AUTHOR: Richard Barager | POSTED: 03/5/11 7:57 PM
CATEGORIES: Literary Prescriptions, The Value of Fiction
What makes a young man or woman want to become a doctor? Ego? Intellectual challenge? The prospect of financial success? Scientific fascination?
The answer for most of us—none of the above—can be found in the 2009 debut novel Cutting for Stone, by fellow physician Abraham Verghese.
It is a novel that is widely loved by readers, if not all critics. The New York Times Sunday Book Review, for instance, concluded its critique of Cutting for Stone on a decided downer: “In Verghese’s second profession, a great surgeon is called an editor. Here’s hoping that in the future the author finds stronger medicine in that line.”http://www.nytimes.com/2009/02/08/books/review/Wagner-t.html?_r=1And the Boston Globe’s traducing review was no kinder: “…not a great work of fiction but an interesting one…Despite its somewhat labored plot and alternately flat and overwrought characterizations, Cutting for Stone is worth reading…”
Most other reviews, however, were glowing, and readers have decisively overruled the above outliers. Many reasons for the book’s appeal have been suggested: Verghese’s engrossing description of Ethiopia, where much of the action occurs; the detailed descriptions of all things medical and of the taxing life of a surgeon (which Verghese is not, by the way—he is an infectious disease expert and professor of medicine at Stanford); the obvious love the author has for medicine; the compassion he holds for his characters.
There is no denying, though, that Verghese qua author found it difficult to detach from being a doctor, and consequently let the physician in him rule the novelist. The price paid is that the book is laden with long, jargon-filled passages that bring its narrative flow to a screeching halt. Yet despite this, it is clear that both Abraham Verghese and his physician-characters in Cutting for Stone became doctors to help people. Which is why the public continues to hold physicians in such high esteem, repeatedly naming “doctor” as the most respected career choice, reserving their deepest contumely for lawyers and politicians. In my opinion, it is on account of its manifestation of human altruism that Cutting for Stone has enjoyed such stunning commercial, if not always critical, success.
Altruism has fascinated mankind for centuries. Altruistic behavior is at first blush inconsistent with Darwinian natural selection, in that it is behavior by an organism that benefits another at its own expense. The great religions of the world use the fact of human altruism as evidence of God’s existence, by equating love of others with love of God: “…thou shalt love thy neighbor as thyself: I am the LORD.” (Leviticus 19:18.)
For unbelievers, the existence of altruistic behavior is a glaring contradiction, an inconvenient conundrum that challenges the very foundation of secular rationalism: evolution. For how could behavior benefitting another to one’s own detriment possibly be explained by evolution theory? But recently, the scientific community—mostly, though not exclusively, atheist—has produced a multitude of studies purporting to show that altruism is purely a neurobiological phenomenon. One of the earliest came out of Duke, and showed that sophisticated MRI scans of the brain revealed relatively greater activation of the brain’s posterior superior temporal sulcus when experimental subjects were watching as compared to playing a computer game. This heightened activity strongly predicted a given subject’s propensity for altruistic behavior. (Nat Neurosci. 2007 Feb;10(2):150-1. Epub 2007 Jan 21.Altruism is associated with an increased neural response to agency. Tankersley D, Stowe CJ, Huettel SA. Brain Imaging and Analysis Center, Box 3918, Duke University Medical Center, Durham, North Carolina 27710, USA.)
Other researchers found that areas of the brain stimulated by food or sex—fronto-mesolimbic networks—became relatively more active when subjects were asked to think about donating a large sum of money as compared to keeping it for their own use. That is, it made them feel good to be altruistic, thereby explaining Saint Francis of Assisi’s famous observation: “For it is in giving that we receive.”
Predictably, it was only a matter of time before a study appeared to advance the notion that altruism was selected out over the course of human evolution in order to confer a survival advantage. Last October, Dr. Tim Phillips and colleagues studied the responses of identical and non-identical female twin pairs to questions about their own altruism and how desirable they found altruism to be in potential husbands. Results showed a link between human altruism and sexual selection, supporting the theory that altruistic behavior evolved as it became necessary for the earliest human beings to choose mates who would be willing to make the sacrifices required for successful child-rearing. (Tim Phillips, Eamonn Ferguson and Fruhling Rijsdijk. A link between altruism and sexual selection: Genetic influence on altruistic behaviour and mate preference towards it. British Journal of Psychology, 2010; DOI: 10.1348/000712610X493494)
So, is altruism a conscious, moral act of free will, or is it a complex neuronal circuit? I have covered this ground before in a discussion on Cartesian dualism and the mind-body problem: Does human consciousness—the mind—exist separately from the human body? This is the larger issue under which any debate about the origins of altruism must be subsumed.
Whatever the answer, the attraction of medicine as a calling is born in large part from the altruistic urge to help other human beings. What the proximate cause of this desire is depends on where one believes consciousness resides: in the soul or in the neurochemistry of the brain. It is my personal belief that the mind and soul are not discoverable by scientific method, as they are infinitely intangible and not part of the observable, accessible universe. Serious works of fiction like Cutting for Stone, however—with complex meanings embedded in narrative in a manner beyond the capacity of ratiocination to convey—are capable of accessing the infinitely intangible.
And of revealing why doctors become doctors.