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Br J Gen Pract. 2006 November 1; 56(532): 896.
PMCID: PMC1927114

Book review

Reviewed by Gillie Bolton

Cecil Helman 
Suburban Shaman: Tales from Medicine'S Front Line.
Hammersmith Press. 2006 PB, 196 pages, £9.99,  1 905140 08 8.
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Suburban Shaman brings medicine (particularly general practice) out of the camera even more effectively than Berger's A Fortunate Man. A disarmingly lightly written story book of Helman's broad experience, it takes down the masks, giving insightful philosophy with consummate wry humour and firmly held opinion. The leitmotif running throughout is humanity in medicine, which Helman demonstrates as being eroded daily by such forces as bureaucracy and technology. He believes the doctor–patient relationship has healing power, and that healing or compassion, informed by science, is the inalienable cornerstone of effective medicine.

Helman does not lecture his reader with this belief and theory. He tells stories that make it self-evident. Examples are offered from all over the world, from all sorts of cultural approaches to healing and medicine, of the power of this relationship. And of the power of narrative, of stories. For this book exemplifies itself. It tells stories of the effectiveness of human humane medicine, and stories of the ineffectiveness and inhumanity of techo-medicine. Like the time he attended ‘Grand Rounds’ at Harvard along with many ‘Important People’. Although interested, Helman waited in vain for the vital lecture ingredient. Finally he inquired of his neighbour ‘ … “what about the patient?”… My question puzzles him. “The patient?” he asks, frowning, shaking his head in disbelief. “The patient?!”’

Suburban Shaman tells us furthermore that the doctor engaging with a patient's story, with the role of their illness in their life as well as their body, has tremendous healing power. This is the whole person of the doctor relating to the whole person of the patient. The fundamental importance of narrative and story to medicine is well documented.14 Frank describes dynamic involvement with narrative or story as working with stories, rather than about them: ‘what counts about any story is what those who hear it choose to do with it’.5 Two things matter, Helman demonstrates: that doctors perceive and act on the stories of their patients; and what they then do with the stories

Helman, retired GP, professor of medical anthropology, lecturer in medical humanities, poet and painter, is the author of Culture, Health and Illness (now in its fifth edition),6 which contains the seven questions that trainee doctors in more than 40 countries are taught to consider from each patient's perspective. In 2004 he received the Career Achievement Award of the American Anthropological Association, and in 2005 the Lucy Mair Medal for Applied Anthropology of the Royal Anthropological Institute

Born brought up and trained in apartheid South Africa, Suburban Shaman starts there. Like the time he won an argument in an operating theatre, insisting black people do feel pain like whites, and that the woman needed an anaesthetic; and his encounter with the white Addison's disease patient, who tragically became black.

Suburban Shaman was Radio 4's ‘Book of the Week’ (March 2006) and has been lauded in all major newspaper reviews, BMJ, the Lancet and so on. Dame Julia Neuberger said in The Independent that she could not put it down. Nearly all these reviewers, including Radio 4's Libby Purvis, say it is a must read for doctors everywhere. I underwrite this completely, but would add: particularly GPs. Suburban Shaman is electric shock therapy for what medicine can and should be. I think Franz Kafka would have put it on his list, when he said: ‘One should only read books that bite and sting one. If the book we are reading does not wake us up with a blow to the head, what's the point in reading?’7

REFERENCES

1. Montgomery Hunter K. Doctors' stories: the narrative structure of medical knowledge. Princeton, New Jersey: Princeton University Press; 1991.
2. Brody H. Stories of sickness. 2nd edn. Oxford University Press; 2003.
3. DasGupta S, Charon R. Personal illness narratives: using reflective writing to teach empathy. 4. Vol. 79. 2004. pp. 351–356. Academic Medicine. [PubMed]
4. Engel JD, Pethel L, Zarconi J. Hearing the patient's story. Sacred Space. 2002;3(1):24–32.
5. Frank A. Asking the right question about pain: narrative and phronesis. Lit Med. 2004;23(2):209–225. [PubMed]
6. Helman C. Culture, health and illness. 5th Edn. London: Hodder Arnold; 2007. in press.
7. Kafka F. In: Staying alive: real poems for unreal times. Astley N, editor. Tarset, Northumberland: Bloodaxe Books; p. 2.

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners