Whilst barbarism predates capitalism, and the pre-secular psyche was dominated by a transcendent Master (of the Gods and religions) and immortality (a form of surplus-value) via sacrifice, capitalism with its immanent and earthly source of immortality (profit, surplus-value via the surprisingly compliant and enslaved – and earthly – waged labour-force) may manifest a different kind of barbarism: possibly a barbarism directed, in the end, at the ‘self’; wherein the self (and castration) is rejected in favor of its replacement by lack posing as Master.

This is consistent with the (impossible fifth) capitalist discourse, of Lacan)

https://ojs.zrc-sazu.si/filozofski-vestnik/article/download/9838/9002

impossible, perhaps, in the sense that it leads to self-destruction and the death of humanity. It is also consistent with a psychic structure (structure may be too strong a word) for narcissistic perversion.

If capitalism (neoliberal economic radical empiricism), incites a turn to narcissistic perversion, it may also incite a turn to bureaucratic perversion – the rejection of castration in favor of both radical disavowal of the unconscious and self-instrumentalised identification with the law (as in an Eichmann like radical banality of evil): the Totalitarian psyche.

Is capitalism responsible for a ‘strict’ law inciting fascism and a demand for racist destruction of the other? Possibly, yes, because the fantasy of endless economic-growth, limitless personal wealth and even immortality, structures the capitalist psyche of today, and demands, strictly, exploitation and consumption.

Capitalism is a Strict Master: strict, in that:

◦ It bans dissent (mainstream media obeisance to the billionaire oligarchy)

◦ Controls the public psyche (advertising)

◦ is hyperbolic (the empty signifier ‘Growth’ dominates public/political discourse)

◦ Threatens with nameless punishments without end – destitution and exile

◦ Preaches xenophobia – the worthlessness of the economically non-productive unemployed and elderly, and hatred of the foreigner.

[individual/systemic, diabolical/radical, agentic/agens, bureaucratic/narcissistic]

A ‘strict’ law is said to have been part of the rise of Nazism, (Vadolas p140), inciting and producing the “death-coveting element of fascism” – but also producing guilt at the conflict between an instinct to care/love for the other and the demanded destruction, this creates an emotionally exhausting conflict with the caring ideal ego (how I see myself) and the superego (monitors compliance with ideal ego) which has been described as the cause of burnout in caring professions, (Vanheule).

This guilt troubles the stability of the psyche and may incite one of four possibilities :

a) a restoration of the law (the hysteric may secure a subjectivity as far as this is ever possible, via this Law): or

b) abandonment of that law, in favor of (castration by) another Law, or big Other as a more or less active (neurotic or hysteric) dissident, which Vadolas , wrongly in my view, described as perversion; or

c) a total rejection of castration by the social signifying structure (the Other of the Unconscious?) but a continued effort to acquire agentic subjectivity and sense of self, and a failing effort to manage the jouissance of lack via the individual’s own Law (the narcissistic perversion); or

d) abandonment of castration by that strict Law, or any other law, and an abandonment of the quest for agentic subjectivity in favor of a total self-instrumentalisation as agens or embodiment of the strict (fascist) law, identifying with the law and acting to enforce the law at all costs, unthinkingly, with a radical disavowal of the unconscious, and of any need to care for the lives of those to be destroyed by command of the Law.

For perversion there are two forms: bureaucratic and narcissistic.

I suggest (tentatively and provisionally) that in case c) above abandonment equates to the totalitarian psyche’s bureaucratic perversion and radical disavowal of the other and abandonment of subjectivity itself in this context / a radical self-instrumentalisation. And, a banal radical evil.

This bureaucratic perverts acts a Agens for the law.

At the same time, in b) above, the stricter the law, the more it causes guilt and leaks and incites abandonment in the form of a narcissistic perversion – contra Vadolas’ theorisation this is due to the attempt to assuage lack through the Law of an Other with its origins within the psyche of the individual and not from any social signifying structure. And, a diabolical evil, more likely associated with the death-drive than the bureaucratic self-instrumentalisation.

The bureaucratic pervert is not formed via one of Lacan’s four discourse structures since the radical disavowal and identification with the law effectively puts the individual in the position of unthinking object, as if a willing slave, not affected by a subject’s division as in the Master discourse.

The narcissistic pervert is also not part of the four discourses since its psychic structure may correspond to, or at least touch upon fleetingly, the (impossible) ‘little inversion’ of the capitalist discourse structure. (EXPAND and check Ferraro)

This differs from Vadolas’ account where hysteric and pervert are both structured by the Master discourse where the hysteric attempts to relate to the law and the pervert to subvert the law. (TO QUOTE).

A strict Law – and fascism; the effects of strictness as a kind of, or even equivalent to, authoritarianism. The stricter the law the more likely to destabilize neurotic and hysteric subjectivity.

Because the strictness and it’s Laws are also vague enough to condemn everyone of sin, by condemning and outing the sinful, in more ways than one, then the more the individual makes and effort is made to prove ‘goodness’.

The strict law often (maybe always?) involves identification of a sinful ‘other’ – other sexuality, culture, color, religion etc.

“He (Hitler) wanted strict laws to prohibit political opposition and to deal with dissidents and resistors.” (Vadolas)

Strictness, as part of a Master discourse, has four tendencies, also found in fascism/totalitarianism:

1. Forbid dissent legally

“The process of crafting a Nazi society was called Gleichschaltung, which translates as ‘moulding into shape’ or ‘forced co-ordination’.”

