There is nothing, then there is something, then there is nothing again

Ken Worpole
5 May 2005

“If I could choose only one book on the planet, it would be this book”, said Dr Iona Heath, a Camden GP for nearly thirty years, flourishing a copy of A Fortunate Man in the air. Many others have felt the same. On the evening of 26 April 2005, nearly forty years after its publication, and as part of a short London season of events based around the work of John Berger, over 200 people, many of them doctors, packed into one of the lecture theatres at Queen Mary College, London, to testify to one extraordinary book which had shaped their lives and political beliefs. The event was sponsored by the Royal College of General Practitioners, who have just republished it.

In 1967 the writer John Berger and photographer Jean Mohr cooperated on A Fortunate Man: the story of a country doctor . It was unique for its time, employing an essayistic, photojournalistic style previously associated with magazines such as Picture Post, and filmmakers such as John Grierson and Humphrey Jennings, but moving it into newer, more personal territory: tentative, exploratory, unheroic. Interviewed for television at the time of publication, Berger claimed that he hoped the book would be read by future generations, because the problems it raised were long-term ones, to do with creating new forms of human solidarity in the face of the breakdown of historic class structures, both in rural and urban communities.

Among John Berger’s writing on openDemocracy:

“The decisive moment” (November 2004)

“Quicksilver, a tribute to Susan Sontag” (December 2004)

“That have not been asked: ten dispatches about endurance in face of walls” (February 2005)

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A Fortunate Man was a book about how one particular man had sought to live his life and carry out his professional obligations to others within an ethical framework still in the making. Berger and Mohr sought to explore how people’s lives are interconnected through networks of place, family, work and professional dependencies and interdependencies. It was a book about the redemptive qualities of “community”, long before much of the left had woken up to the fact that the older solidarities of party and class had been marched unthinkingly into political oblivion.

The psycho-geographical conditions for the event were perfect. In the early 20th century Queen Mary College was known as The People’s Palace, a place where east London’s working class could attend lectures and courses for free. My own grandfather studied bookkeeping there when he came back from the first world war, before settling down as a street bookmaker in Burdett Road. The modern campus is carefully located round an 18th century New Sephardi Jewish burial ground, with its austere, truncated chest tombs laid out in formal order, line after line after line, and raked around in gravel. Et in Arcadia Ego. The meeting was held in a lecture theatre with steeply raked seating, as if we had all been returned to the conditions of our enquiring youth. Doctors of a radical persuasion have played a very important role in this part of London for a very long time. Nothing could go wrong. It didn’t.

The event took the form of a series of political testimonies from a panel of doctors and writers, including Dr Tony Callard, an early medical partner of John Sassall on whose life A Fortunate Man was based. Dr Callard still works at the same Wye Valley practice as he has done for the past thirty-two years.

He used the opportunity of rereading the book to look at the changes which have happened in the doctor-patient relationship since then. At that time the doctor was a figure of power and authority, though he or she could also be a confidant and a friend – a relationship that a 24-hour “on-call” and home-visiting working life underscored. Yet at times, he admitted, the undistanced human relationship could compromise the clinical relationship, and in times of crisis both doctor and patient could be drawn into the same vortex of anxiety and despair.

Most in the audience knew that some years after the publication of A Fortunate Man, its subject, John Sassall, committed suicide under great personal pressure; he “was frightened in case a patient comes into the surgery with a problem I can’t solve”.

The poet Michael Rosen spoke warmly of growing up in a Jewish communist family in east London which regarded doctors and Marxist intellectuals as gods. Hence the surprise when Berger chose to write about a diffident, middle-class doctor in a rural practice – rather than a militant worker or socialist activist – as a significant figure for the times, through which one might understand the dynamics of human meaning and hopes for a better world in which to live.

Among Ken Worpole’s articles on openDemocracy:

“Stockholm Woodland Cemetery” (January 2003)

“Essex shores, Essex lives” (September 2003)

“Death in the Luxembourg gardens” (October 2003)

“A problem with drink?” (December 2003)

Rosen spoke about his own experience of bereavement when his teenage son died suddenly of meningitis six years before to that very evening, and how his doctor’s support and “naming” of the fatal condition had been of crucial importance at the time. Death was never very far away during this evening, and it was the familiarity with death that gave the doctor’s role of recording clerk and witness its unique social privilege.

Writer and film critic, Sukhdev Sandhu, spoke from and about another cultural moment: the role that Asian doctors played – often in the face of enormous racist hostility – in general practice from the 1960s onwards in Britain. He called Berger & Mohr’s book a “covert manifesto” for new kinds of human responsibilities and obligations, though contemporary government policies on health seem intent on stripping all of these human attributes out of the system.

Modern healthcare now seemed more like an industry based on measurable targets and outputs rather than on existential questions of living (and dying) well within networks of medical care rooted in wider social obligations. Sandhu also spoke wittily of the architectural settings in which these changes have occurred, affectionately recalling his own family doctor’s surgery being located in a large, private home, with a waiting room filled with soft furnishings and magazines such as Reader’s Digest and People’s Friend. Today, he said, the modern surgery often looks no different from a small retail outlet in a business park, offering waiting-room video screens showing nightmarish incidents from Casualty in a recursive circle of blood, drama, and inauthenticity.

Two junior doctors, Jane Simpson and Patrick Hutt, dwelt on the impact A Fortunate Man had had on them during medical training, when they experienced the feeling of belonging to two completely different worlds, of clinical practice and human community, the understanding of the latter being almost entirely missing from their training. While their medical education had prepared them for the functions and malfunctions of the human body, it had in no way prepared them for the glaring inequalities in life experience and shocking levels of material deprivation they found out in the wider world. Nor for the stresses and feelings of guilt when tragedies occurred.

To an audience made up largely of men and women in general practice, the National Health Service as a political ideal still seemed to have been one of the great achievements of British politics in the 20th century. Yet its implicit political meanings were perceived to be under attack as never before. Ideals of public service were being replaced by market-based contracts. While it was a good thing that the older deference of the past had been replaced by a greater degree of parity of esteem between doctor and patient, the more communitarian aspects of the doctor’s role had been negated in a target and output-based culture.

Even so many in the audience thought that the continuities in practice between then and now were greater than the disjunctures. People still had children, worried about them, became ill, and sooner or later died, and at the crucial moments of these great life-events and traumas (which even socialism could not abolish), the doctor could still be there to relieve suffering and demonstrate the abiding ties of human solidarity and affection.

This was a most enriching evening, undemonstratively chaired by Dr Gene Feder, another east London GP, as the subject required. It was perhaps even more successful as a shared experience due to the absence of Berger himself, whose attendance might well have drawn attention away from the ideas and images contained in the book, still provocative and without conclusion after all these years. Rereading A Fortunate Man I was astonished to realise that I had absorbed many of the passages in it by heart and have paraphrased them as my own thoughts and insights over the past forty years, forgetful of their origins in this remarkable work.

People left the lecture theatre to a squall of heavy April rain, car headlights gleaming along the Mile End Road, and the neon signs and emblems of a hundred different cafes and cuisines glowing on the wet pavements. In whichever direction people returned home, they could not avoid the pulsating lights of the towering monuments to global wealth and power now located in the former docklands close by, side by side with narrow streets of harsh, demeaning poverty. There is nothing, then there is something, then there is nothing again.

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