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Shostakovich, in his memoirs (whose authenticity some have disputed), describes a minister in the Soviet Union praising a great Soviet cultural event, such as (says Shostakovich) the closing of a theater. Not very long ago, the medical director of the hospital in which I used to work sent an e-mail to all its staff describing a forthcoming glorious event in the hospital’s long history, namely its closure. This, he told the staff, was a great opportunity; at last we were masters of our own fate.

Who the we were to whom he referred he did not actually say: presumably they did not include the staff who would not be re-employed when a new hospital to replace the old was supposedly built. Nor did he say in what way the we who remained would be masters of their fate in a way in which they had not been masters of it before. Certainly, the glossy propaganda-type news-sheet that the hospital, in common with all other British public hospitals, had put out and distributed to its staff before the closure, in which the Chief Executive was surrounded by workers as happy and smiling as the peasants in the Soviet press at the height of a famine, never spoke of anyone not having been the master of his fate. The medical director spoke inspirationally without inspiration, as it were. This was not truth speaking to power, but cliché speaking to fear and impotence.

The hospital had a long and distinguished history, and as the book published on its centenary showed, was a source of local pride. It had even had an architectural magnificence before the state-sponsored modernizers, with their indifference to or even hatred of aesthetic considerations, started on improvements, after which it quickly became a visual nightmare. But for a long time it retained its distinction, with doctors of national and international eminence in their fields.

What was striking, however, about the response to the medical director’s announcement of the closure—“No longer can we blame others for thwarting our ambition, the ball is in our court and the game is ours to lose,” to quote its immortal prose—was its absence. Here was another dog that did nothing in the night-time, just as revealingly as the inactive dog in “Silver Blaze.”

In fact, silence is what greets virtually all pronouncements by the highly-placed in our bureaucracies, no matter how idiotic or malign they may be. Fear has been successfully inculcated, whether by accident or design, in almost all such bureaucracies, so that people are afraid to speak frankly even to their close colleagues, for walls have ears and saying something deemed offensive or discriminatory, failure to use the currently approved aseptic terminology, or criticism of the current policy (which, of course, can change as quickly as Eurasia’s enemies in Nineteen Eighty-Four, if Big Brother so decides), can lead to disciplinary action that is time-consuming, anxiety-provoking, and emotionally wearing, and that can affect an individual’s prospects of promotion irrespective of the outcome. On the immemorial principle that there is no smoke without fire, a person against whom a complaint is made, no matter how frivolous, becomes known as a troublemaker or loose cannon, and therefore unsuitable as a member of a conformist team.

Far from calming tempers, the treatment of offense taken as prima facie evidence of offense given, which is now standard policy in British bureaucracies, pursuant to which, for example, a person is deemed to have been bullied if he merely feels he has been bullied, inflames them. It puts a weapon into the hands of the oversensitive, the paranoid, the fragile the vengeful, and the malcontent. It creates a climate of fear and recrimination; by doing so, it not only makes people manipulable because fearful people are easy to manipulate, but gives powers of adjudication to those higher in the administration, thus having an infantilizing effect on lower levels. An office becomes a kindergarten, in which one child runs to teacher and says, “Please, miss, Joey just pulled my hair,” and the other responds, “She pulled mine first, miss!”

The hierarchy treats its staff in trivial matters as if it were made of eggshell as a quid pro quo for an authoritarian manner in more important ones. If you can get people to concentrate on their feelings rather than on their thoughts or on rational arguments, the threat of rebellion against, or worse still, public exposure of, idiocy is much reduced.

Not that sterner measures by the bureaucracy are neglected in the event of any sign of dissent among the lower orders. The staff of a hospital which I used sometimes to visit were one day sent a form to fill in by the personnel department—now charmingly known as human resources, as if people were a kind of ore to be mined—that asked them for their race, religion, and sexual orientation. This, said the covering letter, was so that the hospital could continue to pay them properly. No explanation was forthcoming as to the relevance of race, religion, or sexual orientation to rates of pay in the hospital.

