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The Unkown Terrorist by Richard Flanagan

“In listening to what Chopin could not explain, she heard an explanation of her own life. Love is never enough, but it is all we have.” From The Unknown Terrorist by Richard Flanagan

Experience is but a moment. Making sense of that moment is a life.” From Question 7 by Richard Flanagan

Chekhov believed that the role of literature was not to provide answers but only to ask the necessary questions………. And why do we do what we do to each other? That’s question 7.” From Question 7 by Richard Flanagan

It’s only recently that I’ve discovered Australian writer, Richard Flanagan’s work, and have so far read two quite different books by him, Question 7, which progresses like a nuclear chain reaction, and blends history, literature and memoir in a beautifully rendered prose, and The Unknown Terrorist. In this piece I will be writing about The Unknown Terrorist, which reads a lot like a cinematic paced political thriller with enough suspense for the reader to keep turning the pages, but it’s more than that, and one could say it is a societal critique and a tragedy, in the sense of one event leading to or generating the next till the breaking, explosive point, like an unraveling of a tapestry. From the beginning we get the sense of inevitability and though we hope for the redemption of the protagonist, almost wanting to step into the story and save her, we know that things will probably turn out badly. There is no catharctic end, but one could perhaps see the ending as a kind of metaphor, suggesting that along with the destruction of the scapegoated and victimized comes the downfall of the perpetrator, at least the one who set the thing in motion. One could perhaps view it as a kind of justice, but ultimately, human lives, the possibility of living better and the possibility of justice or change are wasted all around.

To begin with the title itself is interesting, and perhaps implicit in the title is the idea of The Unknown Soldier, a commemoration of all the missing and unidentified soldiers lost in wars that were not of their own making or choice. There is also a philosophical, political and moral underpinning to the surface layer of the narrative, and Flanagan seems to be nudging us to reconsider the meaning of life, the disconnection from ourselves, others and nature, current harsh sociopolitical realities, unchecked power and greed, racism, terrorism, exclusion from the promise of a future and the means by which a future is possible, democracy and why individual freedom, love and the truth really matter and safeguard us from tyranny. He reveals how the News, and the media more broadly, can manipulate the population, construct our sense of identity, who we are and how we think, how they can be a vehicle to keep people numb, fearful and compliant, and how it is possible that anyone of us could be villainised and our life destroyed through the need to create scapegoated objects, avatars of social fear.

The book is also about loss, and in particular, the loss of love, in its many forms and in its broadest sense. It’s about the loss of caring, empathy and connection in society. The phrase, ‘love is not enough’ is repeated throughout the novel, which could be understood in different ways and applied to different contexts. It recurs like a koan or question the reader needs to confront. Ιn one instance Flanagan describes a scene where the Doll is observing a mother with her young child. He writes: “And the Doll had the overriding sense that, though she was full of many faults, she, like the Vietnamese woman and her son, was love. But for reasons that were not clear to her they would not let her love. Whatever it was—life, the world, fate—it had not let her love……. Then they lied to the world that she was hate, and deserving only of hatred. Hate was to be hunted with hate and, when found, destroyed.” As the story unfolds the reader slowly glimpses at the reasons the protagonist has not been allowed to love what she has wanted to love and why the process has always been disrupted.

The protagonist of this story is Gina Davies, a 26 year old pole dancer, mostly known and referred to throughout the book as the (Russian) Doll. Her being a pole dancer is an interesting choice, and it makes visible the ease with which people will make immediate negative judgments, and it also makes us realise how wrong these stereotypical judgments can often be. The Doll is a “westie,” from the wrong side of the tracks, from a non well off, somewhat dysfunctional family. She works over time and is saving money to go to college to obtain an education and to raise enough money for a downpayment on a flat in a nicer, safer neighbourhood. In her free time she reads decorating magazines or hangs out with her friend Wilder and her young son. When things get tough she copes by using pills and buying classy clothes, which in some sense transport her to her imagined future life.

Her life is disrupted violently when she is wrongly accused of being a terrorist.We follow her plight and the unravelling of her life over 4 days till her breaking point. Flanagan describes this string of events with realism and detachment. Without being aware the Doll is sucked into a vortex, which begins when she starts an affair with an attractive young man of Middle East origin. Initially she meets him on Bondi beach when he saves her friend’s young son and later that day in a carnival like celebratory parade in the city. He’s a computer programmer and a small time drug dealer, who is also wrongfully identified as a terrorist while Sydney is experiencing a minor terrorist scare, and soon after is found murdered in the street. A security camera video of the two of them embracing outside his apartment block results in her been constructed as the Unkonwn Terrorist. She becomes the target of a sleazy and vindictive, TV journalist-broadcaster, who is a regular client at the club she works, in Sydney’s red light distric, frequented by businessmen, media personalities, politicians, and others. He constructs the story based on flimsy evidence, like this misleading video footage, even though he knows that the narrative is problematic and that it’s not the first time he has destroyed someone’s reputation.

Over these four days she is constructed as something other than who she really is. She is being manipulated by the image of reality represented by the media, which in a dystopian way has displaced her real self. The Doll realises with terror that they were “turning her from a woman into cartoons, headlines, opinions, fears, fate. They were morphing her pixel by pixel….., into what she wasn’t.” She becomes the site for others to project their contempt, anger and fear, and above all an object that triggers a chain reaction of events that serve the agendas of people with vested interests, much more powerful than her, who are connected with each other because “at some deeply buried place,” they “understood that to share power was to share guilt.” She has unwittingly become the innocent lamb in the social slaughterhouse, and the biggest irony in the novel is that there are instances where the Doll buys into the fear, the xenophobia and racism, adopting opinions she hears on the News without processing them much.

The theme of societal scapegoating is one of the themes that run through the narrative, and the hunting down and elimination of the Doll remind us of ritual killings, viewed as a necessity, in older societies. From a certain point on her elimination is the most convenient thing for those implicit in the construction and the dissemination of the story. She becomes a public enemy and a useful scapegoat for politicians, and she is hounded by the media, let down by her good friend, whose loyalty is tested when she is threatened and forced to consider her son and her own safety, by the one policeman that is trying to protect her, and by people with authority, and power, who also realise she’s innocent, but are afraid to go against a network and a system they are part of.

During these four nightmarish days the Doll relives her past traumas and wounds, visits the children’s graveyard back in her hometown, where her baby son has been buried, cleans the small patch of land and leaves some flowers, runs out of money, shaves her long hair, always on the run from the police, the media, the newspapers, and anyone who might identify her. Everything has been taken from her: her identity, her privacy, her dignity, her dreams, her past and experiences have been distorted and sensationalised, her hard earned savings, stashed in the ceiling of her dingy flat in Darlinghurst because she has no bank account. While she undergoes this kind of Kafkaesque experience, she awakens to more reality, to what is going on and to how the world works behind the scenes:

“Maybe,” she thought, “there was some need people had to hurt others, some horrible need, that hurting one woman in some way might make others feel safe and good and happy…… And maybe she had to accept that she should be hurt, that maybe these things happen for the common good?” But then she thought, “She couldn’t accept that she should be hurt, she couldn’t just give in and give up.” She wonders if the “terrorism question” had become a fad, like fashion or Botox that hides the truth, and that there was a class of people who “were building careers, making money, getting power and it really wasn’t about making the world safer or better at all.”

