An inconvenient truth
Authors: Theodore Dalrymple
Journal: BMJ (2008)

Christa Wolf was the most famous East German writer, at least in the west. Her reputation suffered somewhat after the Berlin Wall came down from the revelation that she had informed for the Stasi, though only for a short time when she was young. She was widely regarded as an equivocal dissident, half-darling, half-opponent of the regime. One can’t help thinking of the position of medical directors of NHS trusts.

Medicine has long been an interest of Christa Wolf’s. The heroine of her most famous book, The Quest for Christa T, dies from leukaemia. In 1984 Wolf wrote an essay entitled “Illness and Love Deprivation: Questions for Psychosomatic Medicine.” And in 1991 she gave a lecture to the German Cancer Society entitled Cancer and Society, in which she wondered whether there was a cancer personality that, because it was inhibited by its social upbringing from expressing aggression outwardly, turned its aggression inwards in the form of cancer. She quoted the Swiss author Fritz Zorn, who, like many a memoirist of cancer (or other fatal disease) from the privileged sector of society whom I have read, asked the question when he contracted the disease, “Why me?” His answer was as follows:

“The harm that is caused by faulty upbringing can be so great that in its most extreme forms it can manifest itself as a neurotically determined illness, such as cancer, as now seems to be the case with me.”

This is what one might call the Rousseau theory of cancer: that in a virtuous state of nature, man would never get it. This raises the question of what man would die from in such a state (assuming he would not be immortal)—that is, if his upbringing were of a perfection of which Rousseau and Wolf might approve. The answer seems to be that he wouldn’t live long enough to get cancer.

Wolf wonders whether there “is a connection between the widespread inability to handle the truth of a serious illness and our deeply ingrained habit of deceiving ourselves, and letting ourselves be deceived, about the role we are playing and the society we live in?” Here one cannot help but remember T S Eliot’s famous line, that humankind cannot bear very much reality.

Wolf says that “many doctors who avoid the truth when dealing with patients are behaving normally, complying with the norms, conforming to their society”—which, of course, she feels, is all wrong. She seems to be an ally of Mr Grandgrind on this question: facts, and facts alone, are what are needed in life.

I think things are rather more complex, which is no doubt why mistakes are so often made. Where there is a need for judgment, there is always the possibility of error. I remember that when my mother had cancer, she demanded that after her operation she should be told everything. In fact, she had a poor prognosis (the likelihood of recurrence and death within a year was great) and the surgeon, sizing her up, advised against a full disclosure of the facts. She lived another 20 years, and I have little doubt that the surgeon was absolutely right and humane in his advice, which was to mislead, if not actually to deceive, her: or, in Christa Wolf’s parlance, to behave normally.

Wolf says that “many doctors who avoid the truth when dealing with patients are behaving normally, complying with the norms, conforming to their society”—which, of course, is all wrong