Communities that Abide [1 ed.]

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COMMUNITIES THAT ABIDE

Content copyright © Dmitry Orlov. All rights reserved. Published in USA First Published: May 2014 Limited reproduction of excerpts and sections with correct attribution for educational and non-commercial use is permitted and does not require express written authorization. Cover design by Dmitry Orlov

Table of Contents Introduction Dmitry Orlov Communities that Abide Peter Kropotkin Small Communist Communities: What Causes them to Fail James Truong, MD Appropriate Health Care for a World in Flux: A Strategy Capt. Ray Jason The Sea Gypsies: A Hidden Community that Abides Albert Bates Lifeboats: A Memoir Jason Heppenstall Laos: Resilience in the Face of Genocide Peter Gray, MD Village Medicine

Introduction The cover of this book is not just a pretty picture: it offers a valuable object lesson. I took this photograph while living in Costa Rica during the winter of 2014. The pendulous shapes with which the dead tree is festooned are the nests of Montezuma Oropendola, a species of large, tropical, yellow-tailed blackbird. The Oropendola are colony breeders, and here was a colony of well over 50 adult individuals nesting in a dead tree—pretty much right in my backyard! I tend to spend a lot of time hammering on a laptop, and having such a splendid view on which I could periodically rest my eyes was most welcome. These are good-sized birds—the size of the average chicken—but much better flyers. They weave large sock-like nests out of long strands of grass, in which they sleep and rear their chicks. They are gregarious and talkative bordering on raucous, and some people don't like their endless chatter punctuated by loud yodeling, but I got to like them. After a while spent watching them, I realized that most of their yodeling has to do with securing the perimeter and air traffic control. The Oropendola tend to claim an exclusive right over a given large tree, where they post a sentry. They are peaceful (I didn't see a single squabble) but they are so well organized that other birds, from eagles and vultures to the various tiny ones, tend to avoid them. The sentry's job is to check everyone in and out of that tree (although when the sentry is left alone guarding a tree, smaller bird species are welcome to visit). Most of the flights are straight line courses between trees, during which they are bid adieu in one tree and greeted in the next, using two distinctive series of squawks from the sentries. These birds are late sleepers, hiding in their nests until broad daylight, whereas other birds wake up and start singing at first light. Dusk is their favorite time of day; this is when they all congregate and socialize, and mate. They mate in midair, like eagles and vultures, but unlike these, they don't just grab onto each other and plummet but do a maneuver reminiscent of pairs figure skating.

This Oropendola colony seemed like the perfect subject for the cover of a book about resilient communities. Here they were, thriving in a dead tree, just like we are attempting to thrive while still tethered to a civilization that is nearing collapse due to resource depletion, runaway climate change and the suicidal stupidity of the barely sentient moneybags who are running the show. I took a number of pictures of this tree, during different times of day, until I got the one I wanted: the tree is deserted, with the entire colony out foraging for fruit and insects, except for the chicks hiding inside the nests and, of course, the everpresent sentinel. And then, one rainy morning, a few days after I took this picture, I heard the roar of a chainsaw, and then a loud crash. I came out to look, and the dead tree was missing. Instead, there was a large number of Oropendola up in the sky, circling in uncharacteristic silence around the spot where their tree had stood. The object lesson of the Oropendola just became a bit more poignant: this is what collapse looks like. I soon found out that the tree's roots were on an adjoining property, and that the owner of that property killed the tree by pouring a foundation slab over the roots and then, once it was dead and could be declared a hazard, hired some locals to cut it down. That person also owns a gift shop, where tourists can now buy Oropendola nests as curios. The object lesson of the Oropendola became even more poignant: what destroyed their habitat was the profit motive. The birds circled for an hour or so, and then regrouped. They posted sentries on the neighboring tall trees, and spent a few hours drilling: flying back and forth between trees single-file and having the sentries check them out and in again, as before. A day later they started collecting grass for new nests. (They first assemble a giant stockpile of long strands of grass in the crook of a tree, and then commence weaving.) Three days later, they didn't seem any less happy than before the calamity, and a lot louder (clearly, there was a lot more for them to discuss).

The object lesson of the Oropendola is now complete. We are nesting in a dead tree. The tree was killed in order for someone to turn a profit. Our community will abide because: 1. we are self-sufficient; 2. we have the ability to self-organize and recover in the face of calamity; and 3. we will not be tied to any one place but will remain mobile. Dmitry Orlov Editor

Communities that Abide Dmitry Orlov This series of articles is dedicated to the idea that there is much that can be learned from the practices of communities that manage to persist over the long term with their cultures, or subcultures, remaining largely intact. Such communities can provide everything their members need—housing, nutrition, education, medicine, entertainment, companionship, social security and—perhaps most important of all—a sense of belonging. While their specific practices may be alien to us, their commonalities should not be. It may surprise some of you to learn that such communities do exist, right now, right here in the U.S. Some of them are relatively wellknown, others disguise who they are and hide in plain sight. They are as varied as the accidents of history that brought them into being, but they also exhibit a set of common traits that is nothing short of stunning. I have looked at a number of such communities, and though they are as different as groups of humans can be, from a certain level of abstraction they all begin to look the same. To exclude the numerous short-lived experiments, the ones I chose to look at are the ones that have been around for a while—a century at least, preferably a few centuries, and this means that they are all pre-modern (and, being highly resistant to altering their ways, are very likely to remain so). Their attitudes toward gender equality, the rights of sexual minorities, the right to education, ethnic diversity or freedom of religion may, to our modern way of thinking, seem oppressive or decidedly outdated. What this means is that it would be impolitic to propose that any of these communities can directly serve as our models. But although almost none of us would ever want to emulate their ways directly, this does not render their examples any less useful, because the commonalities that unite them have nothing to do with their attitudes toward such hot-button topics as gender or religion.

