Author: Owen Dempsey

Chest Physician Aberdeen with a special interest in asthma. I have a private clinic and website. Apart from asthma I enjoy curling and draughts, and scuba diving off the Aberdeen coast.

False reassurance and Mass rapid testing for asymptomatic Coronavirus infection and infectiousness

This requires a little bit of background. The Johnson PM of the UK government announced a ‘moonshot’ programme, many months ago in September 2019, in which there would be mass daily screening for C19, for the asymptomatic, at a cost of over a billion UK pounds.

… literally millions of tests processed every single day … theatres and sports venues could test all audience members on the day and let in those with a negative result, all those who are not infectious … workplaces could be opened up to all those who test negative that morning and allow them to behave in a way that was normal before COVID … Our plan – this moonshot that I am describing – will require a giant, collaborative effort …

Today, January 2020, the government has begun and now ‘paused’ such a programme due to start in schools because of worries it may do more harm than good.

The key point is that despite doubts about the accuracy of the test and the risks of false negatives, the UK government has been persistent in wanting to roll this out, in order, it claims, to keep pupils in schools and ‘to keep the economy running’. Because of the inaccuracy of this rapid lateral flow ‘moonshot’ test and the collateral harms it will lead to, and I suggest that the UK government’s primary goal is to keep the economy running, even if, as is probable this will cause increased viral community transmission of C19.

Briefly, the test being used is a rapid ‘lateral flow’ test (Innova currently). It was shown in a Liverpool study to only pick up 50-60% of cases. The test is said to be 50-60% sensitive, and other studies suggest this may be an over-estimate. This means it misses 40% of cases, or in other 40 % of negative results will be false negatives.

A false positive result occurred in two of 2981 PCR negative people—a specificity of 99.93% (99.76% to 99.99%). But lateral flow tests missed 23 of the 45 PCR positive participants, giving a sensitivity of 48.89% (33.70% to 64.23%).

Covid-19: Lateral flow tests miss over half of cases, Liverpool pilot data show. BMJ 2020;371:m4848

This means that as many as 50% of people, (students returning to university, school children , or potential visitors to care homes) will be wrongly reassured that they are Covid negative. There have been calls from scientist, including Jon Deeks the co-chair of the Royal Statistical Society’s diagnostic tests group, as well as Gill and Muir-Gray for the government to urgently re-think its strategy.

Note, as well, that although the tests is highly specific – good at identifying positives correctly, this means that because the prevalence of true positivity is low in the general asymptomatic population, then even this high specificity still produces many false positives:

The false positive rate of 0.6% means that at the current prevalence in Liverpool, for every person found truly positive, at least one other may be wrongly required to self-isolate. As prevalence drops, this will become much worse.

In terms of the poor sensitivity and high false negative rates : the danger of having large numbers of people under-diagnosed occur when the negative result is used as a green light for social mixing (e.g. in schools) to continue, because this means that large numbers that are actually infectious will continue to mix, and, crucially, may mix in increasingly risky ways than if they hadn’t had a test at all. At the same time, although many true positives can be told to self-isolate reducing social transmission, all the same this benefit may be outweighed if those testing negative behave as if they are really disease free when they are not, in ways that increase risks of transmission.

In other words, false reassurance may well lead to increasing risky behaviours, rather than just having no effect at all on the risk of transmission compared to the situation where no testing had been done.  In other words, the key question is: What is the net effect on transmission rates of testing compared to no testing?

Understandably some scientists are asking for real world empirical studies to find an answer, but there are no signs of such studies forthcoming, and no doubt they would be difficult to do and interpret, given potential confounders and rapidly changing social circumstances and regulations.

