Your duty to write your story

Whenever I get a chance I tell people to write down their story before they die. I’m boring about it, and most people think that I’m encouraging self-indulgence. “Why would anybody be interested in my story?” The whole world, I answer, may not be, although you could be surprised, but your children, grandchildren, and later descendants will at some stage in their lives be fascinated, no matter how badly written the story might be.

I know this because my most treasured possession is my father’s memoirs, as he jokingly called them. Syd left school at 15, was “no intellectual” (as he boasted), and had hardly ever written anything. But when he retired I urged him to write his story, and he did–by hand, a few pages a day in a school exercise book. Subsequently James, my son, typed it out, a precious intergenerational connection in itself.

It’s about 40 000 words long, which is the perfect length, and reads beautifully. He wrote unselfconsciously, and the story has his voice–funny, sympathetic, direct, and non-judgemental. I used to think that it was written in a childlike way–“X did this, Y did that, page after page”–but rereading it to my demented mother I realise that it’s lyrical if not complex.

The memoir is publishable because of the interesting experiences my father had. Called up during the war, he sailed by Liberty Ship round the Cape to Egypt and fought at the battle of El Alamein. He describes walking forwards through the desert with his bayonet drawn. Mortality in that battle was 50% among the advancing infantry. He was captured during the battle and worked down the copper mines in Italy, where starving he weighed some six stone on his 21st birthday (he was just under six feet tall). Transferred to Colditz he writes of the prominente based there and describes the uncertainty as the Americans advanced on one side and the Russians on the other.

My father was enormously attractive to women, and his relationships with women, including my mother, are prominent in the memoir. While on leave from the army in a grand hotel on the Lido of Venice he looked from his window and saw a woman sunbathing in a white bikini. He spent a week with that woman in her flat in Venice, and when at the end he offered her money she refused.

Before the war he describes as a teenager meeting a man in rural Kent who asked Syd to beat him. He began gently, but as the man shouted for him to beat him harder he grew angry and thrashed him–just presumably what the man wanted.

I have his memoirs as a Word file and have shared them with many people, including a 15-year-old Chinese girl fascinated by the Second World War. I think that Syd, who died in 2004, would have been astonished to think that a Chinese teenager would read what he had written.

I realise that this account of my father’s memoir is working against my main objective–of encouraging everybody to write down their story. Few people experience the dramas my father experienced, but no matter how dull your life it will be of interest to your descendants–and you might discover that you have a talent that can make the dullest life fascinating; ultimately no life is dull.

Think how much you would like to know more about your ancestors, and how much do you know? I know something about my grandparents, but relatively little, and I know almost nothing about my great grandparents; and before that nothing. We disappear quickly without trace.

As we never know when one of death’s thousand doors may open for us, I urge you to start writing your story today. My bet is that once you get started you will enjoy the process–and you will rediscover things about yourself that you have forgotten. You as well as your descendants will benefit.

Syd photo

A committee tries to decide which of its members are demented

Other people’s dreams are usually boring, and even your own dreams are boring–lacking narrative structure and only partially remembered. My dreams, often inspired by red wine, tend to fade fast, but I’ve just remembered something of last night’s dream in which a committee I was chairing had to decide which of its members was demented.

It was a chaotic committee of about 15 people. We weren’t seated around a table but were a disorganised group; although chairing I had to look over the shoulders of some members. I think that we had an expert describing to us how we could recognise dementia. I tried to ensure then that every member of the committee had a chance to speak. The implication was that some of the committee were demented, and I–and maybe the whole committee–hoped that these people would recognise their dementia and step down. That didn’t happen. I felt the need to sum up, and lamely I said “We will all reflect on what we have learnt today and draw our own conclusions.”

One scene I remember clearly was a female member of the committee saying “You chaired that very well.” In my dream, I thought that I didn’t chair it at all well, and I wondered what she might want from me.

I can see easily where this dream comes from. I chair two boards and a collection of continuing workshops, and I’ve chaired many groups and meetings in the past. All groups are dysfunctional to some degree–with people not understanding each other, not saying what they really think, pursuing their own hidden agendas, paying off scores, buttering up others, and even trying to undermine the work of the committee–but some that I’ve chaired have reached high levels of dysfunction.

And dementia is in my mind much of the time not only because of my mother and the rising prevalence of dementia but also because I’m constantly searching for signs of it in myself–and detecting them.

I’ve chaired some committees where some people did seem demented, or at least wholly lacking in insight, and I can imagine a committee trying to find a way to remove kindly demented members. I hope that when it happens I manage it better than in my dream.


Disappointed by the Hokusai exhibition: close examination of a book would be better

The Hokusai exhibition at the British Museum was too crowded to be enjoyable. It was a dramatic contrast to the last exhibition I visited at the British Museum–on modern American prints–which I thought just about the best designed exhibition I’d ever been too.

I appreciate the dilemma of the museum. They want to let as many people as possible see the exhibition, and they need the money. So the temptation is to let as many people as possible into the exhibition, but the result is a miserable experience for everybody: queueing to glimpse a picture; too far away from the captions to be able to read them, and feeling uncomfortable about taking any time because of obliging others to wait.

