Last week, a 17-year-old girl was admitted to my ward with such acute alcohol poisoning that she could scarcely breathe by her own unaided efforts, alcohol being a respiratory depressant. When finally she woke, 12 hours later, she told me that she had been a heavy drinker since the age of 12.

She had abjured alcohol for four months before her admission, she told me, but had just returned to the bottle because of a crisis. Her boyfriend, aged 16, had just been sentenced to three years' detention for a series of burglaries and assaults. He was what she called her "third long-term relationship"—the first two having lasted four and six weeks, respectively. But after four months of life with the young burglar, the prospect of separation from him was painful enough to drive her back to drink.

It happened that I also knew her mother, a chronic alcoholic with a taste for violent boyfriends, the latest of whom had been stabbed in the heart a few weeks before in a pub brawl. The surgeons in my hospital saved his life; and to celebrate his recovery and discharge, he had gone straight to the pub. From there, he went home, drunk, and beat up my patient's mother.

My patient was intelligent but badly educated, as only products of the British educational system can be after 11 years of compulsory school attendance. She thought the Second World War took place in the 1970s and could give me not a single correct historical date.

I asked her whether she thought a young and violent burglar would have proved much of a companion. She admitted that he wouldn't, but said that he was the type she liked; besides which—in slight contradiction—all boys were the same.

I warned her as graphically as I could that she was already well down the slippery slope leading to poverty and misery—that, as I knew from the experience of untold patients, she would soon have a succession of possessive, exploitative, and violent boyfriends, unless she changed her life. I told her that in the past few days, I had seen two women patients who had had their heads rammed down the lavatory, one who had had her head smashed through a window and her throat cut on the shards of glass, one who had had her arm, jaw, and skull broken, and one who had been suspended by her ankles from a tenth-floor window to the tune of, "Die, you bitch!"

"I can look after myself," said my 17-year-old.

"But men are stronger than women," I said. "When it comes to violence, they are at an advantage."

"That's a sexist thing to say," she replied.

A girl who had absorbed nothing at school had nevertheless absorbed the shibboleths of political correctness in general and of feminism in particular.

"But it's a plain, straightforward, and inescapable fact," I said.

"It's sexist," she reiterated firmly.

A stubborn refusal to face inconvenient facts, no matter how obvious, now pervades our attitude toward relations between the sexes. An ideological filter of wishful thinking strains out anything we'd prefer not to acknowledge about these eternally difficult and contested relations, with predictably disastrous results.

I meet with this refusal everywhere, even among the nursing staff of my ward. Intelligent and capable, as decent and dedicated a group of people as I know, they seem, in the matter of judging the character of men, utterly, almost willfully, incompetent.

In my toxicology ward, for example, 98 percent of the 1,300 patients we see each year have attempted suicide by overdose. Just over half of them are men, at least 70 percent of whom have recently perpetrated domestic violence. After stabbing, strangling, or merely striking those who now appear in medical records as their partners, they take an overdose for at least one of three reasons, and sometimes for all three: to avoid a court appearance; to apply emotional blackmail to their victims; and to present their own violence as a medical condition that it is the doctor's duty to cure. As for our women patients who've attempted suicide, some 70 percent have suffered domestic violence.

In the circumstances, it isn't altogether surprising that I can now tell at a glance—with a fair degree of accuracy—that a man is violent toward his significant other. (It doesn't follow, of course, that I can tell when a man isn't violent toward her.) In truth, the clues are not particularly subtle. A closely shaven head with many scars on the scalp from collisions with broken bottles or glasses; a broken nose; blue tattoos on the hands, arms, and neck, relaying messages of love, hate, and challenge; but above all, a facial expression of concentrated malignity, outraged egotism, and feral suspiciousness—all these give the game away. Indeed, I no longer analyze the clues and deduce a conclusion: a man's propensity to violence is as immediately legible in his face and bearing as any other strongly marked character trait.

All the more surprising is it to me, therefore, that the nurses perceive things differently. They do not see a man's violence in his face, his gestures, his deportment, and his bodily adornments, even though they have the same experience of the patients as I. They hear the same stories, they see the same signs, but they do not make the same judgments. What's more, they seem never to learn; for experience—like chance, in the famous dictum of Louis Pasteur—favors only the mind prepared. And when I guess at a glance that a man is an inveterate wife beater (I use the term "wife" loosely), they are appalled at the harshness of my judgment, even when it proves right once more.

