Posted on 12/23/2002 4:01:27 PM PST by aculeus
Rarely does the British Journal of Psychiatry produce in the reader anything other than déjà vu at best and ennui at worst; but an article in the July issue was startling in its implications and accordingly won wide publicity.
Researchers carried out a double-blind trial of the effect of vitamin and mineral supplements on the behavior of prisoners aged 18 to 21. Two hundred and thirty-one such prisoners were divided randomly into two groups: one that received real vitamins, one that got only a placebo. Those who received the real vitamins committed about a third fewer disciplinary offenses and acts of violence during the follow-up period than those who took the placebo.
The researchers demonstrated that the two groups of prisoners did not differ in any respect before the trial (though, importantly, they did not control for previous or current usage of illicit drugs). Thus the reduction in antisocial behavior was in all probability attributable to the vitamins. True, the results have yet to be reproduced elsewhere, and reproducibility is the hallmark of genuine scientific discovery. True, too, the researchers offered no explanation of why the vitamins produced their alleged effects—and the supplements contained so many vitamins, minerals, and fatty acids that it would take several lifetimes to establish exactly which ones produced the alleged effect.
Still, the trial raised hopes of a breakthrough for Britain’s crime-ridden, even crime-dominated, society. Could it be that simply handing out vitamin pills to our potential burglars and muggers could make our homes and streets more secure?
Those who have long been on the lookout for reasons to exempt criminals from responsibility for their acts—as a sign of their own generosity of spirit—will conclude from these results either that crime is a manifestation of physical illness of the brain or that it is the result of poverty that itself gives rise to that illness.
But we should exercise caution: other interpretations are, as always, possible. That many young inmates are grossly malnourished when they enter prison I have absolutely no doubt, because each day I see cases of severe malnutrition among those who have recently entered the adult prison in which I work. Of an average daily intake of 20 prisoners, perhaps six, of whom four are drug addicts, show obvious outward signs of malnutrition. A rough estimate (allowing for recidivism) would suggest that perhaps 1,000 malnourished men arrive in my prison annually: that means (if my prison is typical, and there is no reason to suppose otherwise) that each year at least 25,000 malnourished men enter the British prison system. What is more, the malnutrition that I see in the prison is also to be found in the hospital in which I work, among men (and, to a lesser extent, among women) of the same social class as the prisoners.
Were a film director to need extras to play the part of starving Bosnians in a movie about the Serbian atrocities, he would need to look no further than my prison’s daily intake. The prisoners’ sunken eyes, which appear disproportionately large in the setting of their sunken cheeks and prominent cheekbones, their spindly limbs, and their hollow chests with paper-bag skin, punctuated with unhealing sores, over their bony rib cages, would fit the director’s bill perfectly. The prisoners’ teeth are falling out; their tongues are glisteningly smooth, angrily magenta red, and the corners of their mouths are cracked, as in vitamin B deficiency. They are in their early twenties to their early thirties.
From the dietary point of view, freedom has the same effect upon them as a concentration camp; incarceration restores them to nutritional health. This is a new phenomenon, at least on the scale on which I now see it. Last week, for example, I treated in my hospital a skeletal man who had been released from prison only two months before and had in that short time lost 44 pounds. A recidivist, he had served many short sentences for theft, and his weight went up and down according to whether he was in prison or at liberty. This is a common enough pattern of weight gain and weight loss among the males of my city’s underclass. It has a meaning quite alien to those who believe that modern malnutrition is merely a symptom of poverty and inequality.
About two-thirds of these malnourished young men take drugs, upon which they spend sums of money that, however obtained, would secure them nightly banquets. The drugs they take suppress their appetite: the nausea induced by heroin inhibits the desire to eat, while cocaine and its derivatives suppress it altogether. The prostitutes who stand on the street corners not far from where I live—they work a shift system and commute in from a nearby town in buses chartered by their pimps—are likewise grossly malnourished (they often end up in my hospital), and for the same reason. You’d think famine were stalking the land.
Not all the malnourished are drug-takers, however. It is when you inquire into eating habits, not just recent but throughout entire lifetimes, that all this malnutrition begins to make sense. The trail is a short one between modern malnutrition and modern family and sexual relations.
Take the young burglar whom I saw in the prison last week. There was nothing remarkable about his case: on the contrary, he was, if I may put it thus, an average British burglar. And his story was one that I have heard a thousand times at least. Here, if anywhere, is the true banality of evil.
He smoked heroin, but the connection between his habit and his criminality was not what is conventionally assumed: that his addiction produced a craving so strong, and a need to avoid withdrawal symptoms so imperative, that resort to crime was his only choice. On the contrary—and as is usually the case—his criminal record started well before he took to heroin. Indeed, his decision to take heroin was itself a continuation, an almost logical development, of his choice of the criminal life.
