These days it is considered unusual to be both a doctor and a writer. This might have surprised Avicenna, Galen, Maimonides, Copernicus, Paracelsus, Rabelais, Sir Thomas Browne, Henry Vaughan, John Keats, Friedrich von Schiller, Georg Büchner, Mikhail Bulgakov, Anton Chekhov, Louis-Ferdinand Céline, W Somerset Maugham, Margaret Todd, William Carlos Williams, Arthur Schnitzler, Stanisław Lem, Janet Asimov and countless others. Still, there is a difference between a doctor who writes medical treatises and a doctor who writes absurdist fiction. Do we want our heart surgeon to be an anti-realist? Besides, physician-authors have not always excelled at their own PR. Bulgakov described his fellow medics as ‘casual untalented hacks’; Céline said they were like ‘gas station attendants’. Keats, meanwhile, was told to give up poetry and stick to medicine, on the grounds that it is ‘a better and a wiser thing to be a starved apothecary than a starved poet’.

Iain Bamforth is a doctor, a poet and a philosopher. He jokes that this may be why he has lost all his patients. His works include five collections of poetry and A Doctor’s Dictionary (2015), a medical-philosophical abecedarium. The title of his latest book is inspired by Géricault’s studies of amputated limbs, while also alluding to disiecta membra, the term used to describe fragments of ancient manuscripts, and invoking the scattered words of poets. It is a book of observations and aphorisms, roughly concerned with medicine and the dreamlike business of being a mortal self.

What is health anyway, when everyone dies in the end? The World Health Organization defines it as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. This is a long way from the attitude of the ‘last of the great Bakhtishu family of physicians, around the year 1000 in Baghdad’, writes Bamforth: they found that the perfect state of health ‘does not exist’. What about Schopenhauer and his definition of humanity as a synthesis of the infinite and the finite?

Acutely aware of the overarching weirdness of all of the above, Bamforth has created a fascinating ‘medical dreambook’, full of night terrors and waking visions. He dreams of ‘rales’ and ‘crépitations’, crackles in the lungs heard via stethoscope. He dreams of Thomas Mann and his magic mountain, where Hans Castorp meets Dr Hofrat Behrens, aka Rhadamanthus, judge of the dead. Then there’s Thomas De Quincey, troubled by opium dreams of ‘faces upturned to the heavens: faces, imploring, wrathful’, and Chopin, Wilkie Collins and Schopenhauer (also opium fiends) plagued by a shared nightmare that they might be buried alive.

Perhaps inevitably, Jorge Luis Borges makes an appearance. In his story ‘Funes the Memorious’, a boy strikes his head and wakes with extraordinary powers of recall. ‘He can reconstruct a whole day,’ writes Bamforth, ‘though doing so would take him another.’ As a result he is ‘sealed in a kind of echo chamber’. This has resonances with another story by Borges, ‘The Aleph’, in which the narrator finds a ‘small iridescent sphere of almost unbearable brilliance’ in his friend’s basement, in which he can see absolutely everything that has ever happened and will ever happen in the future. This is horrifying but also quite dull, since nothing can ever surprise him again. What of the weary doctor, asks Bamforth, damned to a form of mortal omniscience, knowing in seconds whether a patient will live or die? This brings him to Luis Buñuel, who ‘liked to imagine a little algorithmic device that would be able to predict the ending of every Hollywood movie based on information provided by the first few scenes’. Yet Bamforth knows that algorithms can fail. There are echoes of ‘Funes the Memorious’ throughout this book. Towards the end, the story is described all over again, as if Bamforth has forgotten he mentioned it earlier. This is most probably ironic. If not, it is a perfect Borgesian mistake.

In Medical Nemesis, Ivan Illich argued, paradoxically, that medical practice can damage society. Bamforth also has a sceptical view of his own discipline: ‘We are living, at least in the West, in the days of the health religion. And whoever doubts it is a blasphemer.’ In general, we have ‘embraced the … crassly reductive trend of extreme biologism or “mindlessness.” This is what you get when you adopt the Cartesian position on the mind-body but refuse to incur its somewhat inconvenient metaphysical baggage.’ The contemporary belief, Bamforth argues, is ‘that technology is bringing us closer and closer to the very nature of material reality’. Yet ‘we are in fact slipping more and more into the realm of representation’.

According to his acknowledgements, Bamforth sent this book off to the printers on 31 January 2020, before the pandemic fully emerged in the West. Yet many of his observations seem bleakly apposite, even prophetic. For example: ‘Just as human illness needs to take account of emerging zoonotic diseases and their relationship with the environment … mental illness needs to consider psychological, biological, personal, familial and social aspects of the person.’ I would like to know what he thinks about the ongoing catastrophe. At one point he takes a line of Claudio’s in Measure for Measure, ‘the miserable have no other medicine but only hope’, and inverts it: ‘the miserable have no other hope but only medicine.’ Bamforth’s disturbing, brilliant and wildly original dreambook is the perfect philosophical companion for our current crisis.