‘We have not lost faith, but we have transferred it from God to the medical profession’: Medicine in Mainstream Literature – Part II
by Victor Grech, Clare Vassallo, Ivan Callus
The locus classicus that, arguably, above all other works, demonstrates the duality of human nature in all of mankind, including in the medical profession, is Robert Louis Stevenson’s The Strange Case of Dr. Jekyll and Mr. Hyde (1886) wherein doctors are portrayed as weak and fallible, primarily because of the potential abuse of their special knowledge and abilities.12 The duality of man’s psyche is the story’s overriding theme, an allegory of mankind’s permanent inner conflict between good and evil through the potential dissociation of a single entity into two opposing selves. The story was recently rewritten by Steven Moffat as Jekyll and billed as a modern-day sequel to the original novella.13
Jekyll, a medical doctor, is the novel’s protagonist: in late-middle age, intelligent, tall, dignified, wealthy, widely respected and with a good house and a household of loyal servants, the epitome of the Victorian gentleman and the embodiment of all that is good in mankind. Nevertheless, deep down and invisible to all but himself, just like common mortals, Jekyll harbours a dark side with secret passions and vices that he is unable and unwilling to unleash, a sinister force that is also manifest in his name, ‘I kill’ in French. For this reason, he concocts a potion that will bring forward only one (the best) of his two halves. The potion is impartial and favours neither good nor evil, and because Jekyll approaches this unnatural endeavour with ambition and unseemly anticipation, it is the evil half, Mr. Hyde, in the Frankensteinian trope (which will be amplified later) that is manifested at this crucial crossroad. Hyde is described as small, distorted and ugly, and any who see him experience distaste and outright horror.
Jekyll is initially in total control over his metamorphosis into Hyde, but slowly damns himself as he finds that he enjoys slipping into the Hyde alter-ego since it endows him with the liberty to perform iniquity with impunity, a freedom that is derived from Hyde’s untouchability, since he can be made to vanish at will. However, this becomes an addiction and Hyde eventually becomes powerful enough to manifest spontaneously. The completely senseless, unprovoked and callous murder of a member of parliament is the nadir of Hyde’s wickedness and Jekyll finds that he now has to take ever increasing doses of potion in order to remain in the Jekyll persona, living in the fear that as Hyde, he will be caught, prosecuted and executed for murder. Toward the end of the novel, Jekyll runs out of potion and is unable to find the necessary raw materials in order to produce a new supply of potion, and realises that the only way to impede his permanent transformation into Hyde, along with prosecution for murmur and execution, is by suicide, a deed that he actually commits, bringing the story to a close.
Lanyon, a medical doctor, also appears in the story, and is used as a scientific foil for Jekyll. Lanyon is unfortunate in witnessing a Jekyll-Hyde transition, and as a firmly rational man, he simply could not adapt to the revelation of the Hyde possibility, a monstrous half that is suppressed in all of us. His stricken soul leads his physical body into a rapid decline and death, also a form of suicide. While ‘a text like Jekyll and Hyde could be said to be premised on a scientific ‘novum,’ […] it is equally overdetermined by Gothic, melodramatic, and imperialist elements’ and hence not strictly appertaining to the science fiction genre.14
This trope has been frequently reused in science fiction, and for example in Darkling (1997), the sentient hologram that is the doctor on the starship Voyager actively endeavours to develop a realistic human personality, and he attempts to accelerate this process by directly grafting character traits that he deems desirable onto his computer subroutines from historic figures, such as Ghandi and Byron.15 This endeavour fails when the darker and more negative aspects of the historic figures’ characters manifest in a literal Jekyll and Hyde manner, with the doctor being intermittently taken over by an evil persona.
