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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 August 25; 335(7616): 403.
PMCID: PMC1952529
Between the Lines

Resistance to good sense

Theodore Dalrymple, writer and retired doctor

When I was young I thought that people always acted in their own best interests (it didn't occur to me to examine my own behaviour in this respect to see whether it was true). Tell them what was good for them, and they would do it. When they didn't do it I assumed they were deaf and hadn't heard properly; I repeated myself, only a little louder and more emphatically.

Dostoyevsky was under no such misapprehension about his fellow beings. The anonymous narrator of his Notes from the Underground starts by telling us that he is sick, although he does not know from what illness. He has the greatest respect for the medical profession, he says (adding that this is because he is very superstitious), but he does not consult a doctor or take treatment—out of spite. He knows that doctors will not suffer if he does not consult them or follow their advice, but still he persists. He would rather get worse than give in.

I think we've all known people like that. But the narrator's problem or sickness is not so much physical as metaphysical. He has seen through the optimistic spirit of the age according to which, if only people saw their true best interests and acted in accordance with them, life would be uniformly happy.

Our underground man, who retired from his civil service position at the age of 40 to live in abject poverty, does not agree. Supposing everyone behaved rationally, according to the best utilitarian tenets, and supposing society had been reformed so that there were no governmental or administrative obstructions to perfect happiness, what then? Will everyone be content to live happily ever after? By no means: “What about all those millions of incidents testifying to the fact that men have knowingly, that is in full understanding of their own best interests, put them in the background and taken a perilous and uncertain course not because anybody or anything drove them to it, but simply and solely because they did not choose to follow the appointed road, as it were, but wilfully and obstinately preferred to pursue a perverse and difficult path, almost lost in the darkness? This shows that obstinacy and self-will meant more to them than any advantage.”

Does this not accord with our clinical experience better than the simple minded notion that, once the advantages of a treatment are pointed out to a patient, nothing much else remains to be done and the patient will simply follow instructions?

The ways of self destruction are infinite. How many times, when I have been talking to a patient whose self destructiveness seems almost rococo in its inventiveness, have I not thought of this passage from Notes from the Underground? “After all, this height of stupidity, this whim, may be for us . . . the greatest benefit on earth, especially in some cases . . . because it does at any rate preserve what is dear and extremely important to us, that is our personality and our individuality.”

Especially in the modern world, where to fail to stand out in some way is to fail properly to exist, resistance to good sense is a way of asserting oneself—perhaps the only way. Some people have a butterfly tattooed on their left buttock or right ankle; others refuse to take their pills. I even sometimes forget them myself.

Some people have a butterfly tattooed on their left buttock or right ankle; others refuse to take their pills. I even sometimes forget them myself

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