(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.
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