Roslyn Weaver
Sydney, Australia

Most classical detective novels start out with a community in a state of stable order. Soon a crime (usually a murder) occurs, which the police are unable to clear up. The insoluble crime acts as a destabilizing event, because the system of norms and rules regulating life in the community has proved powerless in one crucial instance and is therefore discredited. In other words, the narrative incapability on the part of society’s official agents, their inability to discover and tell the story of the crime, thus threatens the validity of the established order. At this point the detective takes over the case, embarks on a course of thorough investigations, and finally identifies the criminal, explaining his solution at length. Thus, through the development of the second story, the absent first story is at last reconstructed in detail and made known. By reintegrating the aberrant event, the narrative reconstruction restores the disrupted social order and reaffirms the validity of the system of norms.
From Peter Hühn, “The Detective as Reader.”¹

The figure of the detective holds a special appeal in society: crime fiction and television series are perennially popular genres with audiences, with some detectives reaching iconic status—Sherlock Holmes, Hercule Poirot—and particular fictional locations gaining notoriety for their unusually high murder rates—Cabot Cove, Midsomer, St Mary Mead.

Metaphors are popular in the medical world, and the detective genre has a particular resonance with medicine. Detectives and doctors both apply deductive reasoning to reach conclusions about the puzzles in their field, whether crimes or illnesses. Like crime, the medical genre is an enduring staple of television series, producing its own array of famous fictional doctors (Dr. Kildare, Doc Martin). As others have pointed out,

“Detective work” has long been a metaphor for clinical acumen. […] Both try to restore a status quo that has been undermined by a crime or disease. During their golden age, the two disciplines thrived on a climate of faith in the apparently unlimited capabilities of science and based their methods on deterministic interpretation of clues, signs, and symptoms.²

Indeed, the most famous detective Sherlock Holmes provides the template for perhaps the most famous television doctor in contemporary culture, Gregory House (House). They share similarities of names (Holmes/House), friends (Watson/Wilson), drug habits (use of cocaine/Vicodin), and hobbies (violin/piano), as well as more general aspects of gender and ethnicity. The producers of House make this connection clear, saying “Actually, [House] started as a team of doctors, trying to diagnose the undiagnosable. What we were trying to do, quite cynically, was to do a cop kind of show in a medical setting.”³

Yet it would not be a simple task to blend crime and medicine unless there was already considerable congruency between the two genres—unless there was already a shared discourse about the place of detection and diagnosis in our culture. This congruency means that viewers understand perfectly well when House and his colleagues use the language of detection in the series: clues, evidence, proof, solving cases. This is not an isolated incidence: Grey’s Anatomy, another popular medical television program, also provides similar themes in its opening episode when a doctor asks his interns to “play detective” for a patient who is “a mystery” (1.01).⁴ It is a sufficiently common theme that some researchers have commented on it elsewhere; for instance, Strauman and Goodier discuss House with reference to his detective persona.⁵

Here, however, I want to extend the discussion beyond the detective-doctor figure to consider more broadly some of the implications and expectations around medicine and society that become evident in this crime context. Returning to the detective genre, we are reminded that much of the appeal of the detective genre is its ability to bring about order and sense to chaos. As Dennis Porter puts it, Sherlock Holmes is heroic because “he possesses the intellectual’s power to produce coherence. Like the scholar/ researcher, Holmes takes the fragments and finds the hidden pattern; he establishes relationships where none had previously appeared.”⁶ Coherence is the key word here. What detectives offer society is the chance for sense-making out of random, distressing events. When life’s order is disrupted by a crime, a detective can bring restoration by explaining clues, process and motives, identifying the criminal, and contributing to justice.

And this returns us to Hühn’s epigraph with its focus on the detective’s role in restoring social order. If we were to recast Hühn’s words in the medical context, how might they read? Would it make sense if applied to popular medical television programs, for instance?

Most classical medical stories start out with a community in a state of stable health. Soon an illness (usually a rare disease) occurs, which the doctors are unable to clear up. The insoluble illness acts as a destabilizing event, because the system of norms and rules regulating health care in the community has proved powerless in one crucial instance and is therefore discredited. In other words, the narrative incapability on the part of society’s official agents, their inability to discover and tell the story of the illness, thus threatens the validity of the established order. At this point the specialist takes over the case, embarks on a course of thorough investigations, and finally identifies the illness, explaining the solution at length. Thus, through the development of the second story, the absent first story is at last reconstructed in detail and made known. By reintegrating the aberrant event, the narrative reconstruction restores the disrupted health care order and reaffirms the validity of the system of norms.

