The English patient: Britten in 1968. Photograph: Cecil Beaton Studio Archive, Courtesy of National Portrait Gallery.
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Notes from a cardiologist: Unravelling the mystery of Benjamin Britten’s heart

Cardiologist Hywel Davies describes the origins of the syphilis claim from Paul Kildea's biography of Benjamin Britten, which began as an "ordinary conversation" in a colleague's house in the late 1980s.

In 1892, William Osler published the first edition of The Principles and Practice of Medicine, in which he stated that tertiary syphilis of the nervous system, known then as general paralysis of the insane, was due to stress. Not many years later, a bacterium, called the spirochaete, was identified as the cause of syphilis and Osler was obliged to modify his textbook for the next edition. I thought of Osler’s dilemma in the context of Paul Kildea’s recent biography Benjamin Britten: a Life in the 20th Century, which claims that Britten had syphilis. The very public denials of this, some of them by people who could not possibly know one way or the other, along with the calls for revisions in the second edition, brought Osler to mind.

In assessing this, I can only gather what seems to be reasonable evidence on either side. For me, this begins with the testimony of my friend and colleague Donald Ross, the surgeon who operated on Britten’s heart on 7 May 1973 at the National Heart Hospital in London. During this procedure, he and his assistant surgeon would have inspected the heart thoroughly, at close range and from all available angles, using feel as well as vision, inside and out. Ross cut out the native aortic valve and replaced it with a homograft, which is made of tissue from a human source. This has the practical advantage of not requiring the use of anticoagulants to prevent clots forming later on the valve, as would have been the case with a mechanical prosthesis.

Ross recorded his impressions in his operative report written immediately after the surgery. This has recently been lodged at the Britten-Pears library, together with a selection of other records from Britten’s medical history, which I have been able to examine. Apart from his account of the procedure, Ross expresses clearly that when he was in theatre he was not able to tell, with any degree of assurance, exactly which disease process he was looking at, writing: “The aetiology of this valve lesion is not clear to me and certainly not characteristic of bacterial endocarditis, nor was the valve of bicuspid structure which would suggest a congenital valve.” The significance of these words is that Britten in 1968 had been treated with heavy and prolonged doses of penicillin for bacterial endocarditis, which means infection on the heart valve. There was none of the expected evidence “whatsoever” on the valve of previous infection from bacterial endocarditis. Nor were there signs of a congenitally deformed valve, since those are usually bicuspid (have only two cusps). This speaks against heart disease in infancy and childhood.

Ross adds that, on closure of the aortotomy (the initial incision in the aorta), the heart “came off bypass without difficulty”, yet: “The external appearances were those of an enlarged, bulky and flabby myocardium with a poorly contracting left ventricle.” In other words, none of the explanations given up to that point for the weakness of Britten’s heart, many of them involving assumptions that Britten had carried since childhood, appeared to be borne out. Ross proceeded to take biopsies from several parts of the heart that, together with the excised valve, were sent to the pathologists for their opinions about what the abnormal appearances might represent. He underlined the word “biopsy” each time he used it, as if to emphasise how critical the information would be to his conclusion.

In recent months, some commentators have asserted that Ross would have announced his thoughts and reservations at once in the operating theatre. On the contrary, it is extremely unlikely that he would have done this, for both intellectual and social reasons. Unclear about causes, he would never have speculated openly about such matters to what was a semi-public audience. He did, at the same time, make clear in his notes that he had been looking at something that was in his wide experience most unusual. It would have taken some weeks for the specimens to be studied and reported on before being reviewed by him. It would not – nor should it – have been a quick and hurried process. Unfortunately, if the reports of the biopsies, together with those of the relevant blood tests, were ever included in Britten’s other medical reports, they are no longer with them, but Ross would have insisted that he see them and they would have been an essential element when he came to draw his conclusions.

