46 pages • 1 hour read
Samuel ShemThe House of God
Fiction | Novel | Adult | Published in 1978A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Themes
The Emotional Impact of 1970s Medical Caregiving
The House of God’s examines the emotional impact of working in the health care system in 1970s America. The interns aren’t given emotional guidance from more experienced doctors about how to handle their feelings in a healthy, productive way that allows them to continue with their trying work. In this context, the interns gradually become isolated from their family and friends outside of the hospital, and even from each other. For example, Roy notes: “[Potts] became more quiet. My questions, my invitations, seemed to echo in his empty rooms. He made it hard to be his friend” (249).
Roy’s increasing distance from Berry, Eddie not being able to see his newborn baby (259), Pott’s distance from his wife as they each work medical internships, and the on-again off-again nature of the friendships among the interns indicate that emotional well-being in such a setting is very difficult to achieve or maintain. As a result, the interns almost all turn to sex with staff members to help them cope and distract them from their problems. Terms such as “gomers,” the objectification of nurses and female patients, and the long on-call hours all contribute to a dehumanization of patients and doctors. This dehumanization is less blatant than the dehumanization of patients fostered by the industrial-scale medicine advocated by the hospital’s higher-ups, but it still distances doctors from their families, patients, and each other.
One of the Fat Man’s distinguishing characteristics is that he can express emotions in ways that allow him to maintain his emotional health. After Potts’s suicide, Roy finds him crying “fat wet tears of desperation and loss” in the on-call room, and the Fat Man says, “Roy, I’m crying for Potts. And I’m crying for myself” (268). The Fat Man recognizes his emotions, expresses them, and balances them with the positive aspects of his work. Roy doesn’t learn these lessons until late in the book and after deciding to switch specialties from medicine to psychiatry.
Questioning/Distrust of Authority
Questioning of and distrust toward authority appears both textually in The House of God and within the book’s social context of the 1970s in American history. In the Afterword, Shem identifies important cultural forces that were happening at the time he was in medical school in the 1970s:
Medical school was turbulent. In the spring of 1970, it was revealed that Nixon and Kissinger had been secretly bombing Cambodia. The Ohio State National Guard murdered four students at Kent State, the cities were in flames with protest, and the campuses went out on strike against the war (374).
The 1970s were also the decade following the civil and women’s rights movements and widespread countercultural movements away from social institutions such as religion, traditional marriages and gender roles, and capitalism. The aftermath of these movements, combined with the new conflicts generated by Watergate—a scandal involving people who were supposed to be the ultimate civil authorities—and the Vietnam War, resulted in a lack of faith in and cynicism toward authority in general.
This dynamic is apparent as Roy navigates the House of God and its authority figures. He ultimately rebels against the Leggo, the Fish, and Jo, all of whom are supposed to be leading and guiding the interns. In his personal life, he pities his father—someone who is expected to be a male authority figure to his son—for his thwarted medical school dreams but does not seem to regard him with respect or value his advice or perspective.
More broadly, many of the interns ultimately become disillusioned from their idealized conceptions of practicing medicine, as illustrated by their breakdowns, Potts’s suicide, and the isolation they feel. Authority in this case is represented by medicine itself (more specifically, the medical culture depicted in the book), and almost all the interns ultimately rebel against or reimagine authority by the end of The House of God. Roy and the Runt decide to become psychiatrists, and Chuck reintegrates into the Southern culture of his upbringing and wants to be a successful role model for other black doctors in his community. The Fat Man exists in the system but transforms it by maintaining his identity and practicing medicine according to his own conscience rather than the dictates of the authority figures. In this way, he exists in the system but subverts it. The failure to push back against the system is shown to be devastating for Potts, who commits suicide, Eddie, who becomes obsessed with pain and dominance, and Hooper, who fixates on the death of patients. As representatives of the dysfunctional medical system, Jo, Leggo, and the Fish are also portrayed as dysfunctional and lacking in humanity—characteristics that mirror those of the medicine they practice.
The Body-Mind Connection
Rather than being separated as the medical system in The House of God tries to portray them, with doctors caring for and concerned about the body and psychologists concerned about and caring for the mind, the book demonstrates that body and mind are intimately intertwined. The dysfunction of the bodies the interns see daily enacts the dysfunction of their emotions and mental health. Their educations, however, have only provided them with information about the technical nature of medicine, not the psychological effects their work can have on themselves or their patients. The interns become physically exhausted from long hours without breaks or sleep and from performing demanding procedures like cardiac resuscitation. This physical exhaustion also results in mental exhaustion, decision fatigue, and emotional distress. Left unaddressed, a doctor’s mental distress will spill over into the physical care the patients receive, perpetuating the body-mind connection. Conversely, physical care alone is not enough to resolve mental issues, as Roy discovers when he takes up running for a short time near the end of the book.
The doctors also lack an understanding of their patients’ psychology and mental health needs, such as compassion, honesty, a sense of personal connection, and a respect for the patient’s wishes (such as Saul’s request for euthanasia that Roy feels unable to fulfill). In contrast to Roy, Berry, a clinical psychologist, emphasizes the mind’s function and health, and Roy’s migration from medicine to psychiatry indicates that he has begun to understand the connections between medical care and the mind.
By the end of the book, many of the interns have come around to the realization that psychological health—both theirs and that of the patients—is as important as physical health, or perhaps more so. After talking with Berry, several of them express an interest in becoming psychiatrists, and while only Roy does, the others make decisions about their futures that reflect their understanding of the importance of the mind and of their own well-being.
