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    Saturday, July 27, 2002

    My Kind of Psychiatrist: Thanks to Ian Murray, I found this interview with Theodore Dalrymple, a columnist for The Spectator and a British psychiatrist who works in an inner city hospital and a prison. Here’s what he says about his approach to drug abuse:

    Peter Saunders: You’ve been writing this column in The Spectator for 12 years, and now the book has come out. Your essays are very rich descriptively, but what is the basic message that we should take away from reading them?

    Theodore Dalrymple: I think it’s the idea that people are not billiard balls. They’re not impacted on by forces like cold fronts in the weather and react accordingly. They actually think about what they’re doing. For example, criminals are conscious of what they’re doing and they respond to incentives. And they have a culture—they have beliefs about what they’re doing.

    PS: But what comes through in your essays is that they themselves talk as though they are billiard balls.

    TD: Well, I think they’ve been taught to speak like that. And you can actually break it down by saying to them, ‘Now come on! You didn’t burgle that house because of your bad childhood, you burgled that house because you wanted to take something in it and you didn’t know how else to go about getting it because you’re unskilled, you have no intention of getting any skills’—and they start laughing! And oddly enough, when I speak with them quite plainly, my relations with them improve.

    PS: Has anybody ever hit you!?

    TD: No, never! I mean there are the true psychopaths who make one’s blood run cold because they are untouchable by normal human relationships. But they are relatively few. So my relations with the prisoners are extremely good. To give you another example, drug addicts come in and they spin me a line, and I just won’t have it. There’s initially friction because I refuse to prescribe for them and one of the things that’s very difficult to get across is that withdrawal effects from heroin, for example, are very minor. They’re trivial.

    PS: Really? That’s not the way it’s portrayed, is it?

    TD: It’s not the way it’s portrayed but it is actually the truth. I can’t tell you how many people I’ve withdrawn from heroin. You never get any problems with it. It’s not like withdrawal from serious drinking which can be, and often is, a medical emergency. From a medical point of view, I’m much more worried in the prison when someone tells me he’s an alcoholic. I’m much more worried about the physical consequences of his withdrawal because they are really serious, and he can die from them. But nobody ever dies from heroin withdrawal. With the vast majority of them, you just take them aside and say: ‘I’m not prescribing anything for you, I will prescribe symptomatic relief if I see you have symptoms, but what you tell me has nothing to do with it, I’m not going to be moved by any of your screaming.’ One chap came in and said ‘What are you prescribing me?’ and I said ‘Nothing’, and he screamed at me, ‘You’re a butcher! You’re a f***ing butcher’, and he screamed and shouted and eventually I said ‘Take him away’. Everyone outside heard this, and they were like lambs!

    There’s a lot to be said for this approach, whether you're dealing with manipulative patients or manipulative countries. “Root causes” are hard to change, but the behavior that occurs in response to them can be changed. That’s why welfare reform has worked, and that’s why the war on terrorism has to be willing to use military force as well as the full force of the law. And that’s why no civilized nation should be appeasing terrorist states.
     

    posted by Sydney on 7/27/2002 11:12:00 AM 0 comments

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