Medicine, landscapes, symbols: “The country Doctor” by Honoré de Balzac

This paper considers examples from research that has interpreted literary works including representations of topographical landscapes, in order to examine the geographical and social perspectives of the author, and of the society in which the author was living and working. We focus especially on the use of representations of therapeutic landscapes in literature to convey the author's perceptions of the aspects of social and physical environments that contribute to human well-being. The novel entitled The country Doctor (Le Médecin de campagne) by Honoré de Balzac, first published in 1833, is the particular focus of this paper and we consider this book in the context of the historical period when it was written and other novels of the period which also portray doctors and medicine in varying ways. We present an interpretation of Balzac's novel which focuses on four themes arising from the discussion in the introduction of this paper: the symbolic use of ideas of ‘therapeutic landscapes’ to represent the ‘heroic’ role of the doctor; the link between landscapes and ideas of medicine and health, corresponding to the Hippocratic heritage; the representation, through images of salubrious landscapes, of planning and economic development and the role of the leader; the significance of the contrast between the ‘therapeutic’ rural world and the unhealthy urban settings found in Paris. We conclude that The country Doctor is interesting because of the ways that it reflects the three aspects of landscape (physical, social and symbolic) that Gesler (1998. In: Kearns, R., Gesler W. (Eds.), Putting Health into Place: Landscape, Identity and Well-Being. Syracuse University Press, Syracuse, NY, pp. 17–35 (Chapter 2)) has identified as central ‘therapeutic’ qualities. Not only does the book reflect a conceptual model of what a therapeutic landscape might be, but it also uses this landscape symbolically as an allegory for spiritual progress and redemption, and for medical and social advance. The novel represents a period of transition from traditional social values and prescientific medical theory towards modernization of society associated with the growing domination of medical science, which continued into the 20th century.     

“They (ARVs) are my life, without them I’m nothing”—experiences of patients attending a HIV/AIDS clinic in Johannesburg, South Africa

This paper is a part of a larger study that explores the “social complexity” of antiretroviral therapy (ART), in resource-limited environments. Drawing on in-depth interviews with a sample of 44 patients in an urban HIV/AIDS clinic in Johannesburg, South Africa, this paper examines how people with HIV/AIDS conceptualise their illness and its treatment in this context. The paper concludes that the fear of stigma plays a significant role in patients’ experiences throughout the disease trajectory. Yet, demonstrates that there are indications that ARVs are transforming the experience of living with HIV/AIDS and a process of normalisation is taking place. Despite the resource-limited context and, often, lack of family and community support, patients see the ARVs as ‘life saving’ and express their long-term commitment to adhere to the drug regimen as well as their trust in health professionals.