2. Mould (as in his ‘ideal’) in his image = controlling values and beliefs (sentiments) – eg laws controlling behaviours (smoking, drug use, prostitution)

3. The strict (authoritarian) Masters make Laws via empty signifiers (Law and Order a common one, others eg Final Solution, The Bomb. The Cure) that always leave doubt about meaning and therefore the impossibility of adequate obedience, and the possibility of being always already sinful (and guilty) : and the interpellation, the instrumentalisation by the Master’s Law, all the more powerful.

4. Strictness may have a tendency to be hyperbolic increase over time as the more or less instrumentalised servant/managers fail to be totally subservient or even rebel. Actual and fear of possible, rebellion/dissent fuels strictness by the insecure Masters.

4. Increasing strictness takes advantage of, or uses, the power of tribalism, the power of a kind of mass hysteria or crowd or herd like unity to foster the implication that foreign (not of our herd or kind) others, ‘they’, are a threat to ‘us’ and the cause of failure to achieve more power, economic growth etc – so xenophobic and racist discourse grows.

What is strictness? It commands via seemingly specific examples but also via a generality of unknown sins, so the commanded is always sinning, always guilty (never ‘good’ enough for the Master), and also commands via the threat of terrible punishments also unknown which makes them more terrifying, but at the very least disapproval for letting down the Master you strive to emulate / to be: hard-working and ‘good’ and even omnipotent. But, as with the psychic castration one can never be like the father , because the father’s desire, the mother, is forbidden.

With Paterson (see below) the strict law could, for example, be from his own father figure growing up. For any individual this would be a possibility. But the state also can impose ‘strict laws’ evoking guilt and unease pressing for even enhanced consolidation of the law (bureaucratic perversion? Or abandonment – the narcissistic version of perversion. Note Meadow was a trophy child. (QV)

As another inquest opens into UK breast surgeon Paterson, (NEED SUMMARY or link to chapter in thesis) this time regarding his alleged role in the deaths of several women, this is an apposite time to look at plausible explanations for the behaviours of medical personnel that appear to be examples of narcissistic perversion. So, what would constitute a plausible explanation? Surely only one that is able to account, in terms of psychic structures and their relation to societal norms, for monstrous levels of destruction of other humans. We can remember and reflect on the behavior of Professor Sir Roy Meadow and the terrible consequences of his now discredited law and characterization of the perpetrators of MSBP. And today we see a Mr Paterson, sentenced to 20 yrs for extraordinary levels of ‘over-treatment’ for false and deliberately fabricated diagnoses of cancer and intended bodily harm to women , and about to be subject to a further inquest into the deaths of seven other women. through ‘under-treatment’ for cancer, using cleavage-sparing techniques proscribed by official surgical guidelines.

Such shockingly barbaric behavior by a surgeon to inflict gruesome injuries on hundreds of innocent unsuspecting women on the basis of a false and deliberately fabricated diagnosis of cancer can be plausibly explained by the structure of narcissistic perversion outlined above.

Paterson’s behaviour is, I suggest, consistent with a psyche that:

a) rejected castration by a social Other, here for example, the professions guidelines on surgical procedures and social norms on probity;

b) therefore, radically disavowed the unconscious (the social signifying structure for those held-in-common social norms;

c) attempted to retrieve subjectivity driven by a need to evade the horror of a subjective void and the death drive;

d) by living according to Paterson’s own law: to “Enjoy this little as much as possible!” Where enjoyment refers to the feelings of agonistic ecstasy: ‘jouissance’ produced and discharged through the evasion and production of identity via repetition without teleology in the symbolic: the death drive . And, where ‘this little’ refers to the destruction of women’s lives under the surgeon’s knife.

The woman’s body comes to represent the object à, but also the horror of the subjective void represented by the (m)other. The (m)other here representing the mother figure of the pre-linguistic and pre-Oedipal phase associated with the presence and then the loss, via language and castration of psychic and bodily unity with the mother.

Paterson’s attempt to obtain a sense of self is, ironically, actually subverted by being through his own law, since ‘he’ is always already without subjectivity or any possibility of effective law giving since he rejected castration. He cannot make sense of himself by his non-existent self. Each attempt via destruction of a (m)other fails to achieve subjectivity stability, only serves to repeat his feelings of instability and subjective nothingness producing more jouissance and driving more destruction.

Paterson’s law, of narcissistic perversion, is diabolically evil in a Kantian sense, because for Paterson it becomes duty for duty’s sake, the denial and absence of a socially signifying structural Other that decides our duty for us, and a Kantian categorical imperative – a maxim through which Paterson wills it becomes a maxim for everybody to live by.

We should note well, that such plausible explanations may also be extended to a different and totalitarian psychic structure: the perversion of health-scientists self-instrumentalised by identifying with the Law of Science demanding The Cure of or Perfect Prophylactic for disease and especially Cancer.

These bureaucratic and totalitarian perversions represent a banality of radical (as opposed to diabolical)evil represented and paralleled by the self-instrumentalisation by scientists in their search for the atomic bomb. This structure helps to account for the continued expansion of anticipatory and medicalising technologies despite their harmful consequences.

The systemic perversion of (scientific) knowledge demands the subjects self-instrumentalisation: as non-agentic Agens for an illusory socially utilitarian programme that has no locatable endpoint. The banality of radical evil.

Our subjectivities and public sentiment towards political policy, and scientific technology are in thrall to the discourse of pragmatism:

This denies our freedom to choose other voices.

Three main political discursive forces are at work:

1. The underlying philosophy of radical empiricism, so-called liberal humanism, and the view of the human as master of his own thoughts, values and destiny

2. The trenchant right-wing critique of the idea of ideology (itself ideological of course),

3. The idea of limitless scientific innovation in the search for solutions as necessarily a ‘good thing’ for humanity,

These three forces have all negated political and scientific potential to prioritize individual autonomy of decision-making and therefore the potential for these decisions to be part of work to benefit the community, so to speak.

Radical Empiricism is a philosophy that is more likely to be believed by, or at least to encourage or even justify the beliefs and values of, individual libertarianism, ultra right wing fanatic and perverse narcissistic psychopaths inclined to totalitarian and fascist polities. As opposed to say, communitarian libertarian polities. But, at the same time it can be used to justify authoritarianism if either a left (ostensibly communitarian: promoting re-distribution of wealth) or right-wing (ostensibly individualist: promoting individualist wealth ‘creation’) politics.

Quote from James 1904 on radical empiricism:

“the only things that shall be debatable among philosophers shall be things definable in terms drawn from experience”

This effectively bans debate on the role of imagination and fantasy and of social structure constituting values and thoughts. And, for James, this is sufficient for a world view.

“a given undivided portion of experience” (1912) … “figures as a thought”

a ‘thick’ description of experience being subjective and objective simultaneously.

“Being pragmatic” as opposed to ideological is sometimes used as a selling point to attract voters by politicians. However, it is actually very poorly disguised code for being conservative, which today in the UK, means being right-wing. It also, denigrates the concept of ideology or ideological critique as if ‘being ideological’ implies an incapacity to be flexible to make compromise which is nonsense.

Being ideological can encompass varying degrees of commitment to this or that dogma.

The terminology is confusing – here is a brief primer:

Many conservatives of an individual libertarian persuasion (in general politically selfish and elitist in outlook) are ‘liberal humanists’ and ‘anti-woke’,

which means they conceive of the individual as a sovereign autonomous decision maker with an unchanging human nature.

Consider the contrast between materialism and idealism:

Materialists (Lacanians and Marxists and other post modern critical theorists) believe in ideology creating fantasy and using imagination through socio-economic structures as the basis for human subjectivity: the determination of ideas and values and desires.

On the other hand, by contrast, idealists (the individualist libertarians and pragmatic liberal humanists) believe the sovereign, autonomous and rational individual mind of modernity is the basis for human identity.

Historical materialists (such as Marx) believe that social structures necessary for survival shape human thought and values, and for example make waged labour appear not just necessary but legitimate and just.

Idealists (as opposed to materialists) such as Hegel, believed that it is thought and ideas that (progressively) change the material world and not the other way round. So, radical empirical pragmatists are idealists who think their thoughts on both: a)choice of target problem; as well as b) of proposed solution, will provide a progressive advance for humanity in general. They choose a specific target problem, and outcome, think of a solution, see that, as radical empiricist, as a thought, as good as empirical evidence and justification for action , and so treat that solution as an effective truth and put that solution into operation – regardless of collateral harms or unintended consequences.

For example this radical empirical pragmatic approach endlessly proliferates (profitable) technologies for earlier and earlier diagnosis of cancer regardless of harms and over diagnosis.

Being ideological isn’t something any individual has a choice about. It means that every individual’s values and actions are to a large extent determined by cultural upbringing and whilst choices are possible, and there is agency, this is always constrained within existing social or cultural limits. Ideology as a determinant of values is the only plausible explanation for the astonishing phenomena of recent and contemporary barbaric fascism as exercised, for example, by states such as Israel. By claiming to be pragmatic today a politician is always necessarily already being ideological and exposing his or her obeisance to a culture of right-wing conservatism that favors entitled elitism, nationalism, competition, politics of envy, and resists wealth re distribution (socialism), and adequate public welfare for those in need. His or speech is performative in the sense that it demands similar obeisance from others to. It is a master discourse in Lacanian terms.

“Being ideological”: For practitioners and influencers, note that being ideological is a derogatory idea used to discredit critique based on Marxist theory. Marxist theory – alongside what is known in general as post structuralism – claims that the psyche and our conscious values are directed constructed by society’s economic framework for survival – and provide fantasies for social identities that value profit over re-distribution of wealth.

So far, so good.

The critique of neoliberalism by Marxism and post-structuralism suggests that, within contemporary social structural constraints at least, it is possible to find other values, and other effective truths (knowledge sufficient to guide action to achieve certain target outcomes).

The dominant contemporary 2022 paradigm for humanity and its knowledge, epitomized by EBM and evidence based public health care and purchasing, most crucially implicitly (and quite silently) denies any ideological basis to human thinking capable of finding and using knowledge, as effective truths, to guide action. To put this differently, the Marxist approach to ideology (which includes the notion that we are always all inevitably being ideological) encompasses the notion that there are, confusingly, material influences that can determine our basic ideas in terms of our values and thoughts – what has been called (historical materialism). The key point is that contemporary dominant scientific knowledge creation claims to be able to avoid being ideological, and that its praxis (being pragmatic according to conservative values in the quest for power/profit/innovation/solutions to profitable questions) can safely assume the public can also avoid being ideological. That is, it assumes scientific knowledge creation and the public and individual capacity for decision-making can proceed as if independent of material social structures and circumstances.

This then is why ‘being ideological’ is code for being anti-social and Marxist, and prone to delusional thinking about knowledge and the possibility of so-called multiple truths.

However, my Marxist and Lacanian, claim that it is only by considering the human psyche as inevitable ideological: constructed in terms of its values and the things it knows and other things if appears not to know, that we can begin to provide a plausible explanation for the surprising, frightening and horrifying, spectacle of humanity’s capacity to inflict so much cruel barbarism on so much of the human population. Only by thinking of the psyche as able to be in apparent total denial of the value of the lives of ‘certain’ others can we begin to explain the barbarism that abounds in the world.

