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Max Weber understood how democracy in the seventeenth century was tied to Calvinist individualism and the rejection of external forms. Thomas Hobbes hated the consequences of puritan rule and argued that politics needed to accept the principle of the mask in order to create social order. The lawyer William Prynne in his Histrio-mastix portrayed theatre as the root of all evils in the royalist regime, but he himself proved a masterly performer in working to undermine the regime. The most radical democratic thinking came from the ‘Levellers’ who harked back to the Garden of Eden and natural human innocence. Shakespeare interrogated the ambivalent myth of Eden in Henry VI Part Two, as did Milton in Paradise Lost. The Putney debates constitute the main focus of this chapter. Common soldiers with Leveller views argued with their generals about constitutional principles. Close analysis of the debate reveals the complications that followed from claims to sincerity, couched as insistence that because God had spoken to them speakers were following their consciences, avoiding rhetoric or hypocrisy. The religious context in fact allowed a high level of democratic exchange.
To the modern political philosopher Amartya Sen, democracy appears a universal good, but others have seen it as a product of European and American thought bound up with colonialism, and have looked for qualities better attuned to ‘Asian’ values like consensus or the connection of human beings to nature. Gandhi presented himself as a man of transparent truth and integrity, so echoing Socrates, the Christian puritan tradition and (except in regard to violence) Robespierre. He disliked Parliamentary democracy, but needed it in order to secure independence. His encounter with Charlie Chaplin highlights the central problem: Was the Mahatma a staged role that he played, or an expression of his authentic self? Many were impressed, but some like Jinnah and Ambedkar were not. Rabindranath Tagore shared Gandhi’s objections to metropolitan Western-style electoral democracy, but distrusted Gandhi’s authoritarianism. As an artist, Tagore saw performance as an essential feature of human nature. He found no way in which he could himself enter the political arena, and fell back upon being an educator.
I stake out a contemporary context in which democracy seems to be under attack from the populist right, and neglected by parts of the progressive left caught up with a politics of the personal. In a polarised world, persuading others to change their sense of who they are has become more difficult. I draw on Jonathan Haidt to show how most decisions are made on the basis of emotion rather than reason. Hannah Arendt and Chantal Mouffe argue for the importance of public argument and the theatricality of political life, prioritising social roles over personal authenticity. From a liberal perspective, Judith Shklar speaks to the inevitability of hypocrisy in democratic politics. Matthew Flinders, Alan Finlayson and David Runciman are contemporary theorists who identify the need for political science to take on the problem of rhetoric. From truth and hypocrisy, I turn to the question of representation. A democratic politician represents those who vote for her or him much as an actor in a play represents a character. Theatre offers a lens through which to contemplate problems of selfhood and identity, and the paradox of the sincere liar.
De Tocqueville helps us see American democracy as a way of life shaped by individualism and a dislike of theatrical display. In John Adams, the ideals of Protestant Christianity and Roman republicanism collided. Adams believed in personal integrity, but was unashamed to perform a social role, inspired by the Roman republican orator Cicero. In the nineteenth century Hugh Blair repositioned rhetoric as a way to speak truth, in a language that in practice confined truth-speaking to the elite. When working-class Irish Americans sought a more inclusive democracy, they found a symbolic representative in the actor Edwin Forrest, and many died in the ensuing riot outside a new opera house in 1849. Black Americans first found a public voice through the person of Frederick Douglass, whose oratory was founded both on preaching and on the old flamboyant republican tradition. Women first demanded a voice in the context of Quakerism and the campaign to abolish slavery. Elizabeth Cady Stanton later argued for female suffrage in terms that were more secular, more individualist and ultimately more elitist.
Rhetoric was embedded in French Catholic education, and in revolutionary Paris rhetorical skills proved essential for any politician who wanted to command the assembly. Fabre d’Eglantine was an actor and director All expert in manipulating the political action behind-the-scenes. His play Philinte propounded Rousseau’s ideal that theatricality should be avoided in human life. Hérault de Séchelles by contrast drew on training by the classical actress Clairon to become a successful political orator, not ashamed to theorise the art of persuasion. The Marquis de Condorcet was a constitutional theorist who believed in truth, but lacked the performance skills to persuade others. The Comte de Mirabeau demonstrated outstanding skill as an orator and politician in the first years of the revolution, making no show of high personal morality, in contrast to Maximilien Robespierre who, partly in reaction, set himself up as a man of total sincerity. He bypassed the Assembly to control events through the more intimate forum of the Jacobin club. His sense of personal conviction owed much to Rousseau.