He was thin and malnourished in the manner I have described. Five feet ten, he weighed just over 100 pounds. He told me what many young men in his situation have told me, that he asked the court not to grant him bail, so that he could recover his health in prison—something that he knew he would never do outside. A few months of incarceration would set him up nicely to indulge in heroin on his release. Prison is the health farm of the slums.
I examined him and said to him, “You don’t eat.”
“Not much,” he said. “I don’t feel like it.”
“And when you do eat, what do you eat?”
“Crisps [potato chips] and chocolate.”
This pattern, however, was not the heroin talking, as addicts sometimes put it. Rather, it was the story of his life.
He had never known his father, who had not even achieved the status of myth in his mind. His father’s existence was more of a logical deduction, the product of the syllogism that runs: all humans have fathers, I am a human, therefore I have a father. To make up for it, he had known stepfathers aplenty, the last of whom was in a steady, though violent, relationship with his mother, a relationship that required the frequent intervention of the police to prevent its premature end through murder. He had left home when he was 16 because his stepfather had made it clear that he was de trop.
I asked the young man whether his mother had ever cooked for him.
“Not since my stepfather arrived. She would cook for him, like, but not for us children.”
I asked him what they—he and his brothers and sisters—had eaten and how they had eaten it.
“We’d just eat whatever there was,” he said. “We’d look for something whenever we was hungry.”
“And what was there?”
“Bread, cereals, chocolate—that kind of thing.”
“So you never sat round a table and ate a meal together?”
“No.”
In fact, he told me that he had never once eaten at a table with others in the last 15 years. Eating was for him a solitary vice, something done almost furtively, with no pleasure attached to it and certainly not as a social event. The street was his principal dining room, as well as his trash can: and as far as food was concerned, he was more a hunter-gatherer than a man living in a highly evolved society.
Far from being unique, his story was typical of those that I have heard hundreds—no, thousands—of times. Another young man, also expelled from home at an early age because his new stepfather, only a few years older than he, found him surplus to requirements, had been obliged to drift from friend’s house to friend’s house for six years. Unfitted by training or education for any particular job, he had worked only casually, for a few weeks at a time, and so never had the financial stability to pay rent on a place of his own (in conditions of shortage, public housing goes preferentially to young single women with children, and he had made the situation worse by having two children of his own by two young women). Needless to say, he had no domestic skills either, never having been taught any; and his friends, coming from the same social milieu, were just as undomesticated. They too ate in an unsocial fashion and expected him to fend nutritionally for himself, which he did by eating chocolate, the only food he could remember having eaten with any consistency over the last few years. Apart from his time in prison (for stealing from cars), he hadn’t eaten a meal in a decade. It can’t be long before someone suggests that the solution to a problem like this is to fortify chocolate with minerals and vitamins.
I meet at least one young man every week in the hospital with a similar story to relate. It is a story that angers and frustrates me. These young men’s malnutrition is the sign of an entire way of life, and not the result of raw, inescapable poverty. Another patient whom I saw soon after, similarly malnourished, told me that he ate practically nothing, subsisting on sugary soft drinks.
It never takes many links in a chain of reasoning to get from their smooth and raw magenta tongues to the kind of family breakdown favored by a certain ideology of human relations, encouraged by our laws and fiscal system, and made viable by welfare payments. It is the breakdown of the family structure—a breakdown so complete that mothers do not consider it part of their duty to feed their own children once they have reached the age at which they can forage for themselves in a refrigerator—that promotes modern malnutrition in Britain. Such malnutrition, according to the public health establishment, now affects millions of British households. And it is hardly surprising if young people who have not learned to socialize within the walls of their own homes, who have not learned even the minimal social disciplines required by people who eat together, should be completely antisocial in other respects.
One of the things British prisons could usefully do, therefore, but do not even attempt, is to teach young men how to eat in a social fashion. Instead, they reinforce the pattern of solipsistic consumption by making prisoners take their food back to their cells, where they eat it in the same solitary and furtive fashion as they masturbate.
As to whether the malnutrition consequent upon a profoundly asocial way of life itself contributes to antisocial behavior, by affecting the brain and hence the capacity of the malnourished person to make reasonable choices, only future research will prove. I personally do not find the idea inherently improbable.
The existence of malnutrition in the midst of plenty has not entirely escaped either the intelligentsia or the government, which of course is proposing measures to combat it: but, as usual, neither pols nor pundits wish to look the problem in the face or make the obvious connections. For them, the real and most pressing question raised by any social problem is: “How do I appear concerned and compassionate to all my friends, colleagues, and peers?” Needless to say, the first imperative is to avoid any hint of blaming the victim by examining the bad choices that he makes. It is not even permissible to look at the reasons for those choices, since by definition victims are victims and therefore not responsible for their acts, unlike the relatively small class of human beings who are not victims. One might extend La Rochefoucauld’s famous maxim that neither the sun nor death can be stared at for long, by saying that no member of the modern liberal intelligentsia can stare at a social problem for very long. He feels the need to retreat into impersonal abstractions, into structures or alleged structures over which the victim has no control. And out of this need to avoid the rawness of reality he spins utopian schemes of social engineering.
