Writing on opium addiction at his blog for Psychology Today, Dalrymple quotes from a book called “The Life of the Heroin User: Typical Beginnings, Trajectories and Outcomes” by Shane Darke of the National Drug and Alcohol Research Centre at the University of New South Wales. Mr. Darke’s findings confirm many of the arguments Dalrymple has long made about addiction, for example, that users are not as easily and helplessly addicted as conventional wisdom and popular culture suggest:

“Whilst opioids are associated with considerable pleasure in their
subjective effects, they have a number of serious negative sequelae.
Use of the drugs, at least prior to the development of tolerance,
produces nausea and vomiting. The novice user has to work through
these effects to become the long-term user we discuss in this book.”

Now in my experience, at least, nausea and vomiting are highly aversive experiences. If I ate some berries from a tree that caused me to vomit I should certainly think twice about returning to them. In other words, to work through nausea and vomiting indicates considerable determination: indeed, of a degree that would be admirable if it were in pursuit of a worthier end.

Read the post here

Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of around 50 or 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor. We are posting one each Wednesday to coincide with the schedule of his old BMJ column. We hope you enjoy them.

Prophecy is a fool’s game, which perhaps is why so many of us indulge in it. In 1924 Bertrand Russell wrote a very short book called Icarus or the Future of Science, a response to J.B.S. Haldane’s Daedalus or the Science of the Future. Daedalus, you remember, gave the power of flight to Icarus, and we all know what happened to him (oddly enough, the Brazilian airline Varig once unadvisedly called its in-flight magazine Icarus).

Haldane painted a rosy future for mankind thanks to its increased control over nature; Russell was more pessimistic. He thought American domination of the whole world was the best that we could hope for, next to the complete collapse of our civilization which, he said, ‘would in the end be preferable to this alternative.’

Russell divides the sciences into two, the physical and the anthropological, of which medicine is much the most important. He believes (correctly, as it now turns out) that ‘the study of heredity may in time make eugenics an exact science, and perhaps we shall in a later age be able to determine at will the sex of our children.’ Though no monogamist himself, he was not altogether sanguine about the results: ‘This would probably lead to an excess of males, involving a complete change in family institutions.’

He sees the march of birth control as inevitable. Opposition to it comes from superstition and the desire of employers to have enough people to keep wages low. However, not all the effects of birth control are to his taste. ‘Before long the population may actually diminish. This is already happening in the most intelligent sections of the most intelligent nations… before long, birth-control may become nearly universal among the white races; it will then not deteriorate their quality, but only diminish their numbers, at a time when uncivilized races are still prolific and are preserved from a high death-rate by white science.’

The other problem is the ductless glands:

More sensational than tests of intelligence is the possibility of controlling the emotional life through the secretions of the ductless glands. It will be possible to make people choleric or timid, strongly or weakly sexed, and so on, as may be desired. Differences of emotional disposition seem to be chiefly due to secretions of the ductless glands, and therefore controllable by injections or by increasing or diminishing secretions.

The politically powerful will inject the masses to make them docile. But if it is not the ductless glands that will give the powerful this control over the masses, it will be some other technology:

We shall have the emotions desired by our rulers, and the chief business of elementary education will be to produce the required disposition, no longer by punishment or moral precept, but by the far surer method of injection or diet.

Of course, the main emotional disposition required has turned out to be not docility, but self-esteem.

Russell foresaw the end of physical want, thanks to the application of science, but luckily we are different from the animals.

Wolves in a state of nature have difficulty in getting food, and therefore need the stimulus of a very insistent hunger. The result is that their descendants, domestic dogs, over-eat if they are allowed to do so.

But because of our difference from the beasts ‘over-eating is not a serious danger.’

As I said, prophecy is a fool’s game.

At his new blog at Psychology Today, Dalrymple responds to an older post by another psychiatrist, Dr. Ken Eisold, that seeks to explain rioters:

In his article, Dr Eisold makes reference both to the social and economic frustrations of the rioters and to the events in Tiananmen Square. But demonstrations are not riots, though they can be turned into such by extremists, and perhaps by the provocation of the authorities. Nor is it true that every frustration is justified, or that it explains, let alone justifies, riotous and destructive conduct. If frustration explained riots, we would all be rioters. But even in riot-torn areas, rioting is not universal.

Read the full post here

On the Salisbury Review’s website Dalrymple proclaims his opposition to smoking, but also to dishonesty:

I was startled by a figure in a recent article in the British Medical Journal titled How the tobacco industry refuses to die. It was a Venn diagram in which the costs and benefits of smoking in the UK were displayed. On the benefits side was a smaller grey circle marked £9.5 billion. On the costs side was a vividly multi-coloured circle marked £12.9 billion.

The text of the article, however, said that the Exchequer received £10 billion in excise duty on cigarettes and a further £2 billion in VAT on cigarettes. British American Tobacco paid £1.45 billion in taxes, and if Imperial Tobacco paid taxes pro rata according to its profits, it would pay £0.7 billion. In other words, the figure in the benefits circle should have been at least £14.15 billion. This does not include the benefits of employment by the industry and – horrible to relate – the reduction in pensions that have to be paid to those who die early as a result of smoking. This would be an unpleasant figure to calculate, but if we are talking of economic costs and benefits it ought to have been included.

This column from 2 weeks ago in City Journal has thankfully been overtaken by events:

…there is a serious risk that little more than 4 percent of the adult population could determine the policies of the next government.