Many of the pictures were small, and I wondered, ironically, whether much was gained beyond looking at them in a book–because they were almost all flat, you couldn’t see the texture of the paint. Indeed, sitting quietly and slowly examining a book of high-quality reproductions and being able to follow his story, philosophy, and development would have been a superior experience. Little seemed to be gained by being in contact with originals and much was lost because of the crowds. I reflected too that on a rainy morning in February I could go up to the room of Japanese prints and study pictures by Hokusai without anybody else being there at all. I must do that.

Some of the failure was my fault, I must confess. I went on the last day and missed all the opportunities for members only to visit the exhibition.

And I did see some pictures I appreciated and learnt something bout Hokusai, not least that he went under five different names. He lived into his 90th year and was convinced that he became a better artist with every year he aged. He worked until the very end of his life and seemed to think that if he could make it to a hundred he would lean much that was hidden and achieve a kind of immortality. Mount Fuji symbolised that immortality.

But sadly I couldn’t enter the mind and world of the artist in the way that the best exhibitions allow you to do. Thumbs down, British Museum.



What are prisons for?

In 1983 as part of a series and subsequent book on prison health care I wrote an article asking “What are prisons for?” I heard the same question discussed on the BBC this morning after yet another damning report on the state of prisons, and it was debated two weeks ago. The only possible conclusion is that there is no agreement on the answer–and perhaps never will be. Yet without agreement on the answer policies will continue to vary wildly and failure will continue.

My article is long but seems to be as relevant today as it was 34 years ago. So here’s a summary of possible answers:

  1. “Serving the courts” is the standard answer but is really just a way of avoiding an answer.
  2. Punishment–yes but “as punishment not for punishment.” Deprivation of liberty is the punishment not having to endure awful conditions.
  3. Keeping dangerous people out of the way–yes, but very few prisoners are very dangerous
  4. Deterrence–largely ineffective
  5. Training and treatment–needs resources, which are often not available; “treatment” of criminals doesn’t work, and the sick oughtn’t be in prison, although many are
  6. Rehabilitation–about a half to two thirds of prisoner reoffend. Only with the greatest effort and investment can reconviction rates be reduced, and prison is by definition a bad place to rehabilitate people to the world outside prisons. Better to recognise that prisons are inevitably bad and do everything possible to keep people out of prison.
  7. As sumps–prisons are composed of the sad, the mad, and the bad. The vast majority are sad and mad. Acting as a sump is the most real of the functions of prisons.



Theories as to what prisons should be for have been through

some dramatic changes in the past 20 years, and these changes

have affected prison doctors as much as any other prison

workers. In the 1960s, particularly in the United States, the

idea that the main function of prisons was to treat, reform, and

rehabilitate the prisoner reached its zenith. Many prisoners

were given an indeterminate sentence on the understanding

that they would be released when “cured.” But research showed

that these treatment regimens in terms of reconviction rates

(which have always, and perhaps wrongly, been the “gold

standard” in penal studies) were no more successful than any

other regimen, and confidence in the ability of prison to reform

dwindled and for many disappeared. Now the prevailing

fashion in criminological circles, if not in the prisons themselves,

is to see prison as inevitably a bad place and to encourage

the courts to keep people out of them as much as possible.

But some agreement must be reached on the purpose of

imprisonment before those running the prisons and those

working in them can plan effectively, and all the British systems

at the moment seem vague about what exactly they are trying

to achieve. The May committee, which was set up by the Home

Secretary in November 1978 in response to deteriorating industrial

relations in the prison service, did discuss the purpose

of imprisonment.’ But it was rushed in its deliberations, and

wasn’t specifically asked to consider such broad issues. It thought,

however, that it could not ignore them and cobbled together a

few thoughts which I will discuss in detail later but which seem

contradictory. Its conclusions, which have been strongly

criticised,2 leave an impression that like so many royal commissions

and committees of inquiry it was trying to say something

to please all parties and nothing to upset anybody too



Serving the courts


The stock answer to the question of what prisons are for is

that they are there to serve the courts. The prisons receive

sentenced prisoners, hold remand prisoners and prepare

reports on them, and provide staff to see prisoners to and from

the courts. But to say that the prisons are there simply to

serve the courts is in many ways just to restate the question in

a different form-for it begs the question of what the courts

see as the function of imprisonment. The stock answer does,

however, introduce the important constitutional point that the

executive which runs the prisons should not theoretically

influence the courts. Neither the prison governor nor the

bureaucrats in the prison department can ring up the local

magistrate or judge and say, “Don’t send anybody else to

prison today or this week because we’re full.” Constitutional

purists, who rate highly the principle of keeping the government,

the judiciary, and the executive as wide apart as possible, thus

tend to respond to the problem of prison overcrowding by

simply saying that more prisons must be built. If the courts

want to send 88 110 people to prison for an average of 613 days

(excluding life sentences) as they did in 1981, then it is up to

the prison department to accommodate them, not to tell the

courts that they are sending too many people to prison for too

long. But it does seem to be acceptable for the Home Secretary

to insist, as he did at the Conservative Party conference,’ that

some prisoners receive sentences of at least 20 years.

