Catch-22 Joseph Heller Vintage Classics, 2008, PB, 544pp, £7.99 978-0099470465
Written by Joseph Heller, himself a veteran airman of the Second World War, Catch-22 chronicles the activity of the fictitious 256th Squadron of the US Army Airforce in 1943 while in action over Italy. The narrative is complex, jumping back and forth in time and continually switching perspective between the many characters of the book. At first this feels incredibly chaotic but, with each leap through time and with each change in perspective, the story, and the characters it concerns, are built up layer by layer until they feel entirely real and believable. It is a rare book in that it has the ability to make you laugh out loud and be deeply moved within a few pages.
As the story builds there is a sense of emerging tragedy and those things that at first seem silly and ridiculous gradually become tragic and, though still ridiculous, chillingly understandable. The trauma to which the men have been exposed, and the ongoing trauma to which they are exposed throughout the novel, is drip-fed to the reader from a variety of viewpoints and, in the end, the absurd storylines finally make sense.
The central character, Captain Yossarian, first presents himself as a self-centred shirker who takes advantage of the fact that he ‘always ran a temperature of 101’ to keep booking himself into hospital with ‘a pain in his liver that fell just short of being jaundice’ which leaves the military doctors bamboozled. But the multi-faceted flashbacks of previous missions gradually let you know that this is actually a brave man who has been pushed to his limit and is desperately seeking an escape.
Perhaps it is my smouldering, undiagnosed psychosis that makes me perceive ideas of NHS reference in all that I read, or perhaps it is just that the book speaks to those of us who work in an organisation that is beyond our control, but, as an NHS doctor, one can’t help feeling an empathy with the American aircrew. They grit their teeth and clench their buttocks through mission after mission as their superiors push them ever harder for their own glorification with little apparent understanding of what it is they are asking of their subordinates.
This book reminded me too that we are all products of our accumulated experience and so, behaviour that at first seems bizarre may be entirely explainable when the full circumstances of someone’s life are understood. I frequently find myself thinking of the characters in this book when, in the 10-minute snapshot I get of a person in the consulting room, the patient’s behaviour seems unfathomable.
Catch-22 represents the paradoxes that trap us all the time. In the novel it appears in various guises but we first meet it when an airman’s mind seems too broken to keep flying. Although the squadron medic, Doc Daneeka, recognises that the man is unwell his hands are tied by Catch-22 because, you see, fear in the face of danger is the product of a rational mind and therefore, anyone claiming to be too frightened to fly must be sane and therefore fit to fly.
Catch-22 dilemmas are those difficult, unwinnable situations in which we are bound by conflicting demands. Catch-22 is being told to refer less and then being criticised for missing cancer diagnoses because you didn’t refer enough.
Catch-22 is being told not to give in to patient demand for antibiotics and then having your pay cut because your patients are unhappy that they aren’t being given antibiotics anymore. Once you understand the essence of Catch-22 you realise that it catches us out all the time.
- © British Journal of General Practice 2016
