Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of around 50 or 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor. We are posting one each Wednesday to coincide with the schedule of his old BMJ column. We hope you enjoy them.

Some writers are better known abroad than in their own countries: among them is Charles Morgan (1894 – 1958), the British novelist who has long been more highly appreciated in France than in Britain. Perhaps this is because he is a novelist of ideas, and the British do not really like ideas; he is also accused by certain critics, from whom I would not entirely demur, of more than occasional descent into flatulent portentousness. He is also that rara avis, a writer who not only had no sense of humour, but was positively opposed to humour.

In 1941 he published a short novel called The Empty Room. It was set in the war, at a time when its outcome could not have been known. The book opens as follows:

On the last Saturday in November, the third month of the war, Richard Cannock performed, on a woman’s eye, a bold and subtle operation that gave him the satisfaction a writer may have in a flawless paragraph.

One suspects that this was a pleasure to which Morgan himself was more than usually susceptible. The above is Maugham without the irony or easy elegance.

The operation over, Cannock takes himself to the Garrick Club for lunch, where ‘the wine steward brought his pint of claret.’ Pint of claret at lunch! It is just as well, perhaps, that Cannock tells a younger surgeon, also lunching at the Garrick, that the operation he performed that morning was probably his last for a long time – thanks to the war, not to drunkenness or the alcohol withdrawal symptoms.

Cannock appears from his character to be an oldish man, and one learns with surprise that he is only forty-four. He is deputed to a research establishment where he helps to develop better bomb-sights. While at this establishment he stays at the house of a friend of his, whose wife, Venetia, deserted him early in their marriage while he was a prisoner-of-war in Germany during the First War. More than twenty years later she returns to him, he having told the only daughter of the marriage that her mother was dead.

Alas, she is not the woman she was, but ill:

While she was in London, she had faced her illness alone; for many days it would leave her free, then there would be a pain in her foot and in the upper part of her nose; it would spread across her left brow, and grip her head, and at the same time her strength, even her will would go from her…

I confess that I thought of a patient whose pain started in her foot and finished in her hair, where it was at its worst. It was far from comic, for she ended up one day by throwing herself, fatally, from the roof.

Venetia, too, kills herself, with the ‘eleven and a half grains of morphia that a young doctor, whose name she did not know, had given her as payment in kind.’ Her intermittent illness, then, was probably a tabetic crisis, and it always left her weak and exhausted.

In the matter of Charles Morgan I think the British rather than the French are right. But even in Britain he had his enthusiasts. My copy of his book was given to its first owner, according to the inscription, in January 1942. In the back, in pencil, is the following:

Re-read Feb. 1977
Re-re-read May 1984

Of how many books is such the fate?

Dalrymple doesn’t hold back in his criticism of the new Whitney Museum in New York City….

The building was a perfect place from which to commit suicide, with what looked like large diving boards emerging from the top of the building, leading straight to the ground far below. Looking up at them, one could almost hear in one’s mind’s ear the terrible sound of the bodies as they landed on the ground below. There were also some (for now) silvery industrial chimneys, leading presumably from the incinerators so necessary for the disposal of rubbishy art. The whole building lacked harmony, as if struck already by an earthquake and in a half-collapsed state; it’s a tribute to the imagination of the architect that something so expensive should be made to look so cheap. It is certain to be shabby within a decade.

…but that’s practically praise compared to his opinion of the New York Times’ “criticism” of the building.

In Taki’s Magazine Dalrymple expresses puzzlement over the interest many people have in the private lives of celebrities:

The psychology of modern celebrity is curious and interesting. There seems to be an implicit contract between celebrities and those who confer celebrity upon them. Celebrity is conferred on people almost, though not quite, at random: their talents are minor and their appearance pleasing, but they must not otherwise be remarkable or too far removed in their tastes and manner, at least in public, from those who give them their fame.

