I suppose that people who feel little control over their own lives or destinies can obtain a slight sense of agency by interfering in the lives of others, in tiny ways. I have noticed that many of the men who are violently dictatorial at home often count for little once they pass their own threshold. They are the Stalins of their own home.
Theodore Dalrymple, interviewed by James Glazov in “Our Culture, What’s Left Of It”, FrontPage, 2005-08-31.
November 1, 2025
October 14, 2025
QotD: The trade in fake doctor’s notes
A reporter for the Daily Telegraph newspaper managed to obtain a certificate from the company to excuse him from work for five months, because he claimed (falsely) to be suffering from the long-term effects of COVID. He obtained the note without providing any medical evidence whatsoever.
The only thing that surprised me about this was that anyone thought that it was necessary in Britain to buy or pay for such a certificate. I thought of the famous lines of Humbert Wolfe, the otherwise all-but-forgotten England man of letters:
You cannot hope
to bribe or twist,
thank God! the
British journalist.
But, seeing what
the man will do
unbribed, there’s
no occasion to.The same might almost be said of British doctors, many of whom, I suspect, issue such certificates incontinently, for one of two reasons: fear of their patients, and sentimentality.
Not surprisingly, doctors do not like unpleasant scenes in their consulting rooms, and refusal of requests for time off sick can easily lead to such scenes, and occasionally to threatened or actual violence.
Naturally, no doctor likes to think of himself as a coward, the kind of person who caves in to such threats. The best way to avoid so humiliating a thought is never to risk having to think it, that is to say by granting the patients’ wishes in this matter immediately.
But in order to do this without feeling self-contempt, it is necessary to rationalize, that is to say to find supposed reasons for why everyone who wants a certificate should be given one. The English philosopher F.H. Bradley once said that metaphysics is the finding of bad reasons for what we believe on instinct, adding however that it was a human propensity to do so. In like fashion, we could say that doctors find bad reasons for giving sick certificates when they suspect that not to do so might lead to a confrontation with a patient.
Thus they convince themselves that if a person tells them that they are unfit for work, for whatever reason, it would be wrong to question it. No one would make a claim to be unable to work unless he were in some way discontented, unhappy, depressed, anxious, stressed, in a word suffering, and it is the object of doctors to reduce human suffering.
The doctor is aided in this train of thought by the looseness of psychiatric diagnosis, so that practically all forms of distress can be fitted into the procrustean bed of diagnosis. Even outright faking can now be construed as an illness or disorder, provided only that it goes on for long enough or is deceptive enough.
Does this mean that the patients seeking sick notes are all faking it? The matter is more complex than this would suggest. There is, of course, conscious, outright fraud, but this is comparatively rare. Just as doctors don’t like to think of themselves as cowards in the face of their patients, so patients don’t like to think of themselves as frauds.
Distress can be conjured out of almost anything and is not necessarily proportional to whatever causes it. Dwelling on the ill treatment one has suffered — and who has not suffered ill treatment at some time in his life? — can magnify something minor into something major, to the point at which it seems almost to have ruined one’s life. And it is certainly capable of rendering a person unfit for work in his own estimation — though in fact continuing at work would be a remedy for, rather than an exacerbation of, the problem.
However, where economic loss is not too severe when stopping work on medical grounds is possible, medical grounds will be both sought and found. In the days of the Soviet Union, the workers had a saying: “We pretend to work, and they pretend to pay us.” In our kinder and more enlightened societies, we pretend to be ill, and they pretend to treat us — except that the word “pretend” does not quite capture the subtlety of the transactions between doctor and patients.
Theodore Dalrymple, “Make Me Sick”, New English Review, 2025-07-04.
Comments Off on QotD: The trade in fake doctor’s notes
September 27, 2025
QotD: Utopian revolution
This illustrates a point that Professor Chirot makes clear in his discussion as to why the Vietnamese communist regime, though often brutal, never descended to anything like the level of horror of neighbouring Cambodia. Among the factors must surely have been the character and personality of the leaders as well as of the countries themselves. In other words, the fate of countries cannot be reduced, either in prospect or in retrospect, to an invariable formula. Human affairs will, to an extent, always be incalculable.
Still, some degree of regularity is possible. I was rather surprised that Professor Chirot overlooked one such. He writes the following of the corruption endemic under communist regimes: “a function of a deliberately exploitative, thieving elite that staved the general economy by its dishonesty than it was the essence of the system itself. Avoiding corruption was impossible because without it the society could not function.”
