Questioning and Skepticism

Health care approaches for chronic conditions include primary and secondary prevention, acute episodic interventions, and expansion of the care circle to recognize the role of caregivers and family. People with chronic conditions require care that is as seamless as possible as they move between primary, acute, specialty, and community care. In high-income countries, chronic diseases have long been the leading causes of death and disability. Health care systems need to realize that the complex chronic conditions affecting their patients’ health cannot be addressed successfully in the doctor’s office alone and that responsible health care isn’t just about the personal responsibility of patients but also requires that the health care system itself be responsible in providing health care consumers with appropriate options. These options can be provided by partnerships with local governments, community organizations, and other health and human service providers to develop strategies to address the social determinants of health.

Nietzsche called free will “a theologians’ artifice” that permits us to “judge and punish.” However, many thinkers believe, as Smilansky does, that institutions of judgment and punishment are necessary if we are to avoid a fall into barbarism. Today, people’s belief in free will is shown to influence the perception of personal control in self and others. The current studies tested the hypothesis that individuals who believe in free will attribute stronger personal blame to obese people and to people with mental illness (schizophrenia) for their adverse health outcomes. Free will beliefs are correlated with attribution of blame to people with obesity and mental health issues. The stigma of addiction is that people with substance abuse disorders are weak, immoral, and simply out for a good time at society’s expense. However, addiction impairs the brain. The earlier the drug exposure, or trauma to the brain, the greater the damage.

The challenge of stopping drugs has to do with deficiency of the prefrontal cortex which is the part of the brain involved with executive function. The job of the prefrontal cortex is self-monitoring, delaying reward, and integrating whatever the intellect tells you is important with respect to what the libido is telling you. The flood of intoxicating brain chemicals called neurotransmitters (chiefly dopamine) during drug use makes the brain relatively insensitive to normal sources of pleasure such as good conversation with a friend, or a beautiful sunset. Agonist medications such as methadone or bupropion can stabilize the craving brain while planning and reasoning processes get back in shape. The person who self-isolates themselves in order to use drugs without inhibition may need to work in a purposeful way to re-acquire habitual joy, such as social interactions, physical pleasure like a swim or bicycle ride, and other healthy enjoyable rewards.

In the healthy brain dopamine is released in response to natural reward, such as food or exercise. Some drugs are able to bind to brain cells and trigger the release of dopamine. Taking drugs produces a euphoria feeling, which in turn, re-enforces drug using behaviour. Drugs release 2 to 10 times the amount of dopamine that natural rewards release. As substance use continues the brain produces less dopamine and/or reduces the number of brain structures that receive dopamine. Thus, dopamine’s impact on the reward network diminishes along with the individual’s ability to experience pleasure. This can explain why individuals who chronically abuse drugs begin to appear lethargic, unmotivated and depressed and report a lack of pleasure in things that were once pleasurable. To counter, they increase their substance abuse in attempts to feel the same pleasure they use to. This creates a vicious cycle of taking increasing amounts of drugs that leads to tolerance.

The dopamine pathway is involved in mediating reward-motivated behaviour. However, biology is involved – a combination of personality and experiences over which they have no control. There is the challenge to deny the reward of craving – it is necessary to avoid the cues that set off cravings. People with addiction lose control over their actions. They crave and seek out drugs, alcohol, or other substances no matter what the cost – even at the risk of damaging friendships, hurting family, or losing jobs. People often describe drug addiction as a habit, and one that is difficult to break. When people attempt to discontinue an addiction like drug use, they can experience withdrawal. The memory of withdrawal is such an unpleasant experience that it serves as a powerful motivator (or cue) to resume the addictive behavior to avoid the unpleasant experience.  Eventually, the relief from withdrawal (by resuming use) becomes pleasurable in and of itself.

Both genetic and environmental variables contribute to the initiation of use of addictive agents and to the transition from use to addiction. Addictions are moderately to highly heritable. Many just appear to be at risk for addiction, then it makes addiction a chronic disease of the brain. Addictive drugs induce adaptive changes in gene expression in brain reward regions, including the striatum, representing a mechanism for tolerance and habit formation with craving and negative affect that persist long after consumption ceases. These neuroadaptive changes are key elements in relapse. Once an individual becomes addicted, the clinical options are untargeted and only partially effective. Counseling for addiction aims to help people change behaviors and attitudes around using a substance, as well as strengthening life skills and supporting other treatments. Some forms of treatment for addictive disorders focuses on the underlying cause of the addictive disorder in addition to behaviors characteristic of the addiction.

