Solomon Posen, MD
Good girls didn’t go to psychiatrists. Psychiatrists were people who testified in court on behalf of murderers or who nannied film stars. They were themselves charlatans, ratbags, sex-obsessed, evil and/or mad (Coombs 1990: 26).
Within three years of graduation some 5% of doctors emerging from British medical schools elect to become psychiatrists and most of these are still practicing psychiatry ten years later (Goldacre et al 2005). Several fictional medical heroes (c.f. Fitzgerald 1934; Segal 1988; Bellaman 1940; Bellaman and Bellaman 1948) and non-heroes (e.g. Frede 1960) decide on psychiatry as their first choice for valid (Frede 1960: 92) or invalid (Frede 1960: 198) indications. Nevertheless, of all medical specialists in fictional literature, psychiatrists are given the most negative treatment (c.f. Winick 1963; Walter 1991; Dudley 1994), with some authors participating in “shrink bashing” even though they are or were psychiatrists themselves (c.f. Hejinian 1974; Shem 1978). While a few fictional psychiatrists (e.g. Meehan 1964), particularly the historical Dr. William Rivers (c.f. Sassoon 1936; Barker 1991), and the flawed but sincere Dr. Thomas More (Percy 1987) are portrayed as compassionate and effective healers, the majority are shown as villains, lechers, sadists, acquisitive businessmen, or useless charlatans. Non-psychiatric doctors are also subjected to such accusations (Posen 2005), but not nearly to the same extent as psychiatrists, who are distrusted by the public and despised by other physicians.
The one-track mind
The medical “One Track Mind” syndrome1 affects a number of specialists and general practitioners (Posen 2005: 158), but it is exceptionally well developed among members of the psychiatric fraternity. For example, a twenty-eight-year-old musician who denies that he hates his father, is regarded as “uncooperative” (Ross 1963: 166). A journalist in her mid-twenties, who cannot accept that a child of four who remains with her deranged and abusive father is acting masochistically, is informed by her psychiatrist that she is “sabotaging the treatment” (MacIver 1961: 202-205). Another psychiatrist, whose office is in the Bronx, believes all psychiatric troubles stem from the sick, capitalistic, competitive American society, and advises his patients to work in factories (MacIver 1961: 92-95). Philip Roth’s Everyman, who has a chronic appendix abscess, is told by his psychiatrist that his malaise and loss of weight are due to the “deep seated envy” of a colleague who has just been promoted. “When circumstances proved him wrong, the analyst appeared unperturbed by his mistaken judgment” (Roth 2006:32-33). Dr. Hugo Spitz, convinced that his patient’s disabling vertigo is psychogenic in origin, makes the poor man get out of his wheelchair and walk to the hallway, where he falls to his death down a stairwell (Capek 1929: 177-183). Dr. Samuel Cozzens, the naval surgeon on The Last Ship, expresses a deep distrust of all matters pertaining to psychiatry and psychiatrists: “I have often wondered,” he declares to the captain, “which, psychiatry or religion, has done more damage” (Brinkley 1988: 34).
Alan Lightman’s psychiatrist, Dr. Ethan Kripke (Lightman 2000: 194-205), practices in a seedy residential part of Boston where, instead of a receptionist, he uses barefooted local urchins to direct the patients to his office. As Bill Chalmers, a new patient, arrives, windows are opened in adjacent houses, and curious neighbors look out to inspect the shrink’s latest customer. When Dr. Kripke emerges, he turns out to be a small, delicately featured man, wearing a bow tie (my emphasis). During the interview, accompanied by the recorded sound of a waterfall, the psychiatrist asks the standard questions about work-related frustrations, family, and sex. He concludes that Bill Chalmers (who has peripheral neuropathy due to an unidentified cause) is stressed and angry, and he prescribes Prozac (210-213).2
The medical literature, while describing the existence of anti-psychiatry prejudices among non-psychiatrists, says almost nothing about the influence (if any) of such prejudices on career choices in the real world. In a study by Lambert et al. (2006), 58% of medical graduates who abandoned psychiatry as a career agreed with the statement that psychiatry is “not sufficiently respected by doctors in other specialties” but only 15% gave that as a reason for changing careers (1-6).
A meaningless hocus pocus
Psychiatry [consists of] speculation, theories, wind. It has no application (Wilson 1966: 60).