This political thriller raises concerns about societal fear, racism and xenophobia, exclusion and the violence that it can potentially generate, the power afforded to governments and other authorities, and the activities involved in the name of protecting or controlling populations. The narrative is not balanced [reality is broader and more diverse] because it’s a novel and Flanagan is bringing to the foreground one part of the story, the hidden or half hidden reality of what goes on or could potentially go on behind our backs, with great intensity. He’s trying to make us aware of the risk of becoming more vulnerabile to forms of tyranny, if we’re obliviously ignorant, and all we are exists only within the confines and parameters of a system that we don’t have much control over.

It depicts a dystopian urban scene in Australia, where life is heavily defined by obsessive use of technology, the influence of the media, the pursuit of power and money, greed, consumerism, and the contrast between wealth and poverty.The novel is inhabited by many angry, desperate, disconnected people, homeless people sleeping in alley ways, beggars, drug addicts and dealers, pimps and crooks, and strip clubs, where those at the bottom mingle with those at the top, who have power, connections and money. This part of Sydney is not the iconic, happy, sunny land, but a place hit by heatwaves, freak storms and terrorist threats, where the public is numbed by shopping, alcohol, drugs and TV shows, and where a ceaseless noise of terror alert News breaks and fear push everyone closer to the edge.

We feel the writer’s anger as he presents us with the harsh side of the reality of injustices and abuses in a first-me society, where the powerful and well connected control and use, and the rest have to fend for themselves as best they can. Flanagan seems to be greving the loss of a world he has known of more social cohesion, of family ties, and of solidarity, which has been replaced by disconnection and social dislocation, and obsessive materialism and individualism. He shows us the bleakest parts of life in a dystopian Sydney, “a place that had once been a community, in a country that had once been a society.”

Αt the end of the book Flanagan acknowledges his debt to Heinrich Böll’s book, The Lost Honour of Katharina Blum. Although this book is different I felt it echoed Heinrich Böll’s story, which I had read in the very late seventies. I skimmed through the book, an old Penguin edition I still have, and I re-watched the film made by Volker Schlöndorff and Margarethe von Trotta in 1975 to refresh my memory. Both writers explore the same concerns about individual freedom, the role of the press, democracy, and how the “war on terror” can be used as an excuse to oppress and to undermine individual freedom and freedom of expression. The film was made in 1975 and it reflects the fear for civil liberties in West Germany during that period. Flanagan moves his story from West Germany in the 1970s to a post 9 /11 world, in Sydney.

Also, both writers have chosen female protagonists, which win readers’ sympathy or at least I would like to think so. The Doll is a good person, as was Katharina Blum, and although they do different jobs [Katharina is a housekeeper], they work hard, have similar aspirations of improving their lives, and share a similar class and family background. Gina Davies is known as the Doll and Katharina is sometimes called the Nun. They are both wrongly accused of being terrorists and both become victims of ruthless journalists / the press, they suffer smear campaigns and violations of privacy, and are finally pushed to the edge. They are also both let down, by people they know, and also institutions. Katharina, for instance, finds out that the institutions she turns to and had expected to help her don’t respond, and people she barely knows or strangers display hostile and threatening behaviours. She essentially finds herelf locked out of society. Two more similarities are that both stories take place over a four and five day period and utilize a carnivalesque, dancing and celebratory backdrop.

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Brief biographical notes

Richard Flanagan, born in 1961 in Tasmania, Australia, is a novelist, historian, journalist and film director. He left school aged 16, later earned a B.A. in history from the University of Tasmania, and in 1984 won a Rhodes scholarship to Oxford University, where he took a Master of Letters degree. He is widely considered the finest Australian writer of his generation. Flanagan and his wife live in Tasmania, and they have three daughters.

Flanagan has written several novels and in 2013 he released The Narrow Road to the Deep North, which was based in part on the experience of Flanagan’s father as a prisoner of war during World War II, and which received various honors, notably the the Booker Prize. He is also an award-winning journalist, on subjects including art, literature, politics and the environment, and is an ambassador for the Indigenous Literacy Foundation, to which he donated his $40,000 Australian Prime Minister’s Literary Prize prize money in 2014. In 2011 a collection of non-fiction writings was published as And What Do You Do, Mr Gable?  In 2015 he published Notes on an Exodus, on the Syrian refugee crisis, which came about after visiting refugee camps in Lebanon, Greece, and meeting refugees in Serbia. The book features sketches made by Australian artist Ben Quilty, who travelled with Flanagan. He has criticized the Tasmanian government’s logging and gambling policies and relationship with corporate interests, and in 2021 published a non-fiction book, Toxic: The Rotting Underbelly of the Tasmanian Salmon Industry. In the BAFTA award-winning BBC documentary on Richard Flanagan, Life After Death [https://vimeo.com/135694839], Flanagan talks about several of his books, including, The Unknown Terrorist, and how certain personal experiences of political pushback influenced him to write this book.

Heinrich Böll (1917-1985) was a German writer and pacifist, winner of the Nobel Prize for Literature in 1972, and he remains one of Germany’s most widely read authors. In 1938 he was called into compulsory labour service, and he served six years in various fronts. Böll’s wartime experiences of being wounded, deserting, becoming a prisoner of war were central to his writing. Böll lived through the end of the war in the Rhineland, where he temporarily deserted and went into hiding with his wife, but fearing that he would be found, court-martialled and shot as a deserter, he rejoined the army at the end of February 1945. Shortly afterwards he was captured by American troops, and remained a POW until September 1945. That same year his first son Christoph was born, but died shortly afterwards. Böll and his wife went on to have three more sons. They have two surviving sons.

About the war experience he wrote: “frightful fate of being a soldier and having to wish that the war might be lost.” In Britannica it is stated that “Böll used austere prose and frequently sharp satire to present his anti-war and nonconformist point of view. He was widely regarded as the outstanding humanist interpreter of his nation’s experiences in World War II,” and due to his writing about the complexities and problems of the past, “some called him the Gewissen der Nation (“conscience of the nation”), a catalyst and conduit for memorialization and discussion in opposition to the tendency toward silence and taboo” (Wikipedia). In his work The Lost Honour of Katharina Blum the journalistic ethics of the time are critiqued as well as the values of contemporary Germany. Böll loved Ireland, and he and his wife had a second home there, which later became an artist’s retreat.

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Medical gaslighting, medical trauma and medical post traumatic stress

“In a man’s [human’s] attachment to life there is something stronger than all the ills in the world. The body’s judgment is as good as the mind’s and the body shrinks from annihilation. We get into the habit of living before acquiring the habit of thinking.” Albert Camus

“There’s no voiceless, there’s only the deliberately silenced, you know, or the purposely unheard” Rundhati Roy

I have written about or referred to medical trauma, and gaslighting in personal relationships and larger social contexts, like education or the media, over the years, but I don’t think I’ve ever written anything about gaslighting in medical contexts. Today’s post explores the issue of medical gaslighting, trauma and gatekeeping through the presentation of a non-fiction book, Medical Gaslighitng, by Ilana Jacqueline. And also, while reading the book I listened to and read some additional relevant material, and so I will be making references to this material, too. Finally, I haven’t included any personal experiences in this piece because the post is quite lengthy as it is.

Before I continue, I’d also like to say at the get go that I consider the field of medicine and the huge progress it has made as greatly contributing to the quality of the lives and longevity of everyone on the planet that has access to some level of medical care and health information. I also have a lot of respect for physicians and health providers. They save lives, stop the progression of diseases, relieve pain, and ideally also provide preventive care. The work physicians do is both valuable and demanding, and also they are required to invest a lot of time, effort and money in order to become physicians. I feel gratitude for the times loved ones or myself have received health care, sound advice or came out of surgery rooms alive. Finally, I also have a lot of respect for doctors who offer humanitiarian aid to people in great distress like poverty stricken areas, war zones, and so on. It is an important and useful profession, especially when it is also experienced as a vocation.