In return for this they live a fairy-tale life of the greatest possible luxury, removed from the economic constraints that circumscribe the lives of their adulators, but they must also allow their lives to be examined and reported on, truthfully or not, in all the media. They must agree to be in the public eye as an old-fashioned family doctor was always on duty for his patients.

Nigel Balchin (1908 – 1970) was a popular novelist in his day but is now nearly forgotten. He studied science at Cambridge, then industrial psychology, before joining a famous chocolate company in York, the output and marketing of whose chocolate bars he helped to improve.

He enjoyed initial success as a writer too. His novels of wartime (published during the War itself) spread, if they did not actually coin, two expressions that are still in use: boffin and back-room boys. When one considers the number of novels that are published, it is clear that few novelists leave so lasting a legacy.

His novel, Mine Own Executioner, was published just after the end of the War in 1945. Its protagonist is a lay psychoanalyst called Felix Milne who has chucked up his medical degree in order to study with a famous Viennese analyst before coming home to London to practice. Like many a religious person, he suffers from scruples: does he really believe or not?

The author himself appears not to be able to make up his own mind. At first he is satirical: the first of Milne’s patients he depicts is Lady Maresfield, a rich, spoilt and lonely woman whose marriage is unsatisfactory and who uses Milne merely as a shoulder to cry on, almost as a paid companion. Her name is surely significant: when Freud came to live in England, his address was Maresfield Gardens.

Later, however, the satirical tone is dropped. Another of Milne’s patients is Lucian, a former prisoner-of-war of the Japanese. He comes to Milne for help because, on his return to England, he nearly strangled his wife to death. Milne injects him with sodium thiopental to get him to speak of his experiences as a prisoner-of-war about which he has previously been unable to speak. After this abreaction Lucian feels a lot better and wonders why. Milne replies, ‘Haven’t you ever had a boil lanced?’ Emotions are like what the British used to say of their teeth: better out than in.

Alas, Lucian has a relapse owing to an unresolved Oedipus complex that Milne has failed to spot or do anything about. Lucian shoots his wife who for him symbolises his mother, who has so betrayed his love for her by allowing herself to have sex with his father (whom he has already slain symbolically in the person of a Japanese guard in the prison camp). After killing his wife Lucian commits suicide, and not surprisingly, perhaps, Milne begins to lose faith in his capacity as a healer.

The book ends in the Coroner’s Court. The coroner is a doctor, Dr Lefage, a pompous, shrivelled-up pedant full of prejudices in favour of doctors. ‘An inquest,’ remarks a character, ‘is a place for arriving at a comfortable verdict that no blame attaches to anybody.’

When I read that, I recalled the first coroner’s inquest I attended as a witness more than thirty years ago. I arrived early and sat in on the previous inquest. It was a tale of woeful incompetence. The deceased had taken an overdose and gone to hospital, where she was told that nothing was wrong with her and to go home, where she died a few hours later. The coroner, a doctor, said, ‘I want to assure the family that all that could have been done was done.’

Of course, things are completely different now.

Dalrymple used to spend months isolated from all acquaintances while journeying arduously through Third World continents, but now he grows anxious if away from his cell phone for a few hours. In Taki’s Magazine he considers how much he misses his old isolation:

I once crossed Africa by public transport. It took me about six months and in many places, indeed for most of the time, I was isolated from everyone I knew, without possibility of calling upon them for anything. In a small way I felt like Arthur Koestler in his condemned cell in Spain waiting to be executed; that is to say, freer than I had ever been before in my life. I was thrilled to be told in Equatorial Guinea that if anybody in authority there knew that I was a writer (of sorts) I would be killed, cut up and thrown into the sea: I had never been important enough to be worth killing before, and in a way I was flattered. This was all thirty years ago next year; the then president, who is still the president, had overthrown his uncle, the first president, in a military coup. The first president was known by the title of The Only Miracle, and certainly he had produced startling changes in the country: a third of the population had either been killed or had fled…

It was exhilarating to be utterly incommunicado.

