In politics as in medicine, first do no harm. - Theodore Dalrymple

1.

The first duty of any worthy campaigner is to provide a lesson in terminology. After all, a worthy campaign is one which has significant consequences for society, and anything significant that needs to be campaigned for implies an insufficiently discerning public to whom suitable distinctions must be pointed out.

One of the most important ideas most people have never heard of is the ‘Cobra Effect’. The phrase derives from an episode that occurred under British rule in India in the early twentieth century. In an effort to reduce the country’s cobra population, the colonial government offered rewards to the public for killing these venomous snakes. Alas, some enterprising citizens began breeding cobras just so as to present their dead skins to the authorities. Soon the reward scheme was abandoned and the breeders released so many new cobras into the wild that the overall number ended up higher than it had been in the first place – an own goal that has come to symbolise any instance of a problem that is exacerbated by its alleged solution.

One section of today’s society that does understand the Cobra Effect is the medical profession. At the beginning of their careers doctors must swear, or at least learn about, the Hippocratic Oath, which enjoins them, above all, to do no harm to their patients. Any medical intervention that inadvertently worsens a patient’s health is dubbed ‘iatrogenic’. Doctors are savvy enough to realise that iatrogenesis is a risk not just when treating individuals but also at the level of society. For instance, the over-prescription of antibiotic drugs can lead to antibiotic-resistant bacteria which cause especially severe infections, so for the benefit of wider society doctors endeavour to prescribe these drugs only when absolutely necessary, much to the chagrin of some patients who demand that something is done for them.

In their aversion to iatrogenic interventions, medical professionals seek to avoid some of the well-known pitfalls that threaten any decision maker. It is always tempting to make a decision lazily – by applying abstract principles injudiciously, not assessing a case on its individual merits, preferring pet theories or procedures over relevant evidence, not engaging closely enough with the problem, or pandering to the prejudices of interested parties. In contrast, making a good decision requires at least two kinds of effort – of self-awareness (in order to recognise the possibility of bad decision making) and of external awareness (in order to study or address the realities of each problem that presents itself).

It is unfortunate that doctors, with one notable exception, tend to confine the application of their harm-aversive intellects to medical problems and interventions, for there are many modern social policies that on close inspection look suspiciously iatrogenic. The exceptional doctor, in more ways than one, is Theodore Dalrymple. In numerous books – among them Life at the Bottom, Second Opinion and Not With a Bang But a Whimper – in which he relates his experiences working in Britain as a prison doctor and inner-city hospital psychiatrist, Dalrymple has brilliantly demonstrated the need for what amounts to a political version of the Hippocratic Oath. His most emblematic case study is the welfare state – emblematic because here the contrast between good intentions and bad outcomes is starkest. Most people today assume, almost automatically, that the leading principle of welfare provision – to support those in severest need – is morally unimpeachable. Dalrymple’s great achievement is to have exposed, by paying due attention to the logical and empirical consequences of such a principle, its moral indefensibility.

Consuming around a fifth of the national income, the British welfare system offers subventions to people facing the costs of unemployment, housing, disability, illness and childcare, and provides tangible goods, including housing and other accommodation, and quasi-medical supplies, such as contraceptives for prostitutes and the replacement drug methadone for heroin addicts. The last example illustrates an important distinction. One might, and Dalrymple does, criticise methadone provision purely on the grounds of the drug itself: methadone is as addictive as heroin, and is more dangerous than heroin alone when the two drugs are taken together (which they often are, contrary to the aims of the policy of replacement). But the utility or otherwise of the resources supplied by the state is an issue which is tangential to the more fundamental form of iatrogenesis resulting from the principle underlying welfare provision.

The principle of supporting those people in greatest need translates into a policy of nonjudgmentalism, which has a significant, albeit not exhaustive, influence on who qualifies for welfare support, the eligibility criteria being varied, detailed and constantly-tweaked by governments and bureaucrats. By nonjudgmentalism is not meant a lack of rigour when assessing an applicant’s need, such that a person may receive subventions to which he is not technically entitled (for instance, someone who is not sick who receives sick pay). Such slackness is undoubtedly a problem – caused by corruption as much as interpretive difficulties or incompetence: the recent Labour government in Britain fiddled the unemployment figures by placing huge numbers of jobless people on sick pay – but it is not the deepest failure of need-based welfare. Rather, nonjudgmentalism means considering a person’s need as more important than what he deserves, and thereby dispensing help without moral judgment, such that no distinction is made between a person whose need has arisen through no fault of his own, and a person whose suffering is the consequence of his own reckless behaviour.

At the root of this moral neutrality are two philosophical notions. First, that it is unjust to hold people responsible for their behaviour, because circumstances, particularly socio-economic circumstances, dictate human choices. Second, that moral judgments are unsupportable because no style of life is morally superior to any other. In sum, nonjudgmentalism in welfare provision means apportioning resources without making any moral judgment as to the deserts, choices or lifestyle of the people seeking support.  

There are ample a priori grounds for rejecting nonjudgmentalism. For a start, it is intellectually dishonest. Do its proponents really believe that no lifestyle is morally superior to any other? Do they stand by this belief in relation to their loved ones? Moreover, the repudiation of the notion of choice is not as charitable as it sounds; after all, it is a strange kind of compassion, notes Dalrymple, which ranks its recipients ‘at the intellectual level of fish, who are, of course, quite rightly not blamed for their own misfortunes when caught by anglers and unable to escape’. Nor, in general terms, is the withholding of judgment genuinely charitable. As Dalrymple observes – with his characteristic, enlightenment-provoking acuity – when an institution such as the housing department ‘makes no judgments as to the deserts of the applicants for its largesse... it cannot express any human compassion whatever. Its estimation of need is mathematical, based on a perverse algebra of sociopathology’.

Yet it is at the empirical level where the full perversity of need-based welfare is clearest. Not only are welfare recipients with self-inflicted problems often not encouraged to change their lifestyle, they may also be told that, as passive victims, they cannot possibly do what is necessary to relieve their sociopathology, namely, make different choices and exert willpower. As Dalrymple puts it, ‘the notion that you cannot do otherwise traps you in the behaviour you’re in’. Indeed, welfare payments are more than just a trap; they are the bait, an invitation to cause oneself problems. Alcoholics who receive sick pay are incentivised to continue with their habit: ‘society is prepared to subsidise them to drink themselves into oblivion.’ A heroin addict who is prescribed methadone is given ‘a saleable commodity free of charge’. A young woman who bears numerous children by numerous violent fathers is, throughout her machinations, remunerated and accommodated by the state: ‘there is, in fact, nothing she can do that will deprive her of the state’s obligation to home, feed and entertain her.’

