by Lewis Thomas
To avoid this outcome (which in a New York Times Magazine article two military authorities, proponents of thermonuclear research, referred to in passing as a “dismal prospect”), I suggest that we use these hostages differently, and persuade the Russians to put up 300,000 troops as tokens of their good faith to be used symmetrically. Bring all the Russian troops to this country and put them on trains, different trains, different lines. Send all 300,000 Americans to the Soviet Union and put them on their trains, at random. Let the trains go off on their normal schedules. Once begun, the program will provide absolute assurance to each side that the other side can never know precisely where its 300,000 soldiers are at any given time. Hence, neither country will send off any missiles, for fear of killing a large number of its own people. American and Russian train schedules are both matters of public knowledge, well enough understood so that both sides can feel secure in their unpredictability.
It is, I grant, a little like the first plan for putting MX missiles on underground railways, but a real improvement, less expensive, and far simpler than running those costly missiles around in Utah or Nevada. It would be the ultimate defense strategy. Enough money would be saved to provide real, old-fashioned Pullman accommodations for all the soldiers, good filling meals, marvelous views, movies, sleepers, the works. The entire railroad systems of both countries would be restored to solvency, maybe even enriched sufficiently to improve the roadbeds. Everyone would benefit, and no one would get hurt. And no one would fire from abroad, not a single missile, for fear of hitting them.
A side benefit, a spin-off, so to speak, might be the effect on the train-riding troops themselves. Looking out of the windows at the countryside views of both countries—the foreign scenery, the farms and gardens—they would catch glimpses, especially as their decoy trains entered the stations of various towns and cities, of something neither they nor their commanders may have realized before: there are people out there.
SCIENCE AND “SCIENCE”
I remain puzzled over how to classify the science and technology underlying nuclear warfare. Because of the high degree of uncertainty involved in this sort of research, as well as the ambiguity and unpredictability of its outcome, I asserted earlier that it should be classed as entirely basic science, by definition, and should therefore be subject to the same budgetary constraints as all the rest of basic research in the nation.
Since then I have changed my mind. I recant, partly under the influence of the Defense Department’s latest announced R & D plans for fighting a “protracted” nuclear war. I take it back. This kind of military research is not at all like any science I have ever heard of, basic or applied. It is a new, peculiar kind of endeavor for which some other term must be invented. It resembles, more closely, an endless game. I suppose you could argue that scientific research is also a sort of game, but there is a difference: ordinary games finish at some point; there are winners and losers. Neither of these seems possible under the rules of nuclear “science,” and the game seems designed to go on forever. I have placed the word in quotation marks, provisionally, until I can think of a suitable euphemism.
There are many differences, but one that is decisive and compelling. In science in general, one characteristic feature is the awareness of error in the selection and pursuit of a problem. This is the most commonplace of criteria: if a scientist is going to engage in research of any kind, he has to have it on his mind, from the outset, that he may be on to a dud. You can tell a world-class scientist from the run-of-the-mill investigator by the speed with which he recognizes that he is heading into a blind alley. Blind alleys and garden paths leading nowhere are the principal hazards in research.
Everyone in science knows about this, although it is not much talked about. Most scientific hypotheses, including what seem the brightest and best, turn out to be wrong. I would guess that the luckiest and most productive of investigators is right in his original notion, the guess with which he starts his work, about once out of a hundred tries, at his peak. What counts is his instinct for spotting wrongness, his willingness to give up on a favorite conviction, his readiness to quit and shift to a better project. Insoluble problems abound. It takes almost as much good judgment to recognize these when they turn up as to perceive quickly the ones that can be settled, solved, nailed down once and for all by research.
There are two ways of clouding the vision of a working scientist in making this discrimination (assuming that he is of average intellectual stature). One is money. If the funds for a particular research project are coming in over his head in cascades, the scientist may be misled into thinking that he is on to a good thing, no matter what his data show. I can only suspect this to be a possibility, having never seen it happen. Second, the researcher may be led down his garden path by his equipment. If he is in possession of sophisticated instruments of great power, and if he is being assured that whatever other new instruments he can think of will be delivered to the door of his laboratory tomorrow, he may find it difficult to stop himself on a dead road of inquiry, even if he knows it to be dead. I have long believed that there is no scientist alive whose career could not be terminated by an enemy, if the enemy were capable of increasing the laboratory’s budget by tenfold or any-fold overnight and, as well, assuring access immediately to any instrument within reach of the victim’s imagination.
Maybe one or the other or both of these things are responsible for what is going on in defense “science” today. Certainly, the cascades of money are out there, with more promised to come, enough to convince any individual researcher that the project must be a good one even if he doesn’t understand why. And meanwhile, like enormous, irresistible, gleaming, and spinning toys, there are the missiles and their warheads, each one more destructive than one thousand Hiroshima bombs, loaded with magnificent navigational equipment more fun to play with than anything else on earth or in space. Any technological whim can be promised instant gratification on demand. Toys indeed.
Still, the damned things are not going to work and the “science” is leading nowhere. Everyone who ought to know knows this, and almost everyone agrees, even in public. It is endgame, a dud, a piece of nonscience flawed enough to qualify as nonsense. There is no way to design or redesign these weapons so that they can ever be used to win a war or even to fight a war, and no technological fix within the grasp of human imagination that can assure defense against them—if what is to be defended is human society.
And yet the “science” goes on, one side adding an embellishment to its threat to devastate the cities of the other side, the other side then dangling a matching ornament; one side donning a new horrifying mask, the other waving a scary banner; a war dance on one side, a counter-dance on the other.
Lord Solly Zuckerman, a longtime science adviser to the British government on science in general and military science and technology in particular, has written a book on this, the best book on the problem that I have read in recent years: Nuclear Illusion and Reality. Zuckerman believes that the “technicians” are the main source of our trouble today. It is interesting that he uses the term as reservedly as do many proper scientists, even when, as in the case of physicists, they are talking about themselves. They do not refer to the workers in the field as scientists or engineers; they are the “technicians.”
Well, Lord Zuckerman says, the technicians have been far too long in charge of the world’s destiny, if you accept that the world’s destiny will, in part, anyway, be determined by how we all come out in nuclear warfare. He maintains, as do most science advisers in most nations, that “nuclear weapons and nuclear weapons systems are not weapons of war.” He says, rather more bluntly than most scientists seem willing to say, that the scientific community itself must carry a heavy burden of responsibility for today’s dilemma. “The scientists who work in the defense departments of governments, or in defense industries, are not apostles of peace. Political and military leaders should cease seeking shelter behind th
e backs of those ‘experts’ who take what is usually called the harder line. . . . If the bridge itself is not to become submerged, the politicians will have to take charge of the technical men.” There it is again, a scientist writing of the work of other scientists, now obliged to refer to them as “technical men.”
It does not often happen that scientists come out with public declarations that an avenue of scientific research should be blocked by public action. Most of the time, the entire scientific community maintains that deep research is unpredictable because it is aimed at uncovering brand-new information about nature. To stop science at any point, in any field, risks a restriction on human knowledge, and scientists as a group believe in their hearts that knowledge and understanding of the world are what the world most needs. There have, of course, been a few exceptions: many eminent physicists and mathematicians were deeply opposed, back in the late 1940s, to any research that might lead to the development of the hydrogen bomb; more recently, a smaller group of biologists advised delay in the pursuit of recombinant-DNA techniques until the safety of the method could be assured.
But it is possible to oppose the kind of research involved in nuclear warfare on grounds that have nothing to do with the traditional openness and curiosity of the scientific mind. This is not an instance of scientists blocking science itself. What is to be blocked, if it can indeed be blocked, is not real science. It has a single objective that cannot conceivably be attained: national security, which lies as far beyond its reach as transmutation for the early alchemists. Indeed, as Zuckerman points out in his book, “the continued growth of nuclear arsenals not only fails to increase, but actually decreases, national security.”
Zuckerman puts it in the coldest language. The development of nuclear weapons, he says, derives its momentum not from any notions of military science or national policy on either side but “from the minds of enthusiastic technicians plying their trade in the weapons laboratories.” He is not talking about people he would be willing to call scientists.
It is hard to see how the nations possessing nuclear weaponry can come to an agreement on arms reduction by simply throwing away part of the arsenals now on hand, although this must somehow be accomplished, sooner or later. But it is even more important, in the interest of longterm stability, that all research efforts to devise better weapons and better defense systems be ended. The world needs a multilateral treaty under which all parties will agree to stop the flow of money into their nuclear R & D laboratories, to stop all testing of weapons systems, and, above all, to stop the “technicians” from cooking up new ideas.
ON THE NEED FOR ASYLUMS
From time to time, medical science has achieved an indisputable triumph that is pure benefit for all levels of society and deserving of such terms as “breakthrough” and “medical miracle.” It is not a long list, but the items are solid bits of encouragement for the future. The conquests of tuberculosis, smallpox, and syphilis of the central nervous system should be at the top of anyone’s list. Rheumatic fever, the most common cause of heart disease forty years ago, has become a rare, almost exotic disorder, thanks to the introduction of antibiotics for treating streptococcal sore throat. Some forms of cancer—notably childhood leukemias, Hodgkin’s disease, and certain sarcomas affecting young people—have become curable in a high proportion of patients. Poliomyelitis is no longer with us.
But there is still a formidable agenda of diseases for which there are no cures, needing much more research before their underlying mechanisms can be brought to light. Among these diseases are some for which we have only halfway technologies to offer, measures that turn out to be much more costly than we had guessed and only partly, sometimes marginally, effective. The transplantation of major organs has become successful, but only for a relatively small number of patients with damaged kidneys and hearts, and at a financial cost much too high for applying the technologies on a wide scale. Very large numbers of patients with these fatal illnesses have no access to such treatments. Renal dialysis makes it possible to live for many months, even a few years, with failed kidneys, but it is a hard life.
