Help, doctor! I've got a dose of moral sickness

The BBC drama 'Casualty' peddles fear and superstition, argues Steven Poole

As the tenth series of Casualty draws to a close on BBC1 tonight, viewers will no doubt be speculating on the fate of Charlie's love-child, on Ash and Laura's prospects of wedded bliss, and on Mike's desertion of Holby in favour of Third World medicine. But what followers of this immensely successful drama (recent ratings have averaged 16.5 million) may not recognise is the message wrapped up in Casualty's slick, enjoyable form. Both the storylines constructed around its patients and the hospital setting are trying to tell us something.

The word "casualty" derives from the Latin for chance, casualitas; it means a victim of outrageous fortune. This used indeed to be the case in Casualty: in the early years, devotees derived enormous pleasure from playing Guess the Accident in the domestic scenes at the start of episodes. If we were shown a child in a kitchen, chances were the kid and the Moulinex would have an unfortunate contretemps - cue the sound of sirens. But in recent years, Casualty has been implying the reverse. Disease and injury, these days, are never accidents but rather the wages of sin.

Here are three storylines from the current series. A construction worker, who spends his family's housekeeping money on gambling, is listening to a race on the radio one day in his JCB. His horse loses, and in despair he accidentally crushes a colleague with a big chunk of concrete. An alcoholic advertising executive takes his girlfriend out on a massive drinking binge; the next day she vomits blood and is admitted to Holby for detoxification. He, of course, vows to give up the liquor for good. Or again, a single father is alone with his young daughter at home one day when he suffers a cardiac arrest. His former wife comes to visit him in hospital, and when her toy-boy turns up she decides to dump him. See: such are the penalties of gambling, drink and home-wrecking.

The simple message is, immorality causes physical sickness. It is an argument with some precedent. Mary Baker Eddy, the founder of Christian Science, wrote in 1875 in her Science and Health with Key to the Scriptures: "Disease is an image of thought externalised ... It is fear made manifest upon the body." Casualty nowadays tells a similar causal story about society in general.

You might expect bad behaviour to end you up in court, rather than in hospital. But it turns out that the hospital is an entirely appropriate arena for this kind of moral drama. For hospitals are actually the churches of secular modernity, the primary places where people from all classes and walks of life gather together, under the shadow of death, in hope of salvation. The poet Philip Larkin recognised the spiritual function of hospitals in "The Building", where he calls the patients "congregations". This is an apt metaphor: in Casualty the victims of gory mishap are usually wide awake. And what are they doing? Confessing.

Just as telling one's sins to a priest is the first step to forgiveness, so the patient must tell her history and symptoms to her doctor. This link between Western medicine and moral argument goes all the way back to the Greek moral philosopher Epicurus, the first four of whose Principal Opinions were known to his pupils as the tetrapharmakos, or fourfold drug.

In Casualty it usually falls to Charlie, the twinkly, caring head nurse, to act as confessor for his patients. Casualty's beds are primarily not places where people get cured or stitched up, but where they learn moral lessons. "You're ill. You need help," Ash tells a patient's violent brother. "Doesn't everyone?" he retorts. All over the country, the congregation nods in assent.

There are several reasons why Casualty's message might be so appealing today. For a public mystified by the technicalities of modern science, irritated by the logic-free semantics of soundbite politics, and betrayed by the placatory waffle of today's bishops, the simple notion that wrongdoing leads to physical harm satisfies our hunger for explanations. But it has more in common with medieval witch-hunts than with modern medicine. To say, "Be good, and you won't get ill" might be reassuring to the healthy, but it is no help to the ill. For all its shiny, fast, video-shot realism, Casualty has become a religious programme, peddling fear and superstition. And fear and superstition are the enemies of medicine.