The physician and authority

The physician and authority: portraits by four physician-writers Suzanne Poirier The power of the physician in the physician-patient relationship has long been apparent to observers and practitioners of medicine. Robert Burton acknowledged it in The Anatomy of Melancholy (1621) when he commented that since "the form of health is contained in the physician's mind," patients should exercise "confidence . . . perseverance, obedience, and constancy" toward their physician.1 Today, as such issues as self-care and patients' rights receive increasing attention, many physicians, such as Howard Brody in Placebos and the Practice of Medicine (1980), assume in their patients a "capacity for autonomous, responsible behavior" that enables them to take an active part in the healing process. Yet Brody senses something intangible, "a culturally designated healing context [that itself] can cause changes in symptoms," which still offers physicians a great potential for power over their patients.2 Over the centuries many physicians, deliberately or not, have abused this power, but many others have labored toward an understanding of their role. Fiction by physicians often reflects this concern. Some of the issues, frustrations, and rewards surrounding the physician's authority can be traced in the writings of four American physicians—S. Weir Mitchell, William Carlos Williams, Richard Selzer, and Walker Percy. As they write about physicianship, in their own words and through their fictitious creations, they furnish an historical survey of portraits of the physician, moving from absolute dictator to unwilling participant in the healing process. The topic of the physician-patient relationship seems to have fallen just beyond the boundaries of the variety of critics studying these four writers. S. Weir Mitchell's non-physician biographers (short, primarily literary studies of Mitchell's work are practically non-existent) write of his medical career but largely record the events of his life and trace the 22 THE PHYSICIAN AND AUTHORITY historical and personal themes of his novels; his one physician-biographer gives Freudian case studies of several of Mitchell's more dramatic characters .3 While all of these writers record the almost magical effect of Mitchell's personality on his patients, the nature and implications of this relationship are never fully explored. Much more attention has been paid to the life and writing of William Carlos Williams, but as with Mitchell, Williams's relationship to his patients is not the center of attention. Recent literary criticism has tended to puzzle over the psychology of this unconventional poet, with his medical career considered a part of his unconventionally ,4 but with the rise of the presence of humanities in medical education, Williams's two careers are more often being considered inseparable . Robert Coles notes Williams's "mixture of authoritative competence and solicitude which earns respect" from his patients, and Joanne Trautmann sees in Williams a "responsible] involve[ment]" with his patients that wraps his fictional patients in a "humanistic context of dignity, compassion, and significance." Both go on, though, to apply this relationship to other issues: Coles to Williams as a "social observer" and Trautmann to Williams's theories of "poetic objectivity."5 In the case of Richard Selzer, most of his commentators explore his metaphors for surgery and medicine. One critic examines surgery as ritual for Selzer, in which both patient and procedure offer a form of absolution to the physician who must violate bodies to serve them, a perception which has tremendous implications for the patient-physician relationship. But once more, these implications are not the main concern of the article.6 Finally, Walker Percy's medical background has excited surprisingly little curiosity, especially given Percy's own comment: "I see my own writing as not really a great departure from my original career, science and medicine."7 To date, Percy's writing seems to have remained the territory of literary critics who look at his views on Catholicism, existentialism, and language (although most of his examples are drawn from medical and psychiatric settings) with little attention to its medical applications. Such a review is not meant to belittle any of the criticism of these four physician-writers' works. Rather, this survey simply demonstrates my point that the physician-patient relationships in these writers' works have been little studied

Art history · Family medicine · Portrait · Historical Psychiatry and Medical Practices · History · Medicine · Medicine and Dermatology Studies History · Mental Health and Psychiatry · Psychology

• The Sovereign Wayfarer

  C Hugh Holman, Martin Luschei•American Literature•1973

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• Weir Mitchell

  Robert E Spiller, Anna Robeson Burr•American Literature•1930

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