The Mike Robbins blog: 2019

Friday, 20 September 2019

Doctor in Jail

Two recent books give a vivid insight into

the life of a prison doctor. It isn’t pretty

It’s an afternoon at Bronzefield, a British women’s prison near Ashford in Surrey. Dr Amanda Brown hears a rumpus going on as she arrives to begin her shift. Prison officers are charging up the metal stairs. “Someone’s having a baby,” she’s told. She follows, noting the “deep stench of overcooked vegetables from lunch ...mixed with sweat and cheap soap.” She pushes her way past a bunch of officers and into a cell, where a tiny young woman is standing, her nightie soaked in blood below the waist. “Get it out of me! Get it out of me!” the woman screams. She is referring to the placenta, not the child; the latter, a tiny baby girl, is lying in a pool of blood on the floor. But the child is alive.

Meanwhile an American prison doctor, Karen Gedney MD, receives a prisoner in her office.

She is trying to give him support and help; he’s a Vietnam veteran who is serving life. He killed a cop and knows he isn’t going anywhere. Gedney has talked to him before but this time, things go wrong; he pins her to the wall using her desk and takes her hostage. He holds her hostage four 14 hours, during which he rapes her. Then the prison staff disable him with a stun grenade and kill him. A few days later Gedney goes to the gym, where another women says she’s glad she’s okay and nothing happened to her.

“No,” I said tightly. “Nothing happened to me, except that I was taken hostage by force, raped, exposed to a concussion grenade and saw someone blown away.” “Um – you need help,” she said, got off the machine, and walked to one further down the row.

If you’re married to a prison doctor, I guess you don’t ask them if they had a good day at the office.

Amanda Brown’s The Prison Doctor was published in June 2019, Karen Gedney’s 30 Years Behind Bars in early 2018. Brown’s book has had a significant impact and has sold very well, at least in the UK; Gedney’s has attracted less attention, but it is just as good a book. Both give a remarkable insight into what it’s like to be a prisoner in the UK or US today. It is not pretty.

Neither woman sought this line of work; it found them.

Karen Gedney qualified as a doctor in the mid-1980s. In the US, this has never been a cheap undertaking; today the average American medical student emerges with around $170,000-worth of debt, and some sources put the total cost of becoming a doctor much higher. But Gedney’s studies were financed by the National Health Service Corps, which provides scholarships for healthcare providers. The payoff is a period of public service in areas where there is a shortage of medical professionals.

Thus one day in 1987, Gedney finds that she’s been placed, unexpectedly, in a prison. Gedney does not name the prison, or even the region of the US, in the book, so I shall respect that and won’t do so here. But it is very easy to identify online if one wishes; suffice to say that it’s in a southwestern state. The upside is that it’s local, and she and her husband will not have to move. The downside is that the prison does not really want her. Gedney later hears that it had been forced to recruit a proper doctor because it faced being sued for inadequate healthcare provision. The medical staff do not give her a warm welcome. No-one seems friendly and one of the first things she sees is a prisoner being forcibly restrained and then bitten by a guard dog while having a seizure (she insists on treating him). Finally one of the staff, friendlier than the rest, offers to show her round. She is then told dismissively by a nursing assistant that the man is not staff but a prisoner and is a child-molester.

Amanda Brown has also arrived by accident. Up to 2004 she has worked as a GP, or general practitioner – that is, a family doctor, the equivalent of a primary care provider in the US. In The Prison Doctor, Brown says that the introduction of a new GP contract in 2004 caused friction between herself and at least one of her practice partners, so she left. The dispute sounds rather sudden. At any rate, Brown pens an angry article about the new contract for the GP’s magazine, Pulse. Another doctor sees it and recruits her for the prison service. It’s not a job that’s ever occurred to Brown but, aged about 50, she decides on a career change.

Brown has an easier introduction than Gedney to prison life, being welcomed by colleagues

at Huntercombe, a young offenders’ prison (at the time; it has since become an adult prison). But she too is taken aback by some of her new patients. Brown is shocked, at first, at the extent to which the inmates self-harm. They do it, she decides, to “displace pain they feel in their own minds – it can be anything from a scratch on the wrist to attempted suicide.” But what Brown finds at Huntercombe is nothing to what she’ll see at her next gig. Wanting a challenge, in 2009 she transfers to Wormwood Scrubs.

The Scrubs, as it is often called, is one of the UK’s oldest and most notorious prisons; as Brown recalls, it’s been “home” to some of the worst people on earth. Brown cites a few, including Charles Bronson and Ian Brady. Built in 1875, it currently houses around 1,200 prisoners. It is a hard place to work. Brown pulls few punches about what she has seen. Within a week or two she answers an alarm after an attempted suicide. She squeezes into the cell with the prison officers already there:

I pushed my way through them into what I can only describe as a bloodbath. There was blood everywhere – splattered across the walls, on the bed sheets. On the concrete floor, writhing in a pool of his own blood, was a young man with a massive slit across his throat.

She wonders briefly whether the prisoner has smuggled a razor into the prison somehow to do this. Later she learns just how ingenious prisoners can be. Drugs can be brought in in the form of letters that have been impregnated with them and are then smoked. She’ll be ticked off herself for absent-mindedly bringing chewing gum into the grounds; it’s banned because it is used to take impressions of keys. Spiral-bound notebooks are also proscribed because wire binding can be used to pick a lock. Phones are forbidden as they can be used for criminal activity, and even an old one, if smuggled in, can command a price of £300-400 (about $360-480 at current rates).