However, there are also inherent inequalitites, gatekeeping processes, unhealthy power dynamics, biases and hierarchies embedded within the medical system as in all areas of society. Additionally, we are all hard-wired to judge, and doctors are no different from the rest of us in this respect, but this tendency and capacity can often result in stereotyping and biased thinking, and when this happens in medical contexts the consequences can impact the quality of care that is provived. Physicians and health providers are human like the rest of us with conscious and unconscious biases, ideologies, interests, values and cultural influences, traumas, personalities and problems, and all these factors can influence and impact the quality of the care they provide. Like in any professions there are individual differences, not all mental health providers are alike, and some are more competent, compassionate and conscientious than others. Finally, it is important to remember that bias isn’t just individual; it’s embedded in research, organizational cultures, policies and guidelines, and societal norms. Therefore, changes need to take places both at a systemic level and at a personal level during patient-doctor / nurse interactions.

Ilana Jacqueline’s book is a practical guide to help patients, mostly women, deal with medical bias or neglect in medical contexts, so as to be better able to get the care they need and deserve. She writes: “this is the essential guide for defending against a medical and societal system that was not built to bear the burden of women who want to be well.” Jacqueline situates her own experience and begins by informing us that a delayed by 19 years diagnosis, which she should have been given at birth for a serious condition related to her immune system, would have saved her from so much physical pain, suffering and loss. The outcome of her life would have been different. She also brings in expert information and advice, and stories by women, who confronted medical gaslighting, eventually received diagnoses and appropriate health care, and have lived to tell their stories. Jacqueline also notes that even though today more people might be aware of the reality of medical gaslighting and gatekeeping, awareness alone is not enough. Her book provides guidance to help increase confidence to advocate for and take control of one’s own health or that of a family member. She discusses ways to master the ability to ask questions, and request information, a diagnosis or a health plan, and how to be mindful of the signs, language and behaviours of medical gaslighting and recognise medical bias.

She claims that for women the possibility of experiencing medical gaslighting, which means having their concerns and symptoms being ignored or dismissed or psychologized, information being withheld, or their being infantilized and made to feel small, or not receiving a diagnosis or treatment plan, has always been real and higher with dire consequences ranging from women avoiding physicians and medical contexts to delayed or multiple diagnoses, deterioration of health and death. She adds that statistics and studies have shown that being a woman of colour, transgender, gay, disabled, over weight, elderly, poor or an immigrant, can compound this further, but she clarifies that ultimately anyone can experience medical gaslighting, especially in an overburdened health system.

In her early chapters Jacqueline discusses the need for a guide to navigate the health system, defines medical gaslighting and explores causality and its serious consequences, writes about how to recognise it and discusses medical bias in some depth. In the second part of the book she explores ways to prepare for appointments, how to respond to medical gaslighting and how to take action after it has occurred, how to survive in the aftermath of medical gaslighting, pain management, medical trauma and medical post traumatic stress.

She begins by explaining that much like herself, the women she interviewed for this book had no idea about the silent dangers of medical gaslighting and how their blind trust was leading them off cliffs they didn’t know existed. Many of them also wondered what might have been if they’d had someone out there to warn them and guide them, and they also wondered if sharing their stories could stop history from repeating. She notes that medical gaslighting is an experience where the patient is “beholden to someone in a position of power who does not have [their] best interests at heart,” which can be the result of many factors, but irrespectively of whether the cause is bias or belligerence, it is still real.

She explains that the definition of medical gaslighting is broad and encompasses multiple tactics, patterns, and motives, and highlights its most common forms.

Purposeful obstruction might look like when a patient’s care is deliberately impeded by a healthcare provider who provides incomplete or misleading information in a patient’s file or other communication about the patient, or does not explain test results or recognises a diagnosis in a patient, but does not inform the patient of the diagnosis. Medical negligence describes a situation in which a patient receives inattentive care, or is not given a diagnosis or treatment or the necessary testing for a suspected diagnosis. She writes: “The alarming reality is that doctors have the power to withhold diagnostics and treatments that can save your life. They can mark your medical records with notes that will make future doctors treat you in the same way.” It could also involve health providers manipulating the power imbalance, discrediting, for instance, the patient’s observations and concerns or refusing to answer questions.

Medical gaslighting, Jacqueline writes, also includes treating patients with bias based on their age, gender, sexual orientation, religion, ethnicity, financial status or class, weight, appearance, lifestyle, disability, and allowing this bias to impact the quality of care provided. Jacqueline provides examples, noting that one of the most concerning areas for medical bias and gaslighting, for instance, is in the care of Black women during pregnancy, labor, and delivery. Statistically, she writes, “the USA is the most dangerous place in the developed world to be a pregnant Black woman.” Also, some medical information is based on theories, inadequate data or data published in the past. For instance, she tells us that there were theories and studies that claimed that Black patients do not need skin care or sunscreen, have lungs that need to be strengthened by heavy labor to perform adequately, or feel less pain than white people.

It can also involve claiming a patient is not being truthful about their level of pain, blaming their perception of pain or explaining their symptoms as psychosomatic, anxiety or other psychological conditions. Also, it might take the form of shaming patients (read more on shame below) or withholding information, which robs the patient of choice, interferes with patients’capacity to seek approapriate help and create a plan of action, as well as, the process of consent. She writes: “You are robbed of your consent—by being purposefully obstructed from getting the information you need.”

Jacqueine delves into the causes medical gaslighting occurs, which are complex and varied. She writes: “In the quest for compassion, care, an accurate diagnosis, and timely treatment, doctors have to fight a variety of factors that lead them to consciously and unconsciously gaslight their patients—and particularly their female patients.” These factors include historical misinformation, the gender knowledge gap, the current limits on our understanding of the human body and disease, implicit and explicit biases, sexism racism, and other -isms, the inherent power imbalance in the patient-physician relationship, an overburdened medical system that encourages the bare minimum, and more.

She begins with the reasons why women have historically been medically gaslit and why misinterpretations of women’s health go way back for centuries, and how women have “been trying to work [their] way out from under the rubble of rumors and best guesses from everyone from great philosophers to religious zealots to politicians with big agendas.” This started, she writes humorously, with the Greek physician Hippocrates, who invented the theory of the wandering womb, and adds that the fact is that many theories that have shaped what we understand today about women’s overall health have really just been theories: “unproven, under-researched, and based on centuries of best guesses that inform the way we’re judged when we dare to be anything anything less than perfectly well…,” and content. Also, she adds a lot has been attributed to women’s overactive brains, and symptoms have at times been explained away as a punishment of God, or as the consequence of their imperfect biology.

Referring to medical research she notes that the medical world was built with the able-bodied, 154 pound (περίπου 70 κιλά), white man in mind. Otherwise, she comments, “you’re just too complicated, too expensive, and too time-consuming to be included in research.” The human described above is also known as “The Reference Man” and he came into being in 1975. She writes: “This “perfectly average, “ideal” human has since shaped the standard for the studies that were given the stamp of approval for use on all humans: male, female, intersex, able-bodied, disabled, underweight, overweight, and of various ethnicities and ages. As you might guess, this radical lack of inclusion in medical research brought with it a fair amount of disaster.” She provides historical examples, one being the better known originally safe marketed drug, thalidomide, for both men and women in the 1950s and ’60s that had never tested on pregnant women, and which resulted in the deaths of 2,000 children. She concludes that it wasn’t until the 1990s that women in STEM started to undo years of neglect from the medical research community. According to Janine A. Clayton, MD, this “lack of women included in medical research has resulted in our knowing less about female biology and less about how to diagnose, prevent, and treat diseases safely and effectively,” and “the knowledge gap is going to take time to address.”

