When prisoners are released from prison, they often say that they have paid their debt to society. This is absurd, of course: crime is not a matter of double-entry bookkeeping. You cannot pay a debt by having caused even greater expense, nor can you pay in advance for a bank robbery by offering to serve a prison sentence before you commit it. Perhaps, metaphorically speaking, the slate is wiped clean once a prisoner is released from prison, but the debt is not paid off.

It would be just as absurd for me to say, on my imminent retirement after 14 years of my hospital and prison work, that I have paid my debt to society. I had the choice to do something more pleasing if I had wished, and I was paid, if not munificently, at least adequately. I chose the disagreeable neighborhood in which I practiced because, medically speaking, the poor are more interesting, at least to me, than the rich: their pathology is more florid, their need for attention greater. Their dilemmas, if cruder, seem to me more compelling, nearer to the fundamentals of human existence. No doubt I also felt my services would be more valuable there: in other words, that I had some kind of duty to perform. Perhaps for that reason, like the prisoner on his release, I feel I have paid my debt to society. Certainly, the work has taken a toll on me, and it is time to do something else. Someone else can do battle with the metastasizing social pathology of Great Britain, while I lead a life aesthetically more pleasing to me.

My work has caused me to become perhaps unhealthily preoccupied with the problem of evil. Why do people commit evil? What conditions allow it to flourish? How is it best prevented and, when necessary, suppressed? Each time I listen to a patient recounting the cruelty to which he or she has been subjected, or has committed (and I have listened to several such patients every day for 14 years), these questions revolve endlessly in my mind.

No doubt my previous experiences fostered my preoccupation with this problem. My mother was a refugee from Nazi Germany, and though she spoke very little of her life before she came to Britain, the mere fact that there was much of which she did not speak gave evil a ghostly presence in our household.

Later, I spent several years touring the world, often in places where atrocity had recently been, or still was being, committed. In Central America, I witnessed civil war fought between guerrilla groups intent on imposing totalitarian tyranny on their societies, opposed by armies that didn't scruple to resort to massacre. In Equatorial Guinea, the current dictator was the nephew and henchman of the last dictator, who had killed or driven into exile a third of the population, executing every last person who wore glasses or possessed a page of printed matter for being a disaffected or potentially disaffected intellectual. In Liberia, I visited a church in which more than 600 people had taken refuge and been slaughtered, possibly by the president himself (soon to be videotaped being tortured to death). The outlines of the bodies were still visible on the dried blood on the floor, and the long mound of the mass grave began only a few yards from the entrance. In North Korea I saw the acme of tyranny, millions of people in terrorized, abject obeisance to a personality cult whose object, the Great Leader Kim Il Sung, made the Sun King look like the personification of modesty.

Still, all these were political evils, which my own country had entirely escaped. I optimistically supposed that, in the absence of the worst political deformations, widespread evil was impossible. I soon discovered my error. Of course, nothing that I was to see in a British slum approached the scale or depth of what I had witnessed elsewhere. Beating a woman from motives of jealousy, locking her in a closet, breaking her arms deliberately, terrible though it may be, is not the same, by a long way, as mass murder. More than enough of the constitutional, traditional, institutional, and social restraints on large-scale political evil still existed in Britain to prevent anything like what I had witnessed elsewhere.

Yet the scale of a man's evil is not entirely to be measured by its practical consequences. Men commit evil within the scope available to them. Some evil geniuses, of course, devote their lives to increasing that scope as widely as possible, but no such character has yet arisen in Britain, and most evildoers merely make the most of their opportunities. They do what they can get away with.

In any case, the extent of the evil that I found, though far more modest than the disasters of modern history, is nonetheless impressive. From the vantage point of one six-bedded hospital ward, I have met at least 5,000 perpetrators of the kind of violence I have just described and 5,000 victims of it: nearly 1 percent of the population of my city—or a higher percentage, if one considers the age-specificity of the behavior. And when you take the life histories of these people, as I have, you soon realize that their existence is as saturated with arbitrary violence as that of the inhabitants of many a dictatorship. Instead of one dictator, though, there are thousands, each the absolute ruler of his own little sphere, his power circumscribed by the proximity of another such as he.

Violent conflict, not confined to the home and hearth, spills out onto the streets. Moreover, I discovered that British cities such as my own even had torture chambers: run not by the government, as in dictatorships, but by those representatives of slum enterprise, the drug dealers. Young men and women in debt to drug dealers are kidnapped, taken to the torture chambers, tied to beds, and beaten or whipped. Of compunction there is none—only a residual fear of the consequences of going too far.