One of Brown’s major duties, in the Scrubs as elsewhere, is to screen incoming prisoners and ensure that they do not need immediate medical attention, and that they have any medication they may need. They may be arriving from another prison, but in some cases they are on remand and have been walking the streets a day or so earlier; they are still in shock and are often very frightened. Gauging whether they can safely be left alone in a cell is a huge responsibility – one that eventually weighs heavily on Brown, especially after she gives evidence at an inquest on a prisoner who appeared normal on arrival but died in a cell from unknown causes a few hours after she saw him. It’s this strain, in part, that eventually persuades her to leave the Scrubs and go to HMP Bronzefield. But she has managed seven years at one of Britain’s most notorious prisons.

Over in the States, Gedney has even more problems. The management staff who do not want her there launch an “official” investigation into her conduct, something she only learns of by accident; shown the files, she is shocked by some of the comments. They include “She gives preferential treatment to blacks because she’s married to one” (which, as it happens, she is). Her director is sympathetic, but says he can’t do anything because “they’ve got something on me”. Gedney has a four-year service obligation and cannot easily cut and run. She sweats it out. And in the end, she stays for good; it is not quite clear why she does so, but the work seems to have got under her skin. She finally retired from the prison as recently as 2016.

There are some differences between the two women’s working environments. Brown presents the prison staff as a mainly good bunch who would like to help the prisoners if they can. Gedney sees a more complicated picture. Early on, a prisoner arrives in severe pain; her nursing staff dismiss him, with contempt, as just having gas. Gedney finds he is havinga heart attack. Meanwhile the director of medicine is the wife of the deputy warden and both are downright unhelpful. Gedney never really finds out why. Her husband thinks he can explain the hostile response from the prison staff. “You probably intimidate them. Think about it. You’re a doctor, and how many of them do you think have even gone to college?” Gedney also encounters racial tensions in the prison and hears of the way some of the prison officers talk about black people. In town, her own husband, a professional man, is pulled over and asked for his parole papers.

The Scrubs

Gedney has two other big challenges that Brown need not confront. One is the death penalty. As a public servant, she regards it as the state’s decision as to whether a man will die; as an individual, however, she feels it is her decision as to whether she will participate. When a man is executed in 1989, she refuses. (Again, she chooses not identify the man so I won’t do so here, but it is not hard to find out who he was.) She doesn’t know him but he clearly knows who she is, and leaves her an extraordinary and moving letter. Later, she treats a cancer patient who is awaiting execution, and accedes to his wish not to prolong his life. She then finds that some people are angry that she did not keep him alive long enough to be killed.

The other horror that Gedney faces that Brown does not, is Vietnam. Today, the American survivors of the war are quite old. But when Gedney entered the prison service in 1987, the last American troops had been out of Vietnam for only 14 years or so; they were still around, and were a mess. To be sure, the country that was really traumatised by Vietnam was Vietnam, with – according to some estimates – three million dead. Nonetheless over 58,000 American troops were killed there, and according to the US Department of Veterans Affairs, a staggering 2.7 million served in-country. Today, according to Bureau of Justice stats, veterans in the US are no more likely to be in jail than anyone else; a bit less likely, in fact. But in 1978 they accounted for about 24% of all prisoners. These figures should be interpreted with care, as men serving in Vietnam were often draftees, and the ability or otherwise to avoid the draft must have been defined to some extent by one’s social class – in short, many of these men were more risk of jail anyway. Besides, there were more veterans; some of Korea and even World War II will still have been around, as well as those from Vietnam. Even so, it is a staggering statistic.

Gedney does not quote these figures, but is very aware of what the Vietnam veterans have been though. Her own husband is one; shot through the chest on Christmas Eve 1969, it took him a year to recover and his first wife, told that he wouldn’t, left him. Gedney encourages him to come into the prison and help found a veteran’s support group, and he does. The fact that she has earlier been raped by one of the veterans does not stop her from doing this.

Although some of the challenges the two doctors face are different, others are the same. Drugs are one; Gedney’s patients are on meth and more, and she encounters a prisoner with Hepatitis B who has been sharing his shooting-up gear with multiple people. Meanwhile Brown must deal with psychotic episodes brought on by prisoners’ use of spice, a synthetic cannabinoid that is being smuggled in in large quantities. Another phenomenon both must deal with is prisoner-on-prisoner violence. This is especially bad when it comes to those convicted of sexual offences against minors – the “cho-mos”, as they are called in the States; in Britain they are known as nonces. Arriving at the Scrubs, Brown is soon called to the first case she sees of violence against a nonce, a man in his seventies who is lying on the floor of his cell after a savage beating. Later she deals with something even worse:

A sickening indefinable smell hung in the airless room. I swallowed hard to stop myself retching. ...Severe burns covered the man’s naked body. His chest and both arms were blistered and bright red, with some areas oozing watery fluid, suggesting deep second-degree burns.

The man has been attacked in the shower. The other prisoners have flung boiling sugar water over him. This is used because it is more painful – the sugar glues itself to the victim’s skin, so that the boiling water is in contact with it for longer. Meanwhile in the States, Gedney treats a man who’s been subject to a “lock-in-a-sock party”, where a group of prisoners attack a cho-mo with sock that have padlocks stuffed down them. He needs 68 stitches on his head.

Brown describes these attacks but does not comment much on them. Gedney does. At one point she recounts a conversation with a sexual offender in which she clearly tries to understand how he got that way. She also tries to understand the savagery shown to them, and quotes a prisoner saying: “Every group needs someone to hate. Whether you’re white, black or Latino, it doesn’t matter. But what we all agree is hating the cho-mos.” A little later she treats a white supremacist leader dying of emphysema and again tries to get his story and listen to him. She comments: “Maybe I was naive, but it seemed to me that many people in both groups [the supremacists and the molesters] shared similar traits. They had been victims themselves, and then become victimizers. That was a cycle that needed to be broken.”

