Addiction Is Not a Disease

From Theodore Dalrymple:

There are cheap lies and expensive lies, and the lie that addiction is a disease just like any other will prove to be costly. It is the lie upon which Washington has based its proposed directive that insurance policies should cover addiction and mental disorders in the same way as they cover physical disease. The government might as well decriminalize fraud while it is at it.

The evidence that addiction is not a disease like any other is compelling, overwhelming, and obvious. It has also been available for a long time. The National Institute on Drug Abuse’s definition of addiction as a “chronic, relapsing brain disease” is about as scientific as the advertising claims for Coca-Cola. In fact, it had its origin as a funding appeal to Congress.

To take only one point among many: most addicts who give up do so without any medical assistance—and most addicts do give up. Moreover, they do so at an early age. The proximate cause of their abstinence is their decision to be abstinent. No one can decide not to have rheumatoid arthritis, say, or colon cancer. Sufferers from those diseases can decide to cooperate or not with treatment, but that is another matter entirely. Therefore, there is a category difference between addiction and real disease.

The pretense that a non-disease is a disease may actually hinder people from deciding to behave better: they will instead wait for their medical savior, as Estragon waits for Godot. Whether this hope is justified or not, the pretense will certainly involve much public expense, just as would fitting out an expedition to discover unicorns somewhere in the world.

To treat addicts as people to whom something has happened rather than as people who have decided to do something is to infantilize them. It is another small step in the transformation of the population into wards of government. Far from being generous and understanding, the government’s directive is a thinly disguised grab for power.

It is the same, perhaps worse, with mental disorders. It is by now notorious that the definitions of mental disorder are so loose that everyone has one, or more than one. They have spread like cars and washing machines. Nothing is easier to fake than mental disorder, especially where it is diagnosed by checklist; and where financial incentives are in place, fakery will flourish. Unfortunately, people playing a role come to live that role if they play it long enough. As my friend, Colin Brewer, a psychiatrist, brilliantly put it, misery rises to meet the means available for its alleviation.

Genuine mental illness exists, but it takes severe judgment to distinguish it from that which is merely reflexive in nature, such as whiplash injury, which scarcely exists in countries whose legal systems allow no compensation for it. (It’s the lawyers who should be sued, not the people who run into the back of cars.) The government’s proposed policy is therefore a charter for everything from human weakness to outright fraud. This, of course, is what some politicians hanker for, a people without powers of decision for themselves, a people without resilience: for then, they need the politicians to save them.


Television Is an Evil

From Anthony Daniels:

Most people read to confirm their prejudices rather than to learn something new or change their minds. Moreover, they recall what confirms their opinions much better than they remember what contradicts them. So aware was Charles Darwin of this human tendency that, at least according to his Autobiography, he wrote down anything he read that contradicted his views, for otherwise (he said) he was sure to forget it.

I must admit that like most of humanity, I am not as honest as Darwin and am reluctant to give up my cherished beliefs even in the face of facts that contradict them. I do on occasion change my mind about something, but slowly and usually without acknowledging that I have done so. I prefer to think that the opinion I now hold is the opinion I have held all my life, rather as Kim Il-sung emerged, according to his hagiographers, as a fully fledged Korean Marxist-Leninist revolutionary by the age of eight. To acknowledge that one has changed one’s mind about something is to admit one’s fallibility and the possibility that if one was wrong before, one might be wrong again. And in our hearts we know that we are always right.

That is why I was overjoyed recently in Paris to find a well-documented book that confirmed one of my deepest prejudices, namely that television is, if not the root of all evil, at least the root of much evil. That is why I haven’t had one for more than forty years. The book was called TV Lobotomie, which hardly needs translation.

The man who put the first germ of the prejudice against TV in my mind was Malcolm Muggeridge, a now-forgotten British journalist who, bizarrely, emigrated to the Soviet Union in the 1930s in search of a better life. Far from finding the paradise he had expected, however, he found a kind of hell. During the Ukrainian famine he sent back truthful reports to the Manchester Guardian (now the Guardian), which published only some of them. He was particularly outraged by the Western intellectuals who took starvation for plenty and tyranny for freedom, and he satirized them mercilessly in his book Winter in Moscow.

Later in his life he became a fervent and somewhat unctuous Christian, by no means a popular thing to do in the 1960s. Perhaps he did so because it was his temperament to swim against the tide. Be that as it may, he also denounced television from his pulpit—which was, of course, television.

He denounced it with all the fervor of a temperance preacher denouncing gin or of a modern public health official denouncing tobacco. At first I laughed at him, but then I saw that he was quite right. Television is an evil.

