Darryl was a difficult patient I had been treating for several years. A stocky man in his forties, he shuffled into each appointment with a walking stick. At first sight, the stick gave him a distinguished quality, but then a trace of his bare belly showed beneath a T-shirt that never quite covered his bulging gut.
Every appointment would begin the same way.
“How are you travelling, Darryl?” I’d ask.
“Yeah, alright,” he’d mumble. “F— insurance pissing me off as usual.”
Darryl was being funded through worker’s compensation after suffering a crush injury to his lower back while lifting crates in a factory. He underwent several operations to insert plates and metal rods in his spine, to the point where scans of his spine resembled a construction site, but his pain and mobility showed few signs of improvement.
His employer had kept him on “light duties”, which was essentially a euphemism for doing the most basic paperwork, but the factory shut down after the manufacturing shifted overseas. He was made redundant but continued to receive compensation payments while he looked for work.
There is an important term in mental health therapy called transference, which refers to the reactions patients arouse in therapists. A good therapist is aware and can override such emotions but also consider them as information about how the patient might affect other people. My mix of mild disdain and sympathy was awoken each time Darryl visited. He was the epitome of the bogan, the kind of person the middle classes belittle and try to avoid.
Darryl often wore striped football shirts and a beanie to appointments, even during the height of summer. He said it was to cover an emerging bald spot. He was the only patient to give me a beer coaster as a Christmas present, which I treasure. He even had a name for his penis, which he not so imaginatively called Rod, a name that emerged in our sessions if sexual side-effects were being discussed. It was one area of his life where he retained a sense of humour.
His childhood memories included his father taking him to the greyhound races. He was able to give a vivid account of the trips, despite having few words for his emotions. “The bookies were loud. They’d be screaming the odds before the bloody hare came out. I remember some dog called Leotard that won at odds of twenty to one. We won a motza and my dad bought me a massive tub of ice cream,” he said with a stealthy grin.
But Darryl’s father, a carpenter, also suffered a work injury and turned to alcohol. He grew violent and started beating his wife, Darryl’s mother, a resourceful woman who worked as an aged-care nurse. She eventually left him, taking Darryl and his younger sister with her.
Darryl had at least one good decade, when he was married to his first wife, had two young children and a traineeship with Telecom. He was proud of his time working with the company during the Sydney Olympics, but he was made redundant soon after. The marriage ended and his children became more distant. He claimed he could never tell them that it was their mother who was unfaithful, leading to his vengeful outbursts in the home. His mood only worsened when his factory job was also stymied.
Now, in my rooms, he was a ball of suppressed rage, usually projected internally in the form of vague thoughts of harming himself, and made worse after he had consumed his evening round of five or six stubbies of beer. He once took an overdose of a prescribed tranquiliser after his new partner threatened to leave him, a prospect that was looking imminent if he didn’t show some improvement.
“It helps me sleep,” he says, in reference to his drinking. “If I take more of those pain meds, I can’t shit no more.”
Despite his efforts to control his rage, it would surface at inopportune times. He had been banned from his stepdaughter’s primary school for fighting with the teachers, once because he thought too many merit certificates were being handed out—“It makes the kids soft”—and once for verbally abusing the middle-aged woman supervising the pedestrian crossing. “She should have let me cross,” he insisted. “There weren’t any f— cars.”
When he drove, Darryl would regularly find himself in heated bouts of road rage, once limping out of his car to threaten another driver for tailing him too closely. He admitted to casually swerving in the direction of people he didn’t like the look of. “I like to give ’em a scare, especially if they look a bit up themselves.”
On the rare occasions he visited the local shops, he was livid at the demographic changes in the area, a place his extended family had resided in for several generations. So many black and Asian faces, too many fancy designer labels and too few people or organisations backing people like him. “There’s outfits helping out refugees everywhere, on every bloody corner,” he railed. “They get extra money at school and everything.”
His sense of displacement was most tangibly felt through his regular tussles with the insurance company paying his benefits, his attempts to have treatments approved and to receive his regular allowance. His mental state was one of free-floating anger that latched onto just about any aspect of his immediate environment and identified it as an enemy.
It is not difficult to see the fragmented rage of people like Darryl as a factor in the rise of political phenomena such as Donald Trump, Brexit and Pauline Hanson. Dissatisfied with the “system”, but with only vague plans for improvement, they represent a pining for simpler collective identities such as the nation.
The Left had its foundations on the valorisation of the working class in the twentieth century, but it has now abandoned them to some degree, and they now hold some of the most conservative social views of any group, particularly on race. Debates on racism are an area where the sneering at the working classes is most obvious. The representations of people attending patriotic protests are an obvious example. The protesters are depicted in tattooed, pierced splendour holding angry signs at racist rallies.
An accusation of racism is often veiled class-sneering, using Muslims and other ethnic groups as cover, evidence of French philosopher Pascal Bruckner’s observation that multiculturalism is sometimes the racism of the anti-racists. What progressive groups fail to realise is that by their expressions of concern for ethnic groups, and thereby separating themselves from the unsophisticated people who don’t express adequate sympathy, progressives are effectively clearing a space for themselves to enjoy the advantages of white privilege.
