A few years ago, a friend of mine, a prison psychiatrist, was asked by the Board of Visitors why so many prisoners changed religion.
After a pause, he said, ‘I expect it’s because they want a change of diet.’
This was not the answer the Board of Visitors expected, or wanted. They wanted him to say that it was because prisoners, after much mature theological reflection, had decided that a, b or c was the true religion.
A secondary reason, of course, was that they wanted to cause the prison authorities as much headache and embarrassment as possible. When I was a prison doctor, I could well understand this. What else was there for the prisoners to do? If I had been a prisoner, I think I would have converted to Jainism.
Therefore, it did not altogether surprise me that the Inspector of Prisons should have found that two per cent of prisoners claim to be transsexual, in their minds if not in their bodies. There are few bigger posers, as Bertie Wooster would have put it, for prison authorities than a transsexual. I remember the arrival in the old days (whenever they were) of a transsexual in the prison, who was, as we now put it, transitioning. Should he or she be held in a male or female prison? The discussion reminded me of when the police arrived at my surgery in South Africa with a naked mad white woman in the back of their caged pickup. Should she be taken into the white entrance because she was white, or the black entrance because she was mad? They opted for the latter.
There is, however, another reason why the figure of 2 per cent does not surprise me. In 2017, an editorial in the venerated New England Journal of Medicine gave a prevalence of 0.6 per cent in the general American population, nearly a third as many as in British prisoners. Since, then, prisoners are believed to be considerably more psychologically disturbed than average, the figure of 2 per cent hardly comes to me as a shock.
Actually, what is more surprising is what happened between 2013, when the fifth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (the DSM 5) was published, and 2017, when the NEJM editorial was published. The DSM 5 gave a prevalence of about 0.008 per cent for the condition: in other words, there had been an increase of 7,500 per cent in its prevalence in only four years.
What accounted for this? Was it a real increase, and if so why had it happened? Was it a recognition at last of what had not previously been recognised and catered for? Or was it a matter of fashion, a bit like the spread of tattoos (about a third of adult males in Britain are now tattooed)? The NEJM did not even deign to wonder.
My own favoured explanation is that it is fashion. In the DSM 5, the prevalence of multiple personality disorder (of The Three Faces of Eve type) is given as up to 1.5 per cent of the general population. But clearly the apogee of this fashionable condition has now passed. My prediction is that the fashion will also pass, probably in a welter of lawsuits.
In the meantime, the solution to the transsexual problem in prison is easy: build a prison for transsexuals. At this rate, however, it will have to be one of the largest in the country.
Theodore Dalrymple has just published False Positive: A Year of Error, Omission and Political Correctness in the New England Journal of Medicine (Encounter Books)