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John Sassall treating patients.
John Sassall treating a patient. Photograph: Jean Mohr
John Sassall treating a patient. Photograph: Jean Mohr

John Berger's A Fortunate Man: a masterpiece of witness

This article is more than 9 years old
In their pioneering book about an outstanding, committed country doctor, John Berger and photographer Jean Mohr provide a timely reminder of how unique, and valuable, British general practice is

First published in 1967, A Fortunate Man is a masterpiece of witness: a moving meditation on humanity, society and the value of healing. It’s a collaborative work that blends John Berger’s text with Jean Mohr’s photographs in a series of superb analytical, sociological and philosophical reflections on the doctor’s role, the roots of cultural and intellectual deprivation and the motivations that drive medical practice. The subject of the book, John Sassall, emerges as an individual deeply committed to inner reflection as well as to his vocation as a physician. When I was a newly qualified doctor it became my habit to give copies as gifts. For years it’s been out of print and increasingly scarce; the habit was becoming expensive.

Early in 2014 I wrote to Berger because I was working on a book about medicine and the human body, and had been struck by the lucidity of his work Cataract, an essay about the renaissance of vision he experienced through cataract surgery. I wanted to ask if he’d let me quote some of his words in a chapter I was writing about the eye. I thought that maybe after a few months I’d receive a reply from an assistant, or more likely, nothing at all, but within a couple of days of posting the request he called me. “Of course you can quote from my books,” he said down the telephone, “but of course!” His enthusiasm was catching, and we struck up a correspondence. I told him how I wished A Fortunate Man was back in print – it was a work considered deeply influential, and one that pioneered the fusion of text and images in photodocumentary – and asked if he’d mind me approaching some publishers to see if they loved it as much as I did. “Of course!” came the reply. “Carry on!”


John Sassall by Jean Mohr

When asked how to approach his work, Berger has often replied: “I’m a storyteller.” “Even when I was writing on art,” he said in 1984, “it was really a way of storytelling – storytellers lose their identity and are open to the lives of other people.” When I asked him how he and Mohr came to write the book, he began by telling me a story.

It started in London, in the early 1950s, when Berger was a commentator on art for the New Statesman. His essays and reviews were unconventional as well as controversial; he had to fight to keep his job. “We received a marvellous piece from an Indian writer called Victor Anant,” he told me, “called ‘An English Christmas’. On the back of the envelope was the return address: ‘Left Luggage Office, Paddington Station’. I jumped on my motorbike and drove over to meet him. He’d not long arrived from Bombay, and this was the first job he’d found.”

Anant, like Berger, distrusted established power; in India he had been imprisoned by the British. The two men became friends and, several years later, when Berger was living in rural Gloucestershire, Anant and his Pakistani wife were drawn to live nearby. Sassall was the general practitioner who attended the two men at that time.

“I became friends with Sassall after going to him with some minor medical problem,” Berger explained. “I used to meet regularly with him and with Anant to play bridge.” The two writers recognised in Sassall an outstanding physician as well as an enthusiast for an unfashionable ideal – the Renaissance dream of aspiring to universal knowledge and experience. As a doctor who sought daily to empathise with people of very different backgrounds and perspectives, Sassall, they perceived, came closer to attaining this ideal than most men or women ever could.

By the mid-1960s Berger had moved to Geneva, but both he and Anant were still in touch with Sassall. One day, Anant suggested that Berger write a book about their friend, his medical practice and his determined pursuit of the universal. Berger again: “‘You know, this man is really remarkable,’ Anant told me, ‘but one day no one will know of him. His goodness will have consequences, of course, but unless you write about him, the specifics of his life and his attitude may not be preserved.’”

John Sassall by Jean Mohr

Mohr was at that time also living in Geneva; a photojournalist with the Red Cross and the United Nations who had done some of his finest work documenting the stateless experience of Palestinian refugees. “Jean is one of the truly great photographers,” Berger told me, “utterly invisible, blending into the background like a lamp-stand – the perfect man to sit in on medical consultations.” Sassall invited Berger and Mohr to live with him and his family for six weeks and, with his patients’ permission, join him night and day in the clinic and on emergency visits.

