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Life and death at his fingertips: watching a brain surgeon at work

Henry Marsh is one of the country's top neurosurgeons and a pioneer of neurosurgical advances in Ukraine. Erica Wagner witnesses life on a knife-edge.

Hands of a craftsman: surgeon Harry Marsh describes neurosurgery as bomb disposal work. Photo: Tom Pilston

It is just after lunchtime on a wet Monday in February when Henry Marsh is finally able to return to the operating theatre in the Atkinson Morley Wing of St George’s Hospital in Tooting, south London, and begin the work that will save a young woman’s life.

Jenny is not long out of her teens; the previous week, she had collapsed – from a haemorrhage, the result of an abnormality in the veins and arteries of her brain. She had been close to death: late at night, Henry had operated to remove a blood clot and save her life. But a later scan showed that the abnormality remained. If the problem was not corrected, she could suffer another bleed at any time. So this will be the second time he has been inside her skull.

While Jenny is prepared, Henry paces the hospital’s long corridors. There is time for us to sit and have a sandwich. He is restless: he wants to get on. He didn’t get this right the first time. He needs to get it right now.

I first encountered Henry Marsh late one night on my sofa. I was too tired to go to bed, and so kept the television on as one programme ended and another started. This was The English Surgeon, a 2007 documentary by Geoffrey Smith about the work that Henry has been doing for over 20 years now at the Lipska Street Hospital in Kyiv, Ukraine. Following a meeting with Igor Kurilets, a Ukrainian neurosurgeon struggling against the post-Soviet culture of poor resources and entrenched, old-fashioned thinking about medical care, Henry began volunteering his time in Kyiv. He brought not only his skills but equipment that had been discarded – generally for no good reason – by the NHS, packed up in wooden crates he made himself.

It is a remarkable, moving film and I was struck by the humane, caustic eloquence of its subject, which seemed unusual for a man in his profession. At the time I was running the books pages of the Times; I thought that he would make a fine reviewer. I emailed him, care of the hospital, not really expecting an answer, but he replied by return. Sure enough, he proved an excellent addition to my stable – and this month he’s published a fascinating memoir, Do No Harm: Stories of Life, Death and Brain Surgery, which is why I’m here with him now, waiting to stand beside him as he operates on Jenny.

Henry is 64: he will retire next year. He is tall and white-haired; outside the operating theatre he is given to wearing battered leather boots and a long duster coat. You read in books of people with “surgeon’s hands”, long, tapered and delicate. Henry’s hands are not like that, but rather like the hands of a skilled woodworker, a keen gardener and an energetic beekeeper, all of which he is. He wears round, owlish spectacles that give him the air of the don he might have been; his first degree, from Oxford, was in philosophy, politics and economics. Medicine came later – he didn’t become a junior doctor until the relatively late age of 29, after spells as a teacher in West Africa and a hospital porter in Ashington, Northumberland.

When he finally went to medical school, at the Royal Free Hospital in London, he wasn’t sure about his choice. “I thought medicine was very boring,” he says bluntly. Henry is not a man to refrain from speaking his mind. “I didn’t like doctors. I didn’t like surgeons. It all seemed a bit dumb to me.” In Do No Harm he writes of his revulsion at what much surgery generally entails: “long bloody incisions and the handling of large and slippery body parts”. But while working as a senior house officer, he observed a neurosurgeon use an operating microscope to clip off an aneurysm – a small, balloon-like blowout on the cerebral arteries that can cause catastrophic haemorrhages. It is intensely delicate work, using microscopic instruments to manipulate blood vessels just a few millimetres in diameter. It is also, as Henry says, like bomb disposal work, in that it can go very badly wrong – with the crucial difference that it is only the patient’s life at risk, not the surgeon’s. If this or any other kind of serious neurosurgery goes right, however, the doctor is a hero. “Neurosurgery,” he smiles, “appealed to my sense of glory and self-importance.”

Most senior surgeons are pretty vain; few, in my experience, are as aware of their vanity as Henry is. As Jenny is wheeled in to the theatre, he acknow­ledges his desire to be “an alpha male”, whether he’s performing surgery or riding his bicycle recklessly along the now-flooded towpaths in Oxford, where he lives with his wife, the anthropologist Kate Fox. (Henry never wears a helmet when he cycles. He has seen too many brain-injured cyclists, even those who’ve been wearing helmets, to wish to survive, should he ever get knocked off his bike.) The young woman’s brain scans are up on the big flat screens on the walls of the operating room; when Henry and his team begin, what they see through the operating microscope will also be projected on these screens.

In black and white, looking like the deltas of a river, are the veins and arteries of Jenny’s brain. The problem is that, in her case, arterial blood can escape into veins, which are not designed to cope with the high pressure of blood as it’s pumped from the heart. Arteriovenous malformation is the proper name for the condition.

“What proportion of the body’s blood goes to the brain?” Henry asks me – and for a moment my own heart is in my mouth, and I feel like one of the interns he questions in the meetings he holds every morning at 8am. He calls these “Hill Street Blues meetings”, after the American cop show, which always began with a similar gathering. They are, as far as Henry knows, unique to his hospital. I sat through one this very morning, six hours ago now, and watched a few young doctors quake under his interrogation. But, having read Do No Harm, I know the answer: 25 per cent; a quarter of the body’s blood feeds the engine of the brain. That is why this operation is so necessary, and so dangerous.

It has taken a while to get the patient ready for surgery because Henry has insisted that she have an angiogram – an injection of dye into her bloodstream which will show whether or not Henry has managed to seal off the vessels he is after – while still on the table. If the angiogram were to happen after surgery (which would make things much easier) and Henry hadn’t accomplished what he is setting out to do, he would have to go back in again, something he is less than keen to consider.

But setting up the angiogram so that it can be done during the operation isn’t simple. A few hours earlier, I’d watched Henry insist to another doctor that the procedure really was necessary. It was clear that he wasn’t going to take no for an answer; it was clear, too, just how insistent he had to be.

Henry’s persistence is probably his chief characteristic. “Zing”, he calls it, a restless energy that always looks for another problem to solve. It is this “zing” that got his patient the angiogram; it’s also what got him to Ukraine. It’s the force behind those morning meetings; and it enabled him to raise over £100,000 so that one of the balconies on the ward could be converted into a roof garden for the use of patients and staff.

Another few thousand pounds was raised to convert an unused biohazard lab into an “on-call” room for his fellow surgeons: a quiet place with a bed, and a desk, and a computer where they can rest between rounds and operations. (Most hospitals used to have these; the European Working Time Directive, which states that doctors must not work more than 48 hours a week, other than by choice, supposedly put paid to the need for such places. Unsurprisingly, Henry doesn’t have much truck with the European Working Time Directive, but not merely because he worked long hours in his youth and believes that “if it doesn’t hurt it’s not worth doing”. Shorter hours produce much less continuity of care, and much less training for young doctors.)

Although he is one of the most senior and experienced neurosurgeons in the country, and pioneered surgery performed under local anaesthetic in the UK, Henry insists that he is not a great surgeon. The surgery itself, he says, is not technically difficult. “It’s the decision-making that is complex and difficult; you are making very human decisions, about the quality of life and the way people will be affected.” This in turn requires a considerable emotional investment – in the patients, in the work. He knows that senior management believes neurosurgeons are arrogant. He does not disagree. “Neurosurgeons deal with life and death every day. It makes you pretty impatient with the tick-boxing that exercises managers.”

Do No Harm is in many respects a self-lacerating document: by and large, it contains stories not of triumph, or the author’s skill and expertise, but of the emotional and psychological toll exacted when things go horribly wrong. When patients are left paralysed or blind, or when they die, it is the surgeon who walks away. Because of this, Henry says fiercely: “Doctors cannot suffer enough.”

His understanding of the nature of suffering is deep and personal. When he had just qualified as a junior doctor, his three-month-old son, William, was diagnosed with a brain tumour. It had been a normal birth, but then one night, as Henry tells it, “My first wife felt he wasn’t quite right. His fontanelle, the soft spot, was very tight – which can be a sign of swelling in the brain. So she took him to the clinic, and they measured his head and said it was far too big. He was admitted as an emergency to the local hospital, in Balham, and she rang me to say that he’d been diagnosed as acute hydrocephalus”: swelling in the brain. A brain scan showed the tumour.

“He was operated on a week later – and it was absolutely torment waiting. The main thing I remember was that at the end of the operation we didn’t know what had happened; we had to wait a few hours for the surgeon to find out. I learned a hugely important lesson from that: which is that when your nearest and dearest are undergoing brain surgery, it’s extremely miserable.” William’s tumour was removed, and he is fine. He is the eldest of Henry’s three children; there are also two daughters from the marriage, Sarah and Katharine.

Scrubs up: Marshs post-surgery decisions determine his patients quality of life. (Photo: Tom Pilston)

As a result of this terrible experience with his own son, Henry always rings the family as soon as possible after serious surgery and waits until the patient is awake in recovery. Only then can he be sure that an operation has been wholly successful. He doesn’t think many surgeons make these sorts of calls. “It’s a kindness; it shows you understand what relatives are going through. But also, if things go wrong, mostly people will forgive you.”

He is less willing to forgive himself. Most of the chapters in Do No Harm have titles taken from abnormalities of the brain: “Aneurysm”, “Meningioma”, “Astrocytoma”. But towards the end there is one called “Hubris”, which recounts the story of an operation that took place over two decades ago, on a man with a petroclival meningioma, a benign but extremely large tumour. The procedure took 15 hours – and towards the end of all those hours Henry, attempting to remove the last bit of the tumour, tore the artery that keeps the brain stem alive, causing catastrophic damage and leaving the patient in a permanent vegetative state. He no longer does 15-hour operations.

As Jenny’s prone form is brought into theatre, his team springs into life. “The quality of my working life is largely determined by the quality of my junior doctors. It’s in my interest that they’re happy,” Henry has said to me – and the same applies to everyone he works with: anaesthetists, nurses, technicians. Operating isn’t solitary work, and I am one of at least half a dozen people present. He greets hospital porters by name. He has worked with Judith Dinsmore, his anaesthetist, for over a decade; one of his aides in theatre has been assisting him since he became a consultant in 1987, as has his secretary, Gail Thompson.

This situation is now highly unusual in the NHS; as in so many other organisations, the perception is that centralisation brings benefits of streamlining and cost efficiency. The men and women who work with Henry Marsh think otherwise. A few days after this operation, Gail describes how she is supposed to schedule Henry’s clinics through a central booking service but does not. “A central booking service won’t keep slots aside for emergencies, for instance. I know Henry’s patients, so when they ring I know if it’s serious or not, and I can deal with it appropriately. Centralisation in the NHS is stopping all that.”

Tim Jones, the specialist registrar, begins to set Jenny’s head in a Mayfield clamp, an alarming-looking metal jaw that holds the patient’s head steady during surgery. Sharp pins drill bloodlessly through the scalp and grip the skull tightly.

Tim is 35, and the person Henry sees as his likely successor. A charming and energetic man – tirelessly helpful to a novice like me in the operating theatre – he took three years out of his medical training to do a PhD in physics because he is very interested in imaging technology, such as the scanner he will soon use to pinpoint where Henry will need to get to inside Jenny’s brain. Last year he won the Norman Dott Medal for outstanding performance in the Intercollegiate Specialty Examination in Neurosurgery, a rare honour. It’s worth remarking that four out of the immediate past five winners of the award have worked in the Atkinson Morley unit at St George’s.

Henry stresses that these surgeons have worked with many other doctors besides himself – but clearly Tim, at least, finds his boss an inspiring figure, not least because he is so open about discussing his own mistakes. This is extremely unusual, in Tim’s experience. “He calls it ‘the departmental hairshirt’,” he laughs. When I ask Tim if he is married, he laughs again. “No. I don’t even own a house. I’m a bit of psychopath, I guess. You have to be to do this job.” Performing surgery, he says, is “exhilarating” – a sentiment that Henry seconds.

Because Jenny has been operated on before, the incision in her head is already there. Tim cuts open her stitches. During surgery the patient is almost entirely draped in sterile sheeting, with only the area on which the surgeons will be working left visible, the edges of the wound held tight with small blue clamps that look almost like paper clips. There is a great deal of blood in the scalp, and the clamps keep the incision from bleeding. As Jenny’s head is opened Henry pulls up his chair, and the operating microscope leans over the patient like an inquisitive crane.

“Here,” he says. “Have a look.”

I come close to his shoulder and look down into the microscope’s second eyepiece. A glittering, undulating landscape of shining whites and greys and reds is revealed in vertiginous 3D; to look through this remarkable instrument (each one costs about £120,000) is to feel as if you could step right into the patient’s brain.

“There,” Henry says, pointing with a delicate instrument at a pulsing, slender cord to the right of my field of vision. “Artery. Mustn’t touch that. Touch that, the whole thing’s over.”

Looking down, I find myself thinking how impossible it is, finally, to comprehend that what I am observing – the matter of the brain – is everything we are. Here is the soul, here is the mind, here is every thought we might have or ever have had about the world around us. Nothing more than shining, pulsing matter. It seems far more difficult to consider than the idea that the pinpricks of light we see as stars in the sky are enormous burning balls of gas thousands of light years away. Our understanding of the universe, our understanding of those stars – it’s right here, under this microscope. From my earlier conversations with Henry, I know that despite his years as a surgeon (indeed, perhaps because of his years of work as a surgeon), he finds this notion as remarkable, and as puzzling, as I do.

See it through: Marsh performs delicate work inside a patient’s skull. (Photo: Tom Pilston)

When I first met Henry, he planned to work until he was 67. He changed his mind when he was threatened with disciplinary action for wearing a wristwatch as he walked through the hospital last year. The rule now is “bare from the elbows down” – not just in the operating theatre, obviously, but anywhere at work.

The episode still fills him with an ill-disguised anger. “If you treat people like naughty children, they’ll behave like naughty children. I love my work: I have my limits.” But it was the last straw in a long line of grievances he bears against the increasingly unwieldy machinery of the NHS in the 21st century. It’s much harder for him to raise money now, he says, for things such as the roof garden, or the beautiful photographs he has arranged to have hung in the ward so that his patients have something pleasant and distracting to look at, rather than peering out at the cemetery just beyond the building’s walls.

“People were willing to give money when they felt it was more like a charitable organisation – but now that the NHS is being privatised by the dumb fucks who run the government, people think: ‘Why should I give money to the NHS?’ Now the buses are owned privately, you think: ‘Why should I give way to the bus?’ Whereas when it was a public service, you thought: ‘I’ll let the bus go first.’ But I’m not going to do that now! You lose a lot that way.”

It is the failings of the NHS that make headlines, he knows, not its successes. “There’s all this mouthing off about how we have to have a ‘blame-free’ environment – but it’s blame, blame, blame all the time. One is no longer trusted. Of course, in any system there’s a certain small percentage of people who are freeloaders or incompetents; but if you design all your systems to deal with that percentage, you may end up so pissing off the 95 per cent of people who are the good guys that you lose more than you gain. I don’t know what the answer is. I’m glad I don’t run the NHS. But you have to trust people.”

Would I trust Henry if I were a patient, or a patient’s relative? I reckon I would. In the day I spend at the hospital I see two surgeries. Before Jenny’s operation in the afternoon, Henry and Tim work together on an older man, who, by a very peculiar coincidence, is suffering from the same kind of malignant tumour that killed my father a few years ago, a glioblastoma.

My father’s was deep in his brain and inoperable; this patient’s tumour is closer to the surface, though it has already cost him much of his eyesight. The operation will be no cure; Henry has made it clear it might buy him a bit of time, but not much. “More and more of modern medicine is palliative, anyway,” he says. “We are not curing people; we’re keeping people alive. These are quality-of-life issues. They are very hard decisions to make: do I want more chemotherapy? Should I have a double mastectomy? These are hard for patients, too.”

The radiotherapy my father was given was probably useless, Henry tells me as Tim opens the patient’s skull. And indeed, although my father spent nearly six weeks in hospital to have it, it didn’t seem to do much good. I have never discussed this with Henry before; now I consider the six weeks my father might have had at home, rather than in hospital – institutions that Henry compares baldly with prisons.

In the afternoon, Jenny’s operation took longer than expected. Henry had said he thought he would been done in an hour or so; in the end, he was working for about four hours. Not one, but three interoperative angiograms had to be done to check that he’d done the job. Sitting straight in his chair – its arms holding his own arms steady as he moved his instruments with finely calibrated delicacy – Henry peered through his microscope, using an electrical current to cauterise the three tiny blood vessels in her brain which were putting her in such danger. Often, he has said, there are many more blood vessels to seal off in such cases, but Jenny’s were tricky because they were so very tiny, and so close to a major artery, as I saw. (This is the stuff, remember, that he thinks is “not difficult”.) Jenny’s operation was a success. She went home from hospital two days later and her problem will not recur.

The prospect of retirement is rather alarming to Henry. He will keep his bees; he will build bespoke bookcases in his workshop; he will, no doubt, lecture (and continue to work as a surgeon) around the world. He plans to go back to Ukraine at the end of this month despite the trouble there.

His hospital in Kyiv is off Maidan Neza­lezhnosti – Independence Square, where the revolutionary protests took place. He is in touch every day with his friends there, all of them Ukrainians who dislike the Russians and hate Vladimir Putin, he says. “I’ve always believed very strongly that Ukraine was an incredibly important country. Because it is the focal point, the pivot between east and west, which goes back hundreds of years. You’ve got Asiatic Russia to the east, and western Europe to the west. It’s one of the most profound fault lines in Europe.”

