A conversation with Samuel Shem

Editor’s Note: This is the first of two interviews with Stephen Bergman, psychiatrist and author who writes under the pen name Samuel Shem. This interview revolves around his first novel, The House of God, while the second will be concerned with his latest work, The Spirit of the Place.

The House of God, which came out in 1978, was Bergman’s first novel and tells the story of Dr. Roy Basch and his internship at the House of God.
Bergman said that his first novel was the hardest to write, but felt it had to be written. He said it came about from a series of “hey wait a second” moments that “make you stop and think. During my internship I had so many of them.”

The House of God was well received by the doctors of his generation but not by the older generation.
"The older generation of doctors hated it,” he said. “My generation loved it.”

The novel has sold more than two million copies and is required reading in medical schools throughout the world.

Bergman was a Rhodes Scholar at Balliol College, Oxford and is a professor at Harvard Medical School. He lives in Newton, MA., and is married to Janet Surrey, with whom he has co-written several works.

Do you consider The House of God a satire, as some critics have labeled it, or a hyper-realistic depiction of your internship year at Beth Israel?

SATIRE, TO ME, IS EXAGGERATION IN THE SERVICE OF POLEMIC. EXAGGERATION? WITH A FEW EXCEPTIONS, THE SITUATIONS IN THE HOUSE ARE AT MOST ONE STEP OFF REALITY. IF THAT'S EXAGGERATION, EVERY WRITER OF FICTION IS AN EXAGGERATOR. EVER SINCE I, A NAIVE YOUTH AT HUDSON HIGH SCHOOL, WON THE NEW YORK STATE AMERICAN LEGION ORATORICAL CONTEST, WITH A SPEECH CALLED 'THE CONSTITUTION, FREEDOM'S WEAPON,' I HAVE BEEN SENSITIVE TO POLEMIC. HOWEVER I HAVE EMBRACED RESISTANCE, WHICH IS DIFFERENT. WHAT IS THE DIFF? POLEMIC IS A BRUTAL VERBAL ASSAULT TO IMPOSE CHANGE, A POWER-OVER TACTIC. RESISTANCE IS A NONVIOLENT GROUP ACTION TO BRING CHANGE. SO CALL THE HOUSE OF GOD A NOVEL OF RESISTANCE USING A ONE-STEP OFF REAL STYLE.

When writing the novel did your training as a psychiatrist find its way into the writing? The ghost of Freud seems to hover nearby, especially in the form of the two policemen.

EARLY ON IN MY 30 YEAR BID AS A SHRINK, I REALIZED THAT FREUD WAS CERTAINLY NOT AN ACCURATE PORTRAYAL OR THEORY OF ANYTHING, OR, TO PUT IT ANOTHER WAY, FREUD WAS AT BEST FARCE. WHAT BETTER HIGHLIGHTING OF THE FREUD FARCE THAN TO HAVE THE POLICEMEN EMBRACE HIM--DEEP DOWN THEY THINK HE'S AN ASSHOLE TOO.

Sex and death seem to be overarching themes of the novel and can be broken down further into the categories of the frenzied, mindless sex typified by the Runt and the intimate, relationship building sex Dr. Basch shares with Berry. Death, it seems, can also be broken down into good death, i.e. dying when its time, naturally, as opposed to the seemingly everlasting death provided by the likes of Jo. When you where writing the novel did this occur organically or was it something you consciously implanted in the work?

ORGANICALLY. IT WAS ALL IN THE REALITY, AND I JUST WROTE IT. BUT ANY GOOD NOVEL IS ABOUT SEX AND DEATH AND REDEMPTION. A NOVELIST NEVER REALLY KNOWS WHAT HIS OR HER WORK IS ABOUT UNTIL SOMEONE READS IT AND TALKS WITH YOU ABOUT IT.

Why did you choose to use Marcel Marceau’s performance as Dr. Bach’s way back into humanity?