Despite the tremendous progress in medicine and medical research there is also still so much we don’t know, and we definitely don’t have all the answers. Jacqueline writes that some doctors meet the unknown with enthusiasm and want to test and search, and others turn away or are indifferent. Another factor she discusses is the fact that many doctors are overburdened and pressed for time. She writes: “… good intentions may not be enough to break through the barriers in their way. They may want to give your situation the attention it needs, but can’t,” and “sometimes doctors can’t figure out what’s wrong or how to fix it. They are cogs in a larger system that is designed not to understand you or fix you, but to patch you up, spit you out, and make a profit. Healthcare will always be messy. Insurance issues. No empty beds. Overscheduled appointments. Unavailable technology. A lack of necessary staff. Being a doctor is hard.” Jacqueline refers to the medical system, clinical settings and circumstances in the USA, where she lives and works, but we can find commonalities in many countires, at least in the so called Western world.

She devotes a chapter on the question of whether a bad experience in a medical setting is the result of conscious or unconscious gaslighting, a medical necessity, or simply the result of the inherent problems in the healthcare system in general. She provides a questionnaire to learn to discern the differences, and suggests we make a list of our own bad or traumatic medical experiences to see if we can figure out if they meet the criteria for medical gaslighting or not. She concludes that patients and doctors stand beside each other in the overburdened healthcare system, and that “we don’t get to choose the circumstances of that existence beside each other, but what we can choose is how we treat each other.”

Another factor that plays a role in all this is implicit bias, which in health care settings occurs, says Jacqueline, every time a healthcare provider stereotypes patients, developing an opinion about a specific patient based on similar patients they’ve seen in the past or have been taught about in their training, or learned about through the media. Medical gaslighting, she writes, “is a behavior that is taught and replicated, learned and weaponized.” Medical gaslighting has a symbiotic relationship with implicit bias, and it occurs when mental health providers fail to see a patient as an individual. As mentioned already, these biases could be about a patient’s gender, ethnicity, age, sexual activity or orientation, mental health diagnoses, facets of their appearance or colour, weight and size, education, outlook on life, politics, etc. In medicine, notes Jacqueline,  this can leave patients dangerously typecast, and can practically mean that a Black patient, for instance, doesn’t get the epidural she needs in time, or a young or a slim woman doesn’t get the tests she needs, or a patient in a larger body isn’t offered the same diagnostics a thinner counterpart would.

There is also the important issue of power imbalance in the relationship between health care provider and patient and the fear of authority, especially, as one’s health or life are at stake. Being the patient, you feel vulnerable because each time we seek help for health issues we have to, writes Jacqueline, “cede control of our bodies, surrendering to the idea that we don’t have the knowledge or the authority to fix the problem on our own. We have to put our lives up as an offering for the chance of expert care,” this particular power imbalance can prove life-threatening, since she tells us, a doctor can dismiss us without a diagnosis or treatment plan, can belittle our fears or laugh at our trauma, can withhold important information that robs us of choice and wise decision making, badmouth us in medical records, and make the journey for care a longer and harder one than it already is.

This power imbalance, she explains, is also why we often remain silent or passive in the face of medical gaslighting, and this is also one reason why a lot of women patients turn to alternative health practices, and often expensive and ineffective wellness products, but this works well for those who are already fairly well. She tells her own story not only of her delayed diagnosis of a rare and serious immune disorder that caused her years of suffering and a string of infections and other issues, her later surgeries and chronic debilitating pain and her need for an integrative pain management approach, but also how in her earlier years she was led to believe that alternative therapies could provide cure; however, what she needed was the right medical tests, a diagnosis and immunoglobulin therapy.

She writes about common signs, phrases or ways of communicating that point to gaslighting like insinuating that women are crazy / hysterical or that it’s all in their head or that they’re too sensitive, suggesting they stop working, offering biased conclusions, choosing limited testing or framing symptoms as less severe and impactful.

Jacqueline also discusses how medical gaslighting is sometimes convenient, as she notes, to shut you up, instead of listening to your needs, to make you a last priority in an overloaded system, to make you redraw your boundaries, to make you accept pain instead of remedying it, and as she puts it:  “… the consequences of this convenience aren’t always just one less body in the waiting room. Sometimes they’re just one less body.” Jacqueline reminds us that when we feel exhausted and disillusioned from an accumulation of hurtful experiences and wonder if it is worth defending at the cost of our emotional well-being, we should know that “the consequences of not recognizing, fighting, and working to systemically alter the practice of medical gaslighting are ones that could cost us far more than we might realise. She explains how the impact of medical gaslighting is not just personal, but also systemic, and writes that when women’s health concerns are silenced in one room, it echoes worldwide.

In the book five categories of consequences to medical gaslighting are discussed:

1)  Shame is explored as both a consequence and a tool of medical gaslighting, a strategy in and of itself, which manipulates patients into accepting substandard care. Medical gaslighting also leaves patients harboring poor self-esteem and feeling shame and, of all the weapons one can wield in a war against women, writes Jacqueline, shame is the sharpest and often leads to a refusal to seek medical care. 2) Delayed diagnosis and disease progression. Once patients have expereinced medical gaslighting or trauma they may refuse to seek care from another provider or they may turn to alternative health contexts, which often results in the deterioration of health and a delayed diagnosis. 3) Generational misunderstanding of disease, when a patient is told their disease symptoms are part of the normal course of health, growing up or aging. 4) Diagnosis of exclusion and data pool pollution, which occurs when healthcare providers fail to provide patients with a thorough diagnostic evaluation, and instead compromise with a diagnosis arrived at by process of elimination, and finally, 5) Irreversible bodily harm and death, by means of delayed care, inaccurate diagnosis, or failure to bridge trust with the health system in time.

Jacqueline expands on shame and notes that shame has been used for centuries as a way to control women, who might otherwise have the audacity to ask questions or advocate for their health, and it can be a solution for an already overburdened system. It can make you feel like you need to apologise for existing. She writes: “While you learned shame, others were learning the power of manipulation. They learned that for you to be manipulated, you had to be vulnerable.” She adds that perhaps many of those who exercised the power of manipulation weren’t fully aware what it was they were doing; but they saw the benefits of doing it because shame deterred and silenced. She asks: Can you think of a system that really needs to stem the flow of people walking through its doors? A system that is overburdened, understaffed, lacking the resources needed to respond to demand?

As mentioned above, this process creates in patients, and women in particular, a feeling of hopelessness, doubt and distrust not just in their physician, but in the health system in general; however, she concludes turning away from health care doesn’t fix the healthcare system, and above all, every delayed visit and delayed diagnosis leads to disease progression. For instance, a study showed that women, on average, are diagnosed with cancer 2.5 years later than men. In chapters 7 and 8 Jacqueline goes into some effective ways of dealing with, and responding to medical gaslighting, when this is beneficial for the patient, things one can do to better prepare for a medical appointment and increase the chances of being treated with dignity as a patient, possible fight, flight, or freeze responses to gaslighting, and when these are productive or unproductive, and the importance to not stop seeking care when things don’t go well in medical contexts. She writes that courage is seeking help, especially knowing it may not be given.