In general, Gedney is a lot more reflective than Brown – at least in print; the latter may have thoughts she doesn’t express. Brown mostly doesn’t know what her patients are inside for, and likes it that way. However, she does have more to say about them when she gets to Bronzefield, where she does give the story behind some of the prisoners, such as Andrea, whose life has fallen apart after being attacked with a claw hammer and raped; I found thatstory quite hard to read. She also meets women whose substance abuse problems bring them back into prison again and again, but often not for long enough for them to be offered effective help. For many women offenders, this is a very long-running story. As Brown told the Daily Mail’s Claudia Connell (June 23 2019): “One girl, an addict, told me it was her own mother who’d first injected her with heroin when she was 14 years old. She wanted her to earn money as a prostitute and controlling her with drugs was the best way to do it. It’s a part of society I didn’t even realise existed before I started working in prisons.” She also notes in the book that some women actually feel safer inside, having been victims of lifelong domestic violence. This is not surprising. The charity Refuge quotes a 2016 Office for National Statistics report that two women die from domestic abuse in the UK every week.

Bronzefield (Andreas Praefcke/Wikimedia Commons)

Brown says little about the prison system she serves, or about the failings of the particular institutions she has worked in. But it is not hard to find the figures from other sources. The Scrubs is a case in point. An Independent Monitoring Board report in 2017 found that 57 prison officers had recently left but only 21 had been replaced. It found that the staff generally had a positive attitude towards the prisoners and wanted to help them, but that there were insufficient resources, resulting in maintenance problems and unsanitary conditions, delays in medical treatment, and poor access for legal professionals to their clients in the prison. There were 40 to 50 violent incidents a month. Bronzefield, too, has hit the headlines now and then, notably after the death of prisoner Natasha Chin in 2016; she had been recovering from major surgery when readmitted to the prison, and the inquest found that prompt medical attention would probably have saved her. (It should be made clear that Brown was not at Bronzefield at the time; she joined it later that year.)

No-one seems to care about prisons much; they’re where you dump people no-one likes or wants, and nobody seems responsible for sorting them out. One of the few to make noises about doing so was the last Minister of State for Prisons, Rory Stewart, but he was in post for only 16 months; his predecessor, Sam Gyimah, held the post for just two months longer. Both have now not only left government, but been thrown out of the ruling Conservative party altogether for voting against it over Brexit. In the midst of the current mess, the Natasha Chins of this world don’t count for much in the halls of the powerful.

But perhaps Brown shouldn’t be expected to say much about this. Unlike Gedney, she hasn’t yet retired from the system, and like most of us, she can’t just say what she likes about the institutions she works for, and is expected to uphold. She seems frank about what she herself has witnessed, and she clearly cares about her patients. Reading The Prison Doctor, I thought that she probably had made quite a few lives a bit easier, and I suspect she’s saved a few as well. And it is a good read. As for Karen Gedney, she is both deeply humane, and is an excellent writer. 30 Years Behind Bars is an uneven book. It loses focus a bit towards the end, and is probably longer than it needs to be. But if you read it, you will not forget it.

These books left me with two impressions. One is anger that prisons are used as underfunded dumping-grounds for those who, for whatever reason, cannot cope. To be sure, there are also people in there who are just plain evil (and one can’t forget that Gedney was raped). But most of the people Brown and Gedney encounter seem as much vulnerable as anything else, often the product of lives that went wrong at the beginning.

The second impression, however, is more positive. These two women were public servants (and Brown still is). These books do remind you that some people want things to be better and will work to that end, even if there’s a cost to themselves. It’s a feeling strengthened by looking at pictures of the two women; so far as I know they’ve never met and are not likely to, but there’s an odd similarity – they both seem tall, confident and very vital, and both look a lot younger than their years. They also look as if they like to laugh.

In a grim time, I find them rather reassuring.

If you liked this, you might like…

There’s Green. And There’s Green
Two books by prominent green campaigners show us different ways to be green. The utopian – and the pragmatic

Politics on the Edge
A look at Rory Stewart’s landmark political memoir. Should you read it? Yes – but it leaves some things unsaid

Attlee, Bevin and the New Jerusalem
Clement Attlee’s government transformed Britain at home. Abroad, his Foreign Secretary Ernest Bevin did much to shape the postwar world and its alliances. What brought these two very different men together? And who were they really?

The Red Wall – How Labour Lost its Safest Seats
In 2019 Britain’s Labour Party saw its northern strongholds collapse. Why? It is still important to know

If Not Us, Who? If Not Now, When?
A story of courage and resistance from inside Nazi Germany

Love in the Time of Brexit
The 2016 Brexit referendum divided Britain along class lines. Why? Two shrewd, gripping novels on Brexit, class and the dynamics of division

The Polish Anne Frank
The haunting diary of Renia Spiegel

The First Book on the Pandemic…
…appeared in April 202. Slavoj Žižek on COVID, lockdown – and the migrant crisis

Two Fine Novels Inspired by Climate Change
A look at two novels, from American writer Kevin Brennan and the UK’s Alison Layland. They’re very different books, but both show an acute understanding of climate change and the way it shapes the zeitgeist

Doctor in Jail
What are our prisons really like? Two very vivid books by prison doctors – one British, the other American; they pull few punches

The Endgame in the Age of Stupid
Could our society collapse? Yes, and it might be happening right now. Not that I want to alarm you, of course

Why Nations Fail
Daron Acemoglu and James A Robinson shared the 2024 Nobel Prize for Economics. Why? And did they know what they were talking about? A look at their landmark book, Why Nations Fail

Why Europe? Peace, That’s Why
The European Union was never wholly, or even mainly, about economics. It isn’t now

An Anthology of Anger
The Anti-Austerity Anthology is the work of many angry, and sometimes very funny, writers

Tonight in the House: Murder, Booze and More
Jeremy Thorpe, a shocking scandal – and Britain’s House of Commons at its boozy, bonkers best

What is Populism?
Well you might ask. A look at populism, how it’s defined, and how it works

Inequality and Democracy: Can they Coexist?
And if not, what will the endgame be? Revolution? Or gradual decline?