‘If you subsidise bad behaviour’, sighs Dalrymple, ‘then bad behaviour is what you get’, both insofar as you attract people to bad behaviour in the first place (‘does not anti-social behaviour increase in proportion to the excuses intellectuals make for it?’) and insofar as you wed them to that behaviour once it has been set in train. When in the hospital consulting with a patient who was being withdrawn from drugs, Dalrymple asked the anxious-looking young man what was the trouble: ‘“Doctor”’, came the reply, ‘“Do you think that if I get better I’ll lose my sick pay?”’. Another patient recounted to Dalrymple how her mother, who had been caught claiming benefits while in paid employment, ‘“had to give up working”’. Cajoled by the incentive of state support, many individuals not only initiate and perpetuate but exacerbate and exaggerate their difficulties, partly in order to compete for resources, in what Dalrymple calls ‘a kind of arms race of social pathology’. For instance, the knowledge that social housing will be offered ‘only if one behaves badly or impulsively enough acts as an irritant in domestic relations: for if a move elsewhere is a real possibility, you can afford to let a minor disagreement escalate into an irreparable breakdown’. This effect can be seen more generally when patients ask Dalrymple to write letters in support of their applications for social housing:

In these missives, my patients tell me, I should emphasize their alcoholism or drug addiction, their bad temper and tendency to assault those around them – the consequence, plainly, of a lack of proper accommodation. I should mention their repeated overdoses, the fact that they resort to tranquilisers obtained illegally, that they have had several abortions and are now pregnant for the fifth time, that they have had three violent and drunken boyfriends in succession, that they gamble their money uncontrollably (or uncontrolledly).

Welfare support bestowed without moral judgement has an iatrogenic effect on the welfare of its recipients. Bad physical health is one consequence of the ‘state-sponsored squalor’ Dalrymple vividly portrays in his work – ‘you’d think that British housing estates were concentration camps’ – but, above all, he laments the psychological impact of need-based subventions. Having worked in Africa and witnessed appalling suffering inflicted by deprivation, diseases and oppressive governments, Dalrymple insists that nothing he saw ‘ever had the same devastating effect on the human personality as the undiscriminating welfare state’. Insofar as it caters for the needs of irresponsible people, come what may, the state renders it unnecessary for such people to cultivate the very characteristic the lack of which led to their difficulties in the first place, namely, personal responsibility based on self-control and conscientiousness. Instead, welfare dependents become lazier and more parasitic, a combination exemplified by social housing tenants who excuse their litter-strewn, unkempt gardens with the pathetic complaint ‘“I’ve told the council but they haven’t come”’, and by a young mother who, upon demanding that social services take care of her three children by three different fathers, was at least more frank: ‘“I can’t be arsed with them no more.”’ Nor does responsibility flourish when badly behaved people are told that they are passive respondents to malign circumstances. Victim status, notes Dalrymple, ‘simultaneously explains one’s failure and absolves one of the obligation to make something out of oneself, ex hypothesis impossible because of the unjust nature of society which has made one a victim in the first place’.    

Never taking any responsibility means failing to learn the association between effort and reward. Dalrymple describes the attitude of his homeless patients, whom society supports via the state: ‘All of them, without exception, consider it part of the natural and immutable order of things that society should do so; they all, without exception, call collecting their social security “getting paid”.’ That is to say, ‘between work and parasitism they see no difference’. In turn, this mindset leads to ingratitude: if every reward requires no work, then recognising generosity becomes impossible. After being brought back by hospital staff from the brink of overdose-induced death, one addict’s first words were ‘“get me a fucking roll-up”’, followed soon by ‘“get me the fuck out of here”’.

By fostering irresponsibility, idleness and ingratitude, the British welfare state has produced a demographic which, in Dalrymple’s estimation, is ‘devoid of either ambition or interests’. We have created a ‘miasma of subsidised apathy that blights the lives of its supposed beneficiaries’; ‘a large caste of people for whom life is, in effect, a limbo in which they have nothing to hope for and nothing to fear, nothing to gain and nothing to lose. It is a life emptied of meaning’.

And it is a life filled instead with cruelty and crime, perpetrated on the grounds of boredom as much as an inflamed sense of entitlement. ‘A system of welfare that makes no moral judgments in allocating economic rewards promotes anti-social egotism’, Dalrymple insists: ‘all departments of social services promote misery through the moral support and financial subsidy of wickedness and depravity.’ In this way, poor people in general, not just the badly behaved among them, suffer the effects of welfare support, and suffer them worse. The downmarket neighbourhoods in which state-subsidised sociopaths typically live are blighted by burglaries, muggings, drugs, sexual offences, domestic abuse, litter, noise, intimidation, foul language and anti-social children who cannot be rebuked for fear of their parents retaliating. ‘In such circumstances’, summarises Dalrymple, ‘decency is almost synonymous with vulnerability’. Indeed, he elaborates, ‘one of the terrible fates that can befall a human being is to be born intelligent or sensitive in an English slum. It is like a long, slow exquisite torture devised by a sadistic deity from whose malevolent clutches escape is almost impossible’. And, of course, it doesn’t help when nonjudgmentalism provides excuses for sublunary malevolence. ‘“I keep thinking who’s the victim?”’, confessed one of Dalrymple’s patients, a man convicted of sex offences against women: ‘“We both are really”.’

But the most blatantly iatrogenic upshot of need-based welfare can be seen in the plight of citizens who are most deserving of help. As Dalrymple reports, ‘one of the consequences of treating large numbers of people as helpless is that the genuine cases are often abominably neglected’. This happens partly because the welfare system’s incentivisation of misbehaviour leads to an expanding number of undeserving applicants, all of whom take up limited time and resources. It also happens because, fundamentally, nonjudgmentalism discourages administrators from distinguishing between predicaments caused respectively by bad luck and bad living. But the cruelest twist is that well-behaved unlucky people are likely to attempt to alleviate their predicament, thus leaving them slightly less in need, and thus a lower priority, than misbehaving people whose problems are likely to be as unrelenting as their bad behaviour. This de-prioritisation occurs despite the fact that people who are seeking to make the best of a bad situation are clearly more deserving candidates for support than people who are wantonly perpetuating their problems. Or, rather, it occurs because such a differential is no longer clear. ‘In the old days’, Dalrymple writes, ‘the great advantage of stating the obvious was that one was unlikely to be flatly contradicted: but it is quite otherwise in these enlightened times of ours’.

