Ideology and Terror

Every generation has a grudge against the previous one, and often that grudge is well founded. When combined with the essential anarchism of youth, that grudge can easily translate into an event like the one described by Richard Gunderman in his thoughtful essay. The incoming class at the University of Minnesota School of Medicine swore an oath to “woke” ideals, drawing attention to the sins of earlier generations, including the original sin in Minnesota, which was to take land from the Dakota people and build a medical school on top of it. How can those sins be redressed? 

Gunderman describes the practical problems behind the students’ proposed solutions, before generously forgiving the students for their naïve idealism. The trouble is not with their particular ideology, he concludes, but with their superficial thinking, likely the result of a poor liberal arts education.

I reach the same conclusion as Gunderman, that many of today’s physicians lack a solid liberal arts education, but I get there via a different path. I do not excuse the medical students for their youthful naiveté. Indeed, the students weren’t all that youthful; they weren’t teenagers and many of them were probably well into their twenties. More importantly, I do not excuse their ideology. On the contrary, ideology was a big part of the problem.

Everyone has an ideology in the sense that everyone has a belief system about how to make the world a better place, and that includes a body of doctrine or a set of ideas. But some ideologies are more malevolent than others, the worst being revolutionary ideologies that destroy innocent lives. Examples are the ideologies behind the Russian Revolution and the later phase of the French Revolution.

The conservative students were likely afraid of the centrists, the centrists were likely afraid of the progressives, and everyone was likely afraid of the progressives’ left wing, who wrote the oath.

Whether an ideology has malevolent potential can be determined not only through the study of its content—ideologies that push racism and anti-Semitism are obvious examples—but also through the study of the psychology of those who push it. For instance, when a small number of people push an ideology while also scaring everyone else into agreeing with them, danger lurks. A zealous minority praises those who actively support the cause while casting suspicion on those who lag behind. People who prefer to avoid politics altogether discover they can no longer sit on the sidelines; they must become either targets for love or targets for hatred. Prudence dictates the best course of action is to stay loved. Although cowardly, this means nodding in approval at whatever the zealots say. 

This seems to have been the case at the University of Minnesota. The anti-racist oath, Gunderman writes, was “penned by a small group of students on behalf of a much larger class.” Here, the conservative students were likely afraid of the centrists, the centrists were likely afraid of the progressives, and everyone was likely afraid of the progressives’ left wing, who wrote the oath. This is a danger signal. A revolutionary ideology is like a rolling ball. People riding it learn that trying to arrest the ball’s motion will only cause them to fall off and hurt themselves; better to kick busily to keep one’s balance; there is no safety except in unceasing advance. Many of the medical students were likely afraid of lagging behind the others in professing their anti-racism. Better to keep kicking and moving; better just to take the oath. When studying the video, no one seems to have tried to get off the rolling ball; no one seems to have abstained.

It was no different during the French Revolution when the royalists feared the moderates, the moderates feared the Girondists, and everyone feared the Jacobins. When a malevolent ideology descends upon society, a contagious mutual anxiety arouses a heated competition among all groups to prove their loyalty by reciting oaths. An example during the French Revolution was the decree issued by the National Convention to destroy Lyons, France’s second-largest city, to purify it of counter-revolutionaries. No one dared whisper the word clemency or compassion, as doing so risked the guillotine. It is the perpetual dread shared by people of all shades of opinion during a revolutionary moment, from conservative to reasonably progressive, of being regarded as backward in the good cause. 

Then there is the psychology of the ideological extremists themselves, those who wrote the oath, and who cowed everyone into reciting it. Some of the students mouthing the oath look uneasy, as if under duress; others look as if they are in a trance or under the influence of some hypnotic spell. It’s a little unnerving to watch. Gunderman doesn’t talk about these extremists, and I certainly haven’t met them, but most educated people know the type and recognize their danger. Although radical ideologues may be fundamentally honest and straightforward, they invariably wear blinkers that make them into intolerant and narrow-minded people for whom only their truth is truth, only their virtue virtuous, only their progressivism progress. To differ from them is criminal; to refuse compliance with every letter of their demands is to show oneself to be evil. They have the detestable pride of the self-righteous, the severe and gloomy courage of the demonically possessed, and the passion of the ecstatic bigot. They are cold-hearted, humorless fanatics who know no other gratification than the triumph of their dogmas, and no other justice than the victory of their cause.

And that is the best type of revolutionary ideologue. There are revolutionaries from idealism, but also those from spite. The latter type is even worse. Rather than try to save the downtrodden, they take vengeance on those who had been happier than themselves, and, having gained some power, they seek to inflict pain on those who have fallen from power. During the French Revolution, it was people like Jacques Hebert, Marie Antoinette’s jailer, who took every possible delight in humiliating and mistreating the queen, especially when she seemed to ignore him. Stalin embodied the same spirit during the Russian Revolution, executing people who had committed no crime other than to have, decades before, crossed him in the schoolyard while they were children. 

When taking care of patients, doctors must be clear-minded realists. … Rather than strive for the unattainable, they must deal in tradeoffs, applying to patients the maximal treatment compatible with good health and the fewest complications. 

