Category Archives: form-filling

Why we read and re-read the doctor-essayist

Dalrymple is identified by an acute English journalist (also a skilled and powerful debater), Peter Hitchens, as

one of the greatest men of our age [second item in Hitchens’s 6th August 2017 column in the UK newspaper the Mail on Sunday].

For decades, Hitchens reminds us, Dalrymple

worked in a major British jail, listening to the excuses and self-justifications of people who had done terrible things to others, and to themselves.

Refusing to follow fashion,

and genuinely concerned for these often very sad characters, he treated them as adults, urging them to take responsibility for their actions instead of offering excuses for them. Many, who had come to despise authority, were glad to be up against someone they could not easily fool.

Hitchens’s guess is that many of those Dalrymple treated

benefited greatly from his tough-minded approach. He didn’t fill them with pills or substitute one drug for another. His observations of the way heroin abusers feign terrible discomfort, after arriving in prison and being deprived of their drug, is both funny and a badly needed corrective to conventional wisdom.

All this, Hitchens notes, is to be found in the Dalrymple collection The Knife Went In (2017).

The title, a quotation from an actual murderer, is an example of the way such people refuse to admit they had any part in the crimes they commit. The knife somehow got there and went into the victim, by itself. It is a series of short, gripping real-life stories in which he recounts his experiences with our broken, lying penal system with its fake prison sentences and its ridiculous form-filling as a substitute for action.

The book is mainly about prisons and crime, but, says Hitchens,

it tells a deep truth about the sort of society we have become. It is one in which almost nobody is, or wants to be, responsible for anything.

Hitchens concludes:

A future historian, a century hence, will learn more about 21st-century Britain from this book than from any official document.

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Why it is practically a duty to lie to authorities

Irrespective, writes Dalrymple, of

the paperless world to which digitisation was supposed to give rise (though it does not seem that there is any less paper than there used to be), it has not reduced bureaucracy. The ease with which information may be gathered, or asked for, has brought inefficiencies and irritations of its own.

Any organisation, governmental or private,

may easily demand to know more about us than we wish to reveal. Our only defence against this prepotent intrusion is lying, which in the great majority of cases will go undetected and be without consequence.

Cruel and stupid ‘mental health services’

Anyone, writes Dalrymple, who has had dealings with the mental health services knows that they simultaneously

neglect the raving mad while concentrating desultory and ineffective efforts upon the voluntarily inadequate. Patients rarely see the same mental health worker twice in succession; and anyone who has examined the records of such patients knows that they consist largely of forms filled out by people who believe that form-filling is the work they are paid to do.

The reason mental health workers concentrate on the voluntarily inadequate rather than the lunatics is that

the former are relatively docile and predictable, while the latter may be hostile and both drug-taking and machete-wielding. They are dangerous to deal with, and best avoided, especially by mental health workers, who can rely on the police to deal with them when they become so disturbed that they can be left to their own devices no longer.

Form-filling

by ever larger numbers of functionaries continues undisturbed as displacement activity, in the way that mice wash their paws when confronted with a cat. They are treating not their patients but their own anxieties, at the same time receiving a salary every month.

This, Dalrymple points out, is the model

for government as a whole, which pursues policies that cause problems that then call for further policies to correct them.

The idea that

for every distress there is an equal and opposite form of therapy, whether psychological or pharmacological, is a superstition, compared with which almost any religious belief is highly rational. It is also a very shallow conception of distress, which can often be immeasurably deepened by talking about it.

Britain, Dalrymple concludes, prefers

going from weakness to weakness: It creates more job opportunities for mental health workers.

Please identify your sexual orientation

Screen Shot 2016-04-14 at 18.56.41

A much better, fuller list

The hospital trust in which he works sends Dalrymple (from 51:02) a form to fill out

asking for my sexual orientation, so that I could continue to be paid.

Listed on the form, Dalrymple explains, are a mere

six orientations.

Dalrymple sends the form back with the comment:

Your imagination is too restricted for me to be able to answer this question.