The welfare system’s neglect of deserving people is implicit in the letters that Dalrymple’s patients ask him to write in support of their applications for housing: ‘In not a single case has anyone ever asked me to write that he is a decent, hard-working honourable citizen who would make a good tenant. That would send him straight to the bottom of the list’. Above all, though, the system’s warped appraisal of deserts is revealed in the stories Dalrymple recounts of the tragic lives of individuals it has failed.

One woman lived in a council house at the end of a virtually uninhabited cul de sac where drug dealers, heroin addicts, alcoholics and prostitutes conducted their affairs, littering her front garden with condoms, knickers, needles and cans. When the drug dealers began repeatedly breaking into her house, the council advised the woman to get a guard dog, which she did, and which she soon grew to love, although the drug dealers were undeterred. After making further pleas to be re-housed the woman was informed that it was a shame she didn’t have any children, because a three bedroom house was available. The best they could do was offer her a place in a hostel, although the dog would have to be put down. On pointing out that the council had advised her to get the dog in the first place, the woman was warned that if she continued to protest the department would wash its hands of her.

Another woman, of Pakistani origin, was disowned by her parents after she broke off her arranged marriage to a husband who had turned out to be repeatedly violent towards her. Having relocated with their child to a council flat in a tower block where the other tenants racially abused her – ‘“We don’t want no fucking Paki bitches here”’ – she asked to be moved again and was told by the council that she was adequately housed. Soon three of the tenants broke into her flat and smashed all her possessions, shouting as they left ‘“Get out of here, you Paki bitch”’, whereupon she took an overdose.  

A young woman who had been beaten by her drunken father, now absent, was subsequently beaten by her brother, who smashed a glass and used it to severely wound her arm. When the girl pressed charges, her mother threw her out. Aged just sixteen, she was deemed by the council to be too old for an orphanage but too young to receive benefits, but a room was found for her in a house where criminals were resettled; her roommate was a heroin addict and professional thief. Meanwhile, social workers lavished attention on her brother, because he was as badly behaved as she was not. Indeed, having previously aspired to train as a lawyer, the industrious girl soon found a job as a clerk in a law office, and was immediately charged full rent for her room. Still unhappy there, she asked to be re-housed but the council refused, and also declined to assist her in pursuing further education, on the grounds that to go to college she would have to give up her job, and by doing so she would have made herself voluntarily unemployed, which would disqualify her from any assistance at all. More support would be available only if she were pregnant.

But even if she were, the girl may ultimately have fallen foul of nonjudgmentalism, as one final story from Dalrymple shows. After leaving the violent, drunken father of her third child (each having been born of different fathers) a woman was given an apartment whose whereabouts he did not know. Soon afterwards she was required to stay in hospital for an operation. However, her youngest child was only two years old, and the woman was unable to make arrangements for his care, so she approached the council for help. Not wishing to judge the biological father, the social services insisted, against the woman’s protestations, that the child be placed in his custody for two weeks. A week later he had the killed the child by smashing its head against the wall. When the woman’s neighbours heard the news, they hounded her out of her home, blaming her for the death. She was granted a room in a house where a drug addict also lodged; he forced his attentions on her. Pleading to be re-housed she was informed by the council that she was not eligible for assistance, because she had no young dependents. ‘Stones might have wept at my patient’s predicament’, intones Dalrymple, ‘but not the housing department: it is far too nonjudgmental to do so’.

No doubt, these anecdotes do not together exemplify a consistent principle; they bemoan, for instance, both the support the state grants to irresponsible mothers as well as its inadequacies in the same regard. But the impossibility of deciding complex cases purely through principle(s) is precisely why judgment is required in every single case when it comes to welfare provision. Making such judgments is never easy – including the fundamental judgment regarding the extent to which the state, as opposed to the more intimate and localised charitable sector, could ever practically make the sorts of judgments that must be made – but Dalrymple’s work leaves no doubt as to the failure of the status quo, the failure of the liberal attitude with its impersonal, principled interventions. He concludes that ‘liberals pride themselves on their tenderheartedness: but the warm glow it imparts to them comes at the expense of the poor, who as a practical consequence live in a torment of public and private disorder’. The eschewal of judgment in welfare in favour of a principle of need leads to perverse iatrogenic outcomes afflicting almost all poor people, including undeserving recipients of welfare as well as deserving but neglected cases.

2.

Schools are often microcosms of wider society, with many children subjected to similar kinds of disincentives as their parents, leading to similarly disastrous consequences. In It’s Your Time You’re Wasting, pseudonymous teacher Frank Chalk describes, from grim personal experience, the alarming state of British state schools. First and foremost, their standards of educational attainment are dismal. The average sixteen-year-old today leaves school with verbal, written, and mathematical abilities strikingly incommensurate with the 12,000 hours of full-time education he or she has received, and also with the abilities of previous generations. Many children, from the beginning to their end of their schooling, lack fundamental competences, such as concentrating, listening to instructions, completing a multi-stage task, making relevant points, or forming a logical argument. ‘The ability level is low and getting steadily lower’, insists Chalk, ‘whatever the Government or the teachers’ unions or the league tables or the exam results say’.

Even more fundamental is the problem of poor standards of behaviour among schoolchildren. Many schools, says Chalk, have seen ‘a collapse in discipline, good manners, morality, respect and decency’, with large numbers of pupils lacking self-control and a capacity to think before they act. These children are chronically disrespectful of authority, and badly behaved – shouting out, answering back to teachers or swearing, often at the teacher. This sort of behaviour, which was rare and taken seriously in years gone by, has been re-characterised as ‘low-level disruption’, while serious misdemeanours now include criminal acts such as threats or even violence towards teachers; ‘the levels of violence in our schools is frightening’, admits Chalk, ‘both in its frequency and its severity’. An unruly atmosphere pervades many schools; pupils use mobile phones, listen to mp3 players or apply make-up – all during lessons, watch pornography on the school computers, wear trainers or otherwise fail to uphold dress codes, skip lessons and wander the school grounds, drink alcohol or take drugs on the premises, graffiti school buildings or smash windows, deliberately set off fire alarms, and slash the tyres of teachers’ cars. Against this backdrop, the education the children receive is inevitably compromised: ‘most of my lessons’, reports Chalk ‘are simply attempts to get them to behave in a civilised manner’.

