The Hippocrates Prize

Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of about 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor.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

Literature and medicine have a closer connection than, say, literature and accountancy (the only literary accountant I can think of offhand, though this may be due to ignorance and lack of sleep, is Sydney Fowler Smith, who lived from 1874 to 1965 and wrote much dystopian science fiction and many crime novels). Accountants, like doctors, must be privy to many secrets but do not seem to turn their insights into human nature into literature. On the other hand, there have been a surprising number of bank or insurance clerks who were great writers, among them Kafka, Italo Svevo and T.S. Eliot. But it is not certain whether certain professions favour the muse, or the muse favours certain professions.

The Hippocrates Prize is an annual award for poetry, now in its fifth year, open to anyone who works, or has worked, in the NHS; there is also a category for poetry about a medical subject, open to anyone in the world writing in English. Altogether there are thousands of entries and the winning poems, the two runners up and all the commended poems, are published in a slim but elegant volume. It is rather difficult to imagine a poetry prize open to people who have worked in accountancy, or to anyone who has filled out an income tax form, attracting quite so many entries.

The pleasures of the poems are various, as you would expect. Valerie Laws, for example, raises a purely intellectual problem in her witty poem, A Question for Neuroscientists:

Where does a memory sit, when it’s at leisure?
Where does it cool its heels, await our pleasure?

There are several poems about anatomy, suggesting that the former discipline – or was it a ritual? – of dissection of a corpse in the education of medical students was of deep cultural and emotional significance. In Anatomy, for example, Jane Kirwan describes, perhaps laments, the decline of dissection:

Professor Cave bustles up to the raised dais,
skullcap, snuff, spotted bow-tie, twiddles his cuffs.

Nothing to be thrown away. “The rules” he tells us
“are plain. No skipping with intestines,
no jokes.” Just formalin…
On each table is a yellowed leathered corpse.

But things have changed:

Thirty years later,
Sue can’t give away a dead body.
Her step-father had said – when the time comes – donate.

At the tenth teaching hospital she’s less subtle:

“do you want it or not?”

No one digs out Gray’s for him,
No Cunningham’s Anatomy, no battered zinc pail.

Sometimes images in the poems are very striking, for example this one in a poem about doctors’ interpretation of MRI scans by Andrew Thomas Martin:

They observe the emergence and
dissolving of all the bats, angels and butterflies
that fill your body…

And in Intensive Care, Friday Afternoon, Kev O’Donnell describes each of the sixteen beds in two lapidary lines:

Bed 15
a foreign student who hung herself, found with a stopped
heart, now
doing her best to die again.

Bed 4
empty, cleaned by a nurse aid
low winter sun through blinds.

Bed 2
dying, curtains pulled
cold air falls.

The power of poetry to concentrate and compress emotion is illustrated in a poem by Frances-Anne King about the wig of a child treated for leukaemia with chemotherapy. The wig is discarded as the child lies dying:

Her scalp shone smooth then,
translucent as the linings of an oyster shell,
her freckles, pale tracings on a fading sea of face.

Diary Australia

I’ve just realized that we’ve missed several articles by Dalrymple in the Spectator. His most recent piece there is a short diary of musings about his just-completed speaking tour of Australia, in which, I was surprised to read, he says that he regularly turns down offers of appearances on British television:

I am plunged into a round of appearances in the media. In England I refuse invitations to go on television by claiming subsequent engagements, or by telling them that in my opinion television is one of the great curses of the last century — which in part, I believe. This generally puts producers off, though not before they tell me that they agree with me. But in my role as a visiting scholar for the Centre for Independent Studies, I am pressganged into my press duties. Still jet-lagged, and with my head feeling as if it were full of lead shot, I find myself in the absurd position of having to give an opinion on the Government’s proposal that the states of Australia should have charge of their own income tax.

Anyway, it’s comforting to know that Dalrymple still writes occasionally for the journal that gave him his start as a writer. Rather than post all of these missed pieces individually, I will just list them here.

24 Oct 2015: Notes on Notes

18 Feb 2016: How references became meaningless in our culture of mistrust

5 Mar 2016: British expats in the EU fear a stronger euro far more than they fear Brexit

26 Mar 2016: Why Britain (and Europe) depends on migrants

You Just Cant

In Taki’s Magazine Dalrymple discusses the difference between hypocrisy and cant, and the prevalence of dishonesty in pretending to love humanity.

