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Giving Pain a Voice

A lone doctor hares down a country lane in his Land Rover, his thumb jammed on the horn to warn the oncoming traffic that he’s not stopping. A woodman’s been pinned to the ground on a remote hillside by a falling tree and every second counts. Even at the start of A Fortunate Man: The Story of a Country Doctor (1967), we are given an inkling of what makes Dr Sassall an exceptional GP. He had his thumb on the horn partly, he explains, so that the man under the tree might hear it and know he is on his way. Dr Sassall understands that even when the immediate danger is physical, his patients need him to keep their minds in mind. A good doctor treats the whole of his patient, not just his wounds.

We’re in Gloucestershire, in the Forest of Dean in the 1960s, and John Berger has spent three months shadowing his remarkable friend the local GP night and day, to paint a portrait of his life. He has also recruited the Swiss documentary photographer Jean Mohr to take photographs to accompany the text. The grainy black-and-white images start by capturing the landscape against which the human drama is set, or behind which it hides. As the book progresses, they focus in – the doctor in his tweed jacket, with tie and pipe, or shirt sleeves rolled up to perform some minor surgery; his patients, sometimes looking him in the eye and hanging on his words, sometimes sitting alongside him as they spill their woes. And the community – debating, dancing, drinking.

Berger sets the scene with six vignettes. This is an impoverished area of rural England, where few people own passports and not all have ventured as far as London. ‘The windows were overgrown with thick ivy and since there was no plaster ceiling and holes in the rafters, the room scarcely seemed geometric and was more like a hide in a wood.’ It’s Cider with Rosie country a generation or so later. There’s an isolated feel to the people – their cottages are miles along a single track or high on a lonely hill. Education is often elementary, families look after their own and society is stratified, with working people cowed and taken advantage of by their superiors. We see the doctor using his middle-class authority to intercede on their behalf, whether with the local job centre or the housing authorities. Without his voice, no one would listen to these ordinary country folk, and Dr Sassall recognizes this as part of his wide-ranging responsibilities.

In some ways it’s very much a book of its time. Part of its intense appeal to me, born in 1961, are the aspects of my childhood it brings back to life. Like Dr Sassall, the Dr Skeggs and Dr Brill of my early years were never to be seen without a tweed jacket and tie and spent a good part of their day on home visits. Just when all else was topsy-turvy – loo seat too cold to sit on, day and night blurred into one, and plots from my bedside bookshelves bleeding into one another in my fevered dreams – one of them would arrive with reassuring authority to tame the illness by giving it a name and issuing an illegible prescription. I remember craning my neck to see what else those brown leather doctors’ bags contained besides a thermometer, an otoscope and a freezing stethoscope, but I don’t remember anything more complicated than a lollipop stick to hold my tongue down. And on some occasions, though for what reason I’m still unclear, they would produce one of those hammers which hilariously caused your leg to shoot up in the air if applied to the right spot. Did they do that just to make us laugh, as part of the treatment?

Along with the nostalgia for a time when home visits were the norm and you could get an appointment with your own doctor on the same day, reading A Fortunate Man also reminded me of the suffocating restrictiveness of that respectful and respectable world. Like my doctors, Dr Sassall provided a cradle-to-grave service, and it was often by knowing the whole family, or the extended community, that he came to figure out what was going on. Only when chatting with some women in a house where he was delivering a baby, for example, did he discover years later the cause of one patient’s irresolvable psychosomatic problems. She had been seduced by her manager at the local dairy. He had promised marriage and then abandoned her, but the young woman could not bring herself to mention the pain he caused her to anyone and was fated to bear the disappointment forever in her body. Today she might have felt more able to open up.

Dr Sassall considered it a failure on his part that he had not been able to elicit the cause of her distress when first she came to see him, and much of the pleasure in this meticulous, elliptical meditation on humanity and healing lies in the remarkable character of the doctor himself. Berger uses the forensic attention to detail, which made his famous Ways of Seeing such a success on the BBC in 1972, to capture the strengths and idiosyncrasies of his friend and bridge partner. Initially influenced by the hardy, self-contained heroes of Joseph Conrad, Dr Sassall was a driven man with a heroic sense of vocation. Self-isolating and with the highest expectations of himself, in his early years as a GP ‘he imagined himself a mobile one-man hospital. He performed appendix and hernia operations on kitchen tables. He delivered babies in caravans.’

Yet as he grew to know his patients better, he realized that they required more of him. To shoulder the responsibilities he laid on himself, he needed to pay attention to their non-medical concerns. He read Freud and, with no psychoanalyst in reach, he analysed his own character and its roots in a painful process that led to six months of sexual impotence. But when he emerged from this, he began listening to his patients on all levels, believing that ‘illness is frequently a form of expression rather than a surrender to natural hazards’. In the evenings, after his supper, he offered psychotherapy to those he felt needed it. For a rural ’60s GP he was way ahead of his time.

Of all the titles on my shelf of favourites, A Fortunate Man is the only one I stumbled upon quite by accident, when I wandered into my local bookshop in need of a break from the intensity of a workshop in which I was taking part. I’ve always loved the intimate and closely detailed sense of a life, a place and a time which is conjured by oral histories like Sheila Stewart’s life of the farm labourer Mont Abbott, Lifting the Latch. A Fortunate Man looked as if it might offer the same. I read it in a sitting and between its covers I discovered a driven hero and a flawed man, a mirror to myself and to aspects of my own endeavours as a psychotherapist. ‘He is acknowledged as a good doctor because he meets the deep but unformulated expectation of the sick for a sense of fraternity. He recognizes them.’ This intimate, individual recognition of each unique human being is the bedrock of the work I try to do, and I am often surprised by how rare an experience it is. It is hard enough to offer it to my patients after eight years of training and sixteen years of my own psychotherapy. In Sassall’s case, with none of that experience and no colleagues to support him, his efforts sometimes led to lengthy periods of depression.

In A Fortunate Man, John Berger too is involved in a profound act of recognition. By analysing Sassall’s commitment to his particular patients and his profession, and by piling observation upon observation, he carefully accumulates a weight of evidence for the value of these unremarkable human lives and of those who try to care for them. By telling their stories, he brings them briefly into the light of his compassionate gaze, according dignity to their struggles as he did to those of so many other overlooked communities during his long career as a writer.

Reading Berger’s afterword, written three decades after the original book, it’s a shock but not a surprise to hear of Sassall’s suicide. It reminded me of Dr Skeggs’s long relationship with alcohol, which only surfaced after his death. The fragile balance of the ‘wounded healer’ is something we recognize more clearly now, but I am still surprised by how little psychological support the NHS offers its staff in their work on the cliff-edge between life and death. I wouldn’t want to do my work without it.

Extract from Slightly Foxed Issue 67 © Rose Baring 2020

About the contributor

Rose Baring divides her weekdays between working as a psychotherapist and as a publisher. At the weekends she turns her attention to a messy vegetable patch and is determined, one day, to produce a good crop of brassicas.

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