Father Munchausen, I Presume!

Editorial Note: This is the fourth of seven Doctor Munchausen posts – Doctor Munchausen, I presume, Dying for a Cure, Dear Louise and the forthcoming Doctor Munchausen as a Sense about Science Trustee, and Doctor Munchausen Joins your local Hospital Board.

I’ve had some criticism of the recent Doctor Munchausen posts. They’re not fair on doctors. Many people have told me of lives saved by good doctors. It’s not fair to tar these good doctors with the brush of a few Dr Munchausens here and there.

Ascent to Golgotha

In recent months the movie Calvary has done the rounds in Ireland and the UK and moved to North America.

It opens with a confessional scene. Someone enters and tells the priest that he is going to kill him the following Sunday on the beach. The priest’s week is spent meeting people around the parish near Sligo in the West of Ireland, sizing them up as the possible killer, and debating with himself about what to do – cut and run or face the music.

The story is highly stylized, cliched and implausible but it has its moments. You might visit Ireland because of the scenery on show but you’d steer clear of its small towns if you thought this was an accurate portrayal of small town life there.

The plot is fueled by the abuse of children by Catholic clergy in Ireland. This issue appears overtly and briefly in the opening scene and at the end. In between is a good thriller. The killer has decided to pick a good priest – a good German – in order to shock people awake. There is little point killing a monster – no one will be surprised or bothered.

The priest he’s picked is clearly good – was previously married but his wife died, so he’s normal. He has an attractive daughter. He lives a very frugal life. He has a gorgeous dog who keeps him company. He mixes in with the locals in the pub but doesn’t drink because of past difficulties with the alcohol.

Detachment

As we approach the climax there are a number of ever more dramatic Passion Week moments. In a key scene the priest finds his dog dead with its throat cut. He is distraught.

In the penultimate scene, faced with the person who might kill him he is asked how he felt when he found his dog and he explains. He is then asked how he felt when he read or heard about episodes of abuse of children – did he cry the same way. He answers honestly – no – and recognizes his detachment from these children compared to his feelings for his dog.

Taking clozapine

If you’re the mother of a son taking Clozapine for instance – or it could be any other drug or problem – and you feel your son is not right, you will complain to the doctor. They are likely to swat away your complaint.

Your sense that something is wrong might be backed up by your son’s pulse rate running at 140 per minute – a recognized effect of clozapine. The doctor might or might not have checked the pulse rate ever but even if she had checked she would likely be detached. So what. Whereas if you were told the pulse rate, you would likely freak.

It can be useful for doctors and nurses to be able to remain detached in order to help you – to be able to step back and take “rational” decisions on your behalf. In an interesting, perhaps deliberate twist to the movie, this detachment makes the doctor in Calvary a freak of some sort – the least human person in the story.

You’re a young boy put on clozapine who gets very anxious in the middle of the night, perhaps feeling like you are going to die. You can feel your heart beat and it appears to be racing. You don’t know that it’s running at 140 beats per minute. You tell the doctor the next day about these worries. You might not have the word available to you to use but you will likely get the sense she regards you as “neurotic”.

A patient of mine some years ago after starting clozapine felt unwell and approached staff on several occasions to say this. He was swatted away by very good staff as neurotic. I was saved from finding out if I’d have done the same by being away. I came back to find the patient in intensive care, expected to die. He had renal failure linked to an interstitial nephritis. He lived and the label for clozapine in the UK now includes interstitial nephritis as a complication of clozapine treatment.

Bad doctors, good doctors & great doctors

So there’s bad doctoring and good doctoring and great doctoring. What would great doctoring mean? Well in terms of a great priest it would mean being able to imagine what it must have been like to be a child and be abused – what the betrayal of trust was like. A great priest would not shut up just because most of the priests he knew were decent men or because the Vatican told him to shut up.

Almost everyone has been thrilled by Jorge Mario Bergoglio almost precisely because he seemed to have some imagination. He didn’t seem to be a box-ticker in the way Josef Ratzinger was before him. Except on the issue of abuse where imagination seems to have failed him.

Why call these men Jorge and Josef? Because of Chekov’s extraordinary story The Bishop which shows how at ultimate moments someone has to discover that The Bishop or The Doctor was once a boy called Peter or a girl called Petra. Unless that discovery is made, the person remains imprisoned inside the role and their imagination is taken over by others.

Jorge Mario has apparently recently said that one in fifty priests are likely to be pedophiles. Who knows what this means – it does not mean that one in fifty are abusers.

A failure of nerve?

I’d bet there are more Doctor than Father Munchausens around the place. There is far, far more scope for a doctor to be abusive than for a priest.

When it comes to handling abuse, whatever about Jorge-Mario’s failure of imagination, the Vatican is miles ahead of the British establishment and both are way ahead of medicine where perhaps because of all the good doctors abuse is rampant.

The penultimate scene in Calvary is quite remarkable. But what on earth or in heaven is going on in the final scene? Does the movie lose the plot? What would you say if you were the man about to speak into the phone?