A Fortunate Man: The Story of a Country Doctor

by John Berger, Jean Mohr (Photographer)

In this quietly revolutionary work of social observation and medical philosophy, Booker Prize-winning writer John Berger and the photographer Jean Mohr train their gaze on an English country doctor and find a universal man--one who has taken it upon himself to recognize his patient's humanity when illness and the fear of death have made them unrecognizable to themselves. In the impoverished rural community in which he works, John Sassall tend the maimed, the dying, and the lonely. He is not only the dispenser of cures but the repository of memories. And as Berger and Mohr follow Sassall about his rounds, they produce a book whose careful detail broadens into a meditation on the value we assign a human life. First published thirty years ago, A Fortunate Man remains moving and deeply relevant - no other book has offered such a close and passionate investigation of the roles doctors play in their society.

"In contemporary letters John Berger seems to me peerless; not since Lawrence has there been a writer who offers such attentiveness to the sensual world with responsiveness to the imperatives of conscience." --Susan Sontag

Genres: Nonfiction, Medicine, Biography, Philosophy, Memoir, Photography, Art

168 pages, Paperback

First published January 1, 1967

About the author

John Peter Berger was an English art critic, novelist, painter and author. His novel G. won the 1972 Booker Prize, and his essay on art criticism Ways of Seeing, written as an accompaniment to a BBC series, is often used as a college text.

Later he was self exiled to continental Europe, living between the french Alps in summer and the suburbs of Paris in winter. Since then, his production has increased considerably, including a variety of genres, from novel to social essay, or poetry. One of the most common themes that appears on his books is the dialectics established between modernity and memory and loss,

Another of his most remarkable works has been the trilogy titled Into Their Labours, that includes the books Pig Earth (1979), Once In Europa (1983) Lilac And Flag (1990). With those books, Berger makes a meditation about the way of the peasant, that changes one poverty for another in the city. This theme is also observed in his novel King, but there his focus is more in the rural diaspora and the bitter side of the urban way of life.

Reviews

[Abel · Rating 4 out of 5]

I enjoyed this. It is filled with Berger’s succinct, extraordinary observations. His ways of seeing are on full display here. The book begins with bucolic scenes, sedate renderings of an English village. Scenes of the doctor’s rounds, in one a tree has fallen on a man in an orchard. We follow the doctor as he arrives. He administers morphine, calms the crowd around him. (It is told in utmost poetic simplicity.) The people tell him of a story about a man, Sleepy Joe, whose was under a felled tree for twelve hours waiting, whereas this doctor was on the scene 20 minutes. In these interactions we are given access to a man in full knowledge the balm his mere presence can provide.

We learn about the formation of our multi-suffixed doctor, Dr John Sassall M.B., Ch.B., D.Obst.R.C.O.G. His roots, in early days. Berger has traced his stoic, impenetrable demeanor to the heroes of Joseph Conrad’s sea novels. The novels Dr Sassall read as a boy. And really, abstract as it seems, it does shed light on our perception of this doctor’s character throughout the subsequent sections of the book.

Without the photographs we wouldn’t get the full idea. The patients in varying states of vulnerability, emotions reside in the eyes, clutching stomach indicating pain. The facial expressions full of pity, we are nearly diagnosticians when we see them: distress, trust, bewilderment, humiliation perhaps. A quite complex facial expression of a soon-to-be mother, his hand pressing her abdomen. This is a degree of intimacy we rarely get to see. We never see inside a doctor’s exam room (unless we’re in there), or seldom do we, or during his house calls. There is a section where Berger writes about the inherent trust we have in doctors, and there it is in black-and-white: authentic bedside manner.

This is not a sensationalized depiction of a doctor. It is low-key, it is everyday. He is elevated by dint of the sheer effort it takes to become a doctor, so in that regard he is an uncommon man. But there are extreme elements to this doctor. Berger diagnoses the doctor himself in the latter chunk of the book, and tone changes. There is the line: What is the cause of boredom? Is boredom anything less than the sense of one’s faculties slowly dying? The man’s bolstered pride, lengthy sections on his sense of inadequacy, and why. (Berger has some pride himself, having injected himself into the essay, clandestinely, There is probably only one other man in the area whose thinking is comparable. But this man is a writer and a recluse. Nobody around him is aware of how he thinks.) And again, the relationship to his patients:

‘Where you’re different Doc is I know I can say Fuck You to your face if I want to.’ Yet the speaker has never said Fuck You to Sassall.
‘You’re the laziest bitch I’ve ever come across,’ says Sassall to the middle-aged woman draper whose day is now made. Yet only he can say this to her.
He has been elevated in the patients' mind to a sort of non-entity, a human above all the regular norms of social interaction. I can imagine the effect that would have on a person’s self-regard.

Abandoning his former self, Sassall now takes a realistic view of the world we live in and its brute indifference. It is the nature of this world that good wishes and noble protests seldom mitigate between the blow and the pain. For most of those who suffer, there is no appeal. The Vietnamese villages are burned alive though nine-tenths of the world condemns the crime. Those who rot in prison serving inhuman sentences which the jurists would declare unjust, rot nevertheless. Most crying wrongs cry until there are no more victims to suffer them. When once the blow is aimed at a man, little can come between it and the pain. There is a strict frontier between moral examples and the use of force. Once pushed over that frontier, survival depends upon chance. All those who have never been pushed that far are, by definition, fortunate and will question the truth of the world’s brute indifference. All who have been forced across the frontier - even if they survive and return - recognize different functions, different substances in the most basic materials - in metal, wood, earth, stone, as also in the human mind and body.

Hence the title, A Fortunate Man. A word like beauty is thrown around a lot and subjective and may be devoid of meaning at this juncture of life, but there is such striking, delineated beauty here. From the outside we slowly work in, down to the atoms of psychology and memory.

[notgettingenough · Rating 4 out of 5]

Years ago I was at a dinner party, one of the group being a quietly spoken woman who had largely stayed mute. Somebody happened to say that she had a good dentist. Suddenly this woman exploded. 'How do you know he's a good dentist', she practically spat the words out. It wasn't a question, it was an accusation. None of us really knew how to respond and I still don't, despite having considered it a lot. Not being a dentist, how could I possibly 'know'? Whereas she, it now transpired, was both a practising and academic dentist. We'd strayed onto her turf and there didn't seem to be any getting off it. She mentioned no names, but talked darkly of dentists who were popular in Melbourne but who were clueless at their work. Gulp. My dentist was popular. I liked him. I went about calling him a 'good dentist'. Suddenly my very teeth seemed to loosen in my jaw. I got a tooth ache on the spot.