The British intelligentsia has thus come up with an abstraction that fits this particular bill perfectly—that is to say, the need to explain widespread malnutrition in the midst of plenty without resort to the conduct of the malnourished themselves: food deserts.
A food desert is a poor area of a town or city, in which there are few shops selling food, and in which those few offer a restricted range of unhealthy and unnourishing produce at relatively high prices. The huge supermarket chains, unwilling to carry out their social duty, have retreated to prosperous areas, where they can sell profitably to people who do not have to worry about what they spend on what they eat. Particularly lacking in a food desert are fresh comestibles: all food available is processed or precooked, full of salt and the worst kind of fat, and lacking in vital ingredients. The people who live in a food desert, therefore, have no choice but to eat unhealthily. Of course, the real—that is to say, ultimate—cause of food deserts is modern capitalism, the system that created and perpetuates the food deserts.
It has become a truth universally acknowledged that food deserts actually exist and must be the fault of the supermarket chains (and, by extension, the System). Indeed, the government, ever on the lookout for new areas of life to control with its dictatorial benevolence, has proposed a new law to eradicate what is now known as “food poverty” by irrigating these deserts with subsidies to food suppliers. As yet the additional provisions of the bill are not at all firm, except for the establishment of a Food Poverty Authority in every district, manned by bureaucrats, who will measure food poverty and count the miles people have to go to get fresh vegetables. One man’s poverty is another man’s employment opportunity: as long ago as the sixteenth century, a German bishop remarked that the poor are a gold mine.
Recently, at a lunch I attended, given by a left-wing magazine to which I sometimes contribute, the matter of food poverty and food deserts came up, and it was with some pride that I heard an area, not more than a mile from where I live, described as the very worst of these deserts, positively the Atacama of food.
As the only person present with personal knowledge—what Bertrand Russell used to call “knowledge by acquaintance”—of the area in question, I felt constrained to point out that I frequently shopped there, at a small Indian store in which one could buy, for example, 22-pound sacks of onions for about $3.40, and in which a huge variety of extremely fresh vegetables could be bought at prices less than half of those in the supermarket chains. Yet the only poor people who shopped there were Indian immigrants or their descendants—housewives who sifted through the produce looking carefully for the best. Practically no poor whites (or blacks) ever went there, though plenty of both live in the area. Only a few members of the white middle class from outside the area took advantage of the wide range and exceptionally low prices.
Moreover, unlike the people who spoke so fluently of the food deserts, I had, in the course of my medical duties, visited many homes in the area. The only homes in which there were ever any signs of genuine cookery and of eating as a social activity, where families discussed the topics of daily life and affirmed their bonds to one another, were those of the Indian immigrants. In white and black homes, cookery meant (at its best) re-heating in a microwave oven, and there was no table round which people could sit together to eat the re-heated food. Meals here were solitary, poor, nasty, British, and short.
The Indian immigrants and their descendants inherited a far better and more elaborate cuisine than the native British, of course, but this is not a sufficient explanation of their willingness still to buy fresh food and to cook it: they continue to cook because they still live in families, and cookery is a socially motivated art. Even among Indian heroin addicts (principally Muslim), the kind of malnutrition I have described is rare, because they do not yet live in the solipsistic isolation of their white counterparts, who live alone, even when there are other people inhabiting the house or apartment in which they themselves live. Drug addiction is thus a necessary condition for much of the malnutrition that I see, but not sufficient.
The owners of the shop only a mile from my door, serving poor Indian immigrants, are almost certainly millionaires: and the fact that their customers are poor has not prevented them from establishing a conspicuously flourishing business. If, however, you examined the convenience stores in predominantly white working-class areas (where the per-capita income is not lower), you would find a much reduced range of produce, very little of it fresh, and the great majority of it processed for ease of preparation. While the Indian store gives the impression of intense activity and hope, the convenience store in a white working-class area gives the impression of passivity and despair. If food deserts truly exist—and they cannot in these times of easy transport be very extensive—the explanation lies in demand, not in supply. And demand is a cultural phenomenon.
The connections I have drawn are obvious, yet denied—or rather avoided altogether—in the typical modern British approach to social problems. The article in the British Journal of Psychiatry at least refrains from trying to explain away the malnutrition of the young prisoners without reference to their choices, ideas, habits, way of life, and pattern of social and family relations. It is completely agnostic as to the source of, or reasons for, their dietary deficiencies. Nor does it attempt to disaggregate the results according to ethnic group: the numbers involved in the trial were probably too small for this to be feasible, even had the authors desired to do so.