Some have argued that the worries about false reassurance increasing risky behaviours isn’t borne out because, for example, the introduction of seat-belts, and cycle helmets etc. didn’t lead to increasingly risky behaviours.  I think that this comparison is invalid for four reasons:

a) The test signifies ‘freedom from danger to others’, a freedom from a need to be careful, from guilt or vulnerability, whereas the hat/belt signifies reduced, but not zero, personal risk but, rather, is a continued concrete physically present, and sensed, empirical reminder of vulnerability;

b) Unpredictably, people may or may not want, or value, a negative result and will tend to believe or not believe it depending upon either, for example, they experience : (i) levels of fear of the disease or fear of loss of income if told to self-isolate; or conversely (ii) a lack of fear of the disease and possible value from secondary gains from a negative result due to, for example, avoiding stresses by being permitted or told to take time away from work or school;

c) Even though under-diagnosis may be, and can be, identified as a false-reassurance and potential risk and, although public health messaging may emphasise this risk to the public, all the same under-diagnosis is an abstract concept, not an empirically experienced event, and so, I suggest, can never be fully grasped or ‘felt’ by individuals as having any personally relevant meaning that should influence individual behaviour. This means, in effect, a ‘negative’ result will always erroneously signify, and be believed by the individual to mean, total personal freedom from infection and infectiousness.

A comparison can be made with the risk of over-diagnosis with mass cancer screening, where once diagnosed the possibility of over-diagnosed becomes disavowed, that is it may be ‘known’ but has no affective value, it becomes a ‘unknown known’, and the diagnosed and treated person focuses on cure as a cancer survivor, not as a possible over-diagnosis victim.

d) individual protection versus protection of others: a negative test result, used in order to avoid or prevent self-isolation, permits continued and, if behaviors change, may even increase social mixing, potentially increasing risk to others; on the other hand, for example, wearing a cycle helmet only reduces the dangers of an existing behaviour to the individual, it prevents continuation of the pre-helmet risk to the individual and doesn’t change existing cyclist behaviour in ways that makes it riskier, or safer, for others.

The Pandemic and an Ethics of Responsibility

Hanaamayer (usefully but, ultimately, inadequately) draws upon Weber’s (transcendental) ethics of responsibility to challenge EBM (Evidence Based medicine) principled conviction (rules-based) to determine good medical practice in terms of a supreme good that ‘maintains life’ on the basis of primarily empirical data and mortality outcomes. The ethics of responsibility places responsibility on individual clinicians to recognise that putative patients may not place the same value on mortality as the EBM guidance. For example, the evidence may suggest screening is a good thing because it reduces mortality, or that for example after a screen-diagnosed cancer that surgery is ‘evidence-based’ (on mortality grounds) and so desirable, if not demanded, but bearing the chance of overdiagnosis in mind and the thought of life after mastectomy might be grounds for an individual to decide against surgery.

As far as programmes of mass screening goes the very sending out of invitations and ‘offers’ to screen for life threatenting conditions or risk, already makes for a loaded invitation, invoking inevitable fear and a sense of moral duty to accept the invitation.

At the same time, in our contemporary capitalist cultures the ideal of maximising ‘life’ is endemic and normative, and part of our consumer culture, and so the offer of a test contains the promise of ‘more’, of everything, of happiness, life, health, meaning to life, and so on.  It is in this sense seductive.

At a public health level, interventions are applied en-masse. The public health programmes, such as mass diagnostic testing demand an unconditional application, that is, the application is not conditional of the personal characteristics of any one individual beyond the population criteria for inclusion (for example age and gender). A question then arises, in the light of the first principle outlined in the previous blog that values maximizing individual autonomy over the body, when this principle is considered alongside a political welfarist societal principle: to try to maximise the potential for health of the most vulnerable and at risk in society – whether for reasons, for example, of age, co-morbidity, or poverty.

There are two scenarios we can consider:

First, an intervention may be primarily for personal individual potential benefit, even though it might carry a risk of personal harm (direct and empirical, such as the effects of treatments, for example, a mastectomy on self-image, or virtual and abstract such as overdiagnosis), and may well create false hopes for individuals and financial and efficiency opportunity costs for healthcare services. The individual’s consumption of, and participation in, the intervention does not have any added welfarist type value for others in society, and is only, in a social welfare context, selfish. [Unless, that is, one theorists that one person’s participation encourages others to participate as well, but even in this case it would be arguable whether this would of harm or beneficial for others in society at large.]

