Apparently one of our political leaders made reference recently to the last piece of the missing jigsaw, and there was widespread hilarity in response to his gaffe. The expression after all, should simply be the last piece of the jigsaw. As a figure of speech, it usually refers to an elusive piece of information which, once apprehended and fitted into that which is already known, allows you to solve a conundrum and present a composite theory, and a complete picture, of something. It’s the sort of thing Hercule Poirot might present before a group of well-to-do people, each harbouring a guilty secret, in the environment of a country house library, or the dining car of the Orient Express. Voilà. Problem solved.
But what could the last piece of the missing jigsaw possibly refer to? If you have that one piece and, say, 999 others are missing, how could you possibly reconstruct the entire solution to the puzzle? Quite impossible, I would have said. But then I’m currently reading Written in Bone by Sue Black (Doubleday 2020). Professor Dame Sue Black is a forensic anthropologist who, amongst other feats, can sometimes reconstruct entire identities on perusing a piece of bone no bigger than a fingernail. Most of the time, she is afforded more generous material to work upon, and her reconstruction, for the benefit of the police, of a complete skeleton, or several skeletons, from a plastic bag of bones dumped in a loch, does indeed resemble the completion of a jigsaw puzzle rendered more difficult by the ravages of time and nature. I guess a forensic anthropologist needs the fastidious attitude of mind, the sedulous attention to detail of the jigsaw enthusiast. I know some jigsaw buffs who like to turn the pieces over and solve the puzzle without reference to the pictorial aid. That seems incomprehensible to me, but then I’ve never done a jigsaw in my life. I’m a crossword geek. As J. Alfred Prufrock has measured out his life in coffee spoons, so have I lived mine out in the half-lit world of amateur cryptography.
Written in Bone is a gruesome, if fascinating read. But putting the work of Sue Black to one side, it strikes me that that last piece of the missing jigsaw might refer to an illusion of enlightenment, an hallucinatory “Ah-ha!” moment when you think you are placing the final piece into a constructed pattern that doesn’t actually exist, other than in your own febrile, fetid imagination. The great scientists know that when they cry “Eureka!” they might have constructed a model that, while it is complete, self-consistent, and beautiful, may yet bear little relation to reality.
I have known patients who have had a Eureka moment while reading a medical textbook, or perusing the Internet. They’ve brought in the literature with them. “That’s me, doc, to a T.” It’s particularly true in the field of mental health. DSM-5-TR is now so vast that it would be strange if you couldn’t find yourself, or somebody like yourself, therein. People have described to me a profound sense of relief when they have discovered that, during all these wilderness years, they had never known that they were on the spectrum. It’s like a confession followed by absolution. They are off the hook. It’s the last piece of the jigsaw. Now it all makes sense.
It is said that when you are a medical student you develop a serious illness at least once a week, when you encounter it in the literature. Possibly because medical students have constantly to stuff their brains with facts, the diagnoses are often neurological; last week, Parkinson’s, this week, Alzheimer’s, next week, a brain tumour. I was never afflicted in this way. Quite the contrary. I was ever in a state of denial. I am like the professor of cardiology at the heart conference, who succumbs to a myocardial infarction, a bottle of antacid parked by his bedside.
We might use the jigsaw, present or absent, as a metaphor for what used to be referred to as “the human predicament”. The pursuit of happiness, or fame, or wealth, or gratification, or goodness, or serenity, or love, or a foe, or whatever pursuit it is that we deem to be important, can seem like the perusal of entrails to be ruminated over, a rune to be deciphered, an acrostic to be solved. If only we could find the key. The trick of life. We search for it in religious texts, belles-lettres, and self-help books, seven billion souls in search of a diagnosis. But nothing appears to fit the uniqueness of our own particular conundrum which, in any case, seems to be changing all the time. Yet still we search. Tomorrow I will wake with buoyancy and hope, full of beans. I will discover the secret formula to my personal fulfilment, and I will say to everybody that it seemed such a small thing, and yet it completely turned my life upside down. Now it all makes sense.
The last piece of the missing jigsaw.