A Case of Self Defense

^A Case of Self Defense Eric Rabkin I have just read "A Case of Amyotrophic Lateral Sclerosis" by David Barnard - for the fourth time. I had best say at the outset diat I grow angrier with each reading. If I believed this were fiction, diat die voice named Barnard were created by some audior as a narrative persona, and diat the character called Dr. Walsh were manipulated by diat author simply to reveal some aspects of the medical establishment, and diat die characters named Paula and Maurice Baker were only constructs in a book who did not die in reality after a year of torment and shame and fear diat was significantly worse dian it needed to be, then I might have read this smoothly written narrative as a subtle revelation of character. But I believe - rightly or wrongly - that all of these names represent historical people. Their reality makes all the difference in the world, a difference that every aspect of this "case" artfully attempts to obliterate. I must stress that I personally believe Barnard and Walsh in no conscious way acted to harm the Bakers. I believe diey would be terribly distressed if diey came to believe they had done less for this couple dian diey could have within die bounds of professional behavior. And yet, naturally enough, acting as professionals, they have largely followed die conventions of their professions. We all, social creatures diat we are, follow conventions, usually thoughtlessly. The lure of conventional linguistic behavior, for example, is compelling. It often determines human relationships. We have all been in the situation of waiting anxiously to meet a new doctor, sitting in the examining room, when we see die door open and in he (or she) walks, wearing a conventional white coat. He dien says, glancing first at die clipboard in his hand, "Well, hello, (your first name]; I'm Doctor [no first name] Smith." He is ostensibly being cheerful, but he is in fact putting you in a subordinate position. If you ask physicians about this linguistic convention — as I have —some will say diat they'd never really thought about it; odiers diat diey are only trying to be friendly; and still odiers diat patients want to think of dieir physicians as superior to diem. Regardless of die state of mind of die physician, however, diis linguistic convention tends to establish a particular power Literature and Medicine 5 (1986) 43-53 C 1986 by The Johns Hopkins University Press 44 A CASE OF SELF DEFENSE relationship, one about which die patient is not consulted and one which, at a time of stress, die patient may not feel capable of challenging. I have no reason to believe diat Barnard and Walsh consciously intended to obscure reality or to work any harm, and yet I believe that they have done bodi. I also believe diat what they have done is common and well-meant behavior in people of dieir professions. While the writing of case histories certainly has contributed to die positive development of humane medicine, case histories are not transparent windows on reality; rather, diey form a conventional linguistic genre, one in which die physician who faces death (successfully or not) and who lives to tell die tale almost inevitably becomes the hero. My profession here is literary critic and my goals in this essay are to read dirough the effective, consistent, common pattern of fictionalizing in order to view reality afresh. I use diis case history as an example only because it comes to hand; I have no reason to think it unusual. But some example must be used, and examined carefully . We must see how we are seduced into defending our psyches by telling ourselves stories if we are to resist die seduction of telling ourselves stories. I realize diat most readers of this essay, if diey have already read "A Case of Amyotrophic Lateral Sclerosis," will - at least initially - reject my anger. After all, die "case" is apparently a moving but nonetheless straightforward report of the frustrations of a doctor and her patient in the face of an inevitably fatal disease. The patient and his ever attentive wife show "love and courage" (reported...