In City Journal Dalrymple provides a detailed analysis of England’s budget crisis: the position in which the government finds itself, how it got there, and the difficulties and Catch-22s of finding a way out.
The biggest demonstration against the government’s proposals was on March 26. A quarter of a million people took to the streets—in solidarity with themselves. Many were teachers protesting the proposed cuts in education spending. Yet after a compulsory education lasting 11 years and costing, on average, $100,000 per pupil, about a fifth of British students who do not attend college after high school are barely able to read and write, according to a recent study from Sheffield University. Considering the disastrous personal consequences of being illiterate in a modern society, this is a gargantuan scandal, amounting to large-scale theft by the educational authorities. No anarchist ever smashed a window because of this scandal, however; and so it is impossible to resist the conclusion that the demonstration was in defense of unearned salaries, not (as alleged) of actual services worth defending.….So it is not surprising that the Guardian, which one could almost call the public-sector workers’ mouthpiece, has reported that hospital emergency departments are already feeling the budgetary pressure and risk being overwhelmed, even before the cuts have been implemented in full. Meanwhile, one can still find plenty of bureaucratic jobs advertised in the Health Service Journal, the publication for nonmedical employees of the NHS. One hospital seeks an Associate Director of Equality, Diversity, and Human Rights; another is looking for an interim Deputy Director of Operations and Transformation. Part of the “transformation” in that case seems to be a reduction in the hospital’s budget, and it is instructive that the person who will be second in command of that reduction will be paid between $1,000 and $1,300 per day.…We seem caught in an eternal cycle, in which a period of government overspending and intervention leads to economic crisis and hence to a period of austerity, which, once it is over, is replaced by a new period of government overspending and intervention, promoted by politicians, half-charlatan and half-self-deluded, who promise the electorate the sun, moon, and stars.….As soon as the crisis is over, though this may not be for some time, the politicians are likely again to offer the public security and excitement, wealth and leisure, education and distraction, capital accumulation without the need to save, health and safety, happiness and antidepressants, and all the other desiderata of human existence. The public will believe the politicians because—to adapt slightly the great dictum of Louis Pasteur—impossible political promises are believed only by the prepared mind. And our minds have been prepared for a long time, since the time of the Fabians at least.
Wasn’t Dalrymple himself a ‘public sector worker’?
Anya: what are you trying to imply by your comment?
Anya wrote:”Wasn’t Dalrymple himself a ‘public sector worker’?”
Then he should know what he’s talking about.
And what a great piece it was too. No wonder the left are gunning for the man.
Absolutely. I’m also a public sector worker (though not for much longer) and am quite familiar with all the pathology described. It’s a shame that institutions that exist for such ostensibly noble purposes are so susceptible to human greed. But they are. Not that many in the public sector would admit it.
In response to the remark, “about a fifth of British students who do not attend college after high school are barely able to read and write……,and so it is impossible to resist the conclusion that the demonstration was in defense of unearned salaries (of teachers), not (as alleged) of actual services worth defending.” How many patients lives did the good doctor save permanently or turn around? Just asking.
I am not sure what point you are making. Do you think the practice of medicine is not worthy of remuneration? What is your definition of “save permanently”, when everyone dies at some time and Dalrymple dealt mostly with mental illnesses, with complex trajectories before, during and after his ministrations? He certainly tried to “turn around” lives but through no fault of the doctor’s, many of the underclass would not respond well to his approach; he said as much himself that “I often tried to change people’s lives in a direction I felt appropriate, but with limited success” (paraphrased)
Does he, at any point, acknowledge the role in which psychiatry itself has to play in all of this?
Yes. In many ways much of his work could be seen as a rebuke of a lot of psychiatry. As he often describes traditional psychiatric practice, “The patient pretends to be ill, and the doctor pretends to treat him.”
He wasn’t dealing with ‘the underclass’. He was dealing with the population of Birmingham – a population as socially heterogeneous as any major American city.