The rise in heroin use is believed to be linked to prescription drug abuse.  Many people who abuse painkillers switch to heroin for two reasons: It is cheaper and often easier to get. Over the past decade fatal opioid overdose has emerged as a major public health issue. Losses of tolerance and concomitant use of alcohol and other CNS depressants clearly play a major role in fatality; however, such risk factors do not account for the strong age and gender patterns observed consistently among victims of overdose. There is evidence that systemic disease may be more prevalent in users at greatest risk of overdose. Compton cautions against conflating all increased drug use directly with COVID-19. For example, shifts in drug availability may also be to blame for increased illicit opioid use deaths; if heroin isn’t easy to access, someone might take fentanyl, which is much stronger.

Existential crisis and dual diagnosis confound the response. An existential crisis is when questions about life, the universe, and humanity’s role in the scheme of things become so important to the individual that deep psychological pain occurs when there are no answers. And when this happens, some use illicit drugs to numb themselves to the profound pain they’re feeling. The qualifications for dual diagnosis are broad. Obviously struggling with depression and alcohol use disorder is a far cry in many ways from a schizophrenia diagnosis with a heroin addiction. However, both are dual diagnoses. Determining which disorder came first, and whether or not it caused the other, can be a tricky situation. Either substance abuse or mental illness can develop first. Someone with a mental health disorder may abuse drugs and/or alcohol as a self-medication for the initial mental problem. Drug and/or alcohol abuse only makes the symptoms of mental health disorders worse.

But experts agree based on research and clinical observation that pandemic-related pressures, from economic stress and loneliness to general anxiety about the virus, are a major driver for the increase. Fentanyl has been linked to many of these overdose deaths. Fentanyl is an opioid that is prescribed as a skin patch. It is 100 times more powerful than morphine and used to treat severe pain. Naloxone is a medication that can temporarily reverse the effects of an opioid overdose and allow time for medical help to arrive, is part of acute care. Harm reduction is part of long-term intervention in substance abuse. Safe injection sites complement existing services; they prevent death, not the problem. Essential to a harm reduction approach is that it provides people who use substances a choice of how they will minimize harms through non-judgemental and non-coercive strategies in order to enhance skills and knowledge to live safer and healthier lives.

Although there is much to learn, we do know that both primary and secondary prevention are crucial to reducing the harms of addiction. The social determinants of health are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems. Drug addiction is a chronic disorder typically characterized with intermittent relapses. Hence, a short-term one-time treatment is generally not sufficient. Research shows that addictions can be managed successfully. Individuals who enter and remain in treatment can manage their addiction and improve their quality of life. It is important to recognize addiction is not about moral failure, rather a chronic disease that requires community support for getting into and staying in recovery.

Severe Acute Respiratory Syndrome (SARS), which presents as pneumonia, was first discovered in Asia in February 2003. The outbreak lasted approximately six months as the disease spread to more than two dozen countries in North America, South America, Europe, and Asia before it was stopped in July 2003. Public health plays an important role. The goal of situation monitoring and assessment is to collect, interpret, and disseminate information on the risk of a pandemic before it occurs and, once under way, to monitor pandemic activity and characteristics. To assess if the risk of a pandemic is increasing, it is important to monitor the infectious agent, its capacity to cause disease in humans, and the patterns of disease spread in communities. It is important to collect data on (influenza) viruses, the genetic changes taking place and consequent changes in biological characteristics, and to rapidly investigate and evaluate outbreaks. SARS was a wake-up call for how we think about global health.