Perhaps the most alarming feature of this low-level but endemic evil, the one that brings it close to the conception of original sin, is that it is unforced and spontaneous. No one requires people to commit it. In the worst dictatorships, some of the evil ordinary men and women do they do out of fear of not committing it. There, goodness requires heroism. In the Soviet Union in the 1930s, for example, a man who failed to report a political joke to the authorities was himself guilty of an offense that could lead to deportation or death. But in modern Britain, no such conditions exist: the government does not require citizens to behave as I have described and punish them if they do not. The evil is freely chosen.

Not that the government is blameless in the matter—far from it. Intellectuals propounded the idea that man should be freed from the shackles of social convention and self-control, and the government, without any demand from below, enacted laws that promoted unrestrained behavior and created a welfare system that protected people from some of its economic consequences. When the barriers to evil are brought down, it flourishes; and never again will I be tempted to believe in the fundamental goodness of man, or that evil is something exceptional or alien to human nature.

Of course, my personal experience is just that—personal experience. Admittedly, I have looked out at the social world of my city and my country from a peculiar and possibly unrepresentative vantage point, from a prison and from a hospital ward where practically all the patients have tried to kill themselves, or at least made suicidal gestures. But it is not small or slight personal experience, and each of my thousands, even scores of thousands, of cases has given me a window into the world in which that person lives.

And when my mother asks me whether I am not in danger of letting my personal experience embitter me or cause me to look at the world through bile-colored spectacles, I ask her why she thinks that she, in common with all old people in Britain today, feels the need to be indoors by sundown or face the consequences, and why this should be the case in a country that within living memory was law-abiding and safe? Did she not herself tell me that, as a young woman during the blackouts in the Blitz, she felt perfectly safe, at least from the depredations of her fellow citizens, walking home in the pitch dark, and that it never occurred to her that she might be the victim of a crime, whereas nowadays she has only to put her nose out of her door at dusk for her to think of nothing else? Is it not true that her purse has been stolen twice in the last two years, in broad daylight, and is it not true that statistics—however manipulated by governments to put the best possible gloss upon them—bear out the accuracy of the conclusions that I have drawn from my personal experience? In 1921, the year of my mother's birth, there was one crime recorded for every 370 inhabitants of England and Wales; 80 years later, it was one for every ten inhabitants. There has been a 12-fold increase since 1941 and an even greater increase in crimes of violence. So while personal experience is hardly a complete guide to social reality, the historical data certainly back up my impressions.

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. Everyone has a right to health; depression is unhealthy; therefore everyone has a right to be happy (the opposite of being depressed). 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 belief that must deprive human existence of all meaning, radically disconnecting reward from conduct.

A ridiculous pas de deux between doctor and patient ensues: the patient pretends to be ill, and the doctor pretends to cure him. In the process, the patient is willfully blinded to the conduct that inevitably causes his misery in the first place. I have therefore come to see that one of the most important tasks of the doctor today is the disavowal of his own power and responsibility. 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.

The conditions for the perpetuation of evil were now complete. She was a young woman who would not want to remain alone, without a man, for very long; but with three children already, she would attract precisely the kind of man, like the father of her first child—of whom there are now many—looking for vulnerable, exploitable women. More than likely, at least one of them (for there would undoubtedly be a succession of them) would abuse her children sexually, physically, or both.

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.

My patient did not start out with the intention of abetting, much less of committing, evil. And yet her refusal to take seriously and act upon the signs that she saw and the knowledge that she had was not the consequence of blindness and ignorance. It was utterly willful. She knew from her own experience, and that of many people around her, that her choices, based on the pleasure or the desire of the moment, would lead to the misery and suffering not only of herself, but—especially—of her own children.

This truly is not so much the banality as the frivolity of evil: the elevation of passing pleasure for oneself over the long-term misery of others to whom one owes a duty. What better phrase than the frivolity of evil describes the conduct of a mother who turns her own 14-year-old child out of doors because her latest boyfriend does not want him or her in the house? And what better phrase describes the attitude of those intellectuals who see in this conduct nothing but an extension of human freedom and choice, another thread in life's rich tapestry?

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.

The result is a rising tide of neglect, cruelty, sadism, and joyous malignity that staggers and appalls me. I am more horrified after 14 years than the day I started.