In woke ideology, this revolutionary type spends much time attacking straight white males. Petty by nature, they take malicious pleasure in humiliating these people and they flatter the worst instincts of the mob when doing so. Naturally, they clothe their ugly behavior in morality. As in the French Revolution’s radical phase, they obsess about “equity” (during the French Revolution, it was “equality”) at the expense of “liberty” and “fraternity,” and they forcibly try to level everything down while mocking their object of scorn. In the case of the recent killing of Tyre Nichols by five black police officers, actress Whoopi Goldberg mused in jest, “Do we need to see White people also get beat up before anybody will do anything?” Such harsh humor comes with an unspoken advisement to put up with such harshness, or even to applaud it, thereby proving one’s loyalty to the cause.

This isn’t just any ideology. This is a malevolent ideology.

All this lay beneath the surface at the medical school ceremony. Yet it is palpable to anyone trained in the liberal arts who watches a replay of the event. The liberal arts enable people to “see through walls,” to intuit the deeper meaning and significance of events beyond their mere physical occurrence. The great novels—for example, Doctor Zhivago and A Tale of Two Cities—teach plenty about human fear, the pressure to fall in line, and how to spot such behavior in real life. The twofold attitude found among malevolent ideologues is rooted in the bipolarity of human nature, which both philosophy and history describe in detail. 

How could a solid liberal arts education have prevented the medical students from mouthing the woke oath all in unison? To some degree, it could not have. A liberal arts education may instill insight, but it does not necessarily instill courage in the face of fanaticism. It does not give people a backbone to stand athwart a revolution and yell, “Stop!”

Still, a liberal arts education can be helpful to medical students. It can remind them to put ideology—all ideology—aside when they actually practice medicine.

Because Gunderman views the students’ ideology as mere naiveté, he does not see the more fundamental problem that ideology poses in medicine. On the contrary, he praises “idealism,” compliments the students for at least trying to do good, and plugs the progressive ideology of nineteenth-century physician Rudolph Virchow as a better alternative. He writes sympathetically about Virchow’s belief that “physicians must shift their focus from individual patients to the social circumstances of the entire population.” He says doctors must be citizens as much as doctors; they need to know political discourse; they need to be complete human beings. 

Yet a solid liberal arts education would teach aspiring doctors something very different: beware idealism, beware ideology. When reading philosophy, such as Marx, students learn that ideology is a simplistic thought device designed to portray society as cohesive rather than riven by conflicts of interest. It distorts reality, like a dream. When reading history, students learn that ideology never really existed before the French Revolution, at least not in its present form. Other than religion, there were no mass popular movements organized around a body of doctrine during the Middle Ages. Kings killed their subjects, for example, the Stockholm Massacre in 1520; wars were fought, for example, between France and England during the fourteenth century; and political rivalries raged, for example, between the Guelphs and Ghibellines in the medieval Italian city-states. But these were not clashes of conflicting ideologies so much as struggles for power between individual personalities, or just opportunities for individual revenge. The lack of efficient communication and the low level of popular participation in politics made conflicts more individualized during that era, rather than struggles with a strong theoretical foundation. Ideology, by contrast, is a tool for dreamers in the modern era to conceptualize the future on behalf of thousands of people. It promotes theories and doctrines that presume to work for all of society. These theories enable dreamers to imagine people’s collective future and elevate it over the importance of any one individual. 

Ideological thinking is disastrous for a doctor practicing medicine. When taking care of patients, doctors must be clear-minded realists. Their power resides not in dreams but in steady persistence. Rather than strive for the unattainable, they must deal in tradeoffs, applying to patients the maximal treatment compatible with good health and the fewest complications. 

While ideologues may view medical work as an opportunity to perform, to virtue signal, to enhance their own self-esteem, or to engage in a kind of chivalric tourney, the best doctors view such work as a carefully thought out game of chess, demanding the utmost intellectual exertion. While ideologues may enjoy growing passionate and overheated in their endeavors, while they may make up their minds with the fiery intensity of people who, when offended, immediately reach for their guns, the best doctors are cautious, steady, and prudent—virtues typically ascribed to the shopkeeper, not the ideologue. 

No less dangerous is for doctors to look at an individual patient and see, in the patient’s place, the people’s collective future. Gunderman alludes to this ominous tendency in medicine today—for example, doctors looking at an individual patient not as an individual but as a member of some larger racial or ethnic group, thereby thinking it proper to make medical decisions “from a photograph or a box checked on a form.” Ideology inspires such dangerous ways of thinking, which can harm patients.

Gunderman says doctors must be complete human beings. He says they must be both doctors who practice medicine and citizens with social ideals. He is right. And the liberal arts enable this. Doctors should be thought leaders in their communities. They should engage in politics. But when actually doctoring, they should put their ideological systems and idealism aside. Ideology and medical practice do not mix.

A patient’s health is a fluid substance in the hands of a doctor; it might slip unawares through his or her fingers at any time. A mindset of supreme confidence and security—of the kind that ideologues enjoy—is dangerous in medical practice. Better for doctors to always be aware that they might be wrong, and may need to turn back and follow a different road. Medical students eager to bring ideology into their work may find it boring and pedestrian to be a practical, sensible person rather than an impractical and romantic one. But in medicine, knowledge of what is feasible can amount to genius. Doctors win their victories by way of a shrewd utilization of thoughts and experiences that are long digested in their minds, not by catchwords or slogans. 

A solid liberal arts education may not prevent medical students in an auditorium, or doctors running for political office, from embracing the fashionable ideologies of the day. But it can teach them enough about ideology to discourage them from bringing ideology into medical practice.