So, let's change that question to 'How do we define why we see one doctor as good and another not?'

For me, it's 'bedside manner'. Some doctors have it, others don't. Despite thinking it is vital, I have never tried to explain what it is. I've only felt either that I've been in its presence, or, more often, I haven't. Having read this book, I can see how trivial my thoughts were. Berger took the opportunity to explore the question profoundly. I think it is important to note the wording of the question. We are not asking which doctor is better, we are asking which doctor we perceive as better and why.

Enter Dr Eskell, presented in the book as Dr Sassall.

How is it that Sassall is acknowledged as a good doctor? By his cures? This would seem to be the answer. But I doubt it. You have to be a startlingly bad doctor and make many mistakes before the results tell against you. In the eyes of the layman the results always tend to favour the doctor. No, he is acknowledged as a good doctor because he meets the deep but unformulated expectation of the sick for a sense of fraternity. He recognizes them.

The book begins by following Sassall about as he attends to patients. From the very beginning we are aware that he is nothing if not fallible. In the first scenario he tells witnesses to an accident in the forest that the victim will not lose his leg. He does. What confidence on the part of both doctor and writer to begin this way.

And then, after these descriptions, Berger starts his process of analysing what it all means.

This individual and closely intimate recognition is required on both a physical and psychological level. On the former it constitutes the art of diagnosis. Good general diagnosticians are rare, not because most doctors lack medical knowledge, but because most are incapable of taking in all the possibly relevant facts - emotional, historical, environmental as well as physical. They are searching for specific conditions instead of the truth about a man which may then suggest various conditions. It may be that computers will soon diagnose better than doctors. But the facts fed to the computers will still have to be the result of intimate, individual recognition of the patient.

On the psychological level recognition means support. As soon as we are ill we fear that our illness is unique. We argue with ourselves and rationalize, but a ghost of the fear remains. And it remains for a very good reason. The illness, as an undefined force, is a potential threat to our very being and we are bound to be highly conscious of the uniqueness of that being. The illness, in other words, shares in our own uniqueness. By fearing its threat, we embrace it and make it specially our own. That is why patients are inordinately relieved when doctors give their complaint a name. The name may mean very little to them; they may understand nothing of what it signifies; but because it has a name, it has an independent existence from them. They can now struggle or complain against it. To have a complaint recognized, that is to say defined, limited and depersonalized, is to be made stronger. The whole process, as it includes doctor and patient, is a dialectical one. The doctor in order to recognize the illness fully - I say fully because the recognition must be such as to indicate the specific treatment - must first recognize the patient as a person: but for the patient - provided that he trusts the doctor and that trust finally depends upon the efficacy of his treatment - the doctor's recognition of his illness is a help because it separates and depersonalizes that illness.

There are certainly openings for criticising this book. Berger perhaps goes too far in his attempts to explain what he sees. As some have noted, he is not exactly waving the flag for feminism either. I think it's obvious that Berger is feeling his way and that we may see this book as the precursor to what then became his life's work, writing of the European peasant and his vanishing world. Without his thinking hard about Sassell and his community, I find it difficult to see that he would have picked up that cause.

But the most interesting point to be made is that both individual doctors and the medical establishment at large still place such great weight upon it. The faint praise waved in its direction by the ordinary reader, as represented on Goodreads, is incredibly different from the place it holds in medical literature.

Professor Roger Jones, in 2015 as editor of the British Journal of General Practice wrote that 'First published in 1967, this is one of those must-read general practice books, essential for every trainer, trainee and practice library, and one, I suspect, which has been more frequently recommended than read.' The review starts out in rather uncomplimentary terms, but grudgingly ends:

However, re-reading it at one sitting very recently, I recognised the limpid beauty of some of Berger’s prose, the subtlety of his descriptions of nature and of human interactions,  and his insights into the needs of ordinary people faced with illness, anguish and loss. His – or is it Sassall’s? – understanding of the role of the general practitioner as a witness and a “clerk of record”, needs to be widely understood, and never more so in these days of therapeutic miracles and performance indicators, when the unmeasurable essence of patient care can so easily be overlooked.

In my opinion, Jones, like lots of others, doesn't understand that Berger is not painting Sassell as a saint, far from it. He is clearly concerned that Sassell is a human being trying to do things that are humanly not possible. And it is made obvious in the text that the 'Fortunate' of the title is not a positive thing. Rather, it is the cause of the doctor's undoing. I don't see at any point during the book anything but concern from Berger. Nobody could read this book and be surprised that its subject killed himself.

In 2005, on the occasion of a general celebration of Berger's work, a special session on A Fortunate Man was held.  Leading up to it,  Dr Gene Feder said that it was '...still the most important book about general practice ever written.'

The plug for it continued:

Speakers will include Iona Heath, Tony Calland (who was a partner in John Sassall's practice), Patrick Hutt (a recently qualified doctor and author of Confronting an III Society), Jane Simpson (junior doctor), Michael Rosen (broadcaster and writer) and Sukhdev Sandu (critic and writer). They will talk about what the book means to them and what it still has to tell us almost four decades after it was first published.

In 2009, in a post by Dr Peter Kramer, he comments not only on how influential this book was on his own determination to become a doctor, but quotes Iona Heath  "If I could choose only one book on the planet, it would be this book." She said it on the occasion of the 2005 event at which a reissue of the book was launched.

On the evening of 26 April 2005, nearly forty years after its publication, and as part of a short London season of events based around the work of John Berger, over 200 people, many of them doctors, packed into one of the lecture theatres at Queen Mary College, London, to testify to one extraordinary book which had shaped their lives and political beliefs. The event was sponsored by the Royal College of General Practitioners, who have just republished it.

Professor Ken Worpole, later commented in his report of the event that 'Rereading A Fortunate Man I was astonished to realise that I had absorbed many of the passages in it by heart and have paraphrased them as my own thoughts and insights over the past forty years, forgetful of their origins in this remarkable work.' His report continues

more here: https://alittleteaalittlechat.wordpre...

[Claire Fuller · Rating 3 out of 5]

I would have given five stars if this had been mostly about the photographs (which are superb), and I would have given five stars if this had been mostly about the case studies - both these elements were wonderful. I was also really interested in how Berger saw Sassall's relationship with his patients, how he felt he needed to imagine what it was like to be them, to almost become them, and also the essay on anguish and how it takes us back to childhood.

