What to think of the Corona Pass?

Written by Sjoerd Bakker
October 18, 2021

Several European countries have introduced a health pass with which people can prove they are vaccinated, tested negative or have recovered from Covid. While the majority of people regard this as a necessary and temporary means to re-open society, others believe this is an example of wicked biopolitics and a clear violation of our basic rights.

What is really going here? Checks on age, criminal record or creditworthiness are commonplace in specific contexts to gain access to places, services, or goods. The corona pass is much more controversial, because it stretches the boundaries of governmental intervention towards our bodies; our body has to meet certain conditions (i.e. tested, cured or vaccinated) to gain access to (semi-)public spaces.

In light of the coronavirus crisis and our longing for ‘freedom’, this (temporary) biopolitical tool may be understandable and acceptable. Yet, the crucial question, from our perspective, is whether we are on a slippery slope towards more, and more casual, uses of such tools. Digital technology would certainly allow for these (automated) checks and the question really seems to be whether a next crisis, health- or otherwise, would warrant such ‘solutions’. Indeed, as a society we could very well conclude that these kinds of tools are once again a necessary evil to fight those crises as well.

Burning questions:

  • What constitutes a slippery slope when it comes to uses of technology and how could we make sure this remains a singular event rather than the start of a pattern?
  • If we were to limit individual freedom in a similar fashion in the future, is it primarily because of technological change and the possibilities this offers, or rather because of broader societal and cultural changes?

How to deal with the medical uncertainty of Long COVID?

Written by Sebastiaan Crul
August 9, 2021

It’s taken a while, but the public is starting to take long COVID seriously. Journalists are writing scores of articles to discuss the mysterious wide range of symptoms experienced by patients and report on the scientific search for possible biological explanations. In addition, the government has realized that the lack of understanding of this mysterious condition is a great biopolitical instrument to target youth: long COVID is also affecting them after mild infections.

Meanwhile, physicians remain divided about all this attention. Some simply ask for more caution when talking about long COVID. They acknowledge that the condition is not “in the mind” but until we have found a biomedical explanation, we should be careful in assessing it. Others claim there is a hidden agenda on the part of physiatrists and advocates of the biopsychosocial model at work, while the most skeptical physicians suggest journalists themselves are an important cause of the super-spread of the “disease”. Endlessly listing the wide range of symptoms makes people believe they have the illness, it is said. Evidently, this is worrying COVID long haulers, who fear new waves of medical gaslighting from professionals, similar to the dismissal of many patients who suffer from chronic fatigue syndrome (ME/CFS).

The core of the problem is perhaps not the uncertainty of the condition itself, but the lack of acceptance of diagnostic uncertainty in the culture of medicine, prompted by the intense focus on evidence-based medical practices, as bioethicist Diane O’ Leary points out in this article. Currently, unexplained symptoms are almost immediately (at least implicitly) explained as having a psychogenetic cause. Instead of humility about the disease, she proposes, we should develop a truthful humility about diagnostic uncertainty.

Burning questions:

  • Which practical guidelines can physicians follow if they want to embrace diagnostic uncertainty?
  • How can we find a balance between underdiagnosis and biological overtreatment with the risk of iatrogenesis?
  • What is the role of patients in this story? Will they ever accept more diagnostic uncertainty?

Building national character based on trauma

Written by Alexander van Wijnen
April 22, 2021

Since the beginning of the coronacrisis, there has been a lively debate on the successful handling of the pandemic in East Asia. In March 2020, we argued that we have to look beyond the idea of “strong governments” to explain why East Asia has coped well. Commentators, however, still point to the political leadership, social trust and state capacity of these countries to explain their success. Yet Western countries that share those characteristics have performed much worse. The key factor that seems to determine success in handling the pandemic is the historical lesson learned by East Asia in 2002/3 with SARS, another coronavirus. Interestingly, one of the most important lessons China learned with SARS is to overcome “impediments to the flow of information through the governmental hierarchy”.

Two years later, China launched its mass surveillance system to boost the flow of information for governments. Fifteen years later, China has been much better prepared for COVID-19 as rapid tracking and testing prevented the virus from spreading like in the Western world. Overall, we can explain the success of East Asia in terms of national character. However, instead of traditions of leadership, trust and capacity, national character also seems to be shaped by far more recent historical experiences.

