| A single case can be illuminating, especially when it is statistically banal—in other words, not at all exceptional. Yesterday, for example, a 21-year-old woman consulted me, claiming to be depressed. She had swallowed an overdose of her antidepressants and then called an ambulance.
There is something to be said here about the word “depression,” which has almost entirely eliminated the word and even the concept of unhappiness from modern life. Of the thousands of patients I have seen, only two or three have ever claimed to be unhappy: all the rest have said that they were depressed. This semantic shift is deeply significant, for it implies that dissatisfaction with life is itself pathological, a medical condition, which it is the responsibility of the doctor to alleviate by medical means. . . . This idea in turn implies that one’s state of mind, or one’s mood, is or should be independent of the way that one lives one’s life. . . .
A ridiculous pas de deux between doctor and patient ensues: the patient pretends to be ill, and the doctor pretends to cure him. . . . The patient’s notion that he is ill stands in the way of his understanding of the situation, without which moral change cannot take place. The doctor who pretends to treat is an obstacle to this change, blinding rather than enlightening.
My patient already had had three children by three different men, by no means unusual among my patients, or indeed in the country as a whole. The father of her first child had been violent, and she had left him; the second died in an accident while driving a stolen car; the third, with whom she had been living, had demanded that she should leave his apartment because, a week after their child was born, he decided that he no longer wished to live with her. (The discovery of incompatibility a week after the birth of a child is now so common as to be statistically normal.) She had nowhere to go, no one to fall back on, and the hospital was a temporary sanctuary from her woes. She hoped that we would fix her up with some accommodation.
She could not return to her mother, because of conflict with her “stepfather,” or her mother’s latest boyfriend, who, in fact, was only nine years older than she and seven years younger than her mother. This compression of the generations is also now a common pattern and is seldom a recipe for happiness. (It goes without saying that her own father had disappeared at her birth, and she had never seen him since.) The latest boyfriend in this kind of ménage either wants the daughter around to abuse her sexually or else wants her out of the house as being a nuisance and an unnecessary expense. This boyfriend wanted her out of the house, and set about creating an atmosphere certain to make her leave as soon as possible.
The father of her first child had, of course, recognized her vulnerability. A girl of 16 living on her own is easy prey. He beat her from the first, being drunken, possessive, and jealous, as well as flagrantly unfaithful. She thought that a child would make him more responsible—sober him up and calm him down. It had the reverse effect. She left him.
The father of her second child was a career criminal, already imprisoned several times. A drug addict who took whatever drugs he could get, he died under the influence. She had known all about his past before she had his child.
The father of her third child was much older than she. It was he who suggested that they have a child—in fact he demanded it as a condition of staying with her. He had five children already by three different women, none of whom he supported in any way whatever. . . .
She was, of course, a victim of her mother’s behavior at a time when she had little control over her destiny. Her mother had thought that her own sexual liaison was more important than the welfare of her child, a common way of thinking in today’s welfare Britain. That same day, for example, I was consulted by a young woman whose mother’s consort had raped her many times between the ages of eight and 15, with her mother’s full knowledge. Her mother had allowed this solely so that her relationship with her consort might continue. It could happen that my patient will one day do the same thing.
My patient was not just a victim of her mother, however: she had knowingly borne children of men of whom no good could be expected. She knew perfectly well the consequences and the meaning of what she was doing, as her reaction to something that I said to her—and say to hundreds of women patients in a similar situation—proved: next time you are thinking of going out with a man, bring him to me for my inspection, and I’ll tell you if you can go out with him.
This never fails to make the most wretched, the most “depressed” of women smile broadly or laugh heartily. They know exactly what I mean, and I need not spell it out further. They know that I mean that most of the men they have chosen have their evil written all over them, sometimes quite literally in the form of tattoos, saying “FUCK OFF” or “MAD DOG.” And they understand that if I can spot the evil instantly, because they know what I would look for, so can they—and therefore they are in large part responsible for their own downfall at the hands of evil men.
Moreover, they are aware that I believe that it is both foolish and wicked to have children by men without having considered even for a second or a fraction of a second whether the men have any qualities that might make them good fathers. Mistakes are possible, of course: a man may turn out not to be as expected. But not even to consider the question is to act as irresponsibly as it is possible for a human being to act. It is knowingly to increase the sum of evil in the world, and sooner or later the summation of small evils leads to the triumph of evil itself. . . .
The men in these situations also know perfectly well the meaning and consequences of what they are doing. The same day that I saw the patient I have just described, a man aged 25 came into our ward, in need of an operation to remove foil-wrapped packets of cocaine that he had swallowed in order to evade being caught by the police in possession of them. (Had a packet burst, he would have died immediately.) As it happened, he had just left his latest girlfriend—one week after she had given birth to their child. They weren’t getting along, he said; he needed his space. Of the child, he thought not for an instant.
I asked him whether he had any other children.
“Four,” he replied.
“How many mothers?”
“Three.”
“Do you see any of your children?”
He shook his head. It is supposedly the duty of the doctor not to pass judgment on how his patients have elected to live, but I think I may have raised my eyebrows slightly. At any rate, the patient caught a whiff of my disapproval.
“I know,” he said. “I know. Don’t tell me.”
These words were a complete confession of guilt. I have had hundreds of conversations with men who have abandoned their children in this fashion, and they all know perfectly well what the consequences are for the mother and, more important, for the children. They all know that they are condemning their children to lives of brutality, poverty, abuse, and hopelessness. They tell me so themselves. And yet they do it over and over again, to such an extent that I should guess that nearly a quarter of British children are now brought up this way. . . .
So while my patients know in their hearts that what they are doing is wrong, and worse than wrong, they are encouraged nevertheless to do it by the strong belief that they have the right to do it, because everything is merely a matter of choice. Almost no one in Britain ever publicly challenges this belief. Nor has any politician the courage to demand a withdrawal of the public subsidy that allows the intensifying evil I have seen over the past 14 years—violence, rape, intimidation, cruelty, drug addiction, neglect—to flourish so exuberantly. With 40 percent of children in Britain born out of wedlock, and the proportion still rising, and with divorce the norm rather than the exception, there soon will be no electoral constituency for reversal. It is already deemed to be electoral suicide to advocate it by those who, in their hearts, know that such a reversal is necessary.
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