Treat with extreme caution

Homoeopathic medicine is founded on a bogus philosophy. Its continued use is a drain on NHS resource

Two years ago, a loose coalition of like-minded scientists wrote an open letter to chief executives of the National Health Service Trusts. The signatories simply stated that homoeopathy and other alternative therapies were unproven, and that the NHS should reserve its funds for treatments that had been shown to work. The letter marked an extraordinary downturn in the fortunes of homoeopathy in the UK over the following year, because the overwhelming majority of trusts either stopped sending patients to the four homoeopathic hospitals, or introduced measures to strictly limit referrals.

Consequently, the future of these hospitals is now in doubt. The Tunbridge Wells Homoeopathic Hospital is set to close next year and the Royal London Homoeopathic Hospital is likely to follow in its wake. Homoeo paths are now so worried about the collapse of their flagship hospitals that they are organising a march to deliver a petition to Downing Street on 22 June. Local campaign groups are being formed and patients are being urged to sign the petition.

Homoeopaths believe that the medical Establishment is crushing a valuable healing tradition that dates back more than two centuries and that still has much to offer patients. Homoeopaths are certainly passionate about the benefits of their treatment, but are their claims valid, or are they misguidedly promoting a bogus philosophy?

This is a question that I have been considering for the past two years, ever since I began co-authoring a book on the subject of alternative medicine with Professor Edzard Ernst. He was one of the signatories of the letter to the NHS trusts and is the world's first professor of complementary medicine. Before I present our conclusion, it is worth remembering why homoeo pathy has always existed beyond the borders of mainstream medicine.

Homoeopathy relies on two key principles, namely that like cures like, and that smaller doses deliver more powerful effects. In other words, if onions cause our eyes to stream, then a homoeopathic pill made from onion juice might be a potential cure for the eye irritation caused by hay fever. Crucially, the onion juice would need to be diluted repeatedly to produce the pill that can be administered to the patient, as homoeopaths believe that less is more.

Initially, this sounds attractive, and not dissimilar to the principle of vaccination, whereby a small amount of virus can be used to protect patients from viral infection. However, doctors use the principle of like cures like very selectively, whereas homoeopaths use it universally. Moreover, a vaccination always contains a measurable amount of active ingredient, whereas homoeopathic remedies are usually so dilute that they contain no active ingredient whatsoever.

A pill that contains no medicine is unlikely to be effective, but millions of patients swear by this treatment. From a scientific point of view, the obvious explanation is that any perceived benefit is purely a result of the placebo effect, because it is well established that any patient who believes in a remedy is likely to experience some improvement in their condition due to the psychological impact. Homoeopaths disagree, and claim that a "memory" of the homoeopathic ingredient has a profound physiological effect on the patient. So the key question is straightforward: is homoeopathy more than just a placebo treatment?

Fortunately, medical researchers have conducted more than 200 clinical trials to investigate the impact of homoeopathy on a whole range of conditions. Typically, one group of patients is given homoeopathic remedies and another group is given a known placebo, such as a sugar pill. Researchers then examine whether or not the homoeopathic group improves on average more than the placebo group. The overall conclusion from all this research is that homoeopathic remedies are indeed mere placebos.

In other words, their benefit is based on nothing more than wishful thinking. The latest and most definitive overview of the evidence was published in the Lancet in 2005 and was accompanied by an editorial entitled "The end of homoeopathy". It argued that ". . . doctors need to be bold and honest with their patients about homoeopathy's lack of benefit".

An unsound investment

However, even if homoeopathy is a placebo treatment, anybody working in health care will readily admit that the placebo effect can be a very powerful force for good. Therefore, it could be argued that homoeopaths should be allowed to flourish as they administer placebos that clearly appeal to patients. Despite the undoubted benefits of the placebo effect, however, there are numerous reasons why it is unjustifiable for the NHS to invest in homoeopathy.

First, it is important to recognise that money spent on homoeopathy means a lack of investment elsewhere in the NHS. It is estimated that the NHS spends £500m annually on alternative therapies, but instead of spending this money on unproven or disproven therapies it could be used to pay for 20,000 more nurses. Another way to appreciate the sum of money involved is to consider the recent refurbishment of the Royal Homoeopathic Hospital in London, which was completed in 2005 and cost £20m. The hospital is part of the University College London Hospitals NHS Foundation Trust, which contributed £10m to the refurbishment, even though it had to admit a deficit of £17.4m at the end of 2005. In other words, most of the overspend could have been avoided if the Trust had not spent so much money on refurbishing the spiritual home of homoeopathy.

Second, the placebo effect is real, but it can lull patients into a false sense of security by improving their sense of well-being without actually treating the underlying conditions. This might be all right for patients suffering from a cold or flu, which should clear up given time, but for more severe illnesses, homoeopathic treatment could lead to severe long-term problems. Because those who administer homoeopathic treatment are outside of conventional medicine and therefore largely unmonitored, it is impos sible to prove the damage caused by placebo. Never theless, there is plenty of anecdotal evidence to support this claim.