Second, a public healthcare intervention, such as a lockdown restricting social mixing to reduce viral transmission in a pandemic, is applied collectively in order to provide relatively greater benefit for those at higher risk.  It is applied en-masse, affects all members of society, and for many at relatively low risk from the virus the intervention requires: a) personal sacrifice of autonomy; as well as b) sacrifice due to the direct harms of lockdown  (for example, loss of income and social isolation, and emotional stresses).

In this second scenario, what is required is a collective welfarist valuation of the lives of those most at risk so that the majority are prepared to make individual sacrifices, even though the ultimate scale of benefit to those at risk is uncertain and the ultimate scale of harms to all are also uncertain and immeasureable.  In effect the majority are being asked (or even commanded by diktat) to risk everything, even their lives ultimately, justified by the value they are asked to place on the lives of the weakest.

Lockdown sceptics

Sceptical voices argue that the risk from the virus are over-stated and that lockdowns cause more harm than good and are an unjustifiable and anti-democratic infringement of personal liberties. 

Some argue that most older people are willing to sacrifice their lives so that younger people may have more freedoms, and that most older people are more harmed and upset by lockdowns than younger people and, in addition, would wish to be allowed their own ‘unlimited’ freedoms, of movement and social mixing, rather than be restricted by lockdowns.  No doubt some of these views are held by some older people.

What is at stake here is political and ideological: a) whether individual practices that are felt as representing freedoms or individual liberty, are actually practices that are in effect self-exploiting and oppressive; b) whether capitalist culture incites a blinkered selfish approach to what are illusory freedoms, and incites an objectfication of the stranger-other, severing social bonds; and d) whether society as such becomes unimaginable and the concept of social-welfarism anathema.

Three issues need to be borne in mind: first, the pandemic, from a welfarist societal perspective is increasingly likely to require authoritarianism as trust in the honesty and competence in central government has been eroded over the last 12 months, and yet, second, authoritarianism incites xenophobia, and finally, third, the current greatest threat of authoritarian totalitarianism and its genocidal consequences, in the West, comes from ultra-libertarianism fuelled by capitalism and supremacist nationalism.

The Moral argument in favour of Lockdowns

I draw on Walter Wink’s arguments against the idea of a ‘just’ war claiming what is required isn’t proof of the justification of action (war), so much as proof as to why inaction (not going to war) is worse. On this basis, I would argue that, morally, it can be argued, perhaps against Wink, that not locking down to resist viral transmission is worse than locking down and therefore locking down is a ‘just’ war – a war on the Covid-19 pandemic as well as on the political forces failing to support the vulnerable financially.

In the absence of proof of the ultimate effects of lockdowns we only have political, moral and ideological arguments. Consider the question: Is not locking down (more or less limitng individual freedoms) worse than locking down (not an all-or-nothing thing, but nonetheless, always involving restrictions on individual freedoms)?

We can consider a moral basis that sees a greater good in compelling individual sacrifice by the collective masses in order to protect disproportionately vulnerable minorities from an existential threat (be it political persecution or a virus) as opposed to allowing the minority to perish through a lack of collective sacrifice and neglect.  This would imply that inaction – not locking down – is morally worse than locking down. 

What does this moral basis depend upon, what is at stake?  What is at stake is the valuation of the lives, futures and hopes of the minorities. The lives of minorities will be neglected if the majority do not value, as much as their own, the lives of those minorities, so that the majority are passive, or promote inaction, in the face of the neglect and suffering of the minorities.  For a society to not value the lives of stranger-others, as much as its own ‘in-group’ lives is to lose touch with our common humanity, capacity to care with love for the other. Voegelin in ‘Hitler and Germans’ refers to this as a de-divinisation, or loss of presence to God. In more secular terms we could says that current libertarian individualism incited by nationalism and capitalism incites an objectifcation of both the self and the other that makes unconscious, or disavows the value of the lives of others.