Doctors once had little choice but to be fatalistic about deaths from pneumonia. Sir William Osler, sometimes called the father of modern medicine, famously called it “friend of the aged” (often rendered as “the old man’s friend”) because it was seen as a swift, relatively painless way to die.  Pneumonia is more of a pathogenic team sport. The pneumococcal vaccine (PPV23) targets 23 variants of Streptococcus pneumoniae (also known as pneumococcus), the bacterium responsible for a quarter of community-acquired pneumonia cases. Even so, the vaccine doesn’t provide protection against all the pneumococcus variants, nor against other types of bacterial infections or the viral and fungal causes of pneumonia. People sometimes make the mistake of viewing the pneumococcal vaccine as the pneumonia vaccine, but it’s not. Moreover, novel causes of community pneumonia keep appearing.

The influenza virus is the one we are most familiar with. It lives longer indoors in winter, because the air is less humid than outside. While it’s alive and in the air, it’s easy for people to inhale it, or for it to land on the eyes, nose, or mouth. We spend more time indoors and have closer contact with each other, which makes it easier for the virus to spread. The influenza A virus does not lie dormant during summer but migrates globally and mixes with other viral strains before returning to the Northern Hemisphere as a genetically different virus. These viruses spread seasonally each year because of a phenomenon known as antigenic drift: They evolve just enough to evade human immune systems, but not enough to develop into completely new versions of the virus. Accordingly, public health promotes a vaccine each year to reduce the morbidity and mortality in the community.

When the flu virus causes pneumonia directly, it’s really the immune response that causes much of the damage, bringing fluid and cells into the alveoli of the lungs. Both the 1918 virus and the more recent H5N1 bird flu virus cause a dramatic immune response that is exponentially larger than the response to the typical flu virus. It’s probably this strong immune response that makes the death rate from infection by those two viruses so much higher than the rate for normal flu. While other types of pneumonia rapidly infect large regions of the lungs, COVID-19 (much like pandemic flu strains) begins in numerous small areas of the lungs. It then uses the lungs’ own immune cells to spread across the lungs over many days or even weeks. This is similar to how multiple wildfires spread through a forest. The long duration of COVID-19 pneumonia, rather than greater severity, may be why it causes more serious complications than other types of pneumonia.

Research has repeatedly shown that women have stronger immune systems than men – they’re less likely to become seriously ill from infections, less susceptible to cancer, and significantly more prone to overreactions such as autoimmune diseases and allergies. Women also tend to mount more powerful immune responses to vaccinations. “The female immune system has to be very different for the obvious reason that they have to be able to become pregnant and not reject the foetus. Therefore you have to have an immune system which has a more intricate feedback mechanism. And that is true from birth,” says Aaby. Previous research has found that the severity of COVID-19 tends to be higher for men compared to women. A study of 17 million adults found that men could face nearly twice the risk of death from the disease than their female counterparts.

Influenza mutates up to three times more often than coronaviruses do, a pace that enables it to evolve quickly and sidestep vaccines. But coronaviruses have a special trick that gives them a deadly dynamism: they frequently recombine, swapping chunks of their RNA with other coronaviruses. Typically, this is a meaningless trading of like parts between like viruses. But when two distant coronavirus relatives end up in the same cell, recombination can lead to mutations on their spike proteins that confer an advantage, creating so-called variants. A subset of these variants spread more easily and quickly than other variants, which may lead to more cases of COVID-19. This leads to an increase in the number of cases that puts more strain on health care resources, leads to more hospitalizations, and more deaths in younger persons. The response has been increased lock-downs, regrettably associated with push back from groups opposing government trampling on individual freedom. The answer is to have everyone vaccinated.

 Once a pandemic virus begins to circulate, it is vital to assess the effectiveness of the response measures. Reducing the spread of disease will depend significantly upon increasing the “social distance” between people. Measures such as individual/household level measures, societal-level measures and international travel measures, and the use of antivirals, other pharmaceuticals, and vaccines will be important. During a pandemic, health systems will need to provide health-care services while attending to the influx of patients with influenza illness. Planning for surge capacity in health-care facilities will help determine the extent to which the existing health system can expand to manage the additional patient load. Health-care facilities need to maintain adequate triage and infection control measures to protect health-care workers, patients, and visitors. A core element in management is to maintain and build public trust in public health authorities before, during and after a pandemic.