On the form were seventeen races, seven religions, and (if I remember rightly, which it is possible that I do not) six sexual orientations. At any rate, there were several hundred possible categories of employee, all to be paid correctly according to the category into which they fell. Perhaps fell is not quite the word: for according to the form you could choose the race that you were, and the hospital personnel department would consider you to be the race you felt yourself to be. If you felt Polynesian (which, unfortunately, meant that you would have to declare yourself as merely none of the above), then Polynesian was what you were, at least for administrative purposes. As for sexual orientation, I am afraid that the briefest of looks into Richard von Krafft-Ebing’s Psychopathia Sexualis would have exposed the woeful inadequacy of the classification used by the personnel department, whose work, I suppose, is not conducive to imagination about the sexual possibilities of the human race.

There was no outrage or revolt over this form, in which the absurd vied with the sinister for dominance, and many of the staff completed it, as if frightened not to do so.

Now, it so happened that at that time I supplemented my income very slightly by publishing some of the official circulars I received in my hospital from either the government or the administration, accompanied by a little commentary (not much was needed), in a political weekly. A medical secretary of my acquaintance in the hospital in which this form had been distributed knew this and handed the form on to me. I duly published it, with a little light mockery; the secretary then copied the article and posted it on several notice boards in the hospital.

The management found out that it was she who had done this: someone must have informed on her, just as happened to Josef K. She was summoned to the management’s office and given a stern warning that she would be dismissed if she ever did anything similar again. An intelligent woman—actually more intelligent than the managers—she was, in effect, told not to think for herself but accept passively whatever was required of her.

Such overt intimidation is not the only means of assuring compliance and silencing opposition. One means of controlling professions that are potentially dangerous for the government and the bureaucracy it thinks that it controls (even if the potential danger from the professions is actually very slight and more a figment of the imagination than real) is to emasculate its members by forcing them to comply with regulations that are patently absurd and have nothing whatever to do with professional fitness or competence.

Shortly into the Labour government that ruled Britain between 1997 and 2010, an eminent doctor and supporter of the Labour Party, Robert Winston, whom that party had elevated to sit in the House of Lords, remarked in an interview in the New Statesman that the Health Service was deteriorating rather than improving under its stewardship. He was provoked into saying this because of the appalling and callous care, or lack of care, that his aged mother had received, and with which many in the country were all too familiar.

Irrespective of whether his claims were true or not, the government was in a panic. The fact is that the public believed Lord Winston, as an eminent member of the medical profession, and not government ministers who tried to contradict what he said and thereby undo the damage. The government learned to its dismay that, while trust in politicians had declined to the vanishing point, doctors were still, on the whole, trusted, respected, and liked, though perhaps a little less than they had once been. It was this continuing public trust that supposedly made them dangerous; in any contest between the medical profession and the government, the former would have the public’s support.

Since it is easier to destroy trust in others than make oneself trustworthy, especially if one is a politician, the independence and probity of the medical profession was consistently attacked and undermined. (Incidentally, this is a particular instance of a general phenomenon. There is nothing that a centralizing government hates more than a professional body independent of itself.) To be fair, this process had been started before, but it was much accelerated.

The medical profession was henceforth not to be self-governing, as it had been for nearly a century and a half of not inconsiderable medical progress. Complaint against the profession, however, was actively encouraged—some complaint is, of course, always justified, for it is impossible for any large group of men and women always and everywhere to behave impeccably—on the spurious grounds that the threat of complaint acts as a restraint on wrongdoing. On the contrary, it acts as a spur to more complaint. Doctors are now enjoined—enjoined—to tell their patients how to complain before they start a consultation. Patients are routinely given detailed leaflets about how to complain. In the waiting area of the outpatient department of the hospital in which I worked, the management had allowed a firm of lawyers to advertise on the hospital CCTV system to the waiting patients (no one, of course, can be expected to go five minutes nowadays without entertainment, which in effect is compulsory entertainment), with the following jingle just to put them in the mood:

Remember, where there’s blame

There’s a claim . . .

One might say that this is a programmed destruction of trust in both directions: patients of their doctors and doctors of their patients.

Some of the doctors themselves are encouraged to complain. The General Medical Council, the regulatory body of all doctors in the United Kingdom, has, as you would no doubt expect, a strong commitment to what it calls “equality and diversity.” I quote from its website:

The themes for our equality and diversity strategy are the result of consulting with our staff, other organisations, and networks representing the views of people with protected characteristics. We are doing more work to set out how we will measure our progress and impact. Some examples of what we would like to achieve include the following.
People who share protected characteristics (including doctors patients and the public) believe that we treat anyone involved in our work fairly, whether they are raising concerns, applying for registration, sitting examinations, being revalidated, or involved in our fitness to practise procedures.
We help to make sure that all patients receive good standards of care by giving doctors guidance and support to understand and meet the needs of patients with protected characteristics.
We have stronger relationships with organisations representing the interests of doctors and patients with protected characteristics. We have comprehensive equality and diversity data on registrants and complainants, and a good understanding of how our activities affect people with protected characteristics . . .