Some groups, including the Parliamentary All Party Penal

Affairs Group, think differently, and see it as mandatory that

the government introduce legislation to restrict courts’ sentencing

power.4 I will return to this point in my next article when

I discuss the problem of overcrowding, but it is worth pointing

out that the courts do not live in a complete fairy land and do

take some notice of what is possible and what is not in disposing

of prisoners. Thus they are willing to accept that places cannot

be found, for whatever reason, in National Health Service

hospitals for prisoners they have decided should be in hospital

and are content to leave them to languish in prison. The

Parliamentary All Party Penal Affairs Group is also unhappy

with this and has called on the Department of Health and Social

Security to accept its responsibility for mentally disordered

offenders.4 5




One obvious function of imprisonment is punishment, but it

has been accepted by the prison authorities since the report of

the Gladstone committee,6 which concluded in effect-though

the famous words come from a few years later 7-that prisoners

are sent to prison as punishment not for punishment. Mr

Leon Brittan confirmed this in his recent speech at the Conservative

Party conference.8 Deprivation of liberty is the

punishment, and prisoners should not be forced to live in

appalling conditions or suffer all sorts of other deprivations.

But although the authorities have accepted the Gladstone

committee’s principle since 1895 the reality has been rather

different. Because all prisoners do suffer extra deprivations.

Their mail is censored; visits are limited and conjugal visits

forbidden; telephone calls are not allowed; they cannot choose

their doctors; and they must do certain, often dreary, jobs.

They also have limited rights when they are tried by prison

committees for offences committed while in prison. In addition,

most British prisoners live in cells without sanitation, often

with two or three other occupants. That convicted prisoners

should enjoy better conditions than those living outside would

be unfair (and whenever there is any suggestion of it happening

the popular press becomes suitably strident), but that they

should suffer so many other deprivations apart from loss of

their liberty does not seem to accord with the widely accepted

statement of the Gladstone committee. The poor conditions

continue not only through historical inertia but also because it

would be politically and economically difficult for any government

to do much at the moment to improve them. Furthermore,

some of the conditions are justified in the name of some of the

prison’s other functions-namely, deterrence and security. But,

at the same time, they make more difficult another aim of the

prison service-reform and rehabilitation. Making people live

in conditions very different from those prevailing in the outside

world. is a poor start for trying to rehabilitate them for life in

that world. As Alexander Paterson, a famous and influential

prison commissioner, put it in a second important aphorism:

“It is impossible to train men for freedom in a condition of

captivity.”9 This paradox of Paterson’s still traps all prison

staff, and not least the prison doctors.


Keeping dangerous men out of the way


That prison should keep dangerous men out of the way

seems to be agreed by almost all factions. Despite the title of

its magazine, the Abolitionist, even Radical Alternatives to

Prison doesn’t push too hard the idea that prisons could be done

away with completely. And certainly, Geoff Coggan, of PROP,

the National Prisoners’ Movement, accepted when I spoke to

him that there were some people who were so dangerous to

society that they needed to be kept apart in secure conditions.

But one immediate objection against seeing this as a prime

aim for the British prison system is that only a small percentage

of those in prison can with any confidence be called dangerous.

Fine defaulters, habitual drunken offenders, and mentally

disordered offenders account for a quarter of all receptions

into prison, although because their stay is usually short they

constitute a smaller proportion of the daily population.’1

Tables I and II give an indication of the kinds of crimes that

prisoners have committed. These figures come from a survey

of a sample of the prison population of the south east region on

2 February 1972.11 (The figures were not published until 1978

and constitute the most up to date figures that are freely available.

This is a good example of the paucity of good information

available on prisons and prisoners.)


TABLE I-Property crimes committed by a sample of 771 prisoners

Crime Number (Pecentage)

None 40 (5)

Trivial, little or no gain 126 (16)

Slightly more serious, little or no gain 218 (28)

Property crime on modest scale 246 (32)

Much gained through careful planning 93 (12)

Spectacular crime, large gain 48 (6)


TABLE II-Crimes against the person committed by a sample of 771 prisoners

Crime No (Percentage)

None 345 (45)

Technical assaults or minor sexual crimes .42 (5)

Distress caused but no major injurv .80 (10)

Serious sexual offences or assaults needing medical attention. . 142 (19)

Intentional attacks, menacing threats, or serious sexual assaults on

adults or older children 140 (18)

Vicious intent resulting in serious injury or death, serious sexual

assaults .23 (3)


Dr Charlotte Banks and others, the authors of the report,

put the figures together and produced six categories of crime

ranging from petty offences to serious offences against property

and persons (table III). If we consider as dangerous those

prisoners who have committed serious offences against persons

then we arrive at a figure of 21 o of the population. But this

must be a maximum figure, as many of those committed even

of murder cannot be considered dangerous. Most people who

are murdered are, as we know, murdered by somebody they

know well in the heat of the moment. Many of these assailants

are very unlikely to kill again.


TABLE III-Overall categorisation of 771 offenders

Category No ( Percentage))

Petty offenders 100 (13)

Minor offenders 127 (17)

Average offenders 272 (35)

Serious offenders against property 109 (14)

Serious offenders against persons 131 (17)

Serious offenders against property and persons 32 (4)


Dr Dorothy Speed, a prison doctor who has been in the

service for many years, estimates that only some 4000 of the

present population need to be in prison because they are

dangerous. She added to the traditional division of prisoners

into “mad and bad” those that were “sad,” and she thinks that

the sad constitute the majority. Few prison doctors seem to

regard many of the prisoners with whom they work as dangerous,

although they point out that a man who is quite safe within the

rigid confines of the prison system may behave quite differently

in the wide world. Many psychopaths exist quite happily in

prison just as they do in other institutions.

