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‘An enemy of the people’: doctors as scapegoats
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  1. John Launer
  1. Associate Editor, Postgraduate Medical Journal, London, UK
  1. Correspondence to Dr John Launer, Associate Editor, Postgraduate Medical Journal, London, UK; johnlauner{at}aol.com

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One distressing aspect of the COVID-19 pandemic for some doctors and health scientists has been to find themselves the targets of hatred for carrying out their professional duties. This has been a particular problem for physicians in public health. Anthony Fauci, chief medical advisor to the US president, has been the focus of systematic attempts to vilify him with the label of ‘public enemy number one’ because of information and guidance he has issued.1 In England, two men have been convicted for a physical assault on the government’s chief medical officer, Sir Chris Whitty, for the same reason.2 Epidemiologists and other experts have been victims of abuse on social media, often with a misogynistic or racist slant. The abuse has included death threats, or threats of physical and sexual violence.3 Disturbingly, some politicians have been complicit in this unhealthy process or have even encouraged it.

It is tempting to believe these malignant practices are new. They are not. Scapegoating, or the victimisation of single individuals for whatever crisis or adversity is at hand, may be as old as human society.4 According to anthropologists, it sometimes includes a stage of idealising people before turning against them to denigrate and reject them. This may explain why everyone in the United Kingdom was invited to go out in the streets and applaud health workers every week for a period, before these became the target of criticism for not being able to meet demand: what one medical leader described as ‘from clap to slap.’5

Similarly, the slogan ‘public enemy’ or ‘enemy of the people’ has been used as to scapegoat people for many centuries.6 Its roots go back to the Roman empire. It was later applied during the French revolution, and used by Stalin, Hitler and other demagogues. Its purpose is to create the impression of a unified mass of individuals with a legitimate desire, allegedly being thwarted by a bigoted minority. This may have no relation to reality, but the aim is to sweep people up into a mindset of ‘us’ vs ‘them’ and marginalise those who disagree or resist.

As well as occurring throughout history, scapegoating also appears in literature, and one of the most important plays in European theatre even has ‘An Enemy of the People’ as its title.7 Its writer, the Norwegian playwright Henrik Ibsen, is often considered to be the founder of modern drama because of his focus on social issues. Uncannily, his play concerns a doctor who is attacked and ostracised during an epidemic. In the light of the past 2 years, it is chillingly prescient.

Political cover-up

The hero of ‘An Enemy of the People,’ Dr Thomas Stockmann, is medical officer to the municipal baths in a Norwegian spa town. He discovers that the water supply there is contaminated, leading to cases of typhoid and other water-borne infections. Early on in the play, he naively expects the townspeople and their leaders to be grateful for his diligence and to do everything they can to avert a catastrophe. He is wrong. The baths are a draw for tourists and a major source of income for the town’s economy. Because of this, the authorities conspire in a political cover-up, led by the doctor’s older brother Peter, who is the mayor. Peter Stockmann puts matters bluntly:

Your report should not be delivered to the Committee. In the interests of the public, you must withhold it. Then, later on, I will raise the question and we will do our best, privately; but nothing of this unfortunate affair – not a single word of it—must come to the ears of the public.

The local newspaper editor, under financial and political pressure, goes back on his promise to publicise the risks of the epidemic. Almost everyone in the whole community becomes concerned about the economic cost of closing the baths and they refuse to contemplate the longer term consequences of diseases spreading unchecked.

At the climax of the play, Dr Stockmann feels he has no option but to call a public meeting to share his findings with the people directly. His brother, however, stacks the meeting with his own supporters and insists it should be chaired by an ally of his called Aslaksen. When the doctor starts to present his findings, Aslaksen intervenes as follows:

‘Both as a citizen and as an individual, I am profoundly disturbed by what we have had to listen to… I propose a resolution as follows: ‘This meeting declares that it considers Dr. Thomas Stockmann, medical officer of the baths, to be an Enemy of the People’

The whole crowd then : ‘Enemy of the People! Enemy of the People!’

Mob rule

In the final act, we see Dr Stockmann’s house attacked with stones by the local populace. He is fired from his job, and the citizens are instructed to boycott his private practice. His daughter, a schoolteacher, is also sacked. Ibsen makes this descent into mob rule within an apparently polite, law-abiding Norwegian town entirely credible. We also see how it leads the doctor at times to lose his own equilibrium and decline into ranting that is itself uncomfortably anti-democratic. The final lines, however, leave us in no doubt about Dr Stockmann’s and Ibsen’s true values: ‘Let me tell you—that the strongest man in the world is he who stands most alone.’

What ‘An Enemy of the People’ demonstrates is how, during a social and economic crisis, people may find it easier to project blame and hatred onto professionals like doctors than to face the truths they are trying to tell. There are several good movie versions and adaptations of the play you can watch, and I would particularly recommend one by the Indian director Satyajit Ray. He changed the setting from a Norwegian spa to a Bengali town with a holy temple, but otherwise stayed faithful to the plot. Nearly 150 years since it was first performed, ‘An Enemy of the People’ has lost none of its power or relevance. Every doctor who wants to understand how honourable colleagues can become scapegoats in times of danger should see or read it.

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Footnotes

  • Twitter @JohnLauner

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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