His colleagues’ concern – for their safety, for their future – is tempered by a certain fatalism. “They’ve always lived in a country where the state is essentially against you. We in the civilised west may criticise our politicians and the state, but the default feeling is that the state is there to help you. In places like Ukraine and Russia, that has never been the case. The state is your enemy. It’s very hard for us to imagine that. It’s very much rulers and ruled.”

Henry says he doesn’t fear for his own safety: but playing it safe has never been his way. His seeming arrogance and self-regard (“Kate and I have been rehearsing a few interviews, so that when I’m asked, ‘Why did you write this book?’ I’ll say: ‘To draw attention to myself.’ That’s the honest answer”) are undercut by his sincere knowledge of his own fallibility – and the price that fallibility can exact. A rueful shrug. “My life is a succession of proving to myself that I’m not as frightened as I think I am.” 

“Do No Harm: Stories of Life, Death and Brain Surgery” by Henry Marsh is published by Weidenfeld & Nicolson (£16.99)

Erica Wagner is a New Statesman contributing writer and a judge of the 2014 Man Booker Prize. A former literary editor of the Times, her books include Ariel's Gift: Ted Hughes, Sylvia Plath and the Story of “Birthday Letters” and Seizure.

This article first appeared in the 12 March 2014 issue of the New Statesman, 4 years of austerity

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The prophets of Trumpism

How the ideas of two pre-war intellectual refugees – the radical Herbert Marcuse and the reactionary Eric Voegelin – are influencing the new culture wars among Trump and his acolytes.

Even after Donald Trump’s more conciliatory address to Congress, American politics seems set to become a battle between the president’s joyless autocracy and a carnival of protest that could end up evoking the anti-war movements of the 1960s. There will be more draconian executive orders and more marches in pink hats. There may well be violence.

The intellectual battle that will be played out in the months and years to come, however, was foretold by two German refugees from Nazi persecution: Eric Voegelin, the doyen of Cold War reactionary conservatives, and Herbert Marcuse, the inspiration behind the revolutionary student activism of the 1960s. Voegelin argued that society needed an order that could be found only by reaching back to the past. Marcuse argued that refusal to accede to tyranny was essential to give birth to a revolutionary politics that would propel progress to a new kind of society. Marcuse the radical and Voegelin the reactionary could not seem further apart, and yet they share a common intellectual root in Germany in the 1920s, from which came a shared critique of modern society. Their ideas may well inspire some of the political conflicts to come.

The culture wars of the 1960s are very much alive for Trump’s acolytes. Steve Bannon, the former executive chairman of the alt-right website Breitbart News and Trump’s chief strategist, blames the counterculture of the 1960s – the drugs, the hippies, the liberal reforms – for America losing its way and, eventually, succumbing to economic crisis in 2008. Bannon set out his ideas in Generation Zero, a 2010 documentary which blamed the financial crash not on greedy, under-regulated bankers but on the moral and cultural malaise that started in the 1960s. He is still fighting people who might have been inspired by Marcuse. “The baby boomers are the most spoiled, most self-centred, most narcissistic generation the country has ever produced,” he told an interviewer in 2011.

Bannon’s thinking, set out in several speeches over the past few years, is that America’s working and middle classes have been betrayed by an elite in Washington, DC (the “Imperial City”, he calls it) which oversees insider deals so that the insiders can profit from global capitalism. Bannon wants to return America to traditions rooted in Judaeo-Christian values and to reassert national sovereignty. Most worryingly, on several occasions he has said that the crisis will only be resolved through the catharsis of conflict and national mobilisation through war.

America has always been a work in progress. Ronald Reagan and Barack Obama were very different presidents but they shared a belief that progress was America’s calling. The reactionary turn in US politics is not just a shift to the right but an attempt to displace progress as the common creed.

Instead, Bannon and his ilk want America to become a work in regress, as the historian Mark Lilla argues in his recent book on reactionary philosophy, The Shipwrecked Mind. Much of the new reactionary thinking echoes Voegelin’s idea that, in order to renew itself, a society must first go backwards to find where and how it lost its way.

 

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Eric Voegelin defies easy categorisation. Born in 1901 in Cologne and brought up in Vienna, he was brave and principled. After a visit to the United States in the 1920s, he wrote two books criticising Nazi racial politics, which got him sacked from his teaching position at the University of Vienna. When the Germans arrived in Austria following the Anschluss in 1938, Voegelin and his wife fled on a train as the Gestapo ransacked their apartment.

