What the Doctor Saw is a fascinating, valuable compendium of observations and reflections on medicine in Ireland and the broader world, presented by one of Ireland’s foremost medical commentators, Dr Maurice Guéret. Dr Guéret is a registered specialist in general practice and member of the Society of Medical Writers. He was previously health columnist at Image magazine and his work has appeared in various medical newspapers including the Irish Medical News and Trinity Medical News.
What the Doctor Saw comprises various articles and columns written by Dr Guéret between 2003 and 2013. Some of these pieces are previously unpublished while others already appeared in print elsewhere, especially in Dr Guéret’s Rude Health column in the Sunday Independent’s Life Magazine. For the purposes of the book, some of the pieces have been re-edited somewhat, with postscripts and footnotes added where appropriate.
The topics covered in What the Doctor Saw are as diverse as they are involving. They range from ‘Patient Bloopers’ to ‘the Irish Daddy’, from ‘Celebrity Doctors’ to syphilis (‘A Pox on the EU’), and from the ‘Nobel Prize for Medicine’ to ‘Suicide Bombers’. The heart of the book, however, lies in Dr Guéret’s thoughts and reflections on clinical medicine and the Irish health service.
There is an extraordinary richness of articles here to choose from, but, for me, some of the most outstanding articles dealt with compensation for individuals affected by thalidomide, ‘the Health of Travellers’ and ‘Antibiotics and Probiotics’. There is also an especially interesting piece about ‘How Doctors Think’, a topic of perennial interest. Perhaps predictably, though, as a psychiatrist, I was especially interested in Dr Guéret’s reflections on the history of psychiatry and specific aspects of mental health care in Ireland and elsewhere.
Thoughts on the history of psychiatry
The cover of What the Doctor Saw displays a photograph of the author’s maternal grandfather, Dr William J. Coyne, chief psychiatrist and resident governor of the Central Mental Hospital (CMH), Dundrum, Dublin. The CMH is an extremely interesting institution that finds it early roots in the Lunacy (Ireland) Act 1821, which directed that applications for admission to general psychiatric hospitals needed to be accompanied by a medical certificate of insanity and a statement from next-of-kin confirming poverty; applications were then considered by the physician and manager of the asylum, and presented to the Board for acceptance.
The 1821 legislation also, however, directed that individuals who were insane at the time of a crime could be acquitted in court but detained in indefinite custody at a psychiatric institution ‘at the pleasure’ of the Lord Lieutenant. Individuals who were insane at time of indictment could also be so detained. To facilitate this, the Central Criminal Lunatic Asylum was opened in Dundrum, Dublin in 1850 under provisions of the Central Criminal Lunatic Asylum (Ireland) Act (1845, 1846) to provide ‘a central asylum for insane persons charged with offences in Ireland’ and detained indefinitely under this legislation. The hospital later became known as the CMH.
Dr Guéret’s grandfather, Dr Coyne, was resident at the CMH between 1948 and 1965, after first gaining experience in psychiatry at London’s Bethlem Royal Hospital (Bedlam) and the private Chiswick House asylum. After working at Mountjoy Prison, Dr Coyne moved to the District Mental Hospital in Monaghan before completing a Diploma in Public Health in 1945 and commencing work at the CMH shortly afterwards. Dr Guéret’s account of the CMH during this period is truly fascinating, replete with intriguing clinical and political insights, such as his grandfather’s reluctance to accept Nurse Cadden as a patient in 1958, and Dr Coyne’s annual encounters with the public accounts committee of the Oireachtas.
Dr Guéret also addresses other topics of relevance to psychiatry in What the Doctor Saw, including, for example, interesting essays about Sigmund Freud (Happy Birthday Sigmund Freud) and electro-convulsive therapy (75 Years of Electro-Convulsive Therapy). Some of the postscripts that Dr Guéret has added to these essays are very interesting indeed. Following his essay on ‘The Irish Lobotomy’, for example, Dr Guéret writes that he received a letter from an elderly man in the North West of Ireland who had a lobotomy as a young man for an obsessional condition and ‘never looked back’. Dr Guéret also received a letter from a retired physician who wrote that a ‘female civil servant patient’ of his had also done well following lobotomy. While lobotomy was rightly abandoned as a routine procedure several decades ago, it is still extremely interesting to hear these reports.
What the Doctor Saw
What the Doctor Saw arrives festooned with praise from various sources. Dr Paul Carson, the international best-selling author, writes that the book ‘pulls together a collection from Irish medicine’s sharpest, funniest and most incisive writer. I’ve read with envy many of his pieces over the years’. Brendan O’Connor, host of RTE’s Saturday Night Show, says that ‘Maurice Guéret is about the only doctor I trust. His humanity is made bearable by a sharp edge, healthy cynicism and a real love for medicine’.
It is, perhaps, this ‘real love for medicine’ that shines most brightly through these articles, columns and reflections. Dr Guéret’s concern for reasonable, effective and humane health care is a central and recurring theme, and one to which his columns make a significant contribution, with their trademark mixture of insight, wit and critical thought. There is a real role for this kind of writing and thinking in both Irish medicine and the Irish media more generally: health is a topic of constant interest in mainstream media, and the more sensible and informed comment that can be delivered, the better it is for all.
