Personal View: The ballad of the poor, young male
Authors: Des Spence
Journal: BMJ (2005)

Elvis Presley's song “In the Ghetto” always brings a lump to my throat. For the uninformed, the song's theme is the cycle of violence in which young black men in Chicago in the 1960s were trapped. It is the emotional inflection of Elvis's voice that moves me, which is odd, as he was a poor white southerner and so can't have known what life was like in the urban slums. My wife suggests that my sentimentality is borne of eating too much quiche in the 1980s and desperately juggling a small baby while shirtless.

In the song a mother finds her young son dead, “face down on the street with a gun in his hand”—sad stuff. The song is 40 years old, but in Glasgow this futility continues relentlessly, our young men dying in street violence. If not killed, many are beaten, “slashed,” or stabbed, and on most nights in casualty departments their broken bodies are strewed across trolleys. I have transfused, stitched, compressed their chests, and pronounced them dead.

If you're male and of the underclass in inner city Britain then watch out, because your life may well be poor, violent, and short. You will leave school at 15 with no qualifications. This in itself doesn't matter, because the real barrier is your complete lack of any life skills or social skills. You will be incapable of living independently and won't even have the basic ability to clean, cook, or pay bills. You will never understand how social systems work, and the height of achievement will be to get on “the sick.”

Your lack of understanding and communications skills means that even when minor problems arise you resort to what you know: aggression and violence. You may have a girlfriend, but when the baby comes along it's all too apparent that you have no parenting skills and can't cope. Your frustration is expressed through taking drugs and beating the only person who actually loved you. You never see her or your daughter again, but her brothers give you a beating just for good measure. Fair go. You seek refuge with your family but your addictions get the better of you. You start lying and thieving to get drugs so you can get a good “gouch on.” You get “papped out” and end up in a godforsaken hostel with a hundred other men you are not related to but each one of whom could in fact be your twin. You continue to steal and take drugs and end up in prison. Inside you get a beating just for looking at someone “the wrong way.” When you are released you get on a methadone script, but you haven't got anything to live for so go back to heroin. Your kind is vilified in the press. At each and every political party conference the leaders stand up and say that they going to get “tough on the causes of crime”—and, not to be too blunt, this means you. Get a job? Sure! But we all know that you're unemployable, because which job advertisement starts with “Seeking a stupid, inarticulate, aggressive ned.”




Figure 1





Life at the sharp end: weapons on sale in Glasgow

Credit: GETTY IMAGES




The years roll by, and you continue to steal, take drugs, and carry and use a blade. One Saturday night a younger version of you, aged 16, sticks a blade in your chest over an argument about football, the passion that is your only acceptable emotional outlet. One hour later the doctors walk away, having split your chest open but to no avail. “Just another dead ned,” they all think. Thank Christ, anyway, because even though you're only 27, in all likelihood you would have strung yourself up in the next few weeks. Your attacker gets 10 years and a ride on the merry-go-round that you've just left.

Nobody cares. This scenario is played out 24 hours a day, 365 days a year across the United Kingdom. You had two risk factors that when present together are a fatal combination: “maleness” and “poverty.” You're lucky if your death gets two lines in a local newspaper. You never had a single advocate other than those paid for through legal aid. You're not even worthy of a song, because your kind are the root of most social evils and your passing is a blessing to most of society.

I wonder if in fact that lump in my throat might be me choking on that bloody quiche. Enough of this emotional claptrap. Back to real medicine and legitimate risk factors such as cholesterol levels and diet.