On cruelty, liberalism, and the moment

Finding the signal in the noise of recent days.

This is a time of change and turbulence in our national conversation. President Trump took office a week ago, and with this new administration has come a raft of changes. I have written over the past few months about the importance of those of us who work in health remaining nonpartisan, of making an effort to take a big-tent approach to health, of leaning into hope and optimism and of recognizing that there are reasons why President Trump was reelected and that we should try to understand and engage with them. We should be willing, always, to listen and learn, towards gaining back some of the trust we as a field have lost. We also owe any new administration a chance to act according to what it feels the American people have called on it to do. We have just had a free and fair election in which two competing visions for the country were defined and debated. One of those visions won, and Donald Trump, for all that is problematic about him, is a known quantity that Americans, of sound mind and body, decided they wanted to reelect. These are facts with which we should engage and which we should seek to understand, with an open heart and open mind.

In the past week, the Trump administration has acted in accordance with what it sees as its mandate to change the country and its engagement with the world. The steps it has taken are sweeping and include withdrawing the US from the Paris Climate Agreement and the World Health Organization, banning DEI in the federal government, announcing an intention to reevaluate US energy policy with eye towards developing domestic energy resources, revoking the last administration’s guidance on gender identity, pushing to end birthright citizenship, announcing a review of trade policy, creating the Department of Government Efficiency (DOGE), pardoning prisoners who were being held in connection with January 6 and for pro-life activism, starting the process of declassifying material about the assassinations of Martin Luther King Jr., John F. Kennedy, and Robert F. Kennedy, and renaming Denali and the Gulf of Mexico.

This is a heterodox, wide-ranging list of actions. I disagree with many of them while acknowledging that there is room for conversation and debate about the rightness and wrongness of individual steps and for the general turn they collectively represent towards a new philosophy of governance. Such debate, and willingness to entertain a plurality of perspectives, is the fundamental stuff of small-l liberalism—a subject about which I have written frequently in The Healthiest Goldfish.

However, what concerns me in the moment is that, while I have tried to consider these actions with a measure of neutrality out of respect for the democratic process that led to them, they are not, in themselves, neutral. They affect the lives of people, of individuals. What focuses my mind as I consider what is happening, is that in a number of these actions there is a cruelty, and a disregard for the people who are caught up in the moment. Policies and broad-brush statements, such as “We are deporting illegal aliens,” can mask the reality that these actions affect real human beings with real hopes, dreams, and fears. Many people who are hardworking, who have been trying to build a life far from countries where they faced violence and horrors, now face being returned to those countries to face renewed horrors. The choice to pull out of the Paris Agreement masks the human costs of not dealing with the existential threat of climate change and extreme weather events with their attendant implications for physical and mental health. Causing doubt and uncertainty about national vaccination policies threatens the health of the millions of people, particularly children, whose wellbeing depends on access to vaccines.

So, my concern is that in the flurry of the moment, and in the language of studied neutrality in which executive orders are couched, we risk giving a pass to cruelty. And we should never, ever give a pass to cruelty.

It is worth noting of course that policymaking, of necessity, often entails what we might bluntly call “winners and losers.” This is just a hard truth of governance, of decision-making at the highest level. Pursuing decarbonization, for example, can mean pain for those working in the fossil fuel industry and for the populations who may find themselves priced out of being able to heat their homes in winter. If we give money to one government department, that can mean we are not giving it to another, which could result in layoffs. If we support a faction in a given global conflict, this may harm individuals and groups on the opposing side who could well be motivated by noble intentions. These realities do not mean we should not pursue policy changes that may involve such tradeoffs when we judge doing so serves the greater good. But the necessary evils of the tradeoffs that occur in policymaking are not the same as deliberate cruelty pursued for its own sake. The new administration has presented a slew of policy changes, and some will reflect these tradeoffs, while some veer too far towards cruelty. It is on us to disentangle this complexity, keeping an open mind about changes that may be hard but reasonable and being adamant in our opposition to cruelty wherever it emerges.

