Life At The Bottom – Theodore Dalrymple – Excerpt

This is an excerpt from “Life at the Bottom: The Worldview That Makes the Underclass” by Theodore Dalrymple. I OCRed the text without really proofreading, so there may be quirks in the conversion, and it’s not the entire chapter…
Anthony (A.M.) Daniels (born 1949) is a British writer and retired physician (prison doctor and psychiatrist), who generally uses the pen name Theodore Dalrymple. He has also used the pen name Edward Theberton[1] and two other pen names.[2][3] He is a critic of liberal thinking and utopian thinking in general. Before his retirement in 2005 he worked as a doctor and psychiatrist in a hospital and nearby prison in a slum area in Birmingham. His philosophical position is “compassionate conservative”.

Tough Love

LAST WEEK, a seventeen-year-old girl was admitted to
my ward with such acute alcohol poisoning that she could
scarcely breathe by her own unaided efforts, alcohol being a
respiratory depressant. When finally she woke, twelve hours
later, she told me that she had been a heavy drinker since the
age of twelve.
She had abjured alcohol for four months before her admis‑
sion, she told me, but had just returned to the bottle because of
a crisis. Her boyfriend, aged sixteen, had just been sentenced to
three years’ detention for a series of burglaries and assaults. He
was what she called her “third long-term relationship”—the
first two having lasted your and six weeks, respectively. But
after four months of life with the young burglar, the prospect of
separation from him was painful enough to drive her back to
It happened that I also knew her mother, a chronic alcoholic
with a taste for violent boyfriends, the latest of whom had been
stabbed in the heart a few weeks before in a pub brawl. The
surgeons in my hospital saved his life; and to celebrate his re‑
covery and discharge, he had gone straight to the pub. From
there he went home, drunk, and beat up my patient’s mother.
My patient was intelligent but badly educated, as only prod‑
ucts of the British educational system can be after eleven years
of compulsory school attendance. She thought the Second
World War took place in the 197os and could give me not a sin‑
gle correct historical date.
I asked her whether she thought a young and violent burglar
would have proved much of a companion. She admitted that he
wouldn’t, but said that he was the type she liked; besides
which—in slight contradiction—all boys were the same.
I warned her as graphically as I could that she was already
well down the slippery slope leading to poverty and misery—
that, as I knew from the experience of untold patients, she
would soon have a succession of possessive, exploitative, and
violent boyfriends unless she changed her life. I told her that in
the past few days I had seen two women patients who had had
their heads rammed down the lavatory, one who had had her
head smashed through a window and her throat cut on the
shards of glass, one who had had her arm, jaw, and skull bro‑
ken, and one who had been suspended by her ankles from a
tenth-floor window to the tune of, “Die, you bitch!”
“I can look after myself,” said my seventeen-year-old.
“But men are stronger than women,” said. “When it
comes to violence, they are at an advantage.”
“That’s a sexist thing to say,” she replied.
A girl who had absorbed nothing at school had nevertheless
absorbed the shibboleths of political correctness in general and
of feminism in particular.
“But it’s a plain, straightforward, and inescapable fact,” I
“It’s sexist,” she reiterated firmly.
A stubborn refusal to face inconvenient facts, no matter
how obvious, now pervades our attitude towards relations be‑
tween the sexes. An ideological filter of wishful thinking strains
out anything we’d prefer not to acknowledge about these eter‑
nally difficult and contested relations, with predictably disas‑
trous results.
I meet with this refusal everywhere, even among the nursing
staff of my ward. intelligent and capable, as decent and dedi‑
sated a group of people as I know, they seem, in the matter of
judging the character of men, utterly, almost willfully, incompe‑
In my toxicology ward, for example, 98 percent of the thir‑
teen hundred patients we see each year have attempted suicide
by overdose. Just over half of them are men, at least 7o percent
of whom have recently perpetrated domestic violence. After
stabbing, strangling, or merely striking those who now appear
in medical records as their partners, they take an overdose for
at least one of three reasons, and sometimes for all three: to
avoid a court appearance; to apply emotional blackmail to their
victims; and to present their own violence as a medical condi‑
tion that it is the doctor’s duty to cure. As for our women pa‑
tients who’ve attempted suicide, some 70 percent have suffered
domestic violence
In the circumstances, it isn’t altogether surprising that I can
now tell at a glance—with a fair degree of accuracy—that a
man is violent towards his significant other. (it doesn’t follow,
of course, that I can tell when a man isn’t violent towards her
In truth, the clues are not particularly subtle. A closely shaven
head with many scars on the scalp from collisions with broken
bottles or glasses; a broken nose; blue tattoos on the hands,
arms, and neck, relaying messages of love, hate, and challenge;
but above all, a facial expression of concentrated malignity,
outraged egotism, and feral suspiciousness—all these give the
game away. Indeed, I no longer analyze the clues and deduce a
conclusion: a man’s propensity to violence is as immediately
legible in his face and bearing as any other strongly marked
character trait.
All the more surprising is it to me, therefore, that the nurses
perceive things differently. They do not see a man’s violence in
his face, his gestures, his deportment, and his bodily adorn‑
ments, even though they have the same experience of the pa‑
tients as I. They hear the same stories, they see the same signs,
hut they do not make the same judgments. What’s more, they
seem never to learn; for experience—like chance, in the famous
