Afterword

Liver Disease and Sociology

In May and June of 2013 I found myself, rather unexpectedly, in a hospital in South Wales, suffering from severe liver disease. When I arrived on an afternoon full of the still gloom of a low grey sky, the consultant admitted me on sight. He was a calm and indestructibly cheerful man, but he did tell me weightily that there is a thirty per cent mortality rate in cases in which the disease is as advanced as it obviously was in me.

‘You mean that I have a seventy per cent chance of survival’, I said brightly, and he nodded. Although I would make what they called ‘a remarkable recovery’ in the next weeks and months, I later discovered that both the consultant and my own GP thought that I would probably die at the time I went into hospital.

Solzhenitsyn begins his excellent short story The Right Hand - based on his experiences as a cancer patient in the 1950s - as follows: ‘When I arrived in Tashkent that winter I was practically a corpse. I came there expecting to die.’ But I did not feel like this at all. Despite my massively swollen belly, the dramatic amount of weight I had lost and my discoloured skin, I never believed that I would die, not even that there was a thirty per cent chance of my dying. I spent the first night in great pain and then in a remote state of blurred euphoria brought about by powerful injected painkillers. However, on my second full day in hospital, I dressed and went outside to walk around the car park on legs that were still tottering and unsteady. After that, I walked every day, in sunshine or in rain, ranging further and further around the hospital grounds and just outside them. I was convinced that the exercise was helping me to recover. I was deeply impressed by the care I was given by the nurses, mainly women, although there were a few male nurses, and by the doctors. I had never taken out medical insurance or paid into a private healthcare scheme in my life, and yet, apart from lacking a private room, I could not imagine being given any better care as a private patient. The humanity and warmth of the nurses were astonishing. My only cause for resentment was the way in which ‘domestic’ workers were treated - the people who cleaned the ward, the bathrooms and the toilets, as well as bringing and serving the meals. They seemed to be put upon by their own supervisors and treated as invisible - or with contempt - by most of the doctors and some of the nurses. I liked the cleaning and catering staff, and I hoped they liked me. One of them, a slim, tough woman with short dark hair, had left her work and showed me the way to the hospital shop and the main entrance on that first walk I took on my weak and uncertain legs. I channelled the frustration and tension that goes with any prolonged stay in hospital into standing up for them whenever I could and declaring loudly in front of doctors and nurses that the whole place would cease to function without their efforts.

Along with my daily exercise I kept my own written record of my condition as it changed day by day, as well as reading and writing. I was delighted when my wife asked me to write some extended notes for a student she was mentoring who was struggling with two essays on Marxism. One of the books beside my bed was Marxism in the USA by Paul Buhle, a gift from my daughter. One day, Tracy, an auxiliary nurse, picked it up and looked at it and began telling me that she had taken a degree in sociology, being thus overqualified for many jobs in the National Health Service. Fortunately, she liked the job she was doing. Things were not easy in my life at that time and the high dose of steroids I was taking often made my emotions seethe like a pan of pasta sauce with the heat turned up under it. Tracy, with her stylish spiky hair, humour and easy gracefulness, was one of those women who improve and warm the atmosphere of any room they enter. Just before the dawn that followed a sleepless night, as I sat on my bed in tears, she sat beside me and talked to me and hugged me.

Some of the men who came to the ward stayed only a day or two and then went home. Others were clearly very ill or dying, and some were very elderly. One man in his thirties - at least twenty years younger than me - showed the same symptoms of liver disease as my own. Over about three weeks there was no improvement in this man’s condition at all and he ceased getting out of bed. Almost certainly he died, at least, one morning he had disappeared from the room he occupied off the corridor that led into the ward - rooms that were given to patients who were more seriously ill and faced a long stay in hospital. The nurses had been talking about him in low, alarmed voices for days and repeatedly calling out the doctors to examine him.

One man had ‘mental health issues’, as the nurses put it when he was not near enough to hear them. After shouting at him on my first (pain-filled) night because of the noise he was making during a prolonged argument with a nurse, I got on well with him; he was highly intelligent, eccentric and starved of intelligent conversation. He was also either a troublemaker or someone who bitterly and relentlessly stood up for his rights, depending on how you looked at it.

About ten days before I went home, three men appeared on the ward within a day or two of each other and happened to be put in adjoining beds. They talked a great deal to each other, got on well and shared the same interests and views. These men wanted the television on more than anyone else had during my stay. The first programme they watched each day, with great amusement and enthusiasm, consisted of appearances by (apparently) normal and ordinary people who talked about their personal and sexual lives to an aggressive programme presenter, in front of a studio audience and thousands or millions of viewers across the country: wives and husbands confronting spouses who were having an affair, men with a gambling addiction who neglected their children, grown up children confronting the mother who had abandoned them in childhood, all of them degrading themselves publicly for the entertainment of others.

