Theodore Dalrymple of the bayou

Rod Dreher, writer of Crunchy Cons and blogger at The American Conservative, writes of a doctor in Louisiana who has reached many of the same conclusions about his poor patients there as Dalrymple has in Great Britain:
He said that many of the patients he sees “are people who are poor because they just don’t want to work. They’ve never had a job and they never will have a job. They’re fine with that.”
He said that the general public has no idea how much money is wasted on medical fraud and abuse by members of the underclass, and on treating people who have no intention of being anything other than dependents on the state, and who will demand treatment “if they as much as stub their toe” because they don’t have to pay for it. He said that if the health care system here in Louisiana had the money it threw away on fraud by and unnecessary treatments for the poor, “we could build a brand-new hospital to replace Earl K. Long.”
He said that most people in society never have to spend any time in the world of the American underclass, so it’s easy to sentimentalize them. That can go both ways of course, and it can be easy to think of all the poor as brutish, etc. But Dr. Smith’s Dalrympian view is that our discussion of health care in this country, especially for the poor, is uninformed by a realistic understanding of the lives many of the poor lead, and the lack of moral scruple and sense of responsibility to themselves and to the wider community.
Dreher does not identify the doctor’s real name but says he hopes to get an on-the-record interview with him soon.
Read the whole post here.

23 thoughts on “Theodore Dalrymple of the bayou

  1. Louise

    What is this doctor’s specialism?

    And, for the millionth time, Dalrymple was a psychiatrist and treated the mentally ill, not the poor (although there may have been some poor people among his patients unless he was cherry picking them which is seriously unethical.)

    This was the ‘slum’ in which he worked:

  2. Jaxon

    I got this far:

    The Trust is a key partner along with local PCTs, GPs and local authorities in the “Right Care Right Here”

    Basically it went Trust, Trust, Trust, Trust…

    “for the millionth time”

    How apposite, maybe this rings a bell

    “The problem is that nonsense can and does go by default. It wins the argument by sheer persistence, by inexhaustible re-iteration, by staying at the meeting when everyone else has gone home, by monomania, by boring people into submission and indifference. And the reward of monomania? Power.”


    “As to why people adopt theories that conflict with the most minimal honest reflection, I will quote T. S. Eliot, who, while not always right, was right about this:

    Half the harm that is done in the world is due to people who want to feel important. They don’t want to do harm—but the harm does not interest them . . . or they do not see it . . . because they are absorbed in the endless struggle to think well of themselves.
    Eliot might have added: the endless struggle to look well in the eyes of their fellow intellectuals and the fear of losing caste. But as a result of their efforts, as Orwell also famously said, “We have sunk to a depth in which re-statement of the obvious is the first duty of intelligent men.”

    what fun… and for some more fun
    What, if anything, do these video clips have in common?

  3. Clinton

    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.”

  4. Louise

    ‘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 mod.’

    ‘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?
    That his colleagues were frauds?
    Is this what you are saying?

    Oh, Doctor Dalrymple, with friends like these…

  5. Steve

    Louise, bless your heart. You are operating on such bad information, I can only shake my head and laugh.

    First, if “all psychiatrists are medical doctors”, why did you say, “What is this doctor’s specialism?… Dalrymple was a psychiatrist and treated the mentally ill, not the poor”? The truth is that he treated people complaining of mental problems as well as people complaining of physical problems, and he did this in a prison and a hospital where most of the patients who arrived seeking treatment were poor (in the relative sense).

    Second, the fact that, as a psychiatrist, he saw patients who were not mentally ill does not mean he treated them for mental illness — or even that he treated them at all. If a man who has just beaten his girlfriend arrives and says he has a mental illness that causes him to act like a brute, but he wants credit for controlling his actions in front of the police or a judge, what should the doctor do? Clearly, the man is just making excuses to deflect blame. What Dalrymple did was to tell him the truth: “You are not mentally ill. You need to control yourself and stop being a jerk.” Other doctors would seek to avoid a confrontation by just giving him medication. You say he was paid to treat sick people, but what if the patient is not sick? Should he treat him anyway? Which brings me to…

    Third, when Dalrymple said, “The patient pretends to be ill, and the doctor pretends to treat him”, he was speaking of other doctors and not of himself.