The goal of communications before and during a pandemic is to provide and exchange relevant information with the public, partners, and stakeholders to allow them to make well informed decisions and take appropriate actions to protect health and safety and response. This is a fundamental part of effective risk management! Public health professionals in Canada and the US are not single-handedly responsible for communication failures during COVD-19 – politicians found it necessary to elbow their way to the front of the communication queue. Thus, initially the people with the least knowledge and experience in pandemic response were impacting the public health message. Government officials were concerned about public panic, so they validated the public’s complacency, leaving us incredibly unprepared. In a February 25^th media briefing a CDC official said bluntly that “disruption to everyday life may be severe.” The stock market plummeted, President Trump was angered, and the CDC was rebuked.

The World Health Organization (WHO) sounded its highest alarm on January 30, 2020 – a declaration called a ‘public health emergency of international concern’, or PHEIC, signalling that a pandemic might be imminent. Few countries heeded the WHO’s call for testing, tracing and social distancing to curb the coronavirus. By mid-March, it had spread around the world. The Trudeau government dismantled a world class Global Public Health Intelligence Network in Canada the year before the pandemic. An expert’s panel’s report found that prior to the pandemic, the replacement alert system lacked standard operating procedures. Senior managers also didn’t fully understand the rationale and the intended audience for alerts. In the US, President Donald Trump and his administration silenced scientists, meddled in their reports and ignored their advice. A coronavirus-crisis sub-committee within the US House of Representatives report notes that the frequency of meddling (such as recommendations altered) increased in the lead-up to the US election.

If something that happens is a wake-up call, it should make you realize that you need to take action to change a situation. In particular, what happened in both the US and Canada is politicians did not understand the basic functions of public health monitoring systems in protecting citizens from the ravages of pandemics. In general, the global pandemic alert system is not fit for purpose; critical elements of the system are slow, cumbersome and indecisive. There has been a wholesale failure to take seriously the existential risk posed by pandemic threat to humanity and its place in the future of the planet. The World Health Organization has been underpowered to do the job expected of it, and the incentives for cooperation are too weak to ensure the effective engagement of States (countries) with the international system in a disciplined, transparent, accountable and timely manner. This situation cries out for change.

The Glorious Revolution in 1688-1689 marked the beginning of modern English parliamentary democracy. It was called glorious because it achieved its goals without bloodshed in England. This struggle between the king and parliament ended in victory for the people. The new parliament separated the dominant institution of the day, the church, further from the process of government to reduce the church interference in government. A democracy relies on power-sharing arrangements, courts, legislatures and a free and independent media to check executive power. Since these institutions obstruct the free reign of populists, they are often subjected to blistering attack. This is especially the case with the right-wing variety of populism that is spreading across the U.S. and Western and Eastern Europe. Populism calls for kicking out the political establishment, but it doesn’t specify what should replace it. Some describe the Enlightenment as beginning with England’s Glorious Revolution.

The Enlightenment writers were concerned about the inequality of the existing system and introduced questioning and critical thinking to replace the dead weight of tradition, and challenge the blind faith in institutions. The philosophers wanted to understand the rationale behind inequality, were particularly interested if there were natural reasons for it, or if inequality came wholly from social conventions. The process of corporate expansion across borders creates rapid change in many communities with subsequent negative consequences for workers. The fact that there is little international regulation has dire consequences for the safety of the people and the environment. Multinational corporations are responsible for the removal of traditional government accountability to a fixed population for much of politics. This creates a lack of ability of those affected by decisions to protect their legitimate rights and interests. The new corporate values of globalization normalize through a doublespeak, selling commercialization and free market choices as democracy.

During the first 20 years of this century, the political, economic and financial elites who brought you the euro crisis, the war in Iraq, the Great Recession of 2008, growing inequality and middle-class income stagnation have made some very serious mistakes, of very enduring consequences, with very startling impunity. Trump perfected the ‘know nothing’ façade of the Republican party to directly appeal to white working-class communities that have a ‘long tradition of hostility towards knowledge.’ Have no doubt neoliberalism serves the interest of financial capital and globalized elites in the redistribution of wealth upwards. The popular lexicon has adopted the term of ‘fake news’ and attributed it to Trump, yet it should be attributed to neoliberalism. Trump supporters now live in a media bubble, getting their news from sources that play to their identity-politics desires, which means that even if you offer them a better deal, they won’t hear about it, or believe it if told.

