possibilities.

PRIVILEGES OF THE KITCHEN

I spend a lot of time in the kitchen myself, but I must confess I don’t follow recipes very often. Cooking without a recipe is a skill that comes with experience, and after reading Niki Segnit’s The Flavour Thesaurus (2010) I started experimenting with flavour combinations. One of my wizard moments was grinding some green cardamom seeds and adding them to the pale amber potion of Japanese quince (Chaenomeles japonica) slowly simmering on the stove, thus creating the most exquisite “gelée de coings du Japon”.

APOLLO AND MARSYAS

It didn’t bother Dizzy Gillespie that he looked like a bullfrog when he played the trumpet: his cheek muscles were supple enough to store air and deliver it to the instrument during one of his famous extended solos.

AN OXYMORON

Browne writes in his Religio Medici: “At my death I mean to take a total adieu of the world, not caring for a monument, history, or epitaph, not so much as the bare memory of my name to be found anywhere but in the Universal Register of God”. Making a “total adieu of the world” is not something to put down in writing, especially writing of such eloquence, learning and humour that it has never been forgotten in the other, sublunary register.

DR ADAM WILL CALL YOU IN

Max Müller (1823–1900), editor of the Vedas, is remembered for his phrase “mythology is a disease of language.” Most gods, he thought, were names for natural phenomena or attributes that were allowed to “assume a more substantial existence.” He saw the “disease” persisting, in the medieval controversy between Nominalism and Realism (to which Crookshank refers): “Men were called heretics for believing that words such as justice or truth expressed only conceptions of our mind, not real things walking about in broad daylight” (Lectures on the Science of Language, vol. 1, 1885).

Doctors and philosophers share a dependency on established language (a mix of rhetoric, logic and “folk memory”) but whereas diseases are time-bound processes, no  concept is ever observable.

LIVING LIKE A GOD

Dostoevsky in this last novel The Brothers Karamazov (Book I, chapter 5) suggested that modern society was a godless reversal of the old story of the tower of Babel, and that we have presided over its construction “not to mount to heaven from Earth but to set up heaven on Earth.”

CIRCUS ACTS

Galen’s dismemberments of live animals are perhaps forgotten precursors of the antics of some contemporary “performance artists” in which audiences are exposed to ever more graphically visceral tactics to overcome the supposed confines of mere art, cf. Hermann Nitsch’s “Aktionen”.

POLITICS AND MADNESS

Frank Ankersmit, in Sublime Historical Experience (2005), suggests that the “sublime” is an overwhelming new reality experienced as a traumatic historical event, in which fear and rapture, awe and terror are melded at a pitch of intensity exquisitely high enough to arouse paradoxical emotions.

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LICK AND SNIFF

Recent studies have shown that respiratory viruses—and other disease processes—can be distinguished by the telltale odours they induce in the human body, a phenomenon now being exploited by dog trainers. Dogs have 350 million sensory receptors dedicated to olfaction as compared to the human 5 million.

WARMTH AND COMFORT

Schopenhauer’s little animal story about polarities clearly exemplifies one of the basic schemes of classical logic: the law of the excluded middle.

SAMARITAN LOGIC

A distinction should be made between destitution (“la grande pauvreté” or “misère” in which a person lacks even the bare necessities) and relative poverty. Albert Camus came close to some Catholic thinkers when he asked his notebook: “What can be desired more than poverty? I don’t mean misery or the hopeless toiling of the modern proletariat. But I don’t see what is more to be wished for than poverty combined with an active leisure” (Carnets 1935– 48).

MY HANDS ARE MY HEART

Gabriel Orozco is a contemporary Mexican artist working in many different genres (installation, video, sculpture, painting and photography) with a knack for giving mundane objects a new lease of life (like his midshortened “DS” car). His mid-career retrospective at MOMA in New York in 2009 was also seen (by me) in Basel, as well as in Paris and London. Mis manos son mi corazón is a small sculptural object made by the impress of his fingers in wet clay, then photographed by the artist in an open and closed hand diptych.

At the other end of the scale is his Dark Wave (2006), a suspended 14-metre roqual whale skeleton. The bones were put together by a team of twenty people working for three months before being cast in calcium. Orozco describes it as a “drawing”—perhaps because the bones are covered in hand-inscribed concentric circles, which take on the appearance of rippling water or sound waves animating its vast bulk. It is, like his clay heart, unexpectedly delicate.

WHAT WE KNOW

Cf. Simone Weil: “En toutes choses, seul ce qui nous vient du dehors, gratuitement, par surprise, comme un don du sort, sans que nous l’ayons cherché, est joie pure” [With all things, it is only that which comes to us from outside, unbidden and by surprise like a random gift, without our having sought it, which is pure joy”] Grace et pesanteur, 1947.

BARE PLOTS

The intrepid writer and critic Viktor Shklovsky (1893–1984) somehow managed to survive the Soviet Union despite plotting against the Bolshevik revolution and being irreverent about politics for the rest of his life. He was a great admirer of Laurence Sterne’s divagatory prose, and a close friend of Sergei Eisenstein, the film director. Like the other Russian Formalists, he was interested in what might be called “textual dynamics”: studying how specific registers, syntax, sounds and figures of speech are deployed in literature over against its social, psychological and historical aspects.

WORK AND LEISURE

I wrote in 2010 about the true meaning of “leisure” in an essay “On the good life” which itself refers to a seminal short book on work and play, Josef Pieper’s Leisure: the Basis of Culture, published in German in 1948 and translated into English fifty years later. Pieper’s explanation of the cultural origins of returns to classical sources, and has little in common with what goes by that name in late capitalist society—and was, until 2020, the world’s single largest economic activity.

A LOST CAUSE

The Oxford Centre for Animal Ethics, established in 2006, reminds us that the city has been home to some heated debates about the fate of animals, long before Ruskin resigned his Slade Chair of Fine Art after the vote to allow experimentation on live animals for the sake of knowledge. While a fellow at Christ Church, Lewis Carroll (Charles Dodgson) had penned an anti-vivisectionist tract Some Popular Fallacies about Vivisection in 1875. His concern with the plight of the powerless was followed by his famous nonsense poem The Hunting of the Snark (An Agony in 8 Fits) in which a crew of ten very eclectic characters whose names all start with the letter B set out to hunt the elusive hybrid creature, the mysterious Boojum.

FALLEN ARCHES

The original fluoroscopes were relatively simple X-ray devices consisting of a source and a fluorescent screen, sometimes with image intensification, which could then be viewed by the examiner (or in this case the youngster getting a new pair of shoes). Their main advantage was to allow real-time moving images to be displayed, but at the cost of exposing the patient (and sometimes examiner) to a higher absorbed dose of radiation than would be required for a static radiograph. Fluoroscopes were used as early as the First World War to enable surgeons to detect embedded bullets and low-dose versions continue to be used in airports for security checking of luggage—as well as in diagnostic medicine.

FUROR THERAPEUTICUS

“Every sentence was once an animal”, wrote the novelist Ben Marcus in the epigraph to his novel The Age of Wire and String, lending a snarl to Emerson’s “Every word was once a poem”. For Paul Valéry, the language itself is an animal (“l’animal-langage”) which gets the better of us much more often than we do it.

Who would expect to find a hunt disporting itself across the antiseptic floor of a clinic? Or a pack of reporters gone on the rampage? And yet with that German adverb “blindlings” Kafka shows that he understood the very nature of the dogged pursuit of an illness (his terminal one), and the “nothing else matters” mentality that prevails at such uncanny moments.

DIAGNOSIS AND TREATMENT

Learning Latin was important in medicine (and other fields) until the end of the nineteenth century as an exercitio intellectualis: according to Henri Ellenberger, those who make it through this test are mentally equipped to construct a vast synthetic vision of their own (Freud, Jung, etc.).

TRAPPED BIRDS

One of the best places to look for precise systematic descriptions of natural objects that are  not intended to evoke lyrical overtones is the botany textbook. Leaf surfaces, to mention only one part of the plant, have many descriptors, e.g. “tuberculate” (“bearing small warty protuberances”), “punctate” (“dotted with minute pits”) or “rugose” (“wrinkled”). Hundreds more such terms exist, most of them Latinate. A copious terminology can also be found in the descriptive medical sciences such as histology and pathology.

The great importance of overtones in medicine is that hearing technologies offer the possibility of exploring the interiority of the body without violating it. A kind of corporeal eavesdropping nonetheless.

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A HAGIOGRAPHY

A hagiography is a biography of a saint or, by extension, an adulatory and idealised biography. Nietzsche, as might be expected, was suspicious that those who attracted the term were actually making life easier for themselves: “The saint, then, makes his life easier by that complete abandonment of his personality, and a man is fooling himself when he admires that phenomenon as the most heroic feat of morality. In any event, it is harder to assert one’s personality without vacillation or confusion than to free oneself from it in the manner described; it also takes much more intellect and thought”. Menschliches, Allzumenschliches, 139.

ETHICS OF PERFECTIBILITY

The notion of the perfectibility of humankind is one of those vague, theosophic ideas which has caused endless harm in political life. Perfectibility of the text is a different matter. I’ve always had a soft spot for the Marxist professore slowly going blind in George Steiner’s novella Proofs, an eminent proof-reader so painstaking and devoted to his task that he cannot allow even a page of scrap newsprint to pass through his hands without making the necessary corrections, errata being more than mere mistakes. “He would deposit it in the garbage receptacle, feeling obscurely rewarded and saddened. Any witness to this rite would have thought him deranged.” The professore has been bitten by the demon of flawlessness (Proofs and Three Parables, 1992).

AN IMMORTAL WINDBAG

The musical windbag is of course the bagpipes, a kind of extracorporeal stomach with attached pipes known in Greek as askaulos. This double-reeded instrument, which requires a “circular” breathing technique in which the player inhales even while storing air in the cheeks, was much favoured by the goddess Athena until she discovered that the other gods laughed at her when she played, no matter how exciting the sound of her reeds. The poet Melanippides of Melos relates that when she caught sight of herself playing, red faced and hamster cheeked, she threw away the reeds and put a curse on the first person to pick them up (►APOLLO AND MARSYAS).

ONION JUICE

As Dr Johnson said (and Socrates before him), we need to be reminded more often than informed.

AUTOMATISMS

As with so many modernist projects, Un cœur fidèle was not a success with its initial public in 1923 but attracted considerable attention from critics and contemporaries who understood its innovative syntax: rhythmic editing, dramatic lighting, distorted lens effects, close-ups and point-of-view shots.

BE HAPPY!

John Stuart Mill’s lines are in his Autobiography (1873). They read in full: “Those only are happy (I thought) who have their minds fixed on some object other than their own happiness; on the happiness of others, on the improvement of mankind, even on some art or pursuit, followed not as a means, but as itself an ideal end. Aiming thus at something else, they find happiness by the way.” I once worked on a health project (i.e. for the improvement of mankind) where our district manager made the instruction “Be Happy!” his mission slogan. He even wore it on his T-shirt.

HYPERFLEXION

The Kafka statement on the ineluctability of suffering is No. 103 of his Zürau aphorisms, written between September 1917 and April 1918.

KIDNEYS AND CITIES

This is James Joyce on the ritual of buying kidneys at the butcher’s in Ulysses: “His hand accepted the moist tender gland and slid it into a side pocket. Then it fetched up three coins from his trousers’ pocket and laid them on the rubber prickles. They lay, were read quickly and quickly slid, disc by disc, into the till.”