What is surprising here is that he does not mention why it could not function, but the answer seems to me perfectly obvious: it was because the communist system abolished the price system and substituted political decision-making in its place. This explanation is sufficient, for where there are no prices, and the economy is thereby largely demonetarised, goods and services can be distributed only by corruption. This is not to say that where there is a price system there will automatically be no corruption, obviously this is not the case; but such corruption will be limited by the very need for money to retain its value where such a price system exists. To that extent, it imposes at least a degree of honesty. The mystery of the Soviet Union or any other communist country is not why it produced so little, but why it produced anything at all: and here Professor Chirot is quite right. The answer is because of corruption: an “honest” communist state would produce nothing. It could not survive.
Theodore Dalrymple, “Longing for Revolution”, New English Review, 2020-05-13.
Comments Off on QotD: Utopian revolution
September 3, 2025
QotD: The distance between NHS PR and NHS reality
It wasn’t difficult to promote such historiography by using horror stories from the past, stories which were perfectly plausible because almost any conceivable system will give rise to such stories. If, per impossibile, a new system were to replace the NHS, it would not be difficult to justify it by reference to horror stories, whether or not the new system was better. A war of anecdotes, while always gratifying to the human mind, is not the way to decide important questions such as the superiority or inferiority of a system of health care. Only anecdotes that also illustrate statistical trends or truths are valuable in such a context.
The statistics are not favourable to the NHS, at least if one chooses reasonable standards of comparison, namely other European countries. The results are not disastrous, but they are not good either. The NHS has failed even in its egalitarian goal: the gap between the health of the richest and poorest in society has only grown under its dispensation. And yet the belief in its levelling effect persists.
The propaganda in favour of the NHS has been so successful that it now accords with the sentiments of the population, a triumph that no communist regime achieved despite herculean efforts at indoctrination. The triumph has been achieved without compulsion or violence and ought to be an interesting case for political scientists who study the successful inculcation of political mythology. Of course, the danger of such a study would be that it might induce doubt or cynicism about other political mythologies, and we all need such mythologies to live by.
Theodore Dalrymple, “Worshipping the NHS”, New English Review, 2020-05-07.
Comments Off on QotD: The distance between NHS PR and NHS reality
August 6, 2025
QotD: Modern English night life
Recently I stayed overnight in a charming small cathedral city in England, genteel by day and Gomorrah by night. It is a little like H.G. Wells’ story The Time Machine, set 3,000 years hence, when humanity has divided into two: the effete, gentle, vegetarian diurnal Eloi, and the ugly, vicious, carnivorous nocturnal Morlocks, who emerge from underground once the sun goes down and prey on the Eloi.
I had booked no place to stay until the last minute, and found only a room above a cavernous, darkened bar, for me an antechamber of Hell, where the Morlock youth of the cathedral city gathered to enjoy themselves — or at least to pretend to do so, for I have long thought that those who cannot enjoy themselves without shouting and screaming are really hysterics, trying to convince themselves that they are enjoying themselves when actually they do not really know how to do so.
Theodore Dalrymple, “Evening Above the Hell-Bar”, Taki’s Magazine, 2019-12-16.
Comments Off on QotD: Modern English night life
August 1, 2025
QotD: The self-serving mythology of Britain’s NHS
The interesting question of why the NHS should continue to hold the affection of the British people, when it is at best mediocre in its performance and frequently unpleasant to deal with, is one that should be of interest to all political scientists. The answer is not pleasing to those who believe in human rationality.
The affection represents the triumph of rhetoric over reality. This rhetoric contains an implicit historiography, in which the pre-NHS era is akin to that of jahiliyya, the era of ignorance before the advent of Muhammad, in Islamic historiography: in short, that there was no healthcare for most of the population before the NHS. This historiography has for decades been continuously and successfully insinuated into the minds of the population. It has been Britain’s pale imitation of totalitarian propaganda. Intentionally or not, Boris Johnson recently reinforced the mythological status of the NHS. And when, in the present crisis, retired doctors such as I were asked to return to work if they were able, it was to help the NHS. This was like asking a soldier to lay down his life for the sake of the Ministry of Defence. It says something about the credulity of the public that the response to slogans like “protect the NHS” was dull compliance, rather than outraged demands as to why it wasn’t protecting us.
I suspect also that the sheer unpleasantness of the NHS is reassuring to the British population. It evokes the Dunkirk spirit: we are all stranded on the beach of illness together. And if we cannot all live in luxury, we can at least all die in squalor. Justice is served.
Theodore Dalrymple, “Empire of conformists”, The Critic, 2020-04-29.
