When reading, I often have an experience of a small phrase triggering my memory and making a connection between the page in front of me and something I’ve read previously, either recently or many years ago. One example of this came from David Schmidtz’s recent (and excellent) book Living Together: Inventing Moral Science. The phrase in question was about giving someone their due, and it brought to mind a time when I read that phrase being used to characterize a very different mindset than the one Schmidtz describes.

The older example, brought back to my memory while reading Schmidtz’s book, comes from an essay written by the British physician Theodore Dalrymple years ago. Dalrymple writes how doctors from impoverished countries will regularly come to England “to work for a year’s stint at my hospital.” He describes how these doctors start out “uniformly enthusiastic about the care that we unsparingly and unhesitatingly give to everyone, regardless of economic status.” Yet, says Dalrymple, by “the end of three months my doctors have, without exception, reversed their original opinion that the welfare state, as exemplified by England, represents the acme of civilization. On the contrary, they see it now as creating a miasma of subsidized apathy that blights the lives of its supposed beneficiaries.”
One step along the process Dalrymple outlines is when these doctors begin to ask “why so few people seemed grateful for what was done for them.” Dalrymple in turn suggests when “every benefit received is a right, there is no place for good manners, let alone for gratitude.” Dalrymple uses an example of one patient who arrived near death, and who “required intensive care to revive him, with doctors and nurses tending him all night.” Upon awakening, this patient treated the staff with a continuous stream of contempt and abuse. These transfer doctors initially “assume that the cases they see are a statistical quirk, a kind of sampling error, and that given time they will encounter a better, more representative cross section of the population. Gradually, however, it dawns upon them that what they have seen is representative.” As for this patient, Dalrymple says, there was “no acknowledgment of what had been done for him, let alone gratitude for it. If he considered that he had received any benefit from his stay at all, well, it was simply his due.”
Simply his due. That was the mindset many come to absorb from a lifetime of living in a welfare and entitlement state. The idea that the labor and efforts of other people is something one is entitled to benefit from, by right, while owing them nothing in return. Because why would I owe anything to these people, when I’m entitled by right to receive the benefits of their work? They aren’t doing anything special for me deserving of compensation, gratitude, or even acknowledgement – they’re just giving me what I’m already owed, what is by right mine to take and which third parties can properly force them to provide if they won’t do it willingly.
A very different picture of giving one their due comes from Schmidtz’s work, where he points out that Adam Smith’s famous phrase “It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own self-interest. We address ourselves not to their humanity but to their self-love, and never talk to them of our own necessities, but of their advantages,” is not, as some careless readers have taken it, a suggestion that people are only motivated to help each other out of self-interest. As Schmidtz puts it:
Second, it makes perfect sense for the author whose first book treated benevolence as primary to subsequently ask how to respond benevolently to trading partners. Why, as a benevolent person hoping to truck and barter with brewers and bakers, do you address their self-love? Answer: because you want them to be better off for having come to you. Notice that Smith does not say bakers are motivated solely by self-love. He says we address ourselves not to their benevolence but their self-love (WN, Book I, chap. 2). This is a reflection on our psychology, not theirs. He is offering insight not into the self-love of bakers but into what it takes to be benevolent in our dealings with them.
In sum, the author of Moral Sentiments gives center stage to virtue and benevolence, but, in elaborating what benevolence means, the author of Wealth of Nations belabors the obvious: namely, a man of true benevolence wants his partners to better off with him than without him. The point of addressing other people’s self-love is to give other people their due. That is what it’s like to succeed in one’s attempt to be sympathetic.
Here, Schmidtz highlights what is wonderfully humanizing and noble about markets and market exchange. Markets encourage us to see other people not merely as servants to our needs, from whom we are entitled to take and to whom we own nothing in return. Markets encourage us to make ourselves better off by making other people better off as well, by providing them what they want and what they value. Some of the less insightful critics of capitalism charge markets with encouraging greed and selfishness – but it’s not so. Markets profoundly encourage us to treat people as they want to be treated and makes improving the lives of those around us the central means by which we improve our own lives in turn.