I understand that all books are a product of the time they're written in, but the first problem for me was how male-centric Berger makes this book, and somehow I wouldn't have expected it of him. When Sassall's patients are discussed as a group they are the foresters - literally those who work with the trees in that part of the world, and male. (The female patients are sometimes mentioned in passing: unmarried girls who come to him when pregnant, women giving birth.) And when Berger compares doctoring with other professions, an artist for example, his examples are male. I simply tired of this after a while.

And secondly I had a bit of an issue with how Berger describes Sassall as so unique and important in the way he goes about his work (perhaps true), but in comparison to an 'average' patient, who 'expects to maintain what he has - job, family home.' I don't believe there was or is an average patient, and I don't believe that there weren't numerous 'foresters' who didn't aspire for something more.

www.clairefuller.co.uk

[Elena Sala · Rating 4 out of 5]

A FORTUNATE MAN: THE STORY OF A COUNTRY DOCTOR (1967) is still a relevant book although it has been published about fifty years ago. In fact, it might be even more relevant now than when it was first published because this book is, among other things, a meditation on the value we assign to each human life.

Dr John Sassall was an English country doctor. He worked in an impoverished rural community and cared for the sick, the dying, the lonely. In 1966 John Berger and photographer Jean Mohr spent a few months in the Forest of Dean following this exceptional professional.

Berger thought Sassall was a fortunate man because his work kept him busy and fulfilled him. His patients were fortunate too: Sassall was a selfless individual who worked long hours, studied ceaselessly and cared deeply about his patients. He listened to them with empathy for he thought that a "patient should be treated as a total personality.... illness is frequently a form of expression rather than a surrender to natural hazards."

Berger's prose is reflective, observational and attentive to detail. His admiring gaze describes Sassall as a stoic, intense and modest individual who suffered from occasional bouts of depression caused by the "suffering of his patients and his own sense of inadequacy". An Afterword written thirty years after the book was written shocks the reader with the information that Sassall had committed suicide.

A FORTUNATE MAN is a moving, exquisite biography of a remarkable individual as well as a tribute to a way of practising medicine that has (almost?) disappeared.

[Argos · Rating 5 out of 5]

John Berger’in müthiş kalemi Jean Mohr’un siyah-beyaz fotoğraflarıyla desteklenince ortaya bu foroğraflı deneme çıkmış. İngiltere kırsalında 25 yıldan beri köy hekimliği yapan ve kitabın yazıldığı 1967’de hala çalışmakta olan bir doktordan da fazlası olan Dr Sassall hakkında yazılmış bir deneme.

Dr Sassall her ne kadar tıbbın sanat olmadığını bilim olduğunu söylese de yaptığı hekimlik tıbbın sanatsal uygulamasıdır. Empati yapar, dinler, çalışır, yılmaz, gözler, düşünür, sorgular, kısaca hekimliğini iyi yapar. Bu davranış biçimiyle yaptığı hekimlik köylülerin kendisine hayranlık duymalarına neden olmuştur. Onun düşünme şekline, bu geri kalmış yörede kendileriyle birlikte kalma tercihine hayrandırlar.

Bu denemede Dr Sassall’ın hayatının psikolojik gerçekliğini geniş bir şekilde ortaya koymuştur J. Berger. Kitabın son üçte biri tamamen felsefik bir metin. Sartre’ın “Bulantı” romanından alıntılarla felsefik deneme yapmış yazar, yoğun ve derinlikli bir bölüm. Dr Sassall’ı zaman zaman depresyona sokan nedenler, yani kendi içindeki yetersizlik duygusu ve hastaların ıstırapları karşısında zayıf kalması konusunda kendisiyle yüzleşmesi irdelenmiş bu bölümde.

İdealini büyük ölçüde gerçekleştiren Dr Sassall ve hastaları konusundaki bu kitabı hekim veya sağlık çalışanı iseniz mutlaka çok seversiniz, değilseniz de ilgi çekici ve düşündürücü bulabilirsiniz. John Berger okuması yapacaksanız bu spesifik kitabı en sonlara kaydırmanızı öneririm.
( Not: benim beğeni notum hekim olmamdan kaynaklanmıştır. )

[Jonathan · Rating 4 out of 5]

A little dated, of course, and a few problematic passages because of that, but generally rather beautiful

[Michael Perkins · Rating 3 out of 5]

Originally I took up this book because I thought there might be some interesting parallels to the first half of my father's career as a small town doctor in New Hampshire. But I soon noticed that the book involved a good deal of philosophizing by the writer.

Background research revealed a lot of omissions from this story. One was the arbitrary exclusion of the doctor's family from the book by the author. But the doctor's wife ran his practice and was his chief emotional support.

Another key omission was that the doctor was manic-depressive. The book was published in 1967. The doctor's wife suddenly died in 1981. A year after that, the doctor shot himself.

In the book the author uses a pseudonym, John Sassall. His real name was Dr. John Eskell. Here is his obituary....

http://europepmc.org/backend/ptpmcren...

[SilviaG · Rating 3 out of 5]

En este libro, el autor nos habla de la actividad profesional del doctor John Sassall en una comunidad rural inglesa.

Durante un tiempo, él y el fotógrafo John Berger, acompañaron a este médico en su dia a dia. Vieron con sus propios ojos como interactuaba con sus pacientes, como los trataba y cual era la relación con ellos. En definitiva, que era lo distintivo en su modo de actuar que lo convertía en tan buen médico.

Este seguimiento y la convivencia con él, dieron como resultado las reflexiones y meditaciones del escritor sobre esta profesión, que también están recogidas en el libro.

Por último, las increíbles fotografías de Jean Mohr acompañan el texto, y nos hablan desde los momentos capturados en ellas.

[Chanel Earl · Rating 5 out of 5]

This little piece of non-fiction is stunning. It describes the life of a doctor in rural England and his interaction with his patients. It isn't very traditional. There are several short stories, or even flash-length pieces in there, and the whole book is illustrated with actual photos.

Philosophically, it discusses what it means to be a doctor and to share such intimate secrets with your patients, what it means to heal and what it means to belong to a community.

I think I want to reread this book.