The overestimation of the value of an advance in medicine can lead to more trouble than anyone can foresee, and a lot of careful thought and analysis ought to be invested before any technology is turned loose on the marketplace. It begins to look as if coronary bypass surgery, for example, is an indispensable operation for a limited number of people, but it was probably not necessary for the large number in whom the expensive procedure has already been employed.
There are other examples of this sort of premature, sweeping adoption of new measures in medicine. Probably none has resulted in more untoward social damage than the unpredicted, indirect but calamitous effects of the widespread introduction twenty or so years ago of Thorazine and its chemical relatives for the treatment of schizophrenia. For a while, when it was first used in state hospitals for the insane, the new line of drugs seemed miraculous indeed. Patients whose hallucinations and delusions impelled them to wild, uncontrollable behavior were discovered to be so calmed by the treatment as to make possible the closing down of many of the locked wards in asylums. Patients with milder forms of schizophrenia could return, at least temporarily, to life outside the institutions. It was the first real advance in the treatment of severe mental disease, and the whole world of psychiatry seemed to have been transformed. Psychopharmacology became, overnight, a bright new discipline in medicine.
Then came the side effect. Not a medical side effect (although there were some of these) but a political one, and a disaster. On the assumption that the new drugs made hospitalization unnecessary, two social policies were launched with the enthusiastic agreement of both the professional psychiatric community and the governmental agencies responsible for the care of the mentally ill. Brand-new institutions, ambitiously designated “community mental health centers,” were deployed across the country. These centers were to be the source of the new technology for treating schizophrenia, along with all other sorts of mental illness: in theory, patients would come to the clinics and be given the needed drugs, and, when necessary, psychotherapy. And at the same time orders came down that most of the patients living in the state hospitals be discharged forthwith to their homes or, lacking homes, to other quarters in the community.
For a while it looked like the best of worlds, on paper, anyway. Brochures with handsome charts were issued by state and federal agencies displaying the plummeting curves of state hospital occupancy, with the lines coinciding marvelously with the introduction of the new drugs. No one noted that the occupancy of private mental hospitals rose at the same time—though it could not rise very high, with the annual cost of such hospitalization running around $40,000 per bed. The term “breakthrough” was used over and over again, but after a little while it came to be something more like a breakout. The mentally ill were out of the hospital, but in many cases they were simply out on the streets, less agitated but lost, still disabled but now uncared for. The community mental health centers were not designed to take on the task of custodial care. They could serve as shelters only during the hours of appointment, not at night.
All this is still going on, and it is not working. To be sure, the drugs do work—but only to the extent of allaying some of the most distressing manifestations of schizophrenia. They do not turn the disease off. The evidences of the mind’s unhinging are still there, coming and going in cycles of remission and exacerbation just as they have always done since schizophrenia was first described. Some patients recover spontaneously and for good, as some have always done. The chronically and permanently disabled are better off because they are in lesser degrees of mental torment when they have their medication; but they are at the same time much worse off because they can no longer find refuge when they are in need of it. They are, instead, out on the streets, or down in the subways, or wandering in the parks, or confined in shabby rooms in the shabbiest hotels, alone. Or perhaps they are living
at home, but not many of them living happily; nor are many of their families happy to have them at home. One of the high risks of severe mental disease is suicide, and many of these abandoned patients choose this way out, with no one to stop them. It is an appalling situation.
It is claimed that the old state hospitals were even more appalling. They were called warehouses for the insane, incapable of curing anything, more likely to make it worse by the process known in psychiatric circles as “institutionalization,” a steady downhill course toward total dependency on the very bleakness of the institution itself. The places were badly managed, always understaffed, repellent to doctors, nurses, and all the other people needed for the care of those with sick minds. Better off without them, it was said. Cheaper too, although this wasn’t said so openly.
What never seems to have been thought of, or at least never discussed publicly, was changing the state hospitals from bad to good institutions, given the opportunity for vastly improved care that came along with the drugs. It was partly the history of such places that got in the way. For centuries the madhouses, as they were called, served no purpose beyond keeping deranged people out of the public view. Despite efforts at reform in the late nineteenth and early twentieth centuries, they remained essentially lockups.
But now it is becoming plain that life in the state hospitals, bad as it was, was better than life in the subways or in the doorways of downtown streets, late on cold nights with nothing in the shopping bag to keep a body warm, and no protection at all against molestation by predators or the sudden urge for self-destruction. What now?
We should restore the state hospital system, improve it, expand it if necessary, and spend enough money to ensure that the patients who must live in these institutions will be able to come in off the streets and live in decency and warmth, under the care of adequately paid, competent professionals and compassionate surrogate friends.