Paul Valéry, the French poet and polymath, believed that we all have three bodies and suffer because we cannot bring them together. The best doctors, I suggest, pay attention to all three bodies, but most doctors, I fear, restrict themselves to one of the three.
The first body, argued Valéry, is the one we live in, the one that is us. For us all, “it is the most important object in the world.”
The second body is the one seen by the world, the façade. It is, said Valéry, “the body which has form and is appreciated in the arts, the body on which materials, ornaments, armour sit, which love wants or wants to see, and yearns to touch.” Titian and other great artists painted this body.
The third body is the hidden machine, the organs we know we have but never see. We know about it “only for having dissected and dismembered it…nothing leads us to suspect a liver or kidney.” This is the body that interests us the least, but it is, of course, the body that is best known to doctors.
Indeed, most doctors feel uncomfortable with the other two bodies. John Berger in his book The Fortunate Man described how the fortunate man, the rural GP, felt uncomfortable doing anything around a patient’s eyes because that’s where we live, behind the eyes. He was coming too close to the first body, a body that is subjective, one that many doctors think lies beyond their territory.
Then the second body carries all sorts of threats for doctors. They mustn’t be appalled by the ugly or attracted to the beautiful. I learnt about Valéry’s ideas in Nancy Etcoff’s extremely interesting book Survival of the Prettiest: the Science of Beauty. Her argument, which she ably supports, is that “beauty is a universal part of human experience, and that it provokes pleasure, rivets attention, and impels actions that help ensure the survival of our genes.” Beauty matters. Those that have it do better than those who don’t. “In the United States,” writes Etcoff, a Faculty Member at Harvard Medical School, “more money is spent on beauty than on education or social services.” (I’m not sure how she arrives at that statement, but if clothes, jewellery, perfumes, cosmetics, soap, toothpaste, hairdressing, and cosmetic surgery are included it’s believable.)
We want, believes Etcoff, “to be not only works of nature but works of art.” We want our three bodies to be a unified whole, which means a lot of work on the second and hoping that the third doesn’t let us down by some vital organ failing. Doctors are not sympathetic to work on the second body.
Dermatologists don’t believe themselves to be concerned with the second body but the third, doing what they can to cure skin disease, but reluctant to mess with beauty. Cosmetic surgeons may enter the territory of beauty, but the profession gives little respect to those who operate on faces, noses, and breasts to make patients happier with their second bodies, preferring plastic surgeons who battle the ravages of fire and cancer. And do those cosmetic surgeons who try to beautify second bodies give enough consideration to first bodies? I doubt it.
But the best doctors surely deal with whole people, which means not only their minds and social life but also all three bodies—extending beyond the third to connect with the subjectivity of the first and showing a willingness to help as best they can with the second.
Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.