[Steven R. Kraaijeveld · Rating 4 out of 5]

"What is the value of a moment?" (134)

Through John Berger's descriptions and Jean Mohr's photographs, we become acquainted in A Fortunate Man with the life and outlook of country doctor John Sassall. Or do we really? Berger describes the lone English county GP as the latter makes his rounds, talking to the patients for whom he is responsible in a way that few modern doctors are—he is not just their doctor, curing their ailments, alleviating discomforts (physical and mental), and witnessing their deaths, but he is also a clerk of their records. He is an intellectual, aspiring to the universal, amidst the relatively impoverished foresters that make up most of his patients. He has come to empathize with his patients to the point of nearly assuming their being. He consequently (is it a causal connection?) goes through spells of depression that last from one to three months. Through it all, questions are raised about the value of what Sassall is doing, to the value of the doctor.

"Then let us ask: What is the social value of a pain eased? What is the value of a life saved?" (165)

To answer the question of a doctor's value, we need to know the value of life. And this, of course, is elusive (for Berger, it is inextricably tied to social structures—to the totality of human relations). Where does that leave us? It doesn't leave us with anything concrete; Berger is unable or unwilling to conclude his essay. This is not so strange. After all, there is no conclusion to life—it goes on. Why should Sassal's life be concluded? When Berger wrote about him, he hadn't died yet.

It is a shame that Sassall's wife wasn't given more attention. The lone doctor could not have been so alone; his wife must have been a source of support when he came home empty after his experiences of the day. I can't help but feel that something meaningful—their relationship—was omitted. Berger's footnote on the subject is not convincing ("I do not attempt in this essay to discuss the role of Sassal's wife and family. My concern is his professional life."). The fact that, after his wife died, Sassall left his practice, travelled for some time in China, and ultimately killed himself, suggests to me that she represented something solid in his life. Aren't the ones we love and share our lives with as integral to our existences as our patients and aspirations toward universal learning and depressions and anything else whose value we might explore?

Be that as it may, there is much to reflect on in this relatively short but evocative book (which, incidentally, contains one of the most impressive afterwords I have ever encountered). The title is to be taken with irony.

"Like an artist or anybody else who believes that his work justifies his life, Sassall—by our society's miserable standards—is a fortunate man." (148)

[ursullla · Rating 4 out of 5]

John Berger, bize Sassall adındaki bir köy doktorunu anlatıyor. Onun köydeki insanlarla olan iletişimini anlatıyor, hem insan olarak hem de bir doktor olarak. Doktorların insan yönünü anlatıyor. Sassall sadece hastalarını iyileştirmiyor, aynı zamanda onların hayatına tanıklık ediyor. Ölüme, doğuma, hastalıklara tanıklık ediyor. Adeta ölümle diğer insanlar arasında bir aracı oluyor. Kimi zaman hastalarına karşı yetersiz hissediyor, depresyona giriyor. Bu bazen onları tedavi edememekten kaynaklansa da bazen de onların içinde bulunduğu şartları hak edip etmediğiyle ilgili oluyor. Kitapta bunun gibi sayfalarca psikolojik analizler, felsefi yazılar var. Psikolojik ve felsefi denemeleri sevenler okuyabilir.
.
Bu incelemeyi tam 4 sene önce yazmışım, tıp fakültesi 1.sınıftayken. Şimdi hiç değiştirmeden buraya ekliyorum. Kitabı bir ders için okumuştum galiba, ama beğenmiştim gerçekten. Kitapta Sartre'den yapılan alıntıları görünce çok sevindiğimi hatırlıyorum.
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[Evan · Rating 2 out of 5]

Of course, it's never an easy thing for a book to live up to the hype. Quite another thing, though, for the hype to be so very incomprehensible. Perhaps it's time: what's revealed a half century after its first publication is a compendium of trite cod philosophy, a model of practice that was outdated by the time it was set down on paper, and some nice photos.

In some ways, the irksome, even dangerous model of practice Berger evangelises is the least objectionable aspect. There's little to celebrate about it, but perhaps that's so transparent it's fairly harmless. Paternalistic doesn't begin to cover it. That's not to blame John Sassall, the titular Fortunate Man, who fades so thoroughly into the background as to become little more than a cipher for Berger's idealising of rural General Practice. So, we're told, Sassall "can argue that the [community members] are in some respects fortunate compared to the majority of people in the world," but is "forced to acknowledge that, by his own standards, they are having to settle for fifth best." Their wellbeing has value only on the basis of the judgement of the educated professional. "He is trusted, almost without question," says Berger at one point – a point of approval rather than critique.

Worse, though, is the daft combination of faux insights and opaque philosophy. On one particularly memorable occasion, Berger believes reads a world into "the difference between [Sassall's] two eyes": "his right eye knows what to expect...his left eye scarcely ever ceases considering the distant evidence and searching." This stretches credulity beyond poetic imagination, and well into comedy territory. It is not the only time.

Beyond laughs, though, is the long middle section which comprises Berger's musings on Sassall's motivations, his relationship with his patients and, in turn, on their hopes and desires. Whatever one thinks of the ideological and theoretical turn of the sixties, and of the dense writings of the like of Barthes, Derrida and Sartre, at the very least the clarity of their thought is thrown into relief by this. It's schoolboy aping of their dense lines of argument. Unfounded statements are the order of the day – so much so that the odd provable assertion – for instance, that depression may have clinical as well as social determinants – slips by unnoticed and unevidenced. A particular delight is the cod-Jungian section which demonstrates, by leaps of faith, that illness and suffering marks a psychological return to childhood in the uneducated. He comes back to this later to 'show' that this explains the community members' "extravagant expectation of fraternal recognition". Later, this infantile simplicity of a community who "expects...little of life" is used as a foil to a doctor who "expects the maximum from life". Queue a digression into the idea of the "universal man'. Like a mansion without foundations, this these grandiloquent words cannot support the weight of their lofty intentions.

Jean Mohr's photos are the saving grace here. Thoughtful, light-touch and ambiguous in a way that none of the text is.

[Wendy Greenberg · Rating 2 out of 5]

This is an essay. It is described as such and it follows the course, in a rather laboured way, to me. Perhaps I had expected more of an insight on the all-consuming working life of a rural doctor in the 1960 and so, was disappointed. (first published 1967)

I found that the photographs spoke more to me than the text. They brought alive the reality of society and its healthcare, twenty years after the introduction of the NHS. The writing seemed to be Berger's views overlaying his observations - assumptions over interrogation. The constant references to Conrad, Sartre, Goethe and ancient medical scientists et al detracted from rather than enhanced his subject as they were drawn from his academic disposition.