I kept my ear plugs in as I got on with reading and writing, but inevitably I overheard a good deal of the conversations between the newcomers on the ward. They were much concerned with foreigners coming to Britain, especially with the ‘millions’ of Romanians and Bulgarians who threatened to arrive and work here. A particularly savage attack was carried out by Muslims in London at this time - young men who were quickly arrested and charged. The three men across the ward from me seemed convinced that the perpetrators would ‘get away with it’ because of the colour of their skin and their religion. When the TV news announced that there were to be marches by the British National Party and the English Defence League, the three new patients reacted with delighted remarks that amounted almost to cheers.

I have always had trouble sleeping at night and I slept less than ever in hospital. When my eyes grew too tired to read I lay thinking about what I had overheard during the day. The lights of the ward - except for my own reading light behind the curtains around my bed - were dimmed almost to darkness and the oblivious silence was broken only by occasional snoring or other bodily noises. (When awake - at least when the female nurses were not within hearing distance - the three new men had the vilest manners of any of the patients I had encountered.)

Interestingly, as became clear from their conversations, these three men were not poor, disadvantaged, socially excluded or unemployed - they were prosperous working class. Also, all three of them were Welsh, not English. I wondered how typical they were. I wondered what their declared beliefs, the newspapers they read and the television programmes they liked might reveal about the state of Britain today. This book was born at about four in the morning in a hospital ward as the early summer dawn was turning the sky milk-coloured and mildly luminous.

George Orwell’s brilliant, impressionistic and sometimes inaccurate book The Lion and the Unicorn was published in 1941, having been written during the worst of the London blitz. A later book by Orwell, The English People, was published in 1946; Orwell spoke of the later work with unjustified contempt. Actually, because the call for a left-wing, non-Marxist revolution in The Lion and the Unicorn was very much toned down in The English People, so that the reader is not distracted by the hoped for revolution that Orwell thought would grow out of the struggle against Hitler, but which did not occur, the later book is of greater value for us today.

In hospital I wondered if it would be possible to write a book about the mental climate of Britain in 2013 - a book more grounded in facts and research than the one Orwell was able to write in London in wartime, surrounded by the devastation caused by German bombs. Are some widely held attitudes signs and symptoms of a possible or probable future? I lay thinking of Derek Raymond’s dystopian novel A State of Denmark, which I had read as a teenager in the 1970s - a book about a seedy dictatorship establishing itself in Britain; this was not the seedy dictatorship that some people in the 1970s and in 2013 believed and still believe already exists in the UK, but an out and out concentration camp and curfew dictatorship.

Tracy’s mention of her degree in sociology reminded me of my copy of The Sociological Imagination by C. Wright Mills, a book I had lost. Mills was an American, of course, but a sociological imagination can be turned to any society. Meanwhile, I had about three hours in which to sleep. By seven in the morning the noise and bustle on the ward made further sleep impossible. There was clearly a great deal to be done. I had survived and now I must readjust, read, plan, think and then write. I had to get home and begin.

Recuperating during the hot weeks of June, I considered whether there were experiences in my past or journeys that I had made that I could draw upon in the effort to make some sense of the mental atmosphere of Britain today. Of course, to be born in a country and then to live in it for most of your life are the most relevant experiences of all. However, more specifically, I thought of my involvement with left-wing politics in the mid-1980s, when I had spent most of my days among people who thought of the present state of society as something to be replaced by a fundamentally different way of life. I had turned out on the picket lines during the Miners’ Strike of 1984–85 as a gesture of solidarity, listening to those I met there and trying to understand the conflict as well as I could. And then, a little later on, I was dissatisfied with official explanations of the situation in Northern Ireland - almost everyone I knew and worked with was equally dissatisfied with such accounts - and so I went there to see for myself.

The BBC Real Lives programme about Northern Ireland, At the Edge of the Union, was banned in 1985. How evocative that title is! That is how it felt to be in Belfast at that time for someone who had known only mainland Britain - the sensation of standing at the faint, fading margins of a society, the place where another reality took hold. This was not just because of troops on the streets, the atmosphere of civil war and the frequency of violent death that was the consequence of the war. I followed the processions on 12 July, Orangeman’s Day, through a city in which the physical divisions between communities and moral and psychological divisions coincided, standing out like the scars of wounds that had been crudely stitched up. Orangeman’s Day at that time was an occasion and a spectacle unlike anything that could be seen in England, Wales and Scotland.