Hypocrisy is, or at any rate can be, a social virtue….Cant or humbug, on the other hand, is always poisonous, among other reasons because it is designed to deceive not only others but ourselves. It doesn’t entirely succeed in this latter task because a still, small voice tells us that we are canting, to which our preferred solution is often to cant even harder, like drowning out something we don’t want to hear by turning up the wireless. That is why there is so much shrillness in the world: People are defending themselves against the horrible thought that they don’t really believe what they themselves are saying.
…Who will admit that he doesn’t love humanity, that it wouldn’t matter to him in the slightest if half of it disappeared, that he can sit through the news of the worst disaster imaginable (provided far away) and eat his dinner nonetheless with good appetite? No, in order to be a good person you have to pretend to be lacerated by awareness of suffering anywhere in the world and show your wounds like Christ showing his heart in one of the Baroque Spanish colonial paintings.

….

As soon, however, as we are in the public arena—at an interview, for example—we must start to mouth sentiments that are not ours in words that mean nothing. Suddenly we start to cant. We must display the wounds we feel at the imperfections of the world. We must award ourselves, and pronounce, creditable motives that we know perfectly well are not ours.

Islamism Down Under

In City Journal Dalrymple discusses the significance of a brutal attack on a fellow inmate by an imprisoned Islamist in Australia:

Against the interpretation of Hraiche’s attack on O’Keefe as a manifestation of purely personal sadism is his previously expressed support for the Islamic State (a case of elective affinity, no doubt), and also the fact that no one in the cells nearest to Hraiche called the guards on their emergency bells for fear of retaliation by Hraiche and his acolytes. In other words, there was a powerful group of prisoners in the jail who thought and felt as Hraiche did, or would at least obey his orders. The Islamists are thus a kind of prison Mafia, with their own version of omertà. This is far from the first time that anxieties have been raised about Islamism in Australian prisons; but the assessment of the scale and scope of the threat is far from straightforward. There is a tendency to oscillate between complacency and panic.

Beached Whales in Bermuda Shorts

Encountering two obese Brits on their way to a beach holiday, and already dressed for the beach though at the airport, Dalrymple is disturbed by their size and their apparel:

What their appearance signified to me was one of two things, or both: the complete collapse of self-respect, at least in the aspect of physical appearance, or a total lack of imagination as to the impression they made on others – or both.

What did they see when they looked in the glass, I wondered? Did they not notice the stretch of the fabric of their upper garment as it failed to meet their lower garment, revealing an expanse of whitish blubber? And did they not notice their pucker-fleshed thighs, their varicosed lower legs?

Scientifically Undermining the Rule of Law

Dalrymple writes at the Library of Law and Liberty on a criminological study that attempts to develop a method for predicting the rate of recidivism. Unfortunately, the study begins with some faulty philosophical premises…

The authors also tell us that the prediction of reoffending may help authorities to decide on dates of release of prisoners. This can mean only that prisoners deemed at low risk of reoffending are to be released sooner than those deemed at high risk, even if their crimes that were proved beyond reasonable doubt were similar or the same. In other words, prisoners are to be punished (or relatively rewarded) not for what they did do, but for what they might do in the future.

This would not be so arbitrary and contrary to the rule of law if the predictions were 100 per cent accurate, or very nearly so: but of course they are not.

…and then proceeds to make statistical mistakes as well:

Whether the prisoners reoffended or failed to reoffend was counted in binary fashion: yes or no. One, two or a hundred offences counted as one. Swedish criminals may be less productive of crimes than British; but even so, it is likely that the true recidivism rate was more than 100 per cent, as measured by crimes committed and not by convictions. Of this the authors of the paper showed no awareness whatever.

Read the rest here

Theodore Dalrymple explains how Britain went down the drain

As Dalrymple continues his tour of Australia, journalist Kevin Chinnery of The Australian Financial Review hosts Dalrymple for dinner and an interview — and reports on both. The opening paragraphs:

He’s the psychiatrist who broke a taboo. In 1990, Theodore Dalrymple, prison shrink, slum area hospital doctor, and freshly appointed magazine columnist started telling the awful truth about Britain’s poor. Long before motormouth welfare queen Vicky Pollard became the butt of a national joke on the television show Little Britain, Dalrymple was warning of a native underclass utterly impoverished not in money, but in language, ideas and ambition.