For me, the most interesting element of Sassall (the country doctor) was his "depressions". We really learn nothing about the state of mind of a man serving his community around the clock and who ultimately kills himself. Statistics today record amongst the highest cases of depression and suicide to be amongst GPs and, of course with the benefit of hindsight, we can see that this should have been on the radar for far longer than it has been.

My criticisms of course come from a period when we have more access to professional lives from memoir and open broadcasts and perhaps this was an early example of peeling back a medical life using evidence and scholarly references. That said The Citadel by AJ Cronin (1937) and Dr Finlay's Casebook (first broadcast 1962) stand the test of scrutiny of rural medics, for a lay reader better than Berger's forensic sociological essay.

I found the ending where Berger scrabbles around for his conclusions, rather bizarre. This is a life being lived that will evolve not Berger's divergent thoughts on conclusions. Surely, if this essay format is being so dutifully followed, the conclusions should be what has been learned from looking at this man, this profession.

[Sophy H · Rating 2 out of 5]

After reading A Fortunate Woman: A Country Doctor's Story, I was drawn to reading this, the original inspiration for Morland's work.

Though the two books follow a similar format, the writing styles are very very different. I really liked how Morland interspersed the GP's work cases with descriptions of the landscape, a look at the community and discussing emerging changes in health care. Berger's work is a lot broader and deeply philosophical, almost to the point of leaving GP "Sassall" behind. Berger appears to get carried away at times with moral, ethical and philosophical quandaries that he feels unable to answer. The text, unlike Morland's also feels patronising at times; the area of the forest is described as backwards and women are referred to by their bust to waist to hip measurements or their physical appearance!

Sassall the GP is examined in a deep, probing manner, with Berger really trying to get behind the psyche of the man. I'm not sure that this works really.

Overall an interesting book, but one that is very very different from Morland's more recent work on a GP working in the same practice in the same area. I think for me, modern wins out. This account by Berger is good, but there seems to be a sweeping generalisation about the text that doesn't sit quite right. The photographs again though are stunning and add immensely to the text.

[Hilary · Rating 1 out of 5]

*Spoiler Alert*

The title of this book is somewhat misleading and I only wish I had read some reviews of it before buying it. The newspaper article which prompted me to get it suggested that this was an account of the life of a country GP in a sole practice in 1960s Britain. Unfortunately only the first section describes his work, his patients, and his role in the community.

It then becomes a philosophical essay analysing what makes the subject, John Sassall a "good doctor" in the opinion of his patients. The language is turgid and at times so impenetrable that I struggled to get to the end of a sentence. Nowhere, interestingly, does it talk about his home life (it transpires he had a wife and children who are not mentioned) and this is an almost totally male world with the exception of a few female patients - usually portrayed as passive and ignorant.

Despite the title "A Fortunate Man" we learn from the Afterword that Sassall took his own life shortly after the death of his wife. Clearly she played a far more important part in his life than Berger gave her credit for in totally omitting her existence.

I could forgive that if he had only written a book that reflected his title and gave us a rounded picture of the life of a country GP at that time instead of a philosophical treatise on the author's view of the man behind the role - an endeavour in which he appears to have failed dismally.

[The Reading Bibliophile · Rating 3 out of 5]

Too much self-centric rambling and not enough about the doctor and his patients. A missed opportunity even though the photography does them some justice.

[Carolina · Rating 5 out of 5]

¿Cuál es el valor de un momento? ¿Y de una vida?

"Es como si el tiempo se transformara en el equivalente del mar de Conrad, y la enfermedad en el equivalente de las condiciones meteorológicas. Es el tiempo, el
paso del tiempo, el que puede prometer 'la paz de Dios' y el que puede azotar y destruir con una furia inimaginable"

Me parece, de corazón, que estamos perdiendo mucho como sociedad, o al menos los médicos, no estudiándonos este pedazo de ensayo. Empieza con historias breves, instantes efímeros pero inmortales de una cotidianidad sencilla, quizás injusta, y termina desarrollándose un texto que abarca lo que es inabarcable con palabras (y mágicamente, se acerca), siguiendo la vida de un médico rural: la angustia; el privilegio de la sutileza y la condena del desasosiego; la infancia y su eternidad diaria; la identidad junto a la pertenencia; la percepción de uno mismo y la vivencia según las condiciones que nos han tocado.

Pero, sobre todo, toca un tema que es muy actual. La hipocresía inconsciente (aunque, a veces, incómodamente consciente) a la que nos sometemos buscando el máximo: ese ideal de hombre universal de Goethe, que sólo puede ocurrir "gracias a" darnos cuenta de la diferencia que hay entre el que especula sobre si el que tiene delante podría y/o debería vivir mejor, si bien esa persona no dedica sus momentos a reflexionarlo. Los límites del paternalismo, de la ayuda, del compromiso de involucrarse sin modificar los objetivos mínimos, tan distintos a los de uno.

"¿Merecen las vidas que tienen, o merecen una vida mejor? Y habrá de responderse, al margen de lo que ellos mismos responderían: se merecen una vida mejor. Se verá obligado a reconocer entonces que lo que puede hacer, si se tiene en cuenta al conjunto de la comunidad, es absurdamente insuficiente. Y habrá de admitir que lo que se debería hacer está fuera de su esfera profesional y de su capacidad individual. Al mismo tiempo, sin embargo, habrá de
enfrentarse al hecho de que él necesita esta situación tal como es; de que, hasta cierto punto, la ha escogido. Es precisamente en virtud del atraso socioeconómico y cultural de la comarca por lo que puede ejercer la medicina en la forma en la que lo hace.
El atraso le permite seguir la evolución de los casos en todas sus fases; le da el poder de la hegemonía de la que goza; le anima a convertirse en la conciencia de la comarca; le proporciona unas condiciones favorables para lograr una relación fraternal, con sus pacientes; le permite establecer prácticamente en sus propios términos la imagen de la profesión. La situación se puede describir de una forma más burda: Sassall puede esforzarse por alcanzar un universal precisamente porque sus pacientes carecen de privilegios".