Recently I spent a few months in the Forest of Dean, where Dr John Sassall, the protagonist of John Berger’s famous extended essay, A Fortunate Man, published in 1967, worked as a general practitioner.

The Forest, to my surprise, retained a little of the geographical and social isolation that it had when Berger wrote his book. Some of the Foresters, as they called themselves (and for some reason Berger chose not to capitalise the word, as if the Foresters were foresters, which most of them were not), had scarcely ever travelled further in their lives than Gloucester. By comparison with the rest of the county, the Forest is still impoverished; but its relative isolation gives it a character and spirit of its own.

A Fortunate Man turned out to be an unfortunate title, because Dr Sassall killed himself some years after its publication. Of course, this is not to say that he was not fortunate at the time it was written; fortunes, after all, change. A man may start lucky in life and end up unlucky, and vice versa; but re-reading this book, which seems to me to have been over-praised, I am struck not by the good fortune of its protagonist but by his tormented nature.

Dr Sassall was a hard-working single-handed rural general practitioner who did everything from operations on the kitchen table to psychotherapy. He was not able to achieve what, in our horrible manner of reducing everything to inelegant jargon, we now call ‘a work-life balance.’ His life, we are told, was otherwise empty; and he worried over the point of human existence, if any:

He is incapable of waiting and doing nothing. He is incapable of resting. He sleeps easily but, at heart, he welcomes being called out at night.

This is surely the mark of a man in flight from something. We are told that he was a slave to his quest for certainty, a certainty that he knew in advance that he could not reach. He was tormented by his inadequacy to relieve all suffering and prevent all death. This may well be a sign of great honesty, and such honest men may be necessary; but fortunate is not the word for them. Moreover, while to be constantly at the service of others is good and admirable, it is not the only good or the only just cause for admiration. There needs to be moderation in self-sacrifice as in other things:

Dost thou think, because thou art virtuous, there shall be no more cakes and ale?

Some of the writing in A Fortunate Man strikes me as portentous, as cliché dressed up as philosophy. The book begins (under a photograph of the rural calm of Gloucestershire):

Landscapes can be deceptive. Sometimes a landscape seems to be less a setting for the life of its inhabitants than a curtain behind which their struggles, achievements and accidents take place.

I look out of my study window at the houses opposite. What do I know of what went on in them last night, what is going on in them now? Nothing. But a life without curtains, real or metaphorical, were it not in fact impossible, would be horrible. The use of the word ‘sometimes’ in the above passage disguises the obviousness of the underlying thought.

This piece in the Salisbury Review gets even funnier after this introduction:

According to an article in the Guardian, two ‘ordinary Yorkshire lads’ went on holiday to Turkey, from whence they travelled on to Syria, presumably to join ISIS. Their names were Hassan Munshi and Talha Asmal. What is ordinary in Yorkshire has evidently changed out of all recognition in my lifetime.

In Taki’s Magazine Dalrymple continues his criticism of Andreas Lubitz as being primarily a person of bad character and not one suffering from mental illness. He admits that one’s upbringing, social circumstances and the surrounding culture can all play a role in producing this character, but then…

It is said, however, that by the age of forty every man has the face that he deserves. The same might be said of a man’s character, only earlier in his life. It is part of the mystery and glory (perhaps also of the misery) of human existence, that our character is in part self-created: not entirely, but not negligibly, either. We are dealt a hand of cards, no doubt, but we do not have to play them in a pre-determined order. No determinist, however firm his philosophical belief, can live as if determinism were true: therefore he can never believe what he believes, or tells himself that he believes.

He concludes with a declaration of the limits of his former occupation:

Psychiatry will never make the likes of Andreas Lubitz whole (if he was as I surmise he was), and of this, in a way, I am glad: for it means that the powers of psychiatry will remain limited. We shall never be putty in technicians’ hands. That is not the same as saying that he should have been allowed to fly aircraft. A little more stigma and prejudice would have saved the 149 lives he so egotistically snuffed out.