Over years of working with and discussing such things with Ross, I came to appreciate how keen and incisive his judgement always was in cardiac and other matters. He probably had as great an experience of assessing beating hearts as anyone before or since and a marked interest in anatomy and structure that he pursued in academic quarters. Between 1964 and 1973, 850 patients, many of them Ross’s, underwent aortic valve replacement at the National Heart Hospital and he worked elsewhere, too. As a cardiologist at Guy’s in the 1960s, I worked closely with him on the launching of his new technique of homograft valve replacement; the world’s first case, naturally in his hands, was my patient. I cared for and studied many of his homograft patients after that.         

Thus, when, during an ordinary conversation in his house in the late 1980s, Ross chose to tell me that Britten’s heart was syphilitic, I took him at his word, knowing that his opinion was that of a seasoned professional at the peak of his power in his field of expertise. I asked no further questions, except one to his assistant surgeon, present on the same occasion, as to whether he concurred with Ross’s conclusion, which he did. Beyond that, I had no particular interest in the story and did not speak to anyone about it.

Except one person. When I lived and worked in Colorado in the 1960s and again in the 1980s, one of my friends was a senior medical scientist named Basil Reeve, an Englishman who had grown up in Lowestoft with Britten, had known him well and had played the piano with him. A qualified doctor, Basil was also friendly in the Second World War with the philosopher Ludwig Wittgenstein, then working at Guy’s Hospital as a porter during the Blitz. One day in the early 1990s when I was visiting Denver again, Basil and I were having lunch in a local restaurant. He talked about these friends and, knowing his interest in Britten, I saw no reason not to mention to him what Ross had told me freely and without pledging me to silence.   

I was surprised, however, that Basil’s reaction was swift and pointed. He said: “The world should know it and we should make the information public.” I had no wish to do this and I declined to go along with his request. He repeated it a few times on the telephone during the following years and, although I realised how strongly he felt about it, I still chose to say no. Shortly after his last request, I sold my home in Switzerland and moved elsewhere. A couple of years later, I happened to call at Basil’s house during another visit to Denver. When he opened the front door, his face paled and he said, “Good God, I thought you were dead.” He explained that in the interim he had phoned again to Switzerland to repeat his request, to be told by the operator that the line had been discontinued and I could not be contacted. He drew the perhaps understandable conclusion that I was no more and accordingly felt able to speak about what I had told him. In 1999, he told the story to Kildea, the young head of music at the Aldeburgh Festival. Kildea was sceptical but, when he came to write his biography in 2008, he tracked me down to check Basil’s information. I initially told him that I was not willing to comment but over time came to realise that he was a serious scholar, interested in getting to the bottom of a puzzling case, and I decided to help him with some of the medical aspects of his book.

Based on what Ross and others wrote at the time and what Ross told me later, we may question further what this most experienced surgeon observed in the operating theatre with such puzzlement. First, Britten’s heart was much enlarged, the bulk of this consisting of a very thick left ventricle. The reason for this was ostensibly a long-standing aortic valve insufficiency – leakage backwards from the aorta into the ventricle after the aortic valve closes. The immediate reason for the enlargement and thickening (hypertrophy) of cardiac muscles is usually excessive work, as occurs in other muscles of the body. Leakage in the aortic valve results in an increase in the amount of blood the heart has to pump.

There are two conflicting descriptions of the condition and function of Britten’s ventricle that appear in the clinical notes. The first is the report on the pre-operative angiogram, which states that the left ventricle “contracts vigorously”. The second is the operation note in which Ross describes the enlarged, bulky and flabby muscle and poorly contracting left ventricle. The use of the word “flabby” speaks for itself and Ross inserted special sutures in an attempt to secure the new valve in the friable, weakened tissue. A month after the operation, Britten’s cardiologist Graham Hayward wrote to Ian Tait, Britten’s GP in Aldeburgh: “He presented us with many problems, as you know, during and after surgery as his heart was much larger and worse than one anticipated.”