Patients like Darryl are an indicator that no collective group or organisation, other than perhaps the football leagues, is actively representing the white working class. Race-based politics has helped entrench the resentment, for it has led the working class to view themselves as an aggrieved racial group left out in the cold.
Men like Darryl may present for treatment because they are also the group least likely to manage the transition that is necessary for all men in response to changing sexual norms. There is an expectation for men to be available emotionally to their partners and children, and to take on more housework. Yet most feminist groups and even the psychiatric classification system don’t easily incorporate rage as a legitimate expression of emotional distress because there is a belief that it will diminish accountability, particularly in areas such a domestic violence. But as psychiatric patients presenting before the law demonstrate, a more nuanced view that incorporates both responsibility and therapy is possible.
As someone from a very different ethnic background from patients like Darryl, I find it particularly interesting to examine racial resentments. Those who express anti-immigration views will often express admiration and affection for authority figures of other ethnicities in their lives, such as their family doctor, but simultaneously harbour anger towards migrants in general.
After the shock of the Brexit outcome in Britain there was a swathe of studies attempting to make links to a wider worldview that supporters may have held, all in a desperate clamour to understand the seemingly inexplicable. A common overlap for supporters was broader authoritarian views, notably support for the death penalty.
As a psychiatrist, such a turn towards authoritarian certainty makes me think of the place of fathers in my patients’ lives. I find it instructive that the handful of my patients with strong ties to anti-immigration groups had limited or ambivalent links with their fathers. Darryl did not have any organised links with racist groups but held similar views.
Another patient of mine, Drago, developed strong links to a group similar to Reclaim Australia, which wants to end Muslim immigration. He was a tall, lanky man raised by a devoted single mother. He pined for his Serbian father, who lived interstate with a new partner. Drago was referred to me from a disability employment agency because, unable to tolerate any kind of frustration, he couldn’t hold down a job. His frustration automatically spilled over into rage, rendering him incapable of handling interactions with authority and negotiating with co-workers.
When I asked Drago about hobbies and interests, I discovered he had formed a group with some local friends which they called the “Slavic brotherhood”. The members of the group had all been raised with little or no presence of their fathers. Did they notice this shared background, I asked? Drago shrugged and agreed, but didn’t think it was a big deal.
The rise of anti-elite, authoritarian figures like Trump appears to represent a yearning for a generation of men derived from the highest proportion of fatherless households in modern history. Without a clear acknowledgment of this deficit or an appropriate channelling into alternative forms of collective identity, such groups will look to assert their group identity through outlets of resentment and authoritarian certainty such as anti-immigration organisations or men’s rights movements.
Reihan Salam, a co-author of Grand New Party: How Republicans Can Win the Working Class and Save the American Dream, writes of an “asymmetrical multiculturalism” whereby minorities are encouraged to celebrate their identity and defend their interests while the majority are discouraged from doing the same. Outward displays of Italian, Indian or Muslim pride are fine, but the same for Anglo-Saxons is unacceptable. Salam believes that due to the white majority being denied the option of celebrating their ethnic heritage, they’re reduced to championing ideological causes like free speech and the rule of law, stripped of any cultural content. These are worthy goals, but they can also indicate a suppressed nationalism without alternative outlets.
In his book Angry White Men, the American sociologist Michael Kimmel coins the term “aggrieved entitlement” as a way of describing the losses felt by the white working class, particularly around their power as males in the household, the dilution of their political power in the face of demographic shifts towards ethnic groups, and their economic disempowerment in the face of globalisation. He describes visiting neo-Nazis, wife-beaters and angry divorced men, and argues that such men are failing to make the adjustment to a world where they must be equals.
There is certainly truth to this analysis, but it is also in danger of applying one of the most common accusations leftists make of conservatives: that they lack empathy for the disadvantaged. By continuing to view working or underclass men through the lens of gender or race and not through class or economic entity, it seems that resentments will only be further inflamed and the whittling away of the foundations of the historical Left will continue.
The Scottish novelist Andrew O’Hagan argues that the English working class is dead, its traditions and values replaced by sentimentality and the illusory promises of credit cards and celebrity. Unlike the Scots and the Irish, who were an innate community held together by songs and speeches about themselves, said O’Hagan, “the English were something else: a riot of individualism, with no sense of common purpose or collective volition as a tribe”.
It is possible that Australians exist somewhere in between, with some overlaps with the Scots and Irish in developing a tribal, light-hearted oppositional identity to the English motherland but also exhibiting a greater individualism born of a stronger cultural influence from America. But with the decline of unions and manufacturing across the Western world, it is difficult to see what traditions, habits and speech bind this amorphous group.
Economically the white working class have much in common with newly arrived immigrants, but they seldom have the same drive and determination to rise up the social ladder. The working class is perhaps now a holding bay for those transitioning to the middle class, with a portion falling through the cracks to take their place in the entrenched, welfare-dependent underclass.