She also explores preventive care, the power and predicament of the electronic medical record, (chronic) pain management and falling down the rabbit hole of pain management; however, I won’t refer to all the points made in the book because Jacqueline is exploring the reality in the USA and the American health system, the opiod crisis and pain management, and the way these heath structures are set up there, which might be different or irrelevant in other countries. Chapter 11, in particular, centres on pain and pain management, and the fact that we can’t always detect who is or isn’t in pain just by looking at them, by observing their behaviours and knowing their schedules. Especially women, she writes, are trained and taught from an early age that life goes on, no matter how bad you feel, they “can smile through it, laugh through it, work and converse through it……. they are rushed back to work after C-sections and vaginal births, denied anesthetic for cervical biopsies and intrauterine device insertion, and taught to always show up, because it’s impolite and selfish not to show up for others, even when our bodies don’t show up for us.”

She refers to gender difference and the fact that there is limited research on pain differences between women and men. She does refer to some related studies: For instance, a 2013 study published in the British Journal of Anaesthesia found that women are at increased risk for chronic pain compared to men, a study at the University of Miami found that women’s pain was viewed as less intense and as benefiting more from psychotherapy than men’s pain, and that these pain biases could be an obstacle to getting women the pain relief they need. What is known however is that women are more apt to verbalize their pain, whereas men are taught from a young age to conceal it and to deal with it privately, but these gendered associations around willingness to complain about pain or acknowledge it in front of other people have created a paradoxical effect. When male patients bring up their pain, doctors are more apt to believe them, women on the other hand, are suspected of over-reporting and sensationalizing their pain.

Jacqueline also devotes a chapter on medical trauma, which can happen both in one instant, as for instance, in a procedure that goes wrong, or it can be cumulative from “small cuts” over time, and medical post traumatic stress, which she claims are both worthy of understanding, exploring, and healing from, in order to avoid getting trapped by these traumas, and end up carrying the trauma through each new medical interaction, often making people even more vulnerable to future medical gaslighting. She refers to study findings, and comments that it’s a lot more common than we think, and it can start very young. For instance, according to a study published in the Journal of Pediatric Psychology, nearly 80% of injured or sick children experienced some traumatic stress response following medical trauma, and between 20 and 30% of their parents, and between 15 and 25%of the children experienced persistent traumatic stress. She discusses Trauma-Informed Care and the need for there to be structures and tools in place to manage the psychological impact of a hospital stay or a surgery or a medical crisis, and the need to address the raptures in trust that occur from medical gaslighting. She refers to Dr. Michelle Flaum, clinical counselor, professor at Xavier University, and author of Managing the Psychological Impact of Medical Trauma.

As I mentioned above, while reading Ilana Jacqueline’s book I also listened to talks and read some relevant medical articles, and also, an article in The Guardian by social affairs writer, Hannah Fearn (January / 2024), which focused on a particular patient group in the UK. Fearn writes that many women with endometriosis that had endured years of excruciating pain, and had being gaslit and told by physicians that their symptoms were all in their head or that they had a low pain threshold, lead them to give up seeking NHS treatment. Fearn goes in to some of the causes, and also, how this reality leaves women feeling “angry, fearful, anxious, frustrated and powerless, with many choosing not to seek further care because of the way they had been treated.” She also notes that lack of confidence to request better care or challenge medical experts means that women are more likely to accept the medical discourse and avoid seeking help in future. Both Jacqueline and other writers of thematically related papers claim that men have a tendency to be more confident and vocal and persistent with their concerns, whereas, many women feel like they need to be “good patients”, which means trusting and accepting without questioning and not advocating for themselves.

Fearn writes that endometriosis affects 1.5 million women in the UK (190 million women globally live with painful endometriosis, cited in Jacqueline, 2024), and a study she refers to that looked at the experiences of treatment and diagnosis of a number of patients, revealed that women often spent years in pain before their condition was diagnosed and during this period participants were told that they were exaggerating their symptoms or their pain was dismissed as psychological. Another study carried out by academics at Manchester Metropolitan University found that: women felt “gaslit” by doctors; treatment was subject to a postcode lottery, and patients in rural areas reported having to travel for hours to access a specialist with full training in this condition.

Fearn quotes Dr Jasmine Hearn, senior lecturer in health psychology and lead author of this paper, who said: “The biggest challenge is the disbelief, the dismissal and the sense of shame and embarrassment.Women are expected to tolerate much higher pain levels than men in general, so when women go [to the GP] with extreme pain, they are at that point of desperation and need to be taken seriously.” Furthermore, many women’s health issues are likely to be misdiagnosed or dismissed by doctors as something less critical. In one study (published in Academic Emergency Medicine) it was found that women who went to the emergency room with severe stomach pain had to wait for almost 33% longer than men for the same complaints.

In one paper a physician in the USA notes that medical gaslighting is a known secret in health care that doesn’t get the attention it deserves and that female patients are continuously gaslit about their health. Sometimes, she notes, it is heart disease labeled as anxiety, sometimes pain and fatigue or an autoimmune disorder dismissed or attributed to depression, and so on. Both Jacqueline and physicians mention that unfortunately there’s still a pervasive belief in the medical community that when a woman complains about her health, it’s mostly related to her hormones or it’s all in her head. They note that the word “hysteria” that originates from the Greek word for “uterus” was once a common medical diagnosis for many women’s ailments, and also applied whenever women displayed anxiety, anger and even sexual desire.

There’s an important connection between the mind and the body that needs to be addressed and not dismissed, and pain and illnesses do not always fit neatly into a cookie-cutter category and often require a more integrated approach. Often health issues are complex and need to have a more comprehensive evaluation. However, certain women’s symptoms may be too easily brushed off as psychosomatic from the start, explained away as anxiety, when they could be caused by thyroid issues, hypertension, early coronary heart disease, any one of several autoimmune conditions, etc. Psychologising all women’s health concerns, symptoms and complaints is problematic and can lead to unnecessary suffering and disease progression, late diagnoses and serious increased health risks.

As I wrap up this article I’d like to mention some of the things that have been suggested in the material I’ve been looking at that could improve the situation. Some physicians have suggested expanding the educational curriculum in Schools of Medicine to include sex and gender, because the one-size-fits-all approach to medicine, as discussed above, negatively impacts women’s health. Over the last couple decades, science and evidence have emerged to show how sex impacts various diseases, and yet the health care delivery model lags behind. Dr. Mieres, for instance, explains that there are still gender biases in health care, and that in 2011, she and her colleagues published data that highlighted some of the sex and gender differences in cardiovascular disease testing and diagnosing. Consider how women are almost twice as likely to die after a heart attack.

Another issue is the fact that many women don’t feel empowered to speak up for their health; therefore, instead of reinforcing the convenient idea that they be “good patients,” it is necessary to encourage them to advocate for their health. It is suggested that medicine and care plans should be a dialogue between a provider and the patient. This would help patients feel empowered because they would feel they’re an integral part of the management process. Another suggestion towards better health care is integrated programs or teams that would take more aspects of a patient into account, like their medical history, symptoms, nutrition, gender, lifestyle factors. Physicians who look at the big picture and can imagine what it might feel or be like to be in their patients’ shoes are likely to deliver more empathic and effective health care. Also, it is suggested that if a patient feels like their physician is gaslighting them or not giving adequate time or answers they should seek a second opinion or a more multidisciplinary approach. Also, it is important for women,and patients in general, to realize that their relationship with their physician is based on partnership, not paternalism.  

I will end with the writer’s personal statement:”…… I want to know what it feels like to get the care I deserve without having to give away every meaningful piece of myself.”

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2026

On kindness

Continued from previous post….