The perception that the entire discipline of psychiatry represents a meaningless ritual goes back to the early days of the specialty and persists to this day. Eugene O’Neill’s Charles Marsden, a writer, whose young protégée, Nina Leeds, has not responded to standard therapy, is disenchanted with the disciples of Freud, their concepts, their methods and their jargon:
"A lot to answer for, Herr Freud! ... Punishment to fit his crimes, be forced to listen eternally ... while innumerable plain ones tell him dreams about snakes ... pah, what an easy cure-all! ... Sex, the philosopher's stone (O’Neill 1928: 34)."
Bennett Landsman, the future surgeon, who is trying to talk his friend, Barney Livingston, out of a psychiatric career, uses more contemporary expressions, but the message concerning “Freudian garbage” is the same:
“Why are you bent on spending the rest of your life in an easy chair [accumulating] … adipose tissue on your ass and telling people they shouldn’t love their mothers?” (Segal 1988: 286).
When Livingston obstinately perseveres in his bizarre urge to specialize in psychiatry, Dr. Clifford Marks, Professor of Neurology at Harvard University, adds his bit of discouragement. After Livingston presents a case on rounds, under difficult circumstances, the professor declares himself most impressed and remarks: “That was a tough one … You did a splendid job. Too bad you’re opting for psychiatry. You should become a real doctor” (Segal 1988: 316). Benjamin Mead, the “born surgeon,” currently a second-year medical student residing at Miss Slagle’s boarding house, takes offence when his classmate, Alexander (“Jack”) Ashby playfully suggests Mead might be interested in psychiatry. “Listen Jack,” Ben spluttered as he jumped up. “I’ll stand a lot of kidding. But there are limits” (Tucker 1939: 11).
Carolyne Dupayne, who makes no secret of her contempt for her brother, Dr. Neville Dupayne, and his chosen specialty – psychiatry – distinguishes between old-fashioned shrinks (who are useless in her opinion) and psychopharmacologists who are at least able to prescribe drugs for their patients. “You can only help patients today because of the neuroscientists and the drug companies. Without them you would be back where you were twenty years ago” (James 2003: 54).
Even Paloma Josse, the precocious, angry twelve-year-old (Barbery 2006, 86-87) feels nothing but derision for psychiatrists in general, and her mother’s psychiatrist, Dr. Theid, in particular. Theid, declares Paloma, “who has been costing my family close to six hundred Euros a month for nearly a decade … [is] no more a doctor than I am … [he is] an old leftie who’s converted to psychoanalysis” (ibid: 205-209). Like all shrinks, Theid is a comedian who believes “that metaphors are something for great wise men. In fact, any sixth grader can come up with one” (ibid: 86-87). A visit to Dr Theid is like a trip to Disneyland with “my life with mother” represented by the hall of mirrors, “my life without mother” by the roller coaster and “my sexual life” by the chamber of horrors (ibid.). To this day, psychiatrists converse with their patients in a curious “double-speak” language, which assumes that the patients’ statements mean something other than what they appear to say. Umbrella, of course, means penis (ibid: 167).
The "mad" psychiatrist
All psychiatrists are crazy (Segal 1988: 390).
The notion that psychiatry attracts peculiar recruits who cannot quite make it in “mainstream” medicine and that these misfits become even more warped through their interaction with their patients goes back to pre-Freudian days. Dr. Simão Bacamarte may be a versatile scholar with a gift for languages and a highly original mind, but he clearly belongs in his own madhouse as a patient (Machado de Assis 1881). Scott Fitzgerald’s Richard Diver, arguably the best known fictional psychiatrist, declares: “The weakness of this profession is its attraction for the man a little crippled and broken” (Fitzgerald 1934: 153). Cronin’s Dr. Robert Shannon expresses similar sentiments:
“In the profession one always tends to look askance at asylum work as being just a little off the normal track. There are some splendid people in that service, of course, but on the other hand, some who are distinctly queer and who get queerer as time goes on. It is an easy life and much medical flotsam drifts into it” (Cronin 1948: 221).
One of the “idlers around the court-house” in King’s Row informs his colleagues: “They say some of them doctors out to the asylum is pretty near as crazy as the patients” (Bellaman 1940: 460). The stereotype of the “mad” psychiatrist is discussed in a scholarly paper by Walter (1989).
Psychiatrists are not only lunatics: they are outlandish lunatics from Vienna and other obscure parts of the globe. They have foreign names and they speak with an accent. When Joyce MacIver makes an appointment to see her fourth psychiatrist, the doctor, whose family name is Portzweig, warns her to be punctual. “You hunderstand you haf to come on time” (MacIver 1961: 202-205). The doctor is unimpressed by Joyce’s reminder that she has seen other psychiatrists and knows all about analysis.
