- © 2007 Canadian Medical Association
If you look to reality TV or the many television hospital dramas to gauge how our society views doctors today, you're following a time-worn tradition. In fact, the 400-year-old extravagant and excessive art form of opera predates TV when it comes to dramatizing our culture's perceptions of the medical profession — and not all those perceptions are positive. As science and medicine changed over the centuries, so too did Western society's idea of doctors as “professionals.” A quick review of the operatic canon offers 3 basic views of the physician.
The pompous pedant: In representations of doctors in operatic stories set before the 19th century, the physician is most often presented as arrogant, foolish and inept, from Mozart's fake mesmerist in Così fan tutte (1790), to the quack Dr. Dulcamara in Donizetti's Elisir d'amore (1832) and on to the Bologna-trained pedant, Dr. Spinelloccio, in Giacomo Puccini's comic opera Gianni Schicchi (1918), set in 14th century Florence. The butt of the joke, the early doctor is not a respected man of science but, rather, a comic figure of general scorn.
With the major shift in medical thinking that came in the 19th century, when clinical medicine's findings were combined with those of pathological anatomy, physicians became the ones who could link the visible and tangible to that which could not be seen — except by microscope or in an autopsy. Add to this the developments in bacteriology and therapeutic advances, and suddenly doctors had new capabilities and powers in clinical medicine, initially in diagnosis and prognosis and eventually in therapeutics. All this gave physicians a new way of looking at the body and seeing, within a patient, conditions not accessible to the untrained eyes of the patients and their families.
New images, more suited to these new medical powers, began appearing on the operatic stage. Some (though very few) were positive; a case in point is the compassionate and kindly Dr. Grenvil in Verdi's La Traviata (1853), caring for his tubercular patient. Even though he can do little for her, he understands totally her prognosis — and fate.
The medical monster: Even more often, however, the newly empowered physician was seen in negative terms, as a sinister figure preying on the sick, such as Dr. Miracle in Offenbach's Les Contes d'Hoffmann (1881), who lures a young woman to do the one thing that will cause her health to fail: to sing. As she dies, the doctor-as-demon sinks into the ground laughing, only to return one final time — to pronounce her dead.
This portrayal is a forerunner to the terrifyingly callous and detached doctor in Alban Berg's Wozzeck (1925), who was based on a medical figure well known in Giessen, Germany, the town where Georg Büchner, the medical school student and author of the play on which the opera was based, lived and studied. Medical science is portrayed as dangerous and harmful to its subjects — or victims.
When Wozzeck begins to show evidence of mental instability while undergoing experimental medical care, the doctor sings: “Wozzeck, you'll end up in a madhouse! You've got a beautiful obsession, a splendid aberatio mentalis partialis of the second species! Highly developed! Wozzeck, you'll get a pay raise!” He proceeds to wax ecstatic, exclaiming: “Oh! My hypothesis! Oh! My fame! I shall be immortal! Immortal! Immortal!” The new powers of medicine are depicted as being subject to misuse, susceptible as they are to base motivation and egocentric desires.
With medicine's increasing advances, physicians came to be seen as powerful by virtue of their unique access to knowledge that allowed them to see what others could not. This knowledge gave the public confidence in doctors' abilities to help, but this confidence was tinged with suspicion about the physician's potential to abuse this new-found power. Opera once again stepped into the fray, this time providing a potential image to counter this negative evaluation by aligning the science with the art of medicine.
Humane healers: Michael Nyman's The Man Who Mistook His Wife for a Hat (1986) suggests that physicians can be humane healers. It is based on Oliver Sacks' story of Dr. P, a famous musician and teacher who is behaving strangely: not recognizing the faces of his students, talking to the curved knob on a chair, asking directions of a parking meter. It opens with the doctor's medical meditation:
Deficit
Loss
Ev'rything that patients aren't
and nothing that they are.
Such language tells us nothing
about an individual's history.
It conveys nothing of the person
and the reality
of facing disease
and struggling to survive it.
To restore the human subject
at the center…
the suffering, afflicted,
fighting
human subject…
we must deepen a case history
to a narrative or tale.
Only then do we have
a WHO
as well as a WHAT —
a patient in relation to disease —
a real person.1
Dr. S (the neurologist) carries out a full neurological examination on stage and does other tests to try to find a diagnosis. His real understanding comes only when he visits Dr. and Mrs. P at their home. Upon examining some of his patient's amateur paintings, he sees a move from figurative to abstract art that he interprets as the progress of the pathology, ending in chaos.
This reading leads to an altercation with the protective wife, who sees the change as an advance in artistic sophistication. At this point, the agitated patient freezes, losing his ability to function. As he regains function, it becomes clear that he has changed the structure of his world from a visual one to an auditory one — and he can continue to function through the use of music. The doctor's pragmatic and humane prescription is “More music.”2
Cultural understanding of professions, people, anxieties and desires are obviously all represented through the whole range of a society's art forms, and not only on TV hospital dramas such as ER. Opera's longevity as an art form and its visceral audience impact — thanks to its combination of engaging characters, its often over-the-top dramatic stories and, most of all, its powerfully moving music — goes beyond merely representing that understanding; it allows us to feel and experience it first hand. Portraying physicians in a more complete, well-rounded manner, one would hope might provide a more empathetic view of the profession. Our pragmatic prescription?
“More opera!”