Afterwards, the two men returned to Geneva and worked in isolation for just a month – Berger recalls the text flowing fairly quickly. “When we got together again, and compared what I’d written with the photographs Jean had chosen, we found we’d replicated one another’s work entirely,” he says. “They were tautologous – as if my text was a series of captions to his images. We had both tried to write the book on our own. That’s not what we wanted at all, so we reworked it so that the words and pictures were like a conversation; building on, rather than mirroring, one another.” Sassall checked the manuscript and made some minor corrections – “medical terminology, technical comments, that sort of thing” – but was otherwise happy with it. In April 1967 the book was published.


The Guardian carried an early review by Tom Maschler, the celebrated editor at Jonathan Cape, placed between a photograph of a Vietnamese baby scarred with napalm and an advertisement for woollen mini-dresses. “It is a beautiful book,” he wrote “John Berger writes with a passion, with an intensity that few writers could achieve.” He was particularly entranced by the way Sassall, as portrayed by Berger, has an insatiable appetite for human experience and imaginatively enters the minds of his patients.

Philip Toynbee, writing in the Observer a few days later, called it “a series of brilliant descriptive sketches … a genuine tour de force, and the admirable photographs of the local countryside and its inhabitants match and illuminate the text with an unusual degree of sympathetic understanding”. Toynbee felt particularly well qualified to comment on the accuracy of Berger’s portrayal of the physician as the book’s subject happened to be his own doctor. “The Sassall who emerges from these pages – both from the text and from the photographs – is indeed the man that I myself have known, liked, and admired for several years. But he is more than the man I know, not because Berger has romanticized him or enlarged him, but because Berger knows him better than I do and has thought about him harder.”

A Fortunate Man is a memorial not just to this exceptional individual but to a way of practising medicine that has almost disappeared. Sassall’s approach to his practice is all-consuming – in today’s culture of working-time-directives and the commercialisation of disease it would be almost impossible to sustain. Sassall has made a Faustian pact: he is rewarded with endless opportunities for experiencing the possibilities inherent in human lives, but at the cost of being subject to immense and, at times, unbearable pressures. These pressures manifest themselves as episodes of profound depression, during which he is overwhelmed by “the suffering of his own patients and his own sense of inadequacy”.

John Sassall by Jean Mohr

The book opens with a series of “case studies”, though the term is too clinical and doesn’t reflect either the emotional subtlety of Berger’s word sketches or the versatility of Sassall’s responsiveness to his patients. They are glimpses of the situations Sassall responds to every day, recognisable to any doctor, but they convey the extraordinary depth of Sassall’s commitment to his patients. They also show how powerful an influence the landscape exerts on the community and its stories. Berger writes in the opening pages: “Sometimes a landscape seems to be less a setting for the life of its inhabitants than a curtain behind which their struggles, achievements and accidents take place.” Within that landscape the community looks to Sassall as a “clerk of records”; the figure to whom they tell their stories: “He keeps the records so that, from time to time, they can consult them themselves.”

Berger and Mohr follow Sassall through these parallel landscapes – the physical landscape of rural England and the metaphorical one of his patients’ lives. The moral possibilities of medical practice are drawn out, without shying away from the risks that doctors such as Sassall run in identifying so closely with those in mental and physical pain. The myth of Faust, the life of Paracelsus, the works of Conrad and the dream of the universal are each examined for the ways they illuminate aspects of Sassall’s motivation. He is compared to one of Conrad’s Master Mariners, though as someone who sets out to compass not the globe but the totality of human experience.

Towards the end, Berger tries to make an assessment of Sassall’s contribution to society, but finds that he cannot. A society that doesn’t know how to value the lives of its people can’t adequately account for the value of easing their suffering. “What is the social value of a pain eased?” Berger asks. “What is the value of a life saved? How does the cure of a serious illness compare in value with one of the better poems of a minor poet? How does making a correct but difficult diagnosis compare with painting a great canvas?” The absurdity of the questions reveals just how far we have to go in appreciating the value of not just art, but life.