Comments Off on QotD: The self-serving mythology of Britain’s NHS
July 24, 2025
QotD: Migrant farm workers
It is certainly true that the fruit-pickers would not be well-paid. Moreover, their accommodation during their stay would almost certainly be uncomfortable and overcrowded. The work they would do would be hard and possibly back breaking. It is certainly not the kind of work I should want to do myself, though I might have thought of it as a bit of an adventure for a couple of weeks to earn some pocket money when I was nineteen. But the Romanian workers are not coming for a bit of youthful adventure: they are coming because they are poor and need the money to live.
The fruit season is short. If the fruit is not picked, it will rot where it grows. Prices are such that farmers cannot offer high wages, and it is surely a good thing that fruit is available at a price that everyone can afford. There have been appeals to the British unemployed (in whose numbers there has been a sudden and great increase) to do the work, but they have not responded. The wages are not such as to attract them, and their economic situation would probably have to be considerably worse before the wages did attract them — and if their situation were to worsen to such an extent, they might choose crime, riot, disorder and looting rather than fruit-picking as a means of getting by economically. As for coercing the unemployed to take the work that is theoretically available to them, for example by withdrawing their social security unless they agreed to do it, the political repercussions would be too terrible to contemplate. It is easy to see in the abstract how our system of social security distorts the labour market, such that we have to import labour to perform such unskilled tasks as fruit-picking, but now is not a propitious moment at which to try radical reform. In politics as in life, you are always starting out from where you are, not from where you should have been had your past conduct been wiser or more prudent.
Theodore Dalrymple, “Contradictions of Labor”, New English Review, 2020-05-05.
Update, 26 July: Original link replaced. Link rot is sadly real.
Comments Off on QotD: Migrant farm workers
June 30, 2025
QotD: Britons and their NHS
I have to run a gamut of procedures to do so and face a receptionist who treats me as a fraud trying to get something to which I am not entitled, and I have no practitioner whom I can call my doctor. The NHS has crowded out private competition, and the nearest private doctor is 25 miles away. Suffice it to say that, if I want to see a doctor, it is easier, quicker and more pleasant for me to go to France than to the health centre about 300 yards from my house in England.
I cannot in all honesty say, however, that my health has suffered in any measurable way as a result of this unpleasantness, because my health is good and I am not a doctor-botherer. But it does reveal something about Britain that is not true in France: in our dealings with the NHS, we are a nation of paupers who must accept what we are given by grace and favour of the system. It may be good or it may be bad, but we have to accept it.
Furthermore, under the NHS doctors themselves are becoming ever less members of a liberal profession and ever more executors of orders from on high, with little leeway to consider whether these orders are good or bad in the case of the individual case before them.
This is a problem in all systems in which a third party pays for patients’ treatment, but it is particularly acute in a highly-centralised and dirigiste system such as the NHS, in which uniformity is the goal, even if it be uniformity of error. And increasingly, it creates an atmosphere of technical, managerial and ethical conformity.
Theodore Dalrymple, “Empire of conformists”, The Critic, 2020-04-29.
Comments Off on QotD: Britons and their NHS
June 15, 2025
QotD: Four stages of revolutions
Professor Chirot writes extremely well and is never less than clear. He uses no jargon and he has a gift for condensing complex historical events into a short compass without resort to procrustean simplification. I would imagine that he is an excellent teacher.
He does not claim to have found a universal law of history that applies at all times and in all places, but he says that large-scale revolutions in the modern world have had a tendency to go through four discernible stages. First, an outmoded governing power refuses to accept that change is necessary and consequently refuses to make the necessary concessions to save itself. This leads to overthrow by relatively moderate leaders who would once have accepted compromise but see that change can only come about by revolution. Second, there is a counter-revolutionary reaction by those who do not accept their loss of power and who provoke a civil war or call for foreign intervention, or both. As a result, much more radical revolutionary leaders come to the fore and defend the revolution by increasing repression of enemies or supposed enemies. Third, the radical leaders, because they hold extreme views and are imbued with unrealistic notions of the complete redemption of mankind from all its earthly ills, impose experimentation on the population which is economically and socially disastrous. Fourth, in the case of its evident failure, the revolutionary regime loses its ideological ardour, and settles down to a kind of routine and less violent authoritarianism accompanied by large-scale corruption and cronyism.
Theodore Dalrymple, “Longing for Revolution”, Law & Liberty, 2020-05-13.
Comments Off on QotD: Four stages of revolutions
May 20, 2025
QotD: The autohagiography of the NHS
I grew up, for example, in the inculcated belief that the National Health Service was, according to the slogan of the time, “the envy of the world”. Millions of people believed this, and indeed it was an assertion heard for many years whenever the subject of health care came up. The slogan was last wheeled out in any force in 2008 for the 60th anniversary of its founding.