In the 1980s, school systems lowered educational standards to protect children from failure. The world would be saved from crime, drug abuse and under-achieving through bolstering self-esteem. This self-esteem movement has had a significant impact – in order to ensure positive self-esteem education standards were significantly lowered, creating a milieu for extreme individualism. When there is too much self-esteem there are problems of self-tolerance, entitlement and narcissism. This person demands automatic and full compliance with his/her expectations. The cult of self-esteem that was created in schools provides a pool of individuals in the 21^st century who view the world from an emotional rather than a rational perspective, supporting extreme individualism and allowing personal feelings to overcome the distinction between right and wrong. This person is addicted to the attention of others for admiration, applause and admiration. Behind this façade they only care about appearances.

Psychopathy is a personality disorder that cuts off those who are affected by it from the emotional reality of others. The core of this pathology is the inability to put oneself into someone’s shoes. Empathy is the seat of conscience, and without it comes an incapacity for love. These candidates are just symptoms of a system run by corporations, which is now revealing the full fledge of pathology incorporated in the United States. When a society lacks understanding of the depth of its darkness, this unaccounted power sees no bounds for its pursuit of a single vision. Those who are devoid of empathy hide their lack of internal structure in a façade of normalcy. By emulating good human attributes, these unknown members of society prey on the rest. They have found the best way to mask their vice by infiltrating governments and directly altering the definition of the norm.

Despite its alleged commitment to market competition, the neoliberal economic agenda instead brought the decline of competition and the rise of close to monopoly power in vast swaths of the economy: pharmaceuticals, telecom, airlines, agriculture, banking, industrials, retail, utilities, and even beer. The U.S. government is highly responsive to the policy preferences of the wealthiest people, corporations, and trade associations – and that it is largely unresponsive to the views of ordinary people. But neoliberalism rejects both the medieval approach of having fixed social classes based on wealth and power and the modern approach of having a single, shared civic identity based on participation in a democratic community. Neoliberalism is the dominant ideology that supports the economic elite. As an answer to the problems of deregulation, privatization, liberalization, and austerity, it offers more of the same or, at best, incremental and technocratic “nudges.”

“Happiness is the feeling that power increases – that resistance is being overcome”, says Nietzsche, and moral concepts are merely façades of the power elite, while happiness is a kind of control one has over their surroundings. In a democracy every citizen has certain basic rights that the state cannot take away from them. People should question the decisions of the government, but not reject government authority. The measure of a successful society is the happiness of its people. Once the voters understand the extent of economic inequality in today’s system, they will possess the knowledge to recognize the need for change. However, democracy remains the best human weapon so far invented for guarding against the ‘illusion of certainty’ and breaking up truth-camouflaged monopolies of power, and create a successful society. It is necessary to return to laws based on equality of persons rather than laws of the market.

Mishra observes, “The new horizons of individual desire and fear opened up by the neoliberal economy do not favor democracy or human rights.” Laissez-faire capitalism Ayn Rand argues, is the only system that protects individual rights. Freedom has nothing to do with democracy or speech or individual rights. Today, for neoliberals in general, and Republicans in particular it is about the freedom of the markets and the elites who control those markets. Republican social policies tend to oppose extensive government regulations, government-funded social programs, affirmative action, and policies aimed at strengthening the power of workers. As the pandemic has demonstrated, however, it is not the existential dangers, but rather everyday economic activities that reveal the collective, connected character of modern life beneath the individualist façade of rights and contracts. Carl Jung says, “One does not become enlightened by imagining figures of light, but by making the darkness conscious. The latter procedure, however, is disagreeable and therefore not popular.”

In America the crumbling façade of democracy has laid bare the weakness of the Republican Party with its full-throated support of small government and minimal regulations of neoliberalism. To distract voters, they embrace the uncertain populist policies of division and misinformation. Fox News tells viewers they are the only reliable source of political information – re-enforcing the alt-right propaganda in social media. At CPAC they do not debate policy, rather embrace a symbol – Donald Trump as the force to move forward with. Trump in true populist form, sans policies, attacks the “Washington elites” as the problem. On the other hand, the Democratic party is still able to maintain the façade of democracy and hide their neoliberal tendencies from the majority of their supporters. However, there are cracks in this façade as progressives press the so-called Democratic establishment to separate the neoliberal institution from the process of government.