Some limitations are an inevitable consequence of their small size; for instance, a community of a hundred or so people, with much of its attention focused on the children and the breeding couples which sustain their numbers, is unlikely to have a particularly active gay scene. In terms of gender as it relates to roles within the community, it is unclear what practical constraints, if any, drive or limit the extent of gender specialization, beyond simple biological factors that dictate that women tend to take a greater role in the care of the youngest children, and that men, being generally larger, are more involved in tasks where greater size is an advantage. Other kinds of role specialization have nothing to do with biology, but if the community has stood the test of time, they should not be dismissed out of hand simply because they seem old-fashioned; nor should they be adhered to slavishly simply because they seem alien to us. Keep in mind, though, that there are enough books to fill an entire bookshelf about utopian communities that were based on various progressive principles, and the vast majority of them did not outlast the generation of their founders. Communities that abide tend to be socially conservative, and while this is hardly a candidate for a general principle, nor is it appropriate for us to shut our eyes, stick our fingers in our ears, and pretend that this tendency doesn't exist or isn't relevant. Moreover, it is important to keep in mind that the rules by which these separatist, insular communities choose to operate are set by them, not by us, and our opinions about them are about as irrelevant to them as opinions can ever be. They are not the ones with a problem and we are not the ones with solutions; thus, they have no reason to be interested in us, but we do have a reason to be interested in them. While there is no reason for any of us to accept and be bound by any of their rules, the ones that they all tend to have in common are interesting because they probably have a lot to do with why these groups succeed, and we'd be foolish to ignore them. Refusing to consider them simply because they do not accord with maintaining a middle-class lifestyle is tantamount to refusing to consider doing whatever might be necessary to survive the extinction

phase of that lifestyle—something that deserves the label “voluntary extinction.” For those who have the will to fight extinction tooth and nail, all options should remain on the table, even the unpalatable ones. What we face The challenges we need to face up to are daunting. Perhaps most immediately dangerous is the collapse of the highly-integrated, globalized forms of finance, commerce and governance that have evolved during the growth phase of industrial economies (and are becoming increasingly maladaptive in the course of its current stagnation). First comes the spiral of increasing austerity that starts when gradual resource depletion causes prices of many key industrial inputs, from crude oil to phosphate rock, to creep above a certain threshold: the price beyond which the population cannot continue paying for them. Next come the increasingly frequent shocks triggered by rapidly accelerating climate change: submerged coastlines, summertime temperatures that make many cities non-survivable once air conditioning is gone, killer hurricanes that wipe out coastal infrastructure (right around where most people live) and so on. Then, as the nation-state enters its agony, it turns predatory, and groups that lack an effective form of self-governance run a much higher risk of becoming savaged by it. Then we have to consider what happens when agriculture fails, forcing the survivors to abandon settled lifestyles and revert to nomadism. (Agriculture appeared during the recently-ended period of unusual climatic stability, and even during this period crop failures resulting in periods of starvation have not been uncommon.) The world as a whole now has a very thin reserve of staple cereals, and it will not take too many failed harvests to tip it into starvation. Looking a few decades ahead, there may not be too many rice-eaters or corn-eaters left around. Lastly, consider the fact that rising sea levels will inundate and destroy coastal nuclear installations around the world à la Fukushima Daiichi, flooding the world with carcinogenic

radioactive isotopes. Industrial installations and toxic waste dumps will suffer a similar fate, releasing their load of long-lived chemical toxins into the environment. Plus, all the plastics produced since mid-20th century will decay—from polymers into very durable, microscopic monomers—a sort of toxic plastic goo that will pervade the environment for centuries, playing havoc with most living things. The combination will render much of the planet uninhabitable for geologic periods of time. (“Voluntary extinction” may be starting to sound pretty good right around now!) “Mistakes were made”—largely over the course of the 20th century (which will probably be known as the most shameful 100 years in our history as a species—unless we manage to make even worse mistakes during the 21st, that is). It was the century during which a species that prided itself on being sentient destroyed its environment, this in spite of having produced a handful of individuals, out of the billions, with enough intelligence and willpower to avoid doing so. The biggest mistakes are: the proliferation of nuclear technology and the stockpiling of nuclear waste; fossil fuel extraction and burning; and inundating the world with the persistently toxic fruits of synthetic chemistry. The predicament of living with the legacy of these mistakes seems likely, in the fullness of time, to reduce the human population, if any should survive, to small, roving, feral bands. But let's not go there just yet! Let's take our inexorable march to perdition in many easy stages, descending this spiral staircase to hell one step at a time rather than taking a sudden headlong plunge to oblivion. That way we will at least be able to bear witness to the terrible wages of our folly. Let us make the best of what we still have, setting our sights neither too high nor too low, neither struggling in vain to sustain the unsustainable, nor giving up prematurely on that which still works. Doing it right The subject of this collection of articles is communities that stand the test of time. It turns out that they have a lot of traits in common—