What are the consequences of inaction? It would be a dehumanising moral failure, according to the above argument, that opens the way to a libertarian form of totalitarianism, or fascism, that ultimately, as described by Arendt, referring to Germany’s National Socialism of the 1930s, commands: “Thou shallt kill”

The anti-lockdown brigade and totalitarian threats

In the UK the anti-lockdown brigade (eg Hitchens of the Daily Mail) rightly see in authoritarian Lockdown measures the potential for totalitarianism and its xenophobic consequences. They point to China as an example, and as a regime to be reviled. What, I think, they fail to see, or admit, is the even more severe totalitarian potential in the kind of ultra-libertarian individualism they advocate that: a) is causing very significant excess deaths, and rising, from Covid; b) creates a mass psyche that believes it is ‘free’ whilst it is destroying itself; and c) sustains the fantasy of a caring government whose power and entitlement thrives on the cultivation of envy, and on social division. In this moment it is this more severe totalitarian threat, of apparently caring libertarianism, that is exacerbating the Covid crisis. A moral response is to value the lives of those that could be saved by Lockdown Plus, where the Plus refers to financial support (UBI) for those affected to minimize the collateral harms of Lockdown

Zero Covid Strategy and National Lockdowns

Zero Covid

The pandemic is highlighting a question: What should a public health response be in the absence of evidence of effectiveness? In particular what should a public health response be to the question of more or less restrictive lockdowns. Lockdowns are there to reduce transmission, illness, hospitalisations and deaths. And, the Covid crisis is clearly causing many excess deaths for the time of year compared to the last 5 year average. At the same time the evidence for lockdown effectiveness on reducing illness and death is persuasive, if circumstantial. Although, as well, lockdowns clearly cause harms to health in many ways.

So, how to decide whether lockdowns are a good thing? An important question as there have been many politicians campaigning against lockdowns in the UK parliament.

There are voices worrying about the sacrifice of so much by so many to save ‘so few’ lives (Pollock), and there is an organization trying to measure the collateral harms of lockdowns. But is it possible to empirically calculate the cost-benefit ratio of lockdown versus no lockdown. How many lives need to be saved by lockdowns for them to be good thing? Whose lives are saved and whose sacrificed and what harms are suffered and how much harm is suffered. Having numbers is never enough and I think this is asking the wrong question.

For me the question needs to draw on an aspect of moral philosophy, about a Kantian judgment that is not just about reason or rationale but focuses on the values a society places on a) honesty and clarity about the benefits and harms, b) when a government can be authoritarian in a crisis, c) the ability to value possible harms, d) the value of the lives of vulnerable minorities, and the most impoverished in society; and e) the aptitude of a majority to take individual action collectively to protect a minority .

Put most bluntly, for lockdowns, the choice between mitigation or zero Covid policies is about a choice between barbarism and civilization. This is the choice between a) intentionally and consciously sacrificing lives according to a law or voice of conscience that says: “Thou shallt kill” – most egregiously demonstrated in recent history by Germany’s National Socialism of the 1930s; and b) intentionally doing one’s best to protect the lives of all, even if this means causing harm to many in the process, to follow a law or ‘voice of conscience’ that demands care of all others (those strange to you) with love.

The consideration of cancer screening poses special questions here, and highlights what is at stake: mass cancer screening programmes arguably protect the lives of a relatively small number of people by preventing by their cancer deaths. In this sense it is caring, albeit impersonally (it is the programme that does the caring). Mass screening is a kind of lockdown – it restricts freedom to be free of the offer of screening that compels compliance. It also causes harms to many through overdiagnosis and possibly premature deaths due to over treatment. However cancer screening is: a) dishonest because it is marketed and offered on false pretenses because it invokes fear which incites desire and compels compliance; b) unjustly morally persuasive because the harm of over-diagnosis cannot be adequately valued by individual citizens because it is an as-if virtual, never sensorily experienced as such event, which is therefore unimaginable as personally relevant; and c) is intrinsically seflish, the individual acts for personal benefit not for the benefit of others. Cancer screening exists because it is first and foremost compatible with a selfish exploitative capitalist ideology.

Considering cancer screening helps us to see what is at stake when it comes to mass lockdowns to eradicate coronavirus.

