Human Diagnostics

In the September 23, 2021, issue of the magazine, Gavin Francis considers three books about the ways we’re in thrall to digital technologies, and how they’re affecting our mental health. In his review, Francis writes that during the pandemic, our devices have been “both boon and curse, strengthening opportunities to connect even as they can deepen a sense of isolation.”

Francis writes regularly for the Review and The London Review of Books on medicine and psychiatry, often drawing on his experience as a general practitioner at a small clinic in Edinburgh, Scotland. In an e-mail this week, composed while waiting in line for his flu shot and Pfizer booster, Francis tells me he thinks of his two careers “as the left and right foot of a steady gait”:

Medical practice is very full, busy, dynamic, active; it incorporates all sorts of roles and traditions, and demands of you that you engage in a series of profound and potentially very upsetting encounters…. For me, time spent writing my own books and pieces is very different from the experience of the clinic—it’s liberating, calm, meditative, reflective, silent. It asks of me that I try to create the most eloquent and elegant sentence I can to convey a particular idea or experience.

If I work too many days uninterrupted as a doctor, I start to get compassion fatigue; if I spend too many days writing in the library, I get agitated, dissatisfied, and miss the direct contact with people. And so I’ve tried to find a balance that suits me, where I go from one to the other, and that way I seem to find them mutually restorative.

His first ambition, when he was a child, was to be a geographer and make maps. But it was medicine that ultimately gave him a way to travel the world, as well as a path into writing. While stationed at Halley Base in Antarctica as a medical officer with the British Antarctic Survey in 2003, with penguins for paltry company, he journaled constantly. It seemed an opportunity to “write the book that I’d most want to pick up and read,” he says, and the experience provided the material for Empire Antarctica (2012). Another frozen trip, between the Shetland Islands and Svalbard, became his first book, True North (2008).

Every so often, he spends a week in the Orkney archipelago, administering care to a community of a few hundred. There he’s on call round the clock, “but with a lot of time to think too, as well as read.” He devoted his book Island Dreams (2020) to the particular solace and desolation of islands, which have always attracted him for their promise of psychic escape. He wrote it during 2019, and hardly knew how timely these themes would be when the pandemic began. But lockdown has imposed a different sort of isolation, more akin, Francis says, to imprisonment:

The psychoanalyst Donald Winnicott wrote that we all need a little isolation, particularly in adolescence—that it helps us develop as individuals and define ourselves as distinct from our parents, and our peers. It helps to consolidate our personalities. But with too much isolation we become insulated from the world.

Life in lockdown is not natural for the majority of Homo sapiens—we’re a sociable, gregarious species—and in the ballooning of mental health problems this year, we’ve seen just how deleterious those kinds of restrictions are.

While intensive care units have been overwhelmed by Covid-19, general healthcare has also been burdened, in ways less visible—particularly by the mental health crisis that has touched every part of the community, in the form of addiction, depression, and anxiety. Since the pandemic began, Francis writes in his review, he’s seen far more patients “strung out with Internet anxiety, sleepless with digital overload, having difficulty distinguishing what’s real from what’s virtual.”

In his most recent book, Intensive Care, published earlier this year, Francis highlights this other front, in which he has spent “the most intense months” of his career. “I wanted to shine a light on the kind of care I’ve seen throughout this pandemic delivered more quietly, without headline news, in rural village streets and community clinics.”

The quality of this care has been compromised despite the best efforts of health workers. In-person consultations with patients—in Francis’s experience, “the best part of medicine, both inspirational and enjoyable”—have been replaced by video calls. Telemedicine, in his view, can’t compensate for more human diagnostics:

When I trained in medicine, I was encouraged very much to value non-verbal aspects of communication with my patients—to pay attention to body language, to silences as much as to words, to what the patient is not saying as much as what they are saying…. The problem that is posed as a patient stands with a hand on the door handle to leave is often the most important one.

After the stress of the last eighteen months, Francis’s thoughts have turned to the long toll of Covid-19 on society, and the need for recovery and convalescence—subjects he will explore in his next book. “I realized I was spending a lot of my time talking to my patients about aspects of recovery that I take as self-evident, but were clearly not self-evident to them,” he says. “So I decided to gather all my thoughts, from almost thirty years of medical practice, into one place.”

His simplest prescription—and perhaps the secret to his writing life—is to unplug. Francis leaves his “pocket panopticon” on the kitchen counter and keeps his screen time down to an hour a day. “There’s always plenty to do with spare time, isn’t there?” he says. “Reading the NYRB and the LRB takes plenty of mine, as well as whatever research I’m doing for my own work, as well as novels, poetry, news, and keeping up to date in medicine. I don’t want for reading material offline.”