BRITISH JOURNAL OF (2002), 180, 81^84

Ten booksbooksTen career in clinical psychiatry remained in- tact. Naturally, when I arrived for inter- Chosen by Simon Wessely view at the Maudsley in 1984, I professed to Robin Murray, who was the gatekeeper to the rotation, a passionate commitment to research, but I was lying. I was still deeply in the culture of the medical senior house officer, in which facts and skills were Let’s be frank. Doctors and scientists don’t I came across Psychiatry in Dissent prized, and uncertainty (the necessary pre- need to read books. Our colleagues in the (Clare, 1976) whenI was a medical cursor to ethical research) seen as weak- humanities use books to communicate – we student. I was enjoying the struggle to ness. Research was what people did when use papers. Most medical books are poorly acquire those clinical skills that were so they should have been teaching me. My written, unless the author happens to be a prized by medical students, which would be greatest triumph was to hear a diastolic Richard Dawkins or a Stephen Jay Gould. my passport to a world that seemed divided murmur, albeit after 5 years of trying. This Some, those tedious multi-author tomes, between Dr Kildare and Sir Lancelot Spratt. event fortunately happened 3 days before I or worse, conference proceedings, should However, I had to admit that I found the sat medical membership, was repeated never have been written at all. intellectual, as opposed to the practical and during the exam itself, and never since. It However, all is not gloom. tribal, side of medicine unsatisfying. I had was not clear where the diastolic murmurs differ from the rest of our medical and done science subjects at school because I of psychiatry lay, but the relevant skills scientific colleagues, in both positive and had always wanted to be a doctor, even if seemed to include talking to patients, an negative ways. As I made my choices, I was I can no longer remember why, but I expertise which I arrogantly thought I pleasantly reminded that the discovery ofof continued to read literature and history in possessed until I tried it. Anthony Storr’s the relevance to psychiatry of literature, my spare time. Starting the psychiatry book (1990), supplemented with large criticism and history (where books remain course was a joy, since here were doctors doses of Dennis Brown and Jonathan the currency of communication) was one who could talk about ideas and did not Pedder’sPedder’s Introduction to Psychotherapy reason why I was originally attracted to the dismiss history as something to be done by (1979), gave me the basis for making my subject.subject. retired physicians on the verge of Alz- interactions with troubled patients some- How to choose? I could repeat the heimer’s. But what were the ideas? Laing, thing more than mere conversation and example of Elisabeth Schwarzkopf on Goffman, Szasz, Illich & Co. were still big, convinced me that psychiatry is, in its way, Desert Island Discs and choose only my but left me doubtful and confused. The no less skilful than swinging a stethoscope own books – but that would leave me with problem was that none of those books and considerably more artful. Rereading it nine empty spaces. Books in which I have inspired one to pursue a career in medicine after many years, some of Storr has dated, appeared? If I was the much missed Robert in general, let alone in psychiatry. but the underlying wisdom that both books Cawley, who began this series, I could have It was Anthony Clare who persuaded possess has not dimmed. included Janet Frame’s (2002) An Angel at me that psychiatry was worthwhile after my TablemyTable, in which he is a central, and all. On the surface, it was an exposition of affectionately drawn, character. But I have the arguments that were convulsing the for the Uninitiated only made it into fiction on one occasion, in intellectual community – but underneath it In the Dean’s presence, I had sworn a Clare Francis novel which I prefer not to was a firm statement that psychiatry was allegiance on the altar of research, but for a recall. So I have followed the convention not quite so damned as Laing and Szasz while my heretical views remained con- and introduced a crude chronology, an would have us believe. stant, if of necessity private. And then I apologia pro mia vita illustrated by the And it was a damned good read. Clare read Lee Robin’s (1978) paper ‘Sturdy books I was reading at different periods of made psychiatry legitimate again, while predictors of adult antisocial behaviour’. my career.mycareer. continuing to address issues and concepts And I waswasAndI hooked – this was research, and that were so much more interesting than it was exciting – clear, clean, coherent and those I had encountered so far at medical relevant. But what kind of research was it? Psychiatry in Dissent school. After Psychiatry in Dissent I wasIwas It was Michael Shepherd who answered Previous contributors to this series have convinced that psychiatry was important, that question for me during our one private paid tribute to those giants of the 1960s – interesting and even glamorous (the first conversation in the 6 months I was his Illich, Goffman and Laing – as inspiring the two I still believe, the last not). Ideas were registrar. The research that had caught my intellectual journeys that led to what would as important as the ability to wield a