The welfare state, by contrast, is a means by which we seek to better our own situation at the expense of our neighbors, and at the expense of our community. And as Adam Smith well understood, and as David Schmidtz correctly reiterates, a person of true benevolence and true sympathy, who wishes to give other people their due, will clearly see the dignity of market exchange and the vanity of the welfare state.
READER COMMENTS
steve
Jul 7 2023 at 1:10pm
I think welfare state is most commonly referred to when the govt provides for those in need. Comparing it to markets doesnt make much sense. If you want to say markets are superior to planned economies that makes sense and markets are clearly better in the very late majority of cases.
Dalrymple is mostly wrong I believe. Not exactly what i have seen over a career in medicine about as long as his. There is no shortage of well to do patients who are ungrateful, to say the least. Many of the Medicaid pts are grateful. If you treat people well and talk to them with respect and understanding most people respond well (drug addicts being a broad exemption). People do tend to remember when it is a welfare pt acts up, but over the years the people who actually complain the most are not welfare pts. but paying patients. One of my favorites was the wife of a local car dealer who was in a major trauma, nearly died in the oR twice, had along stay in our ICU never, was generally rude to staff and we got a letter complaining that people twice had trouble starting IVs and she didnt like the hospitals gluten free dietary options. Since her husband was paying a lot she thought she should get better care.
That said, I do see more problems with our FMGs. They miss a lot of the cultural cues and people have trouble understanding them sometimes. I do too for that matter.
Steve
Kevin Corcoran
Jul 7 2023 at 4:34pm
Hi Steve –
I think you might be overlooking the larger point. The subject here isn’t really about whether paying patients complain more than Medicaid patients, or anything along those lines. It’s not even about medical care per se – nor was Dalrymple’s essay about the effects of medical care, free or otherwise. If you read his essay, you’ll see was about the welfare state itself, as a system where, as you say, “the govt provides for those in need.” As he writes:
And it is this system of having the government provide for those in need – indeed, provide everything for those in need, even entertainment, that Dalrymple argues has the kind of deleterious effects he has witnessed over his life. In discussing the behavior of one particular patient with another doctor, he reports the following exchange:
Dalrymple argues, and I agree, that when the government “provides for those in need,” as you put it, it has real effects on their life, outlook, and their capacity for self-management and self-respect, and not good effects either. As he put it:
steve
Jul 8 2023 at 10:08pm
Hi Kevin- I first read that essay over 20 years ago.Someone recommends every couple years as they think it insightful. AS I said I have been in medicine in some capacity about as long as Dalrymple. In my earlier career I did many home visits in Philadelphia including going to the “projects”. In homes hit by drug abuse what he describes is pretty accurate. For those not hit by drugs it doesnt hold so much. Many people did cook, may ate together. Lots of mothers were making pretty heroic efforts to keep their kids away from gangs and drugs. So back then I could have taken you to blocks that looked similar to what he describes and other blocks where the sidewalks were swept and home exteriors neat, if shabby. It’s just not as uniform as he claims, at least not in the US. (Was stabbed and shot at in those areas so I am not saying they dont have bad actors, but tarring everyone with such a broad brush is not true based upon my experience.)
Your quoted section purports to show that the residents detest the welfare state after 3 months because no one said thank you. I would say that in general if you work in urban hospitals you shouldn’t expect people to say thank you. If you want that go to rural areas where poor and better off people often say thank you.
Finally, note that Dalrymple doesnt really offer much of an alternative for these poor people. If you look at those on Medicaid, part fo that welfare state, a large percentage are disabled. A significant number are well below average in intelligence.
Steve
Kevin Corcoran
Jul 9 2023 at 7:19am
Hi Steve –
Just a couple quick points.
