Today’s Rx: A Shard of Ice

by Theodore Dalrymple (June 2022)

Walk Home II, Soo Rye Yoo


Somerset Maugham thought that a medical education was an excellent training for a writer. A doctor is, or used to be, entrusted with the most intimate details of his patients’ everyday lives, their innermost feelings, their secret fears; and yet, at the same time, he retains an emotional distance because he is an observer of their lives rather than a participant in them. He has to be simultaneously sympathetic and objective. If he were sympathetic without objectivity, he would cease to be of use as a doctor to his patient; if he were objective without sympathy, he would appear so cold that his patient would have no faith in him, however good, technically, his advice.

Oddly enough, doctors seem to have communicated this combination of sympathy and objectivity to their children, for a surprising number of great authors—Flaubert and Dostoyevsky, for example—had doctors for parents. There would, of course, be difficulties in establishing a statistical association with any degree of certainty, for there would be problems both with the numerator and the denominator. How is the class of great authors to be defined? And with what population is it to be compared, in order to show that the number of great authors with a parent who was a doctor was greater than one might have expected by chance? Should the comparison be with the whole population, or only the educated part of it? Should the offspring of doctors be compared with those of lawyers, teachers or businessmen, and if the latter, how successful must they be before they are included in the calculation? Besides, statistical association is not causation, as we are constantly being reminded (though the human brain or mind stubbornly refuses to take this lesson to heart, as it were). Therefore, even if were able to demonstrate an association between great writer-hood and having been born to a medical parent, a statistical association which even after immense effort to demonstrate its existence is likely to be weak, we should not have done enough to justify our original assertion that doctors had been able to pass on their sympathetic objectivity to their children. (Not all great writers show such sympathetic objectivity in any case.) Against this might be objected that if all our assertions about the human world had to be proved with this degree of evidential scrupulosity, we should soon be reduced to silence.

Of course, medical training and practice have changed out of all recognition since Maugham’s time. Maugham qualified as a doctor towards the end of the nineteenth century, when the technical accomplishments of medicine were minimal by comparison with those of today. In many cases, the doctor had little more than a sympathetic ear and a placebo to offer his patients, though in most cases he probably believed in the pharmacological efficacy of his placebo—which often, after all, had serious side-effects, which itself taken was taken as a token of efficacy, for who would knowingly cause such deleterious side-effects without believing that what caused them was also doing some good?

The doctor was once a very close observer of his patients, but now, in many cases, he scarcely examines them. It is a common complaint of patients that their doctor seems more interested in his computer screen, from which he hardly looks up, than in them as human beings. He is like a bureaucrat who orders or co-ordinates tests; he is always so busy that patients seem to be an intrusion on or interruption of what he really ought to be doing. He never has the time, and or apparently the interest, to delve more deeply into his patients’ lives, when to do so might obviate the need for many further investigations.

So perfunctory has history-taking and examination become in modern medicine that an old-time physician of my acquaintance says that all that young doctors do nowadays is put their patients in what he calls the answering machine—that is to say, one of the many kinds of scan now available that purportedly makes the diagnosis for them without further ado.

There is no doubting the technical brio of modern medicine and its many brilliant accomplishments, but something has been lost too, namely humanity. The patient feels that he is on a production line and the doctor is like Charlie Chaplin in Modern Times.

In these circumstances, it would be surprising if medical education, which necessarily reflects modern practice, were still an excellent training for writers: though only time will tell.

If a medical education, as it has now become, is not a good training for writers, what is? Indeed, are writers born or made?

In a sense, of course, they must be made. No one, no matter his genius, can be a writer in a pre-literate society. Furthermore, it is a matter of generally accepted literary history that there are golden ages in literature as there are in, say, painting. Was the sudden flowering of literary ability in a golden age the result of a happy throw of the genetic dice, or were there social conditions that made it possible, if not inevitable?

In this connection, I recall a young Angolan writer in London who went to a meeting at the Angolan embassy under the aegis of the cultural attaché. In those days, Angola was still an ideological rather than a purely kleptocratic state, and in accordance with all Marxist states, felt the need to make absurd propaganda claims.

At this meeting, an official said that Angola was training a thousand writers, whereas before the revolution none had been trained, and ergo the regime was splendidly committed to the advancement of culture. My Angolan friend said, to general dismay, that a thousand writers did not add up to one Tolstoy, which would surely have been correct even if the thousand writers under training were not all supposed to write what in essence was the same thing.

Even without heavy ideological baggage, it would surely be difficult for a teacher of writing not to pass on some of his own tastes and prejudices to his pupils. On the few occasions I have tried to teach someone to write, I know that I have done so, for example my preference for understatement, irony and the implicit rather than overstatement, literal-mindedness and the explicit, though I would be far from claiming that the latter have no place at all. In the introduction to his magisterial anthology of prose in English, the late John Gross, who had not only read more English literature than any man I have ever met (and was the most delightful man into the bargain, who loved to share his learning only because he delighted in his subject and never to impose himself or show off), but understood and remembered it, abjured the temptation to rank prose according to its quality according to some scale of aesthetic or other value. He said, “Prose … fulfils innumerable functions, and it can attain many different kinds of excellence.” And it is surely the glory of a language that it can rise to the heights of poetic expression and make plain speech eloquent. No one would demand, or expect, that all prose should be as orotund as that of Sir Thomas Browne or as pared-down as that of Hemingway, that there was a ‘correct’ way to write, and only one such way. Rules cannot be laid down.