Finalmente, llegamos al absurdismo. Es difícil ser humano, y más cuando lidiamos con la náusea de la conciencia propia y ajena. Es complicado compaginar la ternura del cuidado con los demonios de la obsesión por el trabajo en el que proyectamos nuestras propias condenas. "Pero si en ese momento está buscando inconscientemente una justificación para deprimirse, no tardará en dejarse aplastar por la contradicción existente entre su sensibilidad extrema y la vida carente de todo privilegio de los pacientes que ha escogido".

"En la imaginación humana, la muerte y el paso del tiempo están indisolublemente
unidos: cada momento que pasa nos acerca a la muerte; nuestra muerte se mide, si es que es posible medirla, en relación con esa aparente eternidad de la existencia que ha de continuar después de nosotros, sin nosotros (...) Pero la confrontación con la angustia es aún más importante. Los angustiados están atrapados en un momento engendrado por todo lo que les ha
sucedido. Enfrentados a la rígida irreversibilidad de los acontecimientos, tan terrible para quienes no están preparados-y nadie está completamente preparado- Su
experiencia se curva para formar un círculo: incapaces de atrapar el tiempo por la cola, persiguen el suyo propio, girando ciegamente en un solo momento que abarca toda su vida. ¿Cuánto puede contener, pues, un momento?"

[Cat Pierro · Rating 4 out of 5]

This is a wonderful little book and a genre I haven't yet seen. First published in 1967. A writer and a photographer shadowed the writer's friend, an exceptional doctor, as he made visits to patients in his small town in England. The first third consists of sketches of individual cases they witnessed, and the rest covers wide-ranging philosophical/psychological reflections on what these patients get from their doctor, what this doctor gets from his patients, and the effect of the class difference between them.

This is the first thing I've read by John Berger. I am walking away with the impression that he's a man who's interested in themes: keywords like service, recognition, fraternity, common-sense, cultural deprivation, and the irreversibility of time are elaborated and continually revisited. It is not a work of scholarship; rigor is not a priority for Berger; but often he has good things to say. He certainly has a good eye for specific impressions. I'll quote a couple of my favorite parts, so that you can judge for yourself whether to read it.

"There is another reason why they [the patients] sense that Sasall's [the doctor's] way of thinking is a privilege. [...] He confesses to fear without the least fear. He finds all impulses natural--or understandable. He remembers what it is like to be a child. He has no respect for any title as such. He can enter into other people's dreams or nightmares. He can lose his temper and then talk about the true reasons, as opposed to the excuse, for why he did so. His ability to do such things connects him with aspects of experience which have to be either ignored or denied by common-sense. Thus his 'license' challenges the prisoner in every one of his listeners. [...] The attitude of the villagers and foresters to Sasall's privilege is complex. He has got a good brain, they say, why, with a brain like this--and then, remembering that he belongs to them, they realize that his choice of their remote country practice again implies a kind of privilege: the privilege of his indifference to success. But now his privilege becomes to some extent their privilege..."

"A man or a woman who is sobbing reminds one of a child, but in the most disturbing way. This is partly because of the particular social convention which discourages adults (and particularly men) from breaking into tears but permits children to do so. Yet this is by no means the whole explanation. There is a physical resemblance between a sobbing figure and a child. The 'bearing' of the adult falls away and his movements are limited to certain very primitive ones. The center of the body once again seems to be the mouth: as though the mouth were simultaneously the place of pain and the only way by which consolation might be taken in. There is a loss of control of the hands which again can only clench or paw. The whole body tends towards a foetal position..."

[Stuart Aken · Rating 4 out of 5]

I came to this extraordinary piece of writing via an unusual route. The village hall hosted a short dramatic presentation by ‘New Perspectives’ introducing the book using visual aids, a soundtrack and the skills of two actors to explain how the book came into being. Although that drama was flawed, it was also moving, and it piqued my curiosity, so I ordered a copy of the book. I’m glad I did.
I read the work in a hotel room, during a thunder storm, while waiting to attend a family event.
Superficially, this is the story of a real doctor during the early years of the UK’s excellent National Health Service, and his relationships with his rural list of patients. The book is illustrated with atmospheric black and white photographs of the location (the Forest of Dean in Gloucestershire, England) and of the doctor and his patients. Insightful and honest, these unposed pictures capture the realities.
But this is so much more than the mere story of an honest, compassionate, quick-tempered, passionate and deeply caring man. The author gets under the skin of the times (the tale begins in the 1950s), dissects the social and cultural poverty of the area, and cuts deep into what it is to be human being charged with the medical and psychological care of an isolated rural community.
There is philosophy here, history, an impassioned exploration of the inequalities of society, and a celebration of the life of a unique individual. Moving, entertaining, stimulating and thought-provoking, this is a powerful read from the pen of a gifted and superbly observant writer, augmented by a collection of silent images that capture life as it happens.
Considered a meditation on the role of a doctor, it is still widely read by healthcare practitioners today. And it remains a thoroughly good read.

[Rosie Kirk · Rating 5 out of 5]

I’ve never read anything quite like this before; Berger’s style is simultaneously conversational and full of depth, and his essay structure is a joy. His observations are so astute and he elegantly verbalises concepts that I’ve thought about a lot but never been able to enunciate, particularly regarding the fraternal intimacy of medicine, the need to recognise patients, and the role of the doctor in suffering.

My main criticism would be of the sometimes male-centric approach and the occasional overly detailed descriptions of women’s bodies (ah the 60s).

A number of doctors have recommended this book to me, people who meet the book’s description of a “good doctor”, and like them I think it’s a book I’ll revisit a lot in my career.

[Jo · Rating 4 out of 5]

Recommended reading for all GPs and GP trainers and trainees. Not only a n honest insight into being a GP, John Berger's speculation about the philosophy of care and underlying motivations about work ethic deserve discussion.
Is Dr Sewell as a solo GP with a high degree of procedural as well as psychological medicine living and working in his practice community an anachronism or the doctor of the future he asks and prophetically speculates from 1967 that computers will one day make better diagnoses than doctors, but sees that even in that future age nothing will substitute another person, a GP, being with people helping them to bear, understand, or simply experience their suffering.

[Maria · Rating 3 out of 5]

Interesante experimento, sobre todo la primera parte en que habla de los casos de un doctor rural en Inglaterra en los sesenta. Después el libro es una mezcla rara entre biografía y ensayo sobre la agridulce satisfacción del trabajo bien hecho y las vidas del los pacientes. me ha gustado pero me ha aburrido bastante

[Eric · Rating 4 out of 5]

The 20th century fostered two major writers whose concerns regularly, if not routinely, returned to the subject of western European peasantry.