The reasons for these “many problems” might not have been evident to the surgeons. They would have gone through the main possibilities, including those that the consultant physician John Paulley of Ipswich spelled out in 1960 after seeing Britten. He was the first, it appears, to make the diag nosis of aortic valve insufficiency and, in a letter to Tait, he asked the latter to arrange a WR and Kahn blood test, the standard for syphilis. He could have ordered one himself but he preferred that Tait did it. (“Reasons will probably be obvious to you?”) We must assume that the test was carried out. Paulley’s request is proof, if any were necessary, that syphilis was and still is a major diagnostic possibility in a patient with aortic valve insufficiency. Ross would have known as well as Osler that syphilis is a great mimic of other diseases and a negative blood test does not rule out the disease, especially in patients who had been treated heavily with penicillin, as Britten had.

I have taken a position in this matter largely because I find that the strongest evidence we have is that of the surgeons and I do not believe their conclusions should be cast aside lightly. (In the 1970s, the assistant surgeon passed on Ross’s conclusions to a senior colleague who repeated them to Kildea, so I was not the only route by which they reached him.) On the basis of Ross’s surgical report and his unequivocal opinion, it seems that Kildea is substantially right in what he says, though some amendments to wording, to reflect what we now know from the report, could be made before the next edition of his book. This is a sentiment with which Osler, if he were here, might well approve.

In a long career as a consultant cardiologist, Hywel Davies held posts in leading London and US hospitals before being invited by Sir Terence English to be the cardiologist to the cardiac transplant team at Papworth Hospital

This article first appeared in the 10 June 2013 issue of the New Statesman, G0

Andre Carrilho
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Putin's revenge

Twenty-five years after the demise of the Soviet Union, Russia is consumed by an insatiable desire for recognition as the equal of the USA.

President Trump meets President Putin. It’s the most eagerly awaited encounter in world politics. Will The Donald thaw the New Cold War? Or will he be trumped by “Vlad” – selling out the West, not to mention Ukraine and Syria?

The Donald v Vlad face-off comes at a sensitive moment for the Kremlin, 25 years after the demise of the USSR on Christmas Day 1991 and just before the centenary of the Russian Revolution. Were the heady hopes at the end of the Cold War about a new world order mere illusions? Was Mikhail Gorbachev an aberration? Or is Putin rowing against the tide of post-Cold War history? How did we end up in the mess we’re in today?

These are some of the questions that should be explored in Trump’s briefing book. He needs to get to grips with not only Putin, but also Russia.

 

****

Today President George H W Bush’s slogan “new world order” sounds utopian; even more so the pundit Francis Fukuyama’s catchphrase “the end of history”. But we need to remember just how remarkable that moment in world affairs was. The big issues of the Cold War had been negotiated peacefully between international leaders. First, the reduction of superpower nuclear arsenals, agreed in the Washington treaty of 1987: this defused Cold War tensions and the fears of a possible third world war. Then the 1989 revolutions across eastern Europe, which had to be managed especially when national boundaries were at stake. Here the German case was acutely sensitive because the Iron Curtain had split the nation into two rival states. By the time Germany unified in October 1990, the map of Europe had been fundamentally redrawn.

All this was accomplished in a spirit of co-operation – very different from other big shifts in European history such as 1815, 1871, 1918 and 1945, when great change had come about through great wars. Amid such excitement, it wasn’t surprising that people spoke of a new dawn. This was exemplified by the unprecedented working partnership between the US and the USSR during the First Gulf War in the winter of 1990-91 to reverse Saddam Hussein’s invasion of Kuwait. Bush and Gorbachev agreed that they shared a set of “democratic” and “universal” values, rooted in international law and in co-operation within the United Nations.

