Editorial: One of my regular readers dropped me an email after the last post saying that the Montelukast Withdrawal Syndrome post on RxISK was wonderful but Something Happened on the same day was incomprehensible. The title was a give-away. Something Happened but it doesn’t seem to me that anyone knows quite what. Here’s another take on Something Happened and a currently blank sheet of paper might have yet another take next week. Another angle on this are the RxISK posts on Transgender Meds – where something is happening – but what?
A moral crisis may have been inevitable with the creation of the printing press. The crisis took shape when Martin Luther nailed his theses to a Cathedral door in 1517. It could not be avoided after 1649 when Charles I of England was decapitated.
The word hierarchy derives from hieros (the holy) – and refers to the primacy of the moral or the sacred. An absolute sovereign held a moral rather than just a political order in place. The monarch was responsible for justice and benevolence within the monarchy. Justice involved decisions based on wisdom. The requirements of benevolence meant that we were all, from the monarch down, responsible for the welfare of others in addition to ourselves, and all were answerable to God.
Charles had his head chopped off for moral reasons – for straying too far from godly living. After his decapitation the moral order was going to have be held in place in a different way.
Even though it was a drive to be more religious and moral that led to this outcome, somehow religion alone didn’t seem capable of filling the void. The world that needed governing by then had become more complex than any previous monarchy or theocracy had faced.
Supported by the role of techniques in triggering science, from Descartes in 1649, through Locke and Kant, Enlightenment philosophers claimed they could fill the void. They created the ideal of an autonomous subject reasoning in a detached way about us and our place in the universe. The flourishing of science made this option seem compelling to many. A new individual was born who at least in one part of their lives didn’t just take the word of the Ruler as Gospel or the Gospel as Rule.
In this new dispensation, the requirements of justice and benevolence led to constitutional government, the idea of universal human rights, an independent judiciary, the development of contracts and later welfare systems.
These are achievements to take pride in, but the changing times triggered a “Romantic” reaction. The romantics held there were important values and forces the philosophers and scientists and liberals were missing. The decapitation of Louis XVI in 1793 and the French revolution made liberal civilisation seem like a thin crust beneath which molten passions swirled.
The detached approach was taking us into a world of instruments and procedures. For the romantics there was more to life than this. We needed wisdom rather than just detachment and would need to supplement philosophy or science with something else to believe in. Some turned to Nature, others to Art, some to the People and others to other forces rolling through history that religion had harnessed but disinterested rationality seemed less capable of managing.
Harnessing was something monarchs and religion had done. Managing is what technocrats aim at.
All techniques and procedures embody an intelligible element, an algorithm, just as everything that functions from bacteria and viruses to thermostats and computers do. The question is whether there is more to humanity than a complex collection of intelligible elements. In caricature form, science and technocracy says there is nothing more.
On a political level, Marxism and psychoanalysis were in this sense romantic – religions reborn in a scientific age. Both had technical aspects that gave them the appearance of science, or a footing within the sciences, but at bottom the materialism of dialectical materialism and the libido of psychoanalysis were mystical concepts rather real-world entities with a precise meaning.
The twentieth century brought a new twist. The modernism of science and its turn to techniques and procedures led to bureaucracy on the one hand and a new modern individual on the other – the displaced individual. She has become a stranger in a strange land rather than a child of the universe.
This showed up in modern art, where from T.S. Eliot through to Borges and Calvino rather than stories we had stories told through story-tellers. In painting from the impressionists onward we had art that showed its artifice. In architecture, we ended up with buildings that showed their plumbing on the outside.
Unsurprisingly the same happened to science – in this case it was termed post-modernism. The scientific process and scientific events and their protagonists were all now situated in a story. Discoveries were no longer pure and simple but rather constructs held in place by methods. The objections of scientists to being situated within not just a story but a story-telling is in part what led to the Science Wars. The other part was the clumsiness of the social scientists.
It should have been possible to seduce the scientists in the way Christians had been seduced. While many Christians were distraught about the nineteenth century transformation of the Bible into a set of stories (Ta Biblia) rather than one master narrative (Biblos), for many others the investigation of the Bible produced an even more interesting set of stories. Our new understanding allowed us to celebrate the emergence of a much more person-centered world than had been found in previous hierarchies – whatever about the ultimate meaning of that world ushered in by the events the stories described.
The rhetoric, if not the DNA of science, suggests that faced with uncertainties scientists are less likely to react fundamentalistically than some religious. So, on the face of it, bringing them around should have been possible. But maybe even with the perfect art we would still have had a problem.
Something Else This Way Comes
Perhaps from say 1980 onwards, there was something else at play. This is what Roy Porter’s review of Listening to Prozac says to me – there must have been something else going on.
All through the 1990s and beyond, the surprise for me was that social scientists were being bowled over by what seemed, in the case of things like Prozac, huckster’s trinkets. They seemed as happy to hand over Manhattan for a bunch of the new trinkets as the Indians were when the Dutch turned up just before 1649.