HIS PORTRAIT

Paracelsus’ former house and practice “Zum vorderen Sessel”, at Totengässlein 3 in the Basel old city, is now the university’s Pharmacy Museum—what the Swiss Academy of Sciences (SCNAT) calls a “chemical landmark”.

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DOCTARD

Urban Dictionary also offers “doctator”: a hospital doctor or administrator who regularly induces anxiety in order to ensure compliant or conformist behaviour.

NUMBER ONE

The philosopher Alasdair MacIntyre (►ACKNOWLEDGEMENTS) once refused to attend a conference on business ethics because he said the topic was a contradiction in terms. Notwithstanding, his refurbished Thomism has been adopted by academic ethicists specialising in the workings of the marketplace.

ALL THE GAS

The passing reference here is a remark in Novalis’ Das allgemeine Brouillon (Notes for a Romantic Encyclopaedia): “The spirit is the oxygen of the body—the soul is the penetrating basis of oxygen. Life is a fiery process.” Cf. Sir Thomas Browne: “Life is a pure flame, and we live by an invisible Sun within us.” Urne-Buriall, chapter V.

AN ASPHALT VOLTAIRE

As Barbara Cassin observes in her short essay on nostalgia (La nostalgie: Quand donc est-on chez soi?, 2013), to come home refers less to a specific locus than a place where we are recognised.

NOW!

These one-word commands would fit the jussive (in Jesperson’s table of verbal moods) except that English has no aptitude for this grammatical mood. It is still present in German, for issuing third-person orders and commands, except that its imperative force is attenuated by the subjunctive, which mood in English is almost extinct. It ghosts the phrase: “Mr Sharp requests that you give him the scalpel”, where “give” could be construed as a mandative subjunctive.

THE EVENT-COLLECTOR

One of the moral types not described by Theophrastus in his book Characters, which has inspired many authors from Jean de la Bruyère to George Eliot and Elias Canetti.

KAPOSI SARCOMAS

I was thinking of Hervé Guibert (1955–91), who spent the best part of his life after being diagnosed with AIDS in writing about it.

THE CULT OF VESTIGES

For Descartes, in his attempt to sunder all mental processes from bodily functions, the only organ to retain any kind of psychosomatic ambiguity was the pineal gland. The theory that it might be a kind of higher sense organ owes its former popularity to Helena Blavatsky’s The Secret Doctrine, vol. 2 (London, 1988); and C. W. Leadbeater’s The Chakras: A Monograph (Adyar, India, 1927).

OPEN DATA

Data are neither here nor there: there is an endless amount out there in the data fields, and available for all kinds of statistical manipulation to anyone who wants it. What counts is having the right ideas.

DOCTOR SUBTILIS

Duns Scotus was an antiquus and his immediate successor William of Ockham (of razor fame) a modernus.

NEUROIMAGES

See Matthew Cobb’s book The Idea of the Brain: The Past and Future of Neuroscience (2020) which suggests how models for consciousness built on human experimentation have then become metaphors for “brains”: Descartes’ “bellows”, voltaic piles, tiny factories, robots with a mind of their own, and last but not least computers—a word which used to be applied to people who did computations.

PHARMAKON

In parallel with the term pharmakon, which means both remedy and poison, Derrida liked to make the notion of hospitality—which derives from the Latin “hospes”, meaning both “host” and “guest”)—central to his thinking on ethics. Ethics, being an invitation to unknown others to enter one’s home (ethos), is hospitality. “Hospitality is culture itself and not simply one ethic among others.” Like the pharmakon, the welcome extended to the guest may backfire: “hospes” can also mean “enemy”, as the words “hostile” or “hostility” suggest.

ANTIPSYCHIATRY AND THE MARKET

Susannah Cahalan’s The Great Pretender: The Undercover Mission that Changed our Understanding of Madness (2020) is a thorough investigation of the Rosenhan study, and the fillip it gave the anti-psychiatry movement, although as she concedes the deinstitutionalisation of patients was already gathering pace in the US for political reasons. Embarrassed at the study’s revelation of leaky diagnoses (especially regarding schizophrenia), mainline psychiatrists upped the ante, and insisted even more on scientific certainty where it barely existed. The end of the century got the fourth edition of the Diagnostic and Statistical Manual (DSM) of Mental Disorders and tick-box approaches to the diagnosis and treatment of depression.

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EMOTION STUDIES

Confounded by these issues, as we all are, David Hume relates his method of dispelling them in An Enquiry Concerning Human Understanding (1748): “I dine, I play a game of backgammon, I converse, and am merry with my friends. And when … I would return to these speculations, they appear so cold, and strained, and ridiculous, that I cannot find in my heart to enter into them any farther.”

MORE BODY PARTS

In the scene between Katharine, the princess about to be married to King Harry, and her maid Alice in Henry V (Act 3, Scene 4), Shakespeare played for laughs at the Globe by having the French-speaking princess learn the English terms for various parts of the body: “d’ hand, de fingre, de nails, d’arma, de bilbow”. Katharine is scandalised when Alice tells her that the English for “pied” is “de foot”. With her heavy accent she hears it as “foutre”, the French f- word. Shakespeare’s joke is that although Katharine finds the word unspeakably vulgar she still manages to get it out, three times.

SIGN LANGUAGE WITH ACCENTS

Steven Connor makes many insightful remarks about how psychoanalysis “both asserts and assails” the knowledge that patients conventionally believe doctors possess in second chapter “Know Thyself” of his intricate book The Madness of Knowledge (2019).

“J’AI MAL”

The rare term “algodicy”—meaning an apologetic interpretation of the meaning of pain— crops up in Peter Sloterdijk’s sumptuous study of the Weimar era, A Critique of Cynical Reason (1983). In modernity, political algodicy stands in for the older attempt to reconcile pain and suffering with the divine presence (theodicy): citizens hungry for something “positive” after years of disorientation harden up, shoulder-to-shoulder, and spread their unhappiness. “Those who asked for the meaning of suffering in the First World War were drawn… into a region where politics, natural philosophy and medical cynicism met. Scarcely any speaker in those years refrained from medical metaphors: sickness, cancerous growths, operations and healing through crisis” (►ETHICS OF PERFECTIBILITY).

A PERFECT PROFESSION

The Greek word iatromantis means “physician-seer”. Anthropologists have linked this obscure and semi-mythological figure to older Greek and Asian shamanic traditions: the practice of enkoimesis (“incubation”)(►NEWS FROM THE ASCLEPIUM) enabled practitioners to achieve a luminous and equanimous state of mind higher than that of ordinary vigilance and not unlike the samadhi of the oldest Buddhist suttas.

THE ONLY HOPE

Shakespeare’s knowledge of so many things has always astounded commentators, and he was particularly familiar with the body and its failings. Aside from his experiences in the  generally grotty London of the time it is conjectured that some of his medical knowledge may have derived from his friendship with John Hall (1575–1635), a physick and herbalist who married Shakespeare’s eldest daughter Susanna. He had an intensive practice around Stratford and wrote a text, Select Observations on English Bodies: or, Cures Both Empircall and Historicall, Performed on Very Eminent Persons in Desperate Diseases, which was published posthumously in London.

MEASURE THIS

The energetic German physician and dramatist Georg Büchner (1813–37) died of typhus in Zürich, aged 23. Because of his political activities, he was forced to flee his native Hessen in 1834 for Strasbourg, where he wrote his MD thesis and most of his literary oeuvre which includes Lenz, Danton’s Death and Woyzeck, the play for which he is best known today. Left in fragments on his death, it was first published generations later, and served as the script for Alban Berg’s opera Wozzeck, completed in 1922.

WORD-BEASTS

The French cartoonist J. J. Grandville (1803–47) became famous for his sympathetic  drawings of humans in the guise of animals in such sequences as Scènes de la vie privée et publique des animaux, usually drawn from life in the famous Jardin des Plantes; his work went on to exert a major influence on the illustrators of the once famous Punch magazine. They show a keen analysis of character and much ingenuity in finding an expressive animal physiognomy for human propensities. There would have been no equivalent in his animal taxonomy, one suspects, for the “imperturbable” Galen going about his cutting business (►CIRCUS ACTS).

PARTIALITIES

Psychiatry is still dominated by the biological paradigms that sprang up after 1950 which largely if not entirely consigned psychoanalysis to select chambers in major cities, and the pages of The London Review of Books. A series of serendipitous discoveries after the Second World War led to the development of psychotropic medications that are still in use: the antimanic effect of lithium urate was discovered by an Australian doctor who observed that it sedated guinea pigs and tried it on himself; the use of chlorpromazine as the first antipsychotic developed from its experimental application in anaesthesia; iproniazid was designed to treat tuberculosis when it was observed to have euphoriant effect, and give rise to the monoamine oxidase inhibitors used in depression (►FIXATIVES). Psychodynamics and a theory of mind so elastic nothing could falsify it became less compelling when empirical treatments were effective; besides, medically licensed psychiatrists were not slow to realise that only they could sign prescriptions.

THE BENEFITS OF THE NEGATIVE

For all that he is arrogant, brusque and has a drug habit, Dr Gregory House is still in gainful employment. Most of his colleagues accept his flaws, and his antisocial quirks. And the man is not devoid of humanity. In an episode in the first series when forced to do clinic work he encounters Eve, a young student studying philosophy and religion who has been raped. House clearly doesn’t want to be in the room with her, not because he doesn’t care but because he can’t help feeling for her. “You’re going to base your whole life with who you got stuck in a room with?” he asks her. To which she replies, “I’m going to base this moment on who I’m stuck in a room with. It’s what life is. It’s a series of rooms. And who we get stuck with in those rooms adds up to what our lives are.” Of course, at that moment, nobody can miss the fact that she is stuck in a room with House, MD.

INSTITUTIONALISING ALTRUISM

A friend once called Geneva “the world capital for the effective administration of pity”—he was talking about the International Red Cross/Crescent, which has its headquarters in the city. Ditto for the World Health Organization, just up the road. Better that, I thought to myself, than Geneva’s earlier history as Jean Calvin’s capital of religious pessimism.

ARE YOU HOT?

The emancipation of desire is one of the red threads running through Scattered Limbs. Its horizontal extension is explored in René Girard’s various books on mimetic behaviour, its vertical collapse in Philip Rieff’s work, especially his last book on charisma.

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RED EYE SYNDROME

Ocular disorders of these kinds came about because it was believed by the ancient Greeks that the eye itself emitted light. And some eyes could exert a malevolent force: this belief is preserved in the tradition of the “evil eye”, which persists in the Mediterranean and north Africa (►LOVIN’ IN MY BABY’S EYES/SPECTROSCOPY). Some of the apotropaic talismans and amulets made to ward it off are also known as “evil eyes”.

IN THE DARK

Lakoff and Johnson in Metaphors We Live By (1980) aren’t the only thinkers to notice that idioms like “see the light”, “bring something to light” and “ shed light” put understanding cognitively on the side of the angels. The verb “enlighten” has been around for a long time too, but it is thought “the Enlightenment” entered the language to designate the period of intellectual history the Germans were already calling “die Aufklärung” only towards the end of the nineteenth century.

I like to think it coincided with the first patents on incandescent light bulbs prior to their commercial uptake.

THE NEOPLATONIC DOCTOR

As unlikely as it might be for a Plotinian philosopher to be a doctor, it is just as unlikely that Nietzsche’s scorn for humaneness would ever allow him to be the philosopher-physician he thought he ought to be (►EMOTION STUDIES).

A BALM IN GILEAD

We know from Aristophanes’ play Wasps that bespoke dream-interpretations in the Athens of his day could be had from professional diviners for two obols (a third of a day’s wage), so it would seem little has changed in contemporary Paris.

The quote from John Keats is from Porphyro’s midnight feast in stanza 30 of The Eve of St. Agnes, while that from Shakespeare is Lear’s exclamation in Act 4, Scene 6: there’s still money in it.

THE GREAT PARADOX

Psychoanalysis, at the other pole from science, seems to be convinced that error is the outcome of volition. Correct the will and the error vanishes. But what is left is not necessarily truth which, as Popper suggests, is never self-evident.

CUT THROATS

It is easy to imagine a malevolent deity called “Ahor”, a word which makes the skin creep by forcing that common signal word “Ahoy!” further down the throat.

MORE THAN HEALTH

The Global Wellness Institute™ offers adepts a totalising utopian lifestyle, hopes to “reset the world with wellness”, sees a future in real estate, and claims the trillion-dollar wellness economy accounted for “about 5.3 percent of global economic output in 2017”.

HOC EST CORPUS

The little book by the Bosnian Croat philosopher Predrag Matvejevic Our Daily Bread (translated by Christina Pribicevic-Zoric, 2020) is rich in stories about the cultural and symbolic importance of bread: years after his release from the gulag, where he often had no more than the thinnest gruel to sustain him, Alexander Solzhenitsyn continued to place a morsel of bread under his pillow.

INFINITESIMAL DOUBT

It is of course possible to be an anatomist and no physician. This is especially true of critics.

A MARGINAL NOTE

Marginalia—glosses, critiques, comments, footnotes or doodles—are sometimes the most interesting things in books. Medieval manuscripts sometimes resemble comic books, and kabbalistic documents sometimes boast more marginalia than principal text. Osip Mandelstam’s travel piece Journey to Armenia (1930) is itself a voyage through the margins of the many civilisations of the Caucasus.

PERFECTION AS A PROBLEM

The American journalist H. L. Mencken (1880-1956) insisted on medicine’s limited purview: “The aim of medicine is surely not to make men virtuous; it is to safeguard and rescue them from the consequences of their vices. The true physician does not preach repentance; he offers absolution.” The only problem with Mencken’s definition is that “absolution” sounds rather preachy too. He understood that if people aspired to be “perfect” it meant renunciation, itself a kind of spiritual self-destitution or abandonment; now having a fulfilling life implies nothing even remotely as absolute.

THE NEW ASCETICISM

S. T. Coleridge puts it very elegantly, in the first paragraph of Chapter XIII of the Biographia Literaria: “To the best of my knowledge Descartes was the first philosopher, who introduced the absolute and essential heterogeneity of the soul as intelligence, and the body as matter. The assumption, and the form of speaking have remained, though the denial of all other properties to matter but that of extension, on which denial the whole system of dualism is grounded, has long been exploded” (My italics).

METONYMIES

The coronavirus pandemic gives the lie to Adam Smith’s famous claim that “individuals, without desiring or knowing it, and while pursuing each his own interest, are working for the direct realisation of the general interest”, and to Mandeville’s provocations. Without an associative structure based on trust, genuine leadership and action for the general good, individuals pursuing their “own” interests fall into group identities fuelled by resentment and jealousy, and ultimately bring down the house they live in. This is sometimes known as the “tragedy of the commons”.

LEND ME YOUR PARACHUTE!

Peter Sloterdijk’s musings on the primal companion (“afterbirth”) of all mammals, “Requiem for a Discarded Organ”, can be found in chapter 5 of Blasen (Bubbles), the first volume of his Spheres trilogy. Many animals, of course, regularly eat the placenta (placentophagy), even those that are not normally carnivorous.

IMMANUEL KANT IN THE ARMS OF MNEMOSYNE

The rationalist’s dilemma: being unchained to choose and finding no choice worth making.

Immanuel Kant didn’t spend that much time in the arms of Mnemosyne, the truth be told, having developed a philosophy that made an idol of pure reason. The goddess of memory was a deity whom the Greeks thought so fundamental to the civilisational process they made her a “Titan”. Mnemosyne must have nibbled Kant’s ear, because at the end of his famous Critique, he added a postscript titled “The History of Pure Reason” (my italics) which unseats his whole argument, depending as it does on the genesis of pure concepts a priori. Time and space, she was whispering, have always been preceded by sounds and letters.

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MAKINGS OF A CULT AUTHOR

The key to the cryptic productions of Raymond Roussel—a heroic precursor for both the surrealists and the Oulipo generation—is his posthumous Comment j’ai écrit certain de mes livres (1935), translated sixty years later as How I Wrote Certain of my Books (1995).

THE WINGED MESSENGER

The significance of the snake’s shedding its skin in a kind of perpetually recurrent resurrection was not lost on the psychoanalyst Carl Jung who made it “the commonest dream symbol of transcendence”. Its forked tongue has also allied the snake with those who have the gift of the gab (►THE SERPENT AND THE STAFF).

GRANULARITY

William Dunham’s biography Journey through Genius (1991) of the prolific Swiss mathematician, logician and geographer Leonhard Euler (1707–1783) points out that his number-theoretic speculations were abetted by just such a prodigious memory: not only could do complex mental calculations of up to 50 places of accuracy, he could reel off the first hundred prime numbers (and their squares, cubes and up to sixth powers), and recite The Aeneid in its entirety!

MAN WITH A TIN CUP

Alastair Reid’s poetry is worth reading (also published by Galileo as Footloose) as is his prose, particularly Whereabouts: Notes on Being a Foreigner (1987). He says this about his fantasy of running away from home: “Anyone [in Scotland] who did not seem to be following the stone script was looked on as somewhat raffish, rather like the tinkers and travelling people who sometimes passed through the village where I grew up” (“Other People’s Houses”).

HEALTH AND HIDDENNESS

Cf. Paul Valéry on philosophy, which he claims is imperceptible. “It is never in the writings of philosophers—it can be felt in all human works that are not concerned with philosophy and it evaporates as soon as an author wants to philosophise. It appears when a human being is allied to any particular subject or goal. It disappears as soon as he seeks to pursue it.” Cahiers, I, 480.

TEA AND SYMPATHY

Spilling the tea has long been an incitement to gossip. Best not attempted with mugs. HEALTH AND EFFICIENCY

On the ethical plane, as Chesterton and Gadamer realised, scientism was bound to lead to the ideal of the good life (a shared notion of what is worthwhile) being usurped by that of “well- being”, a vitalist extension of the consumer satisfaction survey (►WELL-PERSON CLINICS).

A MAP OF SMELLS

Rose George’s The Big Necessity: The Unmentionable World of Human Waste and Why it Matters (2008), which I read just after it appeared while working in Jakarta, tackles the world’s most neglected issue: disposal of potentially useful but also potentially toxic human waste matter. When I was in Indonesia only 7% of wastewater was treated, and surveys in urban centres such as Yogyakarta showed that more than three-quarters of water sources were contaminated with faecal bacteria.

HEALTH AND PLENITUDE

The ontological argument for the existence of God (►A GENUFLECTION) was first clearly stated and developed by Anselm of Canterbury in the eleventh century, in which he defined God a priori as “a being than which none greater can be conceived”. Since humans are able to conceive other beings including higher ones, God necessarily exists in reality. He is self- evident.

Although the argument has been popular with many philosophers as far back as Xenophanes it is not held in high esteem by believers.

PECKING ORDER OF THE VANITIES

My translation of the famous bungled operation chapter of Flaubert’s scandalous masterpiece Madame Bovary can be found in The Body in the Library (2003).

HEALTH AND THE MARKET SOCIETY

In our permanent revolution, science has emancipated desire to the extent that it has no finality beyond the satisfaction of immediate consumptive or psychological needs (which can of course be studied scientifically). Robert and Edward Skidelsky’s How Much is Enough? (2012) is a comprehensive examination of how we have strayed from anything resembling a common good.

ONE-UPMANSHIP

My essay on Jules Romains’ play Knock ou le Triomphe de la médecine (1923) can be found in A Doctor’s Dictionary (2015). This satirical play opens with the arrival of a rather Machiavellian new physician in a small town in the Midi where most of the rural patients are in rude health. Dr Knock decides to make them believe they are all much sicker than they appreciate. The distinguished actor Louis Jouvet played the main role thousands of times from 1923 until his death in 1951, and also starred in two film versions. The term “knockisme” has been proposed by two French anthropologists to describe popular gullibility about the need for overdiagnosis and -treatment (►FOLIE À DEUX).

THE LONG GOODBYE

Valetudinarium: a Latin term for the infirmary in a Roman military camp, such as at the fortress at Inchtuthil, on the northern fringe of the empire in Scotland. Valetudinarian: “One who is constantly concerned with his own ailments” (1703).

RULE AND INSTANCE

George Robert Price (1922–75) was an eclectic figure who, in addition to his research into evolutionary theory at the Galton Laboratory and charity work, worked as a chemist on the Manhattan Project, helped to advance IBM’s mainframe computers, developed fluorescence microscopy and liver perfusion technique, and much else besides. His derivation of the equation that bears his name provides a formal description of the effects of selection and transmission on evolutionary change—specifically the change in the mean value of a variable between two aggregates (e.g. parents and offspring)—which has now found an application in many disciplines from economics and epidemiology to cosmology and information theory.

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LIMITED SOCIABILITY

And others, dare I say, perhaps end up like me—in an exclave on the shores of Bohemia.

THE MYSTERY OF A LIFE

Under the democratic impulses of the early nineteenth century people were, in a very real way, noticing each other for the first time: in a society of equals, what was to stop you gazing benevolently, reverently or in sheer incredulity at the person next to you? Christianity had always had to struggle against the more subversive implications of caritas, and here, at least for a generous moment, the old instruction to “love thy neighbour as thyself” found sympathetic expression. Wordsworth extended sympathy to the dispossessed and social outcasts including, here, an old leech-gatherer.

BIGGING IT UP

As well as being up for high jinks and high tech, Americans are good on neologisms, q.v. Ray Kurzweil’s computronium: a zero-energy-consuming IT system with enough computational power to render the entire Universe omniscient. Rapture for geeks, anyone?

THE WRITING CURE

The Romanian writer E. M. Cioran (1911–95) lived for most of his life in Paris where he wrote elegant phrases in a purged French worked on by the exactions of classical rhetoric. His wryly misanthropic observations and aphorisms place him squarely in the French tradition of the “moraliste”, writers like Pascal, Chamfort and Joubert who devoted their attention to describing the moral character of their contemporaries. (Not to be confused with “moralisateur”, a humbug who spouts moral lessons.)

A HOSPITAL LIGHT

Goethe couldn’t suspect how accurate would be the joking prediction made at the close of a letter he wrote from Italy to his friend Herder on 27 May 1787: “Auch, muß ich selbst sagen, halt’ ich es für wahr, daß die Humanität endlich siegen wird, nur fürcht’ ich, daß zu gleicher Zeit die Welt ein großes Hospital und einer des andern humaner Krankenwärter sein werde” [I must say, I too believe that humankind will win out in the end, only I’m afraid that at the same time the world will become one big hospital where everyone is someone else’s humane nurse].

