Unfinished

This is strange.  Dalrymple began writing for The Spectator in the ’80s and returned to the United Kingdom in the ’90s to take up a post as consultant psychiatrist in a Birmingham hospital.  He immediately started writing his medical column.  The portraits he paints of his patients are not exactly flattering.  Indeed, if he is to be believed, he doesn’t encounter a single one with a genuine psychiatric illness.  Most of them, according to him, have absolutely nothing wrong with them.  One wonders why he didn’t switch to something more useful such as brain surgery.  It does not appear that he came to view his patients with such contempt as a result of observing them over a long period but rather that he viewed them with contempt even before he embarked on his career as an NHS consultant psychiatrist.  He claims that the specialism appealed to him because it would give him the opportunity to ‘plumb the depths of human folly..’. As well as giving him lots of little titbits to toss at the readership of The Spectator.  He had made up his mind about them before he started treating them.  He despised them and had no interest in helping them.  They served only to confirm Dalrymple’s own moral superiority and, by extension, the moral superiority of the readership of The Spectator.  As I said you do the math.  On his psychiatric ward no one is depressed, no one is manic depressive/bipolar, no one is personality disordered, no one is schizophrenic.  Indeed, at no time does the good doctor make any kind of psychiatric diagnosis or prescribe any psychiatric medication.  His average day seems to consist of him telling the patients there is nothing wrong with them and refusing them medication.  He is on record as saying that anti depressants do not work.  Could someone please inform the pharmaceutical company of this.  And the psychiatrists they wine and dine in order to persuade them to prescribe their particular brand of psychoactive medication.  He is however something of a cheerleader for neuroleptics.  His objection to benzodiazepines is that they ’empty the mind of all thought’.  This is not true, by the way.  And neuroleptics also have this effect but he does not appear to object to that.  Anything to ensure the patient’s compliance, eh Doctor.  And nothing does that better than a good old solid, dependable, first generation anti psychotic.  Where would you be without them?  You may have to actually talk to your patients.  He claims that he works in a slum hospital, in a slum and his patients are, without exception, slum dwellers.  Now anyone who knows anything about the NHS should know that this is not how the organisation operates.  

NHS psychiatrists have as little to do with their patients as possible.  They leave all that ‘grunt’ work to the staff nurses who, in turn, delegate it to the health care assistants.

My mother has encountered several cases in which psychiatrists have suddenly and unaccountably stopped prescribing medication to patients who have been on it for years.  She is convinced that some of it is down to the psychiatrist’s need to go on a power trip.  Of course, the people who see the consequences of this are not the psychiatrists but the nurses.  The psychiatrist just tosses the hand grenade and waltzes off.

Another objection he raises is that his patients never tell him they’re unhappy but instead tell him they’re depressed.  Well, Doctor, maybe this is because you’re a psychiatrist and why would someone who is merely unhappy consult a psychiatrist in the first place.  Of course, it is possible that at least some of his patients have mistaken unhappiness for depression but there is a referral process in the NHS.  You don’t just turn up one day and get to see a consultant psychiatrist.  Someone referred these ‘unhappy’ patients to Dr Daniels and that someone was probably their Gp.  If his patients are mistaken about their  own state of mind, it is perfectly understandable.  If my GP were to refer me to an oncologist it would be reasonable for me to at least suspect that I might be suffering from some form of cancer. 

Would a practitioner of any other medical specialism get away with being so whimsical? 

If treachery had a face, it would be his.

Tags: NHS, psychiatry, rambling, Theodore Dalrymple