Suburban Shaman, by Cecil Helman

A prescription for the art of medicine

By Julia Neuberger
Friday 03 February 2006 01:00

I simply could not put down this extraordinary mixture of stories from the GP's surgery in suburban London, interspersed with the traditional Indian healer who turns out probably to be a fake, or the man with the bad back who groans in the surgery but almost skips through the park with his two-week sick note on his way home, or the couple in their sixties, both disappointed, who cannot get by without huge doses of antidepressants and tranquillisers. Page by page, the people come alive: the lion tamer who can only bark at the doctor, the compulsive smoker who will not give up, but who is shocked by the doctor's change of approach, the woman who believes a dangerous double has taken the place of her husband, and who is convinced that electricity is leaking out of the walls.

All this would be compelling enough, but the point of Cecil Helman's book - part biography, part old-fashioned storybook, part anthropological study - is the light it sheds on being a doctor in modern Britain as opposed to other areas of the world: notably South Africa, where Helman was born, and southern Brazil, where he goes to see medicine in the poorest favelas of Porto Alegre. There, he sees the traditional healer, Dona Maria. She knows her limitations, as Helman observes, unlike many modern doctors, but she also deals with the "why" questions ("Why me? Why now?"), unlike modern medicine, with its concentration on the "What?" questions ("What is this? What will it do?").

Helman is by no means convinced that modern medicine is going the right way; in his view it is too technical, too dispassionate, and lacks soul. His own experience of a broken ankle leaves him deeply depressed. The doctors explain, but go away, the nurses are too busy and angry, the care is simply not there. As he fails to urinate post-operatively, the staff leave him in agony. As a doctor, he knows he needs catheterisation; as a patient, he becomes increasingly desperate. But no one is looking at the man inside the body, and when he is finally catheterised the relief is immense, and the quantity of urine huge. He asks himself: "What kind of healthcare would allow that kind of neglect to take place?"

Two clear messages emerge from this book, which should be required reading for every medical student. First, medicine must relearn its heart and soul, must relearn to care about what happens to the whole person, rather than continuing with the reductionist approach. Second, there is - however good the technology - no certainty in medicine, and no clear answer as to what it is that cures, or fails to cure, people. Helman describes techno-medicine as "a Utopia where Science replaces spirituality and uncertainty has no place". He adds that "both ambiguity and uncertainty will always be part of any... medical practice".

Helman practised medicine as a GP for 27 years before taking down his plate and moving on to be a medical anthropologist - a shaman of a different kind. He had seen the whole world behind the quiet suburban fences. People had told him stories, had been seriously ill, and had ranged from those who tried to get him to give them a reason to stay alive to those who wanted merely not to go to work.

Everything was there in suburbia. But the man who left apartheid South Africa, where anaesthetists could still argue over whether it was worth anaesthetising a black person because they do not feel pain like white people, is still all too aware of medical cruelty. It is a different cruelty now, one of lack of care, of a belief in machines, of no touching to give comfort, of no understanding of the spiritual. Clearly told, and an extraordinarily good read, this is a passionate cry for humane medicine.

Dame Julia Neuberger's 'The Moral State We're In' is published by HarperCollins

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