The art of controlled violence – Henry Marsh at Swindon Festival of Literature

12 May

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Henry Marsh, eminent neurosurgeon and author of Do No Harm had a rather unorthodox entry into his profession. Yes he went to Oxford University so his brains were never in any doubt but, as a self-confessed ‘self-dramatising teenager’, he chucked it all in for love, found himself a job as a hospital porter and wrote bad poetry.

Although he’s ‘always hated hospitals’ he was drawn to surgery – “controlled violence appealed to me. I’m a violent person.” Fortunately for his future patients (and possibly lovers of verse) he ditched poetry: “Unlike the Vogons of The Hitchhiker’s Guide to the Galaxy, I realised it was bad and gave it up.’

The title of the book gives clue to the constant dilemma faced by doctors and surgeons. Henry expresses his belief in euthanasia; with head injuries he makes decisions whether or not to operate, based not on the probability they will live but if they will have quality of life. It affects his peace of mind: “If I say ‘yes’, I can sleep; if I say ‘no’, I’m awake, worrying that I made the wrong choice.”

He has decided he can live with being a few percent wrong if it means there are less severely disabled people in the world, patients in a persistent vegetative state, and the effect this will have on their families and communities. Controversial stuff but, like a patient with a good doctor, I trust his compassionate pragmatism.

He described the acting skills of doctors. This reminds me of the advice I was given as a public speaker – pretend confidence and your audience will have confidence in you, which makes you confident. Doctors have to act like they belong on a pedestal to protect their patients and themselves; unfortunately this can lead to aloofness and arrogance.

Detachment versus compassion. The life of a surgeon (and all medical staff) is to find that balance and achieve professionalism.

He talked about his love of the NHS and the fun he makes of its bureaucracy; his hatred of hospitals, especially big hospitals which go beyond our brains hardwired capacity to work most effectively in communities of 150. He’s grateful for his life experience before his medical career because he’s seen life from the other side of the bed. Patients need peace and rest and they have neither in modern hospitals; architects still design old-fashioned hospitals with big bays, which only seem like the future because they are new and shiny.

He told us the NHS is the most efficient way of delivering healthcare; costing two and a half times less than in the US, and is more effective. He doesn’t understand the current government’s constant carping about increased efficiency or that none of the political parties come clean to the fact that: ‘the NHS is broke’.

Henry answered each of the audience questions at length with enjoyable detours, leaving Festival director Matt Holland shuffling fruitlessly backwards and forwards to the mic, his track record in punctual time keeping under threat.

Matt needn’t have worried; every word and tale was a gem, delivered by an authoritative speaker tempered by the knowledge of his own limitations. No, he couldn’t tell what was wrong with a brain by looking at it, he relies on brain scans. Kant was right: “Two things fill the mind with ever new and increasing admiration and awe…the starry heavens above me and the moral law within me.”

Henry told us that every thought and action is created by a physical process, which makes it hard for him to have religious faith. He can delve into brains, with their thousands upon thousands of cells, and fix them, often without knowing why, only that it works.

There’s several questions I want to ask him: how is he violent? What does he think of the theory of working and longterm memory and that our minds are simply lots of stored knowledge? Are the best surgeons psychopaths? I decide to ask him if he has a theory on how human speech developed, compared to other primates. He replies: “I haven’t a clue. I’m just a neurosurgeon. What a fascinating question.”

PS. Once again I’m reminded of the Swindon Literature Festival event on boxing, previously with educational theorist Daisy Christodolou and the importance of repetition in creating skill. And in this one: the idea of composure, acting a part and the importance of controlled violence. Brain surgery, boxing, education. Seems we’re not so different.

Henry Marsh was speaking at the Swindon Festival of Literature 2015, today at Swindon Arts Centre.

Words by Louisa Davison. Photos (c) Calyx Pictures.

One Response to “The art of controlled violence – Henry Marsh at Swindon Festival of Literature”


  1. Public Intellectual is not a dirty name – Suzannah Lipscomb at Swindon Festival of Literature | Festival Chronicle - 17th May 2015

    […] Alan Johnson, Roman Krznaric, AC Grayling, Daisy Christodoulou, Danny Dorling, Peter Tachell, Henry Marsh, Robert Hewison, Julian Spalding, Jacqueline Rose, Jules Howard – and boxing trainer Paddy […]

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