Views & Reviews Between the Lines

Shipboard confidences

BMJ 2012; 345 doi: (Published 25 September 2012) Cite this as: BMJ 2012;345:e6482
  1. Theodore Dalrymple, writer and retired doctor

Does illness have a meaning beyond itself? For most of history, people have thought so. It was a divine or other vengeance, a punishment for wickedness, individual or collective. The purely naturalistic attitude to illness is psychologically difficult to maintain consistently. Even the most thorough of rationalists, struck down unexpectedly by malady, are inclined to protest that they did not deserve it, and that they had no bad habits, exercised vigorously, and ate fresh food, for example.

In his 1931 novella Confidence Africaine (African Secret), the French writer and winner of the Nobel prize for literature, Roger Martin du Gard, suggests that illness does have a meaning.

The author is the narrator; the story has something of the atmosphere of Somerset Maugham or Stefan Zweig. It starts in a sanatorium three years earlier where, while visiting a friend, the narrator observes and forms another friendship with the uncle of a young Italian, Michele, who is dying of tuberculosis, and of whom he catches only a glimpse: “What I remember of him above all is him on his deathbed: skeletal, but of a beauty of a Persian prince. The boy was clearly refined and sensitive; and the ‘pain of the uncle was silent, concentrated, almost animal, disturbing to see.’”

The uncle confides that he has taken Michele to seek a cure in every possible climate, but all in vain: “Although all the doctors consulted were unanimous that the boy, tuberculous to the marrow, tuberculous since infancy, had never been curable, the uncle reproached himself for having devoted himself too late to Michele’s health.”

Michele duly dies; the author and the uncle, who have now formed a brief but intense friendship that such situations tend to produce, stay in touch. Then the author visits the town in North Africa where the uncle, his sister, and brother in law have a successful bookshop. The uncle’s sister (the mother of Michele) is grotesquely fat, continually eating; her husband is crude, and the children healthy and vigorous but deeply vulgar. There is a mystery here: how come Michele was so different?

The uncle and author happen to travel on the same boat from North Africa to France. The uncle indulges in that great source of literature in the first half of the 20th century, the shipboard confidence. Michele was not the son of his sister’s husband; he was the son of the so called uncle and his sister, who had a passionate incestuous affair lasting four years and which was the happiest period of their lives.

The illness was the reward or natural consequence of sin: “I am going to confess one thing: I did not understand until very late my own guilt in all this. Very late: at the sanatorium . . . I realised all of a sudden that I was responsible for this birth, this illness, this martyrdom.”

There is ambiguity, however, in the story. True, the fatal illness is brought about or made inevitable by sin; but the child of that sin, the product of love, is a beautiful and refined being; the children of the marriage—which is one of convenience, and more or less forced—are gross and vulgar. Moreover, the sister has deteriorated physically and morally since abandoning her incest.

Shipboard confidences are no longer possible; I doubt that those on aircraft have quite the same intensity.


Cite this as: BMJ 2012;345:e6482

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