traits that account for their ability to persist for many generations in spite of not-infrequent episodes of persecution and hardship. These common traits are very important to consider for anyone interested in organizing communities that are intended to survive the passing of their founders and go on to provide a habitat for the founders' children and grandchildren. But these communities also vary wildly along many parameters: some are sedentary, others nomadic; some farm, others practice trades; some are very religious, others atheist or agnostic; some are conservative and patriarchal, others progressive and practice gender equality; some are willfully illiterate, others pursue higher education with gusto. There is no single recipe, no definable leitmotif; there is, however, a list of essential ingredients, or principles of composition. Thus, in attempting to launch our own communities that abide, we are confronted with radical freedom of choice, but that freedom of choice must be constrained by certain principles, flouting which guarantees failure. The number of communities that abide is quite small compared to the vast number of transient communities, both intentional and unintentional, that don't last beyond a single generation. In a lot of cases, the young people show no desire to follow in their parents' footsteps, and the typical pattern we see is that the community dissolves once its founding generation has passed on. The communities that defy this pattern are a little out of the ordinary. On the face of it, these are not the sorts of communities that the sorts of people who read books like this one might organize spontaneously. They tend to have a significantly different cultural, ethnic, linguistic and religious background than most of us, and it takes quite a bit of effort to draw the parallels and to extract the lessons to make them applicable to what we might want to do. But the exercise is worthwhile, because, in spite of all the superficial differences, both among these communities and between us and them, we can still extract a significant number of, shall we say, best

practices. If a community has been around for a few centuries and is showing no sign of dissolving, then it must be doing something right! Does our society work? In thinking through where we are and what awaits us, there is a very basic, simple, obvious question we can ask: Does our society work for us or against us? The United States—regarded as a single community—does it still function as such? Does it provide safety, security, a sense of belonging, freedom from necessity and want, meaningful opportunities to care for others, and to be cared for in return? Or has it become a cold, savage, alienating place watched over by the ubiquitous surveillance state and held together by “law and order,” the implicit threat of violence and the explicit threat of imprisonment? Has it become a place where meaningful, satisfying work has become a rarity, and where a lifetime of servitude and workaday drudgery is coerced using the threat of marginalization and exclusion? Does it share our values, or does it willfully ignore them, squandering the taxes we pay on war toys that kill innocents, on enabling and subsidizing environmental destruction, on perpetuating an overbearing and intrusive police state in the name of security, and on further enriching a tiny class of already obscenely rich oligarchs? And if that turns out to be the case, the next basic, simple, obvious question to ask is, What might we do about it? Lobby the government? Well, it's not a particularly popular government: a 2011 Gallup poll determined that the U.S. Congress is less popular than King George was in the colonial days. That same year, the Washington Post wrote that it is less popular than either communism or Nixon during the Watergate scandal. Public Policy Polling went even further; according to them, Congress is less popular than cockroaches, lice, root canals, colonoscopies, traffic jams, used car salesmen or Genghis Khan! Looked at as a community, the U.S. is doing rather poorly. Yes, it still leads the world in propaganda, which tends to mask a lot of its

problems, but beyond that the picture is not pretty. Among the world's developed nations, the U.S. leads in many categories in which one would rather not lead, such as obesity, divorce rate, child abuse death, teen pregnancy, incarceration rate, homicide rate, percentage of children brought up fatherless and rate of sexually transmitted disease infection. It leads the world in fear, stress, anger and the use of antidepressants and antipsychotic medications. Suicide is the number one cause of injury death, having surpassed the also-plentiful car accidents and fatal gunshot wounds. More U.S. soldiers kill themselves than die in combat. A third of all employees suffer from chronic debilitating stress; half experience stress that causes insomnia, anxiety and depression; more and more people find the workplace so unpleasant that they are choosing to opt out of the workforce altogether, finding a much lower standard of living to be an acceptable tradeoff. The myriad social problems are so severe and so entrenched that, at this rate, any attempts to “solve” them would border on quixotic. Yes, you could switch from voting for a louse to voting for a cockroach, but is that really going to help? You could even “throw away your vote” on a third-party maggot. But you would still be voting for an American politician, even though you know what they are all like. A different and increasingly popular response is to flee to a happier land, but emigration is traumatic and painful and often causes damage to both self and community. Many of the social problems in the U.S. stem from the fact that it is “a land of immigrants,” which is to say, a land of uprooted, lost souls. But there is another response: escape internally but remain in place by forming insular, separatist communities, with different rationales, sets of standards and codes of behavior from the surrounding society, in order to achieve better outcomes for their members. This approach is one that is being embraced by more and more people. Voluntary subcultures are often formed because of dissatisfaction with society at large, and the reasons for dissatisfaction multiply. Just one example: over half of recent college graduates are now either working in jobs that do not require a degree, or are unemployed or