Participatory Athenian democracy has inspired many political thinkers, despite its imperialist atrocities, slavery and the subordination of women. Pericles is an ambivalent figure, and it is dangerous to see him as the embodiment of a golden age. His speech over the war-dead can be seen as a noble democratic manifesto or the calculated work of a demagogue. In a debate about the punishment of Mytilene, as depicted by Thucydides, Cleon uses the language of reason to work on the emotions, and is a paradigm of the populist or ‘demagogue’. We can see the ‘demagogue’ as an aberration from true democracy, or see the word itself as a standard weapon that can be wielded in any democratic contest. The comic dramatist Aristophanes offers us insight into Cleon’s performance techniques that embrace face, arms and voice, and into the minds of those who supported him. In his Gorgias, Plato theorises the problem of rhetoric. Gorgias was a Sicilian who taught the Athenians that rhetoric was an art which they could pay to learn, and for Plato this was a fundamental flaw in his nation’s democratic enterprise.
This chapter turns from democracy as theatre to the question of theatre’s place within a democracy. Modern political theatre foregrounds playwrights, understood to be people capable of enlightening the audience through their truthful representation of the world. Euripides’ Trojan Women has typically been read as an exposé of political wrongdoing, and an invitation to empathise with the suffering of the protagonists. In Athens, these plays were ’political’ in that they helped spectators unpick rhetorical strategies (Aristotle’s term is dianoia), making them discriminating judges in the law-courts and Assembly. Tragedies were part of a competition where audiences learned to judge the performance skills of writers and actors. Aristophanes’ Frogs is a case study in how decisions were actually made. Plato thought it unacceptable that aesthetic judgements could be based on crowd responses. He coined the term theatrocracy to evoke the power of the crowd to make aesthetic judgements, which he thought should remain the preserve of an educated elite. He saw the rule of the people in the theatre as both a metaphor for democracy and an instance of democracy in action.
This chapter is focused on a battle in the Athenian law-court between two great orators. Aeschines was trained as a tragic actor who worked in a mask, and brought the skills of the stage to the democratic arena. He argued for making peace with the new rising imperial power, Macedon, and tried to persuade the jury to position themselves as authentic democrats. Demosthenes was a skilled writer who wrote speeches for others, and later learnt how to present himself as a public speaker. He won the debate for two reasons. He persuaded the jury to position themselves in nationalistic terms as Athenians, and he also persuaded them that he was sincere while his opponent was merely acting. The reputation of Demosthenes has undergone many changes, and it was only in the nineteenth century that he emerged as an archetypal democrat. In Demosthenes’ day the drive for sincerity was tied to a shift from communitarian thinking to a higher degree of individualism, in a political context where the city was losing its power of self-determination. I end by drawing on Peter Brook’s minimalist definition of theatre to create a definition of democracy.
Democracy, argues David Wiles, is actually a form of theatre. In making his case, the author deftly investigates orators at the foundational moments of ancient and modern democracy, demonstrating how their performative skills were used to try to create a better world. People often complain about demagogues, or wish that politicians might be more sincere. But to do good, politicians (paradoxically) must be hypocrites - or actors. Moving from Athens to Indian independence via three great revolutions – in Puritan England, republican France and liberal America – the book opens up larger questions about the nature of democracy. When in the classical past Plato condemned rhetoric, the only alternative he could offer was authoritarianism. Wiles' bold historical study has profound implications for our present: calls for personal authenticity, he suggests, are not an effective way to counter the rise of populism.
Trauma plays an important role in the development of psychosis, but no studies have investigated whether a trauma-focused therapy could prevent psychosis.
Aims
This study aimed to establish whether it would be feasible to conduct a multicentre randomised controlled trial (RCT) to prevent psychosis in people with an at-risk mental state (ARMS), using eye-movement desensitisation and reprocessing therapy (EMDR).
