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on 19 September 2002
This book is a classic! It is beautifully written and engagingly argued. Dalrymple is a doctor in both a prison and a hospital in Birmingham, and he presents, with case after case after relentless case, the devastating evidence of what happens - especially to the poor - when individuals are separated from the immediate consequences of their actions, only to have those consequences bounce back later with even greater force. This is the effect of the no-blame, no-shame, value-free ideology propounded for more than a generation by our schools, media and criminal justice system. The effect is to trap the poor in poverty and illiteracy and fragmenting families - because they are told that nothing they do is their fault, but rather that of 'society' ... and in any case the state will always pick up the immediate task of mopping up. To subsidise fragmented families is to make them bearable and even desirable - so more families fragment. To ease up the pressure in schools on children to learn the basics is to make it easier for them to opt out of doing so - and so to ensure a generation of illiterates and innumerates who are trapped in poverty. To go easy on petty crime is to allow youthful aberrations to become settled patterns of behaviour, with consequences that ruin the lives of all of us, and especially of the poorest who cannot escape the criminalised environments in which they are forced to live. To call such laxity 'liberalism' is a travesty and an outrage, for it delivers the poorest and weakest into a tyranny.
Dalrymple himself has worked as a doctor in Tanzania and Nigeria, and has no illusions about the dreadful conditions obtaining in those countries. Yet he believes that, all things considered, the life of the British underclass is far worse, because so degraded and without dignity. His colleagues in Birmingham, doctors who have come to Britain from Third-World countries, agree. One Filipina doctor, knowing exactly whereof she speaks, expresses the view that life in a Manila slum is preferable to that of the nightmare which the British have made, and continue to make, for a large proportion of their population.
Dalrymple points out how we disguise the obvious from ourselves by slipping into passive verbs and bureaucrat-ese. Instead of 'I will do', we say that 'something needs to be done'. We duck responsibility for our actions - or inactions.
Even our illiberally-liberal elite, one might think, cannot refute the evidence, which Dalrymple presents here, of what their ideas mean for the poor in practice. So we can safely predict that Dalrymple's book will be studiously ignored by the organs of official culture or that, if they are forced to take notice, there will be cheap-shots against him personally. But this is a brilliant, brilliant book! Read it, and see clearly.
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on 17 November 2004
This is a fine book in which Theodore Dalrymple advances some common sense ideas about why the so-called "underclass" are the way they are. His time as a doctor in an inner city hospital has given him ample time to observe certain inalienable truths about the patterns of behaviour that lead to the chaotic and miserable lives lived by many in Britain today.

He argues that through a combination of bad parenting and poor education people are no longer taught to think for themselves and therefore have no comprehension of the ideas of personal responsibility, cause and effect or that their actions will have consequences. Sadly, through his daily interactions with the "underclass" Dr Dalrymple shows that many of those with whom he interacts tend to think things just happen to them rather than that, as is frequently the case, they are authors of their own misfortunes.

A damning indictment of 40 years of liberal-left social engineering that has led to this appalling state of affairs and betrayed a whole generation. Truly depressing reading.
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on 30 October 2012
These essays are well written, heartfelt and (above all) true. They should be required reading for academics, politicians and anyone else in a position to insulate himself from the harsher realities of life. This alone gives them value.
Like Dr. Dalrymple I have practiced medicine in some of Britain's less salubrious areas and I can confirm that his stories are by no means exaggerated. Similar tales could be told by any Doctor, Nurse, Policeman or Teacher who comes into regular contact with the most depressing ten percent of our population.
So far so unremarkable, six to seven million of our countrymen live extremely miserable lives: - Surely something must be done. This is where Dalrymple parts company from most of the well intentioned people who concern themselves with such matters. He ascribes the misery that is undoubtedly suffered by our poorest people not to poverty itself but to moral degeneracy and this in turn he ascribes to a trickledown effect from the moral relativism espoused by the middle class elite.
