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Human traces
  1. D J McLauchlan1,
  2. T A T Hughes2
  1. 1Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
  2. 2Department of Neurology, University Hospital Wales, Cardiff, UK
  1. Correspondence to Dr D J McLauchlan, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Park Place, Cardiff CF10 3XQ, UK; mclauchland{at}cf.ac.uk

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The book club discussion started with a précis of Sebastian Faulks' background; he read English at Cambridge and has a varied palette, writing new instalments of James Bond, as well as Tolstoy-esque works such as ‘Birdsong’. The research for Human Traces took 5 years, leading to the award of an honorary doctorate. The diligence shows in the book; many of our group were surprised that he had no background in science at all.

The book entwines the story of two neurologists starting from their childhood: Thomas Midwinter, who has an interest in literature, and comes to medicine and neurology seeking an understanding of the human condition; and Jacques Rebière, a Frenchman from a poor background, who is drawn to neuroscience in order to discover why his brother Olivier has developed schizophrenia. They meet by chance, stumble across their common enthusiasm, and vow to work together. The book covers a lot of ground; from mental asylums, to the development of neurology in the Salpêtrière. The life stories come together when the protagonists set up in clinic together in the Alps, and the subsequent evolution of their ideas and beliefs is thoughtfully explored within the novel. Ultimately their perspectives clash and their relationship is sundered by an argument over a misdiagnosis. The novel then moves rapidly forward via an African expedition, to the development of their own neurological illnesses and senescence.

Most enjoyed the book, feeling the themes were dealt with well, and the majority of the neurological practice rang true. Many were surprised to discover that the phenomenon of aural hallucinations may occur in people without mental illness.1

One person raised the intriguing nature of the title—suggesting firstly that mental illness can reduce people to ‘traces’ or shadows of their former selves, but also involving the more heartening ideas (from Thomas's time in Africa) that we leave traces all around us, and that we share a common humanity regardless of circumstance.

There were some jarring notes raised by the group; during Jacques' training in the Salpêtrière, the novel obtrusively highlights future ‘names’ within neurology. Considering the number of students who passed through the building, it seems unlikely Jacques would have become personally acquainted with every significant name in French neurology. Perhaps the temptation to show the extent of one's research is too difficult to resist. One of the more upsetting aspects of the book—the death of Jacques's son, appears to have little narrative value and doesn't materially alter the characters' arcs. The novel itself, having explored in detail the early lives of the characters, ends very rapidly, which left some in the group unsatisfied. There was also a slightly odd episode during Thomas's African trip, where he insisted (for no clear reason) on performing an autopsy on a deceased member of the expedition party when the group was in dire straits.

With regard to lessons for clinical practice, there was a clear contrast drawn between Thomas's theories, drawing on verified data and consisting of mostly testable hypotheses, (many now confirmed), and Jacques's ideas which are based on the teachings and thoughts of individuals—‘the Great Man’ approach, now regarded with scepticism. Secondly, we discussed how Thomas feels his life's work has come to nothing as his ideas fell on deaf ears; he is reminded of the value of common humanity in doctoring by one of his patients whom he rescued from the asylum. Finally we talked about the danger in preconceptions and misdiagnosis—the problem of seeing patients within a clinic ‘badged’ for a particular condition can make it appear that everyone in the clinic holds that diagnosis. It is very easy within ‘transient ischaemic attack’ (TIA) clinic to come to the conclusion that everyone has had a TIA. Finally one group member reminded us of the worrying nature of patients with a functional diagnosis accepting a ‘psychological’ explanation—paradoxically a red flag for organic disease.

This work sits well alongside Sebastian Faulks' substantial historical novels: uncovering a wealth of historical detail displayed mostly unobtrusively through the ordinary lives of the characters, whilst exploring themes of what it means to be human and how our minds work. A significant achievement, and worth reading for neurologists and others alike.

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Footnotes

  • Contributors DJM wrote the text based on the discussion at Cardiff book group. TATH reviewed the manuscript and suggested changes.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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