Burning questions:

  • How will COVID-19 change the national characters of Western countries?
  • To what extent is the outperformance of East Asian governments part of a bigger competitive edge of these countries – and what does that mean for the future?

How do we distil a good narrative from 2020?

Written by Pim Korsten
January 14, 2021

2020 was the year of the coronavirus crisis and in 2021, we’ll hopefully be able to leave this crisis behind. How we do that depends on the story we create about it, and the language, metaphors, narratives we want to use. From the perspective of philosophical hermeneutics, we can consider the structure of this story, and how we can actively build a post-corona future.

Our observations

  • In his book Epidemics and Society: From the Black Death to the Present (2020), historian Frank Snowden writes that epidemics have led to large public investments. The plague, for instance, led to the beginnings of public healthcare, as the temporary agencies and emergency ordnances gradually changed into permanent institutions. In his book Epidemics and the Modern World (2020), Mitchell Hammond writes that such initiatives and the first iterations of public administration were therefore of great importance to the modern state.
  • According to French philosopher Michel Foucault, the Enlightenment and modernity were both a curse and a blessing. On the one hand, modernity has brought us much prosperity, in the form of disposable income, better healthcare, better social and physical infrastructure, and new innovations that make our daily lives better and more enjoyable. At the same time, Foucault contends modernity and the Enlightenment have also brought us a new form of power and discipline, “biopower”, and he viewed the new forms and institutions of public healthcare as laboratories for experimenting with new forms of social control.
  • In their book Metaphors We Live By (2003), George Lakoff and Mark Johnson pose that the metaphors we use in our language also influence our direct physical and social experiences. According to them, the conceptual framework from which we interpret and approach reality is metaphorical by nature, and thus subconsciously influences our thinking and actions. Metaphors aren’t fully rational but integrate feelings, thought structures and our imagination into a figurative “image of thought”.
  • Many contemporary thinkers emphasize that humans are a “story-telling being”, and that narratives are a fundamental determinant of how we relate to reality and are able to shape the future. Think of Yuval Harari in Sapiens, Alex Rosenberg in How History Gets Things Wrong, Jordan Peterson in Maps of Meaning, Jeremy Lent in The Patterning Instinct. The base unit of a narrative is a “narreme”, comparable to the “phoneme” (a unit of sound) in phonology (the linguistic study of sound). A narreme relates to the state of affairs in the world and the positioning of story development and events within a certain wider narrative framework.
  • In his magnus opus Truth and Method (1960), Hans Georg Gadamer poses that different domains of life and various sciences have a different understanding of truth and method from a merely scientific one. The humanities have their method of hermeneutics – the art of interpretation – in which meaning is sought. In his final chapter “Language as horizon of a hermeneutic ontology”, Gadamer contends that meaning is always linguistic in nature as man has always interpreted reality and himself from the perspective of a historical and cultural tradition.

Connecting the dots

In our Retroscope, in which we looked back on 2020, we wrote about the term “crisis”: a moment of truth when we must make decisive judgments on what is actually important and what isn’t. A crisis also always forces us to make a political and ethical choice to transform the current situation into a brighter, more positive future. This makes the coronavirus crisis a real crisis, which has set in motion important choices and developments in the domains of geopolitics, technology and culture. The question now is: how do we interpret the events of 2020, and how will we develop a narrative? This is a matter of how the coronavirus crisis can lead to a new consciousness and how we should understand ourselves. Firstly, we could characterize the coronavirus crisis as a “formative experience”, as a consequence of which a new generation will adopt a new set of values, norms and ideas. This is apparent in our scenarios from the Resilient World in the domains of technology, culture and geopolitics. The coronavirus crisis could also leave an imprint on our political, technical and social systems (just as the Second World War left an imprint on our socio-technical systems). “Imprint” is a term from biology and psychology, which refers to changing behavioral processes of humans (and animals) as a consequence of being exposed to external stimuli (e.g. imprinting in genetics and developmental psychology). The coronavirus crisis will also leave such an imprint on our subjective and objective consciousness.