There is so much to be said against it (and its televisual offshoots) that it is difficult to know where to begin. In my opinion, televisual entertainment is by far the most important cause of boredom in the world, and since the attempt to relieve boredom is a much underestimated cause of social pathology of all kinds, television is ultimately responsible for the squalor in the midst of wealth that is so remarkable a feature of our modern existence.

It may seem paradoxical to claim that entertainment is a serious cause of boredom. But as TV Lobotomie demonstrates, children who grow up with TV as a large part of their mental diet have difficulty concentrating for the rest of their lives, and since the ability to concentrate is essential to finding anything interesting that is not swift-moving and sensational, and since also a large part of life is necessarily not swift-moving and sensational, those brought up on TV are destined for boredom. Degradation relieves their boredom. Better a life of sordid crises than a life like a flat-line encephalograph.

Most parents believe that television is bad for their children, but they insist that they watch it nonetheless. Indeed, they train them to do so, for contrary to what many might think, television is not immediately attractive to young children, who would rather do something else than watch it. Having become accustomed to it, however, they need it as an addict needs his drug. The more they watch it, the worse their likely path through life. Before anyone objects that this is because those children who watch the most television come from bad homes, let me point out first that the relationship between television and scholastic failure (for example) is a causative one, and second that the worst effects of television are seen in the best homes not the worst, precisely because children from the best homes—by best, I mean those with educated parents and high incomes, admittedly a rather reductive definition—have the best cognitive prospects to ruin. As modern European architects have discovered, it is far easier to ruin the good than improve the bad.

To my shame, and against my principles, I have occasionally agreed to appear on television, though even less frequently than I have been asked. I have found those who work for TV broadcasting companies to be the most disagreeable people that I have ever encountered. I far preferred the criminals whom I encountered in my work as a prison doctor, who were more honest and upright than TV people.

In my experience, TV people are as lying, insincere, obsequious, unscrupulous, fickle, exploitative, shallow, cynical, untrustworthy, treacherous, dishonest, mercenary, low, and untruthful a group of people as is to be found on the face of this Earth. They make the average Western politician seem like a moral giant. By comparison with them, Mr. Madoff was a model of probity and Iago was Othello’s best friend. I am prepared to admit that there may be—even are—exceptions, as there are exceptions good or bad in every human group, but there is something about the evil little screen that would sully a saint and sanctify a monster.

Turn off, tune out, drop completely.


Long Live the End of the World

Tenured doomsayer Paul Ehrlich is at it again.

From Theodore Dalrymple:

Being in France again, I read Le Monde. On Saturday 9 February, my eye was caught by a little notice at the top of the front page of the Ideas & Culture section advertising an article on pages 4 and 5 in the same section. The notice read:

Paul Ehrlich preaches in the wilderness: the American biologist predicts the collapse of our civilisation. Studies that agree are multiplying. But no one does anything.

Could this be the same Paul Ehrlich who, in 1968, wrote ‘The battle to feed all of humanity is over. In the 1970s the world will undergo famines, hundreds of millions of people are going to starve to death in spite of any crash programme embarked on now’? Reader, it could be, and it is.

This set me thinking about the typology of pessimists. Naturally I prefer pessimism to optimism, largely because optimists have no sense of humour; and since I have a sense of humour, I must be a pessimist.

But of course it does not follow from the fact that people with a sense of humour are pessimists that pessimists have a sense of humour. This is because there are two main types of pessimist, the existential and the apocalyptic. The former is pessimistic because he knows that Man is an imperfect being, inclined to do wrong for its own sake, often blind where his own best interests are concerned, ridiculous, self-destructive and self-defeating, and endowed with contradictory and incompatible wishes and desires. He knows that life will never be right.

The apocalyptic pessimist is different. He is so earnest that he could almost be an optimist. He believes that the end of the world is nigh, and secretly is rather pleased about it. If he is of a scientific bent, he does the following: he takes an undesirable trend and projects it indefinitely into the future until whatever is the object of the trend destroys the world. For example, he might take the fact that Staphylococci reproduce exponentially on a Petri dish to mean that, within the week, the entire biosphere will consist of Staphylococci and nothing else. Man will be crushed under the weight of bacteria.

Paul Ehrlich is of that ilk. His belief in the end of the world precedes his belief in any particular cause of it. When the end fails to happen as previously announced, his faith is undented. The End of the World has not happened. Long live the End of the World!


The Insolence of Office

From Theodore Dalrymple:

A friend of mine recently gave a lecture at a university and sent his bill for his (modest) expenses. He received by return a form asking him, in order for him to be paid, for his race, religion and sexual ‘orientation’.

