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Tuesday, 12 February 2013
A Stiff Upper Lip May Be Hazardous To Your Health Bookmark and Share
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Fortitude is one of the four cardinal virtues: and it was traditionally the most British of the four. We prided ourselves (a vice) on our stiff upper lip, that is to say on being uncomplaining in the face of adversity (a virtue).

A new study suggests that fortitude is still a British characteristic, but that it might be hazardous to our health. The British, it seems, are more likely than other nationalities, such as the Swedes, Danes and Germans, to delay going to the doctor with symptoms that could be those of cancer, thus decreasing their chances of survival. They say that they do not want to bother the doctor with their complaints.

Certainly I have known such cases. Many years ago I visited a man in his eighties who had been losing blood slowly for a long time and was now so desperately weak from blood loss that he could hardly move.

“Why didn’t you call me sooner?” I asked him.

“I know you’re very busy, doctor,” he replied. “I didn’t like to bother you.”

On the one hand this was absurd, for what more important task could a doctor have than to attend to someone like him? On the other, though, it was admirable, for it implied that, even in adversity, he put others before himself and was modest about the scope and importance of his own suffering. I was much moved.

Another time I was walking through the hospital when I noticed a man whom I knew slightly sitting on a bench. He was in his seventies; he was obviously weak and was so jaundiced that he was almost orange. At his age it could mean only one thing: secondaries in his liver, and death.

I approached him and asked him how he was.

“Not very well, I’m afraid,” he replied.

“I’m sorry to hear that,” I said.

“Well, we’ll just have to do the best we can,” he said, and I wished him well.

He knew that he was dying, and he knew that I knew that he was dying, but he made no fuss. As far as he was concerned, I had expressed an appropriate degree of concern and sorrow. Even two weeks before his death he was anxious not to embarrass me by an emotional outburst. I found this again admirable, both moving and quietly heroic. “See how a Christian can die,” said Addison; I do not know whether this man had any religious faith, but he most certainly possessed one of the cardinal virtues. I felt him to be a model when my time comes.

Of course, the relative British reluctance to go to the doctor might be the consequences of something other than fortitude. It is probably more unpleasant to go to the doctor or a hospital in Britain than in any other similarly developed country known to me.

Despite the fact that we have twice as many doctors practising as 15 years ago, the Government has arranged matters so that it is more difficult now than ever to see the same doctor twice: and most people feel more comfortable consulting someone whom they know and who knows them. British patients increasingly feel they are but parcels in a game of pass the parcel; and while they may get very good treatment they may also get abominable, with very little control over which it is to be.

Moreover, fortitude is not the same as fear. Fortitude is facing adversity without emotional display and with a certain degree of acceptance; fear in this context is not facing reality because of what that reality might be.

A person who goes to the doctor with symptoms suggestive of cancer may in fact be displaying more fortitude than the person who cowers at home. Fortitude is not denial.

It is premature, then, to conclude that the stiff upper lip, the physical metonym of fortitude, is unhealthy or dangerous because it leads to failure to consult a doctor at a time when a disease can be cured. The reluctance to consult doctors early is not necessarily a sign of fortitude. No doubt control of emotional expression can go too far and even become ridiculous, as in “Dr Livingstone, I presume?” But no one who observes modern Britain could conclude that the present-day British are all the phlegmatic types that they are still stereotypically considered to be in places in Europe where the young British never go. (Stereotypes always lag behind the reality they are supposed to depict.) On the contrary, many British people are now incontinently emotional. Their gestures are crude and obvious rather than subtle and restrained; and their upper lips are now far too mobile for my taste.

Nevertheless, it is my impression that, at least in the medical context, the British remain relatively undemonstrative. Perhaps they even like the discomforts of their disagreeable hospitals, because they offer the opportunity for them to display the national cardinal virtue of fortitude.

For if there is one place you often need a stiff upper lip, it is a British hospital.

First published in The Telegraph.

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Posted on 02/12/2013 5:23 AM by Theodore Dalrymple
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