Doctor in search of emotional answers

From apartheid South Africa to medical anthropology and poetry, Cecil Helman's tales offer an engaging insight into the healing art, writes Sunita Rappai

Suburban Shaman: Tales from Medicine’s Frontline
Cecil Helman, Hammersmith Press, £9.99order this book

PART autobiographical, part anecdotal and part a discourse on the nature of medicine, Suburban Shaman is a curious, but always engaging, blend of science and literature. Its central thesis is that medicine is becoming increasingly impersonalised – or to put it another way, that most doctors treat the disease and not the patient.
Threaded through the intricate “mosaic of memories” is a call for a return to the values of the old-fashioned family doctor – combining the best of Western medicine with the principles of the traditional healer or shaman.
Dr Helman, a youthful 62, lives in Muswell Hill and is a lecturer in primary care for the Royal Free and University College Medical School based in Archway. At various points he has been a poet, a ship’s doctor, a lecturer at Harvard and for many years a GP. Writing the book was an attempt, he says, to reconcile the many different worlds he has occupied.
“My mother was an artist and my father a psychiatrist,” he says. “I come from this huge family of doctors. But I always thought there was something else that needed to be included. For me the missing element was literature – stories and narrative. So it is an attempt to reconcile two apparently incompatible worlds – the world of science and the world of arts.”
But an increasing concern about the directions that modern medicine is heading in – and the advent of the “techno doctor” as he calls it – also drove the book.
“There is a blurring of boundaries between patient and machine,” he says. “I have seen consultants pay more loving care and attention to a monitor machine or a strip of ECG paper than to the person lying in the bed.
“It saddens me because it is moving away from medicine’s traditional role of healing and curing. It doesn’t have to be so. You can be a techno doctor but a compassionate one. I fear that we are over emphasising the technical and the numerical over the emotional and the social.
“I’m not suggesting that doctors become shamans or traditional doctors,” he adds. “What I am suggesting is that we learn from their ability to situate their patients in a wider social context. We need to look at a disease not as a disease with a person attached but a person with a disease. And that person exists within a family and a community and not in a vacuum.”
Few would disagree with this idea and Helman illustrates his argument well – with references to patients he has treated, current medical and social theory and his own experiences as an anthropologist, a lecturer and a medical student.
There is a telling anecdote he recounts of a trip to the wards when he was still training. “I remember being told that there was a really interesting spleen, third bed on the left. And I was having visions of this spleen just sitting there and of course there was a patient on the bed. The first thing is to understand what it’s like to be a patient.”
A chapter simply called Hospital – recounting his experience as a patient in an unnamed hospital after fracturing his ankle – should be required reading for all politicians. In cool, dispassionate prose he relates the agony of lying in an impersonal ward, cold, hungry, bladder full to bursting point, waiting for a nurse to relieve him.
But if there is a problem with Suburban Shaman – despite the elegant prose, the thoughtful anecdotes, the insight into an often forbidding world by a member of the “tribe” – it is that its central vision is essentially backward, rather than forward-looking.
To many of us, the benign family practitioner is a comforting ideal. The reality is an overcrowded, underfunded NHS floundering under financial and political pressures that urgently need addressing. By focusing on the personal rather than the political, has he essentially reduced his argument to a plea for a kinder world?
“I’m not a political person,” he says, when I put this to him. “I’m not built like that. I can only talk from my own modest fragment of experience. You might say that I am better on diagnosis than treatment. All I can do is tell my own story.
“The emotional charge from my own experiences at the hospital and from what I’m seeing and hearing upset me but I don’t have any grand solutions. I’m looking at it from the ground upwards. This is a different way of giving information about possible policy changes. It doesn’t have to come from the top down, it can happen the other way.”