Lockdown is resisted by capitalism because it threatens the continuity of commodity exchange and the compulsive need to extract surplus profits for so many.

But mass lockdown to redue viral transmission, illness and deaths of the most vulnerable, is honest, or better, at least more honest, it is a) transparent; and b) its harms are experienceable and/or visible to all. And mass lockdown is an intention to protect the lives of those most vulnerable to the virus – the old sick and poor. National lockdown is a zero Covid strategy that may fail in the end. But it is the only civilized strategy: according to a voice of conscience calling for care of the other rather than calling for hate, exclusion and exploitation. Of course, in the UK, capitalism and elitism is slow to take action to mitigate the harms of lockdown by providing anything like adequate financial support and the health service has been so degraded by privatization it cannot cope with the demands.

Any mass intervention carries moral overtones and becomes an imperative, with oppressive potential. The feature of lockdowns, like vaccinations, is that the individual’s participation is never only about benefit for the individual, there is always at least hope fthat the individual’s participation will benefit the community at large and in particular benefit for the most vulnerable. The participation has an altruistic component that values the lives of others, it could be regarded as an act of caring with love for the other. This is in contrast to the anti-lockdown, herd immunity, let-it-rip, approach, whhc consciously sacrifices the vulnerable and especially the older population, a selfish policy of disregard, de-valuation of the lives of others, a politics in the end of callousness and that opens the door to totalitarian destruction, and the banality of evil characterised by Eichmann.

However the pandemic is global and bearing in mind the sheer scale of the task and the likelihood that, for example, the USA, at least, will seed the world for years to come, there is a compelling argument, for example, to impose sever travel restrictions in and out of the UK, and especially to isolate the USA in particular.

The virus as taboo, and xenophobia

Freud in Totem and Taboo writes of the logic of taboo in terms of the logic of contagion, of transmission of infection with the taboo through touch. The taboo functions to bind a society according to norms that are believed to protect society’s integrity, such as, classically, the incest taboo.

When we travelled back from Palestine in March it felt as if we were, that is, embodied taboo. We were from ‘outside’, strangers, and regarded as in possession of the contagion, and violating the taboo because we were just ‘there’ or traveling through ‘there’, where ‘there’ was anywhere that wasn’t our own community and home; and because of this, we were on the receiving end of discriminatory language and behaviour.

It is as if the virus is the taboo. A taboo always prohibits that which is deeply held to be desirable, even if that desire operates at an unconscious level. For the virus, as with a taboo, it first and foremost prohibits touch which results in a prohibition of freedom of travel, social intercourse, as well as touching.

For the virus, this particular taboo comes with no external signs (invisible, dangerous and mysterious), it is assumed to be possessed by all, that is all who are not ‘us’: where is, the ‘in’ group, might refer to close family, or a member of a community, or even just everybody that isn’t me. For example, for those vulnerable individuals who are shielding, the other is everybody else: family, the delivery man, the hairdresser, the gardener etc.

And the virus is taboo because it signifies unpredictable and sudden death through suffocation. And death, or the dead, is taboo: ‘ Signifying the wrath of the demons”.

Violators or holders of the taboo (the virus) who violate the taboo (by having or risking literally contact with, or touching, the other) are an object of both fear and to be punished because they incite imitation of the violation (eg having raves, traveling on holidays, not isolating, wearing mask etc.) and the intensity of the desire to punish reflects the intensity with which the violating behavior is actually, if unconsciously, desired as well: to touch, to travel, to not wear a mask etc.

Why Locking Down (separating) is necessary

The term lockdown is bandied around – full/partial; national/local etc. and is often used as if it represents an all or nothing event of some kind. And perhaps ‘lockdown’ is a bad term since it misrepresents what should be intended, that is, suppressing transmission by separating people: separation, diffusion or separating might be better.

Here I want to use the term ‘ lockdown strategies’ as referring to the full range of policies and behaviors that limit our contact with other people in order to reduce transmission. So lockdown restricts contact, making it harder for people to mix, (social distancing), which might include shutting up shops and businesses, as well as including the less extreme end: no touching, using sanitizer, wearing masks.