What else might have been going on?
One option is science. The pace of advance picked up relentlessly from the 1940s. The atom bomb turned the world upside down. We crossed a threshold and now we for the first time posed a greater threat to Nature than Nature posed to us.
This was at least as obvious in medicine, as in any other branch of life, which from the discovery of DNA to the Human Genome Project seemed to be handing us the means to remake ourselves. We could make the New Man, and be better-than-well.
But could science, even as epic as this, be the source of our problems? Science is visionary. It might destroy an old order, but it also reaches for a new one. While it doesn’t necessarily make individual scientists any better human beings, it doesn’t make them worse either and pooling our fallibilities as science does has unquestionably advanced our situation in many respects while causing other problems.
Another option also stemming from the Enlightenment lies in the procedures we began to put in place rather than the instruments we developed.
From 1800 or so, it became clear that procedures would be applied to government. This was a move that came from the people – from the bottom of up. We had weights and measures so that even a King couldn’t arbitrarily decide what a certain amount of produce weighed and was therefore worth – we couldn’t be as easily cheated by power.
The production of goods, including medicines began to be standardised and regulated. Professionals like doctors, and others, began to be accredited.
Where England developed the idea of constitutional government and now thinks of itself as the cradle of democracy, the application of procedures to government probably flourished most vigorously in Prussia and underpinned the unification of 39 different States with different religions into Germany.
The ultimate expression of this lay in the Holocaust which became the event it was because of the marriage of terrible intention with efficient bureaucracy. The bureaucracy also played a part in its undoing, when without the appropriate authorisation the camp apparatus refused to release the trains, used to transport “workers” to the camps, to take German troops to the Eastern front.
The first hints that a bureaucracy might be spiritually damaging perhaps lies in Dostoyevsky but the most devastating portraits of its soullessness came from Kafka in the 1920s. Their warnings had no effect. By the 1930s, totalitarian bureaucracy had emerged as a new force in the world.
It’s important to distinguish the primacy of procedures from the people. The assumption in the West after the War was the Nazis were perverted, deviant, psychopathic, evil and we needed checks and balances in place to keep Germans on the rails. But any of the psychological testing done on Germans, even concentration camp guards, showed them to be if anything better balanced and more normal than the American soldiers liberating the camps. And the bureaucracy that had led to the Holocaust was a triumph of checks and balances that now seemed needed to prevent it happening again.
The early successes of Germany in the War led most allied countries, particularly America to figure that the future lay with management – aka bureaucracy or totalitarianism. Far from learning the lessons of the War, troops returning home got a free pass into universities places to learn management science.
This in part underpinned the upheaval of the 1960s where students and others protested against the encroaching of a new apparatus. There were protests against science that seemed to be undermining our understanding of ourselves, and a turn to “religion” in the form of cults, but the deeper protests were against the apparatus and conformity.
On the surface Marx and Freud were pitted against liberalism and science – this was a replay of Romance against Science.
But beneath the surface, Marx and Freud and science were being replaced by a neoliberalism and neomedicalism. Today’s recovery movements and trauma focused therapies in mental health care are cut from the same cloth as the pharmacotherapies they oppose. Both appeal to operational criteria, both shun judgement, both play by the same rules.
There is no better example of this than the transformation of Buddhism into McMindfulness. Buddhism was an intensely moral exercise; McMindfulness is amoral, a product that needs to make its way in a market.
We all now sign up to the dictatorship of procedure. To being managed. To an imprisonment in an Iron Cage. This becomes clear when someone like Roy Porter semi-endorses Prozac.
I wanted to hear him say there is more to life than this. But if he had, it might have sounded like Chris Patten, the last British governor of Hong Kong who, recently protesting about the encroaching of Chinese procedures on Hong Kong, said Britain should stand up to the Chinese as a matter of honour.
Honour and sanctity and virtues like these made sense in the world of Charles I but what could they conceivably mean now? The good official, the ethical official is the one who keeps to the rules, to the procedures, even when lives are going up in smoke.
The Theory of the Managed Enterprise
Government is now a business, a management exercise, rather something visionary. We have rulers rather than leaders – technocrats a.k.a. bureaucrats.
In The Theory of the Business Enterprise, Thorsten Veblen said business and science are not good bedfellows. The scientists want to pursue things that interest them. The businessman wants to maximise the opportunity to make money from the product on the market rather than explore one that might not make it.
Science was robust enough to survive this tension until businesses became corporations (bureaucracies) after the War. The science now, at least in medicine, is totally managed. The new dispensation wants technicians not visionaries. And as for ethics, and morality, it seems a managed scientist like Peter Kramer has no difficulty with the entire literature being ghostwritten and all data being sequestrated and everything possible being done to sell the product – even as the bodies go up in smoke.
But you’d have thought someone like Roy Porter might have said – wait a minute, what about the Holocaust or was that all Fake News?
The next instalment might or might not clarify some bits of this