A Higher Loyalty
Who really is James Comey? And what is his beef with Trump? His autobiography, A Higher Loyalty, gave some of the answers – and was better than I expected

Brexit: Reading the Runes
Brexit and British Politics is not the first book about Brexit, but it’s a shrewd and convincing analysis. This referendum wasn’t just about Europe

Being Beastly in Fleet Street
A brilliant, savage new satire on the Street of Shame. But it’s not the first

On Truth and Lies. And How to Show a Troll the Difference
A keyboard warrior’s workshop manual

Don't like anchovies? Don't bother voting, then
There is more than one threat to democracy in Britain, but the worst is an electoral system that seems set up to sabotage it

Post-Factualism
Brexit, the fragmentation of the media, and the rise of post-factual politics

Thinking of Voting Leave? I’d Have Done, Once
From the time of the Brexit referendum

When the Best Lack All Conviction
Two women who didn’t: Rachel Corrie and Heather Campbell

The English Defence League. Served Hot and Cold
Two books looked at the EDL – in very different ways; one was academic, the other more journalistic. Both were good books, and both still have something to tell us about the Right in Britain

Rear-View Mirror
Blood, sweat and tears go into TV programmes and they’re soon forgotten. Or are they? …And do they leave us with shared memories? A very personal look back at some programmes from the 1970s

Cameron’s next five years
In 2015 British Prime Minister David Cameron unexpectedly won re-election with an absolute majority. These were my predictions for his next five years. I got some things rather wrong. But not all of them

So, who were we?
Three Seasons is a book of three novellas, unconnected with each other, but all set in the south of England in the 1980s. These three stories are portraits of a country and its people on the verge of change

Straight from the Sun
Renewable energy will drive a new industrial revolution. That revolution is inevitable, elegant, and already here …Written in 2013

Margaret Thatcher: Unintended Consequences
A piece written on the death of Margaret Thatcher. Did she really transform Britain as she intended? Or did she actually fail to do so, leaving a vacuum where institutions had once been? Some thoughts from 2013

Can the Lentil Save the World?
Well, that might depend on your digestion. A look at the science behind a popular crop. And some rather nice recipes

It’s the Science, Stupid. Or Is It?
Science is under attack. Both Left and Right cherry-pick from its conclusions; they accept or reject climate science or advances in biotechnology according to their prejudices, and examine the evidence on neither. This is dangerous, for all of us

Dimensions of Democracy
What is democracy? Do we oversimplify it?

Mike is now also on Substack at https://mikerobbinswrites.substack.com/

Mike Robbins is the author of a number of fiction and non-fiction books. They can be ordered from bookshops, or as paperbacks or e-books from Amazon and other on-line retailers.

Monday, 15 July 2019

The endgame in the age of stupid

Could our society collapse? Yes, and it might even be happening right now. Not that I want to alarm you, of course

Consider this as the plot of a science-fiction novel. A scientist discovers the secret of eternal life; Juvenex, a pill that rejuvenates. Its results are miraculous. It can reverse the ageing process; one’s hair recovers its cover, the skin its elasticity, the breasts their firmness. The British government wonders whether this is a good idea, knowing that the old, being young forever, will block and frustrate the truly young, and that there will be more and more mouths to feed. But the secret is out; the people clamour for Juvenex; and the government must fight an election against a Conservative opposition that promises to make the drug available. Of course the opposition win, and the Western world starts popping the pill like there is no tomorrow.

Could society collapse? Yes, but there is no cause for
a llama (Wikimedia Commons/Richard H. Moore)

Then a Chinese government hostile to the West discovers that those who have taken the pill are sensitive to radioactivity, which reverses its effects and causes its users to age so rapidly that they become hideous. It starts an extended round of nuclear “testing”. The West spins downward to collapse.

This novel was real enough. It was Not With a Bang (1965), and was by the British writer Chapman Pincher. who died in 2014 aged 100. Pincher was famous in the 1960s and 1970s as a journalist with a particular interest in defence and intelligence. It is less well known that he wrote five or six novels; I don't think many people read them today. Not With a Bang is pretty much forgotten now, and appears to be out of print – a pity, for it is rather good.

The title itself is drawn from the closing stanza of T. S. Eliot’s The Hollow Men (1925):

This is the way the world ends
This is the way the world ends
This is the way the world ends
Not with a bang but a whimper.

Was Eliot right? Pincher clearly thought so; in the closing scenes of Not With a Bang, thousands of people, grotesquely aged, bent and deformed, shuffle together into the sea. But Robert Frost, writing like Eliot in the wake of the First World War, was not so sure:

Some say the world will end in fire,

Some say in ice. From what I've tasted of desire

I hold with those who favor fire.

