If the doctor has a duty to relieve the suffering of his patients, he must have some idea where that suffering comes from, and this involves the retention of judgment, including moral judgment.And if, as far as he can tell in good faith, the misery of his patients derives from the way they live, he has a duty to tell them so—which often involves a more or less explicit condemnation of their way of life as completely incompatible with a satisfying existence. By avoiding the issue, the doctor is not being kind to his patients; he is being cowardly. Moreover, by refusing to place the onus on the patients to improve their lot, he is likely to mislead them into supposing that he has some purely technical or pharmacological answer to their problems, thus helping to perpetuate them.- Theodore Dalrymple, Life at the Bottom
Theodore Dalrymple, a retired British psychiatrist, who has spent years working with the underclass is a very keen observer of human nature, as is evidenced by this book. His dealings with thousands of these people at close quarters gave him much of the fodder for his thesis which is, I’m sure that some will disagree, that a lot of poverty is caused by dysfunctional values, values that those in power exploit and make worse by creating a culture of victims. Most of these stories and anecdotes are from Dalrymple’s time working in British slums and prisons.
This was a very heavy read and I’m still thinking about it weeks after I read it. There are things discussed that seem so foreign to me because I’ve never had to deal with them, and it’s upsetting that so many do. I learned interesting points around education, literature, the violence in the British culture, the housing, and how often people in need aren’t helped enough because they aren’t tragic enough. It was eye-opening and there is a lot of pain in this book, and so much raises questions.
Also, it’s important to know that several of the essays in this book were written in the 90s, so people’s values have changed since then. I obviously didn’t agree with everything Dalrymple stated in the book, and I haven’t lived in the UK for a long time, so there are things I can’t speak to or challenge, even though I really want to.
I was surprised when Dalrymple alluded that systemic racism isn’t a thing, but his other points about how we should treat people on a case by case situation, not by their race, was well-taken. Also interesting was how he has worked in African and Latin American countries where he talks about the poverty there but says that the Western underclass’s mental, cultural, emotional and spiritual poverty is the worst he has ever seen, something backed up by the doctors from Asia who start working at his hospital:
By the end of three months my doctors have, without exception, reversed their original opinion that the welfare state, as exemplified by England, represents the acme of civilization. On the contrary, they see it now as creating a miasma of subsidized apathy that blights the lives of its supposed beneficiaries.
So much of this book is due to the fact that Dalrymple is tired of people blaming the system and not taking their own actions into consideration. There is a lot of controversial stuff, that’s for sure. But as far as critical thinkers goes, Dalrymple is one of the best I’ve come across recently.
I liked his thoughts on the architectural changes in England following the turn of the 20th century when Britain was entering modernity:
The architects thought that modernity was a value that transcended all other virtues; they thought they could wake the country from its nostalgic slumber, dragging it into the twentieth century by pouring what seemed to them to be the most modern of building materials—reinforced concrete—all over it. Hence, among many other crimes, they tore down the elegant Victorian wrought-iron tracery of my city’s main railway station, with its splendid arched roof over the platforms and tracks, and built instead a brutalist construction of steel and soon-discoloured concrete to a plan that proved no more practical or functional than the old.
One of the points that spoke to me the most was perhaps this:
Experience has taught me that it is wrong and cruel to suspend judgement, that nonjudgmentalism is at its best indifference to the suffering of others, at worst a disguised form of sadism. How can one respect people as members of the human race unless one holds them to a standard of conduct and truthfulness? How can people learn from experience unless they are told that they can and should change?
This book will definitely make you think.