The new order of course assumed the continued existence of the Soviet Union. Despite the USSR’s growing economic and political problems, no one anticipated its free fall in the second half of 1991. First came the August coup, an attempt by a group of anti-Gorbachev communist hardliners to take control of the Union. Their failed putsch fatally undermined Gorbachev’s authority as Soviet leader and built up Boris Yeltsin as the democratic president of a Russian republic that was now bankrolling the USSR. Then followed the independence declarations of the Baltic states – Estonia, Latvia and Lithuania – and crucially Ukraine, which precipitated the complete unravelling of the Union. And so, on Christmas Day 1991, Gorbachev became history, and with him the whole Soviet era. It seemed like the final curtain on a drama that had opened in Petrograd in 1917. A grandiose project of forced modernisation and empire-building pursued at huge human and economic cost had imploded. The satellites in eastern Europe had gone their own way and so had the rimlands of historic Russia, from central Asia through Ukraine to the Baltic Sea. What remained was a rump state, the Russian Federation.

Despite all the rhetoric about a new world order, no new structures were created for Europe itself. Instead, over the next 15 years, the old Western institutions from the Cold War (the Atlantic Alliance and the European Union) were enlarged to embrace eastern Europe. By 2004, with the inclusion of Lithuania, Latvia and Estonia, Nato and the EU reached the borders of Russia, less than 100 miles from St Petersburg.

Initially the West’s eastward expansion wasn’t a big problem. The Kremlin did not feel threatened by the EU because that was seen as a political-economic project. Nato had been repackaged in 1990 as a more political organisation. Indeed, four years later, Russia joined the alliance’s “Partnership for Peace”. And in 1997, when Nato announced its first enlargement to include Poland, Hungary and the Czech Republic, Russia was invited to join the alliance’s new Permanent Joint Council. That same year, Russia became a member of the G8. In short, during the 1990s the consensual atmosphere of 1989-91 seemed to be maintained.

But Yeltsin failed to create a new Russia from the ruins of Soviet communism. Between 1989 and 1992, as the command economy disintegrated, inflation soared and national income fell by one-third – a crash as spectacular as those America and Germany had suffered in the early 1930s. The largest and fastest privatisation that the world had seen created a cohort of super-rich oligarchs. Crime and corruption became rampant, while millions of Russians were condemned to penury. “Everything was in a terrible, unbelievable mess,” Yeltsin’s adviser Yegor Gaidar later admitted. “It was like travelling in a jet and you go into the cockpit and you discover that there’s no one at the controls.”

Meanwhile, the proliferation of political parties resulted in chaos. Yeltsin managed to hang on, thanks to increasingly autocratic rule. In October 1993, after several months of wrangling over the balance of power between executive and legislature, he used army tanks to shell the parliament building in Moscow and imposed a new constitution built around a strong presidency. This and a succession of contrived referendums kept him in power for the rest of the decade. Finally, on New Year’s Eve 1999, an ill and exhausted Yeltsin orchestrated his own departure. Declaring that he would hand over to “a new generation” that “can do more and do it better” at the start of a new millennium, he said that he was conveying his powers to an acting president.

His designated successor was an apparently unassuming little man called Vladimir Vladimirovich Putin.

***

Who was Putin? Where had he come from? Most immediately he had been prime minister since August 1999 – the sixth man to serve as Yeltsin’s premier. Yet he had made his career as a discreet outsider, often underestimated by those around him. In fact, he was a long-serving KGB officer: he joined in 1975, at the age of 23, entering a culture that would define his persona and outlook.

Crucially, the Gorbachev era was almost a closed book to Putin: he never experienced the intoxicating passions of reform politics within the USSR – perestroika, glasnost and demokratizatsiya – because he spent 1985 to 1990 as a case officer in Dresden in East Germany. To him, Gorbachev’s reforms signified destruction: an empire discarded and a country ruined. During the 1990s, as Putin rose through the ranks of the city administration of his home town St Petersburg and was then moved to Moscow, he witnessed the disastrous effects of chaotic privatisation, the erosion of Russia as a great power and the collapse of the national economy.