In the years after publication, Berger moved to Haute-Savoie, a remote Alpine district in the south-east of France close to the Swiss and Italian borders, in order to live closely with people who worked the land. “I didn’t go to university,” he told me, “the peasants were my university professors.” Like Sassall in rural Gloucestershire, Berger became a clerk of records for the people he lived among. He poured his reflections on their lives into his trilogy Into Their Labours, as well as works such as A Seventh Man: his exposition, again with Mohr, of Europe’s exploitation of peasant migrant labour. As a storyteller, Berger wishes to lose his identity in that of his subject and his readers, just as Sassall sought to lose his in those of his patients. His assessment of Sassall could stand for an assessment of his own life and work: “Like an artist, or like anybody else who believes that his work justifies his life, Sassall – by our society’s miserable standards – is a fortunate man.”

In the 1970s, Sassall’s wife died unexpectedly. At the end of his Observer review, Toynbee confessed to a “quarrel” with Berger for leaving her out of the narrative, though the book is dedicated in part to her: “this racked and pain-haunted man would have collapsed long ago, and perhaps irretrievably, if it hadn’t been for his wife”, Toynbee wrote. “Her role is as archetypal as his.” Following her death, Sassall left the Gloucestershire practice and travelled for a while in China, learning the ways of the barefoot doctors who were then the main providers of medical care in rural China. His death in 1982 deepens the enigma of his life. A careful reading of A Fortunate Man reveals its title to be a paradox; fitting for a study of a man whose very openness to experience – his gift to the world – was also his undoing.


John Sassall by Jean Mohr

A Fortunate Man is almost 50 years old but remains fresh, urgent and relevant; a reminder for physicians and patients alike of the essence of medical practice, of the differences between healing and medicating. The patients Berger describes suffer from the same problems as those visiting my own GP clinic today – depression, cardiac problems, minor injuries – but the landscape of the NHS is utterly transformed from the one Sassall knew. The expansion and technical complexity of modern hospital specialties mean that although 90% of patient contact in the UK occurs in general practice, it receives less than 9% of NHS funding. Berger’s book illustrates how good general practice saves the NHS a fortune by doing things hospitals cannot do – knowing patients well; caring for them in their own homes; managing uncertainty; gauging when and when not to push for a diagnosis. We are in the midst of an epidemic of overdiagnosis, and the NHS is in crisis because our politicians seem to have forgotten what it was set up for and have failed to make the case to taxpayers for resourcing it adequately. A Fortunate Man is a timely reminder of just how unique, and valuable, British general practice is.

There have been criticisms of the book: notably that it lacks humour, and that its portrayal of women in the case studies can, to today’s eye, verge on paternalistic. In its defence I’d argue that medical practice can be a restorative, engaging and deeply affirming for both physician and patient, but rarely funny, and that judged by the place and time in which the book was written, neither Berger nor Sassall hold sexist attitudes (it was written, remember, during the glory years of Dr Finlay’s Casebook). One of the most widely read contemporary books on medical practice was Michael Balint’s 1957 work The Doctor, his Patient & the Illness (note the “his”). To give an example of prevalent attitudes, Balint dismissed the slippery problem of patient confidentiality with: “A patient may recognise himself in the description of his case. This highly undesirable hazard is unfortunately inevitable … to miminise this risk we confined our selection to case histories of patients who were thought unlikely to read this book.”

In trying to assess Sassall’s qualities as a physician Berger wrote: “He is acknowledged as a good doctor because he meets the deep but unformulated expectation of the sick for a sense of fraternity.” This quest for recognition has rarely been articulated so beautifully. Back in 1967, Maschler concluded his Guardian review by saying simply: “I am grateful for it.” I, too, am grateful: to Anant for suggesting the book in the first place, to Berger and Mohr for crafting such a masterpiece, and, of course, to Sassall, and his family, for permitting the intimate details of his life and attitudes to be set down.

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