WHY ME?

“It is our fate as human to have no real comprehension of our situation. If God is just, at the very least we do not understand in what way: if it all makes sense, we cannot grasp how. It’s possible that, ultimately, there is no justice. When God is invoked, in Nilotic languages… it is ordinarily as an exclamation, “Why, God?,” above all when a loved one falls sick, with the assumption that no answer will be forthcoming.” David Graeber, “The Divine Kingship of the Shilluk”, On Kings (2017).

NEWS FROM THE ASCLEPIUM

In classical times, dreams were believed to furnish knowledge of the future. The  Oneirocritica (Interpretation of Dreams) by the second-century writer Artemidorus of Daldis is the only “dreambook” which has come down to us in its entirety. Specialised personnel in the Asclepium and other sanctuaries would be on hand to decode the dreams sent to the sick by Asclepius, or any other source, and provide practical therapeutic advice based on their interpretation.

ITS NAME IS LEGION

Cf. Sir Thomas Browne: “In brief, we are all monsters, that is, a composition of Man and Beast.” Section 55, Religio medici, part I.

ON BEING A SURGEON

Surgery is a variety of intense theatre within the drama of medicine itself, and indeed for centuries it was quite distinct from the bookish and theory-bound practice of medicine itself. Technological advances have undoubtedly rendered it more humane and “minimally invasive”, while not entirely dispelling its old “assault and battery” associations.

A MYSTERY DISCOUNTED

Dostoevsky displays a surprisingly detailed knowledge in The Possessed (or Demons, 1871– 72) of confinement and its mechanics, a sphere traditionally reserved for women. Shatov’s estranged wife wants a baba (usually an experienced old woman but without qualifications) whereas Shatov himself insists on sending for the best midwife in town: Arina Prokhorovna Virginskaia. Efficient and practical, she promises a successful birth. When Shatov bursts out with his idealistic hymn as the baby is born (►ONE BETTER THAN HOUDINI), she laughs in his face. She might be professionally dedicated to bringing new life into the world but this minor character is one of Dostoevsky’s cheerful nihilists.

THE AUTISTIC SHIFT

In his many books, which included most famously The Myth of Mental Illness, Thomas Szasz (1920–2012) defended the libertarian position that there is no such thing as “mental illness”, certainly not one to be understood like diabetes or heart disease in terms of an organic model (►PARTIALITIES), but persons suffering a wide range of “problems in living”, whether political, social or interpersonal in origin. “Mental illness” made sense for him only as a metaphor. Like his mentor, the Viennese satirist Karl Kraus, he was concerned at what he saw as the coercive aspects of psychiatric power. And undergirding everything he wrote is a more basic question: “What is the moral mandate of medicine?”

THEATRE

See Elizabeth Craik’s article “Tragedy as Treatment: Medical Analogies in Aristotle’s Poetics” in Dionysalexandros: Essays on Aeschylus and his fellow tragedians in honour of Alexander F. Garvie, eds. Cairns and Liapis, (2006).

AGAINST ENTITLEMENTS

The Millennials, the generation now lipping age forty, grew up in easy times like their Boomer parents, but have never had to face the threats of the Cold War that hung over their parents’ heads. The order of things has been so stable as to seem a part of nature, something that has fostered an overblown sense of entitlement. A generation fed on self-esteem sounds petulant when it doesn’t enjoy what it thinks are rights.

A NURSING ICON

Long before the coronavirus pandemic made 2020 a year like no other in recent memory, the World Health Organization, in commemoration of Florence Nightingale’s 200th birthday, designated it International Year of the Nurse and Midwife—“to celebrate the work of nurses and midwives, highlight the challenging conditions they often face, and advocate for increased investments in the nursing and midwifery workforce”. Most western countries have a chronic deficit of nursing staff—30 000 in Germany alone (Süddeutsche Zeitung).

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THE CONSIDERED LIFE

Consideration: “to fix the mind upon for careful examination, to view attentively”—possibly deriving from old Roman attempts at divination by astrology, cf. the now obscure medical term “sideration”, to be blasted or struck by lightning, as in a sudden paralysis. The term is still used figuratively in French.

“THE BUSY TIME”

John Keats received his licentiate allowing him to practise as an apothecary on 25 July 1816, and continued working as a dresser at Guy’s Hospital until the following March. According to Hrileena Ghosh in John Keats’ Medical Notebook (2020), he wrote at least thirty-five poems during this period, including the long poem “Sleep and Poetry” and his epiphany-sonnet “On First Looking into Chapman’s Homer”.

GODS FOR ORGANS

“The want of adverbs in The Iliad is very characteristic. With more adverbs there would have been some subjectivity, or subjectivity would have made them,” observed S. T. Coleridge. “The Greeks were just then on the verge of bursting forth of individuality”: Table Talk, 9 July 1832.

DAS WERKZEUG

Cf. Organon: instrument, implement or tool, but also organ of sense or apprehension, musical instrument, surgical instrument and philosophical method. The ablaut shift from the base term ergon (work, act, deed) to orgon suggests that the organic was originally conceived as having mechanical properties, or at least being deeply in harmony with energetic work. Engine and ingenuity exhibit the same parallelism.

REVERSE ENGINEERING

“Disinterest” in its original sense of “uninterest”, not in its more usual sense of impartiality. I’m suggesting that what doctors understand as a fixed anatomy is actually a debatable history.

ANAESTHETIC

Oliver Wendell Holmes coined the term “anaesthesia” in 1846 to describe the ability of ether to induce insensibility to sensation (particularly pain) after the first public demonstration of its effect in 1846. Although the effects of local anaesthetics are fairly well understood, and involve no change in awareness of sense perception elsewhere in the body, the effects of general anaesthetics, which render patients unresponsive during surgery, are still not understood. But then consciousness itself is a bafflement to science (►NO PLACE TO HIDE).

A CHINESE SYLLOGISM

In the first act of Ionesco’s play Rhinoceros, the logician character says: “I am going to explain to you what a syllogism is: The syllogism consists of a main proposition, a secondary one and a conclusion.” The rest of the first act shows that this kind of logic doesn’t add up to very much.

LISTENING TO THEIR INSIDES

The whole business of making decisions has been such a fraught one for humanity throughout most of its history, a stressor event (►IN A CRITICAL STATE). Roman generals engaging on a military campaign would always bring their haruspex with them and request his advice before commencing any important action. Entrail-readers were followed by a whole train of possessed prophets, diviners, inspired saints, mad poets, crafty astrologers, and finally tarot card, Ouija board and tea-leaf readers. Then the oracles stopped, and only doctors were left. And still supplicants came, in attitudes of causative expectancy (►HOW TO DEAL WITH EPIDEMICS).

MERE APPEARANCES

In Hundejahre (Dog Years, 1965), one of his Danzig novels, Günter Grass parodies Heideggerian diction to good effect, although it might be thought that a philosopher who could venture that “das Nichts nichtet” (“the Nothing nothings”) was perfectly capable of parodying himself.

PARENTING THE BUDDHA

Count Lev Nikolayevich Tolstoy, having achieved all the trappings of worldly success, including international acclaim as a writer, could not stop thinking of the prince Siddhartha Gautama, and explained what he was doing in My Confession (1880): “And then I began to build up on rational foundations, out of what I knew, an explanation which would give a meaning to life; but nothing could I build. Together with the best human intellects I reached the result that ø equals ø, and was much astonished at that conclusion, though nothing else could have resulted.” Zero equals zero, or the empty set includes its own emptiness—more philosophically unsettling than Dostoevsky’s “2 + 2 = 4”.

A CHILDREN’S SONG

A thoroughly modern children’s song is Patrick Hernandez’s disco hit “Born to be Alive” (the title says it all), released in 1979 and a global success. It is Hernandez’s only successful “tube”, and its royalties have kept him afloat in the forty years since.

UNRELIABLE NARRATORS

Narrative-based medicine (NBM) became the latest Big Thing in medicine around the turn of the millennium and gave rise to many courses at American universities: the core textbook is The Principles and Practice of Narrative Medicine (2016)

THE NOCEBO EFFECT

Nothing more than a whispered suggestion can cause hyperalgesia (increased sensitivity to pain). So don’t read all four pages of adverse effects on that package leaflet!

A FIG-LEAF

One of Hans Castorp’s ancestors? As a prominent citizen of Lübeck, which in the fifteenth century was at the peak of its power as an independent trading city, with links to Novgorod in the east, London and Flanders to the west, and north into the countries abutting the German Sea, Thomas Mann would have known the name of the dynamic mayor who reinforced the city walls, dredged the harbour and organised a great pageant in 1478: Hinrich Castrop (1419–88).

MULTIVIT ME

The myth around vitamin C started with the chemist Linus Pauling, Nobel Prize winner, who popularized “mega” doses in the 1960s as aspect of what he called “orthomolecular therapy”; even now, despite the fact that there is little evidence to show that such doses are good for anything (excess vitamin C in the blood is simply excreted by the kidneys), the myth persists. The assumption seems to be “if something is good, more is better”, which is not necessarily true (►ALL THE GAS).

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BEING PART OF A CONVERSATION

It was Søren Kierkegaard who came up with the obvious argument against all totalising philosophies which pretend to step out of the universe: even if life is to be understood backwards “it must be lived forwards” (Papers and Journals: A Selection, p. 161).

NEEDLEPOINT

Ernst Weiss (1884–1940) was a friend of Franz Kafka, and wrote several expressionistic novels, the best of them being Jarmila and Franziska (both published in English translation by Pushkin Press). His final novel Der Augenzeuge (The Eyewitness) relates what Weiss believed was the true story of Adolf Hitler’s “conversion experience” under hypnosis in 1918, which cured him of the symptoms of hysterical blindness at war’s end but also turned him  into a man with a mission (►TELLING THE TRUTH TO POWER). See also my essay “The Life and Times of Ernst Weiss” in A Doctor’s Dictionary (2015).

“MEIN GOTT, ICH SEHE!”—

The expansion of science is dominated by the extension of sightedness, and the advent of X- rays (short wavelengths, high energy) in 1896 is no exception. Now we have telescopes to detect ionizing radiation: what we might casually think of as the blackness of the sky at night has been transformed by the observations of the eROSITA instrument built by the Max  Planck Institute for Extraterrestrial Physics in Germany, and launched in 2019. The “all-sky” map constituted from data collected by this telescope over 182 days reveals a cosmos trembling with millionfold hot galactic spawn.

HYPNOSIS AND AUTONOMY

Section 11 of Nietzsche’s The Joyful Science offers a sceptical disquisition on “the growth and intermittences” of consciousness: “one thinks that it constitutes the kernel of man; what is abiding, eternal, ultimate, and most original in him.” A ridiculous overestimation, concludes the philosopher.

A NEW COSMOLOGY

Paracelsus’ microcosmic understanding of stellar influences has been superseded by modern science’s spectroscopic methods (►LOOKIN’ IN MY BABY’S EYES/SPECTROSCOPY) which are able to confirm that we are “literally” stardust: carbon, hydrogen, nitrogen, oxygen, phosphorus, sulphur and all the other building blocks of life on Earth are elements found in the farthest celestial reaches.

THINKING ABOUT LAZARUS

One of the striking things about the figure of Jesus in the Gospels is that he isn’t pensive, a “thinker”: he knows what to say or do, and says and does it.