“‘You haf never been touched,’ he allowed. ‘A virgin psyche?’ I asked, surprised. ‘Ya ya, a virgin psyche,’ he was getting impatient. ‘Masochists always make chokes’” (ibid).
When the defense attorney in Traver's Anatomy of a Murder manages, after a great deal of frustration, to obtain the services of an army psychiatrist to testify on behalf of his client, the doctor’s name turns out to be Matthew Smith.
“‘Smith?’ I echoed. ‘Just plain Smith? Are you sure ... you didn't at least say Schmidt? I always thought all psychiatrists simply had to have long foreign names of no less than four syllables in order to get their diplomas - and that all of their first names were Wolfgang’ (Traver 1958: 224). [The same prejudice comes to the surface when Dr. Smith takes the witness stand.] “‘Your name please, Doctor?’ … ‘Matthew Smith.’ ‘What is your profession?’ ‘I am a psychiatrist.’ The jurors glanced at each other, surprised ... evidently sharing … the Hollywood notion that psychiatrists had somehow to look like first cousins to Svengali and Rasputin” (ibid: 421).
The perception of psychiatrists as crazy foreigners and the notion that “Smith” is an inappropriate surname for a “shrink” come up again in Levenkron’s The Best Little Girl in the World. Francesca Dietrich (“Kessa”) who is suffering from severe anorexia nervosa has been advised by her pediatrician to see a psychiatrist. Her father is not at all enthusiastic about this referral, but he bursts out laughing when he hears that the “shrink's” name is Dr. Alexander Smith.
“Smith! What kind of a shrink is named Smith? ... We ought to get a name like Freud or Krunnstaat or even Schmidt for our money, but Smith ... Well at least it's not Keigelfaven. Remember Professor Keigelfaven on the old Sid Caesar show? … Well let's just hope Smith isn't as crazy as old Keigelfaven” (Levenkron 1978: 60-64).
"Psychiatrists aren't proper doctors."
Even when the “foreignness” and “craziness” of psychiatrists are de-emphasized, other disagreeable attributes persist. These include “uselessness,” “laziness” and a perception, especially in hospital settings, that psychiatrists do not practice “real” medicine. They choose their specialty because they “cannot stand the sight of blood” (Walter 1989; Wharton 1978: 131). Their non-psychiatric colleagues regard them as “communists, queers and perverts” (Shem 1978: 341-342). A somewhat extreme case in point is the despicable Dr. Jim Roper, a psychiatrist in O’Hara’s From the Terrace. Roper, “a fairy” (O’Hara 1958: 839), a blackmailer (ibid: 679-681), and a procurer of sexual partners (ibid: 666-667), uses information obtained from his patients to further his own evil ends (ibid). On a less spectacular note, Slaughter’s Dr. Jake Stafford gives sensible advice, but he looks odd (Slaughter 1969: 354). Unlike authentic doctors (especially surgeons) who are tall and handsome, Stafford is “stocky” and “red-headed” (ibid).
Even nurses have less respect for psychiatrists than for “regular” doctors (Percy 1987). The fact that modern psychiatrists act as neuropharmacologists rather than “old-fashioned shrinks” makes no difference (James 2003: 54; Percy 1987: 13-27). “In a small general hospital a psychiatrist is ranked somewhere between a clergyman and an undertaker. One is tolerated [but] one sees the patient only if the patient has nothing else to do” (Percy 1987: 99).
Ravin’s doctors are full of derision for psychiatrists. Dr William Ryan, an intern at “Manhattan Hospital” (a thinly disguised fictitious name for the Cornell Medical Center and the Sloan Kettering Cancer Institute), has an oncology patient who is threatening to throw herself out of an eighth floor window.
“Ryan called the psychiatric hospital across the street. That is, he tried to call. He discovered that the psychiatrist was not available after 4:00 pm, that the psychiatrist would not have come to [the Cancer Hospital] anyway since policy required all patients to be sent to the psychiatric hospital for consult [and] that the psychiatrists did not want patients sent from [the Cancer Hospital] because they depressed the psychiatrists” (Ravin 1981: 94).