Naturally, one might wonder about the standard, and standards, of the relevant higher authorities, especially when it comes to supporting classroom teachers. In Chalk’s inner-city state school senior managers persistently distance themselves from problems, an approach no doubt inspired by the Head’s talent for ‘not noticing that about which he would rather not know’. Abstract analyses are prioritised over workable interventions, meaning that ‘far too many incidents are simply brushed under the carpet’; the managers find it ‘much easier to hold meetings and presentations than support those teachers below them who are trying to improve discipline.’ One of the main factors behind the ‘lack of ability of those in charge to get a grip’ is the school’s government-led preoccupation with bureaucracy. Whether emanating from senior managers or civil servants, teachers are ‘bombarded with initiatives, schemes, directives and action plans’, and most of this ‘pointless paperwork simply acts to take them away from teaching’. This skewed focus is abundantly clear at school inspection time. Warned in advance by the inspectors, the managers at Chalk’s school arranged for the building to be cleaned properly and given a new coat of paint, and a few potted bay trees were placed in front of the entrance: ‘In short we have done everything except address any of our real problems’, observes Chalk.

As well as lacking support, teachers may lack pedagogical ability. The teaching unions refuse to accept performance-related pay and it is rare for incompetent teachers to be sacked. Instead they are given time off for ‘stress’ or sent on taxpayer-funded courses on topics such as ‘Behaviour Management’ and ‘Leadership’. In Chalk’s view these courses are ineffectual and continue in the vein of the PGCE, the route via which most teachers receive their professional accreditation and which offers little in the way of ‘basic skills and sound advice’ but a lot of ‘woolly “concepts and ideas”’.

For instance, many politicians and educationalists share a commitment to ‘inclusion’, the idea that to stigmatise and punish naughty children is futile, even wrong, because such sanctions, allegedly, only serve to exacerbate the disaffection which inspired the misbehaviour in the first place. Disaffection, so it goes, may be caused by behavioural disorders, among them ‘Attention Deficit Disorder’ and ‘Oppositional Defiant Disorder’, or socioeconomic deprivation – the two kinds of explanation, psychiatric and sociological, typically considered to be intertwined. Chalk doesn’t buy either kind – the former being ‘a plethora of diagnoses to mask fact that kids simply aren’t behaving’, the latter being evidently untrue (not to mention sweepingly insulting): many poor children do not misbehave. In practice, both kinds of explanation become exculpations which lead to a failure to challenge pupils in terms of attainment and behaviour: there is ‘too much nonsense babbled about children “choosing”’, summarises Chalk. Teachers are encouraged to practise ‘Positive Assessment’, whereby ‘you can only say nice things to a child’, and advised to make lessons ‘fun and entertaining’. (‘Another name for a children’s entertainer, notes Chalk, ‘is a clown’.) Tried-and-tested learning methods, such as repetition, are shunned; instead, teachers set unchallenging tasks, such as copying out, drawing, group work or colouring in – ‘no exercise is too childish’, rues Chalk. Meanwhile, the ever-vigilant school authorities select the easiest syllabuses (for instance, those containing lots of coursework), thus giving the exam boards – of which there are many, in mutual competition – an incentive to drive educational standards further downwards.

Bad behaviour, too, worsens when unchallenged. ‘It is perfectly natural to explore the boundaries of what behaviour is possible’, explains Chalk, adding: ‘If no boundaries are enforced then the results are plain for all to see’. In Chalk’s school not only is enforcement lacking – truancy and poor punctuality, for instance, are rife – but boundaries are actively made difficult to enforce. A naughty girl who believed she was being picked on by teachers was sent to an educational psychologist who ‘helpfully tops up her head with more nonsense and reinforces her delusions’; Chalk was rebuked by the Head, on Health and Safety grounds, for punishing children by making them pick up litter; teachers who wish to give out detentions lasting longer than ten minutes, or consign children to an isolation room, must fill out a form first; parents, many themselves recent products of the school and its twisted values, may threaten a teacher who disciplines their child; and teachers who are assaulted by pupils often don’t inform the authorities for fear of becoming ‘embroiled in some sort of Kafka-esque nightmare in which the victim becomes the accused’.

Above all, the policy of inclusion makes it extremely difficult to expel a child, because expulsions do not reflect well, bureaucratically speaking, on schools. A convoluted appeal process is available to parents, during which they often argue that the school is discriminating against their child, who they have persuaded a GP to diagnose as suffering from a behavioural condition. ‘We send a clear message to offenders’, opines Chalk: ‘“do that again and you won’t be thrown out”’. (In contrast, parents who wish to take their children on holiday during term time are readily granted permission; unauthorised absences don’t reflect well either.)

When schools are stripped of the apparatus of discipline, and the children know it, the result is that teachers resort to offering bribes to miscreants, which only succeeds in handing them further control. Chalk’s school organises daytrips for the ‘best behaved’ pupils, but in practice the beneficiaries tend to be the naughtiest children who have been showered with ‘merit marks’ by teachers desperate to provide some sort of incentive. Naturally, the long-term effect of pandering to the naughty kids is iatrogenic. ‘Our touchy feely slackness will count against them in a few years’, Chalk points out: ‘So many of our students... must be perplexed when, in later life, they are sacked from work for persistent lateness, petty theft, disobeying instructions and so on. After all, for the previous twelve years at school, this behaviour has been perfectly acceptable.’