OUT OF DEPTH

I read in a French magazine that the book most often borrowed from the library in the lumber town of Caleta Tortel at the mouth of the Río Baker in the deep south of Chile is The Magic Mountain. That set me to thinking. Perhaps the genuine import of Thomas Mann’s novel wasn’t so much about the distance between TB patients on their high Alp and the mundane world of the “flatland” as about the tyranny of distance. These villagers living on the southern edge of Chile were obliged to live even more physically separated from their compatriots than the characters in The Magic Mountain, and with the wind blowing monotonously all year long perhaps had their own special sense of what it meant to be inside and “cocooned”.

THE SOCIAL CONTRACT

Onora O’Neill’s Reith Lecture series “A Question of Trust” in 2002 created quite a stir at the time: it caught the mood of the UK, suddenly aware that social trust, taken for granted for so long and embodied in certain institutions (like the NHS), was being replaced by  accountability (►MORAL HYPERINFLATION). O’Neill saw that the stringent and sometimes absurd demands on institutions and persons to be constantly responsive to inspectors, auditors and examiners made it harder for them to provide their actual services. Her warnings have not been heeded since we now move in a pitiless neoliberal polity that works on centralised planning, reinforced by targets, performance indicators and the “blame game”. Aren’t those old Soviet techniques? (►HOW TO DEAL WITH EPIDEMICS)

MAGIC MADE METHOD

Oliver Wendell Holmes’ quip can be compared to the “Third Law” of the science-fiction writer Arthur C. Clarke (1917–2008): “Any sufficiently advanced technology is indistinguishable from magic”. This is less a law (it can’t be tested) than an adage. It has inspired multiple journalistic variants or “snowclones”.

WHAT WE DESIRE

The great Honoré de Balzac (1799–1850), who wrote more novels that few will ever have life enough to read, wrote not just one but two prophetic novellas, the other being “Le Chef- d’œuvre inconnu” (“The Unknown Masterpiece”, 1831). Although it is set in the seventeenth century, its atmosphere and main character Frenhofer are products of the Romantic nineteenth century. Frenhofer reminds his pupils that the true artist is no copyist; he makes something unprecedented. He espouses total freedom of the creative act; but when his younger colleagues come to see his final “masterpiece” all they can make out is an abstract swirl of colour. Frenhofer dies of disappointment. Balzac anticipates that the only thing the modern artist will be left with—once conventions, etiquette, craft, finesse, representation and even public have been abolished—is conviction, a shaky edifice at the best of times.

A COMEDY IN FOUR ACTS

“The main thing, my dears,” Chekhov told the players before the premiere of another of his comedies at the Alexandrinsky Theatre in St. Petersburg, “is not to be theatrical. The characters are all ordinary, simple people” (►BLIGHTED HOPE).

BEND OR BREAK

I was playing the devil’s advocate here, since resilience is clearly admirable when it is a mixture of courage, good faith, humour and independent thinking (autarkeia), especially when times are good. It is too often trotted out, when things are bad, and by professional psychologists, as a kind of mental hygiene. Perhaps it could also be compared to that now unfashionable quality of steadfastness.

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A STILL LIFE

The Anglo-Belgian artist James, later Baron Ensor, produced so much of his best work in the final decade of the nineteenth century that it comes as a surprise to find he died, aged 89, four years after the end of the Second World War. After painting the portrait of his dead mother,

he largely abandoned the visual arts to improvise on the harmonium, and became a local celebrity in his birth-town of Ostend. Regarding those medicinal flasks, the remarkable main verb in three lines of T. S. Eliot’s “The Waste Land” come to mind: “In vials of ivory and coloured glass/ Unstoppered, lurked her strange synthetic perfumes,/ Unguent, powdered, or liquid.”

RULE OF THREE

Jacques Lacan knew how to bamboozle the media like no one else: his conference with Italian journalists at the French Cultural Centre in Rome on October 29, 1974, has been called “possibly the strangest press conference in the history of the world”. His citation can be found in the booklet Le triomphe de la religion (2005). Lacan’s “Real”, insofar as it lends itself to explanation, is not an external, transhistorical condition that resists symbolic expression but a cleft in the symbolic network itself—something like Auden’s line in his poem “As I Walked out One Evening”: “And the crack in the tea-cup opens/ A lane to the land of the dead.”

And “threeness”—from Coleridge’s “tertium aliquid” to Peirce’s “triadic model”—is everywhere in philosophy, not to be speak of theology (“tri-unity”).

HOW TO DEAL WITH EPIDEMICS

The hollowness of the Prime Minister’s appeal “we’re all in this together” during the coronavirus crisis in the UK, indicates just how far the country is from the fortitude and community spirit that was common in the post-war period, and celebrated by George Orwell in his essay “The Lion and the Unicorn” (1941): “All the culture that is most truly native centres round things which even when they are communal are not official—the pub, the football match, the back garden, the fireside, and the “nice cup of tea” (►TEA AND SYMPATHY).

MORAL HYPERINFLATION

The prolific doctor-writer Theodore Dalrymple (Anthony Daniels) remarked that what now passes as the British Medical Journal—revamped in 2015 after a canvassing of “readers” who wanted fewer words and more pictures—resembles “a kind of Hello! magazine for doctors” (“A Quick Word, Taki’s Mag, 9 November 2015).

SEEPAGE

F. Gonzalez-Crussi’s measured reaction brings to mind, by way of contrast, the “impressionable archaeologist” in Nabokov’s Glory, “who, after having cleared the path to as yet unknown tombs and treasures, knocked on the door before entering, and, once inside, fainted with emotion.”

FUTURE IMPROVEMENTS

The eastern Himalayan kingdom of Bhutan, with its rich biodiversity and manageable human population of 800 000, enjoys seemingly endless journalistic attention for having replaced GDP with Gross National Happiness (GNH), an index to measure the population’s collective well-being. In 2008 it was made a policy goal of the country’s constitution.

THE LAST ACT

In their book Benn als Reporter: Wie Miss Cavell erschossen wurde (2007), Jörg Döring and Erhard Schütz claim that his backdated article about the execution—which, as Egon Erwin Kisch’s comment makes plain, helped to make its author a detested figure for the left during the Weimar era—saved his skin during the Nazi period. The best recent overview of Benn’s career can be found in David Paisey’s Gottfried Benn: Selected Poems and Prose (2013); the hard-boiled loner survived Hitler’s war to end it as the Bundesrepublik’s grand old man of letters.

BETTER TO DO GOOD THAN JUST TALK ABOUT DOING GOOD

“Amicus humani generis” was the sarcastic Latin phrase for those (thinkers) who were friends of humanity in general but tended not to have any friends in particular.

THE PHILOSOPHER AS HOSPITAL PORTER

The Israeli-Australian playwright Ron Elisha’s The Soul of Wittgenstein, in which an illiterate Cockney meets the morally ferocious Wittgenstein, based on the philosopher‘s time as porter at Guy’s Hospital, was first staged in 2016.

CURING FANTASIES, PURGING FOLLIES

Martin Droeshout (1601–50) is best known for his engraving of Shakespeare, commissioned only a few years after the dramatist’s death. His Panurgus reworks an earlier engraving on the same theme by Matthaeus Greuter, a German etcher working in Rome.

BLINDED

I reviewed James Le Fanu’s The Rise and Fall of Modern Medicine in the last issue of the  TLS in 1999. The fact that the medical establishment and government agencies defend evidence-based medicine (EBM) as the ultimate bastion against the power of the pharmaceutical establishment while the same establishment vigorously and vocally supports EBM is a paradox that attracts little comment.

FREUD & CO.

It is strange that so little has been written about Edward Bernays (1891–1995) although it is true that advertising, although obsessively centred on the written word, is itself the great unwritten topic of the twentieth century. As American in its obsessions as Nabokov’s Lolita, it might be said.

Bernays had the distinction of being the double nephew of Sigmund Freud: his mother was Freud’s sister Anna, and his father’s sister Martha married Sigmund. Bernays’ first job in New York was as a medical editor. Even as early as the Great War, Bernays called his press agency work “psychological warfare”, and frequently made use of his uncle’s growing reputation to promote his own as a “psychoanalyst for troubled companies”.

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MYTHIC PHYSIOLOGY OF THE EMOTIONS

A friend of mine, impressed enough by Rudolf Steiner’s writings (although no anthroposophist), espouses the attempt to attain a higher mode of consciousness: he calls this “heart-thinking”. Thoughts have force, as Coleridge insisted; and only true thoughts prevail.

THEN THEY WROTE THE RULES

The Phaedrus is the dialogue which provided Jacques Derrida with the prompt for his musings on the “pharmakon” (q.v.). It is also the dialogue in which Socrates tells the legend of the Egyptian god Theuth (Thoth) making a gift of writing to King Thamus, who is to distribute to the people of the Nile. When Theuth suggests that it will serve as a memory-aid, Thamus replies that its benefits are not what they seem: future generations will hear without understanding, and the function of writing will be not to remember but remind.

AUTONOMY AND CRISIS

A similar formula, this time by Coleridge (the “Great Awakener”), runs like this: “Plants are Life dormant; Animals = Somnambulists; the mass of Mankind Day-dreamers; the Philosopher only awake.” The Friend, II.

A WORD ASIDE

“Herniation”: an expanded noun from “hernia” (“ruptured viscera”), which comes from the ancient word haru, also found in the term haruspex, a diviner or reader of entrails (►LISTENING TO THEIR INSIDES).

A COMMON CAUSE

Lip service: “an avowal of support, allegiance or friendship that is expressed in words but not borne out by deeds; hypocritical respect”.

DEPENDENCIES

Jan de Vries argues that the consumer culture of eighteenth-century Dutch Republic—what he calls “New Luxury”—was a sociable and inclusive affair as contrasted with “Old Luxury”, which thrived only at court and serve to mark social status. The Dutch Calvinists took readily to this “new” luxury and never got bogged down in the hefty moral debates that surrounded it in eighteenth-century Britain and France.

A FATAL LETHARGY

Taphephobia was such a contemporary obsession that Poe was to include the “buried alive” motive in four other short stories, including two of his best known, “Berenice” and “The Fall of the House of Usher”.

THE MILKY WAY

The Milky Way (galaktikós kyklós) revealed its full and unforgotten splendour only when I went to work for a year in 1990 as a hospital doctor in the remote Australian outback town of Broken Hill: I still dream of setting out across scrubland for the nearby hospital after an urgent call at night only to find the billion globules of a spiral chandelier already guiding my way.

THE LITTLE PHRASE

The little phrase that sweeps over Swann “like a perfume or a caress” is a musical one: Proust invented a composer called “Vinteuil” in his first book, and it has been speculated whether his model was Saint-Saëns, Debussy, Fauré or the more obscure Gabriel Pierné. They all feature on the CD “Le Sonate de Vinteuil” by violinist Maria and pianist Nathalia Milstein (2017).

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THE BREATH OF LIFE

Paul Valéry has an interesting comment in his Cahiers. “Pneuma—The soul is the breath taken as the sign of life, and taken as the cause of life, and as life itself, its principle.