underemployed. An entire generation (or two) of young people is finding that their society has led them down a garden path to debt slavery, with no fulfilling, satisfying, productive role for them to play. Given the chance, why would they not want to opt out of it? As time goes on and nothing changes for the better, their dissatisfaction grows, and we should expect their desire to opt out to only increase. Already the level of dissatisfaction in the U.S. is such that some are describing it as a “pre-revolutionary sentiment.” For the time being it is being masked by various government handouts which are keeping the populace placated: over 50 million are now on food stamps and record numbers are on disability, supplemental Social Security and other government aid. The populace is kept placated with cheap or free food and public spectacles designed to reassure them: Rome's “bread and circuses” has been replaced with food stamps, television reality shows and the Internet. But it must be understood that this system is now being perpetuated by nothing more than moneyprinting and endless piling on of government debt: the federal government spends a third more than it collects in taxes. This is not a scheme that can continue in perpetuity, and although nobody can predict with any accuracy when it will stop working, we need to prepare for the day when it does. Society writ small Opting out of the large-scaled society that seems doomed and devoting our efforts to creating some sort of small-scale society—a society writ small—may seem like a good idea for quite a few of us. A small-scale society, or community, can insulate itself from the surrounding systemic failure by focusing on how its members relate to each other face to face. As we prepare, we must understand two things. The first is that little can be achieved by acting alone or as nuclear families; what is needed is a band, a clan, a tribe. The second is that we must think small: within the limits of Dunbar's number, which is somewhere between 100 and 230 individuals, and is commonly taken to be around 150. This number is based on the cognitive limit to the

number of people with whom one can maintain stable personal relationships. Indeed, throughout much of human history, people lived in groups that rarely exceeded Dunbar's number. Larger groups are possible, but only at great expense, either in the form of exorbitant amounts of time expended on “social grooming” (a.k.a. politics) or through the imposition of authoritarian, hierarchical structures which tend to be very inefficient. Thus, larger groups are, by their very nature, less efficient, squandering resources on organizational maintenance, which smaller groups avoid. The number 150 is ubiquitous. It is the typical size of a farming village, the splitting point for a Hutterite colony, the ideal size for a military unit, and (in my experience) the point at which a tech start-up company ceases to be a start-up, becoming burdened with layers of middle management, human resources specialists, marketing experts and other corporate bloat. I have worked in a number of tech start-ups, and have had many occasions to observe the amazing transition that happens when a start-up becomes successful, starts hiring aggressively, and expands beyond 150 employees. It becomes mired in bureaucracy. Suddenly, every proposal has to be put through proper channels and approved. Shortly thereafter the people who are interested in doing innovative work either lose interest or move on. Even at Dunbar's number, cohesion requires that 42% or so of the time be devoted to “social grooming.” Beyond Dunbar's number, social grooming begins to take up too much time and effort, and the community stops working. It then has two options. One is to splinter into two or more smaller groups; the other is to continue to grow, but to resort to hierarchical, authoritarian forms of organization. It can abandon direct democracy in favor of representation and majoritarian rule. It can abandon the principle of equality and create social classes or castes, so that a small number of high-class individuals—small enough to self-organize through social grooming —can run (and ruin) the lives of all those beneath them. The tradition of direct democracy, where everyone gets to speak, where representation is outlawed (treated as hearsay), where decisions are

arrived at by consensus in open meeting—which is the only real kind of democracy there is—are of great value in maintaining a cohesive, cooperative, tight-knit group, and all it takes to undermine it is too much growth. The kinds of group dynamics that are achievable within a given group depend on its size. Anthropologists distinguish bands of 30 to 50 individuals from tribes, which are more loosely bound groups composed of more tightly bound bands, and can number between 500 to 2500 individuals. Beyond that size, organizational structure becomes complicated, and equality and democratic freedom become compromised to an ever-greater extent. Bands tend to top out at 150 adult individuals. When a band reaches 150 individuals, it is time for it to start thinking of breaking it up into two bands. The maximum number of 150 individuals pops up in many contexts. It is the maximum size for Neolithic farming villages—which persisted for thousands of years. It is also the maximum size for a Hutterite colony, and the point at which a Hutterite colony decides to undergo fission, with half the people breaking off establishing a new colony. It is also the maximum size for a military unit. Finally, it seems like a maximum size for a tech start-up company if it wants to continue innovating. The loss of productive capacity as the size of the group increases is very significant. To counter this trend, the group has to split, and to split more or less evenly, because larger size does confer significant advantages. Very small groups lack the resources to provide for all of their own needs, and tend to become fragile, their survival depending on just a handful of key individuals. The optimal organizational structure is autonomous bands of between 50 and 100 individuals federated into tribes, so that the bands can split and merge and exchange members as needed, all without losing either their internal coherence or their wider social context, and without running the risk of lapsing into bureaucracy, authoritarianism or dictatorship. The total community