    If you have evidence against Dalrymple’s account of things, by all means post it here. But you should first seek to understand his argument, because otherwise you just make yourself look silly.

  6. Clinton

    I know that all psychiatrists are medical doctors, and as a non-doctor I don’t know the exact terminology – please educate me there – but I meant that Dalrymple functioned as both a psychiatrist and as a “normal”, non-psychiatric, GP-type doctor who treats non-mental illnesses and injuries. Whatever that is properly called…

    Obviously, you are correct that he should not have been treating psychiatric patients who were not mentally ill. This is the entire point he himself makes when discussing his psychiatric work: most of them were not mentally ill; they were making poor decisions that caused them to be unhappy and often to have attempted suicide, and the solution was not drugs or other treatment but their deciding to live differently.

    At City Hospital Dalrymple worked in the emergency room (I think you call it the casualty department…?), and he has said that the vast majority of his patients were there for having attempted suicide. He was not working as a full-time psychiatrist treating psychiatric patients; he was treating people in the casualty department who had come in for having attempted suicide or for injuries due to violence. Other doctors gave those people drugs, but he mostly did not because their “illness” (unhappiness) was not medical in nature.

    He did not say “The patient pretends to be ill and the doctor pretends to treat him” only in the context of drug addiction, though it certainly applies there (in spades). He said it, just to take one instance, in an interview with the CBC about his patients overall in the hospital. You can listen to the interview (“The Ideas of Theodore Dalrymple”) here:

    What statements from him do your mother and her colleagues consider factually untrue? I’m honestly curious.

    I will google the term you suggested. I won’t be the least bit surprised to discover that your statements about damage from some psychiatrists is true.

  7. Jay C

    If we’re talking about MPD now, this is an area I have extensive knowledge of, in trying to debunk conspiracy theories in both sides.
    MPD was claimed as either demon possession, the result of extreme sexual and physical child abuse: the most common technique being described for induction was to severely beat and deprive a child of all attention for the first 18 months to four years breaking any natural resolve and introduce sexual abuse, usually by parents and relatives, as a “normal” way of expressing love after that. The proponents claimed that produced a totally mind-controlled person with “multiple alters”. Some combined the demons and paedophile theories for “Satanic Ritual Abuse”, which is now held by very few professionals for lack of evidence.

    Therapists and social workers with various ulterior motives used leading interrogative techniques on highly suggestible children and adults, which some say is the real cause of MPD. It is a <> between client and professional. However, psychiatry has had very little role to play; the problems were on the psychosocial side of mental health treatment rather than the biological that Dalrymple would have treated (had he judged it appropriate to do so in the case.)

    It looked like all bets were off on MPD but an anonymous foster carer, Britain’s equivalent of Torey Hayden, wrote a supposed true-life story of a girl of eight raped by numerous men including her father with the assistance of her mother, which claimed she had MPD. The term used was dissociative identity disorder, which is identical; one suspects the terminology was altered to remove the scent of disproven SRA from the diagnosis. The book became a best-seller causing MPD belief to rise again.

  8. Louise

    “Louise, bless your heart. You are operating on such bad information, I can only shake my head and laugh.”

    Well, given that I get a substantial proportion of my information from this very site and from The Greatest Doctor in the Universe himself,  you may have a point.

  9. Clinton

    Louise, the truth was just explained to you (below, by me). So if you still adhere to your false notions about Dalrymple’s career, you have no one to blame for your ignorance but yourself.

  10. Louise

    I am reluctant to accuse you of mendacity. You are probably just a tad gullible. The account you provided of Dalrymple’s day to day career is demonstrably false.

    A couple of questions: 1. Have you fact checked any of this yourself?
    2. How many trips have you made to Birmingham, England?


