Alongside the official textbooks of the medical curriculum, there appears a second canon, a hidden curriculum. Consisting of essays, films, folktales, jokes, novels, plays, poems and television shows, this repository is a refuge, a place where doctors and other healthcare professionals go to think about their profession in a different light, through a different lens. If these works present a refuge to healthcare professionals, they may also document particular nodes of concern or anxiety, areas, in other words, where some catharsis is necessary. Therefore, they become interesting for analyses of shame experiences within medicine not merely because they can describe moments when healthcare professionals feel shame, but because they can track the processes that condition this shame and dictate its conversions, into anger, guilt, regret, detachment and cynicism.
Two influential works in this grey canon are A. J. Cronin’s The Citadel (1937) and Samuel Shem’s The House of God (1978). Although very different in their style—one chuckles to imagine how shocked Cronin’s earnest sentimentality would be by Shem’s picaresque ribaldry—the two novels have proved surprisingly resilient to changes in medical curricula and literary taste. This may be because they both describe doctors in the process of developing their clinical practice, alongside a gradual realization of an endemic corruption in the medical establishment. If, by their conclusions, the ostensible message of both works is to hold fast to the ideals of the profession, while recognizing the temptations of money, power and success, we can by no means be sure that this message has been the primary reason for the novels’ staying power. It is more likely that professionals have found succour in the recognition of themselves and their colleagues in the numerous vignettes that make up both narratives. If this is the case, then we might do better to focus our attention on the ways that the novels map their protagonists’ rises and falls: the ways that they cope with the loss of idealism that attends their growing awareness of medicine’s politics.
When we focus on their trajectory, rather than their terminus, we can see clear lines of connection between the disillusionment or cynicism of the doctors in these novels and moments of shame about their practice. Strikingly, however, the moment where they realize their feelings of shame usually comes after their most bruising cynicism. In other words, while it is shame that generates their cynicism, this shame remains disavowed until, late in the novel, the characters reckon with it as part of their processes of medical formation. This moment of reckoning, in turn, breaks a pattern of behaviour that has been marked by cynical detachment, reconciling the character’s understanding of themselves with an awareness of the weight of what they have done.
In my research article, “Shame-to-cynicism conversion in The Citadel and The House of God,” published in Medical Humanities, I track the dynamics between cynicism and shame in professional practice through the novels to suggest stronger links between cynicism, so often observed among medical students, and moments of shame.
Arthur Rose, University of Bristol