Oddly enough, it never occurred to the people who repeated the slogan to examine the basis of the claim. Who, exactly, were the people doing the envying — not just one or two of them, but en masse? It is no doubt true that immigrants from very poor countries were pleased enough to receive care under the NHS, comparing it with what they would have received at home. But is it really much of an achievement for a developed country to have health care better than that offered in Somalia or Bangladesh?
A war of anecdotes, while always gratifying to the human mind, is not the way to decide important questions such as the superiority or inferiority of a system of health care.
It never occurred to those who repeated the “envy” slogan to look to comparable countries across the Channel or North Sea to see whether, in fact, those countries had anything to envy. In fact, between 1948 and 1975, even Spain under Franco performed better in the matter of improving the health of the population than did Britain. In most respects, in fact, Britain lagged or limped behind other countries, always in the rear and struggling to catch up.
What eventually struck me, then, was the willingness of so many people to repeat and believe a slogan without any compulsion whatever to do so, and without the slightest inclination to examine its truth — indeed without any awareness of the need for such an examination. There was no oppressive force to prevent or deter them from intellectual inquiry, but they preferred the comfort the slogan offered to the effort and possible discomfort of finding the truth. The NHS, or rather the idea of the NHS, played the role of teddy bear to a population with many anxieties.
True enough, many individuals may have experienced deficiencies in the service — long waiting times, offhand or disagreeable interactions with the bureaucracy, etc. But like Russian peasants of old who believed that the Tsar knew nothing of the oppression which they suffered, and would have put an end to it if he had known, the British continued to believe that the National Health Service had been born with original virtue and that the defects they experienced were exceptions. Repeated scandals of gross neglect or sub-standard treatment were shrugged off in the same way. And in a certain dog-in-the-manger way, the British were inclined to believe that if the NHS was unpleasant to negotiate, at least (being more or less a monopoly) it was equally unpleasant for everyone. Fairness and justice were equated with equal misery. Anyway, being ill is always unpleasant, so what did anyone expect?
Theodore Dalrymple, “Worshipping the NHS”, New English Review, 2020-05-07.
Comments Off on QotD: The autohagiography of the NHS
May 16, 2025
QotD: Marxist and socialist revolutions
The collapse of communist regimes in Eastern Europe, which he is happy to call revolutionary, also does not support his rough schema. It is not that the communist regime refused to reform, it is that it was incapable of reform for the same reason that a woman can’t be a little bit pregnant. If a regime makes the kind of claims for itself that the communist regime made, even if the leaders had themselves long since ceased to believe them, namely that it is the ineluctable denouement of all history, if not that of the universe itself, it cannot retreat, all the more so because its crimes, which one could and would have been claimed as a step in the march of history, would thereafter be seen for what they were: the choices of fanatical psychopaths avid for total power.
Professor Chirot seems to have a slight soft spot (admittedly only implicit) for socialism, that is to say for something more than mere social democracy. In his discussion of the case of Angola, in which a revolutionary movement emerged triumphant, but whose post-revolutionary regime was a pure kleptocracy under cover of Marxist rhetoric, he says: “Much more could have been done through either a market-friendly or a genuinely more socialist approach to economic development”.
This surely implies that somewhere, at some time, there was a socialist regime that would have handled Angola’s oil bonanza better, in which case one would have liked an example that it might have followed. Norway, perhaps? But Norway is not socialist, it is social democratic. Besides, Norwegians and Angolans are scarcely the same in a very large number of ways. I would have thought that the chances of Angola following the Norwegian model were, and are, approximately, and perhaps even exactly, zero.
Theodore Dalrymple, “Longing for Revolution”, New English Review, 2020-05-13.
Comments Off on QotD: Marxist and socialist revolutions
May 2, 2025
QotD: The Victorian attitude toward illegitimacy
I am still shocked by the recollection that, as late as the early 1990s, there were still a few women in psychiatric hospitals in Britain who were there principally because they had been admitted seventy years earlier after having given birth to an illegitimate child. No doubt they had quickly become institutionalised and could scarcely have coped with life outside; but to think of a long human life passed in this impoverished way (the wards for “chronics” had beds so close together that they allowed for no privacy whatever) as a kind of punishment for what is now no longer regarded even as an indiscretion, reminds one of La Rochefoucauld’s dictum that neither the sun nor death can be stared at for long. One cannot fix one’s mind on such a horrible injustice for long.
Of course, it was stigma like this that gave stigma itself a bad name — stigmatised so to speak, in fact, to such a degree or effect that the very name of stigma has a completely negative valency. No one has a good word to say for it, though whether there ever was, or could be, a society completely without it, I am unsure.