For example, in 2003 Professor Ernst was working with homoeopaths who were taking part in a study to see if they could treat asthma. Unknown to the professor or any of the other researchers, one of the homoeopaths had a brown spot on her arm, which was growing in size and changing in colour. Convinced that homoeopathy was genuinely effective, the homoeopath decided to treat it herself using her own remedies. Buoyed by the placebo effect, she continued her treatment for months, but the spot turned out to be a malignant melanoma. While she was still in the middle of treating asthma patients, the homoeopath died. Had she sought conventional treatment at an early stage, there would have been a 90 per cent chance that she would have survived for five years or more. By relying on homoeopathy, she had condemned herself to an inevitably early death.

The third problem is that anybody who is aware of the vast body of research and who still advises homoeopathy is misleading patients. In order to evoke the placebo effect, the patient has to be fooled into believing that homoeopathy is effective. In fact, bigger lies encourage bigger patient expectations and trigger bigger placebo effects, so exploiting the benefits of homoeopathy to the full would require homoeopaths to deliver the most fantastical justifications imaginable.

Over the past half-century, the trend has been towards a more open and honest relationship between doctor and patient, so homoeopaths who mislead patients flagrantly disregard ethical standards. Of course, many homoeopaths may be unaware of or may choose to disregard the vast body of scientific evidence against homoeo pathy, but arrogance and ignorance in health care are also unforgivable sins.

If it is justifiable for the manufacturers of homoeopathic remedies in effect to lie about the efficacy of their useless products in order to evoke a placebo benefit, then maybe the pharmaceutical companies could fairly argue that they ought to be allowed to sell sugar pills at high prices on the basis of the placebo effect as well. This would undermine the requirement for rigorous testing of drugs before they go on sale.

A fourth reason for spurning placebo-based medicines is that patients who use them for relatively mild conditions can later be led into dangerously inappropriate use of the same treatments. Imagine a patient with back pain who is referred to a homoeopath and who receives a moderate, short-term placebo effect. This might impress the patient, who then returns to the homoeopath for other advice. For example, it is known that homoeopaths offer alternatives to conventional vaccination - a 2002 survey of homoeopaths showed that only 3 per cent of them advised parents to give their baby the MMR vaccine. Hence, directing patients towards homoeo paths for back pain could encourage those patients not to have their children vaccinated against potentially dangerous diseases.

Killer cures

Such advice and treatment is irresponsible and dangerous. When I asked a young student to approach homoeopaths for advice on malaria prevention in 2006, ten out of ten homoeopaths were willing to sell their own remedies instead of telling the student to seek out expert advice and take the necessary drugs.

The student had explained that she would be spending ten weeks in West Africa; we had decided on this backstory because this region has the deadliest strain of malaria, which can kill within three days. Nevertheless, homoeopaths were willing to sell remedies that contained no active ingredient. Apparently, it was the memory of the ingredient that would protect the student, or, as one homoeopath put it: "The remedies should lower your susceptibility; because what they do is they make it so your energy - your living energy - doesn't have a kind of malaria-shaped hole in it. The malarial mosquitoes won't come along and fill that in. The remedies sort it out."

The homoeopathic industry likes to present itself as a caring, patient-centred alternative to conventional medicine, but in truth it offers disproven remedies and often makes scandalous and reckless claims. On World Aids Day 2007, the Society of Homoeopaths, which represents professional homoeopaths in the UK, organised an HIV/Aids symposium that promoted the outlandish ambitions of several speakers. For example, describing Harry van der Zee, editor of the International Journal for Classical Homoeo pathy, the society wrote: "Harry believes that, using the PC1 remedy, the Aids epidemic can be called to a halt, and that homoeopaths are the ones to do it."

There is one final reason for rejecting placebo-based medicines, perhaps the most important of all, which is that we do not actually need placebos to benefit from the placebo effect. A patient receiving proven treatments already receives the placebo effect, so to offer homoeopathy instead - which delivers only the placebo effect - would simply short-change the patient.

I do not expect that practising homoeopaths will accept any of my arguments above, because they are based on scientific evidence showing that homoeopathy is nothing more than a placebo. Even though this evidence is now indisputable, homoeopaths have, understandably, not shown any enthusiasm to acknowledge it.

For now, their campaign continues. Although it has not been updated for a while, the campaign website currently states that its petition has received only 382 signatures on paper, which means that there's a long way to go to reach the target of 250,000. But, of course, one of the central principles of homoeopathy is that less is more. Hence, in this case, a very small number of signatures may prove to be very effective. In fact, perhaps the Society of Homoeopaths should urge people to withdraw their names from the list, so that nobody at all signs the petition. Surely this would make it incredibly powerful and guaranteed to be effective.

"Trick or Treatment? Alternative Medicine on Trial" (Bantam Press, £16.99) by Simon Singh and Edzard Ernst is published on 21 April

Homoeopathy by numbers

3,000 registered homoeopaths in the UK

1 in 3 British people use alternative therapies such as homoeopathy

42% of GPs refer patients to homoeopaths

0 molecules of an active ingredient in a typical "30c" homoeopathic solution

$1m reward offered by James Randi for proof that homoeopathy works

This article first appeared in the 21 April 2008 issue of the New Statesman, Food crisis

DREW ANGERER/GETTY IMAGES
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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