dictum of Louis Pasteur—favors only the mind prepared. And
when I guess at a glance that a man is an inveterate wife beater
(I use the term “wife” loosely), they are appalled at the harsh‑
ness of my judgment, even when it proves right once more.
This is not a matter of merely theoretical interest to the
nurses, for many of them in their private lives have themselves
been the compliant victims of violent men. For example, the
lover of one of the senior nurses, an attractive and lively young
woman, recently held her at gunpoint and threatened her with
death, after having repeatedly blacked her eye during the previ‑
ous months. I met him once when he came looking for her in
the hospital: he was just the kind of ferocious young egotist to
whom I would give a wide berth in the broadest daylight.
Why are the nurses so reluctant to come to the most in‑
escapable of conclusions? Their training tells them, quite
rightly, that it is their duty to care for everyone without regard
for personal merit or deserts; but for them, there is no differ‑
ence between suspending judgment for certain restricted pur‑
poses and making no judgment at ail in any circumstances
whatsoever. It is as if they were more afraid of passing an ad‑
verse verdict on someone than of getting a punch in the face—a
likely enough consequence, incidentally, of their failure of dis‑
cernment. Since it is scarcely possible to recognize a wife beater
without inwardly condemning him, it is safer not to recognize
him as one in the first place.
This failure of recognition is almost universal among my vi‑
olently abused’, women patients, but its function for them is
somewhat different from what it is for the nurses. The nurses
need to retain a certain positive regard for their patients in
order to do their job. But for the abused women, the failure to
perceive in advance the violence of their chosen men serves to
absolve them of all responsibility for whatever happens there‑
after, allowing them to think of themselves as victims alone
rather than the victims and accomplices they are. Moreover, it
licenses them to obey their impulses and whims, allowing them to suppose that sexual attractiveness is the measure of all things and that prudence in the selection of a male companion is nei­ther possible nor desirable.
Often their imprudence would be laughable were it not tragic: many times in my ward I’ve watched liaisons form be­tween an abused female patient and an abusing male patient within half an hour of their striking up an acquaintance. By now I can often predict the formation of such a Øliaison-and predict that it will as certainly end in violence as that the sun will rise tomorrow.
At first, of course, my female patients deny that the violence of their men was foreseeable. But when I ask them whether they think I would have recognized it in advance, the great major­ity—nine out of ten—reply, yes, of course. And when asked how they think I would have done so, they enumerate precisely the factors that would have led me to that conclusion. So their blindness is willful.
Today’s disastrous insouciance about so serious a matter as the relationship between the sexes is surely something new in history: even thirty years ago, people showed vastly more cir­cumspection in the formation of liaisons than they do now. The change represents, of course, the fulfillment of the sexual revo­lution. The prophets of that revolution wished to empty the re­lationship between the sexes of all moral significance and to destroy the customs and institutions that governed it. The ento­mologist Alfred Kinsey reacted against his own repressed and puritanical upbringing by concluding that all. forms of sexual restraint were unjustified and psychologically harmful; the novelist Norman Mailer, having taken racial stereotypes as seri­ously as any Ku Klux Klansman, saw in the supposedly unin­hibited sexuality of the Negro the hope 01 the World for a more abundant and richer life; the Cambridge social anthropologist Edmund Leach informed the thinking British public over the radio that the nuclear family was responsible for
contents (this, in the century of Hitler and Stalin!); and the psychiatrist R. D. Laing blamed the family structure for serious
mental illness. In their different ways, Norman 0. Brown, Paul
Goodman, Herbert Marcuse, and Wilhelm Reich joined in the
campaign to convince the Western world that untrammeled sex‑
uality was the secret of happiness and that sexual repression,
along with the bourgeois family life that had once contained
and channeled sexuality, were nothing more than engines of
All these enthusiasts believed that if sexual relations could
be liberated from artificial social inhibitions and legal restric‑
tions, something beautiful would emerge: a life in which no de‑
sire need be frustrated, a life in which human pettiness would
melt away like snow in spring. Conflict and inequality between
the sexes would likewise disappear, because everyone would get
what he or she wanted, when and where he or she wanted it.
The grounds for such petty bourgeois emotions as jealousy and
envy would vanish: in a world of perfect fulfillment, each per‑
son would be as happy as the next.
The program of the sexual revolutionaries has more or less
been carried out, especially in the lower reaches of society, but
the results have been vastly different from those so foolishly an‑
ticipated. The revolution foundered on the rock of unacknowl‑
edged reality: that women are more vulnerable to abuse than
men by virtue of their biology alone, and that the desire for the
exclusive sexual possession of another has remained just as
strong as ever. This desire is incompatible, of course, with the
equally powerful desire—eternal in the human breast hut hith‑
erto controlled by social and legal inhibitions—for complete
sexual freedom. Because of these biological and psychological
realities, the harvest of the sexual revolution has not been a
brave new world of human happiness hut rather an enormous
increase in violence between the sexes, for readily understand‑
able reasons.

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