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.

Found in the Bowels of the BMJ

Finally, I have discovered someone else who is not star struck by Theordore Dalrymple/Anthony Daniels:

If Symptoms Persist

1. 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

http://www.bmj.com/content/310/6988/1207.1