If Symptoms PersistBMJ 1995; 310 doi: http://dx.doi.org/10.1136/bmj.310.6988.1207 (Published 06 May 1995) Cite this as: BMJ 1995;310:1207
- Paul Bowden
Theodore Dalrymple Andre Deutsch, pounds sterling8.99, pp 150 ISBN 0 233 98898 X
Writing under a pseudonym in his weekly column in the Spectator, Theodore Dalrymple presents a picture of a lawless world. Dr Dalrymple works at a hospital, and he makes regular prison visits. His life is threatened, and within the space of a week his car is broken into for the third time in a year, his secretary's mother is attacked, and one of his patients is robbed and beaten in two separate incidents. Responsibility for this anarchy is placed squarely on both the courts and the police, who are either stupid, lazy, or interested only in clearing their cells.
Inhabiting Dalrymple's world are an edentulous people, unable to read (with the exception of benefits pamphlets) and sometimes called Jason, who use words like “yoof” (for youth). His patients carry knives, and they tell stories of robberies, burglaries, and vandalism. Their tattoos determine their relationship with the world and proclaim a message which is either unambiguous (“Fuck Off”; “Made in England”; a swastika) or subtle (the Old Borstalians' blue spot on the cheek). They are a whingeing breed “maintained if not created by the welfare state and whose every word is uttered with the dying fall of complaint.” Even in prison the standard British burglar, malevolent and self righteous, lives the life of Riley, endlessly replaying the violent parts of videos.
The environment matches its inhabitants. A community centre's garden is barren because its clients urinate on the plants. Residence in a tower block is possible only if tenants are calmed with Valium. Housing officers and social workers are the targets for attack and manipulation. One man requested a transfer to a three bedroomed flat because his existing accommodation was too small for himself and his 40 ferrets.
Felons blame either drink or drugs. Young women, blessed with many nippers (sic)—who are mostly cared for by someone else—and deserted by their violent cohabitees, become pregnant in an attempt either to force their men to return or to have another person to give them love. Overdoses and threats of self harm have an added value, causing bad debts to be cancelled and those who have been disconnected from services to be reconnected.
A selection of Dalrymple's articles is now available in a book, and the whole could be read as an exercise in satire, with invective and wit being used to dramatise the vice inherent in contemporary urban society. Some hint as to whether or not Dalrymple is a psychiatrist can be deduced from the following. (Of a patient frequently the victim of burglary): “It was fortunate…that she was too poor to have valuable possessions”; (speaking of giving evidence in court): “It gives me great pleasure to cook the goose of some of my more obnoxious patients”; (of a man tormented by hallucinations whose origins he believed lay in an intestinal worm): “No doubt advances in parasitology will soon result in a compact disc worm.” A last example is worth a thousand words, and in it he mocks in trenchant tabloidese: “Single mother victim of bag snatcher outside social security.”
Coming from a doctor's pen it all has a certain shock value. But there is something sinister about a physician presenting in this way people to whom he has a duty of care. It is both exploitative and unremitting in its harshness. It is a perfect paranoid position: reason surrounded by feckless scrounging, short-termism, and greed. But is it not all a fabrication that panders to those who have the responsibility to change things from being what they are but choose not to do so? And do his patients know what he thinks of them?—PAUL BOWDEN, consultant forensic psychiatrist, Maudsley Hospital, London
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