Even at such small numbers, a well-designed community can provide everything its members need: housing, nutrition, education, medicine, entertainment, companionship, social security and, perhaps most important of all, a sense of belonging. To people who live with the feeling that they belong to a cohesive community, where each member puts the interests of the whole ahead of their own individual interest, this is an incredible source of power. Social security, not in the sense of receiving a promised check from an anonymous institution, but in the sense of being tied in with the people around you through an informal web of obligations of mutual self-help, is equally important. These services may seem subpar from the point of view of first-world standards, but at a time when the promise of maintaining such standards rings increasingly hollow for much of the population, this point seems increasingly moot. At the moment, the concept of social security (beyond the name of an increasingly insolvent government program) is all but missing. Social security is the concept of being secure within your society— that because you provided for it, it will provide for you—and this is something that most people no longer have. Instead, everyone is being taught to remain aloof from each other, insisting on their independence even to their own detriment, and the result is a society in which people can't depend on each other to the extent that they need to. Another thing that is often missing is a sense of belonging. In many cases people don't know how they fit in with those around them, and to what extent—or even to what extent they want to fit in. It is typical to have a jaundiced view of one's neighbors, and to put up with them grudgingly, rationalizing that things could always be worse. There is very little left of the sense that they are your people and that you will stick it out with them through thick and thin. A small, self-reliant and interdependent community must inevitably set limits on many things, and this includes one's individuality, but this too has a positive side. There is a universal human psychological need to have well-defined limits within which to

express one's individuality, and a lack of meaningful limits produces anomie, or loss of self. A strong, healthy sense of self requires that one's individuality be constrained by the needs of others. Without such constraints, expressions of individuality are reduced to meaningless gestures, self-indulgent peculiarities and eccentricities, expressions of personal idiosyncrasy, consumer preference, or vanity. What's worse, a lack of meaningful social constraints often makes one feel so socially insecure that it paradoxically gives rise to a compulsive, extreme conformism. Thus we have people who have few close friends, are alienated from their family members, and who react to this rootlessness by compulsively cultivating a nondescript persona, expressing preferences for popular products and sports teams, dress to blend in and do everything they can to avoid awkward holes in their résumé, thus becoming virtual slaves to a fictional self that “fits in” and “belongs” and can make “fast friends,” making it possible for them to function within, and remain dependent upon, a transient social environment. But such superficial interdependence becomes a serious liability as the impersonal systems on which this transient social environment depends come unglued. Social security is a broken promise: the Social Security trust fund has been emptied out, and the unfunded liabilities are in the trillions—well in excess of all household wealth. Other parts of the system have turned predatory: from the student loan crisis, to medical bankruptcies, to the scam that is real estate, which has resulted in record homelessness alongside a record number of empty houses—all of these developments undermine both the system and the individual who depends on it. Of course, most of the individuals have been undermined already—by a system that is designed to insert commerce, finance and government between every two people, making them into pseudo-“rugged individuals” who are, in fact, abjectly dependent on commercial and government services for their very survival. How do we respond in order to avoid falling prey to an increasingly desperate and predatory system? As individuals, we are almost completely powerless. We can attempt to respond as families, but

most families are small and weak, built on airy notions of romantic and erotic love rather than the solid foundations of sacred duty, family honor and tribal responsibility. Strong and cohesive extended families have become something of a rarity, to be found among recent immigrant groups and in various small ethnic and religious enclaves. We can attempt to respond as informal, voluntary, casual groups, centered around community gardens and other such initiatives, but these are unlikely to ever evolve into the sorts of cohesive communities that can provide everything their members need (housing, nutrition, education, medicine, entertainment, companionship, social security and a strong sense of belonging). What is needed is more of a total system based on an alternative living arrangement. When facing adversity, such a system can form spontaneously around a church, a club, a campground and other sorts of venues. How exactly that happens is something of a mystery, but it seems that the impetus for its formation tends to be some sort of ordeal. Those who go through the ordeal together and survive are transformed by the experience, bonding with each other so strongly that everyone else—sometimes even their own families, and sometimes even their own previous identities—recede into the background or disappear altogether. This is no easy trick, but apparently it does happen! Intentional communities There is no shortage of informal, casual groups, organized around such things as community gardens, “transition” initiatives that install solar panels and wind generators, lobbying for more bike lanes, farmer's markets, and so on. But the question is, Will such groups get far enough fast enough? Uniting in support of various good causes is certainly a step in the right direction, but it is very far from constructing the sort of total system of social support that can supplant our decaying and increasingly predatory mainstream institutions. Some people are attempting to come together and form more complete systems, based on an alternative living arrangement. Many

of these call themselves intentional communities, their intentionality being defined by a set of cultural preferences and group practices, such as gardening and composting, alternative energy, emphasis on public space and group venues, perhaps even some rituals that reinforce group cohesion. Such communities tend to take a lot of money to design and construct—money that, more often than not, has to come from jobs that are outside the community. Far from being an autonomous system of social support, the community then turns out to be exactly as fragile as the surrounding economy. An inevitable economic downturn followed by the loss of a few jobs can then doom the entire experiment. When designing and constructing an intentional community, the natural tendency is to start with your own cultural practices and habits, and to extrapolate from them based on some vague general principles such as “energy efficiency” or “environmental footprint.” Given enough money, such efforts may produce a good result—for a time. But even if all goes well, such efforts are unlikely to produce a community that outlasts the generation of its founders—a community that abides. To achieve that result, we must look farther afield, and consciously borrow elements from communities that have stood the test of time, even if these elements seem initially alien to us, and even if we are rankled by them because they go against our prejudices and values. Unless we are willing to disregard many of our cultural practices and biases, what we will be able to achieve, at best, is a system that is only slightly less doomed. It also bears noting that the scope for organizing intentional communities is somewhat limited, because they tend to be playthings of the rich. Most of them are rather white and rather middle-class, making them look like middle-class hobby clubs, to complement the ones that engage in environmentalism and social activism. Some are simply condo associations that are slightly more liberal and progressive than the rest. There may be an element of survivalism to them, driven by the quite justified fear that the wider