“Primitive observation of breathing must have been followed by another which may have singularly strengthened the idea of the power proper to the breath. And that is the effect of breathing upon fire.” (“Philosophie”, Cahiers I)

PERSONAL JESUS

“Personal Jesus” was the lead single on Dépêche Mode’s seventh album “Violator”, released in 1989. The “badass groove” by Johnny Cash on his American IV album is an exceptional cover version.

THE VAGRANT UTERUS

After enjoying a boom in the theatrical 1880s, especially in France, “hysteria” was dealt a death-blow by Charcot’s favourite pupil, Joseph Babinski, who read his paper “Definition of Hysteria” to the Neurological Society in Paris, in which advanced the proposal that it was no more than a particular form of suggestion, and suggested it be replaced by the term “pithiatism” (Greek for “curable persuasion”). Hysterical patients rapidly dwindled in number; and although the French attributed its decrease to Babinski’s evacuation of the concept, the fact that it did so throughout Europe suggests more pervasive cultural factors were at work.

AFTER VIRTUE

Cf. La Rochefoucauld’s aphorism: “Les vertus se perdent dans l’intérêt comme les fleuves dans la mer” (Virtues become lost in self-interest, like rivers in the sea).

THE RADICAL VOTIVE

One of the best books about that great and complex painter Francisco Goya (1746–1828), perhaps because it is so knowledgeable about Spanish and Napoleonic history, is Robert Hughes’ Goya (2003). In a Spain that was moving erratically from absolute monarchy and an inquisitorial clergy towards modernity, Goya was unquestionably most brilliant artist of his time: his work contains royal portraits and exquisite majas as well as the disguised social commentary and sometimes nightmarish etchings of the “caprichos” and “disasters of war” sequence.

AN ATTACHMENT

Friedrich Reck-Malleczewen (1884–1945) was a novelist, mainly of children’s books, and journalist, many of whose books were banned by the Nazis. Like Victor Klemperer (►THE ADVANTAGE OF A COLD EYE) he kept a secret diary during the war (Tagebuch eines Verzweifelten, 1947) which was reissued in English translation as Diary of a Man in Despair, by New York Review of Books Editions, in 2000. He called himself “an illegal watcher among the barbarians”, and paid the ultimate price for his opposition to the regime.

COLLECTIVIST AND SOLIPSIST

Wittgenstein discovered, in the course of his troubled and somewhat monkish life, that we learn to be human not by reflection but by participation. Language separates what in in experience is always an amalgamate.

RABELAIS AT LARGE

Rabelais is the great prolix writer of “français gras”, a master of the language before French decided to become austere and purify itself according to the Humanist ideals of the following century. Rather than write commentaries on Galen and Hippocrates, the medical masters he had studied at Montpellier, or tell vernacular tales, he parodied them by writing something unprecedented, the art we recognise as the novel. As Milan Kundera comments in Les Testaments Trahis (1993), “[Gargantua] has everything: the plausible and the implausible, allegory, satire, giants and ordinary men, anecdotes, meditations, voyages real and fantastic, scholarly disputes, digression of pure verbal virtuosity”. Some of that word-mad virtuosity  has spurred translators in other languages; Sir Thomas Urquhart’s The Works of Rabelais (Books I and II, 1653; Book III, 1693) is still worth reading as an example of an almost perfect match between author and translator.

INASMUCH

Use of this very careful conjunction—to indicate why or to what extent the moiety of the sentence following applies—is common in the King James Bible but has fallen into desuetude. Except perhaps in legal parlance, which always guards its words carefully.

AN ULTIMATE FORM OF DUALITY

The implications of natural selection are still with us: either a higher value should be placed on competition and success, and less emphasis be given to caritas (►THE MYSTERY OF A LIFE), hence the attractiveness of Darwinian theory for those driving the global market in the nineteenth century; or human ethics must self-consciously differ from the rest  of nature, aware that it is deviant and “unnatural” (►RULE AND INSTANCE).

A FLOWER IN THE BREASTCAGE

“A flower in the breastcage” is a reference to Gottfried Benn’s poem “Kleine Aster” (“Little Aster”), published in the collection Morgue und andere Gedichte (1912).

TITRATING THE MIRACLE CURE

Jesus’s dose-titrated effects extend to psychoanalytic sessions in which the analyst takes pains not to “overload” the patient’s nervous system.

BENEFITS OF A WHITE LIE

Given the prevalence of tuberculosis at the close of the nineteenth century, it is startling that a lung specialist examining Katia Mann’s old X-ray films did not see some evidence of tubercular aggression in the lungs: in healthy young people cell-mediated immunity usually

sealed off infected lesions, leading to the formation of Ghon complexes, later subject to fibrosis and calcification in those who survived their illness.

“Opulence-based medicine” bears some resemblance to the term “VIP medicine”, which was coined in a 1964 paper by Dr Walter Weintraub, professor of psychiatry at the University of Maryland. It can unconsciously influence starstruck doctors in their treatment of celebrated patients, leading to errors of judgement and an approach to diagnosis and treatment that may be either too thorough or too hands off.

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EMETICS

Since 2005, ipecac(uanha) has no longer been in use as a rapidly acting and forceful purgative: activated charcoal has been shown to be a more effective and safer method for lowering total body concentrations of poisons especially when coupled with whole bowel irrigation.

AMONG THE METHODISTS

It has been said that it was the Methodist spirituality typical of members of wealthier British middle-class families who married into the aristocracy which gave a seriousness of moral purpose to political life in the British Isles in the nineteenth century, one so solid that it was able to repel revolutionary ideas from crossing the Channel far more effectively than military defeat of Napoleon. Denis Healey famously said that the Labour party in the UK “owed more to Methodism than Marx.”

OMNIPRATICIEN

“Omnipraticien”: a bureaucratic synonym in French for “généraliste”, a doctor who has no particular speciality. Formerly appreciated as the physician “par excellence” (to quote Bariéty in his 1963 history of medicine), only to be lost in the thicket of specialities developing in France after 1968.

LUNGS AND LAUGHTER

Katherine Mansfield may have thought of her lungs as birds because they whistled at odd times. The Romantic perception of TB as a disease of refinement has always struck me as odd, since the destruction of the lung parenchyma by TB causes severe bronchiectasis and airway flow restrictions, with a rapid decline in lung function and frequent exacerbations. Wheezing and paroxysmal coughing were common, and the foul, fetid odour of tissue destruction must have emerged often enough to dispel any association with purity of personhood.

THE ELECT PLACE

Regarding those “two [sacrificed] generations”, Immanuel Kant, a generation before Thomas De Quincey, refused to countenance a philosophy of history that abbreviates its onward march to the construction of a mansion fit only for the last generation with the leisure to turn the lights on. Where did all the poor keep springing from if wealth was visibly being created all around? (See De Quincey’s essay “The Last Days of Immanuel Kant”.)

Dante’s lines about the most harrowing circle of the Inferno—a frozen lake and not a furnace—are from C.H. Sisson’s version of The Divine Comedy (1988): Canto XXXII, lines 70-72.

EMPTY MASKS

SPK’S Aus Krankheit eine Waffe machen (1972) appeared in translation with a foreword from Jean-Paul Sartre. Its fourth thesis asserts that “Illness is the only form of ‘life’ possible under capitalism.” That capitalism has been able to recoup this abject notion without even pausing for breath is evident in the chapter “Spending Ourselves Sick” in Hamilton and Denniss’ book over overconsumption Affluenza: When Too Much is Never Enough (2005).

SOUND AND IMAGE

Psychoanalysis, as a profession, seeks respectability through science but many of its early adepts—including its founder—were mavericks: there are many links between the Victorian interest in spiritualism and what would now be called the “paranormal”, with the Society of Psychical Research first promulgating Freud’s theories in the UK.

BEAUTIFUL SOULS

Given the enmity that existed between the British administration, mandated by the League of Nations to rule Palestine, and the native populations, with wave after wave of refugees from Nazi tyranny in Europe arriving in Haifa, it is perhaps ironic that in 1948 both Britain and Israel were running experiments in socialist utopia that invoked community spirit and the need to endure hardship for the common good. One sought the New Jerusalem, the other the New Zion.

WHAT IS THE VALUE OF A PROFESSION?

Traditionally the professions were considered essential to the good functioning of a civil and democratic society. Since status in a profession was gained through reputation rather than wealth, members were ideally placed to act disinterestedly in pursuit of the public good. As the ideology of the market took hold in 1970s and 80s, long-standing notions of what defined a profession (especially self-government) became blurred with consumerist concepts deriving from the new perception that they were there to deliver services. Government interference became rampant (►SPECIALISTS, EXPERTS AND LEARNED DONKEYS).

A SPINOZISM

The French philosopher Emmanuel Lévinas made the human face the source of ethics, an appeal to “infinite responsibility” that finds no recourse in the digital world where its absence seems to remove the sense of shame that might otherwise hinder obnoxious behaviour on what is euphemistically called “social media”.

ANOTHER KIND OF NOSOLOGY

Nosos, the Greek term for “sickness” (or “plague” in Sophocles and Thucydides) often has a political connotation: Plato in The Republic portrays the conflict between the Greek states “not just as civil wars but as a form of nosos or sickness”.

A RITUAL HUMBLING

Self-esteem has become so associated with individualism of the Californian kind (its  assembly man John Vasconcellos set up a Task Force on the topic in 1986) that it is a surprise to find a former Calvinist, the philosopher David Hume, alluding to the importance of thinking well of oneself (“self-regard”) in exploring the full potential of a personality. But consider the seeming paradox that low self-esteem scores as measured by psychological rating scales are not found in collectivist societies like Japan (►PROACTIVE PATIENTS).

THERAPEUTIC SUBJECTIVISM

The term “allopathy” (“other than the disease”) to describe conventional nineteenth-century medical practice, characterised by its heroically abusive methods (bloodletting, purging and sweating) to induce symptoms thought to be the opposite of the imbalanced humours, was coined by the German inventor of homeopathy Samuel Hahnemann (1755–1843), who initially abandoned his medical practice, so disturbed was he by “the thought of becoming in this way a murderer or malefactor towards the life of my fellow human beings”. (“Allopathic” was therefore meant to be derogatory but is often used now as a catch-all for contemporary scientific medicine.) But Hahnemann’s homeopathic “dilutions” are so subjective as to have no reality outside the doctrine within which they serve as remedies.

THE HOLLOW OF A BODY

The “art-critical” aspect of contemporary art (being essentially all the art in a work like Tracey Emin’s bed) would seem to have its unlikely origins in a Romantic like Delacroix. The painter Lucian Freud—who knew a bit about beds—once remarked of Rembrandt’s painting Woman in Bed, which hangs in the Scottish National Gallery: “You can smell the bed.”

PSYCHOBABBLE

The term “psychobabble” became popular in the 1970s after the publication of R. D. Rosen’s Psychobabble: Fast Talk and Quick Cure in the Era of Feeling (1977). He defined it as “a set of repetitive verbal formalities that kills off the very spontaneity, candour, and understanding it pretends to promote”. The use of buzzwords derived from psychotherapy may be compared to the similarly pretentious but equally vacuous lexicon of socio-economic development: “empowerment” is a term common to both (►CIRCUMLOCUTIONS).

