BJGP Library: Howards End

It would be easy for us — over-stretched target-driven bio-technicians that we seem to be becoming — to dismiss EM Forster and his novels as irrelevant anachronisms. The man himself was a rather prissy mummy’s boy, a closet homosexual, wracked with self-doubt; a timid acolyte on the fringes of the Bloomsbury set. Yet he was, and remains, one of the most perceptive and meticulous cartographers of the inner life, and his 1910 novel Howards End is, dare we but heed it, a powerful warning not to throw out the baby of humanity with the bathwater of science.

The novel chronicles the entanglements of the passionately Bohemian Schlegel sisters — brisk Margaret and giddy Helen — with the prosaic Wilcoxes, a tribe of hard-nosed capitalists, and their house, the eponymous Howards End. A subplot charts the sisters’ patronising and ultimately tragic attempts to improve the intellect and fortunes of an impoverished insurance clerk, Leonard Bast. From the Schlegels we learn the dangers of idealism untempered with pragmatism; from the Wilcoxes, the character-sapping effects of a life predicated on greed and self-interest. The sisters’ invasion of Leonard’s domain warns us against trying to impose our own values on other people in the name of do-goodery.

As a story, so far so English, so last century, so worthy. The Merchant Ivory film of 1992 tells it beautifully. But, as always with great literature, it is the authorial voice and the language in which it speaks through the written text that lift the narrative to the plane of art. In his 1927 collection of lectures Aspects of the Novel, Forster differentiates story from plot. Story, he suggests, is merely an account of events in their time sequence, whereas plot emphasises causality: ‘”The king died and then the queen died”,’ he writes, ‘is a story. “The king died, and then the queen died of grief” is a plot.’¹

In general practice, we deal with plot more than story. Specialism is story; generalism is plot. Generalism is about seeing connections between and within individuals, between their public and their inner lives, between their lived prose and their felt passions. And in chapter XXII of Howards End, we find Forster’s much-quoted aphorism, which to this day I cannot read aloud without my voice cracking: ‘Only connect the prose and the passion, and both will be exalted.’

To see less than both in our patients is to diminish them — and to diminish ourselves.

If any idea has inspired my own career and thinking, it is this.

At the heart of this book is Forster’s unquenchable belief that nothing is more precious, despite their often infuriating complexity, than human relationships. In a personal credo What I Believe, written in 1938, he wrote: ‘If I had to choose between betraying my country and betraying my friend, I hope I should have the guts to betray my country.’²

To say that at a time when Europe stood on the brink of war took courage, arguably a courage that those of us who today are tempted to set the diktats of QOF, NICE, the CCG, and the DH above the interests of our individual patients would do well to emulate.

Good general practice is not a compromise between prose and passion, between science and art; rather, it emerges from an unflinching exploration of their sometimes conflicting values. Truth, we read in chapter XXIII of Howards End, is: ‘... not halfway between anything. It was only to be found by continuous excursions into either realm.’

What should make Forster a hero for us is that he helps us celebrate, amid the surface banalities and small disasters comprising so much of general practice, the glorious frailties within us all.

• © British Journal of General Practice 2016