Out of the traumatic 1990s came Putin’s passion for a strong state. He spelled this out in a 5,000-word document entitled Russia on the Threshold of the New Millennium, published on the Soviet government website on 29 December 1999. In it, he stated bluntly that the Bolshevik experiment had totally failed. “Communism and the power of the Soviets did not make Russia into a prosperous country,” he wrote. It had been “a road to a blind alley which is far away from the mainstream of civilisation”.

Putin welcomed recent “positive changes”, especially the Russian people’s embrace of “supranational universal values” such as freedom of expression and travel, as well as “fundamental human rights and political liberties”. But he also highlighted traditional “Russian values”, especially patriotism – pride in “a nation capable of great achievements” – and “social solidarity”, which, he asserted, had “always prevailed over individualism”. He did not believe that Russia would become “a second edition of, say, the US or Britain, in which liberal values have deep historic traditions”. What he presented as “the new Russian idea” would be “an alloy or organic unification of universal general values with traditional Russian values which had stood the test of the times, including the test of the turbulent 20th century”.

Woven into Putin’s manifesto was a distinctive conception of his place in politics. He envisaged himself as a “statesman” in the Russian sense – meaning a builder and servant of the state, in a country where the state has always been seen as superior to society and the individual. He considered the true leader to be above mere electoral politics, occupying a more permanent position as the guardian of state interests. He looked back admiringly to the autocratic reformers of the late tsarist era – men such as Nicholas II’s prime minister Pyotr Stolypin – and had no time for Gorbachev and Yeltsin, who had both been submerged by democracy and had undermined the state.

Above all, he believed that Russia had to resume its rightful historic place as a “great power”. He considered the vicissitudes of the 1990s an aberration that had to be overcome. Adapting one of Stolypin’s celebrated phrases, he liked to say that the people did not need “great upheavals”. They needed “a great Russia” – with a “strong state” as the “guarantor of order” and the “main driving force” of any durable change.

The “acting president” was elected in his own right in March 2000 and won re-election in 2004 for another four years. During the 2000s Putin concentrated on kick-starting the economy, bringing the oligarchs of the Yeltsin era under firm control and building monetary reserves, aided by rising prices for Russia’s oil and gas. This enabled the country to survive the financial crisis of 2008 and stood in marked contrast to a decade earlier, when the Asian crash of 1997-98 led Russia to default on its foreign debt and devalue the rouble. In rebuilding prosperity and pride, Putin earned the gratitude of millions of Russians, scarred by the poverty and humiliations of the Yeltsin era.

Showing himself off as a military strongman, he targeted Chechnya, which had claimed independence in 1991. Yeltsin had failed to tame the anarchic north Caucasus republic in the Chechen War of 1994-96; Putin imposed direct Russian rule brutally in the first year of his presidency, reducing the Chechen capital, Grozny, to rubble in 2000.

Increasingly secure at home, he began to reassert Russian power in the international arena. Initially, this did not involve confrontation with the West. He co-operated with the US in the post-9/11 “war on terror”, though he didn’t support the toppling of Saddam Hussein in Iraq, abstaining from the Bush-Blair mission of forceful regime change. In 2003-2004 he protested but ultimately accepted the Orange Revolution in Ukraine and the accession of the Baltic states into Nato and the EU – even if the Kremlin regarded them as part of Russia’s “near abroad”. In 2007, however, Washington’s plans for a Nato missile defence “shield” in eastern Europe (deploying interceptor missiles and radar tracking systems), officially justified as protection against “rogue states” such as Iran, prompted Russia to withdraw from the Conventional Forces in Europe (CFE) treaty. This was part of the fabric of co-operation woven in 1990-91. Nevertheless, foreign policy wasn’t Putin’s priority in his first stint as president.

***


In 2008, after two terms in office, Putin was obliged under the constitution to step down from the presidency. Under a notorious job swap, however, he was elected as prime minister to the new (nominal) president, Dmitry Medvedev, who within months pushed through a law extending the term for future presidents from four to six years. Then, in September 2011, Putin announced that he would run for the presidency again.

