The last post The Greatest Failure of What Used to be called Medicine provoked a lot of comment – or at least the photographic images in it did. There was little discussion about the content of the post and what to do about the spectre of bureaucrats in the guideline and the regulatory apparatus hanging together when it comes to something like children hanging after antidepressants.
Gillian Anderson and others asked if its valid to use images like this? Will it do “the cause” more harm than good – put off the people who need to listen?
In 1963 Thích Quảng Đức, a Buddhist monk, set himself on fire in Vietnam in protest against the South Vietnamese Government, soon to be supported in spades by the US Government. JFK said “no news picture in history has generated as much emotion around the world as that one”.
The Americans didn’t listen. It took over a decade to sort things out.
In 1969, Jan Palach set himself on fire in Prague in protest against the Soviet occupation.
Ireland, the home of Lynching, is also the home of the Hunger Strike, and the Boycott – non-violent ways to bring about change – Gandhi, Martin Luther King and others came later. These moves often expose the violence in the system – hunger strikers are let die, the boycotters were shipped off to Australia, Gandhi and King were assassinated.
There is unquestionably something honorable about dying or suffering yourself for a cause.
The people of Prague turned out en masse for Palach’s funeral and his death played a part in the later formation of Charter 77. There is unquestionably something honorable – but does it work.
Gillian and Maria Bradshaw raise points about re-traumatization. Showing a photograph of a hanging child or a lynching will disturb people and this is an injury inflicted on them by the person showing the photograph – me in this case.
I don’t buy this. The violence, trauma, disturbance is real but it comes from the system. There is nothing more that the system would like but for everyone who has lost a loved one to a medical treatment to shut up. They would love nothing more than to help generate the impression that someone who tries to raise concerns is an enemy of the people.
If a photograph of a hanging child traumatises some, well we probably should ensure we don’t talk about these things either. Perhaps there should be trigger warnings on blog posts. This is reverse Stockholm syndrome. In Stockholm syndrome, people held captive by their hostage taker come out singing their sympathy for him.
In Saigon syndrome (we need a good name for this), anyone who tries to rescue people from a prison gets seen as an enemy of the people. The doctors and clinical psychologists who come along to shelter you from something disturbing get seen as the White Knights.
These posts will disturb, unsettle and anger some? Should they not happen?
I and others have gone down and will continue to go down a non-violent route. This is what RxISK is all about.
One of RxISK’s main goals was to tackle the violence of the system by getting people not just to file RxISK reports but to take them to their doctors . Among the most astonishing things this has shown is that people are too plain scared to do so. They sense their doctors will get nasty. And many doctors probably will get nasty, because doctors sense the system will get nasty with them if they don’t squash out dissent.
It is clear that pretty well everyone is being traumatised the whole time. The momentary disturbance triggered by seeing a photograph hints at the pressure everyone is under.
This pressure is not going to go away unless we tackle it. Part of the difficulty in tackling it is alerting people to the fact that their problems don’t come from rogue doctors who make mistakes but from good doctors who keep to guidelines – based on junk. There are few better symbols of the violence of the system than the craven attitude of bodies like NICE to the refusal of pharma to hand over the data.
Its not just NICE who are part of the problem – its non-governmental bodies (NGOs) like Medicins sans Frontiers (MSF), (Doctors without Borders), George Soros’ Open Society, Health Action International (HAI), the American Civil Liberties Union (ACLU) and others involved in Access to Medicines campaigns who will fight the easy fight about the cost of drugs and not the fight about access to the data that turns a chemical into a medicine.
Its not just regulators, and guideline bodies and NGOs who are part of the problem, its everyone who turns to complementary medicine or antipsychiatry or who rejects the medical model one way or the other.
Its professional bodies like clinical psychologists who scream blue murder about trauma but never help a patient disabled by the side effects of drugs to stand up to the doctor who has put them on the drugs.
The system depends on everyone to quietly get on the trains that turn up to take us East. This is a hazard of bureaucracy that was put on our radar by Max Weber a century ago. There was a “there there now Max” response at the time and later outrage at the suggestion he might have been predicting the Holocaust. We are nowhere nearer getting to grips with this than we were a century ago.
Following the death of Jan Palach, Vaclav Havel and others set up Charter 77 to respond as they saw it to the bureaucratic dictatorship in which people in Eastern Europe found themselves. Previous dictatorships had involved a minority and were temporary but the Soviet system ruled in the name of the majority and looked pretty permanent. Havel didn’t want a turn to the West which he saw as pretty capable of going just the same way.
As Havel put it:
“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.
It’s easy to resonate to these nice words now that we know Havel won – largely by accident. It took a shipworker in Poland to galvanise things.
Feeling a warm glow in response to these words is rather like the warm glow that half the population of Dublin had when later claiming they were in the General Post Office (a small building) at the time of the Easter Rising when in fact most Dubliners were hostile to the revolutionaries at the time. The Easter Rising was a curious mix of violence and self-sacrifice – almost like committing suicide by aiming what appears to be a gun at the police.
We need more than the stirring words in Havel’s quote. Written before he won, the key insight is that you become an enemy of the people – even the people who have lost loved ones and been traumatised by the system. Even for the Jews in 1942 or 43, those who took to the woods rather than getting on the trains were enemies putting everyone else’s life at risk.
If you win, the stone the builders rejected becomes the cornerstone. If you don’t, the people call for crucifixion – pretty well force the powers that be down this route.