At times Chalk’s anger crackles on the page. Inclusion is a ‘betrayal of these children’; a ‘cruel and neglectful con trick’; ‘we are taking the easy option but selling them short’. But he saves his angriest verdict for the effect that the policy of inclusion has on well-behaved pupils: ‘Nowadays the rights of one scumbag are considered far more important than the collective rights of the 29 others to be taught without being distracted.’ The sad fact is that unruly children seize resources in as well as out of lessons. As Chalk explains, ‘if you are quiet, well-behaved and fairly bright you will be ignored’; indeed, ‘the behavioural problems take up so much time that there isn’t much left for actual teaching’. There is a cruel irony here. The educational psychologists who describe naughty kids as ‘products of the system’ are oblivious to ‘the real casualties: the other children... who have lost literally hundreds of hours of their education’. Moreover, soon even the ‘decent kids make the wrong choices’ – ‘they see the naughty kids getting away with it time and time again and they think it’s really cool to behave like that’. In failing to reign in the troublemakers – and, in many cases, failing to work either with or against parents, who, like their offspring, may see no value in education – ‘we are allowing them to destroy the lives of their fellow pupils’, insists Chalk. In other words, the policy of inclusion iatrogenically harms all children in the most disadvantaged schools, by depriving them of the opportunity to learn and by teaching them that conscientiousness and goodness are not worth the effort.

A similar outcome can be seen, more subtly, in the growing reluctance among educational planners to stream children by ability within or between schools. ‘Imagine’, writes Chalk, ‘you decided to go skiing for the first time this winter and discovered that the ski school had adopted a policy of mixed ability teaching’. As this commonsense example suggests, mixed ability learning environments fail children across the ability spectrum, including those with the most severe learning difficulties, who increasingly are being dumped in mainstream education where they achieve less than they would have done in a special school. The British education system used to be more stratified, allowing the most intellectually capable children from poorer backgrounds to attend grammar schools, where the syllabus was appropriately weighted towards academic study, while the majority attended secondary modern schools, which taught literacy and numeracy in addition to a range of practical subjects. By the mid-1970s, most schools had become ‘comprehensives’, selecting children not on the basis of ability and aptitude but of residence within a particular catchment area. Chalk recounts this history and its iatrogenic consequences:

The change to comprehensive education was introduced in an attempt to improve the chances of children from poorer backgrounds. Most of them ended up going to secondary modern schools, the theory went, and the results at these schools were not as good as those at grammar schools. Lumping them all in together would even things out... Ironically, the effect of this experiment with our children’s future has been the exact opposite; social mobility is now much reduced in comparison to the situation thirty or forty years ago, as is the education our children receive.

And the quality of that education is not helped when the teachers who care the most, those who try to make a genuine difference amid restrictive conditions, finally lose heart completely and take their skills, as Frank Chalk himself did, to an alternative career – joining, moreover, all the potentially inspirational classroom leaders who were put off by the belittling bureaucratic hoops which must be jumped through in order become a state school teacher in the first place.

3.

Like Theodore Dalrymple, Frank Chalk brilliantly blends anecdote and fact to yield a detailed panoramic view onto a wasteland wrought by well-intentioned incompetence. Another classic example in the genre is David Copperfield’s Wasting Police Time. Copperfield, whose real name is Stuart Davidson, worked as a uniformed police officer in a small town in England before continuing his career in Canada, for reasons made abundantly clear in his book. Davidson documents a litany of Cobra Effects – arising from what he calls ‘the law of unintended consequences’ – which are blunting the activities of the British police force and demoralising its frontline staff.

Foremost among the culprits responsible for this travesty is the iatrogenic hydra of modern state bureaucracy. Davidson pines for a bygone age when police officers would carry out their patrols on foot, getting to know local villains and law-abiding citizens alike, and exercising discretion in regard to petty disputes and disturbances – often a stern talking to or a night in the slammer would be intervention enough. Above all, the preoccupation of yesterday’s police officer was to catch and deter criminals, to stay one step ahead, literally. Not so today. ‘Millions of pounds and thousands of man hours go on coming up with innumerable policy documents’, explains Davidson, so that ‘new ideas are implemented on the basis of how well they comply with regulations’, and the police are left ‘bumbling along in the wake of the thieves’. Much of the bumbling involves completing an obscene amount of paperwork, both at crime scenes and in the police station, to create an ‘audit trail, so that every last detail of force performance can be monitored by central government’.

Out of this Stalinist blueprint, wherein the National Offender Manager for the Criminal Justice Performance Directorate may grandiosely declare herself ‘responsible for reducing the offending of around 320,000 offenders’, the mess that ensues is no less shocking than predictable. Davidson depicts a police force where there is one civilian employee for every two uniformed officers; where so-called ‘support’ staff inundate officers with emails requesting faxes and completed forms to be sent; where standing-room-only meetings take place while elsewhere in the station only a handful of frontline officers are on duty; and where, on one occasion, Davidson was the only uniformed officer on duty in a town of 60,000 people. It is a force in which, having been clocked by a speed camera on the way to an emergency call, Davidson had to send off ‘a copy of the computer printout of the incident, a photocopy of my pocketbook, a detailed explanation of what went on, [and] another completed form’; even the most trivial incidents trigger a cascade of paperwork. Nowhere is this clearer than in the requirement, often based on sly statistical purposes, that officers provide full documentation of incidents in which no-one involved wants the case to be taken further.

Even when the disputants do wish for further action to be taken, in many cases officers go through the required bureaucratic motions against their better judgment. Much of a modern police officer’s shift, notes Davidson, is spent taking and processing statements from bickering, drunken, unemployed people with seemingly nothing better to do than wind each other up then report it to the police, who are obligated to pursue every crime report to its administrative conclusion, whether or not this will realistically involve prosecution. For instance, a trivial case involving an ex-couple sending each other vindictive text messages can necessitate months of paperwork. An exasperated Davidson is left bemoaning his chronic obligation to ‘investigate the petty personal lives of the underclass’. Not that such interventions help much, anyway. Often, the long, drawn-out process of investigation only serves to perpetuate and exacerbate the very situation it is supposed to be resolving; the rest of the time, the process is simply a waste of time. Either way, Davidson insists balefully, ‘the majority of an average patrol officer’s work is of no benefit to the community’. When bureaucratic strictures make it harder for police officers to do their jobs, when ‘the very administration of crime becomes significantly more important than reducing it’, the outcome is iatrogenic.