Detailed examination of this passage is beyond my present scope, and in any case it would take pages to expose its equivocations, evasions and dishonesty. How, for example, can a comparative term such as “stronger relationships” fail to mention what those relationships are supposed to be stronger than? Stronger than they were before, stronger than with other organizations? One suspects that what is meant is strong relationships with pressure groups led by self-appointed political entrepreneurs. As for the term “people with protected characteristics,” it is a sinister euphemism worthy of any totalitarian society. The least one might expect of a regulatory body is that it used language as clearly as possible; failure to do so renders its powers arbitrary and therefore indefinitely expandable. What the above passage makes clear, however, is that there is a desire to set people against one another, to destroy informal trust, and to stimulate fear: free speech cannot survive so radical a loss of trust.

Worse still, doctors are now made to jump regularly through a series of bureaucratic hoops, only very few of which are conceivably related to making them good or better doctors, and none of which has been proved to do so. The purpose of these hoops, however, is really quite otherwise: it is to force doctors to participate in procedures which they know to be meaningless, but which they nevertheless do participate in, merely for a quiet life and to be allowed to practice their profession at all. But in going through the motions, they lose their sense of independence, their pride necessary to be self-directed, and become ciphers or careerists. Careerists there have always been, but this is intended to promote careerism as a universal characteristic. Careerism makes people fearful and therefore both manipulable and disinclined to speak their minds.

Their probity is destroyed; and probity is necessary for genuine freedom of speech. This probity does not have to be universal for freedom of speech to exist, but it has to exist. I will give one small example of how it is destroyed.

Doctors in the United Kingdom now have to go through a procedure called “annual appraisal,” in which a series of pro forma questions are asked of a doctor by another doctor, who may have become a specialist in such appraisals, easily capable of earning £2,000 a day by performing them (every regulation is a certain kind of entrepreneurial opportunity). One of the questions that the appraiser has to ask is “Do you have any concerns about your probity?”

When I was first asked this question, I told the appraiser that I would answer it on the condition that he answered two questions. He agreed, and I asked the two questions.

“The first,” I said, “is ‘What kind of person would answer such a question?’ and the second is ‘What kind of person would ask it?’ ”

“Oh, I know,” he replied, “but just answer ‘No’ so that we can get this over with.”

In other words, a single brilliantly framed question destroys the very quality that it asks after, namely probity. And of course people who have had their probity destroyed, who know that they ought to have protested but have not, are much more likely to seek a quiet life, not to draw attention to themselves, or, to use an expression much in use among prisoners, to get their head down and do their bid, than those who have their probity intact.

This relentless process of regulation, supposedly for the general good, legally imposed and enforced, often with the connivance of those who should and almost certainly do know better, is not of course confined to medicine. I should be surprised if teachers at universities, for example, could tell no similar tales. Mistrust, fear, emasculation, compliance with untruth: these are not propitious for free speech and, perhaps worst of all, require no official censor to restrict it. The population will restrict it all by itself.

In my travels in the communist world in what I suppose, in the light of subsequent developments, we must now call the good old days, I came to a realization about its propaganda, at least for internal consumption, that was, perhaps, pretty obvious, though not immediately to me. It took a little reflection on my part to come to a conclusion that no doubt will seem to you utterly banal: namely that such propaganda was not intended to persuade, much less to inform, but to humiliate. For this reason the less true it was, the better, for by not only forbidding contradiction to its claims but demanding assent to them, the human being’s sense of independence and worthiness as an individual was destroyed from within, as it were, gnawed away until it no longer existed. The more preposterous the claims and the more obvious the defects in reasoning, the more effective they were, especially for intelligent and educated people. And this process of human destruction, perfected as never before in the Soviet Union and its satellites, is now far advanced in Britain and I daresay in the rest of the Western world.

To understand the process, it is necessary, and probably sufficient, to read three authors: Gogol for the pervasive absurdity, Kafka for the pervasive fear and menace, and Orwell for the pervasive lies. Never have all three been united in so smooth-running and self-perpetuating a way as in our contemporary world.