Islamism and the North Korean regime remind Dalrymple of his medical career in the slums of Birmingham:

Every day I used to go to my hospital thinking, “I’ve heard everything,” but I never had. “They can’t surprise me anymore,” I said to myself, but they could, and they did. People who in all other respects seemed deeply unimaginative managed to devise entirely new means to make their own lives and those of the people about them unutterably miserable. The Russian writer V.G. Korolenko (a watered-down Chekhov) once said that man is born for happiness as a bird for flight, which seems to me now about as true as that earthworms are made for ice hockey. I don’t believe in Freud’s death instinct exactly, but many people do seem to have a genius both for misery itself and for the creation of misery in others. Time and again I saw people with no “objective” reasons for unhappiness, but who, with a determination worthy of a better object, pursued courses of action that would obviously lead to disaster, and that they knew would lead to disaster. The fact is that disaster is dramatic and never dull, which happiness can appear to be. We can without difficulty imagine a thousand hells, but even a single heaven escapes our imagination. Seventy-two virgins would pall after a time (whether it is heaven for them also seems not to be very often discussed).