A Fortunate Man

A book-length essay with photographs by Swiss documentarian Jean Mohr, British author John Berger’s A Fortunate Man (1967) reflects on the life and practice of John Sassall, a local doctor in an impoverished, rural area of England. As well as providing a biographical study of Sassall, the essay examines the nature of community and the function of healthcare in a community’s life. Scattered quotations from thinkers including Josef Conrad, Michael Balint, Jean Piaget, Jean-Paul Sartre, William Butler Yeats, and Antonio Gramsci point toward the broader political and philosophical implications of Berger’s argument.

The essay opens with an introduction to the Forest of Dean, Gloucestershire, the area in which Sassall practices. Whole-page photographs reveal a wild area, both bleak and bucolic, a place where the power of nature is felt strongly by its inhabitants. Berger’s accompanying text stresses that landscapes can be “deceptive,” hiding one reality by seeming to reveal another.

Sassall is introduced at the scene of an accident. A local man—a forester like many of the local men—is trapped under a fallen tree. Berger documents how Sassall’s mere presence helps to calm the anguish of onlookers. This incident is followed by a number of “case studies,” illustrating the variety of incidents Sassall deals with on a daily basis, and the variety of patients with whom he is called upon to empathize.



Alongside these case studies, Berger begins to unfold Sassall’s personal history. He traces the doctor’s stoic manner to his boyhood reading of Joseph Conrad’s sea-novels. Berger returns to this connection in oblique ways throughout the text, portraying Sassall as an adventurer in human experience and feeling, as Conrad’s heroes were sea-adventurers.

Berger observes that Sassall began his medical career in a very different role than that of a country general practitioner. Instead, he was intoxicated by emergency surgical interventions, feeling impatient with the vagueness and diagnostic difficulties of everyday medicine.

However, as he matured, Sassall began to recognize the value of the experience he could gain by empathizing closely with patients and entering into their lives. After some years in general practice, Sassall’s interest in the lives around him led him to the study of Freudian psychoanalysis. Attempting self-analysis brought on a period of depression, from which Sassall emerged refreshed and more able to serve his community. Berger speculatively compares this experience to the period of solitary crisis traditionally undergone by apprentice shamans in indigenous societies. Berger’s discussion of Sassall’s self-analysis is accompanied by one of the book’s few close-up portraits of Sassall’s face.



Most of the book is given over to intimate descriptions (and images) of Sassall’s work with patients. Berger captures the intimate paternal or fraternal tone Sassall adopts with the people in his care, describing the image of eccentric outsider which Sassall cultivates, in order to remain outside the social hierarchies which might otherwise restrict his ability to work with everyone in his community. Berger also notes small acts of care, such as Sassall’s habit of putting an electric blanket on his examining couch 15 minutes before a patient arrives.

Berger describes how Sassall incorporates the whole life-history and circumstances of each patient into his diagnosis. He recounts a consultation with a 16-year-old girl. Sassall first tackles with tact and compassion the fact that the girl is pregnant. Next, he addresses what he sees as the underlying cause of her pain: her job is too physically demanding. He offers to phone the Labor Exchange on her behalf to help her find a more suitable job. Meanwhile, he offers her soothing words that, for Berger, speak to his therapeutic understanding of the human mind.

Mohr’s photographs show Sassall at work, performing tasks from bandaging a wound to manipulating an injured muscle. Some photographs find him in his surgery; others are taken in the varied homes of his patients.



Having described Sassall’s life and work, Berger moves on to address more abstractly what it means to be a “good” doctor.  He argues that Sassall demonstrates how medicine can be a vehicle for compassion and solidarity as well as physical care. He stresses that in the context of community general practice, the “scientific” approach to medicine is incomplete. In any case, the “data” of a patient’s life and suffering is often too ambiguous to admit hard scientific conclusions. Berger also highlights the value of Sassall’s holistic approach to diagnosis, which makes the patient the central “character” of the medical story, and not the heroic doctor.

Finally, Berger turns to the political implications of what he has learned from Sassall. He asks how far medicine is shaped and limited by the social and economic structures in which it takes place. He points out that any attempt to objectively assess Sassall’s “contribution” to society would be hopelessly inadequate. How, he asks, can we value kindness when we don’t value the lives of those to whom kindness is shown?