You say the negative effects Dalrymple describes “not as uniform as he claims, at least not in the US.” The welfare state in the US is also not nearly as comprehensive as it is in England, and the idea of entitlement not nearly as widely supported or taken for granted in the US compared to England, so if the welfare state does, as Dalrymple suggests, drive the negative behavior he observes, then such a result being less comprehensive in the US than England is exactly what we should expect to see. That doesn’t prove Dalrymple right by itself, of course, but nothing you’re saying does anything to contradict his central thesis either.
You say:
No, that’s clearly not true. The sections I quoted said the residents turn away from their initially favorable impression of the welfare state because they see it “as creating a miasma of subsidized apathy that blights the lives of its supposed beneficiaries”, that it “promotes antisocial egotism”, and that it has “created a large caste of people for whom life is, in effect, a limbo in which they have nothing to hope for and nothing to fear, nothing to gain and nothing to lose. It is a life emptied of meaning.” The issue of widespread ingratitude is merely the first thing they begin to notice. There’s plainly much more being raised than, as you decided to characterize it, a mere case of “no one said thank you.” Even if you disagree that the welfare state has anything to do with what Dalrymple and the residents regularly observe, to say “residents detest the welfare state after 3 months because no one said thank you” is blatantly false.
steve
Jul 10 2023 at 6:00pm
You are probably right that I was being hyperbolic, but it’s in reaction to what I think is either hyperbole or lying on Dalrymple’s part. I actually went through an internship. I have discussed this piece with a number of fellow docs who were interns, including some who grew up in third world countries and a few who trained in the UK. (Went to the arangetram of the daughter of one yesterday.) What he described is not representative for any of us. How does an intern find the time in 3 months to decide it’s better to live in the slums of Manila than the slums of England? Internship is hard work and you don’t have the time to reach those conclusions. Do you have the time to tell your senior physician what he wants to hear? Heck yes. As an intern you figure that out in the first few days.
Steve
David Seltzer
Jul 7 2023 at 7:02pm
Kevin: My experience with NHS in the UK. I was discharged from the Navy in 1964. I went to Europe for a year, and lived in London for six months. I had a garden variety cold that had me concerned about bronchitis or worse. I sat in a physicians office for nearly three hours waiting to be treated. Some patients had been there longer. When the harried Dr saw me, he did a perfunctory exam, scribbled a prescription for the chemist and disappeared. I suspect he’d seen at least half a dozen patients before me with a full waiting room of people yet to be treated. Friedman said, price will determine the length of a cue. As for having a right to my skills as an aircraft mechanic, one DOESN’T. If one wants to fly safely, as I’m not duty bound to provide for one, remunerate me at market rates and I will do everything I can to secure a safe flight for passengers. Otherwise, find another mech.
Thomas L Hutcheson
Jul 7 2023 at 9:51pm
Ungratefulness and “I only got what is mine by right” seem more typical of your “self made” capitalist than what I’ve heard about NHS patients. The attitude is not proper in either.
nobody.really
Jul 8 2023 at 5:20pm
Vincent de Paul (1581-1660). It appears that ingratitude long predated the welfare state.
Or consider the Book of Job (6th century BCE): God takes satisfaction that his servant Job behaves in an exemplary fashion and expresses gratitude. Well, of course, says Satan, Job lives a comfortable life; moreover, Job lives under the delusion that he has earned his good fortune and thus can take confidence in it. If you took away his creature comforts, he’d be just one more ungrateful wretch like all the others. God doubts this, and so chooses to remove all the comforts from Job’s life. And, sure enough, Job lashes out at God.
In sum, sometimes a person’s expression of gratitude reflects feeling gratitude for a good given or service rendered. But sometime it manifests a mindset derived from living a comfortable life. If you lived a life in which you were constantly in poverty and frequently in discomfort, you might find that you were rarely in a grateful frame of mind. And if you lived in a society that blamed people for their own misfortunes, you might find that the need to rely on charity was degrading, so the act or receiving charity triggered negative emotions rather than positive ones. In other words, a narrow, transactional frame of reference may not provide the best explanation for human behavior. As Walter Annenberg observed, “No good deed will go unpunished.”