imagination was epidemiology. I had inevitably become a distinguished career in stethoscope. Cardiology seemed to be naively thought that epidemiology involved psychiatry. I was not a ‘child of the 60s’, bereft of genuine intellectual arguments – counting things, which was true, but was but a child in the 60s, and my distinguished Tony Clare showed that this was not true of perhaps the least interesting part of it. career has yet to happen. I missed the psychiatry.psychiatry. Shepherd, realising that my knowledge of excitement those gurus generated. Instead, epidemiology did not even justify the word my own desire to be a was rudimentary, pointed me in the direction of initiated by a book that was a sober The Art of Psychotherapy Barker’s slim collection of BMJBMJ pieces response to the intellectual brilliance, but I left medical school and did my time as a (Coggan(Coggan et aletal, 1993). What that showed also excesses, of that decade. proper doctor, but my commitment to a me was that epidemiology counts, but in

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many different ways. It is about illness in of the new genetics, as one recent commen- His post-war career was similarly undistin- populations, a perspective that I had so far tator did, but Showalter’s analysis of how guished and came to a premature end lacked, and it also provided the necessary scientific thinking and advances are re- because of his increasing alcoholism. His intellectual tools for addressing funda- fracted and distorted via both the popular reputation rests entirely on The Middle mental questions on causation that I was view and professional practice of psychiatry Parts of Fortune (Manning, 1930). starting to ask, but had no idea even how to remains as relevant as ever. Manning served as a private soldier at formulate. In due course, I attended the The Female Malady does not cease with Ypres and the Somme, and the experiencesexperiences MSc in Epidemiology at the London School the death of Victoria. In what is perhaps the of his central character,Bourne, are of Hygiene. There I was introduced to more most influential section of her book, closely based on his own observations. adult material, but I still retain affection for Showalter analyses the impact of the First Most of the war fiction with which we this slim, simple introduction to the subject. World War on psychiatric thought and are familiar cannot be divorced from the practice. Contemporaries accepted that the romantic and even pastoral literary influ- War represented a turning point for many ences of its authors. Think Brooke, The Female Malady aspects of thought and culture, but it was SasSassoon,soon, Graves or Owen. Manning is Historical works figure prominently in the The Female Malady that highlighted the diff- erent. For one thing, his language is rest of my choices, since one of the pleasures seismic changes within psychiatry that authentic, and indeed was heavily censored, of psychiatry is that history remains rele- resulted from the flood of shell-shocked the original expletives not being restored vant to contemporary practice. The history and hysterical men returning from the to the text for over 50 years. Its descriptions of cardiology in the 19th century and Western Front. It was, says, Showalter, of the routines of soldiering, the constant pharmacists in Georgian England, the sub- ‘not feminism but shell shock that initiated preoccupations with food, sleep and sex, jectsjectsoftwoseminarsIhaveattended of two seminars I have attended the era of psychiatric modernism’. are rarely given their appropriate promi- recently, are both fascinating in their own The Female Malady shifted the goal nence in other accounts. War in its horrors right, but I did not detect many lessons for posts of writings on psychiatry. Reading it is ever present and on two occasions takes contemporary cardiology or pharmacology. again, I am struck by just how wide- centre stage, but what is faultlessly con- Not so psychiatry. Our debates on de- ranging was her vision. But I don’t agree veyed is the tedium of military life, inter- institutionalisation, psychopathy and with every passage. Edgar Jones and I spersed with periods of seemingly random compulsory treatment would be arid indeed (2002) have questioned the centrality of violence. Hemingway, who probably did without some historical perspective. the First, as opposed to the Second, World know a thing or two, called it the finest In retrospect, the 1980s were the golden War in changing psychiatric thought. The novel ever about the experience of war. years of psychiatric historiography, and soldiers that fought and the doctors that among the classics of the period was the looked after the survivors, were still seminal feminist account of Victorian psy- products of the Edwardian era, deeply chiatry and beyond by Elaine Showalter rooted in concepts of masculinity and Culture of Complaint:The Fraying (1987), who holds the Chair of English courage. The real lessons of the First World of AmericaofAmerica Literature at Princeton, when she is not War, namely the inability of most to I read art history at Cambridge, and holding a BBC microphone. I am now withstand the pressure of intense, indus- laterlaterrememberremember the excitement that Robert privileged to know Elaine well, and never trialised warfare, irrespective of their char- Hughes, Australian, art critique, historian