It’s important how we formulate and understand this in language and concepts, express it in metaphors, media and stories. For example, think of the long-term consequences of pandemics on the development of modern institutions and public government services such as healthcare, and how we should understand and assess these new forms of “biopower”. What’s crucial in this is the narreme we develop; the wider framework from which we consider and position the coronavirus crisis and its consequences within a narrative axis. Northrop Frye (1912-1991) was an important thinker in the comparative narratology in literature. In his masterpiece Anatomy of Criticism (1957), Frye analyzes the narrative categories and patterns in different literary traditions, and devises an “anatomy” of historical modes, ethical symbols and archetypical myths and rhetorical genres.  How does this relate to the coronavirus crisis? And what can we expect from the so-called “post-corona narratives”?

The coronavirus crisis is best perceived from the tragic mode. The Ancient tragedy is about how people relate to their fate and ill-fortune, which serves to inspire pity and fear in the audience in order to achieve “catharsis”: emotional purification. The comedy, by contrast, is marked by protagonists making blunders and mistakes, while still ending happily, thus achieving catharsis in the audience through laughter, humor and enjoyment. The coronavirus crisis caught many people off guard, and is often seen as a manifestation of Fate (e.g. as a religious reprimand or nature’s pushback against the hubris of modern man). In this tragedy, we may apply the framework from Frye’s first essay to distinguish various tropes, such as the highly mimetic coronavirus tragedy (marked by the sacrifices people such as nurses make to fight the coronavirus) or the ironic tragedy (man’s weakness in the face of nature or other lifeforms). When we consider different types of “coronavirus symbols”, the first one we notice is the descriptive symbol of the virus that’s bringing humankind, and even entire “superorganisms” such as economic systems (e.g. healthcare or the economy) to their knees.

The visual symbol ties in closely with the use of metaphors, such as the prison as a metaphor for working from home, or the desert for the empty cities during lockdown. The mythical symbol displays the relationship to other symbols of our time that, as we’ve argued before, are metamodern in nature. The anagogic symbol represents the spiritual value of the coronavirus crisis, and whether it will lead to a better, more enlightened future or not. The mental side of the experience of the coronavirus crisis is also considered, such as the moods inspired by the coronavirus or our ideals in this post-corona world.

This brings us to the archetypical myths: which original images, figures and ideas emerge in our visualization of the coronavirus crisis? Describing these moods, ideals, experiences, in short: the mental side of the coronavirus, isn’t about explaining or categorizing various psychological phenomena – the cognitive and neurosciences are much better equipped to do this – but helps reveal the meaning of our world and existence in society. This means we can expect new media that – implicitly or explicitly – are a result of the moods of the coronavirus crisis and quarantine, in the same vein as the “post-9/11 media” or the “atomic culture” that arose after the bombings in Japan and the critical philosophy (e.g. the Frankfurter Schule) that came into being in response to the Second World War.

This shows that our visualization of the coronavirus crisis and the narrative we create about it is ultimately the product of how we interpret the historicity of the coronavirus crisis: is it the end of the world as we know it, thus an epoch of decay, or in fact the beginning of a better world and thus of spiritual reassessment? It’s interesting to see that “cyclical theories” such as the generational dynamics of Strauss and Howe, the theory concerning technological revolutions and hegemonic cycles and economic paradigm shifts point to such a turning point. They highlight that a post-corona world might look radically different, and that such a narrative might be constitutive or even performative in creating a better future.

Implications

  • The coronavirus crisis could become a new “grand narrative” with which rifts could be closed. This will probably be utopian in content, as a response to postmodern skepticism and modern naiveté. For this narrative to be told, it’s crucial that creative artists can get to work on this. Especially now that many of us are in social isolation, stuck at home without the possibility of seeing friends and family, it’s conceivable that the coronavirus crisis may lead to a period of enormous creativity and invention. Film makers, for example, now have the time to consider new formats and pieces. We’ve written before that the Zeitgeist and a “structure of feeling” are manifesting in art, media and popular culture.

  • Another important aspect of this visualization is speculative design. Precisely because the coronavirus crisis is a real crisis that’s changing the course of the world and humankind, we can’t extrapolate the past and have to experiment with new images and forms of visualization. What scenario thinking is to theoretical thinking, speculative design is to visualization.