Now, to be sure, if you ALSO lived in a very punitive, unforgiving society, you might observe that people receiving charity behaved obsequiously–not because this behavior reflected their honest feelings, but because they’d learned to fear the consequences of expressing their honest feelings. As Robert Heinlein remarked, “An armed society is a polite society.” A social safety net may relieve people of both the fear of extreme deprivation and the fear of speaking with candor.
Given all this, what conclusions should we draw about social safety nets? If your value systems leads you to focus on people in need, you likely conclude that safety nets do much good. Indeed, social statistics from nations with a social safety net look pretty good compared to statistics from nations without them. But if your value system leads you to focus on your own desire to feel satisfaction from other people’s expressions of gratitude, you will likely have a dimmer assessment of the social safety net.
In the US, the Black Lives Matter movement spawned the slogan “Black lives > White feelings.” We might strip away the racial terms to simply say “Lives > feelings.” In other words, I’d advocate evaluating the social safety net based on lives saved rather than the feelings engendered.
ON THE OTHER HAND….
A growing body of research identifies the harms arising from social isolation. While humans evolved in circumstances of interdependence, classical liberalism focuses on facilitating an individual’s ability to live unconstrained by her neighbors. Arguably this goal is facilitated by the social safety net–and would be further enhanced by a basic minimum income. But one likely consequence of all this social intervention is to free people from the burdens of needing ANYONE’s approval. And, with apologize to classical liberalism, it’s unclear that humans thrive under such circumstances.
To take the most obvious example, giving a stream of free money to people with substance addictions seems like a formula for killing them. The traditional story of redemption entails a person “hitting bottom” and finding that she has no alternative but to seek assistance from someone else. It’s a kind of compulsory social interaction, and the person seeking help will do so by expressing some willingness to change (a necessary first step even if that willingness will inevitably prove inconsistent….) A social safety net typically provides assistance with a minimum of social interaction or expectation of change. And for people with a substance addition, a basic minimum income looks like a death sentence because the recipients will never find themselves without an alternative to seeking help.
In conclusion, social safety nets seem like the fulfillment of a long evolution of social policy facilitating individualism. Perhaps we need a model that better balances the goals of facilitating individualism with the common human need for socialization–even when we would not choose it. “Man has been civilized very much against his wishes.” Friedrich A. Hayek, Law, Legislation and Liberty, Vol. 3 (1979), “Epilogue: The Three Sources of Human Values,” at 528-29 (emphasis in original)
Kevin Corcoran
Jul 9 2023 at 7:38am
Hey nobody –
I see a lot to disagree with in this comment, but time is limited for me this morning, so just to go through a few quick points (I may or may not return later for a fuller response – the days are busy!)
You say “ingratitude long predated the welfare state.” Well, yes, but nobody claimed the welfare state was somehow the origin of ingratitude. The question is whether a welfare state that is so comprehensive as to make “every benefit received a right” exacerbates, rather than diminishes, the degree of ingratitude. Simply pointing out that people have been ungrateful even before welfare states is bashing your shoulder against a wide open door.
You say, “If you lived a life in which you were constantly in poverty and frequently in discomfort, you might find that you were rarely in a grateful frame of mind.” Dalrymple addresses this in his essay, describing his own experiences going overseas and seeing the daily lives of people in real and terrible poverty, living lives of far greater “discomfort” than people in England ever experience, as well as suffering under brutal political regimes. And, as he notes, “Yet nothing I saw—neither the poverty nor the overt oppression—ever had the same devastating effect on the human personality as the undiscriminating welfare state. I never saw the loss of dignity, the self-centeredness, the spiritual and emotional vacuity, or the sheer ignorance of how to live, that I see daily in England.” And the general thesis of “people only act this way as a reaction to the burdens and hardships of poverty” is a thesis that I once believed, but it has far too many counterexamples to take seriously. To mention just one (again, found in Dalrymple’s essay), there are immigrant communities in England who have just as much problems with poverty and who also face all the difficulties that come with being immigrants – language barriers, lower social acceptance, etc. So if that thesis was true, we would expect the kind of dysfunctional behavior Dalrymple describes to be even higher among these groups – but what we actually observe is the exact opposite.
