Samizdat Health Writers

A writers collective

Manifesto As Method: Review

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By Pamela Stavropoulos
Author: Living under Liberalism

Significantly, psychiatrist and cultural critic David Healy characterises his most recent publication, A Short History of the Rise and Fall of Healthcare as ‘the Health care Manifesto’. Defined as ‘a written statement declaring publicly the intentions, motives, or views of its issuer’ a manifesto is generally both a short work and a clarion call.  It is relatively brief because fuelled by the urgency of conveying ideas and prescriptions in succinct and minimalist format.

It is arguably also making something of a comeback. In 2017, Yale University History Professor Timothy Snyder published On Tyranny, Twenty Lessons from the Twentieth Century, which became a #1 New York Times Bestseller. In 2019, exiled Turkish journalist Ece Temelkuran published How to Lose a Country: The Seven Steps from Democracy to Dictatorship (which The Times said ‘[v]ibrates with outrage’). While different in some ways, the themes and focus of these texts intersect in important regards. And while Healy’s current offering is contrasting at obvious levels, there are senses in which it, too, is complementary to them.

We are witnessing incremental but seismic shifts in the political, socioeconomic, and cultural landscape which require identification and addressing if we are to avoid being subsumed by them. The domain of health is a key, expanding, but widely underestimated front in a clash of interests now so pervasive and insidious as to risk escape from detection in those terms. How to critique an industry which prioritises ‘wellness’? Building on his previous and well-researched exposes (The Anti-Depressant Era, 1997; Let Them Eat Prozac, 2003; Pharmageddon, 2012) Healy charts a path through the maze. Indeed, in the context of the texts previously cited, The Decapitation of Care might be regarded as a contribution to a publication trifecta for our times.

This raises an interesting question about format as well as content, about the role of the manifesto, and about creation of optimal space/s (such as Healy’s recently launched Samizdat Health) in which to interrogate global industries and practices which are as harmful to human potential and well-being as they masquerade as helpful and democratic.

Marshall McLuhan’s dictum that ‘the medium is the message’ is confounding in the current era of multimedia, the capacity of corporate but also populist interests to seize and monopolise communication channels, and the rewriting – or more accurately outright abandoning – of prior norms of interaction and exchange. The norms of ‘civilised’ debate have never been neutral, and have themselves excluded diverse voices. But ostensible celebration of ‘everyone having their say’ in this neoliberal age of concentrated media ownership, unregulated capital, ‘alternative facts’ and strange bedfellow alliances enacts a reversal which radically changes the rules of engagement in ways which urgently require reconceptualization of the best modes of so doing.

In The Decapitation of Care and also his Samizdat Health posts, Healy questions the optimal means by which to publicise ideas in what he calls a ‘neo-cultural’ age (05 Jan 2020). In this and his intentional claim of the descriptor of ‘manifesto’, he extends the pioneering policy implications for which he is known. He invites us to carve out a space – as yet unformulated- by and in which to address ideas at a time when the wellness industry (itself sick in its unqualified and decontextualized form) has displaced religion and in some ways politics itself: ‘The establishment is now or soon will be a platform, an algorithm. We have to find a way to make things happen within relationships’ (Healy: 13 Jan 2020). Temelkuran (2019: 157) denounces the ‘manufactured political illusion’ of the current right-wing populist upsurge of ‘attacking the establishment while actually becoming the establishment’. New contexts, as much as content, of communication are needed.

A persuasive ground for this need can be found in Healy’s professional pre-history. He writes in Samizdat Health of the response of Robin Fox (editor of JRSM; Journal of the Royal Society of Medicine) to his (i.e. Healy’s) early submission on the adverse impacts of antidepressants on children. Fox is quoted as saying that ‘[t]he difficulty lies in the mixture of review and polemic…medical readers do not relish the fire and brimstone approach…I think that you should describe and leave to others to judge’ (13 Jan 2020).

In the current context and climate, the nature of this rejection (which may have been regarded as unexceptionable at the time and likely by many still) now reads as anachronistic in that it has been superseded by events. It does not speak to a vastly changed context in which rules of engagement in all manner of discourse seem not so much to have evolved as to have been blown out of the water completely. Failure to acknowledge and address this reality is only an option if we’re prepared to be dealt out of the game of exchange entirely.

