In the 1950s and 60s, christenings of babies were important gatherings in the British summertime. They were one of those regular rituals that brought families together to drink warm German wine and to fall out with each other. Nearly everyone was christened, even if their parents had a lukewarm relationship with Christianity. I have only ever attended one christening, in 1965. The baby was Jonathan Bain, who is the son of my mother’s best friend. He retired recently. My family was uniformly and militantly atheist across all generations and remains so. My sister and I belonged to a tiny unbaptised minority at school. Beyond simple lack of faith, our parents believed that religion was a bad thing, and our father, in particular, was unusually forthright about it. Any clergyman who was foolish enough to try to engage with him about religion was given a hard time. As a young man, I felt that it was my duty to rescue people from their dangerous superstitions. I was far from successful in this endeavour. In defiance of a general social trend towards secularisation, a number of my friends changed from passive CofE to active Christianity in their early 20s.
Whilst I was working in Oxford, I made a conscious decision to give up proselytisation. Quite frankly, in the UK, mainstream Christianity has been dying on its arse for years. 50% of the UK population now describe themselves as having no religion. Roman Catholicism seems to be in the process of curling up and dying from the toxic effects of its institutional collusion with child abuse. There is no need for me to evangelise atheism, and I have come to feel that those who do so, like Richard Dawkins and Christopher Hitchens, are replicating one of the worst aspects of religion, namely a lack of respect for other peoples’ beliefs. I have known several people who have become chronically unhappy after losing their faith and I would not want to do that to anyone. This does not mean that my underlying ideas have changed. They have not. However, from when I was a medical student, I have felt that it is important that I should keep my strong personal convictions about religion and politics out of my relationship with patients. To fail to strive to do so would open the doors to abuses of power, proselytisation, and violations of therapeutic boundaries. It is a difficult discipline to adhere to, but patients come to doctors for help with ill-health, and the help they get should not vary according to the doctor’s personal convictions. Doctor-patient relationships should be characterised by tolerance and respect, not by permissiveness and a lack of boundaries
My personal, rather than my professional, position is that Christianity is totally at odds with evidence and reason. I can see no sign that Christians behave any better than anyone else, which is sufficient refutation on its own. Furthermore, some Christian ideas are ethically wrong; people are not born as tainted sinners, suffering does not improve people, and when it comes to rendering unto Caesar what is Caesar’s, well, Caesar was a tyrant who needed to be over thrown. On top of all this, the Church has been an instrument of class and imperial power throughout its history. This is neatly summarised in a quotation of uncertain provenance, usually attributed to either Desmond Tutu or Jomo Kenyatta:
When the missionaries came to Africa they had the Bibles and we had the land. They said ‘Let us pray.’ We closed our eyes. When we opened them, we had the Bibles and they had the land.
Whilst I have some profound differences with people of faith, I endeavour to be respectful of their beliefs, so long as they do not impose them on me or anyone else. I expect them to show the same respect to my beliefs that I show towards theirs. Unfortunately both of these conditions are quite difficult for some Christians to adhere to. A teacher once offended my daughter by saying that she felt sorry for atheists because they could not appreciate beauty. When we complained, a senior teacher said she could not understand why we were bothered because “You don’t believe in anything”. This was a ridiculous suggestion about a family as opinionated as ours. It often appears that beliefs are only respected by authority if they are intrinsically implausible
Although I disapprove of religion in general, my real beef is with Christianity. In the modern world, only the most fervent of evangelical missionary tries to convert people from a different faith, but an atheist is an abomination in the eyes of the Christian believer. No one from any faith other than Christianity has ever troubled me with a serious attempt at conversion, or made a big thing of praying for me against my objections. I have never had Muslims or Zoroastrians knock at my front door, bearing briefcases and unsettlingly white-toothed smiles, asking if I have heard the Good News. Earnest Christians have been a considerable nuisance in my life, and it is a bit late now to wonder who will rid me of these turbulent priests. In retrospect, they started to creep up on me when I was a medical student.