cease to marvel at the breadth and depth of acter or courage, would not be appreciated and cultural commentator, was able to her erudition and sparkle, which are until the Second World War. And one of generate in his history of 20th-century art, evident in all she writes. the reasons why, on that occasion, there TheTheShockoftheNew Shock of the New (1981). His Showalter begins with an exposition of was less resistance to accepting the psycho- extended essay, Culture of Complaint Victorian values. The theme is the contrast logical impact of intense combat, was the (1993) shows his journalistic talents on between images of the female and male in role played by the literature and poetry of the wider stage. He begins with an attack the development of psychiatric thinking. disillusionment that gradually came to on the malign influence of what he refuses She compares the theme of particular dominate cultural memories and accounts to call ‘political correctness’ (Hughes vulnerability of the female with insanity of the Great War. My next choice is not the would no more use a cliche´ like that than with the prevailing stereotype of the best known of the literature inspired by that split an infinitive) on art criticism. He pours rational male. The male is to rational War, but perhaps it should be. scorn on those who have linked aesthetic thought what the female is to emotion, discrimination, which he regards as essen- views propagatedby, but certainly not tial for a healthy culture, with racial or restricted to, aprofession that was almost The Middle Parts of Fortune sexual discrimination. Requiring high aes- entirely male. I decided to avoid fiction in my choices, but thetic standards for any artistic activity As we return now to our alienist roots, as this account of one man’s experience of does not promote, as some have claimed, in which the practice of psychiatry is the Battle of the Somme is clearly auto- injustice or inaccessibility. Authenticity is increasingly restricted to the care of those biographical (except for the ending, which not enough. For Hughes ‘the self is not the with psychosis, Victorian values are as I won’t spoil by recounting it), I have sacred cow of American Culture...we relevant as ever. It is not true to equate included it anyway. have turned arts education into a system the impact of Darwinian theory on Victor- Frederic Manning was a little known in which no one can fail. In the same spirit, ian psychiatry (elegantly dissected by author, largely recognised for his book tennis could be shorn of its elitist overtones, Showalter) with the contemporary impact reviews, who joined the army in 1915. you just get rid of the net’.

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Hughes returns to the question of self passionate defence of science – ‘incompar- actually meaningless. Medawar would have and self-esteem, and when he argues that ably the most successful activity human applauded.applauded. the latter should and can be earned, rather beings have ever engaged upon’. It is a view than assumed of right, he is setting his that has become unfashionable, frequently sights beyond the world of art. And his flag attacked, but never refuted, and it is in ‘Ordinary Men’: Reserve Police is planted firmly on our soil when he Medawar’s writings that one finds evidence Battalion 101 and the Final Solution addresses the current victim culture. Here not just of the power of science, but of its in PolandinPoland we, if not Hughes, must tread carefully. beauty and elegance. In Medawar’s hands, Empathy for the plight of victims is one becomes a thing of beauty, Tell a taxi driver that you are a psychiatrist ofofthethe most attractive aspects of human although I am afraid that psychoanalysis and you are likely to be asked ‘so why did , and if we in psychiatry do not does not.doesnot. he do it, doctor?’ – the ‘he’ referring to favour victims, then who will? But Most scientists and doctors write, but whichever criminal or celebrity (the two are Hughes’s case is not against victims; it is few write well. I came to Medawar when I occasionally and to everyone’s unfeigned against the elevation of the status of was moonlighting as a journalist, deluding delight synonymous) is in the news for victimhood. Being a victim conveys no myself that I was more a man of letters than some misdeed or other. Sadly, my replies automatic moral authority or insight. a mere scribbler. Medawar, along with often have no more insight than those of the Moral authority, like self-esteem, must be Lewis Thomas, showed me the power of cab driver. If you want to learn the answer earned and is not an automatic sequela of the essay and that I would be well advised to ‘why did he do that?’ it is better to turn adversity. Too powerful an identification to keep my day job. to an historian. with an identity defined solely by adversity, Medawar was incapable of writing a When we consider the history of human as happens in the further reaches of the dull paragraph and was contemptuous of misdeeds and their motives, sooner or later Oprah culture, carries dangers. The those who did. ‘People who write obscurely we must consider the overwhelming ques- problem with assuming the victim role for are either unskilled in writing or up to some tion – why did the civilised Germans a prolonged period is that the self becomes mischief’, which takes me to my next organise the greatest