For millions of Russians, this second job swap seemed a cynical power play. Putin won the election of March 2012, naturally – the Kremlin machine ensured that. Yet he gained only 64 per cent of the vote despite having no serious opposition. Rural areas run by local clans tied to him were easily manipulated, but in many big cities, including Moscow, he polled less than 50 per cent.

The 2012 election campaign was the moment when Putin’s conception of the statesman-strongman collided with the democratic expectations of Russia’s perestroika generation, now coming of age. It marked a crunch point in the history of post-Soviet Russia – a clash between different models of the country and its future. Ranged against Putin were those whom the opposition leader Vladimir Ryzhkov, of the liberal People’s Freedom Party, called the new “mass middle class”, formed over the previous two decades. Taking to the streets in protest against the Putin-Medvedev “tandem” were managers, engineers, journalists, lawyers, IT specialists and the like. For these people, Putin had passed his sell-by date. After his announcement that he wanted another term in the Kremlin, images circulated on the internet of an aged Putin dissolving into the geriatric visage of Leonid Brezhnev – whose near-two decades in office symbolised the “era of stagnation” that Mikhail Gorbachev had swept aside.

Social media was transforming urban Russia. Between 2008 and 2012 internet penetration among the over-16s doubled from 25 per cent to 50 per cent. Russia had its own version of Facebook: VKontakte. The Kremlin’s alarm at the upsurge of virtual opposition and street protest was intensified by the Arab spring in 2011. Much international comment highlighted the role of a young “Facebook Generation” in countries such as Egypt and Tunisia, fostering a “digital democracy” that toppled long-standing autocrats – supposedly financed and supported by Washington. Putin liked to claim that the protests in Russia had also been stirred up and/or funded by the then US secretary of state, Hillary Clinton. Little wonder that one of his priority projects after winning the 2012 election was refining a sophisticated system of internet surveillance known as Sorm, run from part of the old secret-police headquarters of Lenin’s Cheka and Stalin’s KGB in Lubyanka Square, Moscow. With that in mind, the oppositionist Ryzhkov declared that even though Russian society was now very mature and “European”, the regime was “still Chekist-Soviet”. This, he said, was the “main contradiction” in contemporary Russia.

The domestic protests and the Arab spring threatened Putin’s determination to rebuild Russia’s position in the world and consolidate its sphere of influence in the “near abroad”. He focused on a “Eurasian Union”, an idea first touted in the 1990s by some central Asian states, notably Kazakhstan, but picked up in earnest by Putin after 2011. Yet, for him, the crux of a viable Eurasian bloc lay in the west, not the east: in Ukraine, with 45 million people, a strong industrial base, and its critical geopolitical position. Putin didn’t just see Ukraine as Russia’s historic “borderland”. Celebrating Kievan Rus – the original east Slavic state of the 9th to 13th centuries – he insisted that Kyiv was “the mother of Russian cities”. Keeping Ukraine within Moscow’s sphere of influence was a red-line issue for the Kremlin.

That line was crossed in February 2014. For a decade Ukraine – an ethnically fractured country (78 per cent Ukrainian; 17 per cent Russian) – had hovered between Russia and the West, depending on the latest change of leaders in this corruption-riddled state. In November 2013 the Russia-leaning Ukrainian president, Viktor Yanukovych, stalled Ukraine’s long-discussed “association” agreement with the European Union. Thousands of pro-EU protesters surged into Maidan Nezalezhnosti (Independence Square) in Kyiv.

In the face of repressive police measures, the mass demonstrations continued for three months and spread across the country, including the Crimea, where Russians were the majority, bringing Ukraine to the brink of civil war. Yanukovych fled Kyiv for Russia on 21 February 2014. The next day Putin began a campaign of retaliation, culminating in the forcible annexation of the Crimea, rubber-stamped by a referendum in which (officially) 96.77 per cent of the Crimean electorate voted to join Russia.

