A Cost Benefit Analysis Of Cost Benefit Analysis

by Theodore Dalrymple (Feb. 2008)

It goes without saying, I hope, that I am utterly opposed to murder. If it were possible to eliminate this, the oldest and most terrible of crimes, from the face of the earth, I should most certainly rejoice at it. So why is it that, when asked to prepare a medico-legal report in a case of murder, whether for the defence or the prosecution, I am extremely pleased and look forward immensely to receiving and reading all the documentation? Why is this, when I know full well that a world without murder would be much better than the one in which we live?

Most murders are merely sordid, of the kind that Sherlock Holmes would have despised as presenting no difficulties, at least from the point of view of the detection of the perpetrator. They take place in grim circumstances. They are, in his terminology, no-pipe problems. But most of them nevertheless contain disputable points, often of a medical nature, and if a point can be disputed, lawyers will dispute it.

I like the discipline that the court procedure imposes. There is nothing like the prospect of being cross-examined by a clever lawyer for the other side to make one very careful about what one says, never going beyond what is strictly defensible on the evidence available. It is rarely in life that we are so constrained, and what is unusual often has the charms of novelty. The fact is that pedantry has its pleasures and psychological rewards.

Testifying often turns into a battle of wits, which is another reason why I find it so enjoyable. I have learned over the years that loquacity in the witness box is disastrous, and that taciturnity is by far the best policy. When asked for advice by people who are about to go into the box for the first time, I tell them to be as near to monosyllabic as they can manage. The longer you speak, the more likely it is that you will say something foolish; and one foolish remark in the box has more effect on a jury than a hundred wise ones.

You must agree immediately if you have overlooked something that is pointed out to you by the opposing lawyer, for nine times out of ten such agreement takes the wind out of his sails and makes you look reasonable in the eyes of the jury – as well, of course, as being in accordance with the truth.

But the real pleasure of involving myself in these cases is the contact that they bring with extremes of human experience and emotion, and the knowledge they provide of the human heart. Furthermore, there is no dinner party whose conversation cannot be revived with anecdotes of murderers one has known, and I don’t think I’ve ever met anyone uninterested in the subject of murder (or they have disguised their lack of interest very well).

If there were no murder, which of course would be a good thing, my life would be somewhat less rich than it is. This is not to say that I could not find an alternative source of interest; obviously I could. The world is so full of interest that a thousand lifetimes could not possibly exhaust it. But thoughts about murder, and re-reading Shakespeare’s Henry IV, has set me thinking about man’s rather peculiar constitution, according to which a problem-free world would be extremely problematic. Heaven on earth would, in fact, be hell on earth.

Falstaff, you will remember, is a man who is lazy, a coward, a boaster, a fornicator, a would-be thief, a sponger on others, a glutton and a drunk. There is not much virtue in him, and he casts doubt on the very possibility of virtue; ‘What is honour?’ he asks, and replies, ’A word. What is in that word honour? What is that honour? Air.’

And yet, far from hating or despising him, we feel the deepest affection for him. When he says, ‘Banish plump Jack, and banish all the world,’ we not only know exactly what he means, but agree with him. It is the perfect rejoinder to the puritan or moral enthusiast who wants a world that is perfect, without the slightest moral blemish, for whom peccadilloes are indistinguishable from mortal sin or radical evil.

There is a difficulty here. We want the world to be large and broad enough for there to be a Falstaff in it, but we don’t want a huge number of Falstaffs. We certainly don’t want everybody to be Falstaff, and we would never take Falstaff as a model for our children, and tell them to imitate him. We see Falstaff when as a man of fifty (old by Elizabethan standards), not as a young man, when he might well have been seriously disconcerting and unpleasant.

Many times in my career I have noticed that people who are reprehensible judged by rational criteria nevertheless contribute something positive to the world. I remember a small and very happy little hospital in which I once worked in which there was a drunken porter. He was lazy and unreliable, and many times other people had to do his work for him. Yet far from being hated or despised, he was universally loved; somehow he contributed to the esprit de corps of the whole hospital, whose staff was happy to carry him (sometimes literally). From the point of view of rational management, he should not have been employed; and yet the attempt to remove all ‘characters,’ from the workforce, that is to say all those inefficient people whose contribution is being what they are rather than doing what they do, usually ends in a miserable and demoralised staff.

Not long ago I was shown a short video made by a notorious Dutch family called the Tokkies. The Tokkies were what I suppose in America would be called white trash. They lived in public housing and had made the lives of their neighbours hell. They were noisy and dirty. They were involved in many battles, involving the use of baseball bats (no baseball is played in Holland), samurai swords, Molotov cocktails and guns, a selection of weaponry suggesting that poverty was the least of their problems.