According to polls, the Scottish National Party (SNP) will win 50 seats in the next Parliament. Polls can be wrong, of course…

In economics, the Nationalists are socialist, or at least corporatist; in politics, their rhetoric is nationalist. They are, in fact, national socialists. Fascism is returning to Europe, though—for now—with a much less aggressive, brutal face.

Governments in both America and England have lately imposed fines on companies about whose practices the governments never previously complained, and in fact benefited from. For example, the tobacco settlement in the US:

Since champerty (an agreement between the plaintiff in a lawsuit and another person, usually an attorney, who agrees to finance and carry the lawsuit) is legal in the United States, though intrinsically corrupt, the chief beneficiary of the litigation against the tobacco companies there were the litigation lawyers. In no case did the lawyers seek to bankrupt the company, or close the company down because of the evil it had done; for he who sues for a reasonable amount lives to sue another day. In effect, this litigation was the means by which the lawyers transferred the profits of the companies, or at least a significant proportion of them, from the shareholders of the companies to themselves.

In the Salisbury Review Dalrymple explains why this quote from the former Governor of the Bank of England, Lord King, is “confession without confession”:

I am not going to talk about individual parties’ culpability because I think the real problem was a shared intellectual view right across the entire political spectrum and shared across the financial markets that things were going pretty well…We as one country could not have stopped the financial crisis occurring.

A recently-purchased book previously owned by a prominent anthropologist and containing an essay on snobbery causes Dalrymple to consider “downward cultural aspiration”:

Until quite recently, emulators emulated those higher in the social scale than themselves, which meant of course that there were more emulators than emulated. Nowadays, however, it is persons in or from a higher social class who emulate those in a lower social class. They adopt the manner of speaking, dressing and cultural tastes of those below them. Intellectuals affect vulgar expressions and anyone with an avowed uninterest either in sport or in popular music is suspected at once of enmity towards the people…

If, as Hocart says, ‘The desire to emulate one’s better has been a most potent, perhaps the most potent, force in the diffusion of customs,’ the fact that the higher echelons now ape the lower means that the lower have no need to aspire to anything in order to imagine themselves to be rising in the social scale, for there is nothing higher to emulate. This false egalitarianism serves, then, to conserve the social structure as a fly is conserved in amber. Social mobility falls while culture becomes less refined.

Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of around 50 or 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor. We are posting one each Wednesday to coincide with the schedule of his old BMJ column. We hope you enjoy them.

The narrator of the novel Lost Horizon is a neurologist who has written a book on amnesia, which is one of the reasons why the story of Conway interests him. Conway, a veteran of the trench warfare of the First World War, is a British consul in Afghanistan who disappears and finds peace in Shangri-La, a Tibetan lamissary, where the secret of the good life has been found and as a consequence that of longevity also. When he leaves Shangri-La, however, he loses his memory, recovers it briefly to recount his story, and then loses it again.

The author of Lost Horizon was James Hilton (1900 – 1954) and his book gave not only a name but a whole concept to the English-speaking world. Strangely enough, he appended a dateline to it: Woodford Green (Oak Hill Gardens, to be exact), 1933. This raises the interesting question of whether there are people in Shangri-La (or rather, Shangri-La-like places) dreaming of semi-detached houses in Woodford Green.

Lost Horizon was not really a success until after the publication of Goodbye, Mr Chips a year later: both were then publishing phenomena, it often being said that Lost Horizon was the first mass-market paperback best-seller in the United States.

Mr Chips – short for Chipping – is a school-master aged 85. He was a teacher at Brookfield School for sixty-three years until his retirement in 1913, when he went into lodgings near the school. He looks back on his life as he dozes in his chair:

When you are getting on in years (but not ill, of course), you get very sleepy at times, and the hours seem to pass like lazy cattle moving across a landscape.

His doctor, Merivale, visits him every fortnight or so and drinks a glass of sherry with him. Dr Merivale is the epitome of the reassuring family doctor:

My dear fellow, you’re fitter than I am. You’re past the age when people get these horrible diseases; you’re one of the few lucky ones who’re going to die a really natural death. That is, of course, if you die at all.

By natural death, I suppose, he means old age, terminal decay, rather than anything like cancer or heart attack; but this jocular reassurance is immediately belied by what he tells Mr Chips’ landlady on his way out:

Look after him, you know. His chest… it puts a strain on his heart.

The puritan modern sensibility would no doubt find this disjunction between what the doctor says to the patient and what he says to the person looking after him shocking, but I am not certain that it is inhumane.

Illness quietly pervades the book. An outbreak of German measles – German measles, who can remember it? – affects half the school and turns much of it into a hospital ward. Everyone thinks of Mr Chips as a confirmed bachelor, but in fact he was once, briefly, married. In 1898, his beloved wife died in childbirth, along with the child, presumably of a prolonged labour. In 1916, Chatteris, the headmaster in his late thirties, and who looks very ill, confides guiltily in Mr Chips, who is now retired, that he, Chatteris, is indeed ill. He has diabetes.

Chatteris fell ill during the winter of ’17… Then in April, [he] died.

Without intending to, Hilton reminds us of how far we have come, medically. Will our own best-selling authors do the same for our descendants?

Dalrymple writes at his Psychology Today blog on the problems of a pernicious modern concept:

When I told patients who complained of lack of self-esteem (admittedly on a selected basis) that at least they had got one thing right, they did not grow angry or upset, but laughed instead as if they had known all along that their complaint was a charade. Of course they had things to complain of – we all do, and they had more than most – but the notion of lack of self-esteem actually discouraged them from examining those things honestly.