Monty Python’s film The Life of Brian, released during my last year at medical school, is generally regarded as one of the funniest films of all time. It has some really great jokes, such as “Blessed are the cheesemakers? What’s so special about them?” There is one outstandingly brilliant paradox-joke that is worthy of Bertrand Russell himself. Brian has been mistaken for the Messiah, and he cannot convince his followers that he is not (something very similar happened to Emperor Haile Selassie when he visited Jamaica in 1966, but that is another story). He tells a crowd that they are all individuals. The crowd chants back “We are all individuals!” except one, who shouts “I’m not!” This joke is so profound that there is a corresponding scenario in real life; for many years, the song that was most frequently played at funerals was Frank Sinatra’s hymn to rugged individualism, “My Way”. The deceased was a rugged individualist, just like everyone else.
The Life of Brian was a satire on cults and religion in general. Monty Python was itself a cult amongst my generation, and the film is by far the most well-realised artefact in their somewhat patchy oeuvre. Christianity, alarmed at the waning of its influence on British life, did not like it. Dyed-in-wool right-wing social conservatives such as Mary Whitehouse and Malcolm Muggeridge objected to the masses seeing the film, despite the fact that they had viewed it themselves without any sign of being corrupted or shaken in their faith. Nevertheless, there was a huge fuss and the film was banned by some local authorities.
As a child, I spent my summers in Suffolk. The Mayfair/Broadway in Bungay was a really charming flea pit cinema. It was tiny and unimproved since it was built in the 1930s. It was owned by a former bin man who manned the box office, sold the choc ices and worked the projector. There is a fantastic short video about the place which I strongly recommend you watch. In 1979, a friend and I stopped off in Bungay for a beer, and afterwards we went to see if the cinema was still open. It was. Alongside the posters for evening main features, there were adverts for the weekday lunchtime showings. From Monday to Thursday, there were porn movies with lurid titles. On Friday lunchtime they were showing The Life of Brian. The Friday advert was the only one carrying an advisory notice: “WARNING!! Customers may find this film offensive.”
During my final year, I had two general practice placements. The first was in a practice in Merton with a GP called Una Kroll. She was a slightly boundary-less woman with long grey hair worn loose. Chatting with her in the car as we travelled between home visits, it turned out that she was a campaigner for the ordination of women. If I had had any interest in religious matters, I might of heard of her, because she was a very well-known activist. As it was, until I met Dr Kroll, I did not know that feminism existed in the Church of England and I was unaware that there was a campaign for the ordination of woman. Dr Kroll was involved in a variety of other campaigns, including one against conversion treatments to change homosexual orientation. She was a Christian radical who aligned herself with marginalised people and we got on well. She made no effort to proselytise about religion, but she still managed to cause some turbulence in my life.
As an enthusiastic smoker of hand-rolled cigarettes, I was prone to chest infections, and I got one whilst I was working with Dr Kroll. Hearing my hacking cough, she prescribed me amoxycillin, an antibiotic. As a direct result, the following evening I developed symptoms of severe candidal balanitis, the male equivalent of vaginal thrush. That night was awful. I think that it is best that I do not linger on the full range of things that I did to try to stop the unbearable itching. In case anyone else is ever tempted, I can say with some authority that undiluted Dettol is not a good treatment for candidal balanitis. Quite apart from its ineffectiveness, it causes an alarming degree of desquamation. I got an anti-fungal cream from my own GP the next day, and I did not have the heart to tell Dr Kroll what had happened. It was a memorable illustration of the fact that even drugs that are generally regarded as benign can have very unpleasant side effects and that they should be used sparingly.
Una Kroll met her husband when she was an Anglican nun and he was a monk. They left their orders and married. She was eventually ordained in the late 1990s. After her husband died, she converted to Catholicism and became a nun again. Over the years, I would spot her occasionally on the TV, campaigning over one thing or another, and I had to admire her energy and her passion.