The other problem with regarding the containment of dangerous

men as being the prime aim of prisons is that it leads to

everything being made subservient to security. Within prisons

security is the all purpose excuse just as time is in the outside

world. The public is rightly concerned that dangerous men

should not escape, and the Mountbatten report,’2 which was

published in 1966, was produced in response to a spate of

escapes by top security prisoners in the early 1960s. It was this

report that led to the dispersal system, whereby category A

prisoners are spread around a number of top security prisons.

Several groups, including the Prison Officers Association, would,

however, prefer a single impregnable “fortress prison.”‘3

Many critics of the prison system and many people working

within it think that the Mountbatten report led to an obsession

with security.” Too many prisoners, they say, are held within

unnecessarily secure and therefore restrictive conditions, and the

obsession inhibits work, education, and even health needs.

What I mean by inhibition of health needs is not that category A

prisoners are unable to have the physical treatment that they

need, but more that the activities of special units like Grendon

Underwood psychiatric prison and the Wormwood Scrubs

annexe (both of which I will discuss in later articles) are curtailed

in the name of security.




Even if prisons cannot manage to reform felons into law

abiding citizens, many members of the public would like to

think that prisons would deter them from offending again.

Many people would like to see prisons made even more unpleasant

than they are now. In the last century this sort of

philosophy led to the treadmill, but apart from objections to the

barbarity of such systems they do not seem to work anyway.’4

Harsh regimens have not in the past led to reduced reconviction

rates, and they may lead to a hardening of attitudes on both sides

of the cell door. Jimmy Boyle in his moving and disturbing

book, A Sense of Freedom,15 makes it quite clear that for him the

only legitimate response to a violent system was violence. Many

people believe that far from deterring prisoners from reoffending

the prisons, and particularly the borstals and detention centres,

serve as “schools for recidivists.”

But even if they fail to deter those inside them, prisons may

succeed in deterring those of us on the outside. This idea, and

a much more sophisticated variant of it, has been peddled by

the French structuralist philosopher, Michel Foucault.’6 For

him prisons-along with hospitals, schools, barracks, and

factories-are there “to exercise a power of normalisation.”

Prisons are not marginal institutions concerned with only a

tiny proportion of the population; they are at the centre of our

society and have developed techniques which have been taken

up by other institutions. Foucault makes his case in a powerful

but difficult book, Discipline and Punish,’6 and includes a

purple quote from a French magazine, La Phalange, published

in 1836 (see box).

This is maybe a little fanciful for the BMJ, but I include it

because although Foucault’s thinking is not clear and easy to

follow it seems to me to contain many seeds of truth and to

point towards associations that we as doctors are not keen to

see. But apart from Foucault’s philosophy, there is much more

concrete evidence of the inability of prison and harsh punishments

to deter crime. For example, a study of the effect of a

16 year old boy being given a 20 year sentence for mugging did

not show any evidence of a fall off in the crime in six urban

areas immediately after the conviction.’7




“Moralists, philosophers, legislators, flatterers of civilization,

this is the plan of your Paris, neatly ordered and arranged,

here is the improved plan in which all like things are

gathered together. At the centre, and within a first enclosure:

hospitals for all diseases, almshouses for all types of poverty,

madhouses, prisons, convict-prisons for men, women and

children. Around the first enclosure, barracks, courtrooms,

police stations, houses for prison warders, scaffolds, houses

for the executioner and his assistants. At the four corners,

the Chamber of Deputies, the Chamber of Peers, the

Institute and the Royal Palace. Outside, there are the

various services that supply the central enclosure, commerce,

with its swindlers and its bankruptcies; industry and its

furious struggles; the press, with its sophisms; the gambling

dens; prostitution, the people dying of hunger or wallowing

in debauchery, always ready to lend an ear to the voice of

the Genius of Revolutions; the heartless rich. . . . Lastly

the ruthless war of all against all.”



Treatment and training


Rule One of the Prison Rules for England and Wales states:

“The purpose of the training and treatment of convicted

prisoners shall be to encourage and assist them to lead a good

and useful life.” The idea that British prisons should aim to

reform and rehabilitate prisoners originates in the report of the

Gladstone committee in 1895. It was a reaction to the treadmill

philosophy of the earlier part of the century, which had failed.

The idea has put down a deep root in the British prison system,

and only in the past few years have prison reformers become

interested in pulling up that root.

The idea that prison could reform had its heyday in the ‘sixties

and early ‘seventies-at the same time as other optimistic

philosophies. A White Paper of 1959, Penal Practice in a

Changing Society, stated that: “The constructive function of our

prisons is to prevent the largest number of those committed to

their care from offending again.” This was to be done “through

more precise methods of classification and continual search for

improved techniques . . . (and) by more personal training.”‘8

The paper also stated that work would begin soon on a psy-

chiatric prison hospital and recommended that psychiatric

services should be available in all the larger prisons. “The value

of psychiatry,” it said, “is not limited to the treatment of those

abnormal states of mind which require the kind of psychotherapy

that will be given in the new establishment. A psychiatrically

experienced doctor can do much to help disturbed prisoners

not only to adjust themselves to prison life but also to change

their general attitudes so that they make a better adjustment in

society after release.” The authors of the paper imagined that

the psychotic would be swept out of prison and into the National

Health Service hospitals under section 72 of the new Mental

Health Act; the new psychiatric prison hospital, Grendon

Underwood, would “explore the problem of dealing with the

psychopath”; and the psychiatrists in the main prisons, some

employed full time by the Home Office and some working part

time in the NHS, would help the ordinary prisoners towards a

better life. Other groups in the prisons would reform with

similar zeal.