“You know, who tells the stories of a culture, really governs human behaviour. It used to be the parent, the school, the church, the community. Now it’s a handful of global conglomerates that have nothing to tell, but a great deal to sell.” George Gerbner

“If you can write a nation’s stories, you needn’t worry about who makes its laws. ” George Gerbner

Rutger Bregman’s book, Humankind: A Hopeful History, offers a more optimistic and probably more balanced story of our complex human nature in a time when the world is lurching towards more authoritarian regimes, division, intolerance, populism and fake news are on the rise, and new refugee crises and immigration waves are increasing nativist fears and hostility. Bregman explores the dichotomy of human nature as expounded by Jean Jacques Rousseau and Thomas Hobbes. He writes that “the opposing views of these two heavyweights are at the root of society’s deepest divides. I know of no other debate with stakes as high, or ramifications as far-reaching. Harsher punishments versus better social services, reform school versus art schools, top-down management versus empowered teams, old-fashioned breadwinners versus baby-toting dads – take just about any debate you can think of and it goes back, in some way, to the opposition between Hobbes and Rousseau.” According to Bregman we have, on the one hand, the dominant Hobbesian perspective that suggests that humans left on their own devices without control and surveillance are ultimately selfish and highly antagonistic, and on the other hand, Rousseau, who believed that it has been the structure of civilization that has fed greed, need for control, conflict and wars over territory. Bregman believes that Rousseau was right in that our human nature served us well prior to the establishment of sedentary, hierarchically structured societies. However, his book is not a sermon on the goodness of human nature; he makes it clear that we are complex creatures with a good side and a not-so-good side, and the question is which part do we choose to nurture and act from, what aspects of our human experiences do we want to prioritize, and what kind of narrative about human nature is reinforced socioculturally.

As I mentioned in the previous post, Bregman, through a multidisciplinary approach and real life examples from different parts of the world, explores how we can nurture our capacity for kindness and care for others to build a better and safer world, and how to use our species’ inherent sociability in positive ways. A growing number of thinkers and researchers have been exploring this tension between human sociability, on the one hand, and human propensity for selfishness, cruelty and violence, on the other. I read somewhere that both our evolutionary legacy as very social animals and our ability to transcend the limits that this legacy imposes on us are aspects of what it is to be human. Our species is a very social animal and we have inhibitions against killing and inflicting violence on others, but we can also understand the potential gain of killing and exploiting others, so we have over time developed practices to bypass our gut level inhibitions, like creating bombs and other weapons of destruction to kill from a distance, using fear and propaganda, tactics of conquer and divide, and culture to shape human nature and to incite populations to perform violence. Being cooperative on its own does not necessarily lead to pro-social or kind behaviour towards others, especially towards those considered members of out-groups.

Additionally, humans can cooperate to do harm and perpetrate atrocities, even while harboring good intentions, as history has shown us repeatedly. Bregman refers to psychologist Don Mixon, who when he repeated Milgram’s notorious experiment in the seventies noted that “In fact, people go to great lengths, will suffer great distress, to be good. People got caught up in trying to be good …” In other words, he explains, if you push people hard enough, if you poke and prod, bait and manipulate, many of us are capable of doing evil. The road to hell is paved with good intentions. But evil doesn’t live just beneath the surface; it takes immense effort to draw it out, and most importantly, it has to be disguised as doing good. Bregman examines WWII and the Holocaust and explores the reasons and circumstances that made participants act as they did, and shows us that cruelty, the lust for violence and chaos for most soldiers and civilians played little role, and he provides a discussion on the role that power and propaganda, loyalty to country, and mostly to friends and comrades, played in the decisions that ‘ordinary’ people and soldiers made, often with horrific consequences. He discusses the available literature on the Holocaust and concludes that “it wasn’t the work of humans suddenly turned robots, just as Milgram’s volunteers didn’t press switches without stopping to think. The perpetrators believed they were on the right side of history. Auschwitz was the culmination of a long and complex historical process in which the voltage was upped step by step and evil was more convincingly passed off as good. The Nazi propaganda mill – with its writers and poets, its philosophers and politicians – had had years to do its work, blunting and poisoning the minds of the German people…..”

However, Bregman demonstates that resistance is possible and can have positive outcomes. The participants in Milgram’s experiments, who managed to halt the experiment used “communication and confrontation, compassion and resistance,” more than the others. He also refers to the Danish resistance to cooperate with the Nazis during WWII, and as a result almost 99 per cent of Denmark’s Jews survived the war. He writes: “It’s a story of ordinary people who demonstrated extraordinary courage. And it shows that resistance is always worthwhile, even when all seems lost.” Historian Bo Lidegaard comments that the Danish Jews were protected by their compatriots’consistent engagement. Resistance sprang up from every quarter, and even the Danish police assisted where they could and refused to cooperate with the Nazis. Bregman comments that where mighty Germany was doped up on years of racist propaganda, modest Denmark was steeped in humanist spirit, and concludes that “the Danish exception shows that the mobilization of civil society’s humanism […] is not only a theoretical possibility,”

He presents literature that supports that unlike what action heroes in films would like us to believe, we are greatly inhibited against violence and killing. He refers to colonel and historian, Samuel Marshall, who found that only 15 to 25 per cent of soldiers had actually fired their weapons, and that at the critical moment, out of more than three hundred soldiers, he was able to identify only thirty-six who actually pulled the trigger. Soldiers who didn’t fire still stayed at their posts, they were courageous, loyal patriots, prepared to sacrifice their lives for their comrades, but still they failed to shoot. Bregman writes that over the last decades, proof that Colonel Marshall was right has been piling up. For instance, Lieutenant Colonel Lionel Wigram complained during the 1943 campaign in Sicily that he could rely on no more than a quarter of his troops, and General Bernard Montgomery, in a letter home wrote, ‘The trouble with our British boys is that they are not killers by nature,’ and later when historians began interviewing veterans of WWII, they found that more than half had never killed anybody, and most casualties were the work of a small minority of soldiers.

Similalry, less than 1 per cent of fighter pilots in the US Air Force were responsible for almost 40 per cent of the planes brought down, and most pilots, one historian noted: “never shot anyone down.” In the 1860s, French colonel Ardant du Picq discovered that when soldiers did fire their weapons, they often aimed too high, and this could go on for hours: two armies emptying their rifles over each other’s heads, while everyone scrambled for an excuse to do something else, and in his Spanish Civil War classic, Homage to Catalonia, George Orwell wrote: “In this war everyone always did miss everyone else, when it was humanly possible.” The last story that Bregman has chosen to tell is about the Christmas truce of 1914, when more than a hundred thousand soldiers laid down their arms. For a long time, he writes it was treated as a myth, but in 1981 a BBC documentary, Peace in No Man’s Land, made it apparent that it was not a myth and that two-thirds of the British front line alone, ceased fighting that Christmas. Similar, less known, truces have also taken place during other wars like the Spanish Civil War, the Boer Wars, the American Civil War, the Crimean War and the Napoleonic Wars.

More recently, writes Bregman, sociologist Randall Collins, who analysed hundreds of photographs of soldiers in combat, and, echoing Marshall’s estimates, calculates that only about 13 to 18 per cent fired their guns, and asserts that “The Hobbesian image of humans, judging from the most common evidence, is empirically wrong,….Humans are hardwired for […] solidarity; and this is what makes violence so difficult.” As for the methods used to boost an army’s firing ratio, Bregman writes that the American military worked on boosting its ‘firing ratio’, increasing the number of soldiers who actually shoot, but it came at a price. He comments that “If you brainwash millions of young soldiers in training, it should come as no surprise when they return with post-traumatic stress disorder (PTSD), as so many did after Vietnam. Innumerable soldiers had not only killed other people – something inside them had died, too.”