BECAUSE I LOVED MARCEL MARCEAU, AND HAD GONE TO A PERFORMANCE OF HIS RECENTLY. AND ALSO, BECAUSE IT WAS EXACTLY RIGHT. WHAT WOULD THE SHAKESPEAREAN POLICEMEN GO TO SEE AND ENJOY? MAMET? NEVER. THEY'D SEE HOW FAKE HIS 'REAL'', WHICH THEY ENCOUNTER EVERY DAY, IS.

About two thirds of the way through the novel, and probably the internship year, Dr. Basch aligns himself with Pinkus, and by extension, the slurpers. It is obviously a coping mechanism as was the other methods employed by the terns. Did this actually happen to you in some form? And if not can you explain how it found its way into the book.

I NEVER BOUGHT INTO THE PINCUS OR SLURPER WORLD. I SEEM TO HAVE A HIGH DEGREE OF SUSPICION FOR FALSITY--THUS MY TORMENT WITH THE PATHETIC LIAR--AS-PRESIDENT GEORGE BUSH--AND MY DESCRIPTIONS ARE INFORMED BY THAT ALERTNESS. AGAIN, THEY WERE THERE IN REALITY, AND I TOOK THEM ONE STEP OFF. (THERE IS IN FACT NOW AT THE BETH ISRAEL HOSPITAL CARDIAC UNIT A 'PINCUS' AWARD, FOR A CHARACTER MOST LIKE HIM IN REALITY)

Who are some of the writers, (besides the Russians, I know they have been important to you) and others, who have inspired you. Did you read Catch-22, for instance, before writing The House of God? I know the two novels have been compared to one another, but in my opinion, they only relate in the sense of the inanity of both systems faced by yourself and Heller.

I NEVER READ CATCH-22 UNTIL AFTER THE HOUSE OF GOD WAS PUBLISHED. I LOVED IT IN PART, NOT AS A WHOLE. THE LITERARY TECHNIQUE WAS TOO LITERARY, AND AS YOU CAN SEE, I BELIEVE IN STORY, NOT SITUATION. ALSO, HE GOT AT LEAST 2 STEPS OFF THE REAL, IF NOT 3. MY HEROES ARE--IN ADDITION TO THE RUSSIANS ABOVE ALL TOLSTOY--SHAKESPEARE, MARQUEZ, FAULKNER, ORWELL--ESPECIALLY 1984--EDUARDO GALEANO (THE MEMORY OF FIRE TRILOGY), AND THEN SPECIFIC BOOKS: TO KILL A MOCKINGBIRD, THE JUNGLE, THE QUIET AMERICAN, UNCLE TOM'S CABIN, USA (DOS PASSOS), THE TIN DRUM, THE PRESIDENT (MIGUEL ANGEL ASTURIAS), NERUDA, WALLACE STEVENS, MARY OLIVER. I WOULD CALL ALL OF THEM WRITERS OF RESISTANCE OR NOVELS OF RESISTANCE.

Do you feel that before and during the time you were an intern that it was possible for there to be internal medicine MDs who retained a sense of humanity? Or did they all end up as slurpers?

YES, MEDICINE HAS CHANGED, PARTLY BECAUSE OF THE HOUSE OF GOD, AND THE HOURS THAT PERMIT MORE SLEEP. YES, LOTS OF DOCS RETAIN THEIR HUMANITY. THE LIFE CYCLE IS THAT THEY GO INTO MED SCHOOL WITH IDEALS, THEY GET THEM BEATEN OUT OF THEM IN THE SECOND TWO YEARS OF MEDICAL SCHOOL AND THEN GET HAMMERED TO A PULP IN THEIR SPECIALTY AND SUBSPECIALTY TRAINING, AND THOSE WHO SURVIVE AND GET THROUGH THEIR MID-LIFE CRISIS TURN INTO WONDERFUL DOCTORS, LIKE HUDSON'S OWN DR. BILL STARBUCK IN MY NEW NOVEL, THE SPIRIT OF THE PLACE.

Another important element in the novel is Nixon’s downfall. It seems Nixon and the Leggo are linked, at least in the mind of Dr. Basch. After Dr. Basch’s return to humanity he seems to be able to see the Leggo as a person and not merely as a representative of the old-guard establishment. Do you feel there is any relationship to this scene and the nation’s possible sense of catharsis at Nixon’s finally leaving office after the Watergate hearings?