This is not a matter of merely theoretical interest to the nurses, for many of them in their private lives have themselves been the compliant victims of violent men. For example, the lover of one of the senior nurses, an attractive and lively young woman, recently held her at gunpoint and threatened her with death, after having repeatedly blacked her eye during the previous months. I met him once when he came looking for her in the hospital: he was just the kind of ferocious young egotist to whom I would give a wide berth in the broadest daylight.

Why are the nurses so reluctant to come to the most inescapable of conclusions? Their training tells them, quite rightly, that it is their duty to care for everyone without regard for personal merit or deserts; but for them, there is no difference between suspending judgment for certain restricted purposes and making no judgment at all in any circumstances whatsoever. It is as if they were more afraid of passing an adverse verdict on someone than of getting a punch in the face—a likely enough consequence, incidentally, of their failure of discernment. Since it is scarcely possible to recognize a wife beater without inwardly condemning him, it is safer not to recognize him as one in the first place.

This failure of recognition is almost universal among my violently abused women patients, but its function for them is somewhat different from what it is for the nurses. The nurses need to retain a certain positive regard for their patients in order to do their job. But for the abused women, the failure to perceive in advance the violence of their chosen men serves to absolve them of all responsibility for whatever happens thereafter, allowing them to think of themselves as victims alone rather than the victims and accomplices they are. Moreover, it licenses them to obey their impulses and whims, allowing them to suppose that sexual attractiveness is the measure of all things and that prudence in the selection of a male companion is neither possible nor desirable.

Often, their imprudence would be laughable, were it not tragic: many times in my ward I've watched liaisons form between an abused female patient and an abusing male patient within half an hour of their striking up an acquaintance. By now, I can often predict the formation of such a liaison—and predict that it will as certainly end in violence as that the sun will rise tomorrow.

At first, of course, my female patients deny that the violence of their men was foreseeable. But when I ask them whether they think I would have recognized it in advance, the great majority—nine out of ten—reply, yes, of course. And when asked how they think I would have done so, they enumerate precisely the factors that would have led me to that conclusion. So their blindness is willful.

Today's disastrous insouciance about so serious a matter as the relationship between the sexes is surely something new in history: even 30 years ago, people showed vastly more circumspection in the formation of liaisons than they do now. The change represents, of course, the fulfillment of the sexual revolution. The prophets of that revolution wished to empty the relationship between the sexes of all moral significance and to destroy the customs and institutions that governed it. The entomologist Alfred Kinsey reacted against his own repressed and puritanical upbringing by concluding that all forms of sexual restraint were unjustified and psychologically harmful; the novelist Norman Mailer, having taken racial stereotypes as seriously as any Ku Klux Klansman, saw in the supposedly uninhibited sexuality of the Negro the hope of the world for a more abundant and richer life; the Cambridge social anthropologist Edmund Leach informed the thinking British public over the radio that the nuclear family was responsible for all human discontents (this, in the century of Hitler and Stalin!); and the psychiatrist R. D. Laing blamed the family structure for serious mental illness. In their different ways, Norman O. Brown, Paul Goodman, Herbert Marcuse, and Wilhelm Reich joined in the campaign to convince the Western world that untrammeled sexuality was the secret of happiness and that sexual repression, along with the bourgeois family life that had once contained and channeled sexuality, were nothing more than engines of pathology.

All these enthusiasts believed that if sexual relations could be liberated from artificial social inhibitions and legal restrictions, something beautiful would emerge: a life in which no desire need be frustrated, a life in which human pettiness would melt away like snow in spring. Conflict and inequality between the sexes would likewise disappear, because everyone would get what he or she wanted, when and where he or she wanted it. The grounds for such petty bourgeois emotions as jealousy and envy would vanish: in a world of perfect fulfillment, each person would be as happy as the next.

The program of the sexual revolutionaries has more or less been carried out, especially in the lower reaches of society, but the results have been vastly different from those so foolishly anticipated. The revolution foundered on the rock of unacknowledged reality: that women are more vulnerable to abuse than men by virtue of their biology alone, and that the desire for the exclusive sexual possession of another has remained just as strong as ever. This desire is incompatible, of course, with the equally powerful desire—eternal in the human breast but hitherto controlled by social and legal inhibitions—for complete sexual freedom. Because of these biological and psychological realities, the harvest of the sexual revolution has not been a brave new world of human happiness but rather an enormous increase in violence between the sexes, for readily understandable reasons.