Vaccine diplomacy

Written by Sjoerd Bakker
January 14, 2021

The global distribution of coronavirus vaccines can remind us of D-Day and the subsequent liberation of Europe. The companies and governments that deliver the vaccines will be hailed as liberators and will likely wield significant political power over the countries they ‘liberate’. China and Russia are clearly aware of this effect as they appear to be quite generous when it comes to distributing their vaccines to needy nations.

Despite concerns over the safety and efficacy of the Chinese and Russian vaccines, many nations are eager to use them. As a consequence, countries such as South Korea and India will be drawn closer to Russia, while Brazil, Malaysia, Indonesia and others will tilt towards China.

Europe and the U.S., by contrast, seem determined to get “their” vaccines to their own people first. While this may be a logical strategy from a domestic societal and economic perspective, the West runs the risk of alienating international allies. As such, sharing vaccines with the rest of the world is not only a matter of humanity, as it is mostly portrayed, but also of geopolitical power play.

Food security will have its moment on the world stage

Written by Julia Rijssenbeek
January 14, 2021

In the year when the World Food Program unexpectedly received the Nobel prize, the fight against hunger faced major setbacks. The COVID-19 crisis laid bare the vulnerabilities in the global food supply chains, causing food insecurity to triple in almost every part of the world, along with the number of people suffering from hunger. The pandemic further made clear that the way we grow food increases the risk of zoonotic outbreaks. Agriculture makes ecosystems more vulnerable and destroys habitats, thus creating the perfect conditions for viruses to emerge.

A third direct link between COVID-19 and our global food system is the undeniable fact that being overweight – a problem for more than a third of all adults globally – makes people more prone to suffering from the virus. To confront global food security issues, international cooperation is needed to set global goals and standards that integrally address the health of people and of our planet. In 2021, the global Food Systems Summit will take place, an event that might induce the establishment of an intergovernmental panel like the one on climate change (IPCC) or a treaty like the Paris Agreement.

The sound and cost of silence

Written by Pim Korsten
December 18, 2020

In his book Sound: A philosophy of musical experience (in Dutch), musical philosopher Tomas Serrien posits that we’re in an auditive crisis, meaning the visual is now more dominant than the auditive. We’re consuming more and more images, domains are increasingly structured according to the logic of the image (e.g. ocular democracy), while large companies are investing more in video streaming.

Yet our ears are increasingly stimulated as well: megacities are host to cacophonies, we can stream sound and music anytime, anywhere, and virtual voice assistants and speech recognition technology have us speaking and listening more, even in public spaces (e.g. in public transport, at work). But just as visual overload can cause “screen fatigue”, the ubiquity of sounds, microphones and headphones can lead to “listener fatigue”, a known cause of physical and mental problems. As a response, several (new) practices are on the rise, such as noise-cancelling headphones (originally invented for airplane pilots), silence wellness retreats, and practices that accentuate the spiritual value of silence (e.g. yoga and meditation). With sound in abundance, the sound of silence is becoming more valuable.

The coronavirus is creating momentum for fiscal diet policy

Written by Pim Korsten
December 4, 2020

Of course, it wasn’t the coronavirus that put obesity on the agenda, but the pandemic could influence policy to reduce it. In most Western countries, the current approach is mainly geared towards education, creating awareness with campaigns or labels meant to stimulate self-regulation in the supermarket. According to the World Bank, this has been moderately effective, but it’s doubtful whether that is enough in a world where both wealth and inequality are on the rise. The WHO therefore pleads for a more fiscal policy, since ultimately, our wallets remain a crucial factor: unhealthy food is (too) cheap, healthy food is (too) expensive.

That’s why more than forty countries have introduced a sugar tax and the coronavirus appears to have resulted in an increased sense of urgency and support for this measure. However, in a world afflicted by COVID-19, where inequality is rapidly growing, the most effective fiscal policy is (wage) subsidy, aimed at making healthy food more affordable, especially for poorer families. Because of the costs, subsidies are not as widely supported as tax measures like the sugar tax, which at least create revenue. Seattle has found a happy medium between the two: “circular” fiscal policy, meaning the revenue generated by the sugar tax is used to cover the costs of the health subsidies.