Method
This started as a mixed-method randomised study comparing EMDR to treatment as usual but, as a result of low participant recruitment, was changed to a single-arm feasibility study. The proposed primary outcome for an RCT was transition to psychosis at 12-month follow-up. Data on secondary outcomes were also collected. Qualitative interviews were conducted with patients and therapists.
Results
Fourteen participants were recruited from the Early Intervention teams. Most people who expressed an interest in taking part attended an assessment to determine eligibility. All those eligible consented to take part. A total of 64% (7 of 11) of participants who were offered EMDR were followed up at 12 months. Of the 11 participants offered EMDR, one (11%, 95% CI: 0.2%, 48%) transitioned to psychosis. Nine patients and three therapists were interviewed. Participants who completed therapy (n = 4; mean 10.5 sessions) found EMDR helpful, but those who discontinued (n = 6; mean 5.2 sessions) said it had not benefitted them overall. Therapists said EMDR could be effective, although not for all patients.
Conclusions
Future studies recruiting people with an ARMS to an RCT may need to extend recruitment beyond Early Intervention teams. Although some individuals found EMDR helpful, reasons for discontinuing need to be addressed in future studies.
This paper investigates whether age of onset of depression, duration of the last episode, number of episodes, and residual symptoms of depression and anxiety are associated with depression relapse in primary care patients who have been on long–term maintenance antidepressant treatment and no longer meet ICD10 criteria for depression.
Methods
An observational cohort using data from ANTLER (N = 478), a double-blind placebo-controlled trial. The primary outcome was time to relapse using the retrospective CIS-R. Participants were followed for 12 months.
Results
Primary outcome was available for 468 participants. Time to relapse in those with more than five previous episodes of depression was shorter, hazard ratio (HR) 1.84 (95% confidence interval [CI] 1.23–2.75) compared to people with two episodes; HR 1.57 (95% CI 1.01–2.43) after adjustment. The residual symptoms of depression at baseline were also associated with increased relapse: HR 1.05 (95% CI 1.01–1.09) and HR 1.06 (95% CI 1.01–1.12) in the adjusted model. There was evidence of reduced rate of relapse in older age of onset group: HR 0.86 (95% CI 0.78–0.95); HR attenuated after adjustment HR 0.91 (95% CI 0.81–1.02). There was no evidence of an association between duration of the current episode and residual anxiety symptoms with relapse.
Conclusions
The number of previous episodes and residual symptoms of depression were associated with increased likelihood of relapse. These factors could inform joint decision making when patients are considering tapering off maintenance antidepressant treatment or considering other treatments to prevent relapse.
Antidepressants are one of the most widely prescribed drugs in the global north. However, little is known about the health consequences of long-term treatment.
Aims
This study aimed to investigate the association between antidepressant use and adverse events.
Method
The study cohort consisted of UK Biobank participants whose data was linked to primary care records (N = 222 121). We assessed the association between antidepressant use by drug class (selective serotonin reuptake inhibitors (SSRIs) and ‘other’) and four morbidity (diabetes, hypertension, coronary heart disease (CHD), cerebrovascular disease (CV)) and two mortality (cardiovascular disease (CVD) and all-cause) outcomes, using Cox's proportional hazards model at 5- and 10-year follow-up.
Results
SSRI treatment was associated with decreased risk of diabetes at 5 years (hazard ratio 0.64, 95% CI 0.49–0.83) and 10 years (hazard ratio 0.68, 95% CI 0.53–0.87), and hypertension at 10 years (hazard ratio 0.77, 95% CI 0.66–0.89). At 10-year follow-up, SSRI treatment was associated with increased risks of CV (hazard ratio 1.34, 95% CI 1.02–1.77), CVD mortality (hazard ratio 1.87, 95% CI 1.38–2.53) and all-cause mortality (hazard ratio 1.73, 95% CI 1.48–2.03), and ‘other’ class treatment was associated with increased risk of CHD (hazard ratio 1.99, 95% CI 1.31–3.01), CVD (hazard ratio 1.86, 95% CI 1.10–3.15) and all-cause mortality (hazard ratio 2.20, 95% CI 1.71–2.84).
Conclusions
Our findings indicate an association between long-term antidepressant usage and elevated risks of CHD, CVD mortality and all-cause mortality. Further research is needed to assess whether the observed associations are causal, and elucidate the underlying mechanisms.