The contributors—physicians, philosophers, and literary critics—examine the relevance of Percy’s work to current dilemmas in medical education and health policy. They reflect upon the role doctors and patients play in his novels, his family legacy of depression, how his medical background influenced his writing style, and his philosophy of psychiatry. They contemplate the private ways in which Percy’s work affected their own lives and analyze the author’s tendency to contrast the medical-scientific worldview with a more spiritual one. Assessing Percy’s stature as an author and elucidating the many ways that reading and writing can combine with diagnosing and treating to offer an antidote to despair, they ask what it means to be a doctor, a writer, and a seeker of cures and truths—not just for the body but for the malaise and diseased spirituality of modern times.
This collection will appeal to lovers of literature as well as medical professionals—indeed, anyone concerned with medical ethics and the human side of doctoring.
Contributors. Robert Coles, Brock Eide, Carl Elliott, John D. Lantos, Ross McElwee, Richard Martinez, Martha Montello, David Schiedermayer, Jay Tolson, Bertram Wyatt-Brown, Laurie Zoloth-Dorfman
About the Author
Carl Elliott is Associate Professor of Pediatrics and Bioethics at the University of Minnesota. He is the author of A Philosophical Disease: Bioethics, Culture, and Identity and The Rules of Insanity: Moral Responsibility and Mental Illness.
John D. Lantos is Associate Director of the MacLean Center for Clinical Medical Ethics at the University of Chicago. He is the author of Do We Still Need Doctors? and coeditor of Primum Non Nocere Today.
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The Last Physician
Walker Percy and the Moral Life of Medicine
By Carl Elliott, John Lantos
Duke University PressCopyright © 1999 Duke University Press
All rights reserved.
Dr. Percy's Hold on Medicine
In 1960 I was a physician who had received some training in pediatrics, psychiatry, and child psychiatry, after which I'd gone to Mississippi to work at an air force hospital, courtesy of the "doctor's draft," as it was then called—we all had to give the country two years of our time and energy. I had thereby come to the South for the first time; I had been born, reared, and educated in New England. During that time, I continued my psychoanalytic training, begun up north, at the New Orleans Psychoanalytic Institute. There I met other doctors, other psychiatrists; but there I also met southerners—who taught me a lot about a region I was, I fear, rather quick to judge out of hand. There I would take part in my first discussion of The Moviegoer —a few months after it was published in 1961.
I was in analysis then, and also taking courses at the institute. One day, after an analytic session and before a seminar, I had supper, and afterward, an hour or so on my hands, I browsed through a bookstore on Canal Street in downtown New Orleans, Doubleday's (long gone). So doing, I spotted a novel whose title really got to me for personal reasons: I constantly "flicked out," as some of us put it, to the point that my analyst, noting not only the frequency but, as he put it, the way I would "use" movies, "immerse" myself in them, get "distracted" by them, had called me a "moviegoer," even as, of course, he had wanted to know why, why—the "defensive" purpose of such activity. If I wasn't so anxious to learn my reasons from him (and myself, talking with him), I most certainly was intent on exploring the matter through this book, which I bought and read eagerly, hungrily—in one gulp (evening), actually.
I didn't return to Boston after my tour of medical military duty was over. I stayed in New Orleans, began studying the effect of school desegregation there on the children who initiated it, and gradually slipped into an odd working life as a documentary observer and writer. In a way, such research was not the total accident it seemed to be (a consequence of an air force assignment that landed me near New Orleans, so that I witnessed firsthand what happened to those children). I had majored in English, written a thesis on William Carlos Williams, got to know him, and had thereby been inspired to go into medicine. I admired not only his poetry and fiction but his doctoring life, the way he evoked and rendered the hopes and worries of the men and women and children he came to know so well as a physician. It became such a privilege to be able to follow, at least in modest part, those giant footsteps—and during my early days of "fieldwork," I was lucky to have his (often tough) criticism as I tried to figure out how to convey in words what I was hearing, seeing.