The liberal intelligentsia has several reasons for failing to see or admit the cultural dimension of malnutrition in the midst of plenty—in failing to see its connection with an entire way of life—and in throwing the blame instead onto the supermarket chains. One reason is to avoid confronting the human consequences of the changes in morals, manners, and social policy that it has consistently advocated. The second is to avoid all appearance of blaming people whose lives are poor and unenviable. That this approach leads it to view those same people as helpless automata, in the grip of forces that they cannot influence, let alone control—and therefore as not full members of the human race—does not worry the intelligentsia in the least. On the contrary, it increases the importance of the elite’s own providential role in society. To blame the supermarket chains is implicitly to demand that the liberal and bureaucratic elite should have yet more control over society.
This is how the British government’s current Food Poverty Eradication Bill should be interpreted. By attempting to tackle the sources of supply rather than those of demand, it will sidestep the question of an entire way of life—a problem that it would take genuine moral courage to tackle—and aim at an easy target instead. The government will increase bureaucracy and regulation without reducing malnutrition.
This, in miniature, is the story of modern Britain.
Note: If heroin were decriminalized, does it remain clear that taking it would still have logically followed for this person?
Criminal penalties are so low in the UK that it might as well be decriminalized. Actually, anything that reduces the cost of taking heroin, whether financial costs or risk of incarceration, is bound to increase consumption.
What floors me about the libertarians who want to legalize harmful drugs is that they have far less interest in legalizing the kind of drugs that their own doctors might actually be willing to prescribe in order to prolong their lives and the lives of their loved ones. Read between the lines of this interview with one of the world's greatest physicians, and you will see how little connection the Phase I-II-III legal approval process has with the way real scientists would determine whether you should be given a drug:
Quiet Celebrity: Interview with Judah Folkman
When the government won't even let our doctors decide what cancer drugs we get, why would anyone consider it a priority item that the government won't let us have heroin?
I am at a loss to understand your comment- as I suspect Dr "Dalrymple" would be, as well.
(Assuming you aren't a heroin addict already) is the only thing keeping you from trying it the high price? Probably not, dealers often make the first dose to a new customer free. No, I suspect there are other reasons why you won't try it at all, even if it were less expensive. Same for many other people. As for control vs. availability, I have read reports that kids find pot and cocaine easier to come by than cigarettes and alcohol, even though the latter are sold in stores. Rather, because they are sold in stores. Dealers can't make money selling things people can mooch from their parents, so they don't even bother to sell them. But the illegal drugs, which are "harder" to find, make for a black market that enters school grounds.
When the government won't even let our doctors decide what cancer drugs we get, why would anyone consider it a priority item that the government won't let us have heroin?
Libertarians are opposed to the endless government regulations spawned by unconstitutional federal agencies such as the FDA; there would be no multi-year, multi million dollar federal drug approval process under a libertarian regime; people would be free to stick with tried and true medications, or they would knowingly participate in experimental trials, or they would knowingly take medications with known, disclosed side effects, or facing the possibility of unknown ones. (And, the drug companies would still be liable for fraud and for concealment of known damaging information, just as they are now.)
To answer the second part of your question, the reason getting rid of the drug war is such a priority is because of its expense, its spectacular failure even more blatant and outrageous than the way cancer drugs are denied, and because of the damage to fundamental rights in this country, including the First, Second, Fourth, Fifth, Sixth, Eighth, Ninth, and Tenth Amendments. That is a rather greater damage and therefore higher priority than the regulatory bungling of cancer drugs.
Thanks for the link to the story. There seems to be no end of ways in which the involvement of the government completely works against the perfectly fine and noble intentions that brought about government intervention in the first place. (When in fact there even are fine and noble intentions at issue.) But ironically, the person being interviewed says he wouldn't change anything.
Medical researchers face frequent charges of being unethical, especially now that every top research hospital has a staff of professional ethicists and lawyers whose job it is to tell them what they can't do. So they are under great pressure to not appear to be rebels, and to go along with the false idea that you can make great medical advances without taking great risks. Plus, in the current litigation environment, few drug testers would want to go to court without FDA cover. Close the FDA without MAJOR tort reform, and innovators will become even more timid. As a result of all this, the era of rapid and dramatic medical advances, the era which gave us tremendous breakthrough life-saving drugs like pennicillin, cortisone, and those which cured TB, has drawn to a close.
Sorry to be such a Christmas eve grouch, and off-topic to boot. Most people do not realize that is anything unnatural about the current rate of medical advance, so it is hard to find a place to discuss this problem.
The notion of repair is as old as failure, as old as society itself; myopic lamentations do little to mitigate the effect of a permanent lower class.
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