Eliot himself would say in old age that the hydrogen bomb had negated this closing stanza of The Hollow Men, and that he would not have written it again. But of course we do not know how our world ends – with fire or ice, a bang or a whimper.

Or do we?

When the Soviet bloc collapsed in 1989 there was a tendency to believe that the capitalist, liberal democracy had triumphed and would now prevail everywhere; that this was, in Francis Fukuyama’s famous phrase, the end of history. A few of us, at least, must have realised early on that this was pernicious nonsense and that, far from being freed from history, we should soon have a surfeit of it. Moreover history is not fated to progress. It can go backwards.

Which brings us to the first of three important books. It's by Joseph Tainter.

Tainter is a Professor in the Department of Environment and Society at Utah State University. He trained as an anthropologist at Berkeley, obtaining his PhD in 1975. He has published widely (the publications list on his CV goes on for several pages). But he is best known for his landmark book The Collapse of Complex Societies (1988).

There have been plenty of books on the collapse of civilization. There is no mystery as to why, according to Tainter. “The image of lost civilizations is compelling,” he writes in Collapse. “Cities buried by drifting sands or tangled jungle ...The image is troublesome to all, not only for the vast human endeavors that have mysteriously failed, but also for the enduring implications of these failures ...civilizations are fragile, impermanent things.”

And yet, argues Tainter, there has been relatively little study of how complex societies collapse. There has been a “seemingly inexorable” trend towards complexity, the growth of ever-larger settlements, and technology. We now understand more and more about the way this happens. “Yet the instances when this almost universal trend has been disrupted by collapse have not received a corresponding level of attention.” In fact, on the evidence of Tainter’s own literature review in Collapse, it has had quite a bit of attention. But that review does show how fragmented and, at times, subjective that study has been. Tainter’s aim is to present a dispassionate theory of collapse based on the evidence, and that he has done.

He begins by telling us what collapse looks like. He describes a number of collapses, from the Western Chou Empire to the Chacoans and Hohokam of New Mexico and Arizona respectively. At times he adds detail that the archaeologists have found; thus the end of the Casa Grande society in Mexico: “The dead were buried in city water canals and plaza drains.” He quotes Stanley Casson’s 1937 book, Progress and Catastrophe: An Anatomy of Human Adventure, in which the author talks of the sudden desolation in what had been Roman Britain after 400 AD. In his own time, Casson had also witnessed Istanbul after the collapse of Ottoman authority in 1918, with intermittent electricity, abandoned trams littering the streets, corpses at street corners, dead horses, no drains, unsafe water and “a police force which had largely become bandit, living on blackmail from citizens in lieu of pay ...All this was the result of only about three weeks’ abandonment by the civil authorities of their duties.” This last example, especially, encapsulates the fear we all feel about a sudden breakdown.

Tainter defines the collapse of a complex society. It occurs when there is “a rapid, significant loss of an established level of sociopolitical complexity.” This includes the loss of specialization – of individuals, but also of geographical entities. The loss of distinct occupations is important. Tainter states that a hunter-gatherer society may contain only a few dozen “distinct social personalities” (in fact one suspects it is less). But a modern European census will, he says, recognize 10-20,000. This prompts questions about definitions and overlap; my cobbler also cuts keys. Conversely, the title of nurse practitioner could cover a number of specialized roles that are actually quite distinct from each other. Still, the point is clearly valid in principle. The Istanbul example is a case of individuals with specialized functions ceasing to perform them. It is also an example of something else: the loss of technology that breaks down, as Tainter puts it, “without the assistance of a bureaucracy that no longer exists.” (That may resonate when we look at the last of these three books, by Michael Lewis. )

Tainter makes a distinction between complexity and civilization; he insists that he is discussing the first and not the second. Indeed he regards the very word ‘civilization’ as a value-judgment, as as a strict rationalist, he does not like those. He is particularly rough on the historians Arnold Toynbee (A Study of History) and Oswald Spengler (The Decline of the West). “Such biases have no place in objective social sciences, and a concept [civilization] that is so laden with this problem is better abandoned or rethought.” In any case, he points out, the collapse of complexity need not be followed by the immediate disappearance of all cultural phenomena. But his own discussion of societal collapse suggests that it often is (in particular, in the case of the lowland Maya, which he discusses in detail). In any case, even if one accepts his statement at face value, the concept of ‘civilization’ – what constitutes, in a sense, almost the whole of our non-mechanical life outside the family unit – is widely accepted, even if badly defined. To most of us, a wholesale collapse in complexity does equate to a collapse of our civilization, however we may define it; everything meaningful will be lost, and this explains our fear of dystopia.

Moreover Tainter rarely acknowledges the human suffering that collapse will bring although the Casa Grande example alone, with the dead buried in drains, reminds us of the implications of his work. The collapse of the lowland Maya seems to have resulted in a population drop from around 3 million to about 450,000 in just 75 years. In the last years, according to archaeologists who have examined the bones, the population was increasingly stressed and weak. Tainter does not say so, but this must have involved terrible suffering. No matter. Tainter is determined to be completely objective, and that does explain why his theory of collapse commands as much respect as it did when The Collapse of Complex Societies was first published over 30 years ago.

That theory, crudely stated is this: As a society grows more complex, the cost of that complexity will rise. It is not hard to see why. Everyone who moves away from the land and into a specialized role (let us say, from peasant to stablehand, or from stablehand to clerk) moves farther from primary production, and is producing nothing directly. (Tainter defines that production, including food, as energy.) Moreover their training will become more specialized and thus more expensive. Meanwhile the cost of their subsistence falls upon those still producing that energy in the form of bread, pulses, whatever.