After a brief stay in Switzerland, he moved to America and in 1942 took up an academic post at Louisiana State University. He then embarked on a prolific career, the centrepiece of which was his sprawling, multi-volume work Order and History.

Voegelin’s philosophy gave expression to the dark and powerful forces that had shaped his life. He believed that modern society was prey to flawed utopianism – he called this “gnosticism” – in which an elite of prophets takes power, claiming special insight into how heaven could be created on Earth for a chosen people. Gnostic sects in the Middle Ages had their modern equivalents in the Nazi proclamation of a racially pure utopia and the Marxist promise of equality for all. Voegelin’s catchphrase was: “Don’t immanentise the eschaton!” (meaning: “Do not try to build heaven on Earth”).

Marxism and Nazism, Voegelin argued, were political versions of religion: we get rid of God only to reinstall him in the form of an elite of reformers with all the answers. In his recent bestselling book Homo Deus, Yuval Harari argues that we are entering a new stage of the process that Voegelin identified. We have become as powerful as gods, he argued, but now need to learn how to be wise and responsible gods.

Today Voegelin’s attack on overreaching perfectionism echoes in reactionary criticism of Obamacare and in the yearning for national certitude. Voegelin thought the role of philosophy was not to change the world, but to understand its underlying order and help us tune in to that, rather than being diverted by the lure of the false prophets of political religion.

He was influenced by the Viennese satirist Karl Kraus, who said that “origin is the goal”, by which he meant that the point of the future was to restore the ancient past. For Voegelin, order comes from a sense of harmony, of everything being in its place. This is a position that opens itself up to deeply conservative interpretations.

When, in his presidential inauguration address, Trump spoke of American “carnage”, he was echoing Voegelin’s account of decay and disorder. When he talked of “one people, one nation, one heart” he was evoking the kind of order that Voegelin spoke of. Trump and his acolytes see their mission as the need to restore a natural order, under which illegal immigrants and aliens are kept well away and white people can feel at home once more in a society where everyone signs up to Judaeo-Christian beliefs.

Nothing could be further from the ideas of Herbert Marcuse.

Born in 1898 in Berlin, Marcuse became a member of the celebrated Marxist Frankfurt School, which included Theodor Adorno, Max Horkheimer and, tangentially, Walter Benjamin. Marcuse emigrated to the United States in 1933 as Hitler came to power. By 1940, he had become a US citizen and, while Voegelin was starting work at Louisiana State, Marcuse was working as a researcher for the Office of Strategic Services, the precursor of the CIA. He continued working for the government after the war and resumed his academic career only in 1952. His best-known book, One-Dimensional Man, was published in 1964.

One of Marcuse’s big ideas was the “Great Refusal”: progress had to start with refusing to accept an unacceptable reality. One should say “no” to a world of alienating work, dominated by corporations and impersonal systems, which allow little room for people to explore their deeper sense of humanity. Marcuse saw the student and anti-war protests of the 1960s and 1970s, which adopted him as their intellectual mentor, as evidence that the Great Refusal was gaining momentum.

Trump has given the Great Refusal new life. The documentary film-maker Michael Moore has called for cities to become “regions of resistance” by offering sanctuary to immigrants threatened with deportation. Angela Davis, the once-jailed Black Panther revolutionary who was close to Marcuse, told the Women’s March in Washington that people had to be ready for “1,459 days of resistance: resistance on the ground, resistance on the job, resistance in our art and in our music”. In a lecture at the Free University of West Berlin published in 1970, Marcuse said demonstrations and protests were an essential first step towards a “liberation of consciousness” from the capitalist machine:

“The whole person must demonstrate his participation and his will to live . . . in a pacified, human world . . . it is . . . harmful . . . to preach defeatism and quietism, which can only play into the hands of those who run the system . . . We must resist if we still want to live as human beings, to work and be happy.”

The Great Refusal was a capacious idea capable of embracing anyone who wanted to say, “No, enough!” It could embrace trade unions and workers, African Americans and feminists, students and national liberation movements, those who were on the margins of society and those professionals – technicians, scientists, artists, intellectuals – who worked at its centres of power and who chose to refuse as an act of conscience.

As a new generation prepares to embark on a period of resistance, what lessons should they learn from the wave of protest that Marcuse once helped to inspire?

Protest is a way to bear witness, to make voices heard and to make it possible for people to bond. Yet the fire of protest can easily die out as the Occupy movement did, even if its embers are still glowing. The carnival-type atmosphere can be uplifting but fleeting. Creating common programmes to be taken forward by organisations demands hard work. The Arab spring showed how quickly a popular revolution can turn sour when a movement is not ready to take power.

