Fifty years ago today, January 19, Jan Palach died. He had set fire to himself 3 days earlier in Wenceslas Square in Prague in protest against the Soviet occupation of Czechoslovakia. The spot was close to Charles University where Jan Hus had begun a resistance to religious oppression 5 centuries before that helped ignite the Reformation. He may have fallen as he began to die on cobblestones made from Jewish gravestones, following the obliteration of Prague’s Jewish community in the 1940s. There doesn’t come a much greater concentration of history in a few square metres.
I have resisted posting some of the images of Palach that can be found on Google as posting similar images of a Buddhist monk mounting a similar protest in Saigon against an American occupation a few years earlier led to Facebook blocking the post in which those images appeared.
Jan Palach’s death played a part in creating what was later called the Velvet Revolution which 20 years later helped “liberate” Eastern Europe. Vaclav Havel was among the key figures who picked up Palach’s challenge and channelled it into a movement that rather like ACT-UP in the US some years later was neither a movement of the Left or the Right but one that took a stand on the value of individuals and their right to live the lives they chose to live.
Faced with a new dictatorship East of the Elbe, that unlike prior dictatorships ruled in the name of the people and looked permanent, Havel framed the issues as follows:
“A specter is haunting Eastern Europe, the specter of dissent… You do not become a ‘dissident’ just because you decide one day to take up this most unusual career. You are thrown into it by your personal sense of responsibility, combined with a complex set of external circumstances. You are cast out of the existing structures and placed in a position of conflict with them. It begins as an attempt to do your work well and ends with being branded an enemy of society. … The dissident does not operate in the realm of genuine power. He is not seeking power. He has no desire for office and does not gather votes. He does not attempt to charm the public. He offers nothing and promises nothing. He can offer, if anything, only his own skin—and he offers it solely because he has no other way of affirming the truth he stands for. His actions simply articulate his dignity as a citizen, regardless of the cost.”
Havel V. Power of the powerless. In Living in Truth, Faber Books London 1978. P 83
Strikingly, while protesting against the new dictatorship in Eastern Europe, Havel and others didn’t look to the West for salvation. And if we look at what has happened, especially in healthcare, since the Velvet Revolution and the End of History, a good argument can be made that what was happening in Eastern Europe was a managerialism that was pioneered there but developed and improved on in the West since then so that we are even more imprisoned that the Czechs were then.
In the late 1990s, Pfizer ran clinical trials for a new antipsychotic Geodon. In one of these trials, a person on active treatment set fire to themselves. They died several days later. The death was coded as death from burns rather than suicide.
This scenario is pretty standard for most of the drugs used in medicine today. The degree of mismatch between what patients experience and what the authorities claim about the reality of treatments is as comprehensive in medicine now as any mismatch between the claims of the State and lives of its citizens ever was in Eastern Europe in the 1970s.
Just as Czechs in 1970 never met those who were the Engineers of Human Souls in Eastern Europe, so patients and even doctors don’t meet the people responsible for the forces that are making encounters in healthcare worldwide today increasingly miserable. Doctors meet managers who insist they keep to guidelines that are based on junk. Patients meet doctors who are keeping to the guidelines. Neither managers nor doctors nor patients get to meet those who engineer the guidelines.
This is a scenario in which the only thing that doctors learn from patients who are injured or killed on treatment is not that there might be something wrong with the guidelines but instead perversely that any questioning of the guidelines risks the loss of a job. Every death of every patient ratchets up the pressure not to question the guidelines – if need be by coding suicides as death by burns.
What’s going on? For Havel, the problem centred on responsibility. Its our willingness to hand over responsibility, willingness to let important things slide by while we tread water (get on with life), willingness to hide in the herd and behind slogans that is the root of the problem.
In 2010, just before he died, after the Czech Republic had been free for twenty years, Havel’s view was that the situation, our situation, was worse now than it had been in the 1980s.
Between Good and Evil
When times are good it can seem to make sense to go along with things as they are. But this being sensible all too easily slides into getting on the train when you are told to do so. Losing the ability to resist is a recipe for death when resistance is called for.
There is a resistance that is non-violent that can seem to transcend the politics and struggles of men and can apparently lead to success as with Gandhi in South Africa, turning the other cheek, or Havel and Walesa in Prague and Gdansk. This looks like it can work when we stand together but we rarely stay standing together for long – without our “leaders” having to bribe us with something.
The morality of this way of doing things sits in the balance along with what can be for some a more psychologically fitting way – a turn to violence. Rather than set fire to yourself, bring the fire down on them. But whether with violence or without, the enduring problem is how to ensure that after the Revolution things don’t end up worse than they were before.
How do restore caring to health, and how do we ensure it remains at the heart of what happens there?