The Enlightenment brought political modernization to the West, in terms of introducing democratic values and institutions and the creation of modern, liberal democracies. In America the Republican Party is no longer a viable choice for democracy. It remains in the hands of the 1% and their proxies and refuses to budge from neoliberal policies. It must be allowed to fail. During the Reagan era the wealthy were mostly funding Republicans. The Democrats needed to move to the right to secure funding from the wealthy, to start winning again. However, in order to restore democracy in America it will be necessary to throw off neoliberal policies of wage suppression, deregulation, and tax cuts; and once again put political power in the hands of the American working class. It is necessary to wipe out the last vestiges of Trumpism, as well as neoliberalism in the Democratic Party to restore democracy in America. Enlightenment is the crumbling away of untruth. It’s seeing through the façade of pretense.

When you have to compete in a world that is structurally unfair and where the game is so often loaded against the little guy, stress and anxiety result. A society of individuals frequently switching jobs, relocating, and preoccupied with personal risk and self-interest is conducive to neither stable families nor cohesive communities. Where career is no longer a meaningful concept, it is no longer possible for one to make and maintain the long-term commitments required of people to form their characters into sustained narratives. Instability and insecurity of the COVID pandemic is also hugely damaging to well-being. Fear and anxiety about a new disease and what could happen can be overwhelming and cause strong emotions in adults and children. Public health actions, such as social distancing, can make people feel isolated and lonely and can increase stress and anxiety.

Neoliberalism should be interpreted as an anxiety-ridden form of crisis management that is constantly attempting to cover over the gaps and ruptures in its own ideological fabric caused by the contradictions that it is structured to conceal. Moreover, creating anxiety and uncertainty among employees, even ones at the highest level, is actually the point. Such anxiety and uncertainty hinder them from taking risks in participating fully in society as political actors. The same logic would apply to environmental, health and safety regulations designed to protect workers, consumers and the population at large. If you want your country to be competitive, it is best to keep such regulations to a minimum. The power of debt in neoliberalism represents a highly efficient mechanism of control and capture, and much more efficient than the modes of resistance put in place by the workers’ movement.

Metaphors can create anxiety: Donald Trump launched his political career by embracing a brand-new conspiracy theory twisted around two American taproots – fear and loathing of foreigners and of nonwhites. The commodification of politics and social services has stoked mass cynicism towards reigning neoliberal elites, creating receptive audiences for populist slogans to ‘drain the swamp’ at the heart of governments. Populists classically claim to speak for, and personify the interests of, ‘ordinary people’ against established elites (even when these leaders often emerge from elites themselves), and they condemn those who disagree as somehow not genuinely ‘of the people’. In particular, they tell people what they want to hear, often appealing to popular beliefs, prejudices, anxieties and fears, without the need to anchor their programs or policies in scientific or expert knowledge.

One reason for the pervasiveness of conspiracy theories is that they serve an important psychological function for people trying to cope with large, stressful events like a terrorist attack. People “need to blame the anxiety that they feel on different groups and the result is frequently conspiracy theories,” Jan-Willem van Prooijen said, defining the term as a belief that “a group of actors is colluding in secret in order to reach goals that are considered evil or malevolent. People don’t like it when things are really random. Randomness is more threatening than having an enemy. You can prepare for an enemy; you can’t prepare for coincidences.” Conspiracy theories also appeal to people’s need to feel special and unique (a form of agency detection) because it gives them a sense of possessing secret knowledge. These people need an explanation for why society is so awful.

The term cognitive dissonance is used to describe the mental discomfort that results from holding two conflicting beliefs, values, or attitudes. In the moment, cognitive dissonance can cause discomfort, stress, and anxiety. And the degree of these effects often depends on how much disparity there is between the conflicting beliefs, how much the beliefs mean to that person, as well as with how well the person copes with self-contradiction. This cognitive dissonance can be seen particularly in economists – scholars, politicians, media commentators. Paul Murawski notes: Neoliberal theories are unable to explain the financial crisis, there is a gap between the accepted theory and reality. Instead of recognizing that a paradigmatic change is necessary in mainstream economics, the economic profession stubbornly sticks to their mathematical models. On the other hand, the general public believes that this ideology supporting individualism, less government and regulations can no longer be falsified by anything as trifling as data from the “real” economy.

