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April 18, 2008

Theodore Dalrymple on Terence Rattigan, Suicide and Prison - or how incontinent compassion has become a Keynesian stimulus to the economy of the caring profession

Posted by Theodore Dalrymple

After seeing Terence Rattigan's The Deep Blue See, Theodore Dalrymple - for many years a prison doctor - reconsiders the phenomenon of prison suicide.

I am an admirer of the plays of Terence Rattigan, and recently saw an excellent production of The Deep Blue Sea at the Gate Theatre in Dublin. Because of the culture into which Rattigan was born, and the necessity to hide his homosexuality from public view, as well (of course) as his literary talent, he was expert at conveying the deepest passion by the most restrained language. There is more emotional charge in "Oh, I see," in Rattigan than in much of the sound and fury that emanates from our stage, or for that matter from our own mouths.

However, I sometimes wonder whether, in a few years' time, anyone will understand Rattigan. Our culture has changed so radically that the restraint upon which his emotional charge relies has been replaced by vehemence of expression, according to which the louder one shouts the more one is taken to feel. The girl who screams loudest in the street is thought by everyone to be having the best (or, of course, the worst) time.

There are several aspects of The Deep Blue Sea that people might soon find incomprehensible. In it, a young woman has left her husband, a judge, for another man, a charming but irresponsible waster. "So what?" everyone will ask. Hardly anyone gets married these days, and those who do divorce soon afterwards; were Andy Warhol alive today, he might say that everyone cohabits for fifteen minutes.

The opening of the play will seem mysterious too. The young woman has attempted suicide by gassing herself, and the other characters discuss whether they should call the police.

Call the police, why on earth would they do that? Because attempting suicide was still illegal when the play was written, but soon audiences won't know that. Having been brought up multiculturally, they will assume that everyone has everywhere and always lived in the same manner and dispensation as themselves. The illegality of suicide attempts will be as alien and unknown to them, perhaps more alien and unknown, than the customs of the Trobriand Islanders are to us.

Curiously, on the day that I went to see the play, I read in the newspapers that the number of incidents of self-harm and parasuicide has gone up rapidly in our prisons in the last four years, from 16,393 to 22,459 incidents. The Howard League, rather predictably, attributed this rise to the bad conditions in the prisons: the overcrowding and squalor, for example.

I am not in favour of overcrowding and squalor, of course, but this seems to me a typical example of "billiard-ball" explanations of social phenomena: that is to say of automatic human response to physical conditions that do not pass through the mind.

The first thing to decide is whether the increase is more apparent than real. What used to be called the Home Office says that the increase is caused by more vigilance among the prison officers, and a better system of recording and reporting such incidents, but I do not believe that this is the explanation. The system has not changed greatly in the last few years. The increase is probably real enough.

In the general population, self-harming behaviour increased between 1985-6 and 1995-6 by a larger proportion than that recorded in the prisons over the last four years, and it is most unlikely that the explanation was increasing squalor and overcrowding. If one wants to refer to squalor at all, it must have been mental squalor, though I prefer not to use such a term since it implies its opposite, mental hygiene, which in turn implies that we could all give our minds a good spring clean.

Which brings us back to the Deep Blue Sea. Suicidal gestures started to increase in frequency in the 1950s, and increased dramatically in the 1960s, after attempted suicide was legalised (it hadn't often been prosecuted before, but it seems likely that even dead-letter illegality has some effect, acting on the general culture of the population). The British are now the champion overdosers of Europe.

In prison until comparatively recently, suicidal gestures such as taking overdoses and cutting the wrists were treated as breaches of discipline, unless the doctor certified the prisoner as suffering from an illness. The person who made such a gesture was therefore as likely to be punished for it as to be offered help. In practice, the doctor's certification depended largely on whether or not he felt any sympathy for a particular prisoner's plight, which inevitably introduced elements of moral judgment, as well as personal likes and antipathies, into the situation.

We have come to prefer the blanket compassion approach, as being kinder, but also as offering a Keynesian stimulus to the economy of the caring professions. The more people who demonstrate their distress, the more work for the professional carers and the administrative infrastructure that they require. In short, the distress of others becomes a career opportunity.

Suicidal gestures vary very considerably in their motive: they may be gestures of absolute despair, or blatant attempts to secure advantages, and anything between the two. Emotional blackmail is common. Blanket compassion will shift the distribution decisively towards the manipulative end of the spectrum, and may paradoxically decrease the compassion with which the genuinely despairing are treated: for they are apt to get lost in the great mass of pseudo-distress and manipulation, and often their conduct draws less attention precisely because it is less attention-seeking.

There are dangers in parcelling out compassion according to the desert of the person who is to be its object. Judgments may be mistaken, hasty and bad-tempered, so that the deserving come to be treated as the undeserving. The need to make a judgment may also provide a cover for sadism. On the other hand, incontinence of compassion, especially when expressed by the granting of tangible privileges or advantages, provokes or gives and incentive for the very behaviour that supposedly necessitates it.

Of these two dangers, which is the greater? There is no universally correct answer; it depends upon the particular cultural circumstances in which it is asked. My own view is that the pendulum has swung too far in the direction of incontinent compassion, though in the days of the silent system I am sure (or at least I hope) I should have argued the other way.

Theodore Dalrymple is a writer and worked for many years as an inner city and prison doctor. He is the author of the author of Junk Medicine: Doctors, Lies and the Addiction Bureaucracy.

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I am a fan of the programme “The Dog Whisperer”, and time and again I see Cesar Millan telling dog owners that when correcting bad behaviour, one mustn’t feel sorry for the dog and what it’s been through. Care and compassion can come later, when the dog is in a balanced state of mind.

Cesar says “if you feel sorry for someone, you can’t help them”, which suggests that he believes the same principle applies to humans also. Accordingly, rewarding suicidal behaviour with friendliness while displaying what he calls “weak energy” can only make things worse.

But remember – we are talking about members of our own species. Unlike dogs, we humans do not “live in the now”. Even so, I think experience shows that “soft and gentle” does not work in this sort of situation.

Posted by: Robert H. Olley at April 21, 2008 08:21 PM

Robert Olley's comments ring true. This is a kind of Tocqueville's Memoirs on Pauperism as applied to canines. This made me reflect on the likely value of comparative studies, which could be considerable. Though human minds are of a complexity of an different order to those of dogs, I would still expect certain behavioural patterns to be similarly observed in both. Indeed, the human capacity for deviousness and emotional manipulation is much more developed in humans, therefore the argument from canis familiaris is all the stronger.

Posted by: cybn at February 17, 2010 03:47 PM
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