Applying these ideas to the medical-industrial complex and it’s search for prevention through screening:

For example, leaving global politics, apartheid, immigration policies, destruction of public services and austerity aside, at a more mundane level, it is how we could plausibly explain, at a psychic level, why official (political) scientific advice and public sentiment feels able to pursue population-based diagnostic screening programs such as breast cancer screening that causes so much direct harm, so much over-diagnosis, and still leads to a failure to reduce all-cause mortality despite reducing breast cancer deaths, (with the logical conclusion that screening must cause deaths from other causes, plausibly from surgical intervention or mammography, radiography).

So, to summarize, the best explanation for the hyperbolic growth in a destructive politics of neoliberal capitalism, and for example iatrogenic harms due to over-diagnosis, lies in psycho-political theory based on the ideas of Marx and Lacan. These suggests all human thinking is necessarily ideological. That it, the values we hold as ‘normal’, and take for granted, are those absorbed in childhood via our cultural norms. And today these are predominantly the values of free market capitalism with its competition, greed, narcissism and violence polluting the global psyche en masse. In certain psychoanalytic theory (Lacan) the individual’s identity or sense of self, it’s ‘I’, is the consequence of the child’s need to escape its lack of identity with which it emerges into the world. And it can only escape this intolerable subjective lack or void by turning to the command and language of a powerful other, by surrendering power to this figure, to gain identity through the acquisition of certain socially normative values, at the expense of other values which are rendered unknown or unconscious. The usual human state is one of being neurotic – in the sense that this identity always only feels partial, resulting in a constant desire for affirmation though more subservience or, in a more hysterical mode of subjectivity, to question the voice of normative power and to seek other powerful voices. The key point here being that the human must always have a voice of power to listen to and to be watched by in order to sustain even a minimum of identity (subjectivity or sense of self).

Having got this far we should return to the relevance of this ideas and theories to the basis and praxis of EBM, or other proposed complex models for determining how knowledge should guide public health care. The relevance is that a) current models are, contradictorily, already being ideological by denying ideology by denying the psyche is constructed to have certain conscious values by the social structure of capitalism that expose lack, create desire, which leads to an apparently autonomous demand to be able to consume products such as anticipatory diagnostic healthcare screening; and b) this denial enables the continued hyperbolic proliferation of techniques for marketing mass diagnostic screening methods; and c) perversely, (a term I use advisedly), even enables scientists to use the dogma of EBM, and it’s reliance on experimental empiricism (and it’s gold standard, the RCT) to critique policies to reduce the spread of Covid through eg mask mandates or economic lockdowns such as closing theatre and cinema and parks and advising work from home etc. This is a tendency by a right-wing individualist-libertarian trend that is consistent with an extreme idealist philosophy that claims that not only is the individual autonomous of social structure but: a) the individual’s thoughts can be considered just, as if not more, valuable than otherwise empirical evidence for determining knowledge to justify action to tackle ‘chosen’ (for their surplus profit and power potential) particular problems; and b) the pursuit of the (superior and most evolutionary useful and productive) thoughts of powerful elites to guide political actions is by definition progressive and advantage for nature and humanity (even if it means destruction of large swathes if the world and its populations). There is an interesting conundrum that emerges – it is as if the EBM enthusiasts are using a preference for experimental empiricism to further the project of individual libertarianism which actually values elite and individual thought as the best empirical guide to political policy.

The USA audience may be even more smitten by the assumption of sovereign individualism than the UK. The scientific-technological relationship to consumerism and individual choice touches on matters of life and death when it comes to asymptomatic medical diagnostic screening programmes such as, most notably, the breast cancer screening programmes. These have been challenged on evidential scientific grounds by such reputable figures as Michael Baum who has called for such screening to be stopped (ref). Perhaps some may be surprised that such challenges have met with such little response – indeed the programmes are being extended to wider age groups rather than reduced. One of the foundations of medical ethics is the idea of freedom of choice for the individual. And rightly so. And a lot of work (including by me in the past) has gone into trying to maximize patient autonomy over decision making by ensuring information given is as user friendly and unbiased as possible. And rightly so.

However, and this is the crux. The premise of these efforts is that proactively offering the screening intervention is a good thing. UK government sponsored ‘Independent’ reviews have concluded, because a) they show that screening reduces specific cancer deaths; and b) that the harms, including overdiagnosis, are known about and quantifiable and therefore can be communicated to the public, that (breast cancer) screening is a good thing. And in general this has been the thinking for most non-targeted asymptomatic anticipatory diagnostic screening.

Just here I will make a small diversion to consider over diagnosis, as an unusual type of harm that perversely is used to promote screening, and yet confuses many, and cannot be adequately valued by many individuals for the harm that it is.

Overdiagnosis / this concept deserves some attention.

First, because knowledge and quantification of overdiagnosis is, somewhat counter-intuitively, used as justification for continuing with proactive screening programmes. (This is on the ground that as long as the public are told ‘the facts’ then people will be free and able to make their own kind up about whether to accept ‘invitations’ (read as compelling demands) to be screened). Of course, life is more complicated than that, and over-diagnosis certainly is. There are two things to know about the concept of over-diagnosis: the first is that it is due to the (necessary) failure of technology to identify a clear distinct borderline between bodily functions/tissues that are ‘normal’ – in the sense that the tissue will not become pathological (literally, cause suffering) and ‘abnormal’ – tissue that is predicative of, (assures with certainty) a symptomatic pathological future. This is because at the borderline the futures of these visually ambiguous and borderline bodily functions and tissues are under the unpredictable whim of random molecular processes. What looks to have carcinogenic potential is just as likely to have an asymptomatic future. This means that asymptomatic screening must always run into misdiagnosis at the frontier between the normal and the pathological. This failure leads to diagnoses of future symptomatic cancer that are simply wrong, a mis-diagnosis. This is overdiagnosis and leads to over and unnecessary treatment causing net harm to health.