In this book Bregman takes us on a tour down history lane, from pre-history to the present day, using study findings and surveys, and a plethora of examples, to argue his points about the history of human nature. He takes us behind the scenes of major historical events to show us a slightly different reality or more holistic story than most of us have been taught at school. We travel back to pre-historical times, ancient civilizations, WWI and WWII, the Holocaust, the Enlightment period, Easter Island, South Africa, Alaska, Venezuela, Colombia, and elsewhere. For instance, Bregman tells us how ordinary citizens in Torres in Venezuela found an answer to some of the most urgent questions of our times, and where all residents were welcome, not only to debate issues, but to make real decisions about their municipality, and all the municipal investment budget was theirs to spend. He writes that a University of California study demonstrated that within ten years of the election of Julio Chávez as mayor, Torres had pulled off several decades’ worth of progress, clientelism was way down, the population was participating in politics like never before, new houses and schools were going up, new roads were being built and old districts were getting spruced up.

He devotes pages to show that more recent discoveries and research contradict all we thought we knew about Easter Island, and he compares the more effective and cheaper prison approach in Norway, which has the lowest recidivism rate in the world, and is based on a ‘principle of normality,’ better material conditions, respect, democracy and rehabilitation, and where prison guards (40% are women) complete a 2 year training course, to American prisons and prison system. He critically reassesses classical social psychology research on human nature, and unravels the stories behind well known social psychology studies conducted by people like Stanley Milgram, Philip Zimbardo, Muzafer Sherif, and others, whose studies have provided the basis for the argument that people are universally and inherently aggressive, antagonistic, selfish and uncaring [I briefly referred to these studies in recent posts on scapegoating, but did not go much into the critical evaluation of the theories and findings, nor the serious ethical concerns].

The chapters on social psychology studies are both interesting and revealing. I will refer to the Robbers Cave Experiment conducted by Muzafer Sherif. Gina Perry, an Australian psychologist, who wrote a book on Sherif’s work, delved into the archives of Sherif’s experiments and uncovered a story that contradicts everything in the textbooks. She discovered that Sherif had tried to test his ‘realistic conflict theory’ before in another summer camp in 1953, where he had also done his best to pit the boys against one another, Sherif had said that that experiment had to be suspended ‘due to various difficulties and unfavorable conditions.’ Perry tells us at that what had actually happened at this other forgotten summer camp was that soon after their arrival, the boys had all become friends, and when day three rolled around, the boys were split into two groups – the Panthers and the Pythons – and for the rest of the week the experimenters deployed every trick in the book to turn the two teams against each other; however, the boys weren’t fighting like Sherif’s ‘realistic conflict theory’ said they would, but instead remained friends, and eventually realised that they were being manipulated, especially, after one boy discovered a notebook containing detailed observations. Thus, the experiment was called off.

Bregman also examines a system of news that deceives us by zooming in on the exceptional, prioritises the worst in humanity, and where a biased selection of news, and a preference on violence and sensationalism is prominent because exceptional and bad news are more newsworthy and profitable than good news, and because it influences the masses’ perception of the world and reality in a certain way. George Gerbner was aware that those who tell the stories of a culture to some extent govern their behaviours. He wrote: “Fearful people are more dependent, more easily manipulated and controlled, more susceptible to deceptively simple, strong, tough measures and hard-line postures. … They may accept and even welcome repression if it promises to relieve their insecurities.” Bregman writes that George Gerbner (1919–2005) was the first to open up the field of research concerning the news, and also to coin a term to describe the phenomenon he found: mean world syndrome, whose symptoms are cynicism, misanthropy and pessimism. Many of George Gerbner’s ideas are still applicable today even if the avenues and the technologies through which we consume news and stories has changed and expanded.

Bregman tackles the legacy of William Golding’s novel The Lord of the Flies and compares it with a real life example of teenage boys, rescued in 1966 by Australian Captain Peter Warner, after being staranded on the small desert island of Ata near Tasmania for 15 months. Unlike the fictional boys from London the Tongan boys cooperated and took care of each other to ensure their collective survival. It’s an uplifting example but it might require we explore the reasons behind the two different outcomes, other than the fact that the first story was the mere product of a writer’s imagination. Could the different cultural values and ways of upbringing of the boys have played a significant role? Bregman writes, “Golding had the zeitgeist of the 1960s on his side, when a new generation was questioning its parents about the atrocities of the Second World War. Had Auschwitz been an anomaly, they wanted to know, or is there a Nazi hiding in each of us?” In his book Golding intimated the latter and created a best seller. The critic Lionel Trilling claimed that the novel “Marked a mutation in culture.” Bregman writes that Goldman had been an alcoholic, prone to depression, who while working as a teacher, once divided his pupils into gangs and encouraged them to attack each other. He further quotes Goldman who had said “I have always understood the Nazis, because I am of that sort by nature.” Bregman further wonders why the real story is unknown to people. He notes: “While the boys of Ata have been consigned to obscurity, William Golding’s book is still widely read.”

Bregman expands on the bystander effect and on what really happened the night Kitty Genovese was murdered. He writes that though the bystander effect is still taught in many textbooks, a meta-analysis that reviewed the 105 most important studies on the bystander effect from the past fifty years [including the first experiment by Latané and Darley with students] has shed new light on what bystanders do in emergencies. Firstly, the bystander effect exists when bystanders feel it makes more sense to let somebody else take charge or when they are afraid they might do the wrong thing or when they  think there’s nothing wrong going on. However, if the emergency is life-threatening and if the bystanders can communicate with one another (they’re not isolated in separate rooms), then there’s an inverse bystander effect. And more bystanders, leads to more helping. Further more, Bregman refers to Danish psychologist, Marie Lindegaard, who was one of the first researchers to ask why researchers think up all these convoluted experiments, questionnaires and interviews instead of looking at real footage of real people in real situations? She showed, with real CCTV footage, that bystanders often do help and do take action. Bregman writes that we find that in 90 per cent of cases, people help each other out. He also asks us to consider the role of the press and the media in reimforcing a particular narrative about human nature, and why in the same years that activism began brewing in New York City, Martin Luther King was awarded the Nobel Peace Prize, millions of Americans began marching in the streets, and Queens counted more than two hundred community organisations, “the press developed an obsession with what it trumpeted as an epidemic of indifference.”

I will add a personal story of a recent incident that happened to me in the street that perhaps supports the fact that bystanders are likely to show concern and step in to help. A few days ago I was walking along a narrow pavement, with several other people and a couple of chairs outside shops. I was in a hurry, so I momentarily stepped down the pavement to move ahead of those walking at a slower pace. At the point where I stepped down there were motorbikes parked behind me. And then the next thing I saw was a man on a motorcycle backing up towards me without slowing down, and I realised he was ignoring my presence. I called out to alert him to my presence, but he kept moving towards me. Then a woman on the pavement, who saw what was going on called out to him in a louder voice, but he ignored her, too. Meanwhile, I was trapped between the motorcycle behind me and his vehicle. He stopped just in time, and when the woman confronted him, telling him that he almost ran into me, he shrugged his shoulders and said I was standing on the road. He made no attempt to apologise, while also keeping his helmet on so that I would not see his face.