This disdain for psychiatrists is extended to paramedical staff working with them. When Diana Hayes, the ruthless cardiology professor wants to be particularly nasty, she remarks: “You sound like a psychiatric social worker” (Ravin 1981: 215), implying that in her hierarchy psychiatric social workers are even lower than the non-psychiatric members of the species. In Evidence, another of Ravin’s novels, Drs. Ann Payson (cardiothoracic surgeon) and Benjamin Abrams (endocrinologist), both from the “St George University Hospital,” are standing in line at a Washington restaurant, waiting for a table.
“A thin man with wiry hair pushed by us and called over the Maître D. He announced he was Doctor Somebody as if he expected the Maître D. and perhaps the entire staff of waiters and cooks to come out and genuflect before him. [The newcomer is making a scene because his reservation is for eight o’clock and his table is not ready.] ‘Can we take this guy out and shoot him?’ Ann whispered in my ear ... We decided [he] wasn't a real doctor but a psychiatrist. We had no way of knowing that but we wanted to believe it. We didn't want him to be one of us” (Ravin 1987: 97).
Hejinian's Dr. Womack, who detests almost all his medical colleagues, finds psychiatrists particularly useless and inefficient. The nail-biting staff psychiatrist who claims that he is “terribly busy,” has just enough time to misdiagnose a middle-aged patient with total amnesia. “Schizophrenia,” he remarks inappropriately, “The guy is an ordinary nut” (Hejinian 1974:18-19). The patient turns out to be a conman, well known to the San Francisco police (ibid: 283-284). Dr. Ainsworth, an incompetent intern in Hejinian’s Extreme Remedies and a potential recruit to the psychiatric service, holds out some promise of developing along the same lines as this staff psychiatrist (ibid: 48-50). Ainsworth, who wears an “explosion of red hair plus a beard” (ibid) has no time to look after his patients or even to answer his pager because of his radical political activities (ibid: 193-196). The resident who has to tidy up after this pathetic character, declares “I sure hope he goes into psychiatry” (ibid: 48-50).
Other works of fiction expressing the opinion that psychiatrists aren’t “real” doctors include Conroy’s The Prince of Tides, which tells the story of Dr. Susan Lowenstein, a Jewish psychiatrist, who phones from New York to South Carolina to inform the next of kin that one of her patients has been admitted to hospital after a suicide attempt. The patient’s mother, a “refined” Southern lady, dislikes New Yorkers, Jews and female physicians but her particular disapproval is reserved for psychiatrists. “‘A doctor called,’ she informs her family, ‘A woman doctor…a psychiatrist. I’m sure she couldn’t have made it in any real field of medicine’” (Conroy 1986: 20).
Ferrol Sams’ Widow Highee of “Faceville,” Georgia states her unflattering views of psychiatrists in greater detail:
“There’s something plumb indecent about going to a doctor that’s not going to do a blessed thing but listen to you and charge you by the hour for it and not even throw in no iron and vitamins or even an eensy-weensy B12 shot…I know a good doctor when I see one. A really good doctor has got a knife in one hand and hormones in the other and I mean he’s coming at you. He’s not sitting there in no leather chair with his legs crossed and sucking on no pipe and acting like if you got the money, he’ll take the time” (Sams 1987: 4-5).
This prejudice against psychiatrists is by no means confined to Southern hicks. Dr. Lowenstein’s parents, authentic New York intellectuals, react equally unfavorably when Susan informs them of her choice of specialty. They were proud of their doctor-daughter but “they were both appalled when she decided to study psychiatry” (Conroy 1986: 192). Similarly, when Dr. Roy Basch, the misfit from Internal Medicine in Shem’s The House of God seeks refuge in psychiatry, his dentist father - who wants him to be a “real” doctor - does not attempt to hide his sense of profound disappointment (Shem 1978).
All the members of David Hellerstein’s medical family beg him not to take up psychiatry. They ask: “Why can’t you do something real, like your father?” (The father is a cardiologist). An endocrine colleague remarks:
“I hear you’re planning to throw away your medical education.” Even a practicing psychiatrist tries to warn him off. “I hear you want to be a psychiatrist. If you’re looking for a quiet comfortable life…forget it. Do something else” (Hellerstein 1986: 141-142).
Naturally, surgeons are particularly contemptuous of psychiatrists. For example, “Hawkeye” Pierce, the military surgeon from M A S H, and his companions are planning to trick the army psychiatrist by pretending to be crazy. They discuss their tactics over drinks where Hawkeye presents the standard “surgical” opinion of “head shrinkers”:
“‘I figure we’d better think this over a little more,’ [Hawkeye] said, ‘psychiatrists are never overly troubled with the smarts, but even the dumbest one is going to smell a rat if we all go in and say the same thing’” (Hooker 1968: 145).