Of course the specialized roles do contribute to primary production; that clerk may be helping to maintain an irrigation system, or a doctor may cure maladies that would otherwise need palliative care, the cost of which would fall on everybody. This is because societies become complex in order to solve problems (such as irrigation or healthcare). But at some point the return on this specialization will fall relative to their cost. “Investment in sociopolitical complexity as a problem-solving response,” says Tainter, “often reaches a point of declining marginal returns.” He explains why in terms of what he refers to as an “energy subsidy”; as societies grow in complexity, the surplus production this requires will be gained through conquest of new land or through new sources of energy. These will be acquired in order of their ease of acquisition. The Romans naturally occupied the nearest and most fertile lands first; it was easier to bring grain from North Africa by boat than by land from inland Europe. And the English turned to coal when they had cut down the forests; as they dug deeper to get it, the steam engine became necessary to pump water out of the deep workings. And so to fracking and to nuclear energy, with the specialized roles they require; all are more complicated, and require more effort and training, per joule released than burning wood.

Complexity grows. The energy subsidy becomes harder to obtain. The rate of return is falling. At some point society will cease to support its complexity, because its costs have weakened the population (as in the case of the Maya) or because the state demands so much taxation from its people that they find its dissolution a rational choice. In fact the latter is Tainter’s view of the Roman Empire; the barbarians were not resisted, in Tainter’s view, because doing so had become so costly in taxes that the peasants thought them a better option; and they were, at the time, right. Civilization (or, for Tainter, complexity) does not “become decadent”. It simply fails to provide the return on investment that it needs to survive.

The Collapse of Complex Societies is an impressive book; a masterclass in clear thinking and expression, the collection and ordering of evidence, and the processing of facts so that they become knowledge. It should probably be compulsory reading for anyone about to embark on a Masters dissertation. But that does not mean we can’t pick holes in it if we choose. For one thing, to me Tainter is too dismissive of the environment as a cause of collapse. He does not ignore it, but says that environmental challenges are problems and complexity is a problem-solving strategy; in effect, if complexity can’t deal with (say) climate change, then it has failed to provide that marginal rate of return on investment. This may be too simple. Biophysical factors – desiccation, a vile winter, disease – can appear in forms that a society had no reason to expect. But it is true that the environment is one of many challenges that complexity is supposed to meet and a society may be judged by the extent to which it does so, a point well made in Jared Diamond’s much more recent book, Collapse.

Another point that Tainter does not address – and in this case, he does not raise it – is that a complex society may yield sufficient returns and yet not be perceived as doing so. It’s with that in mind that I move on to the second of these three books.

Tom Nichols is a lecturer in international and strategic affairs who taught for some years at two of America’s most exclusive institutions, Dartmouth College and later Georgetown University. He is now Professor of National Security Affairs at the U.S. Naval War College, a venerable institution in Newport, Rhode Island. He is a conservative, though with a small C; he never bought into Trump and finally left the Republican Party after the Kavanaugh confirmation hearings. In 2017 he published The Death of Expertise: The Campaign Against Established Knowledge and Why It Matters. It’s just been republished in a new paperback edition.

The Death of Expertise is, in some respects, a good old-fashioned rant. The possession of facts does not, says Nichols, equate to knowledge, but too many people do not understand the difference. The Internet has driven some of this, making everyone an instant expert. It offers an “apparent shortcut to expertise”, but actually just a limitless supply of facts, which does not constitute knowledge. “The Internet,” says Nichols, “lets a billion flowers bloom, and most of them stink.”

Ignorance, says Nichols, has become hip. He cites the raw milk movement – people who demand untreated dairy products. He quotes the New Yorker (Dana Goodyear, April 2012) saying that untreated milk, which is often from pasture animals, is sometimes “richer and sweeter, and, sometimes, to retain a whiff of the farm – the slightly discomfiting flavor known to connoisseurs as ‘cow butt’.” As Nichols points out, the Centers for Disease Control reckon unpasteurized products are 150 times more likely to cause food-borne illnesses. Still, says Nichols, it’s a free country, and if adults wish to risk a trip to hospital for “the scent of a cow’s nether regions in their coffee”, that’s up to them. He also describes how Gwyneth Paltrow has encouraged people to steam their vaginas, which she claims (he says; I haven’t checked) cleans your uterus and helps balance your hormones. People have always been stupid, but the Net does not help; as he says, “in an earlier time, a sensible American woman would have had to exert a great deal of initiative to find out how a Hollywood actress parboils her plumbing.”

All of which is funny, but actually not new. People do not need the Internet to be daft. I remember, a few years before it arrived, there was a fad for colonic irrigation, which some very fashionable people did in London in about 1990. I asked a doctor friend what the health benefits were likely to be. “Peritonitis,” she said crisply. The following year I was travelling in Ecuador and found a craze for the so-called “pulsera de balance”, a wrist ornament that was supposed to deliver energy and equilibrium. In an earlier era the travel writer Norman Lewis and his brother-in law, passing through Madrid in 1934, decided to investigate a reported mania amongst madrileños for drinking animal blood. They visited a slaughterhouse, but were “deterred by a woman on her way out, made terrible by the smile painted by the blood on her lips.” We have never needed the Internet to be bizarre.