In 1971 Lady Megan Bull was promoted to be governor of

Holloway through a similar belief in the power of medicine and

psychiatry to sort out problems of prisoners, and particularly

of women prisoners. She had been in the prison service for only

four years (enjoying incidentally, she says, the best years of her

professional life) and had spent all that time as a prison doctor

in Holloway. She wasn’t well qualified for the job of governor

and didn’t apply for the job. But so strong was the belief that

women prisoners’ problems could best be managed on medical

lines that she was pressurised into taking it on. As it turned out,

she felt that her medical training was of little use in her 11 years

as governor-for those were the years in which belief in the

power of prisons to treat, train, and reform died. The belief

died all over the world in the face of abundant evidence that

treatment and training could not reduce reconviction rates.”

In all systems about half to two thirds of prisoners reoffend.

Table IV gives the depressing reconviction figures for various

categories of offenders from the annual report for 1982 of the

prison department.

Reconviction rates, just like death rates, are a blunt measure,

but they are rightly given considerable importance when

prisons claim to reform. But, undoubtedly, even if few prisoners

come out of prison better men than when they went in, many

come out in better physical and mental health. Professor Gunn

and others’ study of prisoners in Grendon Underwood show

that the mental health of some prisoners can improve while in



The May committee


AlthouLgh belief in the ability of prisons to reform is dead

among researchers and academics, and never existed at all

among many of those wvorking in prisons, it lives on at least in

the minds of those who sat on the May committee. It continues

too in the minds of some ex-prisoners. Jimmy Boyle, for

instance, refuses to accept the pile of depressing evidence that

progressive regimens cannot reduce reconviction rates. He says

that there has never been an experiment conducted with sufficient

commitment. TIhe researchers may design new regimens,

but it is prison officers and prisoners w ho must work within

them, and both of these groLups are steeped in prison culture that

allows no individual responsibility. Jimmy Boyle in his 15 years

inside slaw many orisoners come and go, and never, he says, did

prison officers challenge the prisoners when they returned as to

why they had failed to build a life outside the prison: most

prison officers and prisoners simply accept it as inevitable that

many prisoners will be coming in and out of prison regularly.

Jimmy Boyle also had experience of the Barlinnie Special Unit,

which is one of the few schemes in any British prison where

prisoners are expected to be responsible for their own actionsand

those of each other. I will discuss the Barlinnie Special

Unit in a future article, buLt enough to say for now that there are

a few half developed studies that suggest that giving prisoners

much more responsibility might lower reconviction rates.

Obviously those who foot the bills for the increasingly

expensive prison system and those who spend their lives working

within it would like to believe that prisons can reform. The May

committee recognised this need and so was led to some curious

circular thinking. It recognised that “the rhetoric of ‘treatment

and training’ has had its day,” but then said that “the rhetoric

alone should be changed and not all the admirable and constructive

things that are done in its name.” It recommended

that “if Rule One is to continue” it should be rewritten: the

committee wanted the philosophy of “treatment and training”

replaced with a philosophy of “positive custody.” The difference

between “treatment and training” and “positive custody”

seems to me purely semantic, but another similar sounding

euphemism, “humane containment,” does offer a genuine

alternative. It is the philosophy of the moment. One of its main

architects was Professor Norval Miorris,22 a Chicago academic,

and it is advocated most forcefully in Britain by Roy King and

Rod Morgan.2

They argue that those who run the prison system should

recognise its limitations and so avoid committing too many

resources to prisons or keeping people in prison for a long time

in the mistaken belief that it will make them less likely to

reoffend. Humane containment is based on three principles:

minimum use of custody; minimum use of security; and

normalisation of the prison. It has great advantage over the

nebulous philosophy of “positive custody” of having been tried

out in a scientific study. In Butner Federal Correctional Institute

in North Carolina a controlled trial has been underway

for several years to test the philosophy of humane containment.

I have visited Butner and will describe the study and the

prison in greater detail in a future article, but it is proving a

success in making prisons less dangerous but not in lowering

reconviction rates.’3

The May committee were unhappy with humane containment

because it suffered from the fatal defect of being “a means

without an end.” It would make “prisons into human warehouses-

for both inmates and staff” and leave prison staff “in

a moral vacuum” that “can in the end lead only to the routine

brutalisation of all the participants.” Al(hough it used such

strong terms in damning human containment, the differences

between the committee and King and Morgan are not so

extreme: much of the debate is just the semanticism it seems

to an outsider. Both parties would like to see fewer people in

prison, and neither wants low security risk prisoners to be kept

in unnecessarily secure conditions.

The diffcrences come about because the committee seemed

to imagine that King and Morgan wanted to do away with work,

education, some caring services, and other activities that go on

under the title of “treatment and training.” But this is not so.