society is coming unglued, but it's a sort of bourgeois survivalism, with an emphasis on style rather than substance, with a wall of middle-class privilege insulating it from the hard, gritty, unromantic and unfashionable work of actually surviving. Unintentional communities There are also a lot of unintentional communities taking shape all around us. All you have to do is look around. They spontaneously arise around a club, or a campground, or, for those of us who live aboard boats, a marina or an anchorage. In all of these cases, a group of people spontaneously starts to act as a community out of necessity. The intentional communities that advertise their existence are the tip of the iceberg, and underneath lurk the far more numerous unintentional communities, which do not advertise their existence, and are often not even self-aware of their own existence. It might be a group of prison inmates who have been released and then decide to live together, because they have to pool resources, and find that they are the only ones they can trust and rely on. It might be a group of army buddies who have been discharged and also decide to live together. There are many other types of people that come together and decide to stick it out together—simply because they don't have anything better to do. If you look up the contemporary statistics on roommate situations in the U.S. among those older than 30, a dramatic new pattern emerges. It used to be quite unusual for people to persist in roommate situations into their 30s and 40s. It used to be that you have roommates when you are young and poor, during your salad days, and then settle down, get married and buy a house. But now more and more people are living in roommate situations well into their 40s and 50s. A lot of so-called “empty-nesters”—people with grown children—opt for a roommate situation as they downsize, either because that's all they can afford, or because they have realized that it's a better way for them to live. Why live alone in a big empty house when you can live with friends and have people take care of you, and take care of them? We are now at a point where

there are around 7,000,000 people over 30 in the U.S. living in roommate situations: a significant demographic. What's more, the number of such people is doubling every five to seven years. This is a huge, overwhelming trend, and if we discussed communities but ignored it, then we'd ignore what's most important. It is quite reasonable to point out that there is rather a large gap between roommate situations, even the most flourishing and stable ones, and communities that can go on for many generations. But that gap can be bridged in a multitude of ways. The first step occurs when a community starts pooling resources: combined shopping and meals, organizing a laundry, sharing transportation, combining child care and home schooling, joining forces to earn money... a dozen more such steps, and it becomes a community that can go on for generations. Redefining communism Total communities that take care of all of their members' needs—the ones that persist over many generations—exhibit a substantial number of important common traits. We will discuss all of them, in turn, but perhaps the most important one, and the one we will start with, is that they all tend to be communist. A lot of people are uncomfortable with the term “communism,” having been conditioned to automatically think of state communism in opposition to free market liberalism and representative democracy. Those who chafe at the use of the word “communist” should feel reassured that no military or political “communist menace” is ever likely to reassert itself: state communism is as dead as a burned piece of wood. The one remaining, ongoing attempt at unreformed state communism is North Korea, and it is a deeply pathological case and can be treated as the exception that proves the rule. State communism aside, regardless of your opinions, you too are a communist. First, you are human, and over 99% of their existence as a species humans have lived in small tribes organized as communes, with no individual land ownership, no wage labor, no government, and no private property beyond a few personal effects.

If it weren't for communism, you wouldn't be here. Second, if you have a family, it is likely to be run on communist principles: it is unlikely that you invoice your children for the candy they eat, or negotiate a contract with your spouse over who gets to feed them. The communist organizing principle “From each according to abilities, to each according to needs” is what seems to prevail in most families, and the cases where it doesn't are regarded as degenerate. From this it seems safe to assume that if you are human and draw oxygen, then you must be, in some sense, a communist. None of this has anything to do with the communist style of government or with state communism. That state communism is an oxymoron was recognized from the outset, and it only existed as an aberration of state socialism, which can be made to work—just not very well. Nevertheless, we can learn something by looking at the principles embraced by the great International Workers' Movement of the 19th century. Here they are, as spelled out by the great Russian anarchist revolutionary, scientist and historian Peter Kropotkin: 1. The elimination of wage labor in which the capitalist pays the worker—since it is nothing more than a contemporary form of slavery and serfdom 2. The elimination of private property for all that which society requires for the organization of socialized production and distribution 3. The liberation of the individual and of society from that form of political enslavement—government—which serves to support and maintain a system of economic enslavement These tenets may seem quaint and hopelessly idealistic; after all, what has come of the efforts to implement them? A globalized economy of labor arbitrage that sends the work to the lowest-paid sweatshops... a population abjectly dependent on uncertain wage labor and government hand-outs... But it is nothing short of amazing that the abiding communities I have looked at all seem to embrace these tenets to a fair extent. All of them do their best to not work for