Also, Bregman explores how people respond in crises. For instance, the bombing of cities in London and Germany did not demoralize or turn most civilians into self-interested beasts; rather it generally increased community spirit and solidarity. He looks at the behaviour of civilians during the blitz in London, where the German expectations [based on Gustave Le Bon’s famous book in which he describes how people respond to crises, and in which he asserts that “man descends several rungs in the ladder of civilization’. Panic and violence erupt, and we humans reveal our true nature…” (cited in Bregman)] of the local population becoming demoralized were totally confounded by the Londoners, who displayed ‘blitz spirit,’ and became more incentivized.  The same was true of the German civilians after their cities were bombed by the British, where for instance, in bombed cities the tank production soared relative to cities that were not attacked.

He also explores other crises like natural disasters, and points out [and also provides evidence to support this claim], that most people don’t become monsters. The Katrina hurricane in the USA, writes Bregman, didn’t see New Orleans overrun with self-interest and anarchy. The hurricane, he writes, “confirmed the science on how human beings respond to disasters. Contrary to what we normally see in the movies, the Disaster Research Center at the University of Delaware has established that in nearly seven hundred field studies since 1963, there’s never total mayhem. It’s never every man for himself. People don’t go into shock; they stay calm and spring into action.” He also quotes Enrico L. Quarantelli, a disaster researcher, who points out that “Whatever the extent of the looting, it always pales in significance to the widespread altruism that leads to free and massive giving and sharing of goods and services.” In her account of Katrina’s aftermath, Rebecca Solnit, writes that the truth is that elite panic comes from powerful people who see all humanity in their own image.

Bregman also reminds us that historically the most terrible events and the worst atrocities have been orchestrated and organised by elites or a small number of people, with a lot of power and control of resources and information. In his book, On Inhumanity: Dehumanization and How to Resist It [see older posts: November 8th and 24th, 2023], David Livingstone Smith explores the mechanisms of the human psychology that makes us vulnerable to being able to view whole groups of people as subhuman creatures, and how this innate human propensity has been throughout history exploited by elites, governments, political leaders, and generally, those with power and influence, when they stand to gain. Bregman reminds us that we need to weigh this against the millions of people across history that in general act with courage, kindness and concern for others and try to abstain from causing harm. He also points out that few ideas have as much power to shape the world as our view of other people, and that if we are convinced to believe that most people can’t be trusted, that’s how we’ll treat each other, to everyone’s detriment.

Bregman discusses many more topics like our evolutionary history, the power of expectation and the Pygmalion effect vs the Golem effect, carrots and sticks and motivation, democracy and economic systems, contradictions in Enlightenment thought, Bertrand Russell (1872–1970), Machiavelli’s influence, leadership, the gatekeeping of people and the design of ingenious ideologies to justify why some individuals ‘deserve’ more authority, status, or wealth than others, and why some should be deprived of access to decent education, health care, employment, and other social goods protected by the constitution, at least in democracies, the corruption of power and psychological profiles of people in positions of power, as viewed by experts and historians. Concerning power he refers to research by Dacher Keltner [and others], who has also studied the effects of power once people have it, Findings suggest that power corrupts and people in power display similar tendencies [they tend to be more impulsive, self-centred, reckless, arrogant, shameless and rude than average, less attentive to other people and less interested in others’ perspectives, less capable of mirroring others, as if they no longer feel connected to their fellow human beings, more prone to seeing others in a negative light, etc.].

Although Bregman covers a lot of historical and cultural terrain in his book, which is about 496 pages, it isn’t possible to discuss every angle of this complex and broad topic. There are bound to be omissions or areas he has overlooked or only very briefly referred to. Also, a book cannot contain everything, and the focus here seems to be mostly on Western philosophical and scientific views and narratives of humankind. This is probably due to space, personal expertise and knowledge, and the writer’s selection of focus. Also, he mostly addresses the male narrative, so at times it reads as an analysis on mankind rather than the whole of humanity. It would have been interesting if he had woven more threads of women’s experience across time into his analysis. Positioning women more extensively in the book could have provided more arguments for kindness and a culture of care, and also, shed light on other issues like violence against women and children. Bregman, however, is aware of gendered violence, exploitation and inequality because there are relevant comments, like when he notes: ‘marriagable daughters were reduced to little more than commodities (p.103)….where in prehistory women had been free to come and do as they pleased, now they were being covered up and tethered down,” or in the chapter where he discusses the murder of Kitty Genovese in 1964 and the bystander effect. Yet he does not delve enough into the implications that women’s experience across time might have on his theory of human’s inherent decency.

Also, while discussing the doctrine in the western canon, and referring to the ideas of thinkers like Thucydides, Augustine, Machiavelli, Hobbes, Luther, Calvin, Burke, Bentham, Nietzsche, Freud, America’s Founding Fathers, Herbert Spencer, and others, who each had their own version of the veneer theory of civilization, he mentions, for instance, that the philosopher Herbert Spencer sold hundreds of thousands of books on his assertion that “the whole effort of Nature is to get rid of [the poor] – to clear the world of them, and make room for better,” and further comments that the strangest of all is that these thinkers were hailed as realists, while dissident thinkers were ridiculed. Ηe refers to feminist Emma Goldman, whose struggle for freedom and equality, earned her a lifetime of slander and contempt. Bregman quotes Goldman, who wrote: “Poor human nature, what horrible crimes have been committed in thy name! …. The greater the mental charlatan, the more definite his insistence on the wickedness and weaknesses of human nature.”

In a review of the book, David Livingstone Smith, mentioned below, has critiqued Bregman’s use of the depth metaphor, the common idea of being decent deep down, which implies that when a characteristic is deep it is also an innate feature of the human psyche, and more real than other more surface aspects. In other words, we have a deep essence or nature beneath our learning and cultural influences, which is known as psychological essentialism. Smith claims that psychologists and cognitive anthropologists argue that we have a disposition to think about living things, including human beings, in an essentialist way, and suggests that we need to be careful to avoid the essentialist bias from distorting our understanding. Additionally, essentialism often neglects to take into account socioeconomic, cultural and individual differences.

However, the points made above don’t change the fact that the book is definitely worth reading even if one does not agree with all the ideas. It is packed with information and a lot of research. Additionally, it is very readable and imbued with the writer’s sense of humor, it offers a different and more optimistic narrative, and above all, Bregman raises questions and examines alternative ways of structuring society, bringing to light how things could be done differently, using examples and stories from different parts of the world. Bregman demonstates that viewing the world and humanity from a different and less cynical angle could allow for different kinds of solutions to the many serious problems we are facing today concerning society, democracy, the natural environment, poverty, war and conflict. It may be a fact that there is plenty of evil, violence and injustice in the world and humans can behave in sickenly greedy, stupid and cruel ways; however, it would be somewhat delusional to believe that this is all there is or this is all that’s possible. If this were the only reality, as a species we would not have come as far as we have, nor would we have achieved such an increase in the world population, nor would societies function to the degree that they do, despite the existing many dysfunctions, inequalities and injustices.

To conclude, aside from all the theoretical discussions, research findings, historical conclusions, and different views on human nature, one does not need to be very educated or clever to understand that a world devoid of kindness, caring for others and compassion, would be a terrible and unsafe world for everyone, even those with a lot of power and resources. Also, I don’t think there are many people on the planet that like being the recipients of maltreatment, violence, exclusion, injustice, dire lack, cruelty or simple disrespect and unkindness, so it’s safe to assume that at some level we all value goodness and kindness, at least when it concerns how others treat us. Maybe then it’s essential that we reconsider the consequences of our short and long term choices not only in our micro environments, but also on a planetary level, as well as, the narratives of human nature that we want to adopt and propagate.