I began to realized in the middle 1960s that I had also found another source of medical inspiration, so to speak—another physician whose way of looking at this world gave me plenty to consider. Dr. Percy was obviously different in many respects from Dr. Williams—the former never practiced medicine; the latter did so from his early twenties to his late sixties, almost a half century of constant concern for patients, many of them needy, vulnerable not only physically but socially and economically. Moreover, until old age beset him with an assortment of ailments, Dr. Williams had always been in robust health, whereas Dr. Percy had known a serious, even life-threatening illness, tuberculosis, in his late twenties. It is foolish, of course, to think that the experience of sickness, in and of itself, will guarantee in an aspiring physician a heightened understanding of how patients feel, a greater empathy toward them; but Williams himself once addressed this subject in a way that, years later, would have a bearing on Walker Percy's life as a person seriously ill, as well as on his later philosophical reflections on consciousness, on how our mind often works in the course of a day's activities: "I've never really been flat on my back for any great length of time: down-and-out with something that's given me the feeling—well, there's Keats' 'intimations of mortality' to describe it [that feeling]. Sure, I think I know how it goes for a lot of my patients. I try to put myself in their shoes—I use my imagination, and I've been observing sickness, what it does to folks, for many years, and I keep reading the [medical] journals and the textbooks. But I'm busy—the old story!—and plenty of times I'm way behind in my schedule, and something else is on my mind, and so I'm not really 'with' the patient I'm seeing. That [state of mind] can go on and on: you're treating patients, but you're not giving them your best—I mean really connecting with them. I guess any busy doctor will tell you that happens; but when you do connect, when you listen carefully and have a good talk with someone who's in trouble, in pain, and wants just that, a doctor who offers concern and understanding as wellas a prescription—then you know the difference between going through the motions and really 'being there' for someone."
In a sense, what Williams said in a casual conversation about his ongoing medical life (to a young medical student wondering how to become a reasonably able physician) Percy tried to comprehend in the distanced but penetrating and suggestive manner of the essayist and novelist—the physician become metaphysician. Indeed, after I'd become so taken with The Moviegoer (the novel kept coming to my mind as an analysand in that Prytania Street office I visited five days a week), I realized that I'd already read an essay by the same Walker Percy who had become a novelist, and had even cut it out: "The Man on the Train," published in the mid-1950s in the Partisan Review. That essay is a prefiguration of sorts to all of Percy's fiction. A writer of obvious moral energy is struggling to convey a line of reasoning (and feeling) in such a way that the reader won't easily forget what has been read—an especially important and ironic objective, because the essay is, actually, concerned with just that matter: how readily we lose sight of so much that truly counts, become lost in a reflexic tide of minute-by-minute activity that becomes, in fact, the life we live.
I got to know Walker Percy personally in 1972 —I had been writing for the New Yorker (that is, for William Shawn, its editor) for several years and had done a number of book reviews and a long profile of Erik H. Erikson, who had been an important psychoanalytic guide of mine. (I ended up teaching in his Harvard College class when I returned from the South in 1966, after finishing my research on school desegregation and being much involved with the civil rights movement.) When Mr. Shawn asked me about whom I'd next like to write, I immediately mentioned Walker Percy. I didn't get a quick yes, though—a brilliant but cautious editor wanted to read Percy's two novels, The Moviegoer and The Last Gentleman, and some of his essays, published in philosophical journals and quarterlies and inCommonweal (at the time, his published body of work). Several weeks later, well into the evening, an obviously excited Mr. Shawn called me, and in his usual terse but now charged voice said, "An enthusiastic yes on Percy." I loved that message, and its dual meaning: approval for the profile and a fan's declaration of affiliation.
No question, the Danish philosopher and theologian Søren Kierkegaard was Dr. Percy's great intellectual, moral, and spiritual guide throughout his writing career, and before that, during the years when he was sick, and right afterward, when he was trying to find some direction and purpose for himself—as he told the world on many and diverse occasions, and as I would often hear him say when we talked. Indeed, Kierkegaard came up almost immediately at my first meeting with Dr. Percy in April 1972. Fortunately, I'd been exposed to the demanding work of that idiosyncratic Danish writer by Perry Miller, my college teacher and thesis adviser, who had us read Fear and Trembling and, Lord spare us, Either/Or— and how we tried and tried to comprehend a "thinker" who was then (still, actually) obscure and hugely insistent, ironic, sardonic. It was Professor Miller who got me to attend to Dr. Williams's poetry (not in the early 1950s popular with Harvard's English professors, many of whom had a hard time being interested in the ordinary, even down-and-out life evoked in Paterson, and some of whom had a hard time reaching for humility in themselves, never mind understanding it in others); and, for sure, it was Miller who prepared me for Dr. Percy. I had boned up on Kierkegaard before I went to see the seer of Covington, as some of us called him, out of his sight and hearing distance; and so when, inevitably, "Søren" (as we'd often refer to him) came up as a subject, I was "sort of" prepared. I kept using that two-word phrase as we began our talks—a way of endlessly qualifying what I had to say about the gloomy yet humorous writer whom Percy knew by heart, it seemed. Once, actually, as I yet again said "sort of" in connection with an opinion I had about an aspect of the ever-intimidatingEither/Or, Percy told me that he thought Søren would like my way of qualifying my thoughts, with respect to that book or anything else. At once, I demurred, an automatic response based on a full knowledge of my ignorance— but Walker, as I'd begun calling him (to my dizzying delight) nevertheless seemed impressed, pleased—and by then, he and Søren had, anyway, merged in my mind, and I could only let the matter drop when I seemed to be ahead.