Of course, even before any explanation, the reality of this increase meets angry denial from those with a vested ideological interest in concealing the results of changes they helped to bring about and heartily welcome. They will use the kind of obfuscation that liberal criminologists so long employed to convince us that it was the fear of crime, rather than crime itself, that had increased. They will say (quite rightly) that violence between men and women has existed always and everywhere but that our attitude toward it has changed (perhaps also correct), so that it is more frequently reported than formerly.

Still, the fact remains that a hospital such as mine has experienced in the last two decades a huge increase in the number of injuries to women, most of them the result of domestic violence and many of them of the kind that would always have come to medical attention. The increase is real, therefore, not an artifact of reporting. About one in five of the women aged 16 to 50 living in my hospital's area attends the emergency department during the year as a result of injuries sustained during a quarrel with a boyfriend or husband; and there is no reason to suppose that my hospital's experience is any different from that of another local hospital, which, together with mine, provides medical attention for half the city's population. In the last five years, I have treated at least 2,000 men who have been violent to their wives, girlfriends, lovers, and concubines. It seems to me that violence on such a vast scale could not easily have been overlooked in the past—including by me.

And there is very good reason why such violence should have increased under the new sexual dispensation. If people demand sexual liberty for themselves, but sexual fidelity from others, the result is the inflammation of jealousy, for it is natural to suppose that one is being done by as one is doing to others—and jealousy is the most frequent precipitant of violence between the sexes.

Jealousy has always been a feature of the relations between men and women: Othello, written four centuries ago, is still instantly comprehensible to us. But I meet at least five Othellos and five Desdemonas a week, and this is something new, if the psychiatric textbooks printed a few years ago were right in claiming that jealousy of the obsessive sort was a rare condition. Far from being rare, it is nowadays almost the norm, especially among underclass men, whose fragile sense of self-worth derives solely from possession of a woman and is poised permanently on the brink of humiliation at the prospect of losing this one prop in life.

The belief in the inevitability of male jealousy is one of the main reasons my violently abused women patients do not leave the men who abuse them. These women have experienced three or four such men in succession, and it hardly makes sense to exchange one for another. Better the abuse you know than the abuse you don't. When I ask whether they'd be better off without any man at all than with a male tormentor, they reply that a single woman in their neighborhood is seen as an easy prey to all men, and, without her designated, if violent, protector, she would suffer more violence, not less.

The jealousy of the men—and the passion is commoner in men, though women are catching up and becoming violent in turn—is a projection onto women of their own behavior. The great majority of the jealous men I meet are flagrantly unfaithful to the object of their supposed affections, and some keep other women in the same jealous subjection elsewhere in the city and even 100 miles away. They have no compunction about cuckolding other men and actually delight in doing so as a means of boosting their own fragile egos. As a result, they imagine that all other men are their rivals: for rivalry is a reciprocal relationship.

Thus, a mere glance in a pub directed at a man's girlfriend is sufficient to start a fight not only between the girl and her lover but, even before that, between the two men. Serious crimes of violence continue to rise in England, many of them occasioned by sexual jealousy. Cherchez la femme has never been a sounder guide to explaining attempted murder than it is today; and the extremely fluid nature of relations between the sexes is what makes it so sound a precept.

The violence of the jealous man is not always occasioned by his lover's supposed interest in another man, however. On the contrary, it serves a prophylactic function and helps to keep the woman utterly in thrall to him until the day she decides to leave him: for the whole focus of her life is the avoidance of his rage. Avoidance is impossible, however, since it is the very arbitrariness of his violence that keeps her in thrall to him. Thus, when I hear from a female patient that the man with whom she lives has beaten her severely for a trivial reason—for having served roast potatoes when he wanted boiled, for example, or for having failed to dust the top of the television—I know at once that the man is obsessively jealous: for the jealous man wishes to occupy his lover's every thought, and there is no more effective method of achieving this than his arbitrary terrorism. From his point of view, the more arbitrary and completely disproportionate the violence, the more functional it is; and indeed, he often lays down conditions impossible for the woman to meet—that a freshly cooked meal should be waiting for him the moment he arrives home, for instance, though he will not say even to within the nearest four hours when he is arriving home—precisely so that he may have an occasion to beat her. Indeed, so effective is this method that the mental life of many of the violently abused women who consult me has focused for years upon their lovers—their whereabouts, their wishes, their comforts, their moods—to the exclusion of all else.

