Painful choices

There is so much that is painful in the world right now – events in France, Germany and Turkey come particularly to mind – that there is no shortage of things I might write under this heading. I don’t think I have ever known so depressing a time, politically, in my life. But in this post I want to focus on the particular and personal pain that I have been experiencing: dental pain. And more specifically some organizational things around that pain.

In brief, last week I developed a toothache and went to the dentist who booked me in for some treatment. Over the weekend the pain became truly agonizing – I’ve had dental pain before but nothing remotely like this – to the extent that I had to contact the out of hours doctor for some non-prescription painkillers. This process itself was organizationally painful, involving no fewer than five telephone calls, each one acting as a kind of filter. Thus on the first call I was asked a checklist of questions clearly designed to either put up red flags (‘Pains in chest? Difficulty breathing?’) or to process me to the right person.

There’s nothing objectionable about that, although I could see it leading to many false positives and negatives, except perhaps the fact that each subsequent phone call entailed repeating my symptoms and needs (in summary: ‘I’m in agony, give me some super-strong painkillers right now’ which maybe could have been passed on). But what struck me was that when it came to prescribing medicine I was told about various different possibilities and the downsides – for example potential side-effects – of these. So I asked whether or not I should take the prescribed medicine, although frankly I was in so much pain that I would have done anything, whatever the risk, up to and including amateur surgery. And the response is what I want to write about, because it was to say that what mattered was that I had been ‘made aware of the risks and so could make an informed choice’.

It seems clear to me that this has nothing to do with my making an informed choice and everything to do with organizational self-protection. If things went wrong, I could hardly complain: I had been warned of the risks. But I had no way of assessing these risks or calibrating them against the benefits and so the choice did not in any way empower me; rather, it disempowered me in the event of any problem that subsequently emerged. It reminded me of a point made in my recent book on secrecy where we argue that the ‘full transparency’ of the terms and conditions we sign up to when making online purchases is actually a form of secrecy. The T&Cs are so lengthy and complex that no one reads them or could understand them if they did, yet in the event of a problem or dispute we can be told that we had been given full information and had agreed to it by ticking the acceptance box.

Anyway, I took my medicine and all went well in that the pain was somewhat lessened and I had no unpleasant side-effects (on the contrary, a rather pleasant wooziness) and I went to the dentist again. She told me that I had a choice between having root canal surgery or an extraction and talked me through the pros and cons. A choice again, then, and this time not I think one to do with organizational self-protection but reflecting current understandings of professionalism in healthcare and other spheres. I say current understandings because in the past the norm was for health professionals to simply tell you what to do. It was a more authoritarian, paternalistic approach in which the doctor (or dentist) knew best.

That has now given way to a more patient-centred and, I suppose, consumerist ethos in which clinician and patient together make treatment decisions. The trouble is that I really don’t want this, and don’t have any basis on which to make a choice – and it is a particularly bad time to try to make choices when one is in pain. I would actually rather be told what to do: my choice is not to choose, but that wasn’t an option. So the conversation became an exercise in me trying to detect and provoke signals from the dentist as to what she actually thought was the best course of action.

It may seem a stretch, but I think this links to the post-truth politics I discussed in my recent post The Sleep of Reason where ‘expert’ opinion is derided and we have a mixture of a consumerist market for ideas and an implication that how passionately a view is held is in some way an index of its truth. For some, this is a liberation from the tyranny of authority, but it goes hand in hand with a breakdown in trust and a devaluation of rationality. Perhaps this has had some good effects. The deference shown to experts in the past was not always healthy – for example, I can remember my late father always dressing in his best clothes when he had to visit his GP which seems extraordinary to me. On the other hand, the idea that a few minutes on google can enable us to talk on equal terms with our doctors is even more bizarre. In the face of pain, at least, I am a positivist and I want someone with knowledge of the evidence to tell me what to do about it.

Oh, and for anyone interested the decision was to have root canal surgery, starting this Friday. It was my choice, but I reserve the right to moan about it. Pain does not just make me a positivist, it also exacerbates, if that is possible, my propensity to grumpiness, gloom and outright bad temper.

Goodnight, John-Boy

In a complete shift from recent posts, I am writing today to mark the death in March this year (but which I have only just heard about) of Earl Hamner Junior, aged 92. He was the creator of the TV series The Waltons and the original of its central character John-Boy Walton. The series was in turn based on Hamner’s 1961 novel Spencer’s Mountain and depicts a large, rural American family struggling to cope with the Great Depression of the 1930s. Work, lack of work, debt, insecurity and poverty are the backdrop to the story.

The Waltons is an interesting show at lots of levels. In one way, it can be seen as a reactionary paean to family values as exemplified by George Bush Senior’s speech in 1992 in which he said “we need a nation closer to The Waltons than The Simpsons”. But I think it represents something more than, or anyway only overlapping with, that. Sure it seems like a story of hardworking, self-reliant, god-fearing folk of the sort that might resonate with the American Bible belt. However, read another way it is a story of communitarian values and liberal tolerance. On either account it has a strong moral dimension.

That it can be read in these two ways is reminiscent of the way that Woodie Guthrie’s folk song This Land is Your Land (written in 1940) has been received and used. Guthrie himself was formed by his experience of the Great Depression and the song expresses this and is emblematic of his radical left-wing politics. Its revival in the 1960s by Bob Dylan and others reflects these politics. Yet it was later taken up by Republicans as a patriotic, traditionalist anthem.

