It has been my privilege over the past years to lead an SSU for Medical students in Exeter and Plymouth (UK) on the theme of Medical Facts and Myths into Historical Crime Fiction.
Khalid Hasssan, one of the students has kindly offered to share his thought provoking essay with the crime writing fraternity (and sisterhood).
“Do crime fiction writers have a responsibility to eliminate medical inaccuracies? Khalid Hasssan © 2019/2020
This discursive essay explores the reasons for including medical inaccuracies in crime fiction and other genres, as well as the responsibility of authors to eliminate them. When including medical information in their work, crime fiction authors will often perpetuate certain myths. Such myths have continued for many years even after their accuracy has been debunked. The myths are used as plot devices and as a way to create a more interesting story. Occasionally they are accurate, but they will become outdated. Crime fiction authors should not be held accountable for their work as many other artists perpetuate myths. Currently, such work is unregulated as it is entertainment and art. There are certain myths that authors have a social responsibility to remove as they are harmful to the population.
At first, I could not find any sources when using the terms, ‘medical accuracy fiction’ when searching Trip, PubMed or the Cochrane Library. I then replaced ‘medical’ with ‘scientific’, as the two are inextricably linked, and again found no results. I eventually found results by searching Google. This yielded 3,230,000 results. After narrowing this down to results to the past 15 years, the search yielded 400,00 results. This would guarantee that modern crime fiction was also included. Only the first page of ten results was appropriate to this essay. Searches for critical theory used the term ‘verisimilitude’ with no date restrictions, as many important critical texts were written in the 20th century. Any references to films or books are from my previous knowledge. I could not find any articles about imitability of medical inaccuracies. This may be because I do not have access to other databases, or because no research yet exists. All searches were undertaken in February 2019.
Crime fiction has continually been one of the most consumed genres of literature (Hannah, 2018). It captivates the reader by using medicine, police procedure, and historical settings. These are all fascinating to the reader taking them out of their comfort zone. This allows them to act as voyeurs without being in any danger themselves. However, all fiction has inaccuracies. Otherwise, there would be no point in creating it since real life would be just as interesting. Although sometimes, the inaccuracies are so wrong that they remove any verisimilitude (suspension of disbelief) (Sparshott, 1967), leaving the enthusiast unable to enjoy the story.
A popular example of medical myth in crime fiction can be found in Hergé’s The Adventures of Tintin (1929-1976), a children’s comic series. A running gag in the series is that the lead character is incapacitated several times over the course of the series. Usually, the methods are a sharp blow to the head, or via a chloroform doused rag over his mouth, knocking him out instantly. These methods would in fact either kill him or leave him with life-changing injuries. Instead, he regains consciousness a short while later. The length of time is always convenient enough for the attacker to finish their business and make a getaway (Caumes et al., 2015).
Both of these methods are over-represented in crime fiction. In actual fact, if someone were to be struck on the head hard enough to be knocked out, any period of unconsciousness longer than two minutes would cause serious brain damage (‘Severe head injury’, 2017). In addition, chloroform would not work without sustained exposure. It also has harmful effects on the liver and kidneys (‘ATSDR – Public Health Statement’, n.d.).
Would it be fair to have asked Hergé to depict the incapacitations accurately? The fact here is that violence and drugging are both illegal in their own right, and any characters doing this would either be villains or committing other crimes anyway. There does not appear to be any research on the imitability of inaccurate medical practices in literature, but there are arguments that children will imitate cartoon violence (Kirsh, 2006). This may be because in cartoons there are generally no lasting consequences. It may also be because cartoons and comics are a more visual medium than literature. In this country, films are age classified but books are not. This idea of imitability does not necessarily translate to the genre of written crime fiction.
It can be argued that the quality of writing is the primary responsibility of the crime writer. The use of chloroform in crime fiction is merely a plot device, like the ‘red herring’, used to distract the reader from an important point (‘Red Herring – Examples and Definition of Red Herring’, 2013). It is used to render someone unconscious quickly. An author could probably just as easily use a bouquet of roses to incapacitate their character. However, it is a convention that stops them from doing so and convention that allows the myth to propagate. Readers will know that the scent of a rose does not have such properties. The very fact that chloroform is an inaccessible ‘chemical’ adds authenticity to the trope, without actually being medically accurate. It is a technique wielded in the same way that handheld camera shots added realism in Cinema Verité, ‘a movement of documentary cinema in the 1960s’ (Sturken and Cartnight, 2000). The mere mention of chloroform will prepare the reader to expect its use later in the story. This is a dramatic principle known as Chekov’s gun (‘if you draw attention to something, you will eventually need to reveal why it’s worth noticing’) (‘Chekhov’s Gun’, 2014).