My parents tended to be right-wing in their outlook, at least during my childhood and adolescence. They attempted to bring me up to accept some of their convictions without question, as self-evident, such as ‘Britain is the freest country in the world’ (not that they had ever travelled beyond Britain). This belief may well be quite widely held even today. It may well have lingered in the back of my mind; associating with sincere people in left-wing circles tends to focus the mind upon the possibilities and limitations of capitalist parliamentary democracy at home, which is a perspective that ignores how much capitalist countries vary. I did not re-examine this belief properly until my partner and I spent the summer of 1988 in Finland. When we returned people asked me what Finland had been like. I said that I found Finland strange at first because I was suddenly in a free country, which naturally brought condescending smiles and murmurs about how easy it is to idealize things.

However, we had gone to Finland with very little money, which has usually been the case wherever I have travelled, from Arctic Norway to North Africa and from Ireland to Turkey. I recall landing late at night and taking the airport bus into the centre of Helsinki, getting off with our rucksacks in the darkness of the brief northern night. We intended to camp during our time in Finland, and preferably to save money by putting our tent anywhere we could, rather than on official campsites. Whereas I was weary, my partner - who was pregnant - was exhausted.

We put the tent on the nearest stretch of grass under some trees and awoke next morning to find that we were in the grounds of Finlandia Hall, international conference centre and meeting place of the leaders of East and West. We were also visible from one of the main streets in Helsinki, but instead of flashing lights and men with machine guns, no one took any notice of us. For the next three nights we camped on Seurasaari, an open air museum where historic buildings had been brought from all over Finland and reconstructed. No officious park wardens told us to move on and no one vandalized our tent.

Helsinki, I thought, had something missing: it turned out to be poverty. There were richer areas and poorer areas, but no slums and nothing remotely like the inner city areas of London, Manchester or Birmingham, or the problem council estates attached to most British towns and cities.

In Hameenlinna, northwest of Helsinki, when we asked for directions from a middle-aged woman, she cycled after us with a photocopied map of the town from the library. When we were exhausted and set down at an inconvenient spot while hitch-hiking in eastern Finland, we knocked at the door of a house and asked if we could buy a coffee somewhere nearby. The family simply invited us to camp in their garden and brought us coffee and invited us to breakfast next morning. And when we caught the wrong connection in central Finland and found ourselves on a train taking us in entirely the wrong direction, the ticket inspector reacted with sympathy and showed us the right platform at the next station. Dozens of similar incidents built up over the weeks to reinforce the sense of being in a country in which people were not afraid of each other or of foreigners, in which a culture of freedom and an assumption of equality formed a constant background.

The Finns can hardly be said to have had it easy. They have not spent the last two centuries in the privileged situation of Switzerland. Until the 1960s Finland was a much poorer country than Britain, as well as being the only neighbour of the Soviet Union to maintain a Western style democracy. Unlike British government ministers (particularly in the 1980s) Finnish government ministers did not make speeches justifying nuclear missiles as an essential means of preserving ‘liberty’, getting on instead with the business of freedom and survival as a frontline state in the Cold War of the fifties and sixties and in the second Cold War of the eighties.

In recent years, after the collapse of the Soviet Union and then Finnish membership of the European Union, extreme right wing groups have arisen in Finland, and more recently something equivalent to UKIP, the UK Independence Party. The Conservatives in Britain worry about UKIP winning over their traditional supporters and tend to be cautious accordingly. Too much support for gay rights runs the risk of offending the faithful. In Scandinavia traditional reactionary sensibilities about marriage, the family and gender are not there to be offended, and so anti-European groups cannot boost their support in this roundabout way. When I revisited Finland I found the culture of freedom a little battered and scratched but still very much there. The problem of public drunkenness was also much the same. One of the innumerable jokes the Finns make up about themselves goes like this: you can always tell the Somalis in Helsinki from the native Finns - the Somalis dress in neat suits and are sober.

I read and reread Orwell’s The Lion and the Unicorn and The English People (‘that silly little English People book’ as Orwell called it, with almost pathological modesty, in a letter to Julian Symons in 1947) in the weeks after I returned home from hospital. Orwell had served with the Imperial Police in Burma for five years, lived in Paris for two years and lived and fought in Spain during the Spanish Civil War. He is incisive and perceptive about Britain because he can draw upon his experiences of other countries and very different conditions. This is necessarily so. You cannot know the standard of football in your own country unless your country plays football with the national teams of other countries. It is impossible to judge how well medicine is practised in one country without some information about the care of the sick in other countries. To say that the law is (even) more oppressive in Italy than in Britain, that the crime rate is high and petty theft is common in Naples and Rome, that the piles of rubbish beside roads and the pollution show that the Italians have a disregard for the environment that would not be tolerated in Britain is not to idealize the British or ignore Italy’s virtues.

