A Fortunate Man Read online

  The villagers do not consider him privileged because they find his thinking so impressive. It is the style of his thinking which they immediately recognize as different from theirs. They depend upon common-sense and he does not.

  It is generally thought that common-sense is practical. It is practical only in a short-term view. Common-sense declares that it is foolish to bite the hand that feeds you. But it is foolish only up to the moment when you realize that you might be fed very much better. In the long-term view common-sense is passive because it is based on the acceptance of an outdated view of the possible. The body of common-sense has to accrue too slowly. All its propositions have to be proved so many times before they can become unquestionable, i.e. traditional. When they become traditional they gain oracular authority. Hence the strong element of superstition always evident in ‘practical’ common-sense.

  Common-sense is part of the home-made ideology of those who have been deprived of fundamental learning, of those who have been kept ignorant. This ideology is compounded from different sources: items that have survived from religion, items of empirical knowledge, items of protective scepticism, items culled for comfort from the superficial learning that is supplied. But the point is that common-sense can never teach itself, can never advance beyond its own limits, for as soon as the lack of fundamental learning has been made good, all items become questionable and the whole function of common-sense is destroyed. Common-sense can only exist as a category insofar as it can be distinguished from the spirit of enquiry, from philosophy.

  Common-sense is essentially static. It belongs to the ideology, of those who are socially passive, never understanding what or who has made their situation as it is. But it represents only a part – and often a small part – of their character. These same people say or do many things which are an affront to their own common-sense. And when they justify something by saying ‘It’s only common-sense’, this is frequently an apology for denying or betraying some of their deepest feelings or instincts.

  Sassall accepts his innermost feelings and intuitions as clues. His own self is often his most promising starting-point. His aim is to find what may be hidden in others:

  ‘I don’t find it hard to express uncensored thoughts or sentiments but when I do, it keeps on occurring to me that this is a form of self-indulgence. That sounds somewhat pompous, but still. At least it makes me realize and understand why patients thank me so profusely for merely listening: they too are apologizing for what they think – wrongly – is their self-indulgence.’

  Using his own mortality as another starting-point he needs to find references of hope or possibility in an almost unimaginable future.

  ‘I’m encouraged by the fact that the molecules of this table and glass and plant are rearranged to make you or me, and that the bad things are perhaps badly arranged molecules and therefore capable maybe of reorganization one day.’

  Yet however fanciful his speculations, he returns to measure them by the standards of actual knowledge to date. And then from this measurement begins to speculate again.

  ‘You never know for certain about anything. This sounds falsely modest and trite, but it’s the honest truth. Most of the time you are right and you do appear to know, but every now and then the rules seem to get broken and then you realize how lucky you have been on the occasions when you think you have known and have been proved correct.’

  He never stops speculating, testing, comparing. The more open the question the more it interests him.

  Such a way of thinking demands the right to be theoretical and to be concerned with generalizations. Yet theory and generalizations belong by their nature to the cities or the distant capital where the big general decisions are always made. Furthermore, to arrive at general decisions and theories one needs to travel in order to gain experience. Nobody travels from the Forest. So nobody in the Forest has either the power or the means to theorize. They are ‘practical’ people.

  It may seem surprising to place so much emphasis on geographic isolation and distances when England is so small a country. Yet the subjective feeling of remoteness has little to do with mileage. It is a reaction to economic power. Monopoly – with its mounting tendency to centralization – has even turned what were once large, vital towns, like Bolton or Rochdale or Wigan, into remote backwaters. And in a country area, where the average level of political consciousness is very low, all decision-making which is not practical, all theory, seems to most of the local inhabitants to be the privilege and prerogative of distant policy-makers. The intellectual – and this is why they are so suspicious of him – seems to be part of the apparatus of the State which controls them. Sassall is trusted because he lives with them. But his way of thinking could only have been acquired elsewhere. All theory-makers have cast at least one eye on the seat of power. And that is a privilege the foresters have never known.

  There is another reason why they sense that Sassall’s way of thinking is a privilege, but as a reason it is less rational. Once it might have been considered magical. He confesses to fear without fear. He finds all impulses natural – or understandable. He remembers what it is like to be a child. He has no respect for any title as such. He can enter into other people’s dreams or nightmares. He can lose his temper and then talk about the true reasons, as opposed to the excuse, for why he did so. His ability to do such things connects him with aspects of experience which have to be either ignored or denied by common-sense. Thus his ‘licence’ challenges the prisoner in every one of his listeners.

  There is probably only one other man in the area whose mode of thinking is comparable. But this man is a writer and a recluse. Nobody around him is aware of how he thinks. There are clergymen and schoolmasters and engineers, but they all use the syntax of common-sense: it is only their vocabulary which is different because they need to refer to God, O-levels, or stresses in metal. Sassall’s privilege seems locally unique.