Second, note that overdiagnosis as a phenomenon can only be inferred from the comparison of cancer diagnoses and symptomatic cancer outcomes between screened and non screened groups. In this sense whilst it is real enough it is also as far as any personal experience is concerned, an abstract concept. This is how public health policy makers can get away with not valuing the scale of over-diagnosis in calculations considering whether screening is a good thing (because no individual can stand up and say “Look, I’ve been over diagnosed and had an unnecessary mastectomy!”). This renders over-diagnosis a strange non-valuable, in a healthcare sense, (though profitable) harm as far as the market and its tool: pragmatic public health policy, is concerned. This, in turn, also means that for many (not all) individuals over diagnosis is a confusing concept that cannot adequately be taken into account when making decisions. Of course, for some the knowledge of the existence of overdiagnosis can be sufficient to lead to a refusal to be screened, or anger if insufficient information on over-diagnosis was made available at the time screening was being ‘offered’. This is a digression into the idea of over-diagnosis, that isn’t necessarily a deal-breaker as far as screening is concerned, but in my view adds to the reasons why asymptomatic non-targeted screening should be stopped. The main reason, as elaborated below, being its fundamentally and effectively anti-democratic and coercive nature as a fear inciting commodity in an uncaring free market dominated by capitalism’s demands for new and surplus profits.

So, now, bearing in mind the phenomenon of over-diagnosis as an especially elusive and malevolent kind of harm, we can return to the key questions for screening programmes.

First, what if there was genuine uncertainty about the overall benefits of such screening programmes, in terms of their ability to reduce overall all-cause mortality. After all, Baum has convincingly argued that both plausibly and evidentially, screening and treatment both can cause harm, including deaths, in their own right, and this is why overall mortality reduction due to cancer screening has not been demonstrated.

Second, what if the first principle of care should be to maximize patient autonomy over and above the targeted reduction in specific cancer deaths?

And, third, what if it could be demonstrated that even the proactive offer of such screening fatally undermines patient autonomy?

My argument now follows and combines the lines of thought of both Karl Marx and Jacques Lacan the French psychoanalyst. The key issue to keep an eye on here is the implication for individual freedom of choice.

For Marx, the capitalist system of waged employment to generate surplus value (profits) for business owners, manages to mystify and make invisible the lack of freedom for the worker (who MUST work to live), whose labour is effectively forced from him, stolen and used to generate value of our production that exceeds the cost of wages. This mystification of the exploitation of labour makes it seem as if profits can generated as if requiring virtually no effort at all on the part of the business owners, other than to employ people. Clearly a simple view but essentially true nonetheless.

This gets even more interesting when we introduce a psychoanalytic perspective. Following Lacan, then, who followed Freud: three key things: first, our individual sense of identity, our Ego, is formed within and constrained by cultural norms; second, this sense of identity is always only ever partial, creating a desire to either question, or please our cultural masters; and third, the capitalist system has profoundly affected the cultural Master and its norms – by creating a capitalist/consumerist culture capitalism has largely replaced culturally generated norms with the idea of surplus value itself. This has disrupted the sense of identity held in common by the masses so that we are predominantly driven by the desire for more, always expressly hungry for more and always more or less dissatisfied with what we have. We become the puppets of the system, of the market and advertisers who in turn are also controlled, and turned into mechanical tools of the system which demands competition, winners and losers, and ignores human suffering. This system also exploits the imaginary certainties of the mechanical utopian philosophies of science and the subject of science who is taken to be fully self aware, to have a whole unitary unassailable identity as a sovereign individual in control of his own decision-making and destiny.

The combination of a) the objectivisation of the human into a mechanism to exploit human and natural labour for the bottomless pit of human desire for more; b) the psychologisation of the human as a unitary autonomous atomic sovereign individual by neuron and psychological sciences; and c) the assumption that science can know the truth about nature including human ‘nature’ and the body’s future, all combine to incite the production of a totalitarian perverse psyche over-excited by the fantasy of being in control, of being the one to win, to own, to beat and to conquer the other losers, foreigners, competition, victims. This is brutally xenophobic and exploited by populist nationalist elitist and racist politics.

Unfortunately medical practice has been profoundly damaged by these processes. The result is that what seems like a philanthropic well-meaning offer to test the asymptomatic for signs of anticipated future disease and all that goes with that, has become a tool of capitalist, nationalist and apparently pragmatic business philosophies. But at the time has involved the oppressive exploitation of the consumerist desires and guilt of the masses using fear of future disease, the promises of more (surplus) life, of more (surplus) time with loved ones and so on.

Simply put then, in the end, given the equipoise over therapeutic benefit (let alone all-cause mortality reduction), the unavoidable and profound bias invoked by offers to screen, the in-sensible invisible nature of over-diagnosis, and the primacy of democratizing decision making to maximize autonomy; then the most ‘ethical’ way forward (that does the least harm) is to stop offering non-targeted asymptomatic anticipatory diagnostic screening. There should be a moratorium; debate over how or whether to target screening to high risk groups and whether it is medically unacceptably unethical to agree to screen somebody not at increased risk of disease.