A case in point is President Trump’s recently-announced efforts to end birthright citizenship, the Constitutional principle that makes anyone born in the US or in US territories a citizen. These efforts are redolent of cruelty. Reasonable people can disagree about immigration policy, about how we should enforce our borders, and about the status of those living in this country in violation of existing immigration law. We can do this mindful that borders are, by their very nature, tools of exclusion and that some exclusion may well be a necessary evil supporting the broader project of national sovereignty in a world where that matters for a range of reasons as defined and arbitrated by the democratic process. But to attack this basic principle of citizenship in the manner the administration has pursued is to engage with these issues without regard for the basic dignity and wellbeing of the many, many people who are now thrown into a state of fear and uncertainty for themselves and their children. This would be bad enough on its own, but it is arguably worsened by the degree to which these moves smack of political expediency, of “red meat” being thrown to the President’s political base rather than a meaningful effort at some kind of immigration reform. Almost as soon as the measure was announced, legal scholars pointed out that it would very likely not hold up in court, being deeply constitutionally dubious, and it has since been blocked by a Reagan-appointed federal judge. The President’s team had to know this would likely happen, making the move appear even more politically cynical, an example of cruelty for its own sake, of the kind to which no quarter should be given in a liberal society.

And it is indeed nothing less that the maintenance of a liberal society that is at stake in these debates. What I mean by liberalism, what I was at pains to make clear in my book on the subject, is not liberalism in the sense of being on the political left. I mean liberalism in the sense of having a society where we air differences in a context of free speech and open debate, where policy emerges from a basis of reasoned inquiry, and where our political structures are supported through a continual process of democratic input. There is room for pluralism in this vision, for disagreement, even extreme disagreement. But not for deliberate cruelty. At the end of the day our mission and goal should be to preserve, elevate, and respect the dignity and autonomy and wellbeing of all individuals. Cruelty is the antithesis of liberalism, a concept explored in the work of Judith Shklar, who defined liberalism, in part, as an alternative to cruelty in politics, saying:

“The alternative then set, and still before us, is not one between classical virtue and liberal self-indulgence, but between cruel military and moral repression and violence, and a self-restraining tolerance that fences in the powerful to protect the freedom and safety of every citizen, old or young, male or female, black or white.”

Cruelty in the political sphere reflects a chipping away of the liberal values that animate our society. It is not a matter of left or right. As Ronald Reagan said, “there is no such thing as a left or right. There is only an up or down.” A politics of cruelty points down towards an uglier, less healthy world. Our job in this moment is to, yes, have an open mind about the changes we are seeing, but not to the extent that we tolerate cruelty. We should speak out against cruelty wherever we see it, advocating on behalf of those who are targeted by the politics of cruelty, keeping in front of us at all times our responsibility to build a better world.

As this week concludes, I find myself trying hard to understand the potential implications of the actions that have come from Washington, the consequences of which remain to be seen. We should continue being patient in this moment, to do all we can to channel the energies of this political era into the creation of a better world, even when this means working with those with whom we disagree. But, in doing so, we should not tolerate, we should not extend patience towards, the cruelty inherent in some of what has been done. I have spoken about the danger of illiberalism on the part of public health, but I want to be clear I did that because I think liberalism is central to the work of building a healthier society. It is just as necessary to speak about illiberalism when it emerges on the right, calling out cruelty and illiberalism whenever we see it, as I have tried to do here.

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Also this week.

New in Observing Science, with Michael Stein: thoughts on scientific bias.

New in World Psychiatry, “Post-traumatic stress disorder: evolving conceptualization and evidence, and future research directions.” Many thanks to Chris Brewin, Lukoye Atwoli, Jonathan Bisson, Karestan Koenen, and Roberto Lewis-Fernández for their partnership on this.

It is a privilege to assume the role of Editor-in-Chief of JAMA Health Forum. Thoughts in JHF on paving the way for the future of health policy science and scholarship.

On Wednesday, January 29, I will be giving a presentation as part of WashU’s Assembly Series. The subject is, “Why Health? Reimagining What We Think About When We Think About Health." Register for the talk here.