Therapeutic Pessimism

The nineteenth century idea of “therapeutic pessimism,” that a doctor’s role was not always to heal or even to cure, but to comfort, is shocking to my twenty-first century sensibility of medical science. During the height of French hospital medicine, the poor came to hospitals for care and the hope of cure, but I wonder if they had a sense that they were coming to the hospital to die. The French doctors made huge advances in diagnosis, but Byrnum’s statement that French doctors like “Corvisart, Laennec, and other leaders of the French school were equally at home in the bedside and the morgue” (54) suggests that their progress in the knowledge of tissues and their diseases did not do much to help the patients themselves. Granted, my image of a modern physician as a sort of scientific warrior, perhaps not very personable, even acerbic, but determined to fight death in practically all situations, derives mostly from the media, from television shows like House. But even in my limited personal experience as a patient, my doctors have offered knowledgeable diagnoses and treatments; in the Victorian era, it seems they could only do the former.

In the later Victorian era, wealthier English patients were treated by their family doctors with more tenderness, perhaps, than their destitute French counterparts in Paris hospitals, but hardly more effectiveness. Calling a doctor almost seemed a means of marking a relative’s death rather than preventing it, and death must have been more familial, with a loved one passing away at home with family gathered around. Today, I think, we are more distanced from death, as Lewis Thomas writes in Lives of a Cell. A dying person is whisked away with flashing lights, blaring sirens, shouting, and perhaps the shocks of a defibrillator. Perhaps modern increased efficacy and scientific basis of medicine, then, has necessarily also made medicine more impersonal. One current popular image of medicine, in Hugh Laurie’s cold and analytical blue stare as Dr. House, certainly seems a long way from the Victorian house doctor.