King and Morgan don’t want these activities stopped; they

just want their objectives to be reconsidered and for them to be

reorganised. In terms of medical services this might mean an

end to elaborate attempts to help prisoners reform with psychiatric

techniques (not that much, if any, of this goes on

anyw,ay). The mentally ill would be taken out of the prisons,

and, in the name of normalising the prison, ordinary general

practitioner care would be provided by local doctors rather

than by prison doctors. These are ends that have been argued

for by several doctors, including some prison doctors.


Prison as a sump


Before finishing, I must point out that one of the real functions

of British prisons, although it doesn’t feature in anybody’s

ideal plans, is to serve as a refuge for all sorts of inadequate and

desperate people. Since the emptying out of the asylums and the

closure of many hostels and reception centres more and more

mentally ill, alcohol and opiate addicted, homeless, and mentally

subnormal people have drifted into prisons. Most pass through

only briefly, but they present great problems to prison authorities

and officers and particularly to prison doctors. At Brixton

prison, for instance, which is the remand prison for London,

some 77 000 prisoners come through the gates each year, and

many of these are inadequate and desperate. The prison

doctors have great difficulty sorting out the new prisoners,

many of whom are in a dreadful state and uncooperative, and it

is no surprise that Brixton has the highest suicide rate in the

country. Three prisoners killed themselves in Brixton in 1981.

Everybody is agreed that prison is not the right place for these

people, but there is an appalling lack of political will to find a

better way of dealing with them.




In the last analysis no neat answer can be found to the

question “What are prisons for ?” They serve many functions;

the functions change with time; and in a complicated society

such as Britain different parts of the population have different

ideas as to what prisons are for. But I can conclude that we do

need prisons; that keeping dangerous people securely locked

away is one essential function; and that the idea that prison can

reform has had its day. Accepting the last conclusion means to

me that we should follow much of the thinking of King and

Morgan and use prison as little as possible and make prison as

much like the outside world as is compatible wTith security.




1 Committee of Inquiry into the United Kingdom IPrison Services. Report.

London: HMSO, 1979. (Cmnd 7673.) (May report.)

2 King RD, Morgan R, Martin JP, Thomas JE. 7lhe futmre olf the pri’soni

system. Westmead, Hants: Gower, 1980.

Aitken I. Brittan’s tough line on ‘lifers” quells protests. (JGardian 1983

Oct 12:1.

Parliamentary All Party Penal Affairs Group. Too mianyi pri.soners. London:

Barry Rose Ltd, 1980.

Parliamentary All Party Penal Affairs Group. Still too mnanly prisoners.

London: Parliamentary All Partv IPenal Affairs Group, 1981.

6 Departmental Committee on IPrisons. Report. London: HMSO, 1895.

(Cmnd 7702.) (Gladstone report.)

7 Ruck SK, ed. Paterson o?n pr’is.ons. London: Muller, 1951.

Anonymous. Mr Brittan offers one sop too many. Gutardian 1983

Oct 12:12.

Prison Commission. Principles of the bor-stail s st}ni. Privately printed and

circulated, 1932.

Dean NA. Gaol measures “,iII relieve overcrowding. Guardian 1983

Oct 12:1.

Anonvmous. A survey of the south east prison population. In: Snow R,

  1. Homne Office Research Unit Buiilletint 1978 :5:12-24.

” Committee of Inquiry into Prison Escapes and Securitv. Report. London:

HMSO, 1966. (Cmnd 3175.) (Mounthatten report.)

Fitzgerald M, Sim J. British prisons. Oxford: Blackwell, 1982.

V’right MN. Mltakinlg good: pri-‘sons, anrd beyonid. I ondon:

Burnett Books, 1982.

Bovle J. A sense of freedomii. Iondon: Pan, 1977.

16 Foucault MN. Discipline and pnm7lish. London: Allen Lane, 1977.

Baxter R, Nuttall C. Severe sentences: no deterrent to crime ? Newv

Society 1975 Jan 2:11-3.

Home Office. Penal practice i.n a changing society. London: HMSO,

  1. (Cmnd 645.)

Brodv SR. The effectiveness of senitetncling. Home Office Research Study

No 35. London: HMSO, 1976.

2″ Home Office. Prison statistics: England and Wales 1982. London: HMSO,


21 Gunn J, Robertson G, Dell S, Way C. Psychiatric aspects of im.n1prisonnient.

London: Academic Press, 1978.

22 Morris N. The future of imiprisonmient. Chicago: University of Chicago

IPress, 1974.

2:1 Love CTF, Ingram GL. Prison disturbances: suggestions for future

solutions. Nezw England 7ournal on Prison Lan 1982;8:393-426.


Vector illustration of a man lock up in prison



Quotes from Les Misérables VII: books, those undemanding but faithful friends

He loved books, those undemanding but faithful friends.

‘My friends, remember this, there are no bad plants or bad men. There is only bad husbandry.’

It is our belief that if the soul were visible to the eye every member of the human species would be seen to correspond to some species of the animal world and a truth scarcely perceived by thinkers would be readily confirmed, namely, that from the oyster to the eagle, from the swine to the tiger, all animals are to be found in men and each of them exists in some man, sometimes several at a time.

Dry, withered, acid, thorny, malicious, and venomous, she….

Do what we may to shape the mysterious stuff of which our lives are composed, the dark threads of our destiny will always re-emerge.