The word ‘game’ may seem frivolous in the context of professional exchange, especially when the stakes are so high. But as we know from Healy’s prior alerting about ‘medical’ papers which are actually ghost-written, corporate interests have already led to what Tim Moss has termed ‘evidence debased medicine’ In combination with the ascendancy of right-wing populism, this has made the woods increasingly difficult to discern from the trees for most of us. This is even while trying to stay vigilant while suspecting/knowing we’re being led down the garden path.

We are way past the point of ‘bad apples’ (read errant individuals) and even ‘barrels’ of this proverbial fruit (Samizdat Health, 05 Jan 2020). Anand Giridharadas, author of Winners Take All (2018; another New York Times bestseller) speaks of ‘orchards’ of bad apples, such that uncontaminated offerings are increasingly hard to locate: ‘We have to move from a bad apple to a bad orchard paradigm’ As Healy says, ‘at the moment only one set of interests get heard’ (Samizdat Health, 13 Jan 2020).

But continued faith in ‘the play of ideas’ and ‘all voices being heard’ is itself an illusion when potent and decreasingly constrained interests routinely result in the decimation of dialogue: ‘dissident public figures are under siege from never-ending white noise…communication chaos takes over… Intellectual activity becomes a matter of reacting to fragments of populist discourse with sarcasm, in an attempt to combat them with their own weapons’ (Temelkuran, 2019: 80). And as Healy says, ‘ [a]ll sides can turn staggeringly nasty when threatened’ (Samizdat Health, 5 Jan 2020).

In this context, fact-checking and holding to account are no match for what they are up against. Such tactics are ‘akin to playing chess against a pigeon, as someone once described debating evolution with a creationist: the pigeon will just knock over all the pieces and shit on the board, then depart, proudly claiming victory and leaving the mess behind for you to clean up’ (‘[i]t’s no coincidence that Garry Kasparov, the former world chess champion, left Russia to live abroad after playing an excruciating game with Putin’; Temelkuran, 2019: 77-8). Healy again: ‘[m]iddle ground is the wrong word – it suggests a fudge, a compromise – for this new territory. What is needed now is a call to each of us to exercise our own judgment, our own diagnostic skills… We have lost and need to regain the ability to have our say’ (Samizdat Health, 5 Jan 2020). The inauguration of Samizdat Health is a promising possibility in this regard.

"Use Your Head"

So, too, is the revival of the manifesto. As a medium of communication, the manifesto has been maligned as much as embraced. This is notwithstanding its respectable and even august pedigree, which includes such diverse exemplars as Thomas Paine, Edmund Burke, and Mary Wollstonecraft along with the equally well-known Communist Manifesto. As this rollcall indicates, criticism of the manifesto is despite, and thus almost certainly because, of its potential effectiveness.

And herein lies a key point which we ignore at our peril. Among the charges levelled at the manifesto (e.g. that it is didactic, oversimplified, utopian, etc) is the recurrent charge that it is overtly ‘political’. At a time when the practice and very word ‘politics’ is understandably anathema to so many of us, what could be more discrediting and potentially silencing? Here is the potentially fatal trap. In precipitously conceding this criticism of the genre as a whole (as with any genre there are manifestos of varying quality) we would be throwing out a precious baby along with the bathwater. Precisely because the manifesto can be powerfully galvanising – i.e. ‘political’ in succinctly enunciating principles and providing a corresponding recipe for action – critique of it on this ground needs to be recognised for the silencing tactic it so often is. It is a deflection and sleight of hand we can ill afford not to see when the depth, reach, and destructiveness of corporate interests is now so pervasive as to challenge the extent to which western ‘democratic’ societies can continue to be described as democratic at all.

The more potentially effective – at a time when clear articulation of principles and ensuing action is both elusive and essential – the more vociferous the silencing charge of ‘political’ might be expected to be (and thus the importance of not being intimidated by it). Far from requiring qualification or apology, the manifesto may now and again be an optimal mode by which to communicate important ideas in need of rapid transition and wide uptake.

Manifestos should be assessed on their respective merits, not criticised, much less discredited, in advance. This is also a semantic issue, and further testament to the power of language and the predisposing freight that a single word can convey. To the extent that the term ‘manifesto’ (like ‘tract’, ‘polemic’ etc.) has negative connotations, a term like ‘declaration’ (albeit potentially indicative of spoken than written discourse) may seem preferable. Unless, that is, we reclaim the term ‘manifesto’ and publicise the good ones, which are surely urgently needed, of which Healy’s latest publication is a fine example, and in which he is in good company.

Pam Stavropoulos

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