Not surprisingly, he was displeased by this. He demanded to know why the information was needed, and requested the race, religion and sexual orientation of the person who sent the form and also of the vice-chancellor of the university. In reply, he was told merely that ‘Human Resources’ needed the information before it could settle his bill. No other explanation of why or for what purpose this information was ‘needed’ was offered; presumably, it was deemed self-evident to the writer of the reply.

My friend persisted in his refusal and in his demand for the same information as that that demanded of him. Eventually he received a further reply informing him that Human Resources no longer required the information, and that he would be paid forthwith. There was no explanation, much less apology, in this reply for the change of what Human Resources would no doubt call ‘policy’; nor was there the faintest hint of shame or embarrassment.

What brought about the change in Human Resources’ attitude? Why was information thought essential one moment for the payment of a small bill deemed completely unnecessary shortly afterwards? Had legislation or society changed in the meantime? Had Human Resources had a crisis of conscience, realising that their questions were intellectually stupid, psychologically aggressive, and morally against the commonest of decency?

Of course not. With the instinctive cunning of dullard bureaucrats, they realised that if they persisted in their questions with this particular man, they might cause a lot of trouble for themselves. He would kick up a fuss and draw public attention to their activities, as welcome to them as kitchen light switched on to nocturnal cockroaches. Best, then, to retreat into the cracks. Most ‘difficult’ customers, that is to say those not automatically intimidated by a form into filling it, are satisfied by such a retreat, and make no public comment.

If any semblance of our freedom is to be preserved, the dictatorial idiocy (and, I fear, wickedness) of our bureaucracy should be constantly exposed to public mockery and reprehension, before it becomes too powerful for us to dare to do so.


The Mind of Anders Breivik

From Theodore Dalrymple:

How does a man in one of the most peaceful societies in the world come to the conclusion that shooting a large number of people unknown to him is to serve the cause of his country?

Several ingredients must be in the witch’s brew of Anders Breivik’s mind.

First is resentment; second, self-importance; third, the desire for fame or notoriety; fourth, the search for a transcendent meaning to life, and fifth, a difficulty in forming ordinary human relationships, whether of love or friendship.

A final precondition is an above-average level of intelligence, for this is necessary in order to rationalise the commission of a deed that would otherwise be repugnant.

Resentment arises when you are not treated or rewarded as you think you deserve to be. Your merits, whether by virtue of birth or accomplishment, go unrecognised. You are therefore a victim of injustice. By definition you can do no wrong when you try to right them.

Self-importance prevents you from putting the wrongs you think you have suffered into any kind of perspective.

You do not see that, by the standards of most people, you have suffered little. You cannot see the difference between mere inconvenience or distaste and severe oppression.

In a world in which celebrity seems so important, obscurity is felt by many as a wound to their ego. Why should others be famous and not me?

If you cannot achieve celebrity by force of talent, then you can do so by means of murder – witness the Crossbow Cannibal.

A wider cause gives meaning and purpose to your life, and persuades you that your resentment, your anger, is not petty or personal, but something much grander. Breivik thought that by acting on his personal resentments he was a saviour of Europe; he might just as well have been an animal rights activist as a nationalist. His monomania relieved his inner emptiness.

A difficulty in forming normal human relationships is another cause for resentment of a man like Breivik, and of yet another wound to his ego. It has to be compensated for somehow, and producing an event of historic importance is one way to do it.

A man must be intelligent to act like Breivik – for he needs not only to plan and execute his “historic” deed, but to be able to weave a coherent, if paranoid and ultimately stupid, justification for it.

The pity for others of a mass killer like Breivik is nil; for himself, infinite.


Seven Sick Strategies

Another classic from Theodore Dalrymple:

Observations on NHS bureaucracy

Stapled to my hospital payslip each month is a glossy, expensively printed, eight-page propaganda leaflet from trust headquarters. In true Stalinist fashion, it portrays a happy and contented workforce, proud of being awarded stars by the government. There is always money enough for this kind of thing – though not for medical supplies, equipment, or staff salaries.

The leaflet’s main value, though not its purpose, naturally, is to illustrate how immense sums could now be poured into our public services without any tangible benefit whatsoever to the public. In it, the time-servers lay bare their corrupt souls.

The trust’s director of organisational and workforce development (if inflated titles come, can salaries be far behind?) wrote an article for it entitled “HR in the NHS Plan”.

HR? Hormone replacement, perhaps? No, human resources: you, me, we are all resources now, like iron ore in Liberia.

The director writes: “I have now completed a review of the organisational structure for the HR function and each operational directorate, as well as corporate areas and have a Lead HR Manager who will work with relevant management boards and staff . . . The Trust Board have also [sic] recently agreed our HR strategy which outlines the strategic direction we will follow in continuing to work towards key national and local objectives in order to meet the needs of our users, communities and staff.”

