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.

“What?”

“Don’t.”

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.

 

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

At Large

It seems that our favourite doctor-patriot is at large again, this time on the Daily Express:

‘Unfortunately, English national identity became associated with beer-gutted, T-shirt-wearing, foreigner-hating, shaven-headed football hooligans who chanted Ingerland, Ingerland! while the national football team was playing and generally losing.’

Really, Theo?   In whose mind?  In your own mind?  I think you may be projecting again.  Doesn’t therapy help with that?

And isn’t this what you once aspired to:

‘As a boy, I went to a lot of football matches and was enthusiastic about them in a way that I now find very difficult to understand. Anyhow, there was a cup match which I deemed it of supreme importance that I should attend, and as the tickets went on sale well in advance, I took myself off to the stadium and joined a very long queue. I was about eleven years old at the time.’

What’s wrong, Theo?  Did they reject you?  It might be time to get over it. Resentment is toxic, remember?

Addendum: ‘A bad doctor nearly always blames his patients.’

My G.P.

Oh, and another thing: the only thing decaying round here is you, you foolish, vengeful, embittered old man.

Gotta Love the Daily Mail…

 

Shrinks in the news   For the concept of  collective guilt to have any validity it has to be  applied universally.*

The very mention of this newsworthy issue makes me a ‘monomaniac’ in some people’s eyes: http://blog.skepticaldoctor.com/   I would be the last person to stand in the way of people who are making an effort to correct the deficiencies in their education but I would suggest that while the use of random polysyllabic words can be impressive, it would be even more impressive if you familiarised yourselves with their meaning.

*Addendum: They’re not too fond of geriatricians/gerontologists either.  And if even a fraction of this is true then I’m not sure I blame them.

Taking the King’s Shilling

My response to this:

http://tinyurl.com/6qbpprc

1/11/2012 2:29 PMClinton wrote:
Louise, as Dan said, Dalrymple was both a psychiatrist and a medical doctor. His patients were not poor in the objective sense, though they were almost certainly were in teh subjective, Western sense. The vast majority of his patients were not mentally ill. That is his entire point: that they wanted to blame their problems on a medical condition, when in fact they were simply ignorant of how to live. As he said in describing the typical patient-psychiatrist relationship, “The patient pretends to be ill, and the doctor pretends to treat him.”
Reply to this

‘Dalrymple was both a psychiatrist and a medical doctor. ‘

I think you’ll find that all psychiatrists are medical doctors. If you want to know how our system works then visit your nearest psych hospital. Your system is not that different from ours. If you want to know the damage that some psychiatrists have wrought in your own country then google ‘iatrogenic mpd’.

‘The vast majority of his patients were not mentally ill’

If this is true then he shouldn’t have been treating them. His employer was the publicly funded NHS and he was paid to treat sick people. Something you should be made aware of: I grew up in Birmingham and my mother is a recently retired psychiatric nurse. Many of his assertions are, according to her and some of her colleagues, quite simply factually untrue. And if it is true that most NHS psychiatric patients are not ill then maybe psychiatry is a luxury the NHS simply cannot afford. This would have implications for the US too.

‘As he said in describing the typical patient-psychiatrist relationship, “The patient pretends to be ill, and the doctor pretends to treat him.”‘

Yes, you’re right he did say this but he said it in the context of drug addiction. And doesn’t this make the doctor himself a fraud?

Dalrymple was a fraud?
His colleagues were frauds?
Is this what you are saying?

Oh, Doctor Dalrymple, with friends like these…

Is America’s long love affair with psychiatry coming to an end?

Watch this space.

Addendum: I suggested that Doctor D’s disciples deserve a better messiah. Maybe the reverse is true. Does the Messiah deserve better disciples?

Addendum 2:

The Good Doctor (no 999)

Resentment is the monster that lives within me. My favourite former psychiatrist, Dr Anthony Daniels/ Theodore Darymple has written an essay on the subject. I can only concur with its premise which is that resentment is corrosive and destructive and, in the long term, pretty damned useless. It is insidious though and once it has you in its jaws it will not willingly release you. You have to fight your way out. I’m hoping that my own resentment has plateaud and will soon subside. For to sustain resentment you have to keep feeding it fresh meat. I am nourishing it. It is eating me up and, if I don’t kill it, it will kill me.

Speaking of Doctor Dalrymple: this article (hat tip to his ‘groupies’ here) reminds me of why reading his output frequently leaves me incandescent with rage. ’Narcissist’ is one of the good doctor’s favourite insults but this time he should direct it at himself, for is there anything more ‘narcissistic’ than writing about the heroism of the Chilean miners, making it fit into your latest little pet peeve (sense versus sensibility) and then twisting it round so that it becomes about you and your own putative heroism? And, naturally, he never misses a chance to malign his native country: ‘Of course, I was talking of the British as they once were, not as they now are—world-champion snivelers’. Well, one less ‘sniveller’, Doctor Dalrymple, now you’re temporarily absent from the country. One accusation you could never level at Dalrymple is that he is afflicted with an excess of patriotism.

Malingerers, Malingerers Everywhere

I am currently reading the seemingly endless output of Dr. Theodore Dalrymple,  (Now, remember kids, prolificacy in itself is not a virtue) nom de plume of Dr Anthony Daniels: retired consultant psychiatrist in a hospital situated in a run-down district of Birmingham (in a fit of shrieking hyperbole the good doctor calls it a ‘slum’).  He also spent two afternoons a week working in the city’s Winson Green Prison.  In other words he has spent the latter part of his career treating (to put it bluntly) the criminal and the insane and sometimes the criminally insane.  The kind of people who have been told in no uncertain terms by the judiciary and the medical profession that their behaviour is unacceptable. That is how they wind up in hospital or prison. Dalrymple’s advocates often argue that his experiences in these institutions give him a clear view of the decline of civilization. Well, no, not really; he had been given a clear view of the behaviour and worldview of social deviants.

These people are called ‘deviants’ because they deviate from the norm and yet Dr Dalrymple/Daniels tells us that their worldview and the behavior that emanated from this is prevalent across the country amongst the law-abiding and the non mentally ill.  I am reminded of something a war-veteran neighbour told me about a medical officer he once worked under when he was overseas. Some members of the conscripted lower ranks, shell shocked before they’d set foot on any battlefield, feigned illness in order to avoid being sent into battle. The phrase ‘to shoot oneself in the foot’ is a reference to military personnel who would literally shoot themselves in the foot to render themselves unfit for armed conflict.  A tiny minority of new recruits were willing to do anything to avoid what was coming.  The medical officer wised up to the fact that a small proportion of those who came before him were ‘malingerers’.  In time he began to see ‘malingerers’ every where even when there were none.  And, because of this, many genuine invalids suffered more than they should have.  (There is a similar situation replicating itself in the benefits system in that, according to some sections of the media, some benefit claims are fraudulent so all benefit claims must be fraudulent.)

I strongly suspect that the Dalrympian worldview can be partially attributed to the fact that he spent the twilight years of his medical career treating the mad, the criminal and sometimes the criminally insane therefore, to his mind, many people he sees outside the world in which he once moved are possibly mad, criminal or criminally insane. ‘Mad people, mad people everywhere and I’m not permitted to forcibly medicate a single one.’