The freedom to use chloroform or other medical myths falls under the author’s artistic licence. During my research for this essay, I wrote a short historical crime story that utilised chloroform as a major plot point (Appendix A). I had the knowledge that chloroform requires sustained exposure to fully render the victim unconscious, yet I chose to use the inaccurate representation. The story fitted into conventions already established. Counterintuitively, had I used my knowledge; the plot would have made less sense. If I was required to make my story accurate, I would have lost my artistic freedom. This is actually a United Nations monitored human right (‘OHCHR | The right to artistic freedom’, n.d.).
There is also the argument that stories should be medically accurate for accuracy’s sake. Medical knowledge is a powerful thing and should not be toyed with. After all, the Hippocratic Oath states ‘I will impart a knowledge of the art to my own sons’ (‘Greek Medicine – The Hippocratic Oath’, n.d.). Perhaps the many doctors that eventually write crime fiction have a greater responsibility to curb myths.
The creator of Sherlock Holmes, Arthur Conan Doyle was himself a medical doctor (‘Biography’, n.d.). He often used medical knowledge in his stories. The information was at the time medically accurate. However, the stories were written around 130 years ago and science has changed significantly. It would be ridiculous to say that we should hold Doyle retroactively responsible for his actions.
There is a phrase oft-cited in medical education, “50% of what we teach you over the next five years will be wrong, or inaccurate. Sadly, we don’t know which 50%” (Hillman, 2014). Even with the correct teaching, medical practitioners will inevitably use outdated techniques throughout their careers if they do not keep their training and competencies current. How can we expect fiction writers to ensure all their research is valid if we cannot guarantee that doctors will do the same?
A distinction between a crime fiction story and a medical text is that fiction is entertainment. There is no pretence that crime fiction should be accurate. Medical education is taken incredibly seriously. For example, in the United Kingdom, all medical schools are regulated by the General Medical Council (GMC). The GMC routinely checks each school’s delivery of medical education and its eligibility to award medical degrees (‘Promoting excellence’, n.d.). However, this is where their remit ends. It is neither expected nor able to regulate the medical content delivered as fiction or entertainment.
Regulation is necessary because delivering bad teaching can be life‑threatening in the medical field. The danger in delivering inaccurate medical information in a fiction story comes with its imitability. Incidentally, imitability is also a criterion that the British Board of Film Classification (BBFC) uses when rating films for general release in the UK (‘Imitable Behaviour | British Board of Film Classification’, n.d.).
The BBFC does not make specific reference to medical inaccuracies in its ‘Imitable Behaviour’ guidelines but does mention ‘Portrayals of potentially dangerous behaviour… which children and young people are likely to copy’. They are more concerned with depictions of sex, violence and offensive language, arguably some of the most abundant themes in modern crime fiction. Is knocking someone out potentially dangerous? Of course. It is a violent act. The method in which it occurs is irrelevant.
However, there are certain myths that when perpetuated can be socially irresponsible. One such myth in fiction said to be detrimental to society is the depiction of people suffering with mental health problems. There have been numerous depictions of villains displaying violent psychotic symptoms in various films and books.
One such example is the book American Psycho (1991) by Bret Easton Ellis. It tells the story of a serial killing Wall Street investor with a personality disorder whose mental state deteriorates over the course of the novel. The novel is an exploration of capitalism and consumerism, amongst other themes. However, it appears when it entered popular culture via a film adaptation (American Psycho, 2000), many of these ideas were lost. This is evidenced by the GQ men’s magazine website designating it as the source one of the most stylish Halloween costumes ever (Merrick, 2011). If the irony here is lost on professional writers, imagine what the average reader will think.
In reality, most murders and violent crimes are committed by people without mental health problems (Large et al., 2011). The stigma that has been perpetuated has prevented many sufferers from accessing health services (‘Myths and Facts’, 2012). In 2013, the supermarket Tesco came under fire for selling a ‘psycho ward’ Halloween outfit, based on stereotypes from the Johnathan Demme film The Silence of the Lambs (1991), which had been based on a novel by Thomas Harris first published in 1988 (‘Supermarkets ditch Halloween outfits’, 2013). After the backlash, the product was removed from sale. If a retailer can be chastised for selling a product, then those that create the image should have greater responsibility. It is discrimination and is no different from maintaining racist or sexist views.