My other GP attachment was a strictly secular affair, but nevertheless it had some tricky moments. I was sent back to West Sussex, where I had done paediatrics a year earlier. The GP was a tall, muscular man who had children of primary school age. I stayed with him and his family in their old farmhouse, which was surrounded by extensive orchards. He was ex-military, having served in the SAS. When we were called out at night, he liked to take a short cut to the main road, driving his soft-top sports car at high speed between the trees. There was an awkward moment when his wife noticed that I had bought the Daily Telegraph, which I often did in order to do the crossword. They took the Telegraph too and assumed that I shared their political views. There was no option but to disabuse them. From their reaction to my explanation, it seemed likely that they had never had an actual socialist stay in their house before, but they got over it. The GP and I shared some musical interests. He was a big fan of Jimmy McGriff, a soul-jazz player with a similar style on the Hammond organ to the more celebrated Jimmy Smith. McGriff had adapted to the arrival of funk in the 1970s and I liked his work as part of my slow drift away from rock towards jazz. Soul-jazz, jazz-funk and Steely Dan were the gateway drugs.
I had to acknowledge that the GP was a good doctor, despite being right-wing. He had an old-fashioned personal commitment to his patients. We used to visit an old man with disseminated cancer, sometimes three times in one day, in order to keep him comfortable whilst he died at home, as was his wish. On one occasion, the GP was struggling to know how to help a child with cerebral palsy. We did a joint home visit with the paediatrician, Bud Robinson, who immediately recognised me from a year before. As we approached him in the street he called over “Rob Poole! Best medical student we’ve ever had!” and then he cadged a hand-rolled cigarette from me.
Another edgy secular episode around this time involved hang-gliding. There are many candidates to have invented hang-gliding, starting with Leonardo Da Vinci. It arrived in the UK at roughly the same time as Sony Walkmans and leg warmers. A company offered weekend introductory courses at the Devil’s Punchbowl, and when some of my friends asked me to join a group booking, I could see no reason not to go. Anyone sensible who knew me, aware of my clumsiness and general lack of coordination, would probably have taken a different view. My wife said she was working that weekend and did not come, but she did not discourage me from going. This is a little hard to understand as I did not have life insurance at the time. Sure enough, I was not a natural at hang-gliding, but I survived without permanent injury. I did not fly very high, but even five metres is quite high when there is just you and a large kite. I did not master landing on my feet, so I was repeatedly dragged through cow pats in controlled crash landings instead. Every time I took off, my friend (and future psychiatrist) David Marshall loudly chanted “Pigs In Space!”, which was a sketch from the Muppet Show. I have never felt moved to go hang-gliding again.
There were two chaplains at St George’s. I am not sure that I ever spoke to the Catholic chaplain, an Irish man in his 30s who tended to hang out at the medical school bar, smoking, drinking beer and chatting to the female members of his flock. The Anglican chaplain was Ian Ainsworth-Smith, a qualified psychotherapist who was a presence in the department of psychiatry during my student attachment and throughout my years at St George’s as a trainee psychiatrist. In the 1980s, we had a hospital flat on Clapham Common Westside, and Ian Ainsworth-Smith and his family were our next-door neighbours.
Ian certainly looked the part of a hospital chaplain, with a boyish demeanour, a ready smile and a thick Oxbridge accent, but his tendency to throw strong swearing into conversation undermined the clerical stereotype. He was a thoroughly decent man, and a good psychotherapist. He disrupted some of my more negative ideas about clergy. He told me that he was aligned with David Jenkins, at that time Bishop of Durham, a left-wing Bishop who was widely (but probably erroneously) regarded as a Christian atheist. Ian certain did not believe in the literal truth of the Bible, and yet he was unmistakably a believer. I used to tell him that, although his type of Christianity was superficial attractive, it was based on sophistry; it was a type of intellectual dirty trick to get around the incompatibility between religion and rationality. In the years that have followed, it is not Ian’s liberal Anglicanism that has attracted followers but Pentecostalism and fundamentalism, those forms of Christianity that are most strident in rejecting reason. Ian Ainsworth-Smith was the chaplain at St George’s for 33 years and eventually retired to the West Country. I was sad when I learned that he had died in 2021, just before his 80th birthday.