  11. Clinton

    1. Of course not.
    2. Zero.

    My description of Dalrymple’s career comes from his own writings. If Dalrymple’s account of his own career is demonstrably false, you should be able to demonstrate that it is. Please do so. The burden of proof is on you to show that he has been lying about his NHS career, not on Dalrymple to demonstrate that it is true.

  12. Louise

    ‘Therapists and social workers with various ulterior motives used leading interrogative techniques on highly suggestible children and adults, which some say is the real cause of MPD.’

    But MPD was a diagnosis listed in the DSM and that document is drawn up by psychiatrists and not just any psychiatrists, American psychiatrists.

    I do not buy Dr Dalrymple’s portrayal of the average medical doctor as a sensitive, powerless, delicate little flower at the mercy of omnipotent bureaucrats and detached intellectuals.  Sorry.  These are powerful people and if things have gone wrong then they’ve gone wrong on their watch. Doctors are powerful, psychiatrists are more powerful than most doctors.  In fact many other doctors resent the undeserved hegemony psychiatry has over the rest of the profession.

    And UK mental health professionals employed by the NHS never really bought into MPD.  Just a point about social workers and therapists: I’ve noticed that Dalrymple whines a lot about these two groups of people.  In the NHS the clientele of therapists and social workers are referred to them by doctors (usually consultant psychiatrists).

  13. Jaxon

    Here for another instance

    My two links in previous comment may seem a bit silly and unhelpfully misleading or what have you… but it just so happens that the BBC recently broadcast this (probably not accessible from outside UK)

    I think it says a lot about society – a recipe for an epidemic of ‘mental illness’

    And as TD says in The Frivolity of Evil, top link

    “A sharp economic downturn would expose how far the policies of successive governments, all in the direction of libertinism, have atomized British society, so that all social solidarity within families and communities, so protective in times of hardship, has been destroyed. The elites cannot even acknowledge what has happened, however obvious it is, for to do so would be to admit their past responsibility for it, and that would make them feel bad. Better that millions should live in wretchedness and squalor than that they should feel bad about themselves”

    There’s no magic booth to jump in and pull a lever and move on as if nothing ever happened (thinking there was being a popular route to ‘mental illness’)

  14. Louise

    ‘I think it says a lot about society – a recipe for an epidemic of ‘mental illness”

    Not really. I think it says more about you and your need to shoehorn this subject into almost every thread.

  15. Jaxon

    He hee… Excuse me I’m the only monomaniac in this village!!

    Here’s one I made earlier:

    []I’ll offer a snippet of his past observations on humanity – that will not only go some way to explaining his jaundiced views but perhaps reveal something of the nature of the (un)economy

    “ In the prison in which I work I see many men who have a grossly inflated and indeed repulsive self-esteem. They are young criminals who walk with a swagger, who have frequently committed acts that have caused deep misery to others, who have fathered children without the least concern for their welfare and yet who project a self- satisfaction that is horribly at variance with their actual place in the world.”

    So where’s your actual place in the world? If you’re using, what is largely Gordon Brown’s legacy, as a frame of reference you’ll be woefully misguided; and in a rather bad place with regards to understanding the insights of Theodore Dalrymple; in fact, you’ll merely be compounding Brown’s legacy and that bodes exceedingly badly for… []

    In fact I might call it the Blown economy Bl(air Br)own since they’ve so diligently applied themselves to being the most prominent longest ‘serving’ facilitators of such uneconomy.

    “Not really. I think it says more about you and your need to shoehorn this subject into almost every thread.”

    It is true… I do think virtually all our problems (minus asteroid strikes… and maybe earthquakes) can be reduced, most tellingly, to sexual ‘relations’ (and perhaps that could be taken by some as reflecting not too well on Dalrymple because he’d probably find that too simplistic an assessment) but I stand by it, though maybe ‘shoehorning’ here is too much like preaching to the largely converted – I’ll try to be more mindful of this… and if I improve some credit should probably go to you Louise. But if society improves then most of the credit should go to me 🙂


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