Theodore Dalrymple, The Knife Went In. Gibson Square Books, 2017

Dalrymple’s latest work begins with a bang worthy of the Sun newspaper: ‘I’ve met quite a number of murderers as a prison GP and psychiatrist. I was very young when I met my first, a man who strangled his wife because she would not leave him to read his paper in peace.’

Other chapters start with equal tabloid zap: ‘A prisoner about to be released told me that the first thing he would do when he got out was to kill his girlfriend.’ The reader is quickly hooked. Few modern writers have had such access to prison life, apart from Chekhov who as a doctor visited a penal colony for three months in 1890. Dalrymple has provided copious objective detail while working as a prison doctor in Birmingham for fifteen years. Incarcerated, he says, a ‘longer time than many a robber’.

Starting in the 1980s he quickly found what has been termed ‘journalistic gold’ among drug addicts, wife-beaters and suicidal burglars. Using their words, he brilliantly illuminates life inside the ‘total institution’ of prison, its hidden rituals and language. ‘Tramlining’ prisoners slashing each other with razors melted into toothbrush handles. The evolution of tattoos including the letters ‘ACAB’ (All Coppers Are Bastards), which switches to ‘Always Carry A Bible’ on arrest. The ‘black aspirin’, or punitive use of a prison officer’s boot. ‘Nutting off’ or sending someone to an NHS psychiatric ward, which Dalrymple says is ‘infinitely worse than prison’.

For more than thirty years, people at the bottom have given the good doctor almost thrillingly pessimistic glimpses of modern life. In his notorious Spectator column and numerous books, he has used his experience within the walls of HMP Winson Green as a simulacrum for everything he hates about modern culture. The Knife Went In is not a discussion about the evolution of crime; instead it lays out again Dalrymple’s many well-known themes, particularly the bureaucracy which has seized British life since the 1980s, eroding common sense and initiative.

He believes that many prison sentences should be longer but ‘there is an ethical duty to do something for the prisoners’. This possibility is destroyed by ‘vastly more expensive administrative procedures introduced almost daily’.

He witnessed the arrival of the culture of form-filling and box-ticking. ‘New procedures mean new forms. Information-gathering will solve any problem. It doesn’t do anything about it but shows you have done something. Belief in forms is to us what belief in rain-makers was to African tribes.’

He lambasts our target-driven, ‘Gradgrindian’ culture, detailing the dismissal of a prison teacher of creative writing. ‘There were no statistics to show that writers reduced the rate of recidivism. All policy and expenditure these days had to be evidence-based.’

Dalrymple does not believe much of the ‘evidence’ produced.

Rare in being an openly conservative-thinking doctor, he insists on seeing men as individuals, not as classes and groups. At the start of Chapter Two he says: ‘There is a permanent tension between regarding men as individuals and as member of a class.’

Against all modern belief, he dismisses the culture of dependency and victimhood, demanding each takes responsibility for themselves. ‘Yes, they had terrible childhoods but still there was no intrinsic, or simple causal connection between their experience and what they had done.’ ‘They had decided to do what they had done.’ ‘The well-springs of conduct remained an impenetrable mystery.’

So much for Freud and the ‘tepid therapeutic broth’ institutions now bathe in. Dalrymple dismisses the idea that heroin addicts are victims suffering from a brain disease, which is strongly believed in America. Or that murder can happen by accident because someone ‘loses it’.

‘The dialogues of Plato are infinitely more valuable than the case histories of Freud,’ he says. Life should be about examining one’s own mind and motives, and taking responsibility for one’s actions.

While he’s at it, he excoriates rotten British architects who can’t even design a jail properly, forgetting to put in a proper ventilation system. The Victorians would not have made such a mistake. Planners responsible for ‘dispiriting British cities’ and modern parenting: ‘It is difficult not to conclude that in Britain the hysterical fear of paedophilia is not (an) expression of guilt about the way many now bring up their children, a mixture of neglect, overindulgence and violence.’

His irony and detachment must be baffling for younger readers now that those qualities are in such decline. He rejects popular jargon. He calls ‘shooting up’ ‘injecting’, as that’s what it is. There is no ‘judgemental’ for him, he’s a ‘censorious’ man, knowing that to be the adult word.

His language is delightfully non-PC, one of the joys of reading him. He relishes words such as ‘vice’, ‘wicked’ and ‘bad’, rarely heard now from doctors or clergymen. If he’d been a teacher he’d probably have been imprisoned for verbal ‘abuse’. He still uses outlawed terms such as ‘sub-normal’ and ‘mentally deficient’.



But sadly his language is also a problem. He can be pompous. Of his strange pseudonym, he writes that he ‘chose a name that sounded that of a gouty old man looking out of the window of his London club, port in hand, lamenting the degenerating state of the world.’

That old man lives in the Victorian era or is addicted to Dickens. His speech and constructions are often irritatingly arch: ‘He came no more to prison.’ ‘I was prey to a strange melancholy.’ ‘[Prison] was still not such as would attract most people.’ ‘The coroner’s failure to control the mother of the dead man was a symptom of the decomposition of public culture.’ He can also be cringingly sanctimonious, telling us he’s met a Big Issue seller whom he knew as a convict and buys the magazine, ‘paying more (sic) what he asked for it. He thanked me for what I had done for him’.

We assume the author is quite a wealthy man and don’t really need to know that he gave a few extra pennies. Despite his demand for precision and clarity, the book is peppered with literal errors, as if it has been put together hastily. It’s not always possible to know what he means: ‘their relations with women give rise to jealousy, often insensate’.

This ‘Dalrymple’ he has created tends to have enemies who are tall, with eccentric moustaches. He doesn’t like experts, coroners or most other doctors, yet is rather proud of being an expert himself. He is continually able to destroy defence barristers in court. ‘The court, including the judge but excluding defence counsel, collapsed in laughter. Oddly enough the latter never regained the initiative.’

‘Yes,’ I replied meekly, delighted at the direction in which he was going. I knew I had him in my power.’ ‘Defence counsel’s face grew redder, almost purple. “I am sorry to have to repeat myself,” I said. “But you are getting everything exactly the wrong way round”.’ ‘[One of] the relatives of the victim murmured, “Brilliant” as I went by . . . I heard afterwards that defence counsel had collapsed and died of a heart attack a few weeks later . . . I felt a slight pang of guilt.’

Don’t come up against Dalrymple if you are looking for methadone or trying to get someone a shorter sentence. He leaves the world gasping at his expertise. His last chapter is called ‘Pride goeth’, and perhaps he is becoming slightly complacent. He retired as a psychiatrist in 2005 and may be out of date in some areas. Members of the underclass are no longer called ‘Dwayne’; that has been superseded by ‘Jaden’ and, appropriately, ‘Jaylen’.

He writes that there are few old people in prison. When I worked in a London prison in 2007 there were increasing numbers. They are the fastest-growing group behind bars. Sometimes his insistence on seeing only the individual and not their context doesn’t work. Although he has worked in South Africa he seemed puzzled by an African mother who had blinded her son in the belief that he was harbouring a demon. Such ideas are common in parts of the African community and have been widely reported in the UK.

Perhaps, no longer a captive of his own success, the time has come for him to put prison behind him and get out into the fresh air a bit more.

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