crime in history? I defined by what has been done to one, choice.choice. have read much on this subject, but nothing rather than what one is or has achieved. excels Christopher Browning’s (1992) Hughes’s polemics are provocative, but painstaking analysis of the records and his targets deserve critical scrutiny and his Intellectual Impostors statements of a single German police prose is never less than exuberant. It is hard Alan Sokal is Professor of Physics at New battalion and their actions on one day in not to applaud when he bemoans the York University. In 1996, he perpetrated a July 1942, when they murdered the Jewish coarsening of public debate and encounters, now famous hoax by publishing a paper population of Josefow in Poland. Browning in which there is endless opportunity to entitled ‘Transgressing the boundaries. is scrupulous in his use of the historical ‘unwittingly give, and truculently receive, Towards a transformative hermeneutics of record to guide us through the complexities offence’. He observes with distaste how the quantum gravity’ in a leading American of belief, background, situation and behav- intensity with which beliefs are held has post-modernist journal known as SocialSocial iour that led to the horrors of that event. It become more important than the substance TextText (Sokal, 1996). It was gibberish, and is a masterful account of how to construct a or accuracy of those same views – and that meant to be so. Sokal’s point was not that narrative from tainted sources, illuminating in the intellectual equivalent of Gresham’s all cultural studies and criticism are gibber- where possible, but always aware of the Law, passionate beliefs can triumph over ish (my other choices show that argument limitations of the data. Precisely because he reasoned ones simply because they are held to be nonsense), but that some modern is so careful with his sources, and unwilling strongly. In a world of single-issue politics, intellectuals have taken to using scientific to go beyond what can be justified, his the more the strident and ‘fanatical enlist in terminology without the slightest know- conclusions are penetrating. We can never the crusade, the more sensible people tend ledge of its real meaning. In IntellectualIntellectual know exactly why this bunch of Hamburg to wash their hands of it’. Hughes reminds ImpostorsImpostors (Sokal & Briemont, 1998) he policemen, none of them fanatical Nazis, us that we need to be equally vociferous in takes this thesis further, with a stinging acted in the way they did, but this is as close our defence of reason and tolerance. series of essays on the abuse of language as we can get. perpetrated by such cultural luminaries as The same incident, and the same Kristeva, Latour, Baudrillard (famous for material, also forms a large section of The Threat and the Glory and TheThe declaring that the Persian had not Daniel Goldhagen’s (1997) Hitler’s Willing Strange Case of the Spotted Mice taken place, which if true would have Executioners. Like all Holocaust historians, Robert Hughes made no apology for his deprived me of the opportunity of being Goldhagen pays short shrift to those who defence of high culture as an elitist activity. associated with the research that has given claim that the perpetrators were coerced Peter Medawar made the similar case for me the greatest pride) and finally that old into their actions by fear – the commander science. Medawar was well placed to do so, charlatan himself, Jacques Lacan, who of the police battalion allowed anyone who being a Nobel Laureate as a result of his draws Sokal’s ire not for his pronounce- wished not to take part in the AktionAktion toto work on immunology and transplantation. ments on psychoanalysis, which to me remain in the barracks without censure – But he was not just a pre-eminent scientist, appear gnomic and impenetrable, but for but beyond that he has little to say. His he was also a remarkably well-read man his woeful misunderstanding and misuse conclusion is that Germans, such as the with a gift for lucid exposition. I can still of mathematical and scientific concepts Hamburg policemen, killed Jews because remember the thrill of reading Medawar’s and language – seemingly erudite but they wanted to. Publicly acclaimed, but

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critically damned, his polemical account previously, is a strange forerunner of __ (19 93) Culture of Complaint: The Fraying of America.. contains material guaranteed still to shock veterans with Vietnam flashbacks, and Oxford: . despite its repugnant familiarity – but the ‘The day the dam broke’ remains a classic Jones, E. & Wessely, S.(2002) The impact of Total War lack of any serious historical analysis means account of rumour and panic. But for those on the practice of psychiatry.In Shadows of Total War: 1919^19391919^1939 (eds R.Chickering & S. Foerster).Cambridge: that it remains at the level of reportage and who have never encountered Thurber, his Cambridge University Press (in press). is ultimately unsatisfying. Browning closes genius found its best expression in the Manning, F. (1930) The Middle Parts of Fortune.. with an observation of importance for perfect comic short story, The Secret Life Republished1999Republished 1999 as Her Privates We. London: Serpent’s psychiatry – ‘explaining is not excusing: of Walter Mitty (Thurber, 1945). Walter Ta il.Tail.

