By Alicia Puglionesi
"the mist advanced and the wind
tore into one thing, then another
-- you could think random but you know,
the patterns are there--
a sick time, and the human body,
feeling it, a loss of pressure,
an agitation without purpose...."
-Adrienne Rich, from “Revolution in Permanence (1953, 1993)”
“The wind is a very deceiving thing.”
-United States President-elect Donald J. Trump
Causation is a very deceiving thing. In everyday life it seems straightforward: wind turns a windmill; a rock breaks a window. Most events involve additional orders of complexity. For instance, voters might elect a president because they want to overturn the status quo. They might elect a president because they believe that their well-being is threatened by non-white people. Or, because they are psychologically and economically ground down by an accelerating neoliberal order that contorts reality itself. The president thus chosen does not believe in wind turning windmills. He asserts to a leading newspaper that wind does not, in fact, supply energy in this manner. The laws of physics will not impede him from representing reality in whatever way suits his purposes or desires.
Causation is a fraught subject that fills many philosophy journals. Philosophy isn't my line of work. As a historian, I look for causes that intertwine and work in multiple directions. History leads through a thicket of influences, relationships, and contingencies rooted in specific times and places. Its purpose is not to prove that A caused B-- case closed. The power of history, as Carlo Ginzburg describes it, is to reveal multiple ways of knowing what we can't directly witness. Evidence, itself a slippery concept, comes to us from fallible witnesses. There are divergent points of view on even the simplest event, like the wind blowing. We don't agree on which way it went, or how it felt, or that the wind was a single, unified thing available for all to see and know.
Most people living together in a particular time and place come to respect a basic set of causes and their effects. To its citizens and the world, the United States represents itself as a secular Western democracy where reason and science undergird our shared reality. Thus, we look to experts with scientific training to answer important questions like, “Why did the house burn down?” or “Why did the patient die?” Expert procedures and notions of fact have immense power.
To hold this power accountable, historians, sociologists, anthropologists, and ethicists investigate science's relationships and responsibilities within a larger social world. Naomi Orestes's work on corruption and political influence in science shows how vital this scrutiny is for practitioners and the public, as does the exposure of systemic human rights abuses in medical research by scholars such as Susan Reverby and Ruth Faden. Unfortunately, you can probably find someone with a PhD who will oversee an unethical drug trial, or swear under oath that the wind does not cause a wind farm to generate power, if you're willing to write a big enough check. These are extreme examples in which the basic methods and aims of science seem clearly compromised. But one goal of critical work is to understand how such compromises become possible, how a course of action becomes reasonable for particular people at particular times. Times when a mist descends-- when it becomes hard to speak of the patterns that you know are there.
In the 1930s, physicians in the USSR's forced labor camps began to study health problems widespread among their patients. Their patients were prisoners, and the doctors were prisoners too. The Soviet system known as the gulag slowly starved inmates to death through hard labor combined with inadequate food rations. The slogan, “whoever does not work, does not eat,” was a formula for accelerating the physical collapse of people already weakened by exhaustion and disease. The Soviet regime, deeply invested in scientific demonstrations of the penal system's economic and humanitarian merits, had doctors conduct extensive research on the productivity and health of prisoners. The expertise of doctors and scientists was crucial in normalizing official silence about the ubiquitous effects of hunger-- all of Russia, not just the gulag, was wracked by recurrent famines and food shortages.
Remarkably, given the deadly conditions, doctors reported mortality rates of between 1 and 5 percent of the total gulag population. Remarkably, given that many inmates labored on less than 1,300 calories per day, camps reported little malnutrition or starvation. These statistics were not bald fabrications from the propaganda office. Rather, physician-prisoners at the local level were compelled to produce facts that supported the regime's predetermined version of reality. Instead of diagnosing malnutrition, doctors gave out an array of symptom-based “diagnoses” that masked the underlying cause.
Golfo Alexopoulos, a Russian historian, uses the gulag's recently-declassified administrative archives to investigate how doctors and scientists worked under these conditions. When I picked up the Bulletin of the History of Medicine with her latest article, I was drawn in by the clarity of her moral voice as she mapped this “atrocity-producing situation”: gulag patients were dying from starvation. Physicians were not allowed to name the cause of mass death, but were tasked with producing plausible medical research to spare their own lives. Alexopoulos details how this system co-opted science by distorting and denying evidence, but she returns to a constant refrain: the patients were sick because they were starving. The only solace in this story is her freedom to say, as often as she can, what she knows doctors there saw and experienced, but could not say.
This is far from my area of history – I don't know anything about the scholarly discourse on medicine in Soviet Russia. In American politics, Soviet Russia is a boogeyman of vestigial Cold War alarmism, used to argue that any form of public good sets us on a slippery slope towards the gulag. And the notion of “naming” could bear echoes of the very witch-hunt mentality that the right is once again stoking in the face of dissent. That's very far from my purpose in connecting Alexopoulos' work with our present situation, one in which the “political spectrum” has pretzeled in on itself and the forces that seek to eliminate all public goods simultaneously embrace authoritarianism. Masha Gessen says the geopolitical parallel is with Putin's Russia, and we should be very worried-- I believe her.