Over the years, as I studied Percy's work and wrote about him in various ways and places, I kept going back in my mind to times spent with him; to the jazz we both enjoyed hearing (he had a great collection); to the novelists we discussed (Dostoyevsky, Tolstoy, Camus, Dickens); to the shared experience we remembered as medical students at "P&S" (Columbia's College of Physicians and Surgeons), and as residents on the same (tenth) floor of the school's dormitory, with the same view of the Hudson River, although our stays were fourteen years apart (he'd come there in the late 1930s, I'd arrived in the early 1950s); but most of all, to our conversations about Kierkegaard, and to a lesser extent, Gabriel Marcel, Karl Jaspers, and Martin Heidegger. "I owe Søren a lot—he's the architect of my writing life," Walker once said. In reply, I joked: "Sort of." He smiled at what he recognized as a bit of self- parody on my part, but now he was quick to insist that he wanted no qualifications: "It's all there, in Søren's books." No wonder I began my profile with Kierkegaard—even as I'd done with my piece on Erikson, who was of Danish ancestry, had read Kierkegaard before he'd read Freud, and had a similar (more secret, certainly less acknowledged) interest in essays such as "The Problem of Anxiety" and Stages on Life's Way.
Percy's first novel, The Moviegoer, starts with a dedication to his father's cousin, the poet William Alexander Percy, who became the adoptive parent of Walker and his brothers, Leroy and Phinizy, after their mother's death, which followed by two years their father's suicide. On the next page we read: "The specific character of despair is precisely this: it is unaware of being despair" —that from Søren's The Sickness unto Death. Throughout Percy's career as first an essayist, then a novelist who wrote occasional essays, he hearkened back to that book, that message, and by so doing, affirmed himself as a physician, one who was concerned with a particular kind of "sickness," and, yes, "death": the gravest kind of illness, whose consequences so often are a kind of death that precedes the moment of dying—the extended living death that passes for "life" among so many of us. Binx Bolling, surely Percy's best-known character, caught the imagination of many of us because his life, his mental maneuvers and strategies, was ever so familiar, yet brought us up sharp: that familiarity (with the moral stupor of "everydayness") had become worked into our daily lives all too unselfconsciously—a lack of awareness not at all like that described by Freud and his heirs. Indeed, it was Percy's shrewdly psychiatric sense, his clinical acuity, that discouraged him from imagining Binx as yet another twentieth-century "neurotic"; and it was Percy's talent and skill as a writer that enabled him (so the judges for the National Book Award for 1962 eloquently, pointedly, instructively averred) to shun "the mannerisms of the clinic" in favor of "an intimation of mortality," a lovely way, indeed, of describing a book, and one that connects one writer who aspired to be a physician and suffered from tuberculosis, John Keats, with another whose life, in those respects, was similar.
Once, after a long time together talking of his novels, Percy suggested that I think again about the epigraph for his first novel, whereupon I recited it from memory. He smiled and said: "That's my hold on medicine. I'm trying to be a diagnostician who makes a little sense out of a malaise, a disease, or rather, a dis-ease that influences our lives more than we care to—dare to—realize, admit to ourselves, never mind anyone else." It was then that I remember thinking of him as more than Dr. Percy by virtue of his graduation from a medical school—rather, as Dr. Percy taking the measure of our collective distress, however set aside in our cleverly distracting minds, and rendering in essays and fiction the nature of that disorder, its symptoms, and, not least, its etiology. Moreover, by implication, he offers the obvious, if often hard-to-secure, "treatment plan," the I-Thou of "existentialism," the commitment of one person to another, as in the ending of The Moviegoer and of The Last Gentleman— our "handing one another along," be it Binx (who is to become a doctor) and Kate, or Will Barrett telling Dr. Vaught that he needs him. In both novels, the elusiveness and evasiveness of an egoism that protects from the risks of connection, of human relatedness, with all its responsibilities and possibilities, yield to a bond affirmed—and by the time that has happened, we readers have learned well the obstacles overcome, the apprehensions and worries that exclude us so often, so conclusively, from one another.