A more benign portrayal of the latent duality of human nature and the potential for change is displayed by Dickens in A Tale of Two Cities (1895), where Manette, a brilliant physician, spends eighteen years as a prisoner in the Bastille. Initially, he is found making shoes in prison in order to distract himself from the harshness of prison life, but transforms himself into a man of distinction after he is rescued.16
Tertius Lydgate is yet another doctor, the perfect Aristotelian tragic hero in Eliot’s Middlemarch (1871),17 who has already been briefly discussed in another essay and whose dilemmas are typical of any doctor’s.18 Lydgate is poor, ambitious and somewhat arrogant and starts off with lofty ideals but falls in love, marries, and rapidly runs into dire financial straits and a potential conflict of interest forcing him to seek more lucrative pastures than provincial Middlemarch, among London’s high society, abandoning his high ideals. Even in his role of physician, Lydgate finds himself unable to treat a heart condition or give a prognosis on the case, and indeed, the patient dies shortly after being examined. Moreover, all of the doctors in Middlemarch, that is, Wrench, Toller, Minchin and Sprague, are in their turn depicted as petty and vindictive, jealous of Lydgate and reluctant to embrace new medical advances.
A broader view of the overall ineffectiveness of medicine in mainstream literature is seen in Mary Wollstonecraft Shelley’s The Last Man (1826), wherein Shelley conceived a plot device that would eventually be reused by a string of writers: an apocalyptic plague that threatens to destroy humanity.19 The medical field appears powerless to help out at all except to provide hospitals for the terminally ill. Similarly and more recently, in Albert Camus’ La Peste (1947), not only are doctors completely incapable of arresting an outbreak of bubonic plague in Algerian Oran, but incredibly, take a considerable period of time to realise that a fatal epidemic is sweeping their city and to organise quarantine measures, and this despite rats dying bizarrely and en masse, followed by large numbers of the populace who come down with obvious signs of bubonic plague. The story is narrated in the first person by Bernard Rieux, a physician in Oran who finds solidarity among the other doctors in Oran, all of whom futilely attempt to control the plague. Camus also emphasises another noteworthy observation in that nature is hostile, or at best indifferent to humanity and suffering.20
However, while literature has portrayed medicine overall negatively, the arts have not, and a plethora of paintings have depicted doctors, scientists and students, not only as formal portraits, but also in tableaux with patients, as reviewed by Ludmilla Jordanova and many others.21 The intermingling of medicine and the humanities has been further analysed by Evans and others who propose the study of ‘Medical Humanities’, an interdisciplinary field of medicine which includes the humanities, social science and the arts, along with their application to medical education and practice. The purpose of this endeavour is the improvement in the delivery of healthcare through a better understanding of disease in society, and in the individual, with insights into suffering and the human condition and how culture interacts with individual experience of illness and the way medicine is practised. The thorny issues raised by the ever increasing complexity of medical ethics are also considered.22
It is evident that in all of these narratives, doctors are depicted stereotypically, weak and impotent, unable to perform the job for which they have trained, and this is perhaps a parable, an attempt by various authors to chastise us for believing that science may have all of the answers. These are therefore cautionary tales, warning us of our hubris, and leading us to conclude that human ingenuity, as manifested by doctors and scientists, can only go so far in alleviating the human condition. This essay also demonstrates that despite the growing importance of medicine to the human condition, literature has sidelined medicine, somehow rendering doctors impotent and unable to father cures, with stories that tend to be formulaic and repetitive, casting the medical profession in a mediocre light.
This is not the case in science fiction, where doctors are the heroes in many a narrative, and that is the subject of another manuscript.
12. Stevenson RL. The Strange Case of Dr. Jekyll and Mr. Hyde. London: Longmans; Green & Co., 1886.
13. Jekyll [film] Hartswood Films. 2007.
14. Luckhurst R. The Many Deaths of Science Fiction: A Polemic. Science Fiction Studies 1994;21:35-50.
15. Darkling, Star Trek: Voyager [episode]. 1997.
16. Dickens C. A Tale of Two Cities. London: Chapman and Hall; 1859.
17. Eliot G. Middlemarch, a Study of Provincial Life. London: William Blackwood and Sons; 1871.
18. Grech V. Lydgate, brain drain and the Maltese medical profession. The Synapse 2011;3:10-11.
19. Wollstonecraft Shelley M. The Last Man. London: Henry Colburn; 1826.
20. Camus A. La Peste. Paris: Librairie Gallimard; 1947.
21. Jordanova L. Defining Features: Scientific and Medical Portraits, 1660-2000. London: Reaktion Books; 2000.
22. Evans HM, Macnaughton RJ. A “Core Curriculum” for the Medical Humanities? Medical Humanities 2006;32:65-6.