For the West, Putin had finally overstepped the mark, because the Crimea had been part of Ukraine since 1954. Putin claimed that the Russian inhabitants of the region were invoking the right to “self-determination”, just like the Germans during unification in 1990, or the Albanians in Kosovo in 1999 when seceding from Yugoslavia. But in the West, Russia’s military intervention in an independent state was condemned as a flagrant breach of international law. The US and the EU imposed political and economic sanctions against Russia, precipitating a financial crisis and a collapse of the stock market. By the spring of 2016 the rouble had fallen 50 per cent in two years. This was coupled with a halving of the price of oil, on which Russia’s economy depends. The country slid into recession, reversing the economic success of the president’s first stint in power.

Yet the slump does not appear to have damaged his domestic popularity severely. The state-controlled media whipped up patriotic fervour: Russia v the West. And Putin – the “History Man”, as Fiona Hill and Clifford Gaddy dub him in their book Mr Putin – has deliberately constructed his own version of the recent past to justify his actions. Playing on the trauma and humiliation of the Soviet break-up, he appealed to national pride, touching the emotions of millions of Russians.

Putin has presented his intervention in the Crimea (and subsequently eastern Ukraine) as an assertion of Russia’s right as “an independent, active participant in international affairs”. In a major policy statement on 18 March 2014, he harked back to the era of “bipolarity” as a source of “stability”, arguing that America’s arrogant attempts after 1991 to create a “unipolar” world, exacerbated by Nato’s progressive enlargement, had pushed his country into a corner.

It was not just that Kyiv’s turn towards the EU threatened to detach Ukraine from Russia and its “Eurasian” sphere; talk about actually joining Nato raised the spectre of the Western military alliance being “right in our backyard” and on “our historic territory”. Putin conjured up the prospect of Nato warships entering the Black Sea and docking in Sevastopol, that “city of Russia’s military glory” – a “real threat to the whole of southern Russia”. Enough was enough, he declared: “If you compress the spring all the way to its limit, it will snap back hard.”

***

 

To Western eyes the story looked very different. The enlargement of the EU and Nato was driven less from Brussels and Washington than by the desire of eastern European countries to escape from the clutches of “the Bear”. Putin had tolerated the loss from Russia’s “near abroad” of Warsaw Pact states from Poland to Bulgaria, but the Baltic states (former Russian imperial territory) were a very different matter. Estonia, Latvia and Lithuania had won their independence from the tsarist empire after the First World War, only to be absorbed into the Soviet Union after the Second World War. For the Balts, 1991 therefore represented the rebirth of freedom and statehood; they saw membership of the institutional West – the European Union and Nato – as an essential guarantee of national security.

Nato has become a “four-letter word” for Russia and one can argue that, ideally, the “new world order” should have been based on new institutions. But in 1989-90 the persistence of Nato was essential to allay European fears, not least in the USSR, about a unified Germany at the heart of the continent. There was no discussion at this moment about Nato’s further extension beyond Germany, let alone a firm pledge that it would not. Contrary to Putin’s assertions, an expansionary blueprint did not exist.

Whatever the arguments about ­history, however, relations between Russia and the West are deadlocked. So are we in a “New Cold War”, as touted by the Russian government since Dmitry Medvedev’s speech to the Munich Security Conference in February 2016? In fundamental ways: no. Russia and America are not engaged in an all-encompassing global power struggle, military, political, economic, cultural, ideological. The new Russia is essentially capitalist and fully integrated into the world economy, with a multitude of trade and financial links with the West.

Despite bellicose rhetoric at the top, Russian and US diplomats talk and work together behind the scenes, not least in the recent selection of a new UN secretary general, António Guterres. Above all, the language of “unipolarity” and “bipolarity” no longer reflects the reality of international affairs: a “multipolarity” of world powers, a profusion of “non-state actors” capable of terrorism and warfare, and potent transnational forces, notably mass migration – all of which are deeply destabilising. This is very different from the Cold War.