Many groups have condoned the depiction in fiction, calling for greater public awareness of mental health (Cure et al., 2009). Since entertainment media has a greater penetration into the collective psyche of the populous, perhaps authors should consider carefully their use of mental health as a character flaw. There are many other motives for killing, and using mental health is in my opinion facile. This tired trope affects people on a day to day basis. Their treatment and their perception by the public, whether it be historical or modern crime fiction is irrelevant and is one area that authors should proceed with caution.
Medical myths are not just limited to crime fiction. They are prevalent in all other forms of entertainment, common public perceptions, and even in the medical profession itself. I have discussed how the information has the potential to cause harm. However, there is an expectation that no reasonable person would imitate or consider it to be medically accurate.
Crime fiction authors are artists and use books as their medium. They should not be subject to the same standards as those who practise medicine professionally. Doing so would take away their artistic license and be tantamount to censorship.
I will keep in mind that I will meet patients who have been informed by mass media, intentionally or not, I will need to avoid becoming frustrated with their level of knowledge. After all, studying medicine is a privileged affair and I will need to use my education to teach others without prejudice. I am also aware that people with mental health problems are not flawed and will continue to spread this message.
American Psycho. 2000. [Film]. Mary Harron. dir. Canada, USA: Edward R. Pressman Productions, Muse Productions.
ATSDR – Public Health Statement: Chloroform (n.d.). Accessed: 18th February 2019 <https://www.atsdr.cdc.gov/phs/phs.asp?id=51&tid=16. >.
Biography (n.d.). Accessed: 18th February 2019 <https://www.arthurconandoyle.com/biography.html. >.
Caumes, E., Epelboin, L., Leturcq, F., Kozarsky, P., and Clarke, P. (2015) Tintin’s travel traumas: Health issues affecting the intrepid globetrotter. Presse Medicale (Paris, France: 1983) 44(6 Pt 1): e203-210.
Chekhov’s Gun: What It Is and How To Use It (2014/28/January) Now Novel.
Cure, C., Cannons, L., and Jones, M. (2009) Four stereotypes of people with mental health problems in mainstream cinema. : 7.
Ellis, B.E. 1991. American Psycho. (First Edition). New York: Vintage Books.
Greek Medicine – The Hippocratic Oath (n.d.). Exhibitions Accessed: 18th February 2019 <https://www.nlm.nih.gov/hmd/greek/greek_oath.html. >.
Hannah, S. (2018/12/April) No mystery crime is the biggest-selling genre in books | Sophie Hannah. The Guardian.
Harris, T. 1988. The Silence of the Lambs. (First Edition). United States: St. Martin’s Press
Hillman, T. (30/05/2014) 50% of what you are taught is wrong… Postgraduate Medical Journal Blog. Accessed: 18th February 2019
Imitable Behaviour | British Board of Film Classification (n.d.). Accessed: 18th February 2019 <https://www.bbfc.co.uk/education-resources/student-guide/issues-introduction/imitable-behaviour. >.
Kirsh, S. J. (2006) Cartoon violence and aggression in youth. Aggression and Violent Behavior 11(6): 547–557.
Large, M. M., Ryan, C. J., Singh, S. P., Paton, M. B., and Nielssen, O. B. (2011) The Predictive Value of Risk Categorization in Schizophrenia: Harvard Review of Psychiatry 19(1): 25–33.
Merrick, A. (28/10/2011) 10 Ways to the Most Stylish Halloween Costume Ever. GQ. Accessed: 18th February 2019 <https://www.gq.com/gallery/the-inspiration-halloween-costumes. >.
Myths and Facts (27/06/2012) Time To Change. Accessed: 18th February 2019 <https://www.time-to-change.org.uk/youngpeople/myths-and-facts. >.
OHCHR | The right to artistic freedom (n.d.). Accessed: 18th February 2019 <https://www.ohchr.org/en/issues/culturalrights/pages/artisticfreedom.aspx. >.
Promoting excellence (n.d.). Accessed: 18th February 2019 <https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/promoting-excellence. >.
Red Herring – Examples and Definition of Red Herring (10/07/2013) Literary Devices. Accessed: 18th February 2019 <https://literarydevices.net/red-herring/. >.
Severe head injury (23/10/2017) Nhs.Uk. Accessed: 18th February 2019 <https://www.nhs.uk/conditions/severe-head-injury/. >.
The Silence of the Lambs. 1991. [Film]. Jonathan Demme. dir. United States: Strong Heart/Demme Production.
Sparshott, F. E. (1967) Truth in Fiction. The Journal of Aesthetics and Art Criticism 26(1): 3–7.
Sturken, M., and Cartnight, L. (2000) Practices of Looking. (First Edition.). New York: OUP Oxford.
Supermarkets ditch Halloween outfits (2013/26/September).