The sterile human and the biomedical disease model

Macroscope written by Sebastiaan Crul
October 7, 2020

Viruses and bacteria don’t have the best of reputations. They’re dangerous pathogens and in the past century, they’ve mostly been known as the culprits in virus pandemics and well-known infectious diseases. This image is characteristic of the biomedical disease model, according to which intruders threaten our health. The biomedical disease model has led to great progress but is also subject to much criticism. In the past decades, there has been growing interest in alternative disease models with a new outlook on what it means to be a healthy human being.

Our observations

  • Microbiologists are gaining insight into the complex relationships between us and micro-organisms. From these studies on the microbiome, a more positive image of micro-organisms is emerging than the one common to the dominant biomedical disease model. More and more studies highlight the useful or even crucial aspects to our health of viruses, bacteria and fungi. Consequentially, researchers and medical professionals are calling for a better distinction between the normal, good elements of the microbiome and those that are detrimental to us humans.
  • Scientists are also beginning to view nutrition in a different light. Besides a merely mechanical perspective on food, we’re becoming susceptible to a communicative and informative outlook. Dominant in our view on food are metaphors in which food represents nothing more than energy: food as fuel to keep the engine of our bodies running. In an informational perspective on nutrition, food is seen more as a conversation, and is attributed, besides energizing properties, autonomy and communicative skills. For instance, the genes our food contains can regulate our own genes.
  • In psychiatry in the ‘80s, a strong conviction became prevalent that mental disorders could be captured in a biomedical model as brain diseases. The progress that had been made in the neurosciences had created the expectation that, in the near future, it would be possible to classify all disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as brain disease with a clear cause. Because of disappointing results, after the turn of the century this neuro-centrism was widely criticized, paving the way for alternative disease models that ascribe more importance to psychosocial factors.

Connecting the dots

Of course, that bacteria can be beneficial to our health isn’t new information in medical science. And yet, the history of medicine in the 20th century can be read as mostly a battle against bacteria, which began with the germ theory of disease and the discovery of penicillin. The germ theory of disease was partly responsible for the dominance of a biomedical disease model in modern medicine.
According to this model, there is a straightforward relationship between cause and condition and a clear course of disease, clearly summarized in Koch’s postulates. This functionalist disease model encompasses a mechanical perception of the body. Disease is naturalistically understood as the dysfunction of organs and therapy is focused on recovery and restoring the affected functions. Health then simply comprises the absence of disease; the machine functioning as it should.

Historically, the dominance of the biomedical and functionalist disease model has led to great progress. Sterilization techniques were developed, as were medicine and therapies to effectively debilitate invaders, we learned to disinfect and keep our environment “clean”. Our current life expectancy would have been unthinkable without the biomedical disease model. This “sterile human” has a resistance to infectious diseases and a general level of health unparalleled in human history.
Despite these successes, the biomedical and functionalist disease model has been under fire for decades. Critics argue that the model is too unilateral and unable to explain a plethora of illnesses and phenomena. Auto-immune diseases, for instance, are difficult to classify within the model, hormone diseases are more likely to be the result of disrupted homeostasis and we underestimate the role of our emotional life in the course of physical disease.

Moreover, the dominant biomedical and functionalist disease model still seamlessly fits an anthropocentric worldview, in which the human as a ruling subject is cut off from his environment and is especially attuned to the menacing side of external nature, a nature which can be used for human gain if we so desire. This view of humanity has long been under fire too. New insights from (among others) modern biology, integral medicine, psychiatry and ecology are difficult to reconcile with the dualism of anthropocentrism.
In the past decades, these sciences have shed new light on what it means to be human. A different worldview is emerging in which the world is no longer seen as a large mechanical clock, but as an organic whole in which continual mutual interaction and transference of information take place on different levels of existence. “Subjects” then are not cut off from the world, but only are or become something or someone in relation to others and the environment.