Amid this new world disorder, today’s Russian-American stand-off revolves around differing approaches to international relations. Putin’s policy is rooted in traditions of great-power politics: the control of territory and the assertion of state sovereignty, especially within what Russia regards as its historic sphere. By contrast, the United States, albeit erratically, has promoted humanitarian interventionism, pursued regime change and indulged in the rhetoric of global democracy, especially since the 9/11 attacks.

So, why the divergence? One can say that the West has failed to pay consistent attention to Russia’s sensitivities about its post-Soviet decline. Nor has it given due recognition to the reality of Russia as a great Eurasian power. On the other side, Putin has increasingly pulled his country out of the network of co-operative political forums and agreements forged with the West in the aftermath of the Cold War. He has also challenged the independence of small states on Russia’s periphery. Today, abandoning any vestiges of entente with America, Putin seems to believe that Russia can regain its great-power status only by distancing itself from the West and by overtly challenging the US in hot spots around the world. This is very different from the world imagined by Bush and Gorbachev and pursued to some degree by Bill Clinton and Boris Yeltsin. Putin is undoing what he sees as a “democratic” peace, made to Russia’s geopolitical disadvantage in 1989-91.

Take Syria: Putin knew that Barack Obama had no stomach for wholesale military intervention on such a fragmented battleground, where few direct US interests are at stake. As an appalling human tragedy has unfolded, especially in Aleppo, Putin has exploited his free hand by despatching Russia’s sole (Brezhnev-era) aircraft carrier, the Admiral Kuznetsov, to Syrian waters and building a Russian airbase near the key port of Latakia. US passivity has allowed him to establish a novel, if tenuous, military presence in the eastern Mediterranean and thereby to strengthen his position in the Middle East as a whole.

On the Baltics, Washington drew a firm line last summer: Nato’s Warsaw summit in July 2016 committed Alliance troops and aircraft to each of these states by way of a token but unequivocal act of deterrence. Putin responded by further beefing up the Russian short-range nuclear arsenal in Kaliningrad. This tit-for-tat in the Baltic Sea area is likely to spiral.

In the standoff over Ukraine – where Russia has done nothing to end the fighting – the Americans have been content to let Angela Merkel take the lead in trying to broker a peace deal. While playing tough in the Baltic, she has kept open channels of communication with Putin over Ukraine. Significantly, the president has not spurned her offer to talk. The two can converse without interpreters, in German and in Russian; Merkel seems to be one of the few foreign leaders for whom Putin entertains a certain respect, if only because she recognises Russia’s need to be taken seriously.

Nevertheless, all these various power plays reflect essentially conventional ways by which Putin seeks to unpick 1989-91. More significant is the Kremlin’s increasingly aggressive avant-garde methods of combating the Western “bloc” of liberal democracies – by manipulating transnational financial and commercial ties, spinning the global media and steering policy discourse in target states. Russia can leverage its relative weakness if it cleverly exploits its post-Cold War immersion within the global capitalist system and Western popular culture as a kind of “Trojan Horse” .This is what Putin’s personal adviser Vladislav Surkov has termed “non-linear war”.

It is no secret that, in this vein, Moscow used cyber-power in an attempt to mould American opinion during the 2016 presidential election campaign. For all the media hype about hacked computer systems and leaked emails, the Kremlin’s information warfare is not that innovative. After all, the underlying concepts and most of the techniques were developed by the USSR (and equally by the United States) to interfere in other countries’ internal affairs during the Cold War. Let’s not forget that the young Mr Putin was schooled in KGB Dresden.

So, although we may not be back in the era of bipolarity, some of the new ways are also old ways. Under Putin, Russia seems to have resumed its historic quest for position against the West and its insatiable desire for recognition as America’s equal. Will it ever be possible to forge a stable “alloy” blending “universal” and “Russian” values? That would truly be a Russian revolution. l

Kristina Spohr (London School of Economics) and David Reynolds (Cambridge) are the co-editors of “Transcending the Cold War” (Oxford University Press)

This article first appeared in the 12 January 2017 issue of the New Statesman, Putin's revenge