From Behind the ‘Paywall’ of The Times:

(I’ll remove it if anyone objects.)

Theodore Dalrymple shows us that there is much scope for sadism in the role of prison doctor and how he himself derived much pleasure from this aspect of his role. I suspect that it was almost as much fun as having patients “injected in the buttock” in his primary role as a consultant psychiatrist at an inner-city general hospital in Birmingham. Note that he and the sycophants who surround him have stopped calling it a slum.

Weak doctors leave prisoners hooked on prescription drugs

Theodore Dalrymple: Former Prison Doctor.

The Chief Inspector of Prisons has reported that abuse of prescription drugs in prisons has increased to an alarming extent. I am surprised only that it took him this long to discover it.

By the time I left the prison service after 15 years, I had formulated a rough-and-ready rule: if a prisoner was willing to take medicine, he didn’t need it; and if he wasn’t willing to take it, he did. There were exceptions, of course; but every prison doctor must remember that medication, especially if it has a psychological effect, is coin of the realm in prison. A pill may change hands many times before it is actually taken.

There are several reasons for over-prescription of drugs in prison. Many prisoners arrive already on prescription drugs they don’t need. A high percentage of doctors have been assaulted or threatened by patients in the past 12 months, an even higher percentage in the areas from which most prisoners are likely to come, so doctors are inclined to prescribe potentially aggressive patients what they demand rather than what they need, which in most cases is nothing.

Doctors in prisons feel obliged to continue these prescriptions, partly because doctors do not like to stop other doctors’ prescriptions without deeper knowledge of the patient, and partly because it is easier. To stop a prescription is to court an unpleasant scene, in which the prisoner will accuse the doctor of negligence or worse, threaten to complain, shout and even menace. Not a few prisoners told me that if I did not prescribe the valium they wanted, they would attack or kill a prisoner or a prison officer.

“Let me give you a word of advice,” I would reply.



They would look in my eye and see that I was not to be moved. Some would laugh, others would be angry with the anger of the justly accused. But it took experience and firmness to resist their blackmail.

Experience and firmness of character were just the qualities the NHS did not seek in its prison doctors when it took over healthcare from the Prison Medical Service. The prescription of codeine and other sought-after drugs shot up without the slightest medical reason.

In the modern world, compassion easily slides into sentimentality and moral cowardice. Doctors like to think that their patients are telling the truth. Prisoners are often not like that; but inexperienced and weak doctors are reluctant to recognise it or be “judgmental”, the worst moral failing in the modern world. And so it is Goldilocks against Genghis Khan.

Face it, Doc, your specialism is about as scientific as witch finding and your methods as sophisticated as the ducking stool.

Addendum: (11.2.2013) In 1994 in an article (an op-ed piece) in The City Journal (an American publication) entitled The Knife Went In  Dalrymple writes: ‘As a doctor who sees patients in a prison once or twice a week, I am fascinated by prisoners’ use of the passive mood and other modes of speech that are supposed to indicate their helplessness. They describe themselves as the marionettes of happenstance.’  Once or twice a week?  Interesting.


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Sylvia Plath was given ECT without anaesthetic shortly before her first nervous breakdown and suicide attempt. Collective guilt, anyone? Think about it people.

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15 Responses to “From Behind the ‘Paywall’ of The Times:”

  1. David Duff Says:

    Can’t agree with you on this one, alas. Dalrymple knows where-of he writes. And an excess of fearing to be judgmental is as bad as being overly judgmental. Were I in a position of having to deal with prisoners I would start on the assumption that they were lying and leave them to prove otherwise!


  2. Louise Says:

    Oh, I have no problem with being judgemental. Which is why I am puzzled when people who claim to feel the same way get all hot and bothered when I judge the good doctor.

    And I’d bet my bottom dollar that most drugs in prison haven’t been anywhere near a doctor.

    To be continued…


  3. Dash-Coder Says:

    ‘By the time I left the prison service after 15 years, I had formulated a rough-and-ready rule: if a prisoner was willing to take medicine, he didn’t need it; and if he wasn’t willing to take it,’

    Couldn’t the patient play the same trick on the doctor, in reverse?

    Also, how long would it take for the doctor’s attitude to spread through the prison and the prisoners changing their behaviour to suit that doctor?


  4. Miranda Hart Says:

    Still, it’s not the way you’d want a physician to behave. I don’t care who he’s working for.


  5. Louise Says:

    I confess that I have a grudging admiration for old Dull Rumple.  He disapproves of ‘the talking cure’ and he’s not particularly fond of seeing patients and prescribing meds either.  But that’s pretty much all that psychiatrists do.  So that leaves him with nothing to do.  Just waltz around looking imperious.  At the taxpayers’ expense.  Genius.  He could give the average benefit scrounger a lesson or two in getting something for nothing.


  6. Single Crew Guy Says:

    Do you have a problem with EVERYONE in authority?


  7. silver price Says:

    It is a generally accepted ideal that the quality of medical care and attention should not be determined by the social or moral status of the patient, but by the clinical characteristics of his or her illness. The disposition to limit the impact of adverse moral judgment on medical care and to refrain from exploitation of professional status and power in the service of nonclinical objectives serves patient interests by providing a supportive social relation that encourages patient candor and confidence and that is free of physician motive ulterior to the patient’s clinical interest. This principle applies, for example, to prisoners and to wounded enemy soldiers. To encourage clinically egalitarian medical care for prisoners, prison doctors are routinely kept in the dark regarding the crimes of which their inmate patients have been convicted. It is considered a violation of internationally recognized medical ethical norms to breach the confidentiality of enemy combatants through the disclosure of medical information to their interrogators [12].


  8. Andrea Says:

    “May I never see before me anything more than a man in pain.”


  9. Amy Cherie Says:

    I’m trying to change my shrink right now. The one I’ve got is arrogant and unfeeling. Not sure why he became a shrink in the first place.


  10. SaraMac Says:

    He’s the one who says we’ve all got too much self esteem, right.


  11. Petronella Says:

    Does this guy not know anything about basic medical ethics? Jeez.


  12. Jordan Says:

    All I can say is keep it up. This blog is so needed in a time when every person just desires to talk about how numerous folks someones cheated on their wife with. I mean, thanks for bringing intelligence back to the web, its been sorely missed. Fantastic stuff. Please maintain it coming!


  13. Lara Says:

    This comment might be against the spirit of free enterprise but the times behind the pay wall is not a successful product.


  14. Mable Stokes Says:

    A prison shrink has a captive audience.


  15. Troy in Vegas Says:

    The problems is none of this stuff is peer reviewed.


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