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“POSTMEN LIKE DOCTORS

During Richard Cobb’s career, France saw the development of the Annales school, a writing of history that rejected narrative and unreliable witness, and aimed to tell the “history of events.” This was an “histoire totale” which recruited geography, demography, sociology and psychology “in order to present unchanging (or at least very slowly changing) conditions that stubbornly assert themselves over and over again” (Fernand Braudel). Cobb’s idea of “history from below” might seem incompatible with such an aerial school—and he liked to poke fun at its obsession with quantification and scientistic terms—but the idea of “mentalités” (how people of a given time thought about, lived out, and classified the world around them) is at the core of his own work.

“Postmen like doctors go from house to house” is the last line of Philip Larkin’s last poem “Aubade”.

LITERATURE AND MEDICINE

The French language makes a nice distinction between “un médecin écrivain” and “un écrivain médecin”: the former is a doctor who writes without expectation of literary fame (almost all doctors used to do this, sometimes excessively, until the advent of personal computers), the latter a writer who just happens to earn his keep by practising medicine, Anton Chekhov, for instance, or Louis-Ferdinand Céline. There are some cases where the distinction is not so clear, and we have to opt for the dyad “médecin et écrivain” (Sigmund Freud).

AN OBIT

For many years now, the British Medical Journal has allowed doctors to write their own obituary notices, although only a few have been takers.

THE NEW CONFLICT OF THE FACULTIES

The old conflict of the faculties is the one described by Immanuel Kant (Der Streit der Fakultäten, 1798), a collection of three essays that bear on the combat between the “lower” faculty of philosophy, which answers solely to individual reason, and the other faculties of theology, law and medicine, which are accorded more prestige in the world of business and government. Kant has much of interest to say on medicine’s attempts to remedy and law’s to regulate, and also vindicates the right of philosophy to freedom of expression, a bold position to take nine years after the French Revolution and with the Prussian censor breathing down his neck.

PENSE-BÊTE, GUIDE-ÂNE

Atul Gawande’s The Checklist Manifesto: How to Get Things Right (2009) argues that the volume and complexity of contemporary knowledge has exceeded our ability as individuals to deliver its benefits safely and reliably in all circumstances.

STHENIA

The elderly philosopher A. N. Whitehead—he was aged 79 at the time—touches on this issue in one of the conversations (XIII) collected by Lucien Price in Dialogues of Alfred North Whitehead (1954):

“‘Does a doctor see all of a human being?’ asked Grace.

‘No’, said Whitehead. ‘When a man is full of beans he doesn’t say, ‘Look here, let’s go and see a doctor.’ The doctor is the last person he is thinking of. He only sees us when we are a bit off our feed, and with the psychiatrist it is even worse; he only comes in when our friends are beginning to be worried about us. Taken as a whole, I think the professional classes are bad judges outside of their professions’.”

Professionals may have other interests at heart, whether pecuniary or status-linked,  and be so “deformed” by their profession as to be untrustworthy in other life situations. Elsewhere in the Dialogues Whitehead remarks that when people are in trouble in the classic English novels the person they turn to most often is the family solicitor.

CONSUMPTION AND CONSUMMATION

Steven Connor (who, were he to live in any other European country but the UK, would be an intellectual celebrity) tells us in Beyond Words: Sobs, Hums, Stutters and Other Vocalizations (2014) that the bilabial nasal sound “mmm!” identifies the mother in most languages. I asked linguist friends for exceptions and discovered that in Georgian and Pitjantjatjara mama signifies “father”—and that in the latter language, one of the Western Desert Aboriginal languages of Australia, papa means “dog”.

LOVIN’ IN MY BABY’S EYES/SPECTROSCOPY

Martin Buber’s famous book about relationships Ich und Du (I and Thou, 1923), contains many arresting statements. Here is one: “History is a mysterious approach to closeness. Every spiral of its path leads us into deeper corruption and at the same time into more fundamental return.” Simon Schama talks at considerable length about eyes and Rembrandt in his book of that title, Rembrandt’s Eyes (1999).

The song “Lovin’ in my baby’s eyes” is the classic number by that eclectic scholar of the blues Taj Mahal.

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HOW TO DIE

The central focus of the ars moriendi tradition—dying as an art for the sake of ultimate salvation—figures dying as an accomplishment, and not merely a fate to be endured. Perhaps its modern extension is Heidegger’s notion of Sein zum Tode, living in the face of death. The classic book on the topic is Philippe Ariès’ L’Homme devant la mort (1977), translated as The Hour of our Death (1981).

CIRCUMLOCUTIONS

I once observed Elizabeth Pisani, circa 2006, doing the salsa in the basement of a Jakarta  hotel but was so awed by her technique I missed the opportunity to introduce myself. Her  later travel book Indonesia Etc. is one of the best accounts of that extensive but not much written about region of the world known to Alfred Russel Wallace as “the Malay archipelago”.

WEIGHTLESSNESS

“The future is here”, as The Economist likes to repeat. Radiology and pathology, two medical services based on pattern recognition and which characteristically absorb as much as a quarter of typical health budgets, can be done just as efficiently by AI machines; and robot-assisted surgery is now commonplace. Dermatology and ophthalmology could go the same way. Perhaps hospital doctors of the future will become machine interfaces. And general practitioners will still have to come up with answers to the age-old pastoral questions.

A VISION OF THE HIGHER LIFE

I notice that James Lovelock in his latest speculative book Novacene: The Coming Age of Hyperintelligence (2020) expects the AI cyborgs midwifed by humans and who, in his view, will manage the evolutionary development of the planet after civilisation collapses to resemble “spheres”. The hypermodern returns to ancient Greece, it seems, only an awful lot shinier (►THE WORLD IS ROUND).

GUTS

In one of the footnotes to his exploratory account of the history of consciousness Poetic Diction (1928), Owen Barfield notes that it is incomprehensible today that anyone should literally feel his “bowels moved” by compassion. (And perhaps just as well.) He does suggest, however, that a certain psychic-physical unity still hangs around the expression “I’ve no stomach to go on”: the demoralised admission may be accompanied by a genuine intestinal lurch and sickening feeling.

PROACTIVE PATIENTS

Raymond Tallis is a remarkable medical polymath and philosopher who has defended the humane principles of the National Health Service against their stealthy undermining by so- called “conservatives” in several of his very many books: these include a pamphlet entitled The Mystery of Being Human: God, Freedom and the NHS (2016).

MAN-MIDWIFE

Born of humble origin in Lesmahagow, the Scottish obstretrician William Smellie, pronounced “Smiley” (1697–1763) trained in Paris and London and obtained his MD at Glasgow in the eventful year 1745. Although he was criticised (and lampooned by Sterne) for entering a profession hitherto dominated by women, he helped make obstetrics more scientific, promoted natural birthing whenever possible, invented an obstetrical manikin for instructing his students and improved the design of the existing Richardson obstetrical forceps with a new locking device. He was one of the first physicians to understand that the proper practice of medicine is less a matter of know-what than know-how (►IN A CRITICAL STATE).

CARELESS

Giorgio Agamben’s Il tempo che resta: Un commento alla Lettera ai Romani (2000) was published in English as The Time that Remains: A Commentary on the Letter to the Romans (2005).

WELL-PERSON CLINICS

Not content with ministering to the sick, medicine at the end of twentieth century turned its attention to the well, thus changing the nature of the implicit (and sometimes  explicit) contract between doctor and patient (►THE NEW CONFLICT OF THE FACULTIES). But the truth  is that modern populations clamour for just this kind of providential interference in their lives: when reputable newspapers and journals devote ever more space to what might happen then it makes sense to make a routine appointment at the surgery to discuss those little twinges in the night. Well people learn to incubate what might be called, as in Sam Byer’s first novel, idiopathies (►ONE-UPMANSHIP).

PIG IGNORANCE

The French cultural historian Michel Pastoureau, who has written several fascinating books about the history of individual colours—in order of appearance Bleu, Noir, Vert, Rouge, Jaune—has also published a book on the pig: Le Cochon: Histoire d’un cousin mal aimé (2009).

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ANCIENT PROFESSIONALISM

I find the idea of peripatetic medical practitioners going from market to market to sell their skills quite appealing, although that kind of thing disappeared with modern city-states and the need for heavy equipment, white-coated assistants, and all the other trappings of professionalism (►SPECIALISTS, EXPERTS AND LEARNED DONKEYS). Many rural doctors still cover a lot of ground on call, and I once worked with the staff of the Royal Flying Doctor Service in the New South Wales outback who provided medical services via Cessna aircraft to an area larger than Wales itself.

FREUD’S DEBT TO NIETZSCHE

Nietzsche himself provides a fine example of the self-consciously defensive style of those who ultimately seek solace in knowing for their lack of doing (►IN A CRITICAL STATE).

PITY THIS

The other good thing to be said for compassion is that it holds for our relations with non- human beings too; it is an awareness of the universal claim that all victims of suffering have on us. This extends to the humane treatment of animals (►A LOST CAUSE). Pity, however, is terribly ambivalent: as Hannah Arendt noted, in On Revolution (1965): “Pity, taken as the font of virtue, has proved to possess a greater capacity for cruelty than cruelty itself.”

THE SECRET

The fact that the doctor’s duty of confidentiality to the patient has always been a constant aspect of medical practice, as far back as the Hippocratic Oath, is one of the reasons why patients trust doctors. The Hippocratic Oath leaves open the issue of “what ought not to be spoken of abroad”, but it is generally accepted that this negative privilege pertains only to a secret shared in the provision of medical care. (►LISTEN IN).

DON’T TORTURE THAT INSTRUMENT!

It was the founder of stoicism Zeno of Citium who first suggested that we are all susceptible to sympathy, as Cicero suggested: “If you touch the strings of a lyre, the others sound out too.” Hume and Rousseau played those same strings with combo amps; whereas some twentieth-century philosophers question the very music of the analogy. For the French philosopher Emmanuel Lévinas (►A SPINOZISM) ethics are born from the ineradicably different nature of another person (in his famous “face-to-face”): sympathy therefore runs against human nature.

FUNERAL PRACTICES

Most civilised people would recoil from such unseemly behaviour and bite their lip.

AGAINST DECOMPOSITION

It is an accepted concept in biology that the carrying capacity of any given habitat to support an organism or species is limited; somehow this notion has not been extended to humankind. Yet the SARS-CoV-2 variety of coronavirus doing the pandemic rounds just now—sometimes called a “zoonosis” (as if humans were not also animals)—raises many issues about the world population and anthropogenic intrusion into natural systems. If human numbers now (7.8 billion) were the same as they were (less than 4 billion) when we last had a pandemic (H2N2 influenza in 1968), then COVID-19 might never have emerged from China. The understanding that human welfare is intimately linked to animal welfare and our shared environment laid the basis for the One Health Commission, which advances what might be called conservation or ecological medicine.

BEING KIND

Perhaps Dr Johnson’s words (in The Rambler 2 on 24 March 1750) in a slightly different context are apposite: “what is known is rejected, because it is not sufficiently considered that men more frequently require to be reminded than informed.”

TERMINATOR ETHICS

Also known as “ethics software for robots”.

TELLING THE TRUTH TO POWER

I have written on several occasions about Kafka’s friend Ernst Weiss (►NEEDLEPOINT), whose works are published in German by Suhrkamp Verlag: see “History and Hypnosis” in Quadrant (2010), vol. 54, issue 12.

A MORBID SENSITIVITY

It was of course from the artisanal middle classes—just the kind of people who worked under the protection of Bartholomew the Apostle—that the Elizabethan Renaissance acquired its great writers including Shakespeare.