Eventually, they were evicted from their home. It was just before Christmas. They got into their large van with a trailer, and drove down to Spain for a holiday. An entertainment company had the idea of filming them, dressed in Santa headgear, singing a Christmas song as they drove down to Spain. Husband and wife were utterly blowsy, beer and cigarettes made flesh.

The trouble was that the video was irresistibly comic. Try as I might not to laugh, I couldn’t stop myself. One ended up thinking that a world in which there were no Tokkies would be a poorer one, however glad one was not to live next door to them.

It was the great French sociologist, Durkheim, who suggested that societies had need of their criminals, for their existence has a binding effect upon societies. It is far easier to unite against an enemy, after all, than in favour of something. Criminals are the enemies of society against whom the rest of us can unite, though we may be disunited about everything else. There is a great deal of consolation to be had from universal condemnation. So the criminal also contributes something to society, as Falstaff and my drunken hospital porter did.

Of course, this does not tell us precisely how many criminals we need for the purpose of social unification; perhaps only a few will do and we have many. Even if we had precisely the minimum number necessary to produce the society-binding effect, we would still feel aggrieved of we were personally the victims of a crime: for while it is possible that crime in general has a social function, no crime in particular has such a function.

We want a virtuous society, but not a society that is so virtuous that Ella Wheeler Wilcox is the only poet that means anything to it. As everyone knows, or at least should know, the attempt to enforce absolute virtue results in great evil.

When I read the medical journals these days, I feel I am reading the medical equivalent of Ella Wheeler Wilcox. They speak only the best of good sense (one doesn’t argue with a poem by Ella Wheeler Wilcox). They tell us how we, or rather they, that is to say the general public, ought to live. Not too fat, a certain amount of exercise, no smoking, drinking in moderation of the right kind of wine taken purely as a medicine to ward of heart attacks and strokes, in short, every activity and comestible to be treated as a medicine to be taken in the correct dose.

It is not easy to argue against this rationalistic tyranny, just as it is not easy to answer a puritan without sounding as if you are positively in favour of sin, the more of it the better. No doubt properly conducted studies have shown precisely how much alcohol one should take to achieve the greatest possible longevity; or if they have not been conducted yet, they will be conducted in the very near future. Science will establish precisely how much butter one is allowed per week. Epidemiology will hunt down all the dangers lurking in our habits. From this, prohibitions and imperative duties will inevitably follow. It is only natural, after all, that doctors should advocate whatever saves and prolongs life.

I read recently a wonderful refutation of this outlook on life by the great Belgian Sinologist, Simon Leys. It was he who, throughout the Cultural Revolution in China, mocked and excoriated, in prose so witty that it made you laugh out loud despite its horrifying subject, the western sympathisers, who were legion, of that dreadful revolt against civilisation. It was he who during those locust years defended the immemorial refinement of Chinese civilisation from the brutality of the assault upon it in the name of ideological purity, and who defended intelligence and decency from stupidity and cruelty. He was almost alone and it required courage to say things that subsequently became obvious.

He is also a marvellous and laconic literary essayist, both in English and French, and in a book entitled Le bonheur des petits poissons, he writes of the pleasures of tobacco. In this little essay, only five pages long but pregnant with the most important questions about the purpose of human existence, he mentions a moving letter by Mozart in which Mozart says that he thinks of death every day, and that these thoughts are his inspiration. This habit of Mozart explains both the infinite joy and the infinite sorrow of his music.

When Leys, therefore, sees those terrible warnings that now appear on cigarette packets all over the world, he says that he is tempted, for strictly metaphysical reasons, to take up smoking again. He does not claim, of course, that an early death will make us all Mozarts; that is scarcely possible. But it probably is the case that an excessive interest in the rational means by which we can avoid premature death will prevent a Mozart from ever arising again, perhaps in any field of human endeavour (I know people who know more about music than I who say that in any case, serious music in the west died with Schonberg, that a tradition was killed once and for all, beyond any hope of resurrection, by him and his followers).

Leys is saying that the 36 years of Mozart’s life are not to be regarded as half as valuable as that of someone else who achieved little and who lived to be 72: that is to say that the value of life is not to be estimated by its length or by any other mechanical measure beloved of rationalists.

So, as a doctor, I deplore it when you smoke or otherwise disobey the dictates of good sense; but as a man, I rejoice and am glad that you are incalculable.

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