In the course of their investigations, it is not unusual, says Davidson, for officers to be dispatched ‘to fetch medication, interpreters, friends, relatives or appropriate adults’ on behalf of people who have been arrested. Defence solicitors must also be fetched, and then, with full appraisal of the charges involved, given the opportunity to prep suspects before their police interview. The consideration shown by the police when it comes to the convenience of suspects forms the tip of the iceberg of the Criminal Justice System – ‘a government organisation set up to help criminals’, as Davidson calls it. One of the guiding principles of modern policing, just as in education and the welfare system, is the avoidance and mitigation of ‘social exclusion’. This principle can be seen in a terminological shift imposed upon officers – from the language of ‘criminals’ and ‘victims’ to that of ‘offenders’ and ‘injured parties’. As Davidson explains, the new ‘choice of words reflects the widespread liberal belief that “offending” is understandable because the whole Criminal Justice System – indeed, the whole of society – is a bourgeois creation designed to protect the rich against the poor’.

From this ‘vague idea that it’s not their fault’, much pandering to criminals has followed. Judges hand down pitifully short prison sentences, or worse, community service orders, thereby providing insufficient protection to the community and scant punishment or deterrence to criminals; rulings are not enforced, as in when, ludicrously, magistrates impose driving bans on people found driving a car while banned (or, in an even crazier example reported in a newspaper, from which Davidson quotes, a criminal ‘was released on bail by the court, on condition that he kept to his bail conditions this time’); and the consumption of illegal drugs is commonly taken by the courts not as an additional contravention but as a mitigating factor – ‘the defence will actually say, “He is a burglar but, in his defence, he regularly takes heroin”’. The refusal of the authorities to unequivocally condemn drug usage extends even to the counsel handed out to children, via the government website ‘Frank’, the self-styled ‘non-judgmental source of drugs information and advice’. As Davidson points out, ‘you might expect the Criminal Justice System to say that drugs are a) illegal; b) bad for you; c) part of the explosion of acquisitive crime we’ve seen in the last few decades; and d) damaging society’. But no. Through all such genuflections to illegality, the doctrine of social inclusion wreaks havoc among the very people it is supposed to be serving, an iatrogenic consequence starkly articulated by Davidson: ‘The majority of people living on our worst council estates are completely law-abiding, in my experience. Yet their lives, like the lives of many of the poor and vulnerable in society, are dominated by a fear of disorder.’ In other words, ‘those poor are reaping what the liberal elite have sown. Various criminals run our council estates’.

To an honest, old-fashioned trooper like Davidson, the new-fangled style of law-enforcement is difficult to stomach: ‘No matter how hard I try, I cannot seem to get into the swing of policing in the value-free way I’m supposed to. I maintain my own bourgeois values of thrift, education and respectability.’ The notion that an officer should modify his perspective isn’t baseless paranoia on Davidson’s part. Police training school, he points out, consisted mainly of a discussion of ‘prejudice and discrimination’, with little time allocated to learning how to identify, catch or investigate criminals; similarly, the ongoing education of qualified officers involves a constant stream of awareness-raising training courses and policy announcements on diversity and equality. The iatrogenic consequences of this skewed focus range from the procedurally pointless to the sinister. Davidson insists that for the vast majority of officers a non-discriminatory mindset comes with the territory – the notion of a criminal, after all, transcends social categories, and racism has thankfully been extirpated from mainstream culture – so the bureaucratisation of impartial policing is not only unnecessary but at best a distraction from, at worst an obstacle to, taking action on crime. Consider Davidson’s appraisal of recommendation number 61 of the Stephen Lawrence enquiry:

The effect was that almost anyone I talk to in the street, never mind search, has to be given a similar written record. According to the Metropolitan Police, this record takes seven minutes to complete. So, if I go to an incident and see a group of four people and wish to ask them their names and addresses, it takes me about half an hour. Later, I will also have to enter the details on the computer, a process that takes a further half an hour (drive back to the station, wait in line for the computer, enter in the details).

The problem, which should be obvious, is that while the police are clambering through bureaucratic hoops in the name of impartiality, hate crime goes unsolved – not to mention crime in general, which afflicts minorities disproportionately by virtue of their overrepresentation among poor people, the likeliest victims of crime. In this way, useless administration purporting to protect minorities actually makes them more vulnerable.   

There is also a creepy intrusiveness involved when minority groups are bureaucratically fussed over, as in when Davidson’s force sent out reassuring letters to local homosexuals ‘only if they were out’. The forms that police hand over after speaking to or interviewing members of the public contain two boxes that must be ticked to detail the subject’s ethnicity, one as described by themselves, the other as described by the officer. Davidson recites various awkward interactions in which subjects were unable to give a self-description fitting any of the categories – Kurds, for instance, or a young lady from Bali with an Indian father and a Malaysian mother. ‘The government system of racial classification’, groans Davidson, ‘would be familiar to anyone with experience of South Africa under apartheid’. This seemingly flippant remark has a justification that is subtle but deep, in keeping with the insidiousness of the iatrogenic outcome it draws attention to. ‘We record someone’s ethnicity’, notes Davidson, ‘to ensure that they are treated differently according to their needs’.

That is to say, officers are encouraged to perceive and act on alleged differences among racial groups, an approach which is dangerously close to racism; after all, as Dalrymple points out, ‘the opposite of a racist is not an anti-racist but someone who does not think in racial categories at all’. In a cringe-worthy exemplification of this, North Wales Deputy Chief Constable Clive Wolfendale addressed the inaugural meeting of the North Wales Black Police Association in 2004 by delivering a rap. The patronising opening verse gives a flavour of the eleven that followed:

            I’m just a white boy called the Deputy CC.

            They said I’d never make it as a bitchin’ MC.

            You got it all wrong, ’cos now here I am

            Giving it for real in the North Wales BPA jam.  

If Wolfendale was trying to be friendly, the same can’t be said for officers who, out of fear of accusations of misconduct, take refuge in officiousness when interacting with ethnic minorities. Davidson notes that whereas white people who are stopped and searched may get an informal ‘“how’s the wife and kids”’ approach, non-whites get a sterner but legally more protective preamble, often while flanked by multiple officers who have been radioed in purely to act as witnesses: ‘You have been seen acting suspiciously by CCTV near some cars. I am searching for evidence that you are going equipped. I am PC 1234 Copperfield. I am based at Newtown Police Station. You are entitled to a record of the search. This search is conducted under section 1 of PACE 1984. You are detained for the purposes of the search.’ In other words, the anti-discrimination bureaucracy that looms large over police interactions with ethnic minorities has the iatrogenic result that ‘Ron the white drugs dealer gets totally different treatment from Steve the black car thief’. The same dynamic may also characterise relations between officers. Davidson wonders whether the seemingly disturbing fact that officers from minority groups are more likely to be subjected to misconduct hearings has its roots in the paranoid application of officiousness: ‘If you were a sergeant or inspector, would you dish out a good, old-fashioned dressing down to an errant female or [ethnic minority] officer, risking accusations of racism or sexism, or would you make it official at an early stage, have everything in writing and cover your backside?’