THERE WAS NO CATHARSIS WHEN NIXON LEFT, BECAUSE GERALD FORD PREVENTED IT WITH A PARDON (IN THE SAME WAY THAT WE RISK MORE TROUBLE IF THE CHENEY/BUSH/RUMSFELD/RICE CRIMINALS GET OFF SCOTT FREE). YOU CAN'T LOOK AHEAD UNLESS YOU LOOK BEHIND--AMERICA'S SINGLE GREATEST PROBLEM IS A BLINDNESS TO HISTORY, WITNESS THE UPCOMING 'SURGE' IN AFGHANISTAN, OR THE RECENT NO-SUPERVISION BAILOUT OF THE RICH. NIXON'S DOWNFALL AND LEGGO'S PRESIDENCY OF THE RESIDENCY ARE THE SAME POWER OVER MODEL. THE ONLY MODEL THAT WORKS, LONG TERM, IS A POWER-WITH MODEL. THE DIFFICULTY IN A HIERARCHICAL SYSTEM IS TO KEEP YOUR SENSE OF MUTUALITY AND COMPASSION, WHICH ROY ARRIVES AT AFTER HE'S GONE. THE LEGGO IS A LOST SOUL AND WILL DIE THAT WAY. HIS KIDS WILL HATE HIM..

France, as described in the novel, seems to be a place that drenches the senses and helps Dr. Basch recuperate after the year in the House of God. Why France? What about that country, and the part of France they go to, has the ability to help him, at least in part, to focus on the body/spirit as opposed to the body/anatomy?

AFTER MY INTERNSHIP I WENT DIRECTLY INTO MY PSYCHIATRY TRAINING, BUT I WENT TO THE DORDOGNE AS SOON AS I COULD WITH MY THEN GIRLFRIEND, NOW MY WIFE. IT WAS, AND IS, LIKE ANY NATURAL SIMPLE PLACE, A HEALING SPIRITUAL ARENA.

When you wrote the novel it was a time before television was inundated with doctor dramas such as ER and Gray’s Anatomy. Do you feel that The House of God may have helped spawn or at least laid the groundwork for this? What do you think of these types of shows?

THE HOUSE OF GOD WAS RIPPED OFF FOR THE FIRST TIME IN ABOUT 1980 WITH A SHOW CALL SAINT ELSEWHERE (A TERM I USE IN THE NOVEL) AND I THOUGHT OF SUING THEM BUT DIDN'T. SINCE THEN IT HAS BEEN RIPPED OFF FOR 30 YEARS. I HAVE NEVER WATCHED A SINGLE EPISODE OF ANY OF THESE SHOWS--TO ME THEY'RE WITLESS, BRUTAL, AND CRUDE. OUR DAUGHTER IS IN LOVE WITH HOUSE, SO I TRIED TO WATCH THAT, BUT LASTED ONLY ABOUT 9 MINUTES AND HAVE NEVER WATCHED ANOTHER EPISODE. THERE IS ONE PURPOSE FOR THIS STUFF, TO MAKE MONEY, AND THEY DO THAT VERY WELL BECAUSE PEOPLE WILL GO FOR THE VULGAR AND THE PHONY. MIND YOU, I DON'T HATE ALL SIT-COMS. OUR DAUGHTER LOVES RERUNS OF FRIENDS, AND I LOVE THOSE GUYS. THEY'RE REAL EVEN IF THE PLOTS ARE SOMETIMES NOT.

Humor plays a huge role in the novel. I know that in my own line of work as a crime reporter, humor seems to help temper the ugliness of death. Was that true for yourself and your fellow interns?

EARLY ON IN WRITING THE NOVEL, I HAD A TOUCH OF THE MUSE ON MY SHOULDER: "THIS STUFF IS SO HORRIFIC THAT FOR ANYONE TO READ IT IT HAS TO RIDE ON HUMOR" AND THAT'S WHAT I DID. AND THAT'S WHAT WE DID IN THE INTERNSHIP--HUMOR AND SEX.