This is a book about closed worlds, and a glimpse into them. The dissecting knife of the title is wielded elegantly and incisively by Jane Haynes, using her professional skill as a psychotherapist to get under the skin of her subjects, to find out what lies beneath that persona of doctor.
I was invited to review this book partly because of my own background in the NHS—training as a nurse at St Thomas' Hospital in the 1980s, and then returning as a psychotherapist in 2004. Reading this and then reviewing it for people who have maybe not experienced the medical world made me think about the closed nature of that world. The doctors talk matter-of-factly about their experiences in intensive care, of doing multiple intimate examinations in a day, of dealing with dying and death, of cutting up cadavers at medical school. I have inhabited parts of this world, a fact that I am reminded of whenever I visit anyone in hospital. I have a familiarity with it that others may not. I know what goes on behind the curtain, in the theatre. The terminology is no accident. There is the public performance and there is the backstage world, with its off-colour jokes and human frailty. This book takes us behind the curtain. Jane asks the questions that an outsider may wish to ask about that world. Her co-author, Martin Scurr, provides the back-stage pass through his intimate involvement in that world which stretches across the generations, a doctor who is also the son and now father of a doctor. He has his own questions too, which drive much of the book. Jane opens up that closed world, not just to the readership but also to the doctors themselves, inviting them to step outside and peer back in.
At the heart of the book, what kicks it off, so to speak, is Martin's own question—what is it about medicine that seems to lead the children of medics to choose it as a career? Not everyone interviewed is a son or daughter of medics although it is remarkable how that is often the case. It is Martin's own son Cosmo, choosing this career over the many other
options available to him, that has piqued his curiosity and led him to open himself, and Cosmo, up to Jane's questions, and to reflect back over his own career.
Jane Haynes explores this and other questions through individual interviews with ten other doctors over several sessions. She asks questions relating to family influences on the choice of becoming a doctor, the process of training, further career decisions, the nature of work as a doctor and the personal impact of the work. She is passionately engaged with her subjects, and brings something of herself into the dialogues. The questions and answers are offered without comment or interpretation. It is a curious device, which I was surprised to experience as alienating at times. The reader is an eavesdropper on these intimate, wide-ranging conversations, into the closed world of interviewer and interviewee. Although it is not presented as therapy, they cover some ground that is clearly new and at times startling to the interviewees, the world of the psyche being dissected as Jane asks about attitudes towards death, sexuality, parents and illness.
There is also an explicitly political dimension to Doctors Dissected, as stated in the introduction: the loss of the traditional role and function of the family GP, caring for their patients from cradle to grave; and the increasing frustrations of working within the NHS. However, the format of the book means that it is skewed towards the personal, leaving the political to be read predominantly through each individual's experience. It is left very much to the reader to draw their own conclusions about, for example, what draws people into medicine, or drives them out of the NHS. This could be frustrating, as it was easy to get caught up in the detail of each individual but lose what may be universal in their experiences. The lack of any overarching narrative to the book leaves the bigger questions, for me, underexplored; seen only through the experience of each individual.
How Jane Haynes selected her interviewees is not explained, though the introduction makes clear that this is not an attempt at quantitative research. There are a couple of apparently coincidental overlaps between interviewees: Caroline, the subject of chapter five, describes an
incident that sounds very familiar, until we and Haynes notice that it is the same incident told to her by Cosmo, Martin's son, in an earlier interview; and Ben (chapter six) goes to locum for Martin Scurr when he takes a sabbatical. This leaves an impression of another small, if not quite closed world; predominantly London-based and predominantly populated by well-connected, even inter-connected people.
One possible answer to Scurr's question is that it is the closed world of medicine that draws the children of medics to choose to join it, combined with a desire to dissect, to get under the skin of another closed world, that of the body. Perhaps psychotherapists too are drawn to closed worlds with a corresponding desire to dissect them. The title reminded me of Adam Phillips citing Harold Searles in the preface to his book Equals, that those who are drawn to this work may resemble surgeons in their harbouring ‘powerful, long-repressed desires to dismember’. For psychotherapists reading this book, what they may be left with is a desire to know more, to go further into each portrait, and explore those repressed desires, or conversely to stand further back, to reach conclusions about the nature of this world. As with any psychotherapeutic enterprise, these portraits shift the reader's focus continually between that which can be universally conceived, and the peculiar, intimate, unique world of the individual.