Michael Rulle
Jul 9 2023 at 7:57am
The patient who felt no gratitude for having his life saved is an unfortunate moral failure of a particular individual. He must be an unhappy or miserable person.
And while I agree with the insights of Adam Smith and Mr Corcoran ——-and believe our best chance at optimizing or maximizing economic outcomes is the market system, I have to say there are complexities here that do not fit neatly into the gratitude paradigm.
Ray Charles was a virtual lifetime heroin addict. Somehow he chose to quit in his 60s——-and I can see the morality of Charles getting his heroin——although I think he was better off without it—although he always said he never regretted his years as an addict.
I think integrating gratitude with the idea of markets or the evolution of social safety nets ———is a very complex paradigm. I must think they are independent or separate elements of human nature.
The founding fathers were both realists—even pessimists—- about human nature, but tried to create a system where the good would dominate thru rational laws and freedom—-like Hayek in a way.
The administrative state (an example of which is Mr. Corcoran’s ,description of British medicine) has overstepped its bounds——-and would love to see us reverse it.
nobody.really
Jul 9 2023 at 4:55pm
1: Is that the question you’re exploring? Or are you exploring whether the welfare state exasperates EXPRESSIONS of ingratitude? Recall the insights of Baptist: Beware basing conclusions solely on what you see, and ignoring what you do not see. The degree of ingratitude may differ from the degree of expressions of ingratitude.
If we want more expressions of gratitude, the obvious approach would be to cause people to fear the consequences if they fail to demonstrate sufficient obsequiousness. In nations where people fear those with sufficient power to bestow or withhold benefits, I would expect recipients to obligingly make a display of their gratitude. In nations that provide benefits unconditionally, I would expect recipients to discontinue making such displays—except for recent immigrants, who might maintain mores of obsequiousness they learned before immigrating. These expectations appear to conform to the data.
But none of this tells us anything about people’s actual gratitude.
2: Moreover, the question you explore differs from the question I would explore—a question reflected in the slogan “Lives > feelings”: Does the social safety net result in better social outcomes, even if it also results in reduced expressions of gratitude?
The Christian concept of agape refers to promoting another person’s best interest, whether or not that person reciprocates—or, indeed, whether or not you feel like promoting that person’s interest. I ask if, ceteris paribus, social safety nets result in reduced hunger, or reduced adverse health effects related to hunger, or greater life expectancy, or greater educational attainment, or reduced crime—or even reduced public anxiety regarding these outcomes.
I remain open to the conclusion that it does not. Dalrymple raises this hypothesis. Likewise, I hypothesize that social safety nets may facilitate social isolation, and the resulting harm of isolation may more than offset other benefits. But neither of us back up our hypotheses with much data. And, while I also find expressions of ingratitude galling, I don’t regard them as having much bearing on the merits of social safety nets in general.
Consider the Fifth Dynasty pharaoh hearing people whining that his innovation called “police” had failed to eliminate crime, and thinking “Why do I bother? I offer my largesse, and the public just adjusts their expectations. Where is the gratitude…?” Fast forward to today: We still complain about the police, and the police still feel that the public fails to express sufficient gratitude. Based on four millennia of data, should we conclude that public policing is a bad idea? Or that expressions of ingratitude are a poor basis for evaluating public policy?
nobody.really
Jul 9 2023 at 5:02pm
Here’s a small test of this hypothesis: How many of us were socialized to say “Please” and “Thank you” when asking and receiving services? And how many of us say “Please” and Thank you” when asking Siri to to place a phone call for us? I still occasionally say please–but the behavior is gradually being extinguished in me. Should I feel ashamed for failing to make a display of my gratitude? Has my soul been degraded?
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