Since the protests that Marcuse was involved in, no comparable movement of the left in the United States has mobilised such a broad support base. Instead, that period of resistance was followed, at the end of the 1970s, by a shift to the right in the US and the UK. It was reactionaries, not revolutionaries, who set off forward to the past.

Now we seem to be in for an intensifying cycle of conflict between the adherents of Marcuse and Voegelin: between the Marxist revolutionary and the mystic conservative; between resistance and order; between those who want to live among a cosmopolitan, urban multitude and those who want a society of provincial oneness and sameness; those who want change, innovation and creativity and those who crave simplicity, stability and authority.

That much is obvious. Yet what is striking is not how different Marcuse was from Voegelin, but how alike they were. The best way to respond to the rise of Trump might be to blend their ideas rather than set them against one another, to create a new intellectual and political combination. Indeed, they could be seen as different branches of the same intellectual tree.

Voegelin was influenced by the German- Jewish philosopher Hans Jonas, who studied with Martin Heidegger in Freiburg in the 1920s. Jonas joined the German Jewish Brigade, which fought against Hitler, before emigrating to the US, where he became a professor at the New School in New York. He was one of the foremost scholars of gnosticism, which became Voegelin’s focus. Towards the end of his life, Jonas took up a chair at the University of Munich named after Voegelin.

Voegelin did not study at Freiburg, but one of his closest friends was the social ­theorist Alfred Schütz, a student of Edmund Husserl’s who applied his phenomenological thinking to the sociology of ­everyday life. Marcuse studied with Husserl and Heidegger at Freiburg, at the same time as Jonas and Hannah Arendt. From that shared intellectual root have emerged some powerful ideas that could unite progressives and conservatives.

Only at moments of profound crisis – of the kind we are living through – do we see just how contingent, vulnerable and fragile our society is. Voegelin warned: “In an hour of crisis, when the order of society flounders and disintegrates, the fundamental problems of political existence in history are more apt to come into view than in periods of comparative stability.”

A crisis should be a time for profound reflection, yet leaders are more likely to resort to “magical operations” to divert people’s attention: moral condemnation, branding enemies as aggressors, threatening war. “The intellectual and moral corruption,” Voegelin wrote, “which expresses itself in the aggregate of such magical operations may pervade society with the weird ghostly atmosphere of a lunatic asylum, as we experience it in Western society.”

Welcome to the Trump White House.

 

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Voegelin is a timely reminder of how unconservative Donald Trump is and of how conservatives should be a vital part of the coalition against him. Conservatism comes in several strains: laissez-faire conservatives such as George Osborne want small government, free trade, low taxes and freedom of choice. Status quo conservatives such as Angela Merkel want stability and continuity, even if that entails sticking with social welfare programmes and liberal democracy. Authoritarian conservatives, however, are prepared to use the big state to engineer change.

One important question for the future is whether the laissez-faire and status quo conservatives will realign around the ascendant authoritarian camp promoted by Trump. Merkel is the world leader of the conservative-inspired opposition to the US president. But his most profound critic is Pope Francis, who uses language similar to Voegelin’s to condemn the “material and spiritual poverty” of capitalism, and the language of Marcuse to condemn the process of dehumanisation embarked upon by Bannon and Trump.

“As Christians and all people of goodwill, it is for us to live and act at this moment,” the Pope has said. “It is a grave responsib­ility, since certain present realities, unless ­effectively dealt with, are capable of ­setting off a process of dehumanisation which would then be hard to reverse.”

The challenge for progressives is to reframe resistance in terms that can appeal to conservatives: to use conservative ideas of character and spirituality for progressive ends. We will spend a great deal more time trying to conserve things. The swarm of legal challenges against Trump will hold him to the principles of the US constitution and the rule of law. Many of the young people attracted to Bernie Sanders and the Occupy movement yearned for the restoration of the American dream.

Building bridges with the conservative opposition is not merely a tactical manoeuvre to widen support. It has deeper roots in shared doubts about modernity which go back to Freiburg and the man both Marcuse and Jonas renounced in 1964 for supporting the Nazis: Martin Heidegger.

For Heidegger, modernity was a restless, disruptive force that displaced people from jobs, communities and old ways of life, and so left them searching for a sense of home, a place to come back to, where they could be at one with the world. Technology played a central role in this, Heidegger argued, providing not just tools for us to use, but an entire framework for our lives.