In his other novels, Dr. Percy pursues a not dissimilar direction, if through different pathways. Love in the Ruins is his sharpest, most sardonic (and gloomy) take on the end-of-the-millennium social (and moral and spiritual) situation in this country and its brother or sister nations of Europe (the so-called advanced capitalist societies). The novel also happens to be a doctor's story in the sense that Percy fills it with plenty of neuroanatomical references, drawing on his memories of medical language and medical meetings. He also alludes to the messianic aspirations of scientists, often overlooked by those ready to be skeptical of religious thinkers, but all too uncritical of what is offered in the name of the natural sciences, or even the social sciences, no matter their murkiness or pretentiousness. In Lancelot, a novelist who has worked in clinics and hospitals struggles mightily, ingeniously, with the heart of medicine—how one person communicates with another. "What I know, I know first from you," I once heard Dr. Williams tell a patient who wasn't as forthcoming as the good doctor wanted—needed—him to be; hence the coaxing, but also the flat-out acknowledgment that when we speak (as we so often do) of the "doctor-patient relationship," we are addressing the very matters that haunted Dr. Percy for decades, namely, as he put it in one essay, "The Mystery of Language," our distinctive human attribute. The Second Coming takes us back to Will Barrett, that "last gentleman"; and in the story, a writing doctor once again struggles with the vicissitudes of human connectedness—with our yearnings for and fear of others, with the loneliness Kierkegaard knew to probe intellectually, even as he experienced it in no small measure. Finally, The Thanatos Syndrome, by its very title, signals a doctor's inquiry into a matter that has only grown more serious and challenging in the decade or so since that (prophetic) book appeared: our secular inclination to play God with life, or, put differently, to be all too sure of ourselves as to who ought to live and why.
Then there are the essays—those two wonderfully and suggestively named books, The Message in the Bottle and Lost in the Cosmos: The Last Self-Help Book. The first offers an ever so powerful reminder of who we are as human beings, and how we might better know ourselves, learn and remember what matters around us. When the dean of Harvard Medical School, Dr. Daniel Tosteson, was contemplating a "new pathway," a curriculum that would emphasize ideas, a manner of thinking about things, rather than the heavily rote knowledge of an accumulated factuality (tested and tested by multiple-choice questions), he went to see Dr. Percy in Covington—a significant journey, indeed. Many of the essays in that book would serve both medical students and their teachers well—and do so, in some schools. As for Lost in the Cosmos, it is brilliantly, humorously telling in its scrutiny of us, who are more vulnerable and sadly desperate (hence gullible) than we dare comprehend, let alone say out loud to others. True, the book is parodic, its focus social and cultural, rather than clinical; but again, a physician sees through so much nonsense, mocks so many pieties, out of a tough, medical awareness that has enabled him to be properly skeptical where others rush to embrace with unstinting enthusiasm.
Excerpted from The Last Physician by Carl Elliott, John Lantos. Copyright © 1999 Duke University Press. Excerpted by permission of Duke University Press.
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Table of ContentsAcknowledgments ix
Introduction/ Carl Elliot 1
Dr. Percy's Hold on Medicine/ Robert Coles 9
The Act of Seeing with One's Own Eyes/ Ross McElwee 16
Why Doctors Make Good Protagonists/ John Lantos 38
From Eye to Ear in Percy's Fiction: Changing the Paradigm for Clinical Medicine/ Martha Montello 46
Prozac and the Existential Novel: Two Therapies/ Carl Elliot 59
Ethics in the Ruins/ David Schiedermayer 70
Walker Percy and Medicine: The Struggle for Recovery in Medical Education/ Richard Martinez 81
Now You are One of Us: Gender, Reversal, and the Good Read/ Laurie Zoloth 96
Inherited Depression, Medicine, and Illness in Walker Percy's Art/ Bertram Wyatt-Brown 112
Pathology Rounds with Dr. Percy: The Modern Malaise, Its Causes and Cure Brock Eide 134
Walker Percy, Reluctant Physician/ Jay Tolson 150
Afterword: Writing and Rewriting Stories/ John Lantos 160