4.

I do not mean to deny that prejudice, in the police force or elsewhere, is a bad thing, or that educational failure is a bad thing, or that indifference towards citizens who fall on hard times is a bad thing. Quite the opposite. The whole point of drawing attention to iatrogenic outcomes in each of these domains is to protest against the increased levels of prejudice, educational failure and poverty that result from good intentions which backfire. And the whole point of emphasising the need to deter criminality, indiscipline and irresponsible behaviour is to demonstrate that policy interventions which exacerbate these problems also tend to exacerbate the problems of racial inequality, educational failure and poverty. In sum, a necessary condition for the success of any attempt to reduce racial inequality, educational failure and poverty is that any such intervention doesn’t increase criminality, indiscipline and irresponsible behaviour.

If I have spelled this out rather relentlessly, it is because a sizeable proportion of the population relentlessly refuses to entertain the notion that liberal interventions, such as need-based welfare, educational inclusivity, and bureaucratic social-inclusion and anti-discrimination policies in policing, could be anything other than effective, let alone roads to hell. Part of the explanation for this refusal is that there are vested interests when it comes to such interventions. The public sector in Britain accounts for around 50% of GDP and employs around six million people. Many of these – from local authority officers to educationalists and police support staff – work for action groups, taskforces, strategy units, and so on, involved in the implementation, administration or promotion of iatrogenic policies. ‘In the looking-glass world of modern public administration’, notes Dalrymple, ‘nothing succeeds like failure’ – this being true ‘so long as the final purpose of the public service is to employ the people employed by the public service’. Clearly, some people will lower their scruples in return for a healthy salary and a government-guaranteed pension. But this cannot be the whole story. Those same people don’t believe that, say, armed robbery is an acceptable way to earn a living (for them at least). And a commitment to iatrogenic policies can be found among many citizens who are not remunerated by the state. Deeper than any financial considerations is the mindset that precludes awareness of iatrogenic outcomes.  

Just as rivers descend to ground-level from rarefied origins, ideas flow from the intelligentsia into culture. Unfortunately, what is currently flowing down from modern intellectuals, particularly within the academic humanities, is a dangerous cocktail of nonsense. In principle, the role of humanities scholars is to seek knowledge about humanity (in both senses – as a species, and as a virtue) in the service of humanity (in both senses). The starting point for philosophers, sociologists, theologians, critics, and the like, should therefore be an analysis of the human condition, with all its actualities and potentialities. In rough outline, our condition is as follows: we live in a strange place called reality; each of us has a body which includes a brain; our bodies and brains belong to reality, and are thereby subjected to various constraints and impulses as described by biologists and psychologists; yet, precisely because we are conscious of our lives, we can learn about reality and our proclivities and make choices; we can even try to become better people. Humanities scholars can help us in all this, by extracting relevant insights from the behavioural sciences and combining those insights with reflections on matters of profound human importance that cannot be addressed solely (if at all) by science – such as morality, wisdom, well-being, art and creativity.

Alas, such a combination isn’t readily forthcoming, because very few academics employed in the humanities agree with the starting point that I have described. The overriding agenda of most humanities scholars is to deny being a free and conscious individual inside a human body within the real world – a denial that typically takes the form of an insistence that nothing whatsoever can be known about reality, not even that it exists at all. This insistence is not equivalent to the critical scepticism of the scientist or businessperson, whereby theories and strategies are either corroborated or refuted through testing and analysis; rather, the insistence amounts to nihilistic scepticism, or philosophical idealism, whereby all beliefs about the world are considered equally invalid. One particularly fashionable modulation of idealism is the doctrine of postmodernism, which claims that there is no truth beyond the arbitrary words, texts and symbols of human language. Another, more time-honoured modulation, is the religious notion that the tangible world is less than real, because God, or some other sacred entity, is the deeper, spiritual truth. By all such means, scholars seek to extricate themselves from any intellectual consideration of the reality that surrounds them, including that of their own embodiment.

This disjunction is especially evident in the typical antipathy, and consequent apathy, displayed by philosophers, postmodernists and religionists towards Darwinism. Through his theory of natural selection, Darwin realised that nature is a vast arena of mutual antagonism in which organisms must compete (or, at best, co-operate to compete) in order to survive and reproduce. In contemplating this backdrop to life, all but the most hard-hearted people experience a touch of melancholy, as Darwin himself did. But melancholy doesn’t generally prevent people from accepting that life is what it is – that you must either get busy living or get busy dying. In contrast, many intellectuals flee from Darwinism and seek refuge in obfuscation – a strategy which is as futile as it is neglectful. If you can’t stand the heat of Darwinism you can’t simply get out of the kitchen. Reality, not just nature, is Darwinian to the core. From solar systems and pebbles to terrapins and iPads, all things exist only by successfully imposing themselves on their surroundings. In rejecting Darwinism, intellectuals are actually rejecting reality. No doubt, this urge to reject is intensified by reality’s up-close and personal intrusion into our constitutions as human beings; like all species, we retain, encoded in accumulated adventitious genetic mutations, the behavioural propensities that enabled our ancestors to survive and reproduce. But the proximity of a source of anxiety is no excuse for ignoring it – quite the opposite. The failure of humanities scholars to reflect on Darwinism is, most acutely, a failure to reflect on human nature, an oversight which leaves humanity more, not less, exposed to unwanted biological influences.

Granted, there are ‘materialist’ philosophers who acknowledge Darwinism. But they are not, on the whole, interested in learning anything about reality and human nature. Rather, their preoccupation is to deny that it is possible for genuine freedom and human consciousness to exist against such a backdrop; these philosophers do not wish to reflect on the human condition so much as to remove the potential for reflection from that condition. In this respect, the mindsets of materialism, nihilistic scepticism, philosophical idealism, postmodernism and religion share a fundamental shortcoming. Each involves a reluctance to pay attention to reality and human nature, where attention involves a combination of self-awareness and external awareness.

