Confessions of a prison psychiatrist
Dr Theodore Dalrymple worked at Birmingham prison in the 1990s. He looks at what has gone wrong
Two days after the shocking conditions in Birmingham prison were made public, and the Government took it back into public control from G4S, the private company running it, the headline of the French newspaper Le Figaro ran: “Escapes, assaults… the black summer of French prisons”, with an article detailing serial escapes, attacks on warders, suicides and “a penitentiary system at the end of its tether”.
But the fact things are just as bad, or perhaps even worse, elsewhere does not make things good at home. Last week’s scathing report by the Chief Inspector of Prisons, Peter Clarke, said HMP Birmingham was the worst he had ever inspected, with cockroaches, rats and an overwhelming smell of drugs.
All this suggests deficiencies not only in the prison, but in his own inspectorate – the large-scale riot in the prison in 2016 should have alerted them that close or special attention needed to be paid to it. Cockroaches, rats and large quantities of drugs do not appear overnight.
I arrived in Birmingham prison as a psychiatrist and medical officer in 1990. Integrated lavatories had been installed, putting an end to the antediluvian process of “slopping out”. I came to have a high regard for the officers. They were not highly educated, perhaps, but they were intelligent, shrewd and often kindly.
Given the choice between prison and psychiatric hospital, the prisoners would choose prison any day: “You’re not going to nut me off, are you?” they would ask with fear in their voice.
The morale and discipline of the officers were high. It was out of the question that they should cower in their offices for fear of the inmates, as reported last week. They were brave: I remember one officer who unhesitatingly risked his life to save a prisoner who had set fire to his cell, and another, in his early 60s, who was injured when he went to help break up a fight between rival gangs. He returned to work the next day: “I’ve only been injured three times in 30 years. I don’t call that bad, do you, doctor?” I admired his spirit.
Control of drugs into the prison was then relatively effective. Of course, in those days there were no drones and no synthetic cannabinoids, which make control such a nightmare, but neither was there a defeatist attitude to the problem, such as the inspector found. In 15 years, I did not see a single overdose of heroin or any other opiate, while in the hospital next door I saw scores of them. Perhaps this helped to explain why the death rate of prisoners was just over half that of the population from which they were drawn: a very sad commentary on our society, no doubt, but a fact that should put deaths in prison into some kind of perspective.
Even then, the struggle against drug smuggling into the prison was difficult, given the ingenuity with which it was attempted. Mothers would sometimes insert drugs into the rectums of their babies, to be removed during visits to their baby-fathers (to use the term in current use for male parenthood).
Tranquillisers, sleeping tablets and painkillers were currency in prison and it was essential to resist the demand for them except on strict grounds, because one demand only led to another, even more insistent. Sometimes a prisoner would blackmail the doctor by saying he would kill another prisoner or himself if he did not get what he asked for. It was nerve-racking to refuse – one could never be quite certain that he would not carry out his threat – but no patient ever did in my time. A vital factor in the successful management of any prison is the morale of the staff. If morale is low, the prisoners easily take over and it is abundantly obvious (as any prisoner will tell you) that the worst prisons, the ones most to be feared, are those in which the prisoners, not the officers, are in control: which, in effect, means the rule of psychopaths. The prisoners may pretend that they hate the officers, but they know that the officers are what stands between them and hell. The high morale had its darker side, as any desirable human phenomenon does. The officers were united in membership of the Prison Officers’ Association and as they worked in what the sociologist Erving Goffman called a “total institution”, they saw themselves as a band of brothers (and increasingly
sisters) in contradistinction to the rest of the world. This made investigation of any wrongdoing difficult, and when a prison officer was bad, he could be very bad. It was a fine job for sadists.
For example, a vital piece of resuscitation equipment would repeatedly go missing. Only an officer could have done it, which meant that he wanted attempts at resuscitation to fail. Another officer was suspected of cruelty, but no one would inform on him, prisoners or staff, though they did not approve of what he did. I went with him once into a cell in which a prisoner was having an epileptic fit and he said in a stentorian voice, “Don’t you do
that in front of the doctor!” If I hadn’t been there, I think he might have kicked him. Later, he was suspected of having infused bleach into the eye of a prisoner. He was later dismissed, but only on a relatively minor matter.
I was keen to stress that ascendancy over prisoners should be moral rather than physical, albeit that sufficient physical force had to be available.
It was important to be sympathetic to real suffering, but not so sentimental as to be easily manipulable. This was the counsel of perfection, no doubt, and it required sufficient staff to carry it out even partially. But it also required leadership and probity, and I had an instance of it in the last governor under whom I served. I had broken the prison rules by having photographs taken of the squalid cell of a prisoner, whom the NHS refused to treat for schizophrenia, which I threatened to send to the Home Secretary. Because of my threat, the NHS reluctantly agreed to treat him. The governor, who was due soon to retire, came to me afterwards and said “What you have done is completely against regulations. Well done!” We have all too few people of his calibre.
A situation such as the one that developed at Birmingham is almost always the result of multiple failures, but especially that of leadership, which itself is all too common in modern administration. But given we have by far the highest rate of violent crime in western Europe, it should not be allowed to distract us from the long-term failure, lasting more than half a century, of the British state to perform one of its primary functions – the keeping of the peace.
Dr Theodore Dalrymple was a prison psychiatrist in Birmingham and Dalston and is author of The Knife Went In: A Prison Doctor on Britain’s Dark Side (£9.99 at books.telegraph.co.uk or 0844 871 1514)