Theodore Dalrymple, “The Situational Nature of Scorn and Stigma”, New English Review, 2020-04-28.
Comments Off on QotD: The Victorian attitude toward illegitimacy
April 11, 2025
QotD: Teaching in modern universities
In two sentences, Leys has pinned, like a butterfly to an entomologist’s board, the bureaucratic sickness that has overtaken our institutions of higher learning (and not only those institutions). There is no madness more difficult to treat than that which believes itself sane, and there is no irrationality greater than that which believes itself perfect. It is no surprise that Leys retired early from his university chair because the university no longer bore any resemblance to what it had once been and misled students and the rest of society into believing it still was. A community of scholars had become an organization of foremen on a production line.
Theodore Dalrymple, “Rare and Common Sense”, First Things, 2017-11.
Comments Off on QotD: Teaching in modern universities
March 24, 2025
QotD: Communism and western intellectuals
Mao Zedong was the blank page or screen upon which they could project the fantasies that they thought beautiful. China was a long way off, its hundreds of millions of peasants inscrutable but known to be impoverished and oppressed by history; its culture was impenetrable to Westerners without many years of dedicated and mind-consuming study; Western sinologists, almost to a man, upheld the Maoist version of the world, some of them for fear of losing their access to China if they did not, and thereby created the impression that Maoism was intellectually and morally respectable; and so perfect conditions were laid for the most willing and total suspension of disbelief. Mao’s Thoughts — that is to say, clichés, platitudes, and lies — were treated by intelligent and educated people as if they were more profound, and contained more mental and spiritual sustenance, than Pascal’s. As so often before, mere reality as experienced by scores of millions of people was of little interest to intellectuals by comparison with the schemata in their minds and their own self-conception. “Let the heavens fall so long as I feel good about myself” was their motto. One didn’t know whether to laugh or cry.
Theodore Dalrymple, “Rare and Common Sense”, First Things, 2017-11.
Comments Off on QotD: Communism and western intellectuals
December 15, 2024
The fall of the house of Assad
In the New English Review, Theodore Dalrymple considers the fall of Syria’s dictator as the al-Assad family is finally toppled from power:
When I saw video clips of the joyful toppling of statues of Bashar al-Assad, as well as the tearing from walls of his ubiquitous portrait, I wondered what it must be like to be a dictator and see images of yourself everywhere (not that I have any ambitions myself in that direction).
Do you come to imagine, for example, that they are a manifestation of genuine popular affection for yourself, or are you like the Nicaraguan dictator Anastasio Somoza, of the poem by Ernesto Cardenal “Somoza Unveils a Statue of Somoza in the Somoza Stadium” (the fact that Cardenal, a Nicaraguan priest, was a commie doesn’t mean that he wasn’t a good poet).
The Somoza of the poem is perfectly clear-sighted. He knows that people didn’t erect the statue spontaneously, out of love for him, because he knows that he himself ordered it to be erected. Nor does he think that it will be a perpetual monument to himself because he knows also that the people will tear it down as soon as they can. No, he had it erected because he knew that the people would hate it, in other words that it would humiliate them, and a humiliated people is easy to cow into submission, at least until — to use a word of slightly different zoological connotation — the worm turns. (A note to pedants before they write in: I do not think that the verb to cow has any etymological link with the female herbivore known as the cow.)
It seems to me, however, that Cardenal may have simplified a little. Such is the complexity and potential dishonesty of the human mind that a dictator would be perfectly capable of imagining that a statue of himself is a manifestation of people’s affection for him and that there are people plotting to bring down both the statue and him because they hate him. This is not totally irrational or impossible. After all, as Americans know, even in a free democracy some people love the leader and some people hate him (usually more of the latter after he has been in power for some time).
Assad junior, it seems to me, is a living refutation of Solzhenitsyn’s famous remark that Macbeth was capable of killing only a handful of people because he was motivated by no ideology, and it requires an ideology to bring about hecatombs of the Nazis or Communists. Assad junior had a self-justification for his rule, no doubt, as every ruler and dictator has and must have, but he did not really possess a full-blown ideology in Solzhenitsyn’s sense. His trajectory is worth recalling.
The son of a monstrous dictator, he seems at first to have had no inclinations in that direction himself. Among other things, he didn’t seem to have the physical attributes of a dictator, but rather of someone pliant and weak, more herbivore than carnivore, more giraffe rather lion (though giraffes can kick a lion to death). And it spoke rather well of him that he should qualify as a doctor, apparently quite genuinely so, and wish to become an ophthalmologist, to which end he studied in London, where his conduct was not that of a spoilt brat but by all accounts rather modest — laudably so, in the circumstances.
Comments Off on The fall of the house of Assad