However, Nichols is not simply being (or at least, only being) a grumpy old man. There is a serious point here. “Laypeople must take more responsibility for their own knowledge, or lack of it; it is no excuse to claim that the world is too complicated and there are too many sources of information, and then to lament that policy is in the hands of faceless experts who disdain the public’s views.” This is not just about parboiling one’s plumbing; in ceasing to respect expertise, people no longer acknowledge that the world cannot be run without it. “It is ...ignorant narcissism for laypeople to believe that they can maintain a large and advanced nation without listening to the voices of those more educated and experienced than themselves.” This was directly reflected in the 2016 election result, according to Nichols. Trump’s election was, in his view, partly achieved by sneering at experts – which tapped into a long-standing American prejudice.

Why is this happening? Nichols has more than one target; the Internet, to be sure, but also a decline in academia. He opines that universities are not teaching critical thinking; that they are instead just peddling the “college experience”, part of the “commodification of education”. Given the mountain of debt with which students emerge from college, it is not surprising that they see themselves, sometimes, as customers, rather than realise they are there to learn intellectual rigour. This is also a problem in the UK, where the introduction of tuition fees means that students are, increasingly, being sold a product, and that they expect to get concrete promised returns afterwards, having paid for it. A recent £65,000 settlement won by a student in England because she felt her degree was not meaningful could be seen as a demonstration of this. Objective data on whether universities really are commodifying and abandoning the obligation to make people think is hard to find, and universities have always varied in quality. Still, Nichols may have a point – he talks, for example, about lecturers being evaluated the way a Yelp review is done of a restaurant, and it is by definition absurd to have situations where all the students are above average.

Nichols also blames the media for failing to check facts and for spreading disinformation through sheer laziness. The classic case he describes is a story that claimed new research had found that chocolate helps weight loss. There is of course no real evidence for anything of the kind. The story had been cooked up by a science writer, John Bohannon, to demonstrate bad science and how easily its “results” could be accepted. The institute claimed to have done the research did not exist. But the journalists who spread the story did nothing to check (“I Fooled Millions into thinking Chocolate Helps Weight Loss. Here’s how”). It wasn’t difficult because journalists are lazy and want a ready-made story.

I have seen this myself. Early in 2019 a right-wing, anti-European British MP, Daniel Kawczynski, tweeted angrily that Britain had received no aid at the end of WWII – “No Marshall aid, unlike Germany; nothing,” he wrote. I knew this was not true, and it took me seconds to confirm that Britain actually got the largest single share of Marshall Aid, some 26%. I tweeted back to this effect. I was genuinely angry that an MP should spread disinformation in this way, and my tweet was perhaps a little rougher than it could have been. Hundred of people picked it up. The next day I found that a British paper had made a story out of the the original tweet and my response. It was a “news” story that I could have written myself in five minutes. Moreover the paper in question never links to its sources. Not all journalists are like this, of course – one could cite much better ones like Carole Cadwalladr and her long dig into the funding of the Brexit campaign, or Will Saletan of slate.com, who wrote in depth about GMOs. But Nichols is right; the media are part of the problem.

Academics get a battering as well. Nichols devotes a chapter to saying that experts themselves have been producing research that cannot be replicated (there is a “replicability crisis” going on, especially in some areas of the social sciences). There is great pressure on academics to publish, which does not help. Neither are research journals always so rigorous as they should be. I cannot help wondering how Andrew Wakefield’s notorious MMR-and-autism study was published by the The Lancet, but it would at least not have done it had it suspected that data had been falsified. Other journals might not have been so scrupulous.

All of this has helped build public distrust of “experts”. But perhaps the most important factor is one that Nichols mentions only briefly. He quotes political scientist Richard Hofstadter, writing in Anti-Intellectualism in American Life (1963), as follows: “In the original American dream, the omnicompetence of the common man was fundamental and indispensable… Today, he knows that he cannot even make his breakfast without using devices ...which expertise has put at his disposal; and ...he reads about a whole range of issues and acknowledges, if he is candid with himself, that he has not acquired competence to judge most of them.” Hofstadter said that this complexity induced feelings of helplessness and anger among a people that knew they were at the mercy of smarter elites. “Once,” says Hofstaedter, “the intellectual was gently ridiculed because he was not needed; now he is fiercely resented because he is needed too much.”

This is a rich vein that Nichols could have mined much more deeply than he does. If people seek to abandon complexity, could it be as much because of this as because of Tainter’s declining marginal rate of return on it? As Nichols himself says, Trump’s election was partly achieved by sneering at experts, which tapped into a long-standing American prejudice. “Trump’s eventual victory ...was ...undeniably one of the most recent – and one of the loudest – trumpets sounding the impending death of expertise.” And he adds elsewhere: “It is ...ignorant narcissism for laypeople to believe that they can maintain a large and advanced nation without listening to the voices of those more educated and experienced than themselves ....The celebration of ignorance cannot launch communications satellites ...or provide for effective medications.”

Which brings us to Michael Lewis.

Lewis is a successful writer and journalist with 18 non-fiction books to his credit. Originally from New Orleans, he graduated in art history and wanted to pursue it as a career, but found there was no money in it so became a bond salesman in the City of London instead. After a few years he returned to the States and became a financial journalist. Now in his late fifties, he has written widely on Wall Street, the roots of the financial crisis and subjects as diverse as technology and baseball. He has a particular interest in risk.

In 2017, he wrote a series of pieces for Vanity Fair on the transition to the Trump administration, highlighting the Department of Energy, the US Department of Agriculture (USDA) and the Department of Commerce. In 2018 these pieces matured into a book, The Fifth Risk. It looks at the experiences of the civil servants in those departments as Trump took over. This sounds like a rather dull book. It isn’t. Lewis has a clear, deadpan approach; he nowhere tells the reader what to think, but you are left in no doubt, at the end, of what you have learned.