It is apparent that medicine, then, functions in a similar way to detection. Doctors, too, can restore order and coherence to chaos. What doctors offer society is the chance for sense-making out of random, distressing events. When illness disrupts our lives, doctors can bring restoration by explaining symptoms, causes, pathology, identifying the disease, and contributing to healing.

We need only think about the anxiety and distress of many patients as they wait to see their doctor to see that sense-making is one—albeit undoubtedly more abstract and unconscious—aspect of the doctor’s role. Even when doctors offer difficult, chronic, or terminal diagnoses, in some cases diagnosis alone mitigates some (not all) of a patient’s anxieties. Put another way, doctors may not always be able to save patients’ lives, but the act of solving the medical puzzle is enough to restore order, just as the act of solving a crime restores order even when victims are already dead. Thus, the critical element is the resolution of the puzzle rather than the restoration of the person; though in medicine the two goals are necessarily linked. In this way, House and other medical narratives can work to reassure viewers that medicine does work, that trust in health care and scientific knowledge is valid and justified.

And yet I wonder what some of the other implications are of this unity of detection and medicine. The appeal of the detective story as a framework for medicine is obvious. A detective’s determined, resolute commitment to solving cases is appealing; just as a television doctor’s determination to diagnose and cure a patient has obvious pleasures for the viewing audience.⁷ Yet there are more unsettling implications as well when we consider the intersections of detection and medicine. Framing medical practice as mystery solving suggests that there always will be a neat resolution, that superior intellect and intuition allied with persistence and technology will suffice, that technology and relentless tests will eventually produce answers, and that once the mystery (the disease) is solved (diagnosed), that is the end of the story. The answer is usually to administer the cure and discharge the patient. This rather obviously highlights doctors instead of patients, who become merely a crime scene or the site of a mystery, and raises the question of the usefulness of such a metaphor in the context of patient-centered care approaches.

As many patients and their families know, moreover, medicine cannot always solve the mysteries of illness and disease. Some patients cannot be treated, or treatment cannot bring longevity or quality of life. Sometimes doctors cannot identify an illness: patients may see multiple specialists and experts without any diagnosis eventuating. If the illness cannot be diagnosed, there is a potential message that medicine has fallen short because it cannot solve everything, and the social order remains disrupted, unstable.

Patients are never simply intriguing cases or crimes to be solved. They are people, with all the complexities this entails. The connections between detection and medicine are, then, limited, for patients and doctors know that illness and health are much more complicated than mysteries. Nonetheless, detection offers a useful lens for helping us to understand some of the ways in which society sees doctors. Just as the crime genre continues to highlight the special, sense-making role of detectives in our society, so too our fictional medical narratives remind us that doctors also play a valuable role in restoring order out of chaos in patients’ lives.

Notes

1. Peter Hühn, “The detective as reader: Narrativity and reading concepts in detective fiction,” Modern Fiction Studies 33.3 (1987): 451-66. p. 452.
2. Claudio Rapezzi, Roberto Ferrari, and Angelo Branzi, “White coats and fingerprints: diagnostic reasoning in medicine and investigative methods of fictional detectives,” BMJ 331 (2005): 1491-4. p. 1491.
3. House. “Special Features: The Concept.” Season One DVD. Fox. 2005.
4. Grey’s Anatomy. “A Hard Day’s Night.” Season One DVD. ABC. 2005.
5. Elena C. Strauman, and Bethany C. Goodier, “The doctor(s) in house: An analysis of the evolution of the television doctor-hero,” Journal of Medical Humanities 32.1 (2010): 31-46.
6. Dennis Porter, The Pursuit of Crime: Art and Ideology in Detective Fiction (New Haven: Yale University Press, 1981), 225.
7. See Wicclair’s discussion of the appeal of watching House for viewers. MR Wicclair, “Medical paternalism in House M.D,” Medical Humanities 34.2 (2008): 93-9.