wages, refusing to be proletarianized. Let us look at some specific examples. The Roma, also known as the Gypsies, are the largest abiding separatist group in existence. Their numbers in the U.S. are known only approximately (they usually refuse to be counted in the census and often hide their identity) but are generally believed to run well into the millions. They will contract to do work as work groups (called kumpania) but never as individuals, and all the earnings are given to the Rom baro, the big man (or woman) who is the self-appointed leader with the responsibility for distributing these earnings according to merit and need. This system is extended to every other type of good that is taken in from the outside. Aid workers are often displeased to find that their handouts don't necessarily go to the person they designated as the recipient, but are instead redistributed based on merit and need as determined by the Roma themselves. The Hutterites, an Anabaptist group which has its origins in 16th century Tyrol and which has since traversed many countries including Russia, eventually settling in the Canadian provinces of Manitoba, Alberta and Saskatchewan, as well as in Montana and the Dakotas. They number in the tens of thousands, are growing rapidly because of their very high birth rate (it was at one point the highest of any human group by some estimations). They live in agrarian communes of between 75 and 150 adult members, and are entirely communist, practicing the doctrine of “everything in common.” While the Hutterites are at one end of the spectrum with regard to private property, the spectrum extends to other groups: other Anabaptist communities (Amish, Mennonite), the Mormons and the Roma all unconditionally pledge a large part of their private property to the common cause, in order to support an extensive system of mutual self-help. For example, the Amish have successfully lobbied the federal government in the U.S. to be exempted from the Social Security system. They did not mind paying into it, seeing it as the work of charity, but they did not want their members individually receiving checks from the outside, seeing this as detrimental to their internal system of mutual self-help. Likewise, the Mormons and the

Orthodox Jews run internal welfare organizations that make their communities independent of government hand-outs. Among the Roma, the social unit within which mutual self-help is practiced unconditionally is the vitsa, or clan, and within it the free sharing of individual wealth takes the place of child support, insurance and retirement. In addition to having as little as possible to do with the government, all of the above groups refuse to have anything to do with the military. The Roma escape military conscription by virtue of being nomadic and not having an address to which a conscription notice could be sent. They also make it a point to make it hard to identify them individually by maintaining an internal, secret name and an external, public name which they change frequently, especially when moving from place to place. The Hutterites are likewise pacifist, and have been forced to flee Russia for the U.S., then the U.S. for Canada, to avoid conscription. The Dukhobors, who faced persecution in Russia due to their pacifism (one of their founding episodes involved gathering and burning all of their weapons) relocated to Alberta, but then were forced to relocate to British Columbia over their refusal to pledge allegiance to the provincial government. It makes perfect sense that such small, widely dispersed groups would find no use for weapons or for militarism: should they ever try to stand up to the majority militarily, they would be wiped out. Instead, their defenses include posing no threat and being willing to flee. The Roma in particular are often ready to flee on a moment's notice. Although all of these groups (with the exception of the Dukhobors, who have all but dissolved in the surrounding Canadian society for reasons we will take up later) have done well to curb wage labor and private property and to remain free of the tentacles of the government, such independence is sometimes impossible to maintain: the need to pay property and land taxes forces these groups into trade with the outside, and sometimes even into wage labor. Taxes are these groups' Achilles' heel, and tax avoidance (along with avoidance of military service and compulsory public

education) must be a prime objective of all groups that want to maintain their independence. Peter Kropotkin has this to say on the subject of taxation: “This is how, quietly and gradually, control of the people by the aristocracy and the rich bourgeoisie—against whom the people have once risen up, when confronting them face to face—is now exercised with the consent and even the approval of the people: under the guise of tax! “Let's not even talk about taxes to support the military, since by now everybody should know what to think of these. Was there ever a time when a permanent army wasn't used to hold the population in slavery? And was there ever a time when the regular army could conquer a land where it was confronted by an armed populace? “Take any tax, be it direct or indirect: on land, on income or on consumption, be it levied to finance government debt or to pretend to pay it off (since, you know, these debts are never repaid, but only grow). Take a tax levied to finance war, or a tax levied to pay for public education. If you study it, and discover what it leads to in the end, you will be stunned by the great power, the great might which we have relinquished to those who rule us. “A tax is the most convenient way to hold the population in poverty. It provides the means to bankrupt entire classes of people: landowners, industrial workers—just when they, after a series of tremendous efforts, finally gain a slight improvement in their wellbeing. At the same time, it provides the most convenient means for refashioning government into a permanent monopoly of the wealthy. Finally, it provides a seemly pretext for accumulating weapons, which one fine day will be used for the suppression of the people should they rise up. “Like a sea monster of ancient tales, a tax provides the opportunity to entangle all of society and to redirect the efforts of individuals toward the enrichment of privileged classes and government monopolies.

“And as long as the government, armed with the tax, continues to exist, the liberation of working people cannot be achieved through any means—neither through reform, nor through revolution.” *** I once had a conversation with Albert Bates of The Farm in Summertown, Tennessee, at one time one of the largest hippie communes ever, and Orren Whiddon of the Four Quarters Interfaith Sanctuary in Artemas, Pennsylvania, a sprawling campground that is also a church, a monastery, a winery, a precision machine shop and a school. The discussion centered on ways in which small communities can avoid becoming entangled in the tentacles of officialdom, and the conclusion was that the community stands the best chance if it is simultaneously all of the following things: 1. 2. 3. 4.