Jean Giono is one; John Berger is the other.

While Giono genuinely grew up in rural Provence, Berger is natively a burgher of grand old Londinium.

Certainly Berger writes deftly here and elsewhere upon the subjects of poor people, culture, and community, but he is a very different kind of writer than Giono. With Berger, with this subject, there is always the slightest sensation of a compensatory thrust....

On the face of it, the purpose of A Fortunate Man is to give narrative to the three months the author spent shadowing one Dr. John Sassall -- keeping abreast of this small, industrious man who quixotically and compassionately endeavored to single-handedly serve some 2,000 members of a rural English backwater. Deemed fortunate because he possessed the opportunities necessary to leading the life he wanted to live, this was the sort of doctor who lay down to sleep each night with the vague hope that an urgent house-call would rouse him from his bed and back out into the field of work.

And we do get to follow him about a good bit.

However, the majority of the text is tied up in a series of interconnected sociological and philosophical takings to task. Berger asks questions such as, "What makes a doctor a good doctor?" and "How does Sassall's life story square with the concerns of his generation?" Berger makes sound arguments for driving his readers toward the belief that he believes Sassall believes what he himself (Sassall) believes. That isn't to say that Berger's purpose finds expression in judgment of his protagonist. But one gradually begins to question whether it is entirely accurate to consider Sassall a protagonist at all, or purely that, at any rate.

And ultimately it becomes more and more clear that, as Berger analyzes Sassall, Berger is in fact analyzing Berger. The parallels are never stated as such, but history tells us that Berger exiled himself from England to put down permanent roots in a tiny French village some three years before he wrote this work. In other words, as Berger dilates upon the complexities inherent in the forging of meaningful relationships between an extremely literate, highly educated Sassall and his depressed, impoverished patients, he is either drawing upon his own fresh experience in bringing about much the same ends, or else (and this seems more likely) shadowing this isolated man with more of a blended motive than initially suspected -- that is, as a kind of Master Class in entering into the fold.

Fans of Berger tend to know the older man -- gray, lined, sixty and above -- who's so entrenched in, so naturally a member of the ancient ways permitting his Alpine refuge to persist that even the son he's sired there is almost more of a medieval farmer than an artist (though certainly he's both).

The final pages of A Fortunate Man are strangely prescient, if not accessory to crime. Berger isn't sure how to draw his book to a close, and he lets you know. He considers the fact that the writing of lives comes most easily when the subject is dead. The facts about the man, woman, or child are more or less fixed. The writer is, after all, and always has been a kind of secretary of Death, attending to the spoils of expired lives, that is, lives that are in a position to be manipulated and framed. So, Berger wonders, how to end this work which takes as its focus a man who is still among us, still practicing medicine? How to bring resolution to something so irresolute as a living, breathing man?

"He cures others to cure himself," Berger writes, pursuing (from one angle) the doctor's clinical depression -- hinting at an event that must, in retrospect, assume the mantle of inevitability. And so, at some point in the years following the book's publication -- and this detail has never made it into an afterword or postscript -- Dr. John Sassall took his own life.

Lastly, I don't want to skip over an appreciation for Jean Mohr's astounding photos. They're scattered throughout the text and serve less as accompaniment than as vital information, as instructive, incisive, and insightful as anything that Berger writes.

P.S. Because I'm a slave to the star system here, my mind makes sentences like, "I wanted to give this book five stars but I'm choosing four." So I gave it 4. As I've mentioned in another review, Berger is best when least abstract; there was a little bit too much of his trademark synthesizing of the works, however relevant, of other intellectuals in the fields of sociology, philosophy, economics, politics, etc. -- and not enough of the absolutely picture-perfect fieldwork observations.

[Annie Bose]

{notes on how i feel about Berger's writing after having read this book:}

“Landscapes can be deceptive. Sometimes a landscape seems to be a setting for the life of its inhabitants than a curtain behind which their struggles, achievements and accidents take place.”

Rarely, there comes a writer who identifies such a curtain camouflaged within the chaos of life. Even more rarely, upon identification, a writer lifts this curtain and takes a peek and communes this secret for his or her readers without subtlety or pretensions, but with restraint and nuance. One such writer, in particular, is Berger. The lines quoted are the opening lines of “A Fortunate Man”. Every time I read him, I feel I have been falsely accused of being an idealist in the past.

Berger champions a longing and rooting for sincerity, which is what he situates the human condition in and the means to improve this condition he suggests is through an understanding birthed of empathy. I started this review on a positive note because I like Berger and the hopes he expresses are mine too. However, I have some frustrations that have only recently began to unravel after having read a few of his books for comparison and I want to see if these opinions change with time.

I think he could’ve done better with this book. Perhaps a mistake I made was reading the Foreword before starting the actual text, which revealed to me the motivations behind writing the book and thereafter every omission or assumption seemed to me to be criminal. This is my fault though. I went in with too many expectations in an emotionally charged state and to avoid the limitations that arise from going in with that many expectations, I’ve reread the book a few times now but I don’t know how much that has helped me interpret the book without being biased. It is dangerous to start reading a book with expectations. It makes you miss out on a lot of what is being said and you end up having to re-read the book a bunch of times to pick up on what the book/writer/publisher had intended for you to pick up on and now no matter how many times I read the book, I feel I’ve missed something.

Berger possesses the ability to express himself and convey empathy unlike few other writers I have come across. He does not stir turmoil, but he whispers realisations in a reflective style. This is, according to me, a limitation in Berger’s writing-it does not address anger or feelings of resentment or bitterness, a whole range of emotionally charged experiences that inevitably come along with a lot of the psychological and social conditions he writes about. His language assumes an infallible human experience, one that does not account for impatience, urgency, hopelessness and despair (the latter two I find that he unhelpfully infantilises too much and writes about through an adult/child binary).

Another thing I am not particularly ecstatic about-Berger writes about a woman’s endurance in relation to her physical being. What her interior world is, his meditations leave out (he does not even speculate like he does with other things). At best, he interprets their actions only in the form of stereotypical social roles and behaviours, when he is not omitting them entirely (he’s entirely left our Sassall’s wife from the book, not even a singular mention).