This is clearly an authoritarian stance, but a lesser of two evils, as it is, I claim, less authoritarian than exposing the masses to the fear induced exploitative provocation of proactive asymptomatic anticipatory diagnostic screening programmes.

Discussion

The account above is an intervention that creates a new and disruptive discourse around asymptomatic diagnostic screening. It is a critique from the perspective on the human whose essence is one of a lack of a complete sense of individual identity constructed within normative cultural constraints and has taken three factors into account: a) effective truth, exercised by b) political power, to create c) an ethos or ethics of pragmatic action in the name of targets productive of surplus-value. It does not claim to be promoting a good of some kind, but rather to be promoting a lesser evil.

The context for the intervention is the culture of deregulated capitalism. The ethics discussed apply to an intervention affecting individual rather than social or communitarian health outcomes, for example screening for things like cancers, hypertension, coronary artery disease risk, diabetes, depression etc. So, one caveat is that my argument does not extend to asymptomatic diagnostic screening for infectious conditions – such as Covid. This is because in this case an argument can be made for encouraging individual sacrifice (for example, in terms of freedom of movement and socialization) for the sake of, or in order to protect, vulnerable members of the community.

As a rule self-sense is constituted via the imagined demand of a Big Other to follow the Big Other’s (or symbolic Father’s) Law. This constitution involves what in psychoanalytic terms is called castration. It enables the individual to achieve a degree of stability for identity and to be able to repress his knowledge that in reality, at base, he is without identity: a subjective void.

As a rule one follows the law, but as Vadolas has suggested it may be possible for some, with a totalitarian psyche, to identify with the law

To identify with the Law: is to think that one’s self, in one’s being, IS the Law, and this excludes the role of the imagined (lacking) Other/Father/Master in constructing the sense of self or identity.

But when this Law is fascist/sociopathic, is decreed by a Master of Fascism (the ‘ideal-type’ narcissist), then identification with this law produces the Totalitarian psyche. What’s at stake here is a) following a Law, versus b) being that Law.

Two questions:

1. What is the implication for the discourse structure for the individual – in the social context where this Law has effects?

2. Is this the same for the perverse narcissistic psyche?

To BE the Law, and to reject castration, (is to confront the death drive and it’s void and the danger of the (m)other). This isn’t a simple perversion as it were (if this isn’t a misnomer) because the totalitarian psyche is given the Law to follow – he is a follower. He does not make the Law up for himself. He may believe his thoughts to be as good as empirical evidence for determining particular effective truths and therefore for determining actions to serve those truths – that is, he may be a radical empiricist/pragmatist.

Whilst there may be classical slaves for totalitarianism, those who are uneasy but still obey the totalitarian law; conversely the totalitarian psyche may have a perverse psyche that identifies with the Totalitarian Master’s Law and could be described as an extraordinary-slave. These totalitarian followers or extraordinary slaves of totalitarianism would be the ones that appears to have no doubt or uneasiness, to be dogmatic and certain and over zealous, to always go a destructive step further and always seem to ‘enjoy’ destruction and for destruction to spur them on to even great destruction. I don’t know if this level of extremism is a rarity or not. This psyche does not think but only is. He is where he does not think, as Lacan pointed out. This means he is not amenable to reason or argument, and (perhaps like the psychotic) may not be analyzable. Imagination does not play a role in the constitution of his psyche. Classically the Law he follows consists of extreme levels of destructive racism, ultra-nationalism, patriotism and/or religiosity.

The Master-Fascist may, perhaps, NOT be a perverse narcissist. But also may be. He may also be a libidinal, classical, Master

In this tweet,

Thank you @opdempsey. I have been worried that certain utopians would try to create a new war in Europe for some time . I never thought Putin would be stupid enough to give them their opportunity. https://t.co/54QT3rmIOj

— Peter Hitchens (@ClarkeMicah) May 1, 2022

related to this very interesting article from 2014:

The Foul Tornado

Mr Peter Hitchens refers to ‘certain utopians’ wishing to create war in Europe today, 2022:

This seems to speak to the question of the causes behind the escalating war in Europe today, 2022. I argue here that by laying the blame at the door of ‘certain utopians’ he leaves something out? I suggest that the key driver for the creation of war today is an out of control capitalism that has both a) given Fascist Masters power; and b) captured the social psyche: creating a self-destructive narcisssitic perverse monster.

Whilst he (justifiably and importantly) implies human choice and agency, albeit of a utopian kind, he doesn’t mention the systemic causes driving the drift to extreme right-wing politics and the demand for more war.

This systemic cause is, (following Marx and Lacan), capitalism and its incitement to limitless barbarism and the totalitarian social psyche. This incitement operates through the irresistible lure of surplus-value (of many kinds including financial, but more of everything), as if for free, an illusion offered by the capitalist model of the exploitation of waged Labour, that triggers a radical shift in the operation of the psyche into an unbearable narcissism.

This narcissistic turn in the masses, conditions the masses to accept, and even desire and find a kind of pleasure in, the hate-speech used by Fascist Masters (who abound in right-wing politics today) to incite hatred of all kinds.

This capitalist power and it’s supremacist arrogance demands violent surplus-value: more war and destruction of what is deemed an alien threat to ‘our way of life’. This destructive drive consummates and consumes (Mura), feeding the demand for an always de-compensating, hypertrophic and self-destructive libidinal excitement.

So what?

Doesn’t this mean that today, to be effective, any anti-war movement must also be anti-capitalism. It must act against capitalism and its reactionary progress towards self destruction. Even though this will lead to a continuing battle between left and right.