  The attitude of the villagers and foresters to Sassall’s privilege is complex. He has got a good brain, they say, why, with a brain like this – and then, remembering that he belongs to them, they realize that his choice of their remote country practice again implies a kind of privilege: the privilege of his indifference to success. But now his privilege becomes to some extent their privilege. They are proud of him and at the same time protective about him: as though his choice suggested that a good brain can also be a kind of weakness. They often look at him quite anxiously. Yet they are not, I think, so proud of him as a doctor – they know he is a good doctor but they do not know how rare or common that is – rather, they are proud of his way of thinking, of his mind, which has mysteriously allowed him to choose to stay with them. Without being directly influenced by it, they make his way of thinking theirs by giving it a local function.

  He does more than treat them when they are ill; he is the objective witness of their lives. They seldom refer to him as a witness. They only think of him when some practical circumstance brings them together. He is in no way a final arbiter. That is why I chose the rather humble word clerk: the clerk of their records.

  He is qualified to be this precisely because of his privilege. If the records are to be as complete as possible – and who does not at times dream of the impossible ideal of being totally recorded? – the records must be related to the world at large, and they must include what is hidden, even what is hidden within the protagonists themselves.

  Some may now assume that he has taken over the role of the parish priest or vicar. Yet this is not so. He is not the representative of an all-knowing, all-powerful being. He is their own representative. His records will never be offered to any higher judge. He keeps the records so that, from time to time, they can consult them themselves. The most frequent opening to a conversation with him, if it is not a professional consultation, are the words ‘Do you remember when …?’ He represents them, becomes their objective (as opposed to subjective) memory, because he represents their lost possibility of understanding and relating t
o the outside world, and because he also represents some of what they know but cannot think.

  This is what I meant by his being the requested clerk of their records. It is an honorary position. He is seldom called upon to officiate. But it has its exact if unstated meaning.

  I am very well aware that there is a certain clumsiness in my metaphorical devices. And what do they matter? On the one hand a sociological survey of medical country practice might be more useful: and on the other hand various statistical analyses of the degree of satisfaction expressed among patients after different forms of treatment might be more revealing. I do not for one moment deny the usefulness of such exercises – and indeed have drawn upon many of their findings whilst preparing this essay. But what I am trying to define here are relations which cannot yet be reached by a question-and-answer analysis.

  What I am saying about Sassall and his patients is subject to the danger which accompanies any imaginative effort. At certain times my own subjectivity may distort. At no time can I prove what I am saying. I can only claim that after years of observation of the subject I believe that what I am saying, despite my clumsiness, reveals a significant part of the social reality of the small area in question, and a large part of the psychological reality of Sassall’s life. The greatest stumbling-block to accepting this is the false view that what people cannot express is always simple because they are simple. We like to retain such a view because it confirms our own bogus sense of articulate individuality, and because it saves us from thinking about the extraordinarily complex convergence of philosophical traditions, feelings, half-realized ideas, atavistic instincts, imaginative intimations, which lie behind the simplest hope or disappointment of the simplest person.

  To a large extent Sassall has achieved his ideal. As much as a man can on land, dealing with illness and not the sea, and living in the middle of the twentieth century, he has achieved a position which is comparable to that of a master of a schooner.

  He has his relative autonomy and his solitary responsibilities. (Unlike most G.P.s, he has access to ninety per cent of his hospitalized patients, because all but complex major surgery cases go to the local town hospital at which he is one of the house doctors.) He deals with all emergencies which arise – from serious accidents in the quarries or at harvesting time in the fields, to the despair of a young woman who wants to kill her illegitimate baby or the slow suffering and eventual collapse of a retired vicar who has lost his faith. He is trusted, almost without question.

  It is true that his attitude to the individual patient, far from being based on explicit authority, is based on answering an unmade demand for fraternity, but this fraternity is not mutual: it is an imaginative projection on Sassall’s part, as true, but also as artificial as a work of art: nobody fraternally recognizes Sassall: and this makes him the commander.

  His position as ‘clerk of the records’ not only means that, more than any other man, he knows the continuing history of the area; it also attributes to him the power to comprehend and realize for the community. To some extent he thinks and speaks what the community feels and incoherently knows. To some extent he is the growing force (albeit very slow) of their self-consciousness.

  Lastly, the area, because it is backward and depressed, is subject to the minimum of direct influence from outside. Its condition is entirely dependent upon what happens and what is decided elsewhere. But very few people, very few ideas – except the ready-to-wear ones of the misused mass media – arrive to challenge Sassall’s hegemony.

  What is the price of Sassall’s achievement?

  I do not propose to discuss all the daily irritations and inconveniences of a G.P.’s life. This can safely be left to representatives of the doctors themselves. Some of their grievances are real enough. But the general tone of them is the result of fear and resentment at the sensed but not fully understood fact that the nineteenth-century status and categories of the medical profession are becoming obsolete.