Where does this evil come from? There is obviously something flawed in the heart of man that he should wish to behave in this depraved fashion—the legacy of original sin, to speak metaphorically. But if, not so long ago, such conduct was much less widespread than it is now (in a time of much lesser prosperity, be it remembered by those who think that poverty explains everything), then something more is needed to explain it.

A necessary, though not sufficient, condition is the welfare state, which makes it possible, and sometimes advantageous, to behave like this. Just as the IMF is the bank of last resort, encouraging commercial banks to make unwise loans to countries that they know the IMF will bail out, so the state is the parent of last resort—or, more often than not, of first resort. The state, guided by the apparently generous and humane philosophy that no child, whatever its origins, should suffer deprivation, gives assistance to any child, or rather the mother of any child, once it has come into being. In matters of public housing, it is actually advantageous for a mother to put herself at a disadvantage, to be a single mother, without support from the fathers of the children and dependent on the state for income. She is then a priority; she won't pay local taxes, rent, or utility bills.

As for the men, the state absolves them of all responsibility for their children. The state is now father to the child. The biological father is therefore free to use whatever income he has as pocket money, for entertainment and little treats. He is thereby reduced to the status of a child, though a spoiled child with the physical capabilities of a man: petulant, demanding, querulous, self-centered, and violent if he doesn't get his own way. The violence escalates and becomes a habit. A spoiled brat becomes an evil tyrant.

But if the welfare state is a necessary condition for the spread of evil, it is not sufficient. After all, the British welfare state is neither the most extensive nor the most generous in the world, and yet our rates of social pathology—public drunkenness, drug-taking, teenage pregnancy, venereal disease, hooliganism, criminality—are the highest in the world. Something more was necessary to produce this result.

Here we enter the realm of culture and ideas. For it is necessary not only to believe that it is economically feasible to behave in the irresponsible and egotistical fashion that I have described, but also to believe that it is morally permissible to do so. And this idea has been peddled by the intellectual elite in Britain for many years, more assiduously than anywhere else, to the extent that it is now taken for granted. There has been a long march not only through the institutions but through the minds of the young. When young people want to praise themselves, they describe themselves as "nonjudgmental." For them, the highest form of morality is amorality.

There has been an unholy alliance between those on the Left, who believe that man is endowed with rights but no duties, and libertarians on the Right, who believe that consumer choice is the answer to all social questions, an idea eagerly adopted by the Left in precisely those areas where it does not apply. Thus people have a right to bring forth children any way they like, and the children, of course, have the right not to be deprived of anything, at least anything material. How men and women associate and have children is merely a matter of consumer choice, of no more moral consequence than the choice between dark and milk chocolate, and the state must not discriminate among different forms of association and child rearing, even if such non-discrimination has the same effect as British and French neutrality during the Spanish Civil War.

The consequences to the children and to society do not enter into the matter: for in any case it is the function of the state to ameliorate by redistributive taxation the material effects of individual irresponsibility, and to ameliorate the emotional, educational, and spiritual effects by an army of social workers, psychologists, educators, counselors, and the like, who have themselves come to form a powerful vested interest of dependence on the government.

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.

I am not sure they are right. They lack courage. My only cause for optimism during the past 14 years has been the fact that my patients, with a few exceptions, can be brought to see the truth of what I say: that they are not depressed; they are unhappy—and they are unhappy because they have chosen to live in a way that they ought not to live, and in which it is impossible to be happy. Without exception, they say that they would not want their children to live as they have lived. But the social, economic, and ideological pressures—and, above all, the parental example—make it likely that their children's choices will be as bad as theirs.

Ultimately, the moral cowardice of the intellectual and political elites is responsible for the continuing social disaster that has overtaken Britain, a disaster whose full social and economic consequences have yet to be seen. A sharp economic downturn would expose how far the policies of successive governments, all in the direction of libertinism, have atomized British society, so that all social solidarity within families and communities, so protective in times of hardship, has been destroyed. The elites cannot even acknowledge what has happened, however obvious it is, for to do so would be to admit their past responsibility for it, and that would make them feel bad. Better that millions should live in wretchedness and squalor than that they should feel bad about themselves—another aspect of the frivolity of evil. Moreover, if members of the elite acknowledged the social disaster brought about by their ideological libertinism, they might feel called upon to place restraints upon their own behavior, for you cannot long demand of others what you balk at doing yourself.

There are pleasures, no doubt, to be had in crying in the wilderness, in being a man who thinks he has seen further and more keenly than others, but they grow fewer with time. The wilderness has lost its charms for me.

I'm leaving—I hope for good.