understanding is not forgiving’. Neither Mitty is all our secret fantasies, whether it Medawar, P. (1991) TheThreat and the Glory: Reflections author forgives, but only one explains. be the intrepid torpedo-boat commander on Science and Scientists.Oxford:OxfordUniversity defiant of weather and enemies in equal Press. My Life and Hard Times andand TheThe measure, the attorney saving his client, the __ (19 9 6) The Strange Case of the Spotted Mice.Oxford: Oxford University Press. Secret Life of Walter Mitty surgeon with nerves of steel who repairs the anaesthetic machine with his penknife Robins, L. N. (1978) Sturdy childhood predictors of I readIread My Life and Hard Times (Thurber,(Thurber, while operating with the other hand, or adult antisocial behaviour. Psychological Medicine,, 88,, 1933) first as a boy. I could never get 611^622. finally, the insouciant resistance fighter, beyond the first chapter, ‘The night the bed facing the firing squad, cigarette in hand, Showalter, E. (1987) The Female Malady: Women, fell in’, without dissolving into helpless Madness and English Culture, 1830^1980. London:.London: defiant to the last. laughter. It was some 20 years before I Virago.Virago. Sokal, A. (1996) Transgressing the boundaries.Towards realised that it was not, in fact, a recollec- Brown, D. & Pedder, J.(19 (1979) 79) Introduction to a transformative hermeneutics of quantum gravity. Social tion of Thurber’s turn-of-the-century child- Psychotherapy. An Outline of Psychodynamic Principles and Tex ttTex ,, 46, 217^230. hood in Columbus, Ohio, but a parody of a Practice. London: Tavistock Publications. genre. I still love it, and as the years go by, I Browning, C. (1992) ‘Ordinary Men’:Reserve Police __ &Briemont,J.(1998)Intellectual Impostors.. London: Profile Books. recognise more and more of the episodes as Battalion 101 and the Final Solution in Poland.NewYork: Harper Collins. containing more prophecy than parody. Storr, J. (1990) The Art of Psychotherapy (2nd edn).edn).(2nd London: Routledge. Thurber’s fictional aunt was played for Clare, A. (1976) Psychiatry in Dissent. London: Tavistock Publications. comic effect by having her believe that Thurber, J. (1933) My Life and Hard Times.NewYork& London: Harper & Bros. electricity leaks out of sockets unless they Coggan, D., Rose, G. & Barker, D. J. P. (eds) (1993) Epidemiology for the Uninitiated (3rd edn). London: BMJ __ (194 5) The secret life of Walter Mitty.InThe Thurber are covered with metal foil. I have now seen Books. CarnivalCarnival. London: Hamish Hamilton. several patients and one Sunday newspaper Frame, J. (2002) An Angel at myTable. London:.London: supplementsupplementwiththesamebelief.The with the same belief. The Women’s Press.

grandfather who occasionally leaps out of Goldhagen, D. (1997) Hitler’s Willing Executioners: Simon Wessely Department of Psychological bed shouting that the Army of the Potomac Ordinary Germans and the Holocaust. London: Abacus. Medicine,GKT School of Medicine and Institute of is doomed, seemingly unable to accept Hughes, R. (1981) The Shock of the New.NewYork: Psychiatry,103 Denmark Hill, London SE5 8AF,UK. that the Civil War had ended 30 years Alfred A.Knopf.A. Knopf. E-mail: s.wessely@@iop.kcl.ac.uk

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