I hope all this is clear to you. If not, the director goes on to explain that “the strategy has been developed around four key areas”.

What are they, the four key areas? HR in the NHS Plan (National Strategy). The aims and values of our Trust. The Improving Working Lives Standard (IWL). Local Workforce Development priorities.

She then informs those who are not yet tearing their hair out or banging their heads on the wall to make this drivel go away that there are “seven key areas for delivery” – that is to say, the seven key areas of the four key areas of the strategy.

The seven key areas (will Walt Disney ever make a cartoon of them, I wonder) are: HR strategy and management; equality and diversity; staff involvement and communication; flexible working; health workplace; training and development; and flexible retirement, childcare and support for carers.

If I have understood correctly, the strategy is to draw up a strategy so that the strategy is delivered, give or take a strategic subordinate clause. “Delivery of the strategy will be based on a firm foundation of accepted behaviours and man- agement principles which I believe are key to building trust and confidence and set standards around communication, decision-making, dignity and respect and a framework for learning and education.”

No doubt it would be wise to call in a few external consultants (former employees of the trust) to ensure that the strategy is working strategically.

One does not know whether to laugh or cry. Who are the people who write this stuff? The whole of the British public administration is so riddled with thousands of unscrupulous, cunning, careerist dimwits, who will do anything they are told as long as it preserves their jobs and careers, and who routinely mistake their own activity for work, that recovery or amelioration is impossible.

Our corruption is now far worse than the money-under-the-table or brown-paper-envelope sort. It is a deep moral and intellectual corruption, and therefore far harder to eradicate or control. It has turned the whole of the public service into a legalised pork barrel for low-grade bureaucrats. And the government connives at it, because it extends its power.


Goodbye, lady with the lamp

A classic from Theodore Dalrymple:

Observations on gobbledegook

If anyone wants to know why British public services do not work properly, I should suggest that they look at the document containing the self-assessment rating scale of the 17 “learning outcomes” required for specialist practitioner registration by the UK Nursing and Midwifery Council. A nurse in training kindly drew my attention to this document, which she said she could not understand. Her incomprehension does her credit.

The linear “competency scale” goes from left to right, through the following points: (expert), absent, low (awareness), moderate (conceptual understanding) and high. The person in training is asked to circle which point on the scale best corresponds with his “current level and skill” for each of the 17 learning outcomes, among which are the following:

2. Set, implement and evaluate standards and criteria nursing interventions by planning, providing and evaluating specialist clinical nursing care across a range of care provisions to meet the health needs of individuals and groups requiring specialist nursing.

14. Identify specialist learning activities in a clinical setting that contribute to clinical teaching and assessment of learning in a multidisciplinary environment within scope of expertise and knowledge basis.

No doubt, when you clutch your chest as you suffer your next heart attack, it will be a great consolation to know that the nurse looking after you believes that she has a moderate (conceptual understanding) of the fifth compulsory learning outcome – that is to say: facilitate learning in relation to identified health for patients, clients and carers. What a relief to have done away with all that terrible lady with the lamp stuff!

Actually, a moderate conceptual understanding of these 17 learning outcomes is pretty good going: without undue modesty, I should put myself in the highest quartile of intellectual ability in this country, but should estimate my understanding of the said outcomes as being approximately absent.

The document is symptomatic of the deep moral and intellectual corruption that pervades the entire public service of this country, and now renders improvement of it virtually impossible. After all, the Nursing and Midwifery Council sets the tone of the nursing profession, and any person or group of people who could write a document such as the one I have quoted is beyond redemption. To entrust the nursing profession to the Nursing and Midwifery Council is thus rather like entrusting an aviary to bird-eating spiders.

We have trained vast numbers of people to write and presumably to think this rubbish. Indeed, the inexorable spread of this meaningless language is the sign of a quiet social revolution: we no longer live in a meritocracy, but in a mediocracy, for only people without talent, originality or integrity can master this language. But mastery of it is now the key to advancement, at least in the public services. The troubling thing is that the corruption has gone so far that it has become unconscious: those who produced the document from which I quote are so corrupt that they do not know they’re corrupt.

Interestingly, a consultant colleague recently tried to look up the website of the Plain English Campaign on a hospital computer. As quick as a flash, a message appeared on his screen: ACCESS DENIED: ADVOCACY GROUP. Our mediocrats may be lacking in talent and originality, but they have a sure instinct for survival: they know that plain English, and the use of words that have meaning, would be a grave threat to their position.