An under-recognised aspect of social class and Australian life is noticeable in my work in rural areas. For me this kind of work has been fly-in and fly-out, like so many miners, but wearing cardigans instead of fluorescent vests. Working in regional towns is some of the most rewarding work a doctor can engage in. There is a special Australian quality to the specialist flying in from the city to a small town and flying out again in the evening. The airline attendants sometimes delay the flight while they wait for me to rush across the tarmac after finishing my final consultation of the day. Likewise, the rural farmer striving for self-sufficiency against the elements is a quintessential symbol of the modern male and his psychological battles.
The patients are grateful to see a city specialist. The small interventions can transform lives, from switching to a tablet with more tolerable side-effects to explaining the origin of their psychic distress. But there can be a slapdash element to it given the enormous demand, time constraints and diminished resources. For all its benefits, the service is another example of long-term mental health therapy and its slower unravelling of self-knowledge not being as accessible to the relatively poor.
While many residents in regional towns have lived there for generations, a great deal of the migration is evidence of other trends, from a geographic trickle outwards of the disadvantaged—the disability pension goes a lot further in Bourke than Blacktown—to the white flight from the big cities. When my parents upgraded our family home from Toongabbie to the leafier suburb of Epping in the early 1990s, I didn’t consider that the elderly couple who then moved to the Central Coast were the beginning of a longer-term demographic trend.
Many of the patients I see in regional areas are searching. They are sometimes escaping disastrous marriages or family breakdowns, looking to start afresh, perhaps with some extended family support. Many are looking for some idea of community that they felt was no longer available in the big city. The idealised image of the tightly-knit rural town is not as accurate it used to be. Fewer people make a living from the land, more women have jobs outside the home and people increasingly gain a sense of community from online networks based on mutual interests. But a common thread that reminded me of the grievances of patients like Darryl was the pining for a sense of the local, a feeling of belonging where they lived.
When English supporters of Brexit were interviewed, a common theme was they no longer felt they belonged in the communities they lived in. There were tinges of racism in these stories, with tales of walking to the shops and only hearing Polish or Romanian and no longer recognising others on the street. There is a nostalgia for the past in such stories that borders on fantasy, but they are nevertheless the lived experience of many.
Patients like Darryl express similar views. When Darryl walked to the local shopping centre he felt like a member of a minority group in the place where his family had lived for generations. He noticed signs and organisations advocating for newly arrived immigrant groups such as asylum seekers. Any sense of being part of a collective was limited to buying his Lotto ticket or watching his footy team on the weekend. Given Darryl’s psychological frailty, he was not indicative of the majority. Most people are adapting, but his inner concerns were pointers to wider trends in dissatisfaction among his demographic group.
A British sociologist, Will Davies, writes that the Leave campaign slogan “Take Back Control” was ingenious because of the way people like Darryl felt. Their inner experience was one of what is known in psychology as “learned helplessness”, where sufferers feel like a rickety boat being tossed around in choppy waters. This diagnosis has traditionally been applied to survivors of trauma, particularly women subjected to long-term domestic violence. But in politics as used by Trump, the Leave campaign and to some extent Pauline Hanson, the slogan spoke directly to the inadequacy and embarrassment felt by the white working-class man and magnified by the sneering of the inner-city bourgeoisie. As Davies writes, what such voters crave more than anything else is “the dignity of being self-sufficient, not necessarily in a neo-liberal sense, but certainly in a communal, familial and fraternal sense”.
I used to think that attempting to engage with patients like Drago and Darryl, trying to help them gain insight into their coping deficits, was doomed to failure, that they were not psychologically minded. But experience has taught me otherwise, that men of limited education, few words and diminished resources are capable of engaging in individual analysis. This does not, however, address the wider dimension of their position. Changes in political economy have affected working men disproportionately, and the wider project of helping them gain a greater mastery of their emotions and, in turn, their lives, is a worthy social goal. The individual versus society is a more relevant struggle for most than that of labour versus capital.
Unfortunately I was not able to keep Drago in any kind of therapy, but the disability agency informed me that the addition of a medication that helped reduce his impulsivity and increase his tolerance of frustration allowed him to hold down a job in a car wash. It wasn’t a dream job, but it gave him some structure and purpose. I doubt he took much notice of my interpretations regarding his fatherlessness, but I’m confident his anger towards other racial groups was tempered once he was able to maintain some kind of employment.
Darryl, on the other hand, was a difficult but eventual success story. Instead of projecting his rage outwards he was able to see that his own failures of communication and regulating his mood were major contributors to the direction his life had taken. The moral, individual dimension of his problems became more apparent, mediated through the process of therapy and psychiatric medication. He managed to keep his new partner—just—and he had initiated contact with his children after many years.
This is an edited extract from Dr Tanveer Ahmed’s new book Fragile Nation: Vulnerability, Resilience and Victimhood, published last month by Connor Court.