Screen Shot 2016-04-14 at 18.42.18

Example of a form with a similarly limited number of orientations but with a bit more imagination

Manual labour

Screen Shot 2015-08-08 at 23.18.56Many staff in state organisations and large commercial concerns are in the habit of substituting activity for work, or rather, placing their unproductive or antiproductive activity in the way of your work, activity in this context being defined by Dalrymple as

doing things for pay that one would not do unless paid to do them but which conduce to no useful end except filling time and giving the appearance of busyness to superiors. That is why bureaucrats don’t saunter down corridors, they scurry. A lot of what goes on in offices (and not just in the public sector) is activity in this technical sense rather than work. It is designed to give a false impression and to fill an existential void.

It would not matter so very much, writes Dalrymple, if such activity were a form of bureaucratic masturbation, of self-pollution, only.

But alas, it is not so.

Screen Shot 2015-08-08 at 23.35.42

A manager in the UK’s National Health Service plans his day

Others, and the work of others, must be polluted also. Activity

in my technical sense has a knock-on effect, imposing obligations on people with real work to do, for example by devising new forms for them to fill in the course of their work, slowing them down.

The information gathered on such forms

is rather like old holiday snaps, never looked at again.

However,

if bureaucrats are told to work even harder, they indulge in meta-activity; they devise procedures to discover whether their previous procedures are being complied with. This becomes a labyrinth from which there is no extrication, the bourn from which no traveller returns.

...and let us get on with some real work.

…and leave us to get on with the real work.

Therefore Dalrymple would prefer it if municipal and state bureaucrats (other than rat catchers, hospital porters, and street cleaners) were idler.

They get in the way enough as it is; to insist that they fill every minute of their time with activity is to court further useless paperwork and obstructionism.

Bureaucratic mentality

H.M. Prison Winson Green, where Dalrymple was a specialist

H.M. Prison Birmingham

Speaking grosso modo, Dalrymple writes that prison officers he worked with were more astute and kinder than staff at psychiatric hospitals.

They had not had their heads filled with psychological jargon. When they came to me to tell me that a prisoner was not himself, or was acting strangely, or that ‘he’s not your typical con’, I soon learnt to take their observations seriously.

Rampton Secure Hospital

Rampton Secure Hospital

Dalrymple says that prisoners he knew were in general

far more afraid of psychiatric hospitals than they were of prisons. One of their most plaintive cries was, ‘You’re not nutting me off, are you, doctor?’

In official reports of disastrous cases in psychiatric hospitals, salient phrases include ‘lessons have been learnt’ and ‘errors of communication’.

One could write almost all reports on disastrous cases before they have occurred. By ‘lessons have been learnt’ is meant ‘it will be exactly the same next time’.

The lesson that has been learnt

is always that a new form, longer and more complex than the old, should be introduced. The form-filling gets in the way of genuine contact with or concern for the patient. The form-filling is the work itself.

Idiocy and callousness of Britain’s psychiatric services

Screen Shot 2014-06-14 at 19.34.12England’s psychiatric services are appropriate, writes Dalrymple,

to a nation of paupers forced to accept what they are given.

Relatives of patients

are either ignored altogether or treated as if they were the patients’ worst enemies with some discreditable ulterior motive. That they know the patients better than anyone else, and are therefore better able than anyone else to spot deterioration, is denied by psychiatric workers who in all likelihood have never met the patient before. This leaves the relatives bemused, frustrated and furious, as well as convinced of the unutterable incompetence of the services with which they have to deal.

A feature of these services

is their extreme bureaucratisation. An anthropologist visiting from Mars might conclude after his study that those who work for psychiatric services have such a belief in the efficacy of form-filling that they actually worship forms and ascribe magical powers to them. Not long ago I looked into several disastrous outcomes that occurred in the same place at the same time. I was immediately struck by the colossal number of forms that had been filled on each patient, often the same form asking the same questions, but filled with contradictory answers. It was clear that no one could possibly have read them (except me); for the persons who filled them, the filling of the form, not the welfare of the patient, was the purpose of their work.

The impression

is of timeservers on a job-creation scheme waiting for their salaries at the end of the month rather than of professionals whose concern is for patients.