The media also creates cognitive dissonance, this feeling of uncomfortable tension, in many individuals in other areas. The cult of individualism makes us particularly prone to cognitive dissonance because our personal identity is very important. We see ourselves as stable self-contained beings. However, advertising that we may be missing something, or not fitting in creates anxiety. Television tends to feed an information diet (of self-approval) similar to consuming too much sugar inducing short-term euphoria and happiness while distracting from reality. The weakness of the mass media remains an inability to transmit tacit knowledge and an inability to deal with complex issues, so they tend to focus on the unusual or sensational, and the promotion of anxiety and fear. Confirmation-bias draws us into the one-sided outlets, and the cognitive dissonance pushes us away from conflicting ideas. Cognitive dissonance stops us from hearing other opinions that conflict.

Now many workers find themselves stressed working 60-70 hours a week as the only way to survive. These long hours are mentally and physically exhausting and lead to stress at work and at home. Long-term stress can result in anxiety, high blood pressure, and a weakened immune system. It also contributes to depression, obesity and heart disease. People who experience excessive stress often deal with it in unhealthy ways such as overeating, eating unhealthy foods, smoking cigarettes or abusing drugs and alcohol. The New Economics Foundation’s analysis of European data found that the difference in well-being between temporary and permanent workers was actually greater than that between temporary workers and the unemployed. If this seems surprising, that’s perhaps because we so drastically underestimate the anxiety and stress caused by insecurity. The promotion of ‘flexible labor markets’ in the name of growth and competitiveness may therefore not make us better off if it leads to the proliferation of insecure work.

The diagnosis of social anxiety is now commonplace – you become very anxious about what other people may think of you, or how they may judge you. Social anxiety is now the third most common psychological disorder after depression and alcoholism. SmithKline Beecham, makers of Paxil decided to promote it as treatment for social anxiety – bringing social anxiety into focus in the community. A multibillion-dollar marketing campaign linked the disorder to all manner of interpersonal and job-related problems in a way that fashioned all social discomfort as disease. However, success in the competitive marketplace emphasizes the importance of networking, self-presentation and the belief in the ever-present potential for opportunities; the required vigilance maintaining the kind of personal image that attracts them demands relentless self-monitoring. The problem is in the workplace of enterprise culture: anxious self-surveillance is both pathological and prescribed. We need to stop overthinking.

Neoliberalism in terms of its practical effects on people working in areas subject to its power creates a climate of fear and marginalization which expresses itself in the form of cultural anxiety and doubt. Søren Kierkegaard (1815-1855) claims everyone harbors a fear of being alone, forgotten by God, overlooked by his friends and relatives. He concluded that it was in our anxiety that we come to understand feeling that we are free, that the possibilities are endless. Even though anxiety can ignite all kinds of transgressions and maladaptive behavior, we should recognize it as a dual force that can be both destructive and generative, depending upon how we approach it. Kierkegaard argues, without anxiety there would be no possibility and therefore no capacity to grow and develop as a human being. Kierkegaard concludes, “Whoever has learned to be anxious in the right way has learned the ultimate… Anxiety can be replaced only by the freedom whose harsh requirements are its cause.”

Neoliberalism must be replaced by a social movement pressing for support of the working classes. We must counter the structural domination of capital – of alienation, loneliness, anxiety and isolation. Johann Hari observes, “Depression and anxiety are signals telling us that our needs are not being met, and I would say the single most helpful thing we can do going forward is to allow ourselves to hear the signal.”  We can learn positive lessons about how to redesign our society to reduce depression and anxiety going forward if we allow ourselves to hear this signal. The single most important thing that has to be done to deal with people’s depression and anxiety is to deal with the financial insecurity they’re facing.¹ It is necessary to limit this powerlessness by acting in solidarity through unions, social movements and election campaigns. The way we negotiate anxiety plays no small part in shaping our lives and character.

¹ Roge Karma (28 March 2020) Coronavirus, anxiety, and the profound failure of rugged individualism https://www.vox.com/2020/3/28/21196268/coronavirus-johann-hari-lost-connections-anxiety-depression-failure-rugged-individualism