Or are you automatically qualified for membership of the underclass by virtue of being ‘mentally ill’?
Is that what happens in America?
How very humane.
Dalrymple was dealing with the underclass during his years in Birmingham. He was not dealing with the mentally ill for the most part.
He was working in the Winson Green area, at City Hospital (as a medical doctor) and Winson Green Prison (as both a medical doctor and psychiatrist).
At the hospital his patients were certainly members of the underclass by any definition. He has described seeing approximately 10,000 victims or perpetrators of domestic violence, has said “…practically all the patients have tried to kill themselves”, and has recounted interactions with drug dealers, violent predators, and lifelong recipients of public assistance. He has said, “…their existence is as saturated with arbitrary violence as that of the inhabitants of many a dictatorship”, that “70 percent of the births in my hospital are now illegitimate” and that his patients’ lives were “dominated, almost without exception, by violence, crime, and degradation.” If he were making it all up, I think we would have heard from his coworkers by now. I have never been to Birmingham, but 10 minutes on Google convinces me that it is not particularly crime-ridden compared to other English cities, but that the Winson Green area most certainly is.
In the prison he did work partly as a psychiatrist, but has said that very few of the inmates were mentally ill.
This last point is key to understanding Dalrymple’s position: Namely, that his patients (both in the hospital and the prison) were not mentally ill (nor objectively poor), but had forgotten how to live properly. Their family structures were broken, taking education seriously was considered socially unacceptable, they resorted to violence easily because they accepted few limits to their behavior, etc. He has very often criticized the psychiatry directed at these people as: “The patient pretends to be ill, and the doctor pretends to treat them.”
His tough-love approach is humane, because he knows these people are capable of living better, happier, less destructive lives, and making better decisions is their only possible road to improvement.
I am about to sound a tad supercilious and for that I apologise. I strongly suggest you conduct some research into the NHS and the way in which it operates. There simply aren’t enough resources to make psychiatric services available to accommodate the non- mentally ill.
Please be aware that I have first hand knowledge of the issues you raise above.
Who determines whether the patient is mentally ill or not?
You may want to correct his Wikipedia entry then:
In 2005 he retired early as a ‘consultant psychiatrist,’ writing in the Sunday Telegraph: “Retired at last! Retired at last! Thank God Almighty, retired at last! Such are the feelings of almost all hospital consultants and general practitioners who retire from the National Health Service after many years of service: years that increasingly have been ones of drudgery, servitude and subordination to politicians and their henchmen, the managers, who utter Pecksniffian pieties as they secure the advancement of their own inglorious careers.” He now divides his time (with his wife, Dr Agnes C. Nalpas) between homes in Bridgnorth, Shropshire, and France, and continues to write.’
‘If he were making it all up, I think we would have heard from his coworkers by now.’
Perhaps incompetent NHS psychiatrists are two a penny. This is what Daniels/Dalrymple has ton say about his co-workers:
I am aware that hard cases make bad law, but I could cite many such cases as the one above; of cases, for example, where doctors have changed their diagnoses in order to avoid the responsibility of finding hospital beds for their patients, and where they have even perjured themselves in court to evade that responsibility, to the great detriment of the patient and the safety of society alike. These are now part of everyday practice.
Oh, I think you are sure about the point I’m making but I will spell it out all the same. Dalrymple thinks that teachers don’t earn their salaries because a fifth of students cannot read or write properly despite the teachers’ efforts. In that case does Dalrymple not earn his salary because a high proportion of his patients carry on taking drugs, committing crime, killing themselves etc? Does he not think that the teachers might try as hard with their pupils as he does with his patients? Most do you know. On another point, he keeps going on about the cost of compulsory education and how too many still cannot read or write despite the enormous cost. Yet it is a fact that private school pupils do better than state school pupils. In other words the more money is spent the better i.e. £5000 per pupil per year at state school v £30,000 per pupil per year at Eton. Eton pupils ( and all private pupils) fare better every time. £5000 per year is a paltry amount.