Similarly, Dr. Peter Mallory, a cancer surgeon in Doctors and Women (Cheever 1987), entertains his residents and nurses with the old joke about internists who know everything and do nothing and surgeons know nothing and do everything. In his version there is also a psychiatrist.
“The psychiatrist is the doctor who thinks he knows everything and doesn't tell anything. (Peter Mallory didn't believe psychiatrists knew much of anything but a joke is a joke)” (ibid: 43).
Even in the mid–twentieth century, when, at the height of the psychoanalytic craze, a sizeable proportion of New Yorkers were spending much time and money seeing “shrinks” (C.f. Ross 1963, MacIver 1961), Ross’ Dr. Max Pooley declares himself a non-believer in psychiatry and psychiatrists. “He’s a surgeon,” explains Annie Melvin, the sister of one of Pooley’s colleagues. “He’s got better ways of getting his kicks” (Ross 1963: 105).
Dr. Alan James, a successful neurosurgeon in Pictures at an Exhibition, serves on a committee that has been set up to bring the disciplines of neurology and psychiatry closer to each other. Predictably, the exercise proves “a vain effort.” Furthermore, James seems somewhat disappointed when his medical son, Dr. Christopher James, decides to become “a shrink” (Thomas 1993: 78). (Actually, Christopher may be the natural son of a psychiatrist so that his career choice may not have come as a complete surprise to Dr. James Senior).
"Psychiatrists have no morals."
In addition to the representation of psychiatrists as incompetent and generally ineffective, their perceived lack of “moral rectitude,” often pollutes their professional activities as well as their personal lives. Whether based in Park Avenue, New York City (Marks 1957), in “Harley Street” London (Coombs 1990: 270), or in a Shanghai hotel looking after alcoholic expatriates (Jones 1986: 26), psychiatrists engage in inappropriate physical relationships with their patients on such a scale, that sexual advances are almost taken for granted and the term “horizontal” acquires sexual as well as psychoanalytic connotations (c.f. Rhinehart 1971, Marks 1957). Supposedly sick women arrive at their psychiatrists’ offices, expecting the doctor to respond to their “writhings, declarations, propositions, strippings and attempted rapes” (Rhinehart 1971: 82-83). As might be expected, doctors working in such an environment are liable to succumb to sexual temptations, with predictable results on their long-term relationships with their more suitable partners. Even outside fictional literature, studies show that disastrous marriages, alcoholic wives and drug-addicted children are encountered amongst all kinds of doctors, but these problems occur in a more virulent form among psychiatrists (Rollman et al 1997).
The pathetic Dr. Burns in The Sunlight Dialogues, who asks the local police chief for marital advice, is, of course, a psychiatrist (Gardner 1972: 665). The lonely, dying surgeon in Three Dog Night, who needs female company, asks a psychiatric friend for the loan of his wife (who is also a psychiatrist; Goldsworthy 2003). Dr. Henry Ramsey, one of the psychiatrists in MacIver’s Frog Pond, regularly ties his wife to a chair and locks her up in their apartment (MacIver 1961: 68-71). Thomas contrasts the marriage of Dr. Alan James, a neurosurgeon, with that of his son, Dr. Christopher James, a psychiatrist. Neither father nor son leads a satisfactory family life but the underlying causes differ significantly. The neurosurgeon is a chronic womanizer whose wife walks out on him. The psychiatrist is an unsatisfactory lover, whose wife seeks and obtains sexual comfort from other men including her virile father-in-law (Thomas 1993). According to Michael Crichton, the classical family set-up in a psychiatrist’s home consists of a drug addicted son who obtains his supplies from his father, “to the mutual satisfaction of both” (Crichton 1969: 206).
Even the psychiatrists’ strictly professional activities threaten traditional values. They encourage patients to abandon old-fashioned, idealistic concepts like heroism, saintliness and sacrifice, and, instead, yield to their temptations, particularly temptations of the flesh, in order to rid themselves of “inhibitions” and other neuroses. This permissive attitude seems amusing to Maurois’ Dr. O’Grady (Maurois 1950: 244-257), but it disgusts Mauriac’s Catherine Schwartz, a psychiatrist’s wife, who finds her husband’s methods “unclean” (immonde; Mauriac 1959: 119-138). In Rhinehart’s scheme, the psychiatrist has totally abandoned not only the concepts of right and wrong, but even those of beneficial and harmful, advisable and inadvisable, and has substituted the roll of the dice for rational choices (Rhinehart 1971).