  Sassall is not really alarmed by this, for he has established his own special position. As a result of this special position, however, he has to face, far more nakedly than many doctors, the suffering of his patients and the frequent inadequacy of his ability to help them.

  It is generally assumed that doctors take a professional view of suffering and that the process of professional insulation begins in their second year as medical students when they first start dissecting the human body. This is true. But the question is far deeper than overcoming any physical revulsion at the sight of blood or guts. Later, other factors are an aid to their self-protection. Doctors use a second, technical, entirely unemotional language. Frequently, they need to act quickly and to carry out complicated manual tasks which demand exclusive concentration. Increasing specialization encourages an increasingly scientific view of illness. (In the eighteenth century and earlier the doctor was often thought of as a cynic: a cynic is by definition a man who assumes a scientific ‘objectivity’ to which he has no claim.) The sheer number of their cases discourages self-identification with any individual patient.

  Yet, however true this may be, the suffering which certain doctors witness may be more of a strain than is generally admitted. This is so with Sassall. He is a man of extreme self-control. Nevertheless, when he was unaware of my presence, I saw him weep, walking across a field away from a house where a young patient was dying. Perhaps he was blaming himself for things done or left undone. He would transform his pain into a sense of painful responsibility, for that is his character.

  But his sensibility is not just the consequence of his character: it is equally the consequence of his position and the way he practises. He never separates an illness from the total personality of the patient – in this sense, he is the opposite of a specialist. He does not believe in maintaining his imaginative distance: he must come close enough to recognize the patient fully. Although he has about 2,000 patients, he is aware of how they are all interrelated – and not only in the family sense – so that the numbers seldom acquire a statistical objectivity for him. Most important of all, he considers that it is his duty to try to treat at least certain forms of unhappiness. He very seldom sends a patient to mental hospital for he considers it a kind of abandonment.

  What is the effect of facing, trying to understand, hoping to overcome the extreme anguish of other persons five or six times a week? I do not speak now of physical anguish, for that can usually be relieved in a matter of minutes. I speak of the anguish of dying, of loss, of fear, of loneliness, of being desperately beside oneself, of the sense of futility.

  One aspect of the confrontations seems to me to be important and not much discussed, and so the reader must forgive me if I concentrate on this and ignore others.

  Anguish has its own time-scale. What separates the anguished person from the unanguished is a barrier of time: a barrier which intimidates the imagination of the latter.

  A man or a woman who is sobbing reminds one of a child, but in the most disturbing way. This is partly because of the particular social convention which discourages adults (and particularly men) from breaking into tears but permits children to do so. Yet this is by no means the whole explanation. There is a physical resemblance between a sobbing figure and a child. The ‘bearing’ of the adult falls away and his movements are limited to certain very primitive ones. The centre of the body once again seems to be the mouth: as though the mouth were simultaneously the place of pain and the only way by which consolation might be taken in. There is a loss of the control of the hands which again can only clench or paw. The whole body tends towards a foetal position. There are good physiological and psychological reasons for all this: but we can observe the similarity without knowing them. And why is the similarity so disturbing? Once more I believe the explanation goes further than our sense of convention or compassion. In some way the similarity, once established, is brutally denied. The sobbing man is not like a child. The child cries to protest. The man cries to himself. It may even be that by crying again li
ke a child he somehow believes that he will regain the ability to recover like a child. Yet that is impossible.

  Anguish need not necessarily involve weeping. It may be composed more bitterly in hatred, vengeance or in that half-mocking anticipation of cruelty with which the desperate sometimes await their own destruction. But all anguish, whatever its expression of cause and whether it is rational or neurotic, returns the sufferer to a childhood which increases his despair. Or at least that is what I believe as a result of my own observation and introspection.

  It is a platitude that as we grow older time seems to pass more quickly. The remark is usually made nostalgically. But we seldom consider the contrary effect of the same process – the elongation of time as it must affect the young and very young. The young themselves can say little about it, because they only have a standard of judgement when they become aware of time changing its pace and by then it’s too late for any direct evidence. If we knew how long a night or a day was to a child, we might understand a great deal more about childhood. Could it not be that the deeply formative nature of early childhood experience is due not only to the force of its impact (a force measured by the child’s relative weakness) but also to the fact that by the child’s own reckoning the experiences continue for so long? It may be that, subjectively, a childhood is at least equal in length to the rest of a lifetime. The phenomenon of old people, when their daily practical preoccupations are reduced to a minimum, remembering more and more clearly more and more about their childhood may confirm this; subjectively, their childhood was perhaps most of their life.

  Yet why should time seem to change its pace? What is the difference between a child and an adult in this respect? Sartre in his first novel5 offers a clue. The book as a whole is partly concerned with a similar and parallel problem: how to achieve a sense of adventure given a full awareness of the nature of time. This is how he describes the habitual life of the adult.