His books, essays, and columns for The Spectator, The Times and the New Statesman, have been compared to Orwell in their observations of Britain. But the plight of Orwell’s working class, stricken by the Depression and the collapse of employment is moving and dignified in a way that Dalrymple’s post-welfare state underclass is definitely not. He shows a new Gin Lane, a Hogarthian horror show of self-destructive behaviour: drink- and drug-addled deadbeat parents, feral children, random violence and chosen idleness. Chaos and ignorance, encouraged by the welfare and education systems, and treated as both normal and unavoidable…

The Panama Cabal

What surprises have been revealed by the so-called Panama Papers scandal? That people go to great lengths to reduce their taxes? Surely we already knew that. One interesting lesson, though, is that people think recovering that extra “lost” tax revenue would make a difference.

…even if the money hidden offshore were paid in taxation, it does not follow that public services such as schools would improve proportionately. After all, it cannot be for lack of expenditure that a significant proportion of British children are semiliterate after eleven years of compulsory attendance at school.

Dalrymple at Taki’s Magazine

Asylum Piece

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

The writer Anna Kavan (1901 – 1969) was a heroin addict for most of her adult life. She was born Helen Woods and published six novels under her married name of Helen Ferguson before changing her name by deed poll to Anna Kavan. The choice of surname was odd, since she had used it in one of her novels to depict her husband as a drunken, sadistic, violent brute.

For many years she was dependent on Dr Karl Theodore Bluth, a psychiatrist who had been an exile from Nazi Germany and came to live in England. She found in him a soul-mate, and it was he who supplied her, legally, with her heroin, sometimes injecting her with it. Dr Bluth was himself a writer, having published essays in the highly-literary magazine, Horizon, edited by Cyril Connolly, and a book on the philosophy of Leibnitz. Of their relationship Kavan wrote (in fictional form):

Their relationship had not been clearly defined. It had seemed to achieve itself spontaneously, without effort on either side, and with no preliminary doubts or misunderstandings. To her it was both inevitable and invested with dreamlike wonder that, among all the earth’s teeming millions, she should have met the one being complementary to herself.

Clearly not the usual doctor-patient relationship, then; and when he died, in 1964 (there was an obituary in The Times), her behaviour became increasingly erratic and she described herself as waiting to die.

Her best book, probably, was the first written under her new name, Asylum Piece, which was published in 1940. It is a series of thematically connected short stories, very sparely written, and some have compared it with Kafka, whom she had almost certainly by this stage read.

The stories are told in the first person by someone who is either paranoid or very nearly so. The characters appear mostly under an initial, R or H or D. This in itself lends the atmosphere something mysterious and sinister; in the story Machines in the Head she is woken early in the morning by the sound of distant machinery of the reality of whose existence we are never quite certain, but which seem directed at her.

In The Enemy, she describes the atmosphere of hostility by which she believes she is surrounded. The story opens in a way reminiscent of Kafka:

Somewhere in the world I have an implacable enemy although I do not know his name. I do not know what he looks like, either. In fact. If he were to walk into the room at this moment, while I am writing, I wouldn’t be any the wiser.

All she knows is that he exists and in the end will come for her in a white coat, take her away and inject her with tranquillisers.

In fact, she had been in and out of private sanatoria, and in the story Asylum Piece she describes what she witnessed. The asylum is “a charming eighteenth-century house” by a Swiss lake on the French border. It was in the days of authority rather than of evidence-based medicine; the “chief doctor” arbitrarily forbids the mother of a patient from visiting her, and when the patient discovers that her mother has come to the asylum without seeing her, an omission that she ascribes to her mother’s wishes, she runs far out into the grounds:

Her heart breaks, she clutches handfuls of the sharp pine needles which pierce her flesh, while from between her thick lips, smeared with saliva and rouge, issues a desolate keening that soon leads her pursuers in the right direction.

Turning Tricks Into Sympathy

Who is to blame for prostitution, the suppliers or the consumers (to put it in crass economic terms)? The question itself betrays a false assumption. Does it really have to be one or the other? Apparently, France seems to think so.

It has passed a law, similar to those passed in a few other countries such as Sweden, criminalizing the patronage of prostitutes. Patrons will be fined and sent to an education course on the harms of prostitution. The supply side will not be criminalized, however, because the suppliers—those who in right-thinking publications such as the world’s leading medical journals are now called sex workers—are considered victims.