The Real Elephant Man

Whether it be the issue of same-sex marriage or refugees and asylum seekers, in today’s society, we are continuously confronted with ideas and beliefs that challenge our own and which require an openness of mind and empathy for our fellow human beings. Just as we celebrate diversity and individuality in our society, the same should be kept in mind by health professionals in their interaction with patients, for patients are much more than what is so often reduced to just a patient ID number and the disease they have.

The hospital is in many ways a microcosm of society, and the doctor-patient relationship is no different to any other human relationship. This is vividly captured in the recent play, ‘The Real and Imagined history of the Elephant Man’, performed at the Malthouse theatre in Melbourne in August this year.

The play is a theatrical adaptation of the story of Joseph Merrick, an English man who developed severe deformities early in life and was displayed in ‘freak shows’ in the late 19th century, after which he lived in an asylum at the London Hospital. His experience with the institution was depicted in the play as a reflection of a broader society which struggled to accommodate difference.

Set against a dark backdrop, the hospital scene sits startlingly harsh as panels of bright white lights flash intimidatingly from all directions. Joseph, acted by a man with disability himself, is stripped down to his underwear and completely deprived of dignity before the public.

In a prolonged clinical examination, measurements of his deformed head and limbs are taken, every abnormal growth on his skin reported in detail, as are the bone deformities of his arm and hip, all presented as if he is nothing more than a curious specimen to be studied and collected. At the close of the exam, the hospital staff shower Joseph with all the possible options to correct his deformities, such as wearing a cast, and correcting his mouth to improve slurred speech.

One of the staff, a woman affected by dwarfism, however questions, ‘did they really needed to fix him?’ and invites us, the audience, to challenge what is perceived as the ‘norm’ in society. Do they really need to enforce all sorts of corrective surgeries to make him what the society accepts as the ‘normal’ figure?

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Similarly, despite advances in our thinking about autonomy, patient consent and respect in clinical practice, the tendency for doctors to do all they can to diagnose and treat patients’ illnesses means that despite being driven by the best of intentions, it is easy to forget that rather than treating the disease, they are treating a person whose disease has an impact on every facet of their life and identity.

Medical students are exposed to the hospital environment early on, which perhaps makes it easy to forget how foreign the hospital environment can be for patients. The rush in the corridors packed with incoming and outgoing patients, family visitors and hospital staff, the large team of doctors, nurses, registrars, interns and medical students who tower over the patient on ward rounds, along with the drawn curtains that do little to ensure patient privacy all seem to make the hospital as intimidating as it can be.

Just as Joseph is stripped naked and examined under such harsh white lights, it is not difficult to understand how the hospital experience may only compound the feeling of vulnerability and detachment patients may feel in a time when they are already physically or mentally fragile.

One of the most powerful moments in the play comes as a nurse attempts to determine if Joseph is mentally ‘sane’ by asking him to say one word that immediately comes to his mind each time, in response to a word she says. Instead of seeking to provide the ‘correct’ answer, Joseph pours out his fears, desires, and long-suppressed feelings about his deformities into a string of disjointed words and images. Ignoring the horror expressed by the nurse at this sign of supposed insanity, the outburst of emotions in fact reflects one of the few moments when he is empowered as a person rather than being the patient, the object or specimen that the others take him to be.

Likewise, in a doctor-patient relationship where the power imbalance is omnipresent, being able to approach the patient at their level to listen to their concerns, medical and otherwise, is important for the patient to feel empowered and in control of their own health and life.

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Later in the play, the ominous harbinger of death who appears at various points of the play to bring people to ‘the other world’, comes to collect the body of the woman affected by dwarfism. The scene is made all the more harrowing as the body collector hurries to preserve the body while making it clear to Joseph the preciousness of such a ‘unique’ specimen for study and collection by museums.

The scene serves as a crude reminder of how easily and frequently a person can be reduced to a condition or disease they happen to have. No, people like Joseph are not ‘interesting cases’, but rather people who happen to have an uncommon affliction that lands them in the medical system more frequently than they would like.

As the play draws to a close, the audience is confronted with a stark contrast to the hospital setting: a scene set outdoors with the stage covered in falling snow. It is at this point, after Joseph has escaped from solitary confinement in the asylum, that he is able to experience nature for the first time. His amazement at his ability to experience the world through all his raw senses and to feel an authentic presence in the world culminates in a deeply emotive monologue whereby he proudly declares himself to be a ‘new species’ defying societal norms and expectations.

We are now 100 years past the time of the play, but it still sends a pertinent message to the contemporary society about our treatment of those perceived as ‘different’ to the norm. In caring for the sick, health professionals should reflect on their own humbling role in their relationship with their patients, and not let themselves forget the person that comes before the patient. More importantly however, as members of an increasingly diverse society, we should be wary of our preconceptions that seek to categorise, rather than liberate people from perceived norms, for perhaps the real elephant man is among ourselves.