The straightforward questions of “genuine” doctors, the factual answers required from the patient, the physical examination, and the patients’ requests for precise information, are replaced in psychiatric settings by discussions of apparently irrelevant subjects. Alice Brill, a surgeon’s daughter, comes across this phenomenon at the age of ten. Alice has been referred to Dr. Pinch, a Park Avenue psychiatrist, because of repetitive blinking. (The habit begins after the child pays a surprise visit to her father’s office and finds him on his desk making love to his nurse.) Alice finds it strange that the doctor does not even mention her tic or her eyes. Unlike her “jovial pediatrician” who asks where it hurts and then investigates the relevant area, Dr. Pinch
“asked me seemingly irrelevant questions about magical wishes and dreams – did I ever think I didn’t live with my ‘real’ family, did I ever daydream about having a twin?” (Wolitzer 2006: 29)
The psychiatrist does not discover the cause of Alice’s blinking habit, which goes away after a few weeks.
Psychiatric interviews are perceived to consist of meaningless circular dialogues about sex. When the doctor asks: “Are you afraid of sex?” in Lau’s “The Mirror People,” the patient replies: “Am I, Doctor?” A little later she asks: “Doctor, do you recommend that I go out and fuck someone? To overcome my fear?” The psychiatrist answers: “Well, that’s a decision only you can make” (Lau 1991: 172-179). Is it any wonder that the medical student in Miss Slagle’s boarding house (Tucker 1939) and other students with a scientific background considering residencies and future careers will accept “anything but psychiatry?” (ibid: 308).
Of all medical doctors, psychiatrists receive the most negative treatment at the hands of writers of fiction. Their foreign origins, their accents and their eccentricities set them aside from “proper” doctors, who regard them as useless charlatans. Psychiatry is chosen as a career by those who cannot make it in real medicine, and who are further marginalized by their association with “crazy” people. Instead of a straightforward history and a physical examination, psychiatrists talk to their patients in a meaningless bible-babble and always about sex. Their lack of moral principles is contagious and may spread to the unfortunate people who consult them. These widespread perceptions, which have not changed in 100 years, are, at least in part, responsible for some early negative career choices.
- The medical term “One Track Mind Syndrome” is a condition said to be present in doctors who know only one diagnosis or one kind of treatment which they apply, with varying degrees of success, to all patients. The doctors’ misconceptions range from harmless crackpot theories to lethal forms of intervention. Surprisingly, the syndrome persists into the twenty-first century and is not confined to practitioners of “alternative medicine.” (Posen, 2005: 158)
- The efforts by pharmaceutical companies to promote proprietary rather than generic names have been so successful, that it is almost impossible to find generic terms in twentieth century fictional literature. Physicians in novels prescribe “Sintron” (Simenon, 1963: 33-34) and “Elavil” (Wharton, 1981: 159-162) much the same way as doctors in the real world prescribe “Viagra” rather than "Sildenafil." In due course the drugs become obsolete and the brand names unrecognizable. Gaddis (1955) creates nonsense poetry out of the drug-naming process, an essential prelude to the launch of a particular product: “Palagren or Passiphen or Pento-Del or Phanodorn. Seconal or Sedamyl, Tolyphy or Tolyspaz. (ibid: 714) …Diasal or Lesofac, Amchlor or Gustamate” (ibid: 732).
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, MD is an emeritus professor of medicine at the University of Sydney; he majored in English before obtaining his medical degrees (MB BS, MD) at the University of Adelaide, Australia. He is a Fellow of the Royal Australasian College of Physicians, a Fellow of the Royal College of Physicians, London, and a past president of the Endocrine Society of Australia. He lives in Sydney, Australia. Dr. Posen taught General Medicine and Endocrinology at Sydney University for almost 30 years. He served on the Editorial Boards of several medical journals; he is the author of some 130 scientific papers (mainly in the field of calcium metabolism) and a co-author of a book on Alkaline Phosphatase. He is the author of a projected four-volume work titled The Doctor in Literature. The first volume, (“Satisfaction or Resentment”) was published by Radcliffe in 2005. The second volume (“Private Life”) appeared in 2006. This paper is based on extracts from Chapter 4 of the unpublished third volume (“Career Choices”).