God knows, it’s easy to be kind; the hard thing is to be just.

Easter Island teaches us a terrible lesson

While on a delightful holiday in rural France I dreamt about the lesson that Easter Island teaches us that our urge to buy, consume, build, and worship will destroy us. I dug out my blog from 2011 on the boom from which I learnt the story of Easter Island.


What contrary creatures we humans are. I begin the year convinced that our civilisation will collapse soon but at the same time enjoying the continuous Mozart on Radio 3, abandoning alcohol for the month with enthusiasm, and committing myself to three runs and 70 000 steps a week. As my wife, who also thinks that our civilisation is approaching its end, says: “Nothing matters, but everything matters.” I didn’t know I’d married a mystic.

I’m convinced of the imminent end of our civilisation because of the best book I’ve read in 20 years, A Short History of Progress by Ronald Wright. The book is pithy, witty, erudite, highly readable, full of marvellous quotes, and ultimately devastating.

Wright, a Cambridge trained archaeologist turned essayist and novelist, sets out to answer Gauguin’s three questions asked in one of his last images painted while he was ill, suicidal, and impoverished: “D’Où Venons Nous? Que Sommes Nous? Où Allons Nous” Where do we come from? What are we? Where are we going? (I visited the Gaugain exhibition for the second time over the holidays and felt sad that such beautiful artefacts might soon be no more.)

The first question is the easiest to answer, and Wright reminds us that the 10 000 years of civilisation, beginning with Sumeria, represent just 0.2% of human existence. Life may have been “nasty, brutal, and short” for 3 million years, but prehistoric humans could not destroy the planet. The possibility of doing so arose with the so far short lived experiment of civilisation. As Wright puts it, “Nature let a few apes into the lab of evolution, switched on the lights, and left us there to mess about with an ever-growing supply of ingredients and processes.”

Technology presented us with problems right from the beginning. “The perfection of hunting spelt the end of hunting as a way of life”–because free living, food providing creatures were wiped out. This is the “progress trap,” best illustrated by how the capacity to make a big bang is progress but then leads to the capacity to make a bang big enough to destroy the planet. (When I read the sentence on hunting I wondered if it might be possible to substitute the word “medicine” for “hunting.”)

Much of Wright’s book is spent exploring the collapse of civilisations—Sumeria, Rome, the Mayans, and Easter Island. His main conclusion is that humans destroy their civilisations, as they expelled themselves from Eden, by “fouling their own nest,” poisoning their environment.

The short tragic story of Easter Island should be taught to every schoolchild—and to every medical student who doesn’t know the story. When Dutch sailors first glimpsed the island on Easter Day 1722 they saw it to be treeless and barren. Imagine their astonishment when they landed and discovered hundreds of huge stone heads, some 10 metres high. Who had built these heads? And how could they have been erected without any timber to provide leverage and scaffolding?

We now know the story of Easter Island. It was first settled in the 5th century AD by people who arrived by boat to a highly fertile, thickly wooded island, bringing with them “dogs, chickens, edible rats, sugar cane, bananas, sweet potatoes, and mulberry for making bark cloth.” Within five or six centuries the population had grown to 10 000, a lot for 64 square miles. The best land had been cleared for farms, and the society had split into nobles, priests, and commoners.

Like other Polynesians, the islanders built stone images to honour their ancestors. The building of these images became ever more competitive and extravagant, and trees were felled to aid the building faster than they could be replaced. By 1400 the trees and tree pollen had all gone, and, as Wright describes it, “the people who felled the last tree could see it was the last, could know with complete certainty that there would never be another. And they felled it anyway.”

For a generation there was enough wood to carry on erecting the heads and building seaworthy boats. But soon all but scraps of wood were gone. There was no escape. Wars broke out. People starved, and by the time Captain Cook arrived at the end of the 18th century there were just a few “small, lean, timid, and miserable” people left, the sorriest he’d seen in the South Seas. The Easter Islanders had destroyed themselves through “ideological pathology.”

The biggest heads were erected shortly before the collapse, illustrating mankind’s powerful capacity for denial.”Look on my works, ye mighty, and despair,” wrote Shelley in Ozymandias, his poem about the “shattered visage” of the “king of kings.” The planet is littered with the often beautiful remnants of collapsed civilisations.

So will we be any different? “Where are we going?” The difference with our experiment is that we live in a globalised world, and our experiment is thus the last experiment. All of man’s other experiments with civilisation have failed, but might ours succeed? A great advantage we have over our forebears is detailed knowledge of what happened in their experiments. We have the knowledge to save ourselves if we can only apply it.

The three ingredients of collapse are “the Runaway Train, the Dinosaur, and the House of Cards.” We are surrounded by Runaway Trains–“the rise in population and pollution, the acceleration of technology, and the concentration of wealth and power.” We used 70% of nature’s yearly outputs in the early 60s, 100% in the 80s, and 125% by 1999. The Dinosaur element is going on behaving in the same old way, felling trees, and building giant statues until the last tree is gone. “Our present behaviour,” writes Wright, “is typical of failed societies at the zenith of their greed and arrogance…hostility to change from vested interests, and inertia at all social levels.”

When collapse comes it comes suddenly, the House of Cards effect. Civilisations are very vulnerable when living at their ecological limits. We may fear the world slowly warming, but it may be that droughts, floods, fires, hurricanes, crop failures, new pandemics, mass migrations, and nuclear war over scarce resources will hasten our end. And “wealth is no shield from chaos.”