On the first point I am inclined to agree, it is not strictly necessary to take drugs, steal, beat your wife and desert your children the minute your income falls below five grand a year. It may well be true that living on seventy one pounds a week job seekers allowance does not encourage virtue but basically I agree that the underclass would be happier if they took some responsibility for their own, often reprehensible, behaviour. Personally, after 10 years working in a "gigantic slum", I was so completely dispirited by the passivity, irresponsibility and sheer hopelessness I saw all around me that I had to leave for the sake of my own sanity.
On the second point I part company from Dr. Dalrymple, his arguments here seem very simplistic; to the extent that I wonder if he really believes them himself. Whilst he has a lot to say about liberal immorality he is remarkably silent about the consumer culture, "greed is good" capitalism and corruption in high places. Presumably the underclass haven't noticed these phenomena. Dalrymple makes it abundantly clear that he disapproves of fundamentalism but isn't it true that those of us who are not fundamentalists are, at least to some extent, moral relativists? That is not to say we have no morals at all and I simply do not believe that my (relative) social liberalism has an adverse effect on the unemployed. Similarly I would describe myself as a supporter of multiculturalism, by this I mean that I think the country has been enriched, rather than the reverse, by immigration, it doesn't mean I'm in favour of forced marriages or female circumcision. To suggest I can't hold one belief without the other is simply ridiculous. Then we come to the difference between "high" and "low" culture. Dalrymple attributes some of the underclass' misery to their lack of exposure to the former. Again he has a point, Beethoven really is better than The Beatles and Keats really is better than the Dandy. Just who are all these "liberals" who believe any different? Strangely enough I don't seem to have met any of them just as I have never met a multicultuaralist who thinks chopping off little girls clitori with a bit of broken glass is a good idea. Maybe I have gone through life believing that I am a liberal when in fact I was a conservative all along and I just needed Dr Dalrymple to point this out to me.
When it comes to solutions to these problems I must admit that I haven't really got any and disappointingly Dalrymple hasn't either, at least none that he is prepared to state explicitly. It does however strike me that his strong implication is that if the government simply stopped interfering in the lives of the underclass things would improve automatically by a sort of free market magic.
Dalrymple bemoans the lack of historical knowledge he found amongst his erstwhile patients but it strikes me that the lot of our most "deprived" population hasn't actually changed all that much over the last century. Drunkenness, wife beating, child abuse and child neglect are sadly nothing new, neither are ignorance and philistinism and all of these things were to be found in abundance long before the welfare state. Stop the dole and people would have to take more responsibility for their actions; this might well be good for some of them. It would undoubtedly lead to the deaths of a lot more, many of them children. This seems a high price to pay to reduce the incidence of self tattooing.
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on 2 December 2004
The author as a doctor is a witness to prisoners and patients in a deprived area. A brilliant book, which describes how the underclass has absorbed the dogma from the liberal elite; you are not responsible for your actions, it's all the fault of society. He explains the pathology of this in a forthright, entertaining and often humourous way (taking issue with the reviewer- the tattoo comments were an example of this humour, and only the dimmest of readers could possibly think this was a serious comment- he goes on to explain an observed link by the percentage of prison inmates who are tattoed). It's uncomfortable reading for the left-wingers who think that by simply giving away money as a reward for irresponsible, bad, violent or selfish behaviour (the Welfare State) solves problems. Rather, it has led to a significant proportion of people who cannot accept that their actions are caused by their deliberate choice. An example he cites: 'Doctor, can you give me something to stop burgling houses?' The criminal cannot comprehend that his preference to robbing others rather than work is because of his greed and idleness; rather it is an illness which needs treatment by prescription drugs. A real eye-opener of how low this country has sunk.
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on 1 January 2005
This is the best book I have read in years. A comparison with Orwell's Road to Wigan Pier is unavoidable. Life at the Bottom like Orwell's book deals with the plight of the poorest and least fortunate members of our society. Both books are brilliantly written in concise elegant English that makes them an easy read. Where the books differ is in their analysis of what causes the under classes misery. Orwell blamed capitalism and thought the cure was socialism. Dalrymple successfully argues that it is the ideas of left wing intellectuals, like Orwell, that are in fact at the root of most of our current social problems. Surprisingly considering the grim nature of its subject the book contains a lot of humour . A fact lost on at least one reviewer who took the hilarious chapter on tattoos too literally.