My problem with Berger is that through him I get a man’s perception of a ‘unique’ sense of beauty and vitality in each 'woman' (and not 'man'). A lot of it has to do with her body, but her interiors are unknown. He speaks and writes of a man’s perspective too but brings me no closer to the particularity of particular men (he does try in G., but even then this particularity of his protagonist was limited to the stereotype of the rake and the adult/infant binary). The men he chooses to focus on, he writes elaborately about, but leaves out the women from the purview of the influence they may have (not limited to the influence/meanings their bodies signify), and when he does talk about women, it is in relation to the vitality their physical beauty/appearance signifies.

Another thing: Berger writes about private matters not oft discussed in the mainstream, but these are abstract notions about the private he will ruminate over (loneliness, alienation, sex, peasant etc.) but he stops there. His intention is to (socially) identify an entity, define its limits and explore the contents within in depth. Some of these entities are unconventional and this becomes the instrument used to expose the limitations of the status quo. He writes about some very vulnerable aspects about the human experience. He writes with tenderness and empathy, he writes conscientiously about pain and pleasure, the country, childhood, sex, grief, life, duty etc. He fails to include possibilities or love, forgiveness or patience (although he writes about endurance, but they are not the same). Sassall is painted as Conrad’s protagonist, a Doctor in search of the universal Ideal, not as a man in real time who was more than a doctor. He was a husband, a friend, a student, a man, a person. Berger moves towards universal definitions and this is where I find a rupture in my understanding of anyone who speaks of a Universal or an Ideal. How can one attain all these Ideals or even arrive at an understanding of a universal when we cannot envision, let alone enforce it for ourselves, on a daily basis? Sassall is supposed to be an example of an exception, but his exceptionality is emphasised on through a vignette, with a focus on the social role of his pursuits and those who interact with these pursuits, with other factors that influenced the person who chose to become this doctor blackened or blurred out. Berger’s motive for the ‘country doctor’ is evident-he wants to talk about the uniqueness of one individual and build him up as the Universal Man, but at what cost and what negligence? How does one remember the life of a loved one and erase the lives of those closest to him? Those who were directly related to and even to some extent responsible for the material and emotional well-being of Sassall? And now this is what remains of Sassall’s life-not the person, but the doctor, a protagonist the modern world would like to fantasise about amidst their real time dissatisfaction of present day medical institutions. The John Sassall we meet in “A Fortunate Man” is a protagonist, a legend.

As much as I would love to believe that a kind of perfect understanding can be attained about pain, love, power, loneliness, beauty, no matter how secure it might make me feel, it isn’t realistic. Not unless one has attained a comfortable distance in detaching themselves from the Thing-Under-In(tro)spection.

The ‘worth’ of any moment is right there in that moment, for all to consider. Our myopia comes from our unwillingness to see what’s beyond the purview of our use for it. What is the ‘worth’ of this moment? What is the worth of the ‘worth’ of this moment for me?–Berger inches you closer to contemplating the difference between these two questions. His writing offers you a ticket-for-two on a journey to understand things outside of oneself. But like us all, Berger is human too. My frustration with him is with what he fails to notice, not in the things he already has. Which is why this text would be incomplete without Mohr’s photos.

It /is/ comforting to read Berger. But I am torn between feeling validated and invalidated. Infantilised, when it is the adult world that is more infantile. Berger is quite articulate about (some) abstractions and social institutions (and the roles they engender), however I’m not sure he fully understands the difference in how different people respond to the same situation differently. I suspect that this might partly be because while he considers the social/private/political aspects of an individual’s/community’s perspective/perception, he doesn’t address the nuance within these socially understood invariabilities that go into a person’s makeup. He manages to locate privacy, but does he understand the personal?

How much of this essay inspires introspective reflection?
It's my turn to hold up this dialogue.

I hate the way I speak. I hate the way I write, it doesn’t come close to tying together what I think and feel. I need to read more and talk more to people who haven’t written books. I cannot deny that it feels fkn brilliant to read someone who at least writes with some clarity and learn from him. But peeking through the curtain only gets you a perspective from the outside. Berger is a storyteller. He notices patterns in society that produce patterned effects. Berger (the writer) is not Sassall. Berger (the writer) puts the curtain down when he is satisfied of looking. I must keep looking for someone who doesn’t. I must keep looking.

[Keen Reader · Rating 3 out of 5]

3.5 Stars!

“What is the value of a life saved? How does the cure of a serious illness compare in value with one of the better poems of a minor poet? How does making a correct but extremely difficult diagnosis compare with painting a great canvas?”

This is a study which is as much about the patients as the doctor. I always enjoy works which manage to seek out the magic in the everyday, and the unassuming, especially when they amplify the banal and ordinary and make them seem extraordinary- even if only for a short while.

This has its flaws and I am not sure that the black and white photos hold up so well today (they seem to distort as much as they reveal). But Berger's character study is certainly compelling if not a tad over reaching at times. He gives us plenty to mull over and this was an enjoyable little read.

[nkp · Rating 5 out of 5]

Fantastic. I almost wish it was longer so I could’ve savored it more. I didn’t know what to expect going into it and I was very surprised at how many different ideas and emotions could be woven into a very short page count. The format is very creative, I wish more essays were structured like this. Berger is the only Brit that matters to me.

[José Miguel Tomasena · Rating 3 out of 5]

Una mezcla original de narración y ensayo etnográfico sobre un médico rural. La agudeza del punto de vista del observador es admirable.
Las especulaciones psicológicas sobre el médico, discutibles...

[Evelyn · Rating 2 out of 5]

A portrait in words and photographs of the life and practice of an English country doctor in the middle of the Twentieth Century. The book is at its best when describing the practice and presenting case studies. However, it becomes tedious when the essay descends into philosophical and speculative musings about the psychological underpinnings of the doctor’s practice, his motivations for undertaking it and his relationship with his patients.

It rates 2.5 stars.

[Emma · Rating 4 out of 5]

Oof. I mean, I genuinely respect Berger but the way he sees women is utterly alien and he barely considers us the same species as himself. I realise he wrote in a different time but for a guy credited with insight into how culture affects our ways of seeing, he doesn’t seem to have spotted his bias here. It makes a book about the humanity of a doctor a bit of a difficult read. When he talks about his female patients, he might as well be a vet.

[Margaret Haigh · Rating 1 out of 5]

This book was a real challenge to read. It came highly recommended and I thought it would be the story of a country doctor in the sixties, a bit like the James Herriot books. However, it was a philosophical essay on a particular doctor by a no doubt very learned writer whose style unfortunately made me want to give him a severe kicking.