Views & Reviews Between the Lines

Double trouble

BMJ 2009; 338 doi: (Published 10 June 2009) Cite this as: BMJ 2009;338:b2301
  1. Theodore Dalrymple, writer and retired doctor

    However hard it is to be a doctor, it must be much harder to be a medical impostor. Not only must you do a good imitation of being a doctor, and therefore suffer all the anxieties that a genuine doctor suffers, but you must also suffer the constant fear of exposure, ridicule, and retribution that goes with any impostor’s part.

    Of course, many if not most doctors must have felt at times that they are impostors, when they tell patients things that are beyond their knowledge or provide reassurance not entirely based upon the truth. And I dare say we all know doctors of limited capacity who nevertheless exude an air of authority to which we do not believe that they are entitled, though it may fool some patients. On examination, then, the distinction between an authority and an impostor turns out to be a little like that between hypertension and normotension, a matter rather of degree than of kind.

    Paul Theroux, the author who was so hurt by V S Naipaul’s sale of his copies of Theroux’s novels inscribed to him that he wrote an entire book about his former friend’s character, wrote a short novella, Dr DeMarr, at the heart of which is what one might call a meta-imposture.

    George and Gerald DeMarr are identical twins who grow up hating one another because everyone treats them as interchangeable, as two limbs of one organism, as it were. They are therefore desperate to achieve their individuality, to lead separate and unique lives.

    They do separate, until one day George turns up after many years at Gerald’s house and asks for shelter. This Gerald reluctantly gives him, until about a week later he finds George dead from a heroin overdose. He disposes of his brother’s body in the municipal waste site, thinking that in this way he has managed at long last to ensure his uniqueness.

    This turns out not to be so, however. Gerald discovers that George was a doctor, and almost out of curiosity takes his place as such. George’s qualifications, however, were bogus, that is to say forged: he specialised in treating hypochondriacs who, as Theroux puts it, wanted confirmation of their illness rather than cure. He also had a lucrative sideline in supplying prescriptions to drug addicts.

    Unfortunately, Gerald, the impostor of an impostor, does not know how to write prescriptions; and while the hypochondriacs can be fobbed off with suggestions about diet, the drug addicts cannot be. They inject Gerald to death with heroin for not complying with their wishes, just as they injected George to death because he tried to break free of them; and so Gerald fails in his bid for uniqueness.

    This is a disturbing little book, not least (for doctors) for its suggestion of how easily a completely untrained person may do so much of their work. Most disturbingly, it describes a world in which individuality does not develop spontaneously, has consciously to be worked at, and, precisely because it has to be worked at, will fail to develop. This is surely the world in which we now live, in which so many people resort to ornamental self mutilation in order to distinguish themselves from others, failing in the process precisely because there are so many others with exactly the same idea.


    Cite this as: BMJ 2009;338:b2301

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