The problem of course is that, because attention is a prerequisite of making good decisions, the patterns of intellectual inquiry which are prevalent today are inherently conducive to bad decisions, especially insofar as those patterns have come to predominate in wider society. For one thing, inattentive people, especially the most impulsive among them, are less likely to make wise decisions and lead a good life. But the most damaging manifestation of society’s pandemic lack of attention can be seen in the iatrogenic bureaucracy that currently dominates the state apparatus (and which, in turn, no doubt consolidates its own intellectual basis through the selective allocation of academic funding). The agenda is set within the civil service by graduates of humanities degrees who go about their duties with barely a consideration for real outcomes, that is, for the viability of various government schemes amid countervailing forces, or for the likely consequences of those schemes given the propensities of real people. What matters is the realm of ideas, theories, notions and intentions, as codified in paperwork, reports, forms and flow-charts – the stock-in-trade of bureaucrats who, in Dalrymple’s judgment, ‘imagine that, because they are doing something that no-one would do in his spare time if he had the choice, they must be working’.

The same lack of interest in reality and human nature also influences the ideological basis of the state, or, rather, makes an ideology of the state, by way of a matrix of interlocking intellectual failures and their ideological consequences. Failing to take account of the cruelty inherent within nature, ergo within human nature, allows utopian schemes to appear achievable, and this encourages, indeed obligates, the unchecked expansion of the state. In turn, overlooking human nature’s dark side encourages the assumption that bad behaviour is not something that needs to be carefully policed and disciplined out of people; rather, bad behaviour represents a failure of the state to create good behaviour ex nihilo. From this notion it follows that fostering good behaviour simply requires a suitably inclusive approach – welfare for people who make bad choices, or lenience towards criminals and naughty children. Further justification for the policy of inclusion arises from the favouring of socioeconomic exculpations for bad behaviour over moral explanations that cite individuals’ failure to consciously control their biological urges. Socioeconomic exculpations are based on the notion of cultural determinism, which – like materialism, another exculpatory doctrine – alleges that human behaviour is shaped entirely by forces beyond individual control. But whereas biological forces are held to be inexorable, malign socioeconomic forces can, so the theory goes, be mitigated or altered through a policy of inclusion. Accordingly, the fundamental goal of bureaucracy becomes the reduction of socioeconomic inequality. In addition, cultural determinism leads to the notion that different racial groups have little in common because they occupy different cultural environments. Noting down each citizen’s race and treating members of each group according to suitable generalisations, ostensibly (and, indeed, ostentatiously) so as to avoid oppressing such groups, becomes the quasi-racist mission of the state.

With its fixation on equality, the foregoing statist ideology typically shades into flippant anti-capitalism. People who don’t believe that human cruelty has Darwinian origins do believe that money is the root of all evil; indeed, they believe that money creates evil by stoking a Darwinian kind of mutual antagonism among members of society. This naive view overlooks the fact that businesses cannot compete economically without a massive amount of internal and mutual co-operation, that is, without non-zero-sum gains; and it overlooks the fact that the economy is not a finite resource to be carved up, equitably or otherwise, but rather a dynamic resource that can be added to and shared in by willing participants. Moreover, when inequality is not being exacerbated by iatrogenic interventions, it is in large measure caused not by money but by genetic variation, and by the fact that human beings – including poor people, if you care to ask them – are innately more motivated by the prospect of status and material rewards than ubiquitous parity. Also overlooked is the fact that poor people benefit more from the economy than from egalitarian government schemes, the latter’s negative social outcomes often undermining the former. Indeed, statism actually fosters the worst excesses of plutocracy, since excessive taxation undermines vulnerable businesses, and control-obsessed governments prefer to deal with a handful of large and powerful traders than with a multitude of independents. Most tellingly, even under communist regimes traders are invariably not dispensed with, but, rather, the ruling elites co-opt the market to enrich themselves at the expense of everyone else, including the poor; a modus operandi that betrays the essentially parasitic nature of statism’s relation to capitalism. In all these ways, anti-capitalist policies have iatrogenic effects on the poor.    

Modern life is a minefield of dreams, with trouble strewn all around resulting from disastrous interventions based on bad ideas. Blights such as poverty, educational failure, criminality and racial inequality, far from being extirpated, are exacerbated by the state-driven, bureaucratic interventions favoured by the majority of people today. Public concern, to the extent that it may be described as such, is increasingly shot through with the same philosophical hypochondria that is rampant among the intellectual elite, for whom reality and human nature are sources of fear and denial. We call ourselves ‘socialists’ or at least we claim to care about social problems, but we delegate to the government all responsibility for tackling those problems; we pronounce vigorously on what society should be like, yet we remain wilfully ignorant of the factors that render it not so; we exculpate ourselves and others (at least everyone but the rich), yet we don’t pay attention to the way we live. Above all, we are unrelenting. We bemoan the problems of society yet we insist on the continuance of the very policies that have iatrogenically brought those problems to a crisis point. We cannot let go for fear of owning up to what we have done. We are like Lenny, the gentle brute in Steinbeck’s heartbreaking tale Of Mice and Men, who hugs the farmer’s wife to death.

So what should we do? Or, rather, how can we undo what we are currently doing? The opposite of a philosophical hypochondriac is someone who faces up to reality and human nature; who pays attention to himself and his actions and their likely consequences; who understands that ideas put into practice must meet countervailing forces, and makes allowances for those forces; who recognises his freedom and takes personal responsibility, rather than delegating everything to the state; who measures compassion – his own and others’ – according to the extent of one’s charitable undertakings rather than one’s willingness to apportion government funding; who doesn’t reflexively shun but embraces the principles of business so as to harness the powers of trust, reciprocity and co-operation, those pillars of human motivation and progress; who engages with flesh-and-blood human beings – individuals and actual communities – rather than with abstract notions such as classes and culturally sealed ethnic groups; who positively influences the lives of others around him by judiciously knowing when to praise and when to condemn or punish; who dreams, but, crucially, wakes up too.

Ben Irvine is a writer, campaigner and philosopher. He is editor of the Journal of Modern Wisdom and author of the book Einstein and the Art of Mindful Cycling. 

He is currently running the London Cycle Map Campaign, lobbying for a Tube-style map and network of cycle routes in the UK capital.

Find out more about Ben’s work at www.benirvine.co.uk

Note: this article originally appeared at New English Review