There is one thing that I think most writers who aspire to greatness must have, and that is a shard of ice in the heart or, if you prefer, a certain ruthlessness. They must be prepared to make sacrifices for their art, withstand criticism of the hurt that they may cause, and treat the social world as grist to their mill. They must believe that what they write takes precedence over the usual social niceties that guide (and inhibit) our actions. In short, they must be prepared to pay no respect to the decent opinions of mankind, though their convictions may coincide with them.

It is important to remember that the shard of ice is a necessary, not a sufficient, quality of writers who would be great. There are plenty of people with such shards who are not writers at all, let alone great ones, and who exist in all walks of life. And the shards can be of different sizes, even blocks to occupy the whole of the heart.

How do people come by their shards of ice? I have a little one myself and I think I know how I came by it: the lack of love in my household when I was a child. By nature, I was affectionate; the shard was at first protective against the disappointed need for love, but then became an obstacle without, however, becoming so great as to be an advantage in a literary career (irrespective of any lack of talent). It was this experience in childhood that caused me to react so strongly to words in John Ruskin’s Praeterita, in which he enumerates first the advantages of his childhood in a rich and cultivated household, and then the disadvantages. “First,” he said, “the absence of anything to love.” Could any words be more piercing, especially for those who knew from experience what he was talking about?

No doubt there are some born with shards of ice in their heart, for either genetic or congenital reasons (not the same). But that apart, it is circumstances, adverse in some way, that place the shard there. Such circumstances can be so overpowering as to destroy a person for ever, but a dose of adversity in childhood can also strengthen and has the advantage, if advantage it is, that happiness is never afterwards taken for granted even as it is experienced. I doubt, in fact, that many great writers had entirely happy childhoods.

Dickens is a famous case in point. He was sent to work in a boot-blacking factory when he was twelve, which was a traumatic experience for someone of his background. His mother was in favour of him continuing to work in the factory even when the immediate pressing need was past. He wrote to his friend and biographer, John Forster:

I do not write resentfully or angrily: for I know that all these things have worked together to make me what I am: but I never afterwards forgot, I never shall forget, I never can forget, that my mother was warm for my being sent back [to the factory].

This seems to me to be an admirable passage. I am not sure I quite believe that he did not write in anger or resentment, though he is clearly trying his best to control it; but his mature acknowledgement that his childhood adversity played a constructive role in his life even though it was horrible and he would much rather not have lived it is both intelligent and manly: and it would be difficult to deny that this childhood adversity was (apart from his genius) indispensable in making him one of the greatest writers in world literature about the child’s apprehension of injustice. Precisely because he never forgot and never could forget the outrage done him by his own mother, he was able to recapture so vividly the child’s perception of injustice which, if his childhood had gone more smoothly, he might not have been able to do.

The passage is also interesting about the nature of traumatic memory. When Dickens said that he never could and never would forget, he did not mean that the memory was ever-present in the forefront of his mind, filling it every waking moment of his day to the exclusion of all else. He meant that he could call up the memory if and when he wanted or needed to; no doubt it would on occasion rise unbidden to his mind, but he was nevertheless able to get on with other things (and how!). His memory did not have to be ‘recovered’ or suggested to him by a psychotherapist. In that sense, it was ever-present; it was also ever-present in his awareness of the wrongs done to children and gave colouring to his work. But if ever there were a man who was able to turn trauma to account, it was he. He did not wallow in, but utilised, misery. Of course, it helped that he was of a rare genius.


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Theodore Dalrymple’s latest books are Neither Trumpets nor Violins (with Kenneth Francis and Samuel Hux) and Ramses: A Memoir from New English Review Press.

Follow NER on Twitter @NERIconoclast


5 Responses

  1. My physicians are fine. But it is fairly obvious to me that I am on a treadmill when I respond to what would normally seem to be an invitation to conversation. It’s obvious that my response has thrown them off their pace, though they try to correct the course without the little signs of irritation; to wit, that I am obtuse to the fact that their friendly sallies are necessarily included in the package. I can see they are pressed for time by the corporations that direct them. So I’ve tried to do my part and not flop off the conveyor belt. I didn’t go there for a friend. I like to think we share a sort of quiet camaraderie in our silent suffering under the cronyism of the modern corporation and government.

  2. Why would anyone go to a doctor nowadays if there was something wrong with them? It would be akin to going to a politician and asking for a recent policy to be changed. or asking a shop assistant for a product which is not available any more….

    1. Yes. I know some people whose relatives were euthenised with what they call a “driver”. We’re all praying that we don’t get sick here in Blighty.

  3. I have heard the trope about writers before and after political change before, and I believe that the Angolan writer was conscious of that version, which was, in the Soviet Union a publicist said ‘Now we have [x number of] writers in this district; before the Revolution there was only one.’ But of course that one was Tolstoy. I think the mention of Tolstoy clinches it.

  4. So true. What you write about the corporate doctors (often to their own dismay). But that’s not what got my attention. An ice shard that dwells within….that’s what brought me to tears. The image is extraordinary. I bore up well and prospered despite great difficulties after my husband abandoned my two children and me in the late 1960s. But fifty plus years later I still worry about the ice shard existing in my adult children. One still yearns openly for his/her father. My other “child” shut down emotionally years ago, Without saying a word, s/he noticeably withdraws when “Dad” is mentioned. The ice shard I retain within me drips with salty tears for them.

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