A church A nature preserve A historical society Minority-owned

For those of you who dislike the idea of church, you may want to look into Pastafarianism. The Church of the Flying Spaghetti Monster is being given official status in more and more countries. It requires you to have official photographs taken wearing a pasta strainer on your head. It also encourages eating pasta on Fridays. None of this seems particularly onerous, but it does provide a way for your community to achieve tax-exempt status. Communism is efficient There are two organizing principles that self-sufficient communities can rely on in order to succeed: communist organization of production and communist organization of consumption. Both of these produce much better results for the same amount of effort, and neither is generally available to the larger society, which has to rely on the far more wasteful market-based or central planning-based mechanisms, both of which incur vast amounts of unproductive

overhead—bankers, traders and regulators in the case of marketbased approaches, and government bureaucrats and administrators in the case of centrally planned approaches. History has shown that market-based approaches are marginally more efficient than centrally planned ones, but neither one comes anywhere near the effectiveness of communist approaches practiced on the small scale of a commune. Here is an extended passage from Peter Kropotkin's Anarchy in which he explains the benefits of communist production and consumption: “Leaving aside the question of religion and its role in organizing communist societies, it should be sufficient to point to the example of the Dukhobors in Canada to demonstrate the economic superiority of communist labor over individual labor. Having arrived in Canada penniless, they were forced to settle in an as yet unoccupied, cold part of Alberta. Due to their lack of horses, their women would hitch up to the plough 20 or 30 at a time, while the middle-aged men worked on the railroad, giving up their earnings to the commune. However, after seven or eight years all 6000 or 7000 Dukhobors achieved a level of well-being, having organized their agriculture and their life with the help of all sorts of modern agricultural equipment— American mowers and bailers, threshers, steam-powered mills—all on communal principles. “Moreover, they were able to buy land on the shores of the Pacific Ocean, in British Columbia, where they founded a colony devoted to growing fruit, which these vegetarians sorely lacked in Alberta, where apples, pears and plums do not bear fruit because their blossoms are killed off by May frosts. “And so here we have a union of 20 communist settlements, where each family lives in its own house, but all field work is done together, and each family takes from the communal stores what it needs to live. This organization, which for several years was supported by their religious idea, does not correspond to our ideals; but we must recognize that, from the point of view of economic life, it has

conclusively demonstrated the superiority of communal labor over individual labor, as well as the ability to adapt this labor to the needs of modern mechanized agriculture.” A similar, contemporary example is provided by the Hutterites, who tend to be up on all the latest trends and techniques in agriculture and make productive use of industrial resources. It stands to reason that communist production methods would outperform capitalist ones. On the one hand, you have a group of people driven to work together out of a sense of solidarity and mutual obligation, cooperating of their own free will, free to switch tasks to keep life from becoming monotonous, free to do what they believe would work best, using work as a way to earn respect and improve their social standing, knowing full well that their fellows will take care of them and their families should they ever become unable to work. On the other hand, you have commoditized human beings pigeonholed by a standardized skill set and a job description, playing the odds in an arbitrary and precarious job market, blindly following orders for fear of ending up unemployed, relying on work to keep them and their immediate family from homelessness and starvation, and looking forward to being discarded and joining the burgeoning ranks of the long-term unemployed once they have “burned out” on the set of tasks for which they were considered “qualified,” or once their skills become obsolete. The result of all this is that 70% of the workers in the U.S. say that they hate their job, putting a gigantic drag on the economy: “Just 30 percent of employees are engaged and inspired at work, according to Gallup's 2013 State of the American Workplace Report, which surveyed more than 150,000 full- and part-time workers during 2012. That's up from 28 percent in 2010. The rest … not so much. A little more than half of workers (52 percent) have a perpetual case of the Mondays—they're present, but not particularly excited about their job. The remaining 18 percent are actively disengaged or, as Gallup CEO Jim Clifton put it in the report, “roam the halls spreading discontent.” Worse, Gallup reports, those actively disengaged

employees cost the U.S. up to $550 billion annually in lost productivity.” [Source: CNBC.com] *** Having discussed the superiority of communist production methods, let us turn to communist consumption. Kropotkin again: “In addition to these successful attempts at communism in agriculture, we can also point to numerous examples of partial communism having as its goal pure consumption, and which takes place in the many attempts at socialization taking place in the midst of bourgeois society—among private persons as well as entire cities (so-called municipal or city socialism). “What is a hotel, a cruise-ship, a boarding house, if not an attempt in this direction being made within a bourgeois society? In exchange for a certain payments—so many rubles per day—you are allowed to choose what you like from ten or more dishes, which are offered to you on board a ship or a hotel buffet, and it does not occur to anyone to account for how much you eat... “The bourgeois have understood perfectly well what a huge advantage they gain from this sort of limited communism in consumption, combined with full independence of the individual. And so they have arranged things so that, in exchange for a certain payment—so much per day or per month—all of their needs for food and shelter are satisfied without any additional worry. Luxury items, such as richly appointed rooms or fine wines, have to be paid for separately, of course, but for a payment which is the same for all, all the basic needs are satisfied, not caring how much or how little each person will consume at the common table.” Putting both production and consumption together, let us consider the case of a small farming community that grows, among other things, corn. If it were organized along communist lines, it would grow the corn, and then distribute that same corn, cook it, and eat it. If it were organized along capitalist lines, it would grow the corn, then

sell it to a processor at $5 a bushel and then buy it back from a supermarket at $1.69 for a 15-ounce can (of mostly water). Disregarding the weight of the water, what they get back is around 80 times less corn. By participating in the market economy, they would effectively be allowing their corn to be taxed at a 98.75% rate. What all of this adds up to