This new worldview lays the groundwork for a different understanding of disease and health, which have received more attention in the past decades. In this transition from the Anthropocene to what we could call “the Microbiocene”, we are given the impression that being healthy demands continual exchanges between humans and their environment. Our kind is not just in danger, we would also benefit from this continuous exchange between us and, for example, the bacteria and viruses in our surroundings. This exchange, however, encompasses far more than we can comprehend and control. In this view of humankind, the ability to self-heal of nature and the ecosystems in which we live, are highly valued and trusted.
Key concepts around this idea of health are balance or homeostasis, self-regulation, adaptation, motivation and adjustment. The phenomenon of being ill also becomes more complicated than in the unilateral biomedical model. Disease arises from an interplay of a number of relationships that are impossible to oversee for us humans, which is why we always overlook some of them.

This new perception of disease and health results in contrasting ideas about medical intervention. Intervention and sterilizing humans and their environment can lead to immediate and quantifiable gains for the sterile human, but in accordance with the new worldview, it can also result in imbalances and vulnerabilities in the long-term. One of those new vulnerabilities has come to light in studies on antibiotics. Medics have been expressing increasingly vehement concerns over the unbridled growth of antibiotics, which is leading to antimicrobial resistance, now globally recognized as a serious problem.

Should medical practitioners then intervene less, as advocated by the anti-vaccination movement? On the one hand, the new worldview appears to implicitly call for more laissez faire and restraint when it comes to medical intervention. Human hubris regarding nature should make way for more modesty. The worldview prevents us from suffering iatrogenesis, harm caused by medical treatment. On the other hand, the common purpose of medicine lies largely in therapy through intervention, interventions have proved extremely successful (e.g. in the treatment of measles and pox), and the possibility of treatment causing harm is not sufficient reason to refrain from intervening.
The question therefore begs nuance: how do we retain what led to progress in the unprecedentedly successful functionalist and biomedical medicine, while also being more attuned to the vulnerabilities and imbalances it may cause?

The embedding of biomedical intervention in a more complete disease model that’s better suited to the complexity of disease and health appears to be the right way forward. The more dynamic and procedural disease models found in psychiatry might be a good starting point. In these models, disease and health are not discrete entities but located on a continuum.
They often do not have a clear-cut beginning or end, and there is often no apparent distinction between cause and effect or pathogen and symptom. In this ecological perspective, when designing a therapy, all manner of biological, psychological and social factors are weighed against each other. From this perspective, the biomedical model generally fixates on only one point or temporary condition in this complex relational field, such as the point when a virus in a human body begins multiplying uncontrollably, thereby damaging the organs. This interventionism of the biomedical model is an indispensable tool of medicine but is thus also viewed from a broader perspective on health.

Implications

  • The current battle against the coronavirus shows the implications of the contrasting disease models and worldviews. The biomedical model is particularly suited to answering the question how to intervene now, how to contain the spread of the virus and develop an effective vaccine. But if we want to answer the question how to maintain a healthy relationship with viruses in the long term, we need a disease model that is more attuned to the broader ecological embedding of humans and the everyday relationship we have to viruses. Both questions will have to be taken into consideration, even if they invite contrasting answers and thus fail to provide governments and medical institutions with a clear direction for policy.

My plant the therapist

Written by Jessica van der Schalk, august 26 2020

What happened?

Among young adults, who often live in small spaces in cities, the popularity of indoor plants has grown strongly in recent years worldwide. Internet search data shows that interest has increased tenfold since 2010. The sales of indoor plants has also increased strongly, especially among millennials. So-called plant influencers on Facebook, Instagram and YouTube are getting more and more followers and offers from major brands in the plant sector. The Covid-19 lockdown has given this interest an extra boost, because people have started to pay more attention to home.

What does this mean?

Several reasons are given for the growing popularity of indoor plants. For example, research shows that the presence of greenery, even if it is only a few plants in the house, can reduce stress. What is more, plants have the ability to lower the carbon dioxide content and remove pollutants such as formaldehyde, trichlorethylene. Finally, it is indicated that plants offer millennials, who often start a family later and live in small houses without a garden, the opportunity to take care of a living being, which gives a sense of homeliness.

What’s next?

The growing popularity of indoor plants among millennials in particular, fits in with a broader trend of healthy eating and activities that reduce stress such as yoga and mindfulness. With the global pandemic, an economic crisis and climate change, the need for things that offer peace of mind in everyday life will persist. This trend is also consistent with the idea that people will never get used to an environment in which little nature is present, such as in cities.