I have no confidence that an anti capitalist movement will succeed, I think things have gone too far. However, if mankind survives these cataclysmic times it feels better to speak out and resist the barbaric drives even if, like the Dissenters and Levellers we fail. The middle classes criticize but Fascist minded governments stop listening – this is not the sign of a happy society.

In summary, I argue here that, perhaps surprisingly, Covid vaccine mandates, (laws, for example, that say health and care-home workers must be vaccinated in order to be allowed to do their work), are a thin end of a discriminatory and authoritarian wedge that open an ideological pathway to belief in the same kind of nationalist myths, promoted by Nazi Germany, that mandated enforced sterilization, and euthanasia of the elderly and disabled in the 1930s.

Background

In the UK, and in other countries during 2021, there has been a push for Covid vaccines to be mandatory for staff in health and care settings.

On the one hand, some argue Covid vaccine mandates would protect vulnerable patients and care home residents, while others argue such a government imposed mandate would breach a long standing public health, ethical, stance, that respects individual autonomy over personal bodily interventions that involve personal risk. At the moment such a mandate is not being put into practice in the UK, although the policy is still under review and may change, but in some countries, such as Austria, there is now such a mandate.

To begin with we should try to clarify two things: a) the difference between freedom of speech and freedom to act upon self or others; and b) regarding bodily autonomy, the difference in terms of the body’s internal workings as distinct from the body’s actions on the external world.

Freedoms

So, first, we need to be clear on the difference between a freedom to express a view (free speech) as contra-posed to a freedom to discriminate against others through actions. The latter is a form of xenophobia (an example is provided below) that incites hateful violence against minority groups.

Second, we also need to bear in mind the difference between personal bodily autonomy vis à vis the internal workings of one’s body as contra-posed to a bodily autonomy that refers to actions taken by that body, for example, behaviours such as seat-belt wearing.

Bodily autonomy

For adults: “Bodily” means anything that involves the internal workings of the body that affects personal health (in Canguihelm’s sense – the ability to maximize potential for functioning) and the idea of “autonomy” as used here refers to something that is as a result of a personal decision.

Of course the idea of personal decision making is problematic as we are, and our imaginary identities are, an amalgam of personal vs cultural identities. But I won’t explore this further here.

The idea of “bodily” here, is limited to its internal workings and excludes its (the body’s) material actions on the external world (eg fighting) whilst recognizing that, for example, taking anabolic steroids, a personal bodily decision, affects the metabolism and personal health AND may lead to aggressive behaviour towards others, a social action.

Vaccine Mandates

In summary, to reiterate, such mandates are a thin end of a wedge that opens an ideological path to belief in the same kind of nationalist myths held by Nazi Germany that mandated enforced sterilization and euthanasia of the elderly and disabled.

I argue that where there is personal risk of harm from vaccines. involved there should be a red line for medicine: this is because preventive interventions always carry risk of harms that cannot be valued adequately, such as over-treatment (and for tests, over-diagnosis), they are over-sold/hyped leading to fear which incites desire felt as an imperative demand, whilst generating surplus profit and power.

Bodily autonomy and Ideology:

An example

The following example is intended to illustrate how confusing free speech with freedoms to act socially highlights how vaccine mandates are a freedom to act socially that discriminates against a social grouping. In the case of vaccine mandates what is at stake is a) the freedom to have a personal belief; and b) autonomy over decision making with respect to the body itself.

Fundamentalist Christian groups follow a socialized normative belief that claims homosexuality is a sin. Followers of this ideology have tried to weaponise the principle of free speech in order to legitimize discrimination against gays on the basis, NOT of speech, but of actions, namely a refusal to sell or serve gays in shops.

A case in point is where gays were refused service by a baker to buy a wedding cake in a Christian evangelists cake shop because the owner believes their sexuality is a sin.

The court ruled in favor of the Christian fundamentalists but ONLY on narrow technical grounds (insufficient impartiality on part of the commission ruling the bakers actions unlawful).

The court arguing:

“any decision in favor of the baker would have to be sufficiently constrained, lest all purveyors of goods and services who object to gay marriages for moral and religious reasons in effect be allowed to put up signs say­ing ‘no goods or services will be sold if they will be used for gay marriages,’ something that would impose a serious stigma on gay persons.”

I suggest that any apparent “Free speech” that expresses discrimination against personal choice re bodily autonomy should be against the law as it amounts to socialized discrimination on the basis of personal belief of the ‘other’. It’s a tactic to claim this is a freedom of choice for the owner of the store; just as it is a tactic to claim that vaccine mandates is a form of freedom for the vulnerable in health and care settings. When, in fact, it’s is a form of universalized social discrimination – to refuse work to somebody on the basis of their beliefs or lifestyle. .

The argument that the unvaccinated pose a risk to the vulnerable in care fails when a) it is known that even the vaccinated have waning immunity and can be re infected, and b) more importantly, the primacy of personal bodily autonomy protects us all, even the vulnerable – and remember the vulnerable under Nazi-style fascism suffered enforced sterilizations and euthanasia. This is an extreme example but illustrates why vaccine mandates should be a red line the health and caring professions should not cross.

“Arthur Li, the chair of @HKUniversity Executive Council told @BBCNewshour that he cannot call the Tiananmen “events” a massacre because he wasn’t there to verify it. I assume, by the same logic, that he cannot call the Nanjing “events” a massacre either? Beijing’s trumpet”

(https://twitter.com/JEyal_RUSI/status/1474069005694603266?s=20)

A tweet 23/12/2021 by an associate director of RUSI (UK’s Royal United Services Institute).