Marcuse, writing four decades before ­Facebook and Google, warned that we needed to resist a life in which we freely comply with our own subjugation by technical, bureaucratic systems that control our every thought and act; which make life rich but empty, busy but dead, and turn people into adjuncts of vast systems. We should “resist playing a game that was always rigged against true freedom”, he urged, using language that has been adopted by Trump.

Writing not far from what was to become Silicon Valley, Marcuse pointed to a much larger possibility: the technological bounty of capitalism could, in principle, free us from necessity and meet all human needs, but “. . . only if the vast capabilities of science and technology, of the scientific and artistic imagination, direct the construction of a sensuous environment; only if the world of work loses its alienating features and becomes a world of human relationships; only if productivity becomes creativity are the roots of domination dried up in individuals”.

Writing in the 1960s, when full employment was the norm and advanced society was enjoying a sense of plenty, Marcuse foreshadowed the debates we are having now about what it will mean to be human in an age of machines capable of rapid learning. Mark Zuckerberg’s argument in his recently published manifesto that Facebook creates an infrastructure for a co-operative and creative global civil society is a response to concerns that Marcuse raised.

 

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Just as Marcuse saw that capitalism was a union of contradictions – freedom created on the basis of exploitation, wealth generated by poverty – Voegelin thought modern society was self-defeating: it declined as it advanced. Giving everyone wages to buy stuff from the shops was not progress, he said, but a soulless distortion of the good life, an invitation to spiritual devastation. The gnosticism that Voegelin so hated, the effort to design a perfect society, was also the source of the technological and rational bureaucracy that Marcuse blamed for creating a one-dimensional society. Voegelin would have regarded the apostles of Silicon Valley as arch-gnostics, creating a rational order to the world with the insights gleaned from Big Data and artificial intelligence.

Marcuse and Voegelin point us in the same direction for a way forward. People need to be able to find a sense of meaning and purpose in their lives. Both would have seen Trump’s ascendancy as a symptom of a deeper failure in modern society, one that we feel inside ourselves. The problem for many of us is not that we do not have enough money, but that we do not have enough meaning.

For Voegelin, living well involves “opening our souls” to something higher than buy and sell, work and shop, calculate and trade, margins and profits. Once we detach ourselves from these temporary, Earthly measures of success, we might learn to accept that life is a mysterious, bubbling stream upon which we cannot impose a direction.

A true sense of order, Voegelin argues, comes from living with an open soul and a full spirit, not being part of a machine manufacturing false promises. If we cannot manage to create order from within, by returning to the life guided by the soul, we will find order imposed, more brutally, from without. Marcuse, likewise, thought that turning the Great Refusal into a creative movement required an inner renewal, a “liberation of consciousness” through aesthetics, art, fantasy, imagination and creativity. We can only escape the grip of the one-dimensional society, which reduces life to routines of buying and selling, by recognising that we are multidimensional people, full of potential to grow in different ways. It is not enough merely to resist reality; we have to escape it through leaps of imagination and see the world afresh.

Václav Havel, the leader of the Czech resistance to communist rule, called this “living in truth”. Havel’s most influential essay, “The Power of the Powerless”, written in 1978, is about how to avoid the slow spiritual death that comes from living in an oppressive regime that does not require you to believe in what it does, merely to go along with “living within a lie”.

The greengrocer who is the central figure and motif in Havel’s essay eventually snaps, and stops putting in his shop window an official sign that reads: “Workers of the world, unite!” Havel wrote: “In this revolt the greengrocer steps out of living within the lie. He rejects the ritual and breaks the rules of the game. He discovers once more his suppressed identity and dignity. His revolt is an attempt to live within the truth.”

Human beings by nature long to live in truth, even when put under pressure to live a lie. In language evocative of Voegelin and Marcuse, Havel writes: “In everyone there is some longing for humanity’s rightful dignity, for moral integrity, for free expression of being and a sense of transcendence over the world of existence.”

In communist Czechoslovakia that meant taking a wide and generous view of what counts as resistance as people sought their own ways to “live in truth”. Under President Trump, many Americans are finding they are living within a regime of lies, and they will be drawn back, time and again, to find ways, large and small, personal and political, to live in truth.

Resistance to Trump and Trumpism will succeed only if it mobilises both conservative and progressive forces opposed to authoritarianism, and it needs to stand for a better way to live in truth, with dignity.

Charles Leadbeater is the author of the ALT/Now manifesto, which is available to read at: banffcentre.ca

This article first appeared in the 23 March 2017 issue of the New Statesman, Trump's permanent revolution