But Alexopoulos's story about the political distortion of science cleared a mist that had descended over my thinking. I didn't open the fall Bulletin until two weeks after the U.S. presidential election, though my copy arrived on that night, delivered by a former roommate who came over to watch the results with a group of friends. We had a supply of whiskey, which no one touched. There was no point in clouding over the danger. The journal sat on the coffee table. My profession, a specialized niche within academic history, did not appear particularly relevant.
Along with the majority of American voters who did not support the electoral college winner, I was struck by my uselessness, whether individually or in collective resistance. A Trump presidency unchecked by other branches of government actively threatens the democratic form within which voices of protest are heard and honored. I was speed-dialing my congresspeople's beleaguered receptionists.
When I finally sat down with “Medical research in Stalin's gulag” (standard historian-of-medicine weekend reading), the importance of speaking honestly and publicly about what we, as researchers, observe fell on my mind. That everything we respect and value as knowledge depends on a world in which it is possible to speak in this way.
Many smart Americans work on solving problems of human suffering. They flock to medicine, public health, education, nonprofits, and progressive start-ups motivated by social concern rather than personal enrichment. Getting that work done requires narrowing focus and specialization, breaking apart problems into smaller parts and addressing what's doable, using the tools at hand in the world we have. Workers know the larger forces that cause problems and see how the available methods put band-aids on deeply festering social inequality and economic neoliberalism. They accept that treating urgent symptoms is often the only way to lessen real-time suffering. Solidarity strong enough to effect structural change is very, very far from most people's experience.
For instance, physician and historian Mical Raz describes how the effects of poverty are routinely pathologized and transformed from a collective social ill to an individual mental health problem. After November 8th, many more of us got to join the pathological difference club; people endangered by harassment were directed to mental health resources to treat the disorder of not sufficiently resembling their white or male fellow-citizens. Philosopher Adrian Parr and political scientist Peter Dauvergne write about climate change fixes based on eco-business models of ethical consumption: how preventing massive global harms becomes a matter of “individual conscience,” obscuring the underlying economics of carbon emissions that continue unchecked.
This routine of segmenting “solvable” from deep-seated causes subtly shifts how we talk and think. It can feel simplistic, idealistic, or clumsily political to point at the underlying causes of suffering. Inequality, systemic injustice, the upward flow of wealth: their ubiquity makes them unremarkable. The assumption that we all know how the system works makes it seem naive to harp on such blunt concepts. At the same time, scientists and academics tend to worry that our understanding of the big problems could differ from what colleagues are seeing; that we'll fail to account for some nuance or counterargument.
Fear of being wrong, or being criticized as wrong, helps keep us quiet. This should not be the case, because we're in top condition for responding constructively. The humanities and the sciences require a culture of active critical reflection. It takes a thick skin to hear negative feedback from peers and adjust one's views, but we develop that resilience because advancing knowledge is not about individual egos. Good researchers are willing to learn about themselves as well as learning about the world. In contrast, the far political right and emerging white nationalist right are brittle because they can't withstand scrutiny. Their intellectual culture entails amplification and cheer leading, spreading a meme and responding to doubts with aggressive escalation. When Donald Trump blames “the rigged system,” he puts together causes and effects in self-serving ways that deny research-driven knowledge about society, health, and the economy.
Right now, practitioners of science and medicine and scholars who study how science and medicine function must defend a way of knowing grounded in observation and evidence, humility and humanity. As a matter of civic responsibility, we can make it a routine practice to state in the clearest terms what we know about the larger systems within which our phenomena occur: how the phenomena are shot through by inequality, injustice, and the forces of capital; how current actions will exacerbate these effects. Building positive alternatives is surely the harder work, but in order for alternatives to succeed, we've got to keep their absolute necessity in stark public view. While alternatives are permissible, we've got to articulate the values that underpin them: social and economic justice, human welfare, intellectual freedom.
Chimamanda Ngozi Adichie puts it simply: “now is the time to talk about what we are actually talking about… Now is the time to discard that carefulness that too closely resembles a lack of conviction.” We must describe causes at the deepest level we can see them. In the face of institutional displeasure, we must assert that naming causes does not defy professional neutrality or scientific objectivity; as practitioners, we are responsible for communicating what we know, and how we know, to the public. The assumption that everyone sees and knows the obvious, and that naming a larger phenomenon is politically charged, normalizes silence. It isolates us when we could stand together.
Wind causes windmills to turn. Illness has causes that run deeper than a virus or a malfunctioning heart valve. If you study or teach about humans and our history, keep observing, keep representing, keep speaking. It's possible to lose the freedom to name what you know is there. By naming causes of suffering, by tracing how they operate and interconnect – by doing this again and again and again – we can refuse to give up ground. We can hold this measure of freedom. The wind is a complicated and powerful thing. There are many ways of understanding how the wind works, and we'll need all of them to harness it.