It is unhelpful to use the term lockdown without. being more specific.

Current attempts to slow down the spread are inspired by

a) the historic excess deaths already caused by the virus, shortening people’s lives – mostly the older population; and

b) the recent exponential rise in the proportion tested that are positive, and hospital admissions.

Nobody knows how bad the death rate and impact on hospital care will be, but the recent rises suggest we are not at a peak yet. And it is acknowledged that lockdowns certainly cause harms to many directly (to mental health, through isolation, economically, and in terms of opportunity costs for healthcare).

But, if left to run unchecked there is a risk that the NHS will be overwhelmed, many will die earlier than if the virus was contained, also affecting healthcare for other problems.

The virus will become increasingly prevalent to the extent many people may be infectious, may be too ill to work, or too scared to work or travel. People won’t risk traveling by plane. Many businesses will likely shut down, unemployment and poverty will soar. In other words there will not just be large numbers of earlier or excess deaths but a longer term economic hit.

To repeat: without a significant slowing of the rate of transmission businesses will not be safe to operate and there will be even more business failures and redundancies.

There will be an even greater and longer term economic recession.

The current trend against lockdowns that include shutting shops and businesses and offices has been inspired by right wing ideology that is frightened that the myths of the current liberal democratic capitalist system are being exposed: it makes the rich richer and makes social inequality worse. This right wing inspired trend tries to frighten by justifying future austerity measures. It suggests debt must be repaid somehow but on the contrary, when Modern Monetary Theory clearly shows that government can produce money to meet welfare and social needs, to pay for socially useful, essential, productive work and where tax can be adjusted to counter inflation if necessary.

Modern monetary theory: a short guide for a world that now realises that it’s an explanation of what’s now happening

The right wing trend to criticize lockdown is a short term and mistaken perspective to prop up the potential to continue making profits, and justifies austerity that is socially unjust and affects the poorest most.

Eradication may prove impossible but amelioration of the impact to protect the vulnerable and to improve and maintain living standards of those affected is within the power of the State. And testing may have a role though public trust in any testing system must be very low.

Clapping for Carers is Clapping for totalitarianism

On the one hand the community clap began as and, we can assume for the sake of argument, was felt to be a good faith gesture by those who genuinely feel grateful. But, at the same time, it is not entirely their, individual, or our’s, the people’s, gesture – it is a gesture that was instigated by an other (a woman in South London), and was then rapidly appropriated by the media, politicians and celebrities – and it began to be imbued with moral exegesis, it became normative – and morphed into a kind of political religious ritual as a paen to the sacrifice others make for our lives, in the name of the NHS, the remnants of a tattered welfare state. It becomes a tool that invades the consciousness to induce the belief that the NHS exists as a publicly funded welfare scheme for all, that the government will keep the NHS safe, that the government is in control and retains its full might, power and determination. The clap in reality becomes a mass hysterical homage to the state that is destroying the NHS, and cultivates a deeper obedience and deeper repression of the knowledge of the destruction of the NHS and the harms inflicted to the welfare state and the vulnerable by neoliberal capitalist ideology. In short the clap cultivates a totalitarian mentality on the fertile ground of subjective wastelands for the benefit of the Egos of those in power.

“The creation of new symbols and rituals to evoke belief in a higher cause are central to the concept, ‘political religion’, prevalent in fascism studies for at least two decades.”

In addition, of course, the idea of worthy sacrifice for the lives of the many has been mooted as a common fascist trope and fits with the idea of a certain and absolute instrumentalisation of both identify and the very fabric of the body as embodying the Law of the Leader or the universal master myth. Trump lauded the essential workers as if they were selflessly “running into a hail of bullets”, headlines in the UK lauded and encouraged the sacrifices of teachers and other essential workers, and calls have been made for the elderly to sacrifice their lives for the sake of those yet younger. This idea emphasizes that the true totalitarian psyche is totally instrumentalised and given over to the sacred Law, so that no sacrifice of the self, and no destruction of the other can be too much.

