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The Healer's Power.

Sick people have become weak people, and they hope the doctor will bring their strength back to them," I heard Dr. William Carlos Williams say many times, as I accompanied him on his New Jersey house calls--mostly made to the homes of people vulnerable not only by dint of illness, but by their social, economic, racial marginality. I thought of those moments, those words, as I read The Healer's Power, Dr. Howard Brody's most recent book--an original, thoughtful, suggestive one, indeed. Dr. Williams had a keen sense of the disproportion, the asymmetry that obtained between him and those he treated--the many poor folks whose ailments made them even more vulnerable. Even his well-to-do patients were, suddenly, not his equal in certain respects, as he once pointed out in a prefiguration of Dr. Brody's thesis: "No matter who comes in my office, as a patient, there's worry that arrives at the door, too--and I hope I remember that." A pause, then this important self-addressed warning: "If a doctor forgets his patient's fears, he's in danger himself--flirting with the seductions of tyranny." I thought at the time that Williams may have been a bit dramatic with that last comment, but Dr. Brody's book makes clear how intuitively on target his writing predecessor had been, as he looked back at his long medical life a year or so before it would end. In no time, actually, I would hear him talking from quite another vantage point--the patient who rails against one or another high-handed, all too tight-lipped physician.

In fact, Dr. Brody calls upon Dr. Williams--the well-known story "The Use of Force," wherein a doctor is struggling (in the preantibiotic era) to obtain a throat swab from a girl who may well have diphtheria. The child resists mightily, but the doctor persists stubbornly, and soon enough, excitedly; he is taken with the child's powerful defiance and stirred to prevail. As in all good stories, the reader can make many interpretations (the sensual if not sexual, the aggressive aspects of this human scene), but surely power is vividly at stake, that of the doctor over a patient. It is Dr. Brody's thesis in his book that the "force," the power Williams renders in his story, is a major presence of sorts in our medical, our healing lives--and so what we do, how we are perceived, who we are in our own minds, has to do with the authority we have and, in various respects, keep wielding.

Dr. Brody spells out this thesis in many ways. He calls upon Dostoyevsky's Grand Inquisitor and William's fictional evocation of medical life to illustrate certain attitudes--the need many of us have to submit to absolutist authority and, correspondingly, the seduction such a posture can have for doctors (Dostoyevsky) and the rationalizations available to physicians, once they start insisting upon their unquestionable right to practice medicine their way (Williams). He looks closely at the everyday assumptions that medical students and house officers gradually learn to make their own: the doctor's rights, the doctor's responsibilities, the doctor's burdens, the doctor's possible jeopardy (malpractice suits). All too often the patient figures only slightly in such a socialization--as if the ideal sick person is the one who willingly (if not graciously, smilingly) defers to the doctor's wishes, procedures, recommendations. He goes further, examines the "rescue fantasy" that supplies psychological and moral energy to many of us in medicine--a notion of ourselves as determined protagonists, ever ready and able to do battle with death, with life's fateful turns. To be sure, it is well that doctors do fight long and hard on behalf of their patients, but there are potential costs or hazards, Dr. Brody warns, in the uncritical egoism of someone who is lording it over the person to be "saved," even turning him or her into an object to be probed, tested, "treated," rather than regarded as an ally, one to be informed, consulted, and not least, respected, even at times given the last word.

No question, this book is a bold, even courageous effort to mention the unmentionable, to challenge the conventional. "I offer speculation," the author says (p. 21), "not argument or data, for here we are dealing with a sensitive area of the human soul that few people, physicians or not, are willing to expose fully to daylight." He explains his though, his surmise, this way: "I speculate that somewhere in our more primitive depths is a lust, half childish, half sadistic, to use whatever power we might have to victimize others less powerful, and to enjoy it--to glory in the fact that they and not we are the victims, and to escape for a moment into the fantasy that since we can avoid their victimhood through our power, we are invulnerable and need never again feel fear."

A strong, unflinching observation--one not meant to be psychologically reductive and not meant, certainly, to preclude other observations about us human beings. We can also be thoroughly kind, caring; honestly, deeply interested in helping others; wonderfully sensitive to the troubles and burdens of those we attend as doctors, nurses, or indeed, as fellow mortals. But Dr. Brody knows how much easier it is, quite naturally, for the positive side of our nature to be acknowledged, celebrated, than for the kind of observation he makes even to be discussed with some openness of mind, let alone be accepted. His book, really, is an effort to put such matters right on the table--to prompt in us some thought about how our need to control things (and people), our sometime urge to lord it over others, our inclination, even, to boost ourselves at the expense of those who are down on their luck, our occasional wish (to push matters further) to get a kick or two out of those who are suffering long and hard, all have a bearing on how we behave--the thoughts we have, the things we say, the decisions we make.

In a bold, candid, lucid manner this book challenges the reader both emotionally and intellectually, even as the author is himself forthcoming about his doubts, his worries, his apprehensions. We are given a narrative kind of ethical reflection here, rather than an emphasis on do's and don'ts, a list of when what is to happen and why. A writer comfortable with life's ironies and ambiguities and unafraid of its darker side, while still hopeful about the value and worth of introspection, conjecture, human discourse, dares take on our many contemporary medical problems and quandaries--the way we doctors practice medicine, the way our patients experience us, and not least the way, at various moments, our fateful authority gets used. Dr. Brody writes with a singular, a compelling, a powerful, a persuasive voice. He is interested in our rock-bottom nature as healers, in our character, in the possibilities for good and for bad that are to be found in each of us. Such an informed, searchingly honest look at those who heal others (and need their own kind of healing) is altogether rare and well worth the closest of attention at this time of turmoil in our profession's historical life.
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Author:Coles, Robert
Publication:The Hastings Center Report
Article Type:Book Review
Date:May 1, 1993
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