ALWAYS AT A LOSS

Just as neurology, medicine’s “most intellectual domain” as a colleague once told me—and indeed illnesses per se, involve privative symptoms, therapy involves giving something up, otherwise known as renunciation (►PERFECTION AS A PROBLEM). The beginnings of Oliver Sacks’ illustrious career as neurologist and writer raise pertinent issues about how much doctors should reveal of their clinical encounters with patients whose symptoms are so floridly idiosyncratic as to render them identifiable in spite of all precautions to disguise their identity (►BEING IN THE PAPERS).

FOLIE À DEUX

One of the striking lessons of David Healy’s book Pharmageddon (2012) is that pharmaceutical companies now spend an average of 17% of their revenue on marketing (and repurchasing their own shares), sometimes twice as much as on research and development.  No medical school of my acquaintance provides doctors with any instruction in the efficacy of marketing techniques and how they work (►FREUD & CO.).

CUTTING OFF YOUR NOSE

…to spite your face, of course: the quintessentially modern evil. See my essay “Hygiene of the Soul” in A Doctor’s Dictionary (2015).

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PRESUMPTIONS

Gabriel Josipovici’s The Book of God (1988) is about a different kind of knowledge, one based on the most famous book of all. It retells the stories we all thought we knew by heart as strange narratives that instead of offering immediate sense make meaning manifest as something blossoming right in front of our eyes—or, rather, ears.

COLOURS OF THE WORKING WEEK

The fourth chapter of James Joyce’s A Portrait of the Artist as a Young Man opens with a devotional Catholic working week just as busy as Thomas Hardy’s, but colourless. A mortification of the senses is being demanded.

Interviewed in The Guardian on 22 January 2021 Dame Judi Dench, marooned by the coronavirus crisis, revealed that she had just learned the meaning of the word “synaesthesia”. “And I thought; ‘Well, that’s me.’ Because I always saw the days of the week in colour. I never gave it a second thought, it’s just how my mind works. And all of a sudden it’s not  there any more. The days of the week have no colour at all. There’s no structure, no planning.”

PARALLEL WORLDS

For instance, many people consider that screening offers a simple and straightforward approach to preventing disease when experience shows that it is complex, often counterintuitive, and sometimes even paradoxical in its effects.

FINGER TO MOUTH

The ostensive, in directly correlating a word with a thing, is not so much a cognitive act as a communicative one: it extends beyond the individual person to serve as a focus for mutual attention.

ETHICAL POLES

The dialectic between self and community is a subtle one: a society based on consumerism needs to produce “units” for economic reasons (as much as anything else) but sometimes give the impression of being one of individuals without individuality—what the French anthropologist René Girard called “interdividuals”. Even a nuanced individualist like Nietzsche who wanted to be the “poet of his life” (and sometimes appears to embrace Max Stirner’s notion of “self-ownership”) could tell his notebook in 1875, “To make the individual uncomfortable, that is my task.”

DEPRESSION AND RATIONAL DESIGN

Antidepressants until about 1982 were used primarily to treat severe mood disorders, and enjoyed only a fraction of the sales volume of the benzodiazepines that were widely marketed for anxiety—“mother’s little helpers”—until the backlash of the 1980s when they became associated with dependency and withdrawal. This opened the market for a new group of drugs untainted by the tranquilliser label. Drug companies had almost written off the SSRIs (derivatives of existing antihistamines and not especially novel) as being less effective than the older antidepressants and therefore commercially of no interest (the story of the antidepressant lithium salts which, deriving from a chemical element and therefore non- patentable, is highly instructive). The ability to patent isomers and a massive campaign to rewrite psychiatry’s definition of common nervous disorders (suddenly every case of anxiety was hiding a depression) meant that “mood stabilisers” became blockbusters for pharmaceutical firms. The complete story is told in David Healy’s Pharmageddon (2012).

THAT THEY MIGHT HAVE LIFE, AND HAVE IT MORE ABUNDANTLY

Those are Jesus’ words in John 10:10. This is just after talking about thieves, robbers and false shepherds, and those who come to steal, kill and destroy the flock in its pen (►A VERSION OF PASTORAL). I assume “abundant life” to be a quickening, for those whose lives are “cabin’d, cribb’d, confined”, and not the American way of life.

TAKE RABELAIS’ ADVICE

Jean Calvin was attacked in his lifetime by critics who played on the fact that his name (spelt Caluin in those days, although he was actually christened Jehan Cauvin) was an anagram of Lucian, the first-century satirist of the new religion of Christianity. Christophe Garasse attacked Calvin in these words: “Soon afterwards came Caluin with the double mind of those two false prophets: as poisonous as Lucian (whose name he bore as a fated and inauspicious anagram) and as much of a buffoon as Rabelais.”

Rabelais, theologically close to the liberal figures of Erasmus and Melanchthon, enjoyed the patronage of the humanist statesman Cardinal Jean de Bellay—who argued for a reformed Gallican Church when France almost followed the example of Henry VIII in England and broke with Rome—slandered Calvin by name in his novel.

It is known that the “Geneva impostor” had a copy of Pantagruel in his library. It is not known whether he ever read it.

AN ECTOPARASITE FROM THE CRETACEOUS

Most parasites are typically far smaller than their hosts and do not kill them in a predatorial manner (in the lurid manner of the non-carbon-based life-forms in Ridley Scott’s Alien films); they are often highly specialised and live in or on their hosts for extended periods: the entolomogist E. O. Wilson memorably characterised them as “predators that eat prey in units of less than one”. It has been calculated that of the 7.7 million species existing on Earth (a staggering increase from Linnaeus’ initial catalogue of 20 000), about 40% are parasites, at least one hundred of which are specific to humans (see “Homage to Linnaeus: How many parasite? How many hosts?” Dobson A et al. PNAS 2008; 105(1):11482–9.)

SIGNE D’APPEL

A “signe d’appel” is a presenting or pathognomonic sign. See Kant’s remark on what makes human cognition interesting (►OUR NEWEST COLONY).

TOTAL LIABILITY

Traditional Chinese medicine was strongly inflected towards prevention and doctors were commonly paid a retainer provided their patient remained healthy. It is most improbable that attending doctors (unless they attended to the royal body ►THE BODY OF POWER) would be put to death for failing to cure an ailing patient. The original comment is in Elias Canetti’s

Die Provinz des Menschen: Aufzeichnungen (The Human Province, 1978).

MEDICAL HUMANITY

Seeking, receiving and following advice and treatment from a medical practitioner offers a patient many opportunities for not following through, not all of which are intentional. In the old days this used to be called “non-compliance” or “non-adherence”—after all, the doctor has just prescribed a regimen. The Royal Pharmaceutical Society now prefers the term “concordance”. Sometimes the patient simply has something else in mind entirely (►AN ASPHALT VOLTAIRE).

THE ADVANTAGE OF A COLD EYE

Jane Austen’s Aristotelian doctrine—too much and too little care are deficient in relation to the virtuous mean—leaves no place for what ethicists call “supererogation”, going one over the score in helping someone, both those close by and the distant needy. Many people are moved by humanitarian campaigns to attend precisely to those distant needy, though sending  a remittance to an NGO, for instance, entails very little in the way of the immediate responsibilities that Austen envisages.

George Orwell was clear about the danger of having words “think for us”. He seems to have worried about quantity—“Every year fewer and fewer words, and the range of consciousness always a little smaller”, whereas the remarkable Victor Klemperer (1881– 1960) focussed in the secret diaries he kept during the Second World War on quality: how the Nazis manipulated the German language to simplify complex social issues and twist facts (Lingui Tertii Imperii: Notizbuch eines Philologen, 1947). More recently, the French writer Eric Hazan wrote a book which pastiched Klemperer’s title: his LQR: La propaganda du quotidien (2006) concerns itself with the idiom and terms adopted by the French governing class (“governance”, “transparency”, “diversity”, etc.) to justify neoliberal policies and “domesticate” minds: the emphasis is on conformity through consensus (another keyword).

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A WORD TO STAND BY

“Cure is a religious category”, as Philip Rieff observes in his The Triumph of the Therapeutic: Uses of Faith after Freud (1987), which argues the now unfashionable case for the founder of psychoanalysis: its expansion of the freedom to choose was not intended to cure anybody.

A HARD THING

“Death is no artist” is the terse entry in Jules Renard’s famous Journal, a year before his death in 1910.

THE OTHER CONSCIOUSNESS

At the beginning of his long career, Freud used to initiate a mesmeric type of relationship  with his patients by extending his hand and placing his palm against their foreheads. He wrote to Josef Breuer telling him that he had abandoned “this small technical device” in favour of the more abstract dispositions of the talking cure, which surrenders suggestibility (Freud was concerned about mutual transference) for hermeneutics. Freud was concerned to avoid transference, dependency and the erotic element that often arose between analyst and patient. That is also why the analyst sits behind the patient, seeing but not seen.

HOCHSTAPELEI

The confidence-trickster or “Hochstapler” (literally: “high-stacker”) was a new social type who emerged most prominently in German literature between the wars (although Herman Melville already in the nineteenth century sensed the possibilities in American culture for  men who want to stack as high as they can). In Thomas Mann’s novel “Felix Krull” the Hochstapler emerges as a kind of magician who has a malign genius for exploiting confidence, both his and ours.

POETS AND MANAGERS

Perhaps the most influential version of cybernetics today is Lovelock and Margulis’ “Gaia hypothesis”—the notion that the Earth is a complex self-regulating system—is in Earth system science, which studies the interactions between biosphere, hydrosphere and geosphere, and even between life and non-life. An unresolvable hypothesis, of course, since earthlings have never encountered another life-bearing planet on which it could be tested.

(I was also reminded recently that the French understanding of the word science differs from that of empirical English speakers when I entered a section of Strasbourg’s university library bearing the lettering: “Sciences religieuses”.)

AN ODD CASE

Criteria can be applied to data as tightly as can be wished, and still not produce good explanatory models. Statistical methods freeze and distort the cosy commonsensical world in the interests of empirical outcomes, and often provide invaluable findings; the only problem is that the statistical case is never entirely congruent with the flesh-and-blood person. The German psychologist Gerd Gigerenzer, who studies heuristics and probability theory in decision-making, has published a lot of embarrassing papers showing that very few doctors are “risk literate”. But should they be (►WHAT IS THE VALUE OF A PROFESSION)?

BLIGHTED HOPE

The last film of Louis Malle’s distinguished career was Vanya on 42nd Street; it featured the then young starlet Julianne Moore (as Yelena) and an excellent soundtrack by the Joshua Redman Quartet with Redman on tenor sax and another rising star, Brad Mehldau, on piano. His “After Bach” album (2018) is one of the best attempts by a jazz pianist to rise to what Bach was best known for in his lifetime: improvisations.

“THOU ART TRANSLATED

In his Correspondance (I, 38), Balzac observes, after encountering on a visit to the Père Lachaise cemetery the tomb of an army major known to his family: “The inscription read, ‘Here lies M. Mallet… passed away 5 August 1819… This monument erected by his inconsolable widow.’ Think about that! If you ask me, he must have written it himself.”

Perhaps we should add that writers are horribly honest people who say what has to be said, even when it’s unspeakable.

TACT

This entry was written after reading Theodor Adorno’s remarks on the topic in his bracing Minima Moralia (1951), to which Scattered Limbs owes a certain formal allegiance. Iain Bamforth, January 2021.

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