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on 27 December 2005
Dr Dalrymple writes with forensic articulacy on the circumstances which have led to the creation, tolerance and encouragement of a large underclass in the UK.
One forms the opinion that he is actually very angry at the patients and prisoners that he has had to deal with, day and daily, and the knowledge that he has chosen to retire from the front line at 56 years of age would tend to confirm that he can no longer stand to be confronted with the people whose outlook and behaviour he so lucidly describes and utterly despises. His writing is undoubtedly the mechanism by which he vents his spleen at the individuals - and the system - which makes fools of all responsible citizens trying to practice and retain reasonable civilised values in the UK today.
This is a very, very uncomfortable book for anyone attempting to live by even a modicum of traditional values and social responsibilty. It demonstrates that not only are the barbarians at the gate but also that they are well and truly among us and that they are driving social, political and economic policy in 21st century Britain to the detriment of those whose values, historically, have been the foundation and backbone of this country.
The book shows that the genie is well and truly out of the bottle, almost certainly never to return, and that UK citizens who subscribe to and depend upon the societal values, norms, checks and balances of only a handful of decades ago would do well to consider emigration in the face of the rise and increasing prominence of the thug/gormless class who expect the world around them to mould itself to their view and ways rather than vice versa. The anecdotes recounted in this book are quite laughable in some respects but very unhappy and deadly serious in their consequences for all of us in others.
In the face of the apparently unrestrained (and now unrestrainable?) rise of this selfish, unthinking, atavistic class the outlook for civilised people - i.e. net contributors to society rather than drains upon it - in the UK is extremely bleak and Dr Dalrymple has chosen to emigrate to France, a nation not without considerable social problems of its own. That alone says it all.
This is a book that is admirable for its telling of the plain, unvarnished, non-PC truths underlying much of British society today but its brutal frankness will truly disturb most readers who consider themselves to be of a normal disposition and outlook. If you are such a reader prepare to be depressed by its lucid, but necessary, exposition of that which is all around us.
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on 11 June 2006
As a general practitioner in the English Midlands I have long been an admirer of this author who has been writing in the medical and national press for over 10 years.

His perception and analysis are exquisite.I see the same poverty of the spirit and medicalisation of dysfunctional and criminal behaviour every day in my own practice.This book comes as a welcome although lone voice of reason in countering the chorus of psychobabble emanating from so called experts in sociology,psychiatry and primary care medicine.

It should be required reading for every G.P and psychiatrist working in urban Britain.
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on 14 March 2013
The author spent most of the book telling us how dysfunctional certain sections of British society was. I have to agree with him but what I was waiting for was his thoughts as to what were the solutions. Maybe it was his intention to make the readers think for themselves and thus create their own possible solutions to dealing with the dysfunctional people he wrote about. I was somewhat disappointed.
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on 30 December 2004
Dr Dalrymple seems to have practised in the bits of our nation that very few of us want to look at let alone work in. To my mind the time he has served has given him the right to subject the underbelly of British society to a pretty trenchant analysis. Analyse it he has and the results are not pretty. I can only hope he is mistaken, but am pretty certain he is not.
The work as a whole is a cogent, incisive digestion of some of the most severe problems which affect those of us least able to cope with them and, despite avoiding the histrionics employed by those on the other side of the debate, still manages to vividly convey the fundamental inhumanity of the 'liberal/progressive agenda.'
If the author has a weakness it is that there is a strong vein of paternalistic arrogance in his worldview - he means well, that much is certain, but comes across as a rather irritating person which can make reading his work hard.
All in all this book left me with a deep sense of sadness for my country - not only because this state of affairs exists, but because there are no signs that anything will ever be done to stop it.
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I read this book the first time it was released and again on my phone. I find it dark, cynical, harsh, true, and often hilarious in equal measure. I have spent a lifetime working in the public sector and found myself nodding along in agreement to a lot if it. I have a little more sympathy though, as if you are born into it and it is all you know it would be hugely difficult to escape a life in the underclass. But much of it is sadly very true. A great read. Anyone working in the British public sector and having daily dealings with the underclass - now a recognised description by the way - would love this book.
JN - author of Kibbutz Virgin
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