Amongst us medical students, religion was not generally a big issue, but there was a handful of committed Christians. One of them was a tall student who had grown up just a few miles from me in London, on the other side of the river in the East End. His name was Chris Cook, and when I first met him I thought that he looked like a young curate. I did not even know that he was a Christian at the time, so this was a good call. We were friendly with each other throughout the clinical course and I would not have believed that we would get locked in a slow waltz of disagreement that would last four and a half decades (so far). Chris is a man with a serious coffee habit who has done an impressive range of different things. He is a former professor of psychiatry, an ordained priest and a theologian. He received the Canterbury Cross from the Archbishop of Canterbury in 2020, and in 2021, the American Psychiatric Association gave him their Oskar Pfister Award. These awards were for his leadership of the movement to integrate religion into British psychiatric practice. I have worked very hard to thwart that movement.
As students, Chris and I could not resist locking horns in good-humoured but fierce debate about religion, which was pointless, because neither of us was likely to shift our opinions one inch. More recently, we have published papers separately and jointly about religion and psychiatric practice. Chris thinks that what matters is that we agree about most things. I insist that we have fundamental disagreements that are important. Herein lies one of the tortures that modern Christianity inflicts on the outspoken unbeliever. In 2010, Chris was chair of the Royal College of Psychiatrists Spirituality and Psychiatry Special Interest Group when they organised a debate between a former Archbishop of Canterbury, George Carey, and me (I’m not making this up). On that day, not only did George Carey tell me that he agreed with me about almost everything, but so did another opposing speaker, Andrea Minichiello Williams. Ms Williams is the Director of the Christian Legal Centre, an organisation apparently funded by the American evangelic right. They fund court cases in pursuit of right-wing fundamentalist Christian causes. They have received strong support from Nadine Dorries. I do not know how Andrea Williams came to think we agreed about anything at all. I have to admit that compared with Carey and Williams, Chris is quite presentable in polite society.
My objection to the integration of religion into clinical practice obviously has a relationship to my atheism, but from the outset it has been supported by some health professionals who do have a faith. My position is that people come to psychiatrists because they have an expertise that is underpinned by science and an explicit set of values. I do not deny that people find religion comforting when they are ill, but it is readily available from chaplains and others with religious expertise. There is no need for psychiatrists to do religion, and there are predictable potential harms. For example, in the xenophobic atmosphere of post-Brexit Britain, a Muslim confronted by a Christian psychiatrist who insists on deploying religion as part of the treatment could be expected to react with alarm. Conversely, praying with a patient of the same faith as the doctor implies a more-than-professional bond, which is a breach of the appropriate limits of the relationship and invites further boundary violations. This is not to suggest that patients’ faith is out of bounds, but, in my opinion, it should only ever be brought into the consulting room by the patient. Psychiatrists can legitimately enquire about the role of religion in a patient’s life, but there are no circumstances where religious ritual should be part of the consultation. To me, this all seems pretty obvious.
Like me, Chris married young, but his wife became seriously ill and died. For medical students, as for many health professionals, disease and death are things that happen to other people, and so this tragedy was really shocking. Chris went on to do research in the field of substance misuse, particularly on the Alcoholics Anonymous approach. One of the controversial aspects of the AA 12-step programme is the expectation of acceptance of concepts that derive from religion.
About 15 years ago, I started to organise mental health professionals to oppose the incorporation of religion into psychiatric practice, because it looked as if no one else was going to. I have ended up with an international profile as an advocate for secular medicine. Chris and I continue to waltz around each other in the pages of the peer reviewed journals, like the couples in the dance marathon in the great 1969 movie, They Shoot Horses, Don’t They? I fear that when I die, pissing off Christians is the only tangible achievement that will be mentioned in my obituary in the British Medical Journal.