Wright wisely doesn’t attempt to answer definitively Gauguin’s question of “Where are we headed?” and he sees a brighter future if we can make the “transition from short term to long term thinking, from recklessness and excess to moderation and the precautionary principle….We have the tools and the means to share resources, clean up pollution, dispense basic health care and birth control, and set economic limits in line with natural ones.”

Can we do it? I ended his book thinking not, but I urge you to read this book and see what you think. What I am sure about is that the more people who read this book the greater our chance of long term survival.

Easter Island

Executed for blasphemy: a review of Unspeakable by Dilys Rose

If Thomas Aitkenhead had been born 50 years later he might have been one of the leaders of the Scottish Enlightenment instead of the last man in Britain to be hanged for blasphemy. As Dilys Rose makes clear in her evocative novel, it was his love of learning, debate, and thinking for himself that led him to the gallows in 1697.

Edinburgh at the end of the 17th was a grim theocracy. The Church ran a kind of secret police. Rose describes how Aitkenhead’s mother, who along with many other Scots of her age loved to go A-Maying, dared to go with her children for a day of fun on Mayday beside the Water of Leith on the Sabbath. But she is seen by “the two black-coated elders…who [if they were frank] would admit to thoroughly enjoying their time in the open air, free from coccyx-numbing pews and the asphyxiating odours of humanity which accumulate between kirk walls during a Sunday sermon.” The result, despite the elders chased away with stones, is that his mother must stand in church for six weeks “on a raised wooden form situated directly beneath the pulpit, from which she and fellow sinners can be scrutinised by the congregation.” Her children share her humiliation.

Rose paints a vivid picture of 17th century Edinburgh, and her use of Scots in dialogue (which is easily understood after a few paragraphs) adds to the sense that you are there in the narrow, dark, grimy, stinking streets among the crowds. She creates the times as effectively as Hilary Mantel created Tudor England, an achievement that is rare in historical novels.

Aitkenhead’s father was a herbalist, contributing to his son’s taste for inquiry and allowing Rose to share the poetry of his stock and the secrets of his remedies, including a love potion that is, of course, forbidden by the church. A poor businessman, Aitkenhead’s father heads to bankruptcy and an early death. His family is, however, taken in by rich relatives, giving Rose a chance to describe the world of the rich as well as the poor. The rich relative provides for Aitkenhead to become a medical student at Edinburgh University at a time when the seeds of the Enlightenment were beginning to sprout.

Meeting men like Alexander Pitcairn who were willing to ignore the strictures of the church and read, think, and talk widely and exposed to the books flooding in from the world, Aitkenhead was intoxicated by the intellectual possibilities. Even while enjoying the fragrance of a physic garden he notes that “Every plant form is so particular, complex, perfectly designed. For some– for many–such abundance is proof of the existence of God. But why, if the true purpose of life is to conform to God’s will, would He need so many different species, such endless variety?” Darwin’s great book was more than a century away, but the questions were there.

Some of the teaching at the university was dull, and bored and hungry in a geometry lesson Aitkenhead reacts to the teacher asserting that “the principles of geometry were given by God so that his people might labour more efficiently.” He asks to speak: “if God is responsible for the rules of geometry, which can be proven mathematically by the rules of logic, why is not possible to follow a similar computation for the Creator Himself?” He continues and knows from the reaction in the room that he is on dangerous ground, but he can’t stop himself going further: “As Aristotle posited, we can imagine a creature that is half hart and half goat, but we know it doesn’t exist. We may be able to imagine a man incarnating God while knowing he doesn’t exist. Man’s imagination, with art and industry, can create anything.” After a whiff of atheism, the last sentence captures the spirit of the Enlightenment.

Like all students, Aitkenhead plays and jokes with his colleagues, none of whom are as questioning and curious as him and some of whom are jealous of his wit and learning. At a horse race Aitkenhead objects to the abuse of the horses, but his false friend says “It’s God’s will that an animal does man’s bidding.” The debate continues and responding to a Biblical quote from his friend Aitkenhead says: “If he ask me, the doctrine o theology is a rhapsody o feigned and Ill -invented nonsense. It’s patched up pairtly o the moral doctrine o philosophers, and pairtly o poetical fictions and extravagant chimaeras.”

These words combined with others he has said and some invented by his enemies are his undoing. His false friend reports his words and soon he is arrested, imprisoned, and tried. His punishment of hanging is recognised as excessive even at the time, and perhaps it reflected the theocracy recognising how learning, debate, and free-thinking would mark its decline.

It seems extraordinary in contemporary Britain that anybody could be executed or even fined for blasphemy, but it still happens in many countries. In Pakistan, as in 17th century Edunburgh, accusations of blasphemy are used by the unscrupulous to get rid of their political enemies. ISIS will kill for blasphemy much less than that of Aitkenhead.

As he sits in prison awaiting execution, Aitkenhead writes a letter to his family and friends to try and explain and justify his words and actions. “Each word must be weighed like a granule of precious matter; each must contribute to a true representation of his beliefs.” As I read that sentence, I thought how Rose in her novel has succeeded in creating a compelling novel by weighing each word and sentence like a granule of precious matter.