QOTM
Because I've been reminded of this by recent discussions in other journals (especially nellorat's), here's Dorothy L. Sayers, from her 1941 book Mind of the Maker, in the "Problem Picture" chapter (in which she is discussing both theology and detective stories):
2. The detective problem is completely soluble: no loose ends or unsatisfactory enigmas are left anywhere. The solution provides for everything and every question that is asked is answered. We are not left with a balance of probabilities in favor of one conclusion or another; nor does the fixing of the crime on the butler involve the detective in fresh enigmas connected with the cook. Such uncertainties may appear to arise in the course of the story, but they are all cleared up in the end by the discovering of the complete solution. It should not be necessary to point out here that this happy result proceeds from the simple fact that the author has been careful not to ask the questions that the solution will not answer.
Now, our tendency to look for this kind of complete solution without lacunae or compensatory drawbacks badly distorts our view of a number of activities in real life. Medicine is a good example. We are inclined to think of health in terms of disease and cure. Here on the one hand is (we think) one definite disease, and there, on the other hand, should be the one, definite and complete "cure." Apply the cure to the disease, and the result ought to be an exact "solution" of the "problem" presented. If the physician cannot name the disease on sight and immediately produce the prescribed cure, we feel resentfully that the man does not know his business.
In the same way, there used to be a firmly-rooted belief that to every poison there existed "the antidote"--a benevolent drug which would exactly reverse, each by each, the effects of the original poison and restore the body to the status quo ante. There are in fact, I believe, only two drugs which are complementary in this way, atropine and physostigmine (incidentally, neither of them is "benevolent"--both are deadly poisons). With other drugs which are used to counteract one another, the reversal of the effects is only partial, or is rather a counteraction of the symptoms than a healing of the mischief done to the organs. In most cases, the usefulness of the curative drug is only to hold off or mitigate the effects of the poison until the body can summon its physical resources to cure itself. In certain instances, one disease can be got rid of only at the cost of contracting another, as in the malaria treatment of syphilis. Or the treatment demanded by--let us say--a diseased condition of the lungs may be impossible for one particular patient, because his constitution could not stand its violent effects upon the heart.
We have, perhaps, abandoned the superstitious belief in antidotes; but we continue to hug the delusion that all ill-health is caused by some single, definite disease, for which there ought to be a single, definite and complete cure without unfortunate after-effects. We think of our illness as a kind of cross-word of which the answer is known to somebody: the complete solution must be there, somewhere; it is the doctor's business to discover and apply it.
But the physician is not solving a cross-word: he is performing a delicate, adventurous, and experimental creative act, of which the patient's body is the material, and to which the creative co-operation of the patient's will is necessary. He is not rediscovering a state of health, temporarily obscured; he is remaking it, or rather, helping it to remake itself. This may indeed be looked upon as a problem; but it is not the same kind of problem as that presented by those in the algebra-book: "If a cistern is filled by pipes A and B in 25 and 32 minutes respectively"; and the answer is not likely to be so precise or to cover all the conditions so satisfactorily.
The patient's best way to health and peace of mind is to enter with understanding into the nature of the physician's task. If he does so, he will not only be better placed to co-operate creatively with him, but he will be relieved from the mental misery of impatience and frustration.
2. The detective problem is completely soluble: no loose ends or unsatisfactory enigmas are left anywhere. The solution provides for everything and every question that is asked is answered. We are not left with a balance of probabilities in favor of one conclusion or another; nor does the fixing of the crime on the butler involve the detective in fresh enigmas connected with the cook. Such uncertainties may appear to arise in the course of the story, but they are all cleared up in the end by the discovering of the complete solution. It should not be necessary to point out here that this happy result proceeds from the simple fact that the author has been careful not to ask the questions that the solution will not answer.
Now, our tendency to look for this kind of complete solution without lacunae or compensatory drawbacks badly distorts our view of a number of activities in real life. Medicine is a good example. We are inclined to think of health in terms of disease and cure. Here on the one hand is (we think) one definite disease, and there, on the other hand, should be the one, definite and complete "cure." Apply the cure to the disease, and the result ought to be an exact "solution" of the "problem" presented. If the physician cannot name the disease on sight and immediately produce the prescribed cure, we feel resentfully that the man does not know his business.
In the same way, there used to be a firmly-rooted belief that to every poison there existed "the antidote"--a benevolent drug which would exactly reverse, each by each, the effects of the original poison and restore the body to the status quo ante. There are in fact, I believe, only two drugs which are complementary in this way, atropine and physostigmine (incidentally, neither of them is "benevolent"--both are deadly poisons). With other drugs which are used to counteract one another, the reversal of the effects is only partial, or is rather a counteraction of the symptoms than a healing of the mischief done to the organs. In most cases, the usefulness of the curative drug is only to hold off or mitigate the effects of the poison until the body can summon its physical resources to cure itself. In certain instances, one disease can be got rid of only at the cost of contracting another, as in the malaria treatment of syphilis. Or the treatment demanded by--let us say--a diseased condition of the lungs may be impossible for one particular patient, because his constitution could not stand its violent effects upon the heart.
We have, perhaps, abandoned the superstitious belief in antidotes; but we continue to hug the delusion that all ill-health is caused by some single, definite disease, for which there ought to be a single, definite and complete cure without unfortunate after-effects. We think of our illness as a kind of cross-word of which the answer is known to somebody: the complete solution must be there, somewhere; it is the doctor's business to discover and apply it.
But the physician is not solving a cross-word: he is performing a delicate, adventurous, and experimental creative act, of which the patient's body is the material, and to which the creative co-operation of the patient's will is necessary. He is not rediscovering a state of health, temporarily obscured; he is remaking it, or rather, helping it to remake itself. This may indeed be looked upon as a problem; but it is not the same kind of problem as that presented by those in the algebra-book: "If a cistern is filled by pipes A and B in 25 and 32 minutes respectively"; and the answer is not likely to be so precise or to cover all the conditions so satisfactorily.
The patient's best way to health and peace of mind is to enter with understanding into the nature of the physician's task. If he does so, he will not only be better placed to co-operate creatively with him, but he will be relieved from the mental misery of impatience and frustration.