Dr. D's Diagnosis.

Life at the Bottom: The Worldview That Makes the Underclass, by Theodore Dalrymple (Ivan R. Dee, 256 pp., $27.50)

Grim news on the social front seems to be something people everywhere just have to accept as a fact of modern life. But in Britain-solid civilized old Britain, which gave the world fair play and the stiff upper lip-the news is worse than elsewhere. Until quite recently, the poor in Britain lived decent crime-free lives, but now the country is a world-beater in crime, illegitimacy, and illiteracy. The yob has replaced the gentleman as the national stereotype. Where to begin with the recital of everyday cruelty and violence? Last year, to give just one instance, nearly 700,000 mobile telephones were stolen by the young; in other words, half the teenage population has been robbing the other half. Adding insult to injury, blame has been attached not to the little thugs, but to the telephone companies-because they failed to equip their mobiles with some anti-theft device. In the overturning of all previous value judgments, a society is visibly decomposing in front of us.

Theodore Dalrymple is made of other stuff. It is an open secret that his real name is Anthony Daniels-and so he signs other books and articles-and he is a doctor in both a hospital and a prison in Birmingham, a city once the proud heart of Britain's industry but now a compendium of contemporary ills. Over the years, he tells us, he has attended to some ten thousand patients. He has been writing up the observations drawn from this large and representative sample in essays for New York's City Journal, collected here into a book.

And an extraordinary book it is. In its pages, the reader learns that Dalrymple is the son of a curmudgeonly former member of the Communist party who had once emerged from the slums through natural intelligence and education. Poverty, the author knows firsthand, is not something to sentimentalize. As a doctor he has worked in the Third World, notably in Africa, taking the measure of a much more profound expanse of human suffering than anything to be found in Britain.

Survival in the Third World is an achievement in itself, and that helps the poor to retain their dignity. In contrast, the Birmingham hospital offers almost unrelieved degradation. Here are teenagers suffering from acute alcohol poisoning, heroin addicts, girls with no idea who the fathers of their children are, women who have been hung out of the windows of high-rise buildings or had their heads rammed down lavatories, psychopaths patterned all over with scars and tattoos, murderers so heedless that one of them can say that he had to kill his victim, "otherwise he didn't know what he might have done." Over two- thirds of the men and women are veterans of domestic violence. Almost every one of the 1,300 patients each year in the toxicology ward has attempted suicide by overdose, usually in order to obtain more benefits from the state. Dalrymple coins an unforgettable maxim: "Misery increases to meet the means available for its alleviation."

It appalls Dalrymple that such numbers of people display sheer ignorance of how to live. Character, will, or ambition might as well not exist. Simple instincts of self-preservation are absent. Instead there is, among them, a profound aversion to anything that smacks of intelligence and education, and so they live in "a squalor which is moral, spiritual, and cultural." Sometimes, in their twenties or thirties, they realize that there must be more to life than this. Usually it is then too late for natural intelligence to save them. "They say I'm stupid because I'm clever," is one poor girl's lament about those taunting her for trying to better herself. Dalrymple has heart-rending stories to tell about those who have tried to break out of this setting of despair but found no support in society.

These ...