When finally she leaves him, as she almost always does, he regards it as an act of the utmost perfidy and concludes that he must treat his next female companion with even greater severity to avoid a repetition. Observing the fluidity of the sexual relationships around him and reflecting upon his own recent experience, he falls prey to a permanent sexual paranoia.

Worse still, the social trend to these kinds of relationships is self-reinforcing: for the children they produce grow up supposing that all relationships between men and women are but temporary and subject to revision. From the very earliest age, therefore, the children live in an atmosphere of tension between the natural desire for stability and the emotional chaos they see all around them. They are able to make no assumption that the man in their lives—the man they call "Daddy" today—will be there tomorrow. (As one of my patients put it when talking of her decision to leave her latest boyfriend, "He was my children's father until last week." Needless to say, he was none of the children's biological father, all of the latter having departed long before.)

A son learns that women are always on the point of leaving men; a daughter, that men are not to be relied upon and are inevitably violent. The daughter is mother to the woman: and since she has learned that all relationships with men are both violent and temporary, she concludes that there is not much point in taking thought for the morrow as far as choosing men is concerned. Not only is there little difference between them except in the accidental quality of their physical attractiveness to her, but mistakes can be rectified by the simple expedient of abandoning the man, or men, in question. Thus, sexual relationships can be entered into with no more thought than that devoted to choosing breakfast cereal—precisely the ideal of Kinsey, Mailer, et al.

But why does the woman not leave the man as soon as he manifests his violence? It is because, perversely, violence is the only token she has of his commitment to her. Just as he wants the exclusive sexual possession of her, she wants a permanent relationship with him. She imagines—falsely—that a punch in the face or a hand round the throat is at least a sign of his continued interest in her, the only sign other than sexual intercourse she is ever likely to receive in that regard. In the absence of a marriage ceremony, a black eye is his promissory note to love, honor, cherish, and protect.

It is not his violence as such that causes her to leave him, but the eventual realization that his violence is not, in fact, a sign of his commitment to her. She discovers that he is unfaithful to her, or that his income is greater than she suspected and is spent outside the home, and it is only then that his violence seems intolerable. So convinced is she that violence is an intrinsic and indispensable part of relations between the sexes, however, that if by some chance she alights next time upon a nonviolent man, she suffers acute discomfort and disorientation; she may, indeed, even leave him because of his insufficient concern for her. Many of my violently abused women patients have told me that they find nonviolent men intolerably indifferent and emotionally distant, rage being the only emotion they've ever seen a man express. They leave them quicker than they leave men who have beaten and otherwise abused them.

The sexual revolutionaries wanted to liberate sexual relations from all but the merest biological content. Henceforth such relations were not to be subject to restrictive bourgeois contractual arrangements—or, heaven forbid, sacraments—such as marriage; no social stigma was to attach to any sexual conduct that had hitherto been regarded as reprehensible. The only criterion governing the acceptability of sexual relations was the mutual consent of those entering upon them: no thought of duty to others (one's own children, for example) was to get in the way of the fulfillment of desire. Sexual frustration that resulted from artificial social obligations and restrictions was the enemy, and hypocrisy—the inevitable consequence of holding people to any standard of conduct whatsoever—was the worst sin.

That the heart wants contradictory, incompatible things; that social conventions arose to resolve some of the conflicts of our own impulses; that eternal frustration is an inescapable concomitant of civilization, as Freud had observed—all these recalcitrant truths fell beneath the notice of the proponents of sexual liberation, dooming their revolution to ultimate failure.

The failure hit the underclass hardest. Not for a moment did the sexual liberators stop to consider the effects upon the poor of the destruction of the strong family ties that alone made emergence from poverty possible for large numbers of people. They were concerned only with the petty dramas of their own lives and dissatisfactions. But by obstinately overlooking the most obvious features of reality, as did my 17-year-old patient who thought that men's superior physical strength was a socially constructed sexist myth, their efforts contributed in no small part to the intractability of poverty in modern cities, despite vast increases in the general wealth: for the sexual revolution has turned the poor from a class into a caste, from which escape is barred so long as that revolution continues.