This short blog was written before Russia invaded China. It is prescient in the sense that it already warns us of the west’s sophistry and hypocrisy when it comes to manipulating reality in order to massage public sentiment with false but effective truths. It reveals the cycle of mutual antagonism caused by these lies, and the failure to acknowledge and value these as harmful to global (and therefore western) security. I am not an expert on geopolitics or international relations but I can see the lies covering the west’s imperial and criminal past and present in the way it supports regimes like Israel and Saudi Arabia. And I can see how these sustain the cycle of antagonism leading to more violence. The manipulation of historical realities to whitewash western crimes is in itself anti-democratic – it manipulates the representation of political values and deceives the meanings and sense held-in-common by the masses.

In short, a comment by a senior security think tank executive accused a politician of being deceitful about the truth of the massacre of Tianneman Square. And accused the politicians of being a trumpet for Beijing. Of course we should know the truth of the massacre. However, at the same time such think tank executives act as trumpets for, for example, Saudi Arabia and Israel, by covering up their massacres, by being silent about them and by encouraging them with the supply of money and arms. To point this out leads to accusations of ‘whataboutery’ as an attempt to point to a ‘as if’ disconnected observation to discredit the speaker as it were.

However I suggest that so-called ‘whataboutery’ is an important and relevant observation signaling the need to admit the anti-democratic and dangerous manipulations of truth being exercised by the Western powers and that these are in themselves a danger to global security.

So, to return to my response to the above tweet.

Subsequently, when I pointed out that similar criticisms could be made of other regimes that attempt to erase massacres or genocides from history, such as Turkey and the Armenian genocide, and Israel and the Nakba, for example see “Burying the Nakba: How Israel Systematically Hides Evidence of 1948 Expulsion of Arabs” this was effectively dismissed and characterized by Eyal as ‘whataboutery’.

But, I suggest, this point would only be ‘whataboutery’ if the original critic is also just as willing to critique these other revisionists. It seems pretty clear from the analyses I cite and arguments I produce below that my point is not ‘whataboutery’ because there is a political bias within the western establishment and its security advisors.

For context RUSI’s “RUSI’s mission is to further independent debate on defence and security in the United Kingdom and across the wider world.”

This isn’t a critique of RUSI in general, but explores the potential implications of Eyal’s tweet for the way it addresses “defense and security”.

The implication I draw from this is based upon the failure of Eyal to acknowledge the sophistry of, for example, Israeli-zionist deniers of the Nakba (catastrophe) inflicted upon the indigenous Palestinian population by Jewish-zionist terrorists in the 1950s (aided and abetted by the British). It is only an implication but has more weight when past analysis of RUSI’s output is considered.

For example see: “Why is the BBC presenting RUSI as objective analysts of the Middle East?” From 2015. This analysis points to the importance of sensitivity to the way security debates are framed, how this framing may ensure a partisan state-sponsored outlook at the expense of objectivity, and of the harms being caused by military interventions by western ‘Allies’.

The implication, then, not surprisingly, is this: that a self-identified independent think tank on British security in reality does analyses from the perspective of the western powers and NATO. But why does this matter?

On a softer, less certain note, it is important to ask whether this kind of manipulation works to reduce rather than increase global security.

This matters: a) because it shows how so-called facts are being manufactured (as effective truths) by so-called liberal democracies to manipulate the mood, ‘atmospherics’ and public sentiment in order to ensure policies are publicly acceptable; and b) because the manipulation of truth, and of so-called ‘public sentiment’ is essentially anti-democratic. For example, it ensures public opinion, on things like the decision to attack Iraq, or to support Saudi military attacks in Yemen, is based on an unrepresentative, narrow and ultimately misleading perspective.

For example, support of a so-called western ally such as the Israeli-State, may serve to stimulate military aggression to undermine democracies globally, because Israel, despite its relatively small physical size, is a disproportionately powerful global marketeer of military technologies, as described in detail by Halper in his book: “War Against the People: Israel, the Palestinians and Global Pacification”.

So, there is a potential domestic threat to domestic security and democracy in the name of promoting western and global security.

This raises the question of the basis of contemporary geopolitical alliances and antagonism.

To what extent are these based on, for example, a) perceived threats from (selective) ideologies of failed-states or tyrannical (Islamic) regimes (but, contradictorily, not some others); or on b) a perceived need to ensure things like energy (oil, gas, electric) security that depends on other nation-states, including perceived antagonists (threats to energy security) such as Russia and China. How valid are the accepted truths of western security regimes under the banner of organizations such as NATO?

To what extent are these manufactured effective-truths self-fulfilling, because the inherent antagonisms assumed by those truths, and the biased manipulation of public sentiment, actually aggravate backsliding anti-democratic tendencies, and provoke aggression from other global actors.

The problem, of course, is that other nation-states practice the same self-fulfilling anti-democratic manipulations, provoking the same transnational aggressions. So we seem to be stuck in a cycle.

One solution, ultimately appears if we view most nation-state policy as driven by corporatism and the pursuit of effectively unregulated (at transnational or infra national levels) capitalism. This solution may be found, in the longer term, in current anti-capitalist trends.

To finish off then,: what is the most plausible explanation for the “whataboutism” response to my observation that historical revisionism has been practiced by many nation-states, including Israel with respect to the Nakba and not just China with respect to Tianneman square?

I would argue that the “whataboutery” response stems from, a possibly unconscious, awareness that RUSI’s culture is inherently biased towards western imperial expansionist intentions and targets, and itself practices sophistry and manipulates public opinion in anti-democratic ways. And, that this is itself a threat to global security.