Despite its cosy image, The Waltons was quite bold in tackling issues about racial prejudice, female emancipation, environmentalism, pacifism and the trauma of war – all controversial and current themes in the 1970s when it was aired. I’m not trying to say that it was some kind of radical social commentary, of course. And it was schmaltzy, soapy and sentimental, for sure. But it wasn’t just that.

It can now be seen through at least three different lenses. As a story about the 1930s, as a story about the 1930s seen from the 1970s, and as a story about the 1930s seen from the 1970s as seen from today. Plus there is perhaps yet another lens which is that of the UK rather than US. After all, my memory of it is watching it in the UK in the 1970s, shown at 8.10 on a Tuesday evening if my memory serves me well. I’ve written elsewhere about how at that time popular TV shows were a kind of cultural glue in that the small number of channels meant that they were a shared experience.

The show ran from 1972 to 1981 and overlapped with the next big American soap that also was a hit in the UK and elsewhere. That was Dallas (which ran from 1978 to 1991). The focus again was the a family in the American south but this time a family riven by internal feuds and characterised by huge wealth rather than grinding poverty. Somehow this seems to capture the shift, on both sides of the Atlantic, from a post-war consensus formed in part as a reaction to the pre-war depression to the neo-liberal revolution of Reagan and Thatcher. The Waltons was a kind of reminder of where that consensus had come from; Dallas a harbinger of the harsher casino capitalism that replaced it.

I said that this post marked a complete shift from recent posts but perhaps not entirely. Viewed now, at a time when there is populist backlash against that casino capitalism and the globalization that accompanied it, The Waltons might be seen to resonate with this. Hard times are back for the white working class. But the Walton family were depicted as resolutely Democrat in their politics, supports of the Roosevelt New Deal and notably open-minded and tolerant on racial matters, and some episodes directly repudiate anti-immigrant prejudice. In this way it reminds us that there is no necessary connection between being poor and disadvantaged and being intolerant and close-minded.

 

A new landscape?

Within less than a fortnight some of the consequences of Brexit are becoming clear. What was dismissed as ‘project fear’ turns out to have been true. The pound has collapsed, the FTSE-250 has collapsed, foreign investment has collapsed, the UK is facing breakup and the political system has broken down. These aren’t just short-term things and they will reverberate for years to come. A country that a week ago seemed like a bastion of stability now seems a scary and unstable place. The leaders of the leave campaign have mainly disappeared and those that are left don’t know what to do. Someone said to me the other day that the issue is not that the remainers are ‘bad losers’ but that the leavers are ‘bad winners’: at their moment of victory they regret it and exit.

The UK media are hardly reporting the big strategic and economic issues and are obsessing about the Westminster politics of who will lead the political parties. That matters, a bit, but does not begin to speak to the political and economic meltdown that is happening. For that, you have to go to the foreign press. And there is also a cultural meltdown, most obvious in the rise of racist abuse and attacks. This has been widely reported but to personalise it a friend of mine, out shopping in the afternoon, was punched in the face for having a foreign accent; a Chinese student I know was spat at and told to pack her bags. Welcome to post-Brexit England.

I’ve written before about how the divide now is between cosmopolitans and locals, and Tony Blair – of whom I have plenty of criticisms, but few can doubt his sensibility to events – has said something similar, arguing that the political cleavage is no longer left versus right but open versus closed. So the shape of twentieth century politics, based on capital versus labour, no longer makes sense and nor do the party structures that mirrored it.

We need, fast, a political realignment around this. What we currently have is a situation where the locals (or closed) have defeated the cosmopolitans (or open) but the irony is that the former look to the latter to deliver what they have voted for. It’s striking that about the only person in the UK showing any sort of leadership now is Mark Carney, the Governor of the Bank of England. And who is he? A technocratic expert, and an immigrant to boot!

This new politics certainly makes for some strange bedfellows, especially between the internationalist left and the global free-market right; but this is the landscape that we are now going to have to work within. It makes a nonsense of the politics of most of my lifetime, and I am still adjusting to it. I talked to a friend of mine the other day, a lifelong working class socialist, who said that he wanted the working class who voted Brexit to suffer unemployment and punitive public service cuts so as to teach them the error of their decision. That seems incredibly harsh but he said the alternative is to infantilise those voters by saying that they did not know what they were voting for. We shouldn’t patronise them, and so we have to say that they have to accept the consequences of their choice.

I kind of understand that argument and at all events I see a very strange situation having opened up in which the people expected to sort out this mess are those in business, the civil service, civil society or even academia who largely did not vote for it and who were derided as the experts and the elite. Where are the leaders of populist insurgency? Nowhere to be seen. So their insurgency is to be put into practice by the very people they have rejected. I’m not sure that there has ever been a situation quite like that in modern history.

We are very, very far from seeing the dust settle on the Brexit vote, but I think that the dynamics I have described here define where the dust will settle. And, if so, that has an import far wider than Brexit as it seems to define what the politics of post-globalization will look like. This isn’t a matter of merely British interest. For one thing, when such a big economy makes such a bizarre decision it has global effects. But, beyond that, it could be said that Britain led the industrial revolution, led the neo-liberal post-industrial revolution and is now leading this post-globalization, post-truth, revolution.

I don’t pretend to have a complete handle on this, and these are just preliminary thoughts, written during a crisis which is both personal and political. In a few months they may seem naïve or just misguided; and the one thing which social science should teach us is to be wary of prediction. Even so, I think that what has happened here these last few days and what it will mean over the next few years is something fundamental which will change all our lives.