In essence, Lewis describes an administration with no interest whatever in the government machine and no understanding of what it does. Normally, a candidate recruits a transition team that will base itself in Washington in the later stages of a campaign, preparing policy and choosing and screening the several thousand political appointees that will need to be put into the various departments during the period between the election and the inauguration. Of Trump’s team, only Governor Chris Christie understood how important this would be, and how much work would be involved. Trump himself did not, and only reluctantly permitted Christie to set up such a team.

Three days after the election, Christie and much of his team were fired, and the files and references they had collected were junked. Over the next two months, the senior civil servants at the three departments waited for the Trump transition teams to arrive. Almost none of them did, leaving the machinery of government rudderless. The staff at Energy were taken aback when, quite simply, no-one turned up. Two weeks after the election, they read in the papers that one Thomas Pyle, an energy-company lobbyist who had worked for the Koch brothers, was to lead the transition team at Energy. Pyle visited once, briefly, but then stayed away. He eventually sent a request for a list of officials who had been involved in climate meetings. He then disappeared. Meanwhile the Chief Financial Officer of the Environmental Protection Agency under Obama, Joe Hezir, received no instructions as to whether he should go or stay. “Not knowing what to do, but without anyone to replace him, the CFO of a $30 billion operation just up and left,” says Lewis. Even six months after Trump took office, there was still no-one to run the federal disasters management agency, FEMA; the Transportation Security Administration (TSA); the Centers for Disease Control; or the Patent Office. When the senior appointees finally did appear, they seemed mainly chosen to dismantle their departments and had little interest in understanding their work.

Having told us all this, Lewis then briefs us on the wide range of things these department actually do – far more than we suppose. The US Government’s two million employees manage a portfolio of risks that no smaller entity could manage. They include the obvious ones, such as financial crises, terrorist attacks and hurricanes. But they also include those we are less likely to think of, such as a prescription drug suddenly proving to have been addictive and dangerous, and killing thousands of people a year (Lewis does not say so, but he is clearly thinking of the opioid crisis). Other risks, Lewis adds, feel unreal – a virus that kills millions, economic inequality that causes violence, and so on. “Maybe the least visible risks,” he adds, are “of things not happening that, with better government, might have happened. A cure for cancer, for instance.”

What Lewis is describing is complexity, and the many skills on which it draws. As we’ve seen, Tainter pointed out that a modern European census will recognize 10-20,000 distinct roles. I also quoted above Nichols’s statement that: “The celebration of ignorance cannot launch communications satellites ...or provide for effective medications.” But what this complexity also does is manage risk.

Lewis interviews the former Chief Risk Officer of the Department of Energy and is told that there were five key risks that the Department must manage. The first four are nuclear weapons, loss of or accident with; the nuclear threat from North Korea; likewise from Iran; and threats to the electric grid. The fifth risk, which gives the book its title, is project management. Lewis does not explain the latter; he is a show-not-tell writer and takes us instead to one of the DoE’s biggest projects, the Hanford nuclear facility in the Pacific Northwest. In 1943 the US army evicted the population of a large area in eastern Washington State and transformed it into a nuclear facility. Between 1943 and 1987, when it closed, Hanford created two-thirds of the US’s plutonium and supplied the material for 70,000 nuclear weapons. It is now being cleaned up. According to Lewis, the DoE spends $3 billion, or 10% of its budget, into the place. Asked what it would take to clean it up, the former Chief Risk Officer tells Lewis: “A century and a hundred billion dollars.”

“The people who created the plutonium for the first bombs, in the 1940s and early 1950s, were understandably in too much of a rush to worry about what might happen afterward,” says Lewis. “They simply dumped 120 million gallons of high-level waste, and another 444 billion gallons of contaminated liquid, into the ground. ...They dug forty-two miles of trenches to dispose of solid radioactive waste – and left no good records of what’s in the trenches. ...Beneath Hanford, a massive underground glacier of radioactive sludge is moving slowly but relentlessly toward the Columbia River.”

In short, complexity still generates that rate of return, for its loss would be a catastrophe.

What has changed is not that rate of return but our perception of it. Joe Klein, reviewing The Fifth Risk in The New York Times in October 2018, asked whether we have: “Grown too lazy and silly and poorly educated to sustain a working democracy? We live in a moment when tribal bumper stickers — both left and right — pass for politics, when ignorance and grievance drive policy. The federal government exists at a level of complexity most people just can’t be bothered to understand. We have little idea what it does, only the vague sense that it doesn’t do anything very well.”

Richard Hofstadter was right; we resent our lack of control of complexity. But we cannot do without it, and if resentment and willful ignorance make us try, we will find out why. Especially if we live near Hanford. That underground glacier of radioactive sludge could be our future; this is the way the world ends – not with a bang but with a peevish, agonised, long-drawn-out whimper.

But it hasn’t happened yet, and I do not believe in any form of predestination. I began this piece with a quotation from T.S. Eliot’s The Hollow Men. Let’s end with one from his Little Gidding (1942):

Sin is Behovely, but
All shall be well, and
All manner of thing shall be well …

The words are not Eliot’s; they are those of the 14th-century Julian of Norwich, a woman who witnessed a savage age (she lived through the Black Death), but in whose teachings God is seen as ultimately loving and merciful. These words tell us that sin – by which, it seems, she meant all bad things – is necessary (‘behovely’) for our self-knowledge, but that God will forgive all. So perhaps that radioactive sludge, or some other avoidable disaster, will be our wake-up call; and “all manner of thing” may yet be well. After all, Tainter is describing a mechanism; he at no point says that it is our certain fate. It is for us to create our future, and we can do so.