Mass ritual and the associated joint binding excitement, represents perhaps relief, the mutual benefit of the atmosphere created functions almost like a release of suppressed sexual energy, the lack of ‘jouissance’, compelling psychic work to create surplus orgasmic jouissance that excites but also sustains the elite’s power

The Totalitarian psyche: avoid over-using the term fascism

The term fascism is emotive, gets people’s backs up and obscures the essential features necessary for progress and debate. But nonetheless it is essential to recognize what we know as fascist politics – if we are to learn from history and avoid catastrophe. So, here I suggest we use the term totalitarianism in a particular way. Here I also distinguish between left and right wing, as economic polarities that seeks to redistribute wealth (left) or seeks to maintain wealth inequality (sometimes arguing that it is envy that is needed to motivate people to be productive and this is progressive. Liberal, here, refers to individual freedom and authoritarian refers to collective central control. But I also point out that apparently liberal and democratic ideals can always potentially morph into authoritarian policies, that is incite the totalitarian psyche, over time.

Nazi Germany was and Nazism is classically fascist (mythical leader, nationalist Ayran myths, Jewish scapegoat etc.) whereas Stalin’s Soviet Union was more classically industrially and economically totalitarian, with not so much the nationalist racist myths operating as myths built around industrialized concepts of production and science – a totalitarian extreme version of capitalism (Castoriadis). Instead here, following Vadolas (Perversions of Fascism) I use totalitarianism as a more generic term that embraces both the commonalities of Nazism and Stalinism, and which refers to a particular relation between the citizen’s psyche and authoritarian power. This theory speaks to the haunting question: “Why do good people do bad things?” How can a public accept racist and genocidal policies? How does power infiltrate and cause qualitative psychic shifts that make totalitarian policies more publicly acceptable?

Nazi fascism and Stalinist power have in common a psychic shift in the way people form their identities or sense of themselves in relation to the normative laws set down by elite powerful leaders. It is more useful, in terms of finding some explanations for the power of totalitarianism, to avoid taking a liberal democratic perspective (as some post world war 2 scholars have done) – that demonizes authoritarian communism and assumes liberal democracy provides an antidote to fascism – a mistake and misleading since liberal democratic politics contain totalitarian potential as well.

We should avoid over-using the term fascism – and instead veer towards a more generic definition of totalitarianism in ways that avoid taking a so-called liberal perspective, (as, for example, taken most famously by Arendt) since this also has totalitarian potential.

Totalitarianism can usefully be defined in terms of a psychoanalytic notion – a way the psyche identifies with an omnipotent law – the failure of the paternal metaphor and associated neurotic hysteria no longer applies. Dangerously the Law survives through identification and destruction of a scapegoat other – the weak, fearful, different others. The law demands the unconditional relation with others in ways that elide individuality and excise difference as the enemy.
Totalitarianism in the time of coronavirus. TBC.

As the article below points out Trump’s current behaviour (October 2020) is classically totalitarian – signifying omnipotence to his actual and potential admirers.

Unfortunately the viral pandemic has destabilized the public emotionally by removing those things and social relations we know and rely on for our sense of ourselves – thus providing a fertile breeding ground for totalitarianism as an antidote but an ultimately self-destructive one.

Totalitarianism relies on a politics if friend or enemy (see Carl Schmitt) to maintain the elite leader’s apparent omnipotence. This fuels and doubles down on always already latent xenophobia which can be shaped, and directed, by elite power to demonize particular others: such as those deemed too different: intellectuals, left wing activists, homosexuals, immigrants and travelers, and as in Nazi Germany particular ethno-religious peoples.

Elsewhere I describe psychoanalytic perspectives on how a totalitarian psyche, and xenophobia, is being provoked and intensified by the pandemic in the context of already existing global creeping ‘fascism’, neoliberal capitalist exploitation, nationalism and anti-immigrant sentiments. This is happening in ways that are making totalitarian policies more publicly acceptable and therefore more likely to hold sway.

It is important to try to recognize and resist these threats by disobedient but non-violent actions.