Sadly, the British are too often incapable of seeing Britain as a piece in the mosaic of European societies, despite decades of cheap travel. They have forgotten the line from Kipling, one of their most enthusiastic gutter patriots: ‘What do they know of England who only England know?’ For example, several of our nearest neighbours are republics - Finland, Iceland and Ireland (I deliberately omit France). The impressive beginnings of parliamentary democracy in northern Europe were made in Iceland, not in Britain as is fondly believed. As for Ireland, the first woman to become the President of the Republic, Mary Robinson, transformed the office to which she was elected and transformed the image of Ireland abroad and the way in which the Irish perceived themselves. After her seven-year term of office, she declined to seek a second term, becoming UN High Commissioner for Human Rights. And yet some educated people in Britain still justify the continued existence of the monarchy by saying: ‘Of course, whatever the faults of a constitutional monarchy, republics are much worse.’ Is there a member of the British Royal Family whose achievements equal those of Mary Robinson? The half-conscious belief that what the British do not do cannot be done ripples far too often under the surface of life in Britain.

I lived in Spain for two years between 1991 and 1993, mainly in Andalucia, the poorest and largest region of Spain in the days of Franco and in the 1990s. Yet economic deprivation did not breed crime and violence in the rural area in which we lived; people in most English and Welsh villages I had been in - particularly young people - were far more aggressive. Even the large southern cities of Malaga and Algeciras were far less threatening than most British (or Italian) cities. In the rural villages there was no vandalism, telephone boxes and public seats were not broken or defaced, and children were welcome in every bar, although alcohol was not sold to those under sixteen.

The sullen aggression that pervades drinking places in Britain was unknown. This was an area of great unemployment, but the social security laws seemed to ease the situation. Those receiving benefit were required to do sixty days community service each year. Such a law hovered in the background as an oppressive spectre in Britain, but its implementation in Andalucia was quite different. The local elected mayor had some real power in these mountain villages (which is not to say that he was always popular or that he was never resented). And it was the mayor who authorized the payment of benefits and provided most of the informal cash-in-hand jobs, although technically the law denied benefits to those doing paid work. Those doing community service were allowed to leave it whenever any cash-in-hand work came their way; there were no authoritarian Job Clubs or punitive Youth Training Schemes. The British, German and Danish ‘exiles’, some of whom had lived in the area for many years, were accepted as part of the community by the Andalucians, even - or rather especially - those who were extremely poor.

I wrote an article on the way of life of the area for the magazine Social Care Education, which was published in the winter 1991/92 edition, and before I sent it off I read it to some of the English-speaking exiles who had lived in the area for some years; they had, after all, provided me with much of my information.

There was no church and no priest in the village in which we lived, although there was a church hall. Even before the Spanish Civil War, and especially during the war, large numbers of the Spanish poor had come to the realization that the Roman Catholic Church in Spain was simply part of the machinery of oppression - something which the Franco dictatorship confirmed yet again. On the other hand, no one objected to a priest coming to the church hall to conduct Catholic weddings, which were becoming popular with some young people. The village had a solitary and unarmed officer of the Policia Local. The community was indeed self-regulating and self-policing, which was an expression of the anarchist and socialist tradition of the mountain villages. The tradition was receding somewhat under the pressure of social change in the 1990s, and yet it was still alive. But anarchism and socialism of that kind can never work! So people fondly believe - especially in Britain... Until or unless they happen to see it working.

As I reflected on British social attitudes and how they might influence the future, my pessimism increased as my health steadily improved. I also felt that Britain’s future is inseparable from the state of the world, which has given very little cause for optimism since 11 September 2001.

The veteran Marxist Terry Eagleton is blunt in his appraisal of the state of the world:

For the first time in history, our prevailing form of life has the power not simply to breed racism and spread cultural cretinism, drive us into war or herd us into labour camps, but to wipe us from the planet... What used to be apocalyptic fantasy is today no more than sober realism. The traditional leftist slogan ‘Socialism or barbarism’ was never more grimly apposite, never less of a mere rhetorical flourish.[1]

This may well be so. However, we must return to Tolstoy’s famous opening line in Anna Karenina. ‘All happy families resemble one another, but each unhappy family is unhappy in its own way.’ Thus, all humane societies may resemble one another, but each barbaric society is barbaric in its own way. If Britain faces a grim future, that future will grow out of the distinctive attitudes and features of British society and out of the intersection of those attitudes and features with the state of the world, which will affect Britain and every other country. The mental climate of some countries may make them more able to resist disaster and the mental climate of other societies may make them slide into disaster more easily. The evidence needed for a clear understanding of the consequences of our attitudes is surely all around us in the words we hear and read every day.

1 Terry Eagleton, Why Marx Was Right, New Haven & London, 2011.