If Symptoms Persist by Theodore Dalrymple: my highlights

A retired psychiatrist tells all. Warning: Controversy and cynicism ahead.

“I find my own cynicism witty and sophisticated; but in others I find it callous and brutal.”

[About health promotion]: I am so heartily sick of the tepid existence which we doctors are now peddling as the elixir of life that when one of my patients refuses to take my good advice, I want to jump up on my table and give three cheers.

I know there are medical fascists around –a former President of the Royal College of Physicians is one –who would make such patients pay for the treatment of their ‘self-induced’ diseases, but this seems to me to come perilously close to the Erewhonian nightmare, in which youths who bash old ladies over the head will receive treatment but people with heart attacks will be punished.

It is a well-known fact that one of the best preservatives against ill health is self-employment. The self-employed cannot afford to be ill, while those in the employ of others cannot afford (it often seems) to be entirely well.

I should have bought something for my ward with the £ 5, of course, but the devil entered me and I decided to go through the proper channels. [What follows is his recount of how he spent multiples of the “thank you” from a patient on the bureaucracy of “proper channels”].

‘I’ve realised, doctor,’ she said, ‘that life’s not worth killing yourself for.’

The symptoms of her illness were vague but debilitating: she could no longer summon up the energy to do the thing she did not wish to do, such as vacuum-cleaning and ironing.

[About a patient who didn’t notice at all that she was being seen by a doctor who was standing in for her regular doctor, Dr S, who is a very warm-hearted individual]: I feel rather sad on Dr S-’ s behalf. He thinks his patients value his efforts, but in fact he is valued only for his function, as a vacuum cleaner or washing machine is valued.

[About a woman who immigrated to the UK and successfully built a life there, only to find her one of her sons deliberately unemployed and one in jail]: How has her dream of thirty years ago been turned into this nightmare? I do not have the whole explanation, but I suspect that those who teach that employment is exploitation, that law is injustice, and that racial prejudice is so ubiquitous and all-pervading as to render personal effort superfluous, have much to answer for.

No matter how deluded and paranoid people are, they are usually able to refrain from attacking several policemen, each of whom is over six feet tall.

Since activity is as good as action, the first thing to do is to form a committee… The purpose of this committee is to assure the Health Authority that it can assure the Ministry that it can assure the Minister that he can assure the Government that it can assure the Opposition that something is indeed being done.

As everyone is aware, alcohol is responsible for accidents, murder, suicide, cirrhosis, cancer, heart disease, stroke, divorce, crime and ruination, as well as 95 per cent of the enjoyment at social occasions and a considerable, if lesser, proportion of government revenue.

[On health education]: Their jobs depend upon a permanent effervescence of publicly-funded panic.

Dealing with people makes you appreciate things.

[To a patient]: ‘What you’re really saying to me is this: when you have found the single piece of buried treasure in my psyche that explains my behaviour, I will automatically stop breaking into people’s houses; but if you don’t find out what it is, which is your job as a doctor, then, when I break into people’s houses and steal their videos, it is really your fault and not mine.’

In the eternal struggle between doctor and patient, I told a medical student last week, the patient always has the upper hand. This is because, while the doctor is constrained by a code of behaviour, the patient is not: he can use any means he likes to bring about his desired end… A doctor has to learn to accept blackmail, I said, with a good grace.

Surely, if passive smoking is bad for one, the passive consumption of junk food must be even worse.

The ward smoke alarm went off in the midst of my reflections. I went to see what was happening: the alarm was being tested. It took three men to test it, one up a ladder, one with a clipboard at the base of the ladder, and one –a Fire Prevention Engineer –to oversee operations. And then, suddenly, the whole meaning of life became clear to me: so to arrange things that we survive until tomorrow.

One of the worst things about being a doctor is that you have to pretend that repulsively bad manners are a sign of suffering.

After all, if you don’t do anything, you can’t be accused of inefficiency.