Views & Reviews Between the lines

Illness as metaphor

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39204.473900.59 (Published 10 May 2007) Cite this as: BMJ 2007;334:1009
  1. Theodore Dalrymple, writer and retired doctor

    Not long ago, I published a short article in which I mentioned that some of the best people I had ever known—the only ones who seemed to me genuinely to love humanity—were nuns working in Africa. Not being religious myself, I had no particular axe to grind, and was surprised by the vehemence of the hostility my remark gave rise to. I hadn't realised that so many people loathed nuns with a terrible, if somewhat forced, loathing. But how could anyone loathe people who had devoted their lives to looking after people with leprosy, I wondered?

    In Graham Greene's novel, A Burnt-Out Case, a man called Querry (a composite of Query and Querulous, perhaps), who is a world famous architect, buries himself in a Catholic missionary leper-colony in a remote part of the Congo, towards the very end of Belgian rule. Querry is the burnt-out case of the title: life in general being a disease from which he has hitherto suffered. I am not sure that I much care for leprosy as a metaphor for life.

    The father superior at the mission discusses Querry's motives with Dr Colin, the atheist medical officer, who has devoted 15 years of his life to looking after people with the disease.

    “What do you think of Querry, father? Why do you think he's here?” [asked Dr Colin]

    “I'm too busy to pry into a man's motives . . . Perhaps he is only looking for somewhere quiet to rest in.”

    “Few people would choose a leprosarie as a holiday resort . . . I was afraid for a moment that we might have a leprophil on our hands.”

    “A leprophil? Am I a leprophil?”

    “No, father. You are here under obedience. But you know very well that leprophils exist, though I daresay they are more often women than men.”

    Does the concept of leprophilia cast any light on the nuns whom I knew in east and west Africa? I don't think so. Their compassion was as far as possible from the exhibitionist variety of, say, modern celebrities. Their work was carried out in complete obscurity; they had nothing and lived simply; many of them were old and would be buried in unmarked, or barely marked, graves as their reward.

    What is Querry running away from, that makes him allegedly a burnt-out case? Firstly, he has lost his faith in the Catholicism of his youth; secondly, as the veteran of many affairs, he realises that he is incapable of love for a woman; and thirdly, he realises that his creativity as an architect has dried up. (I must confess that I wish that most 20th century architects had buried themselves in the Congo, preferably before they built anything.) Dr Colin says of Querry at the end of the book, “[It] was like the crisis of a sickness—when the patient has no more interest in life at all.”

    Greene's wallowing about in the swampy analogy between leprosy and life makes me feel distinctly queasy. It seems to be an invitation to self pity by the privileged and the healthy, an invitation that is hardly necessary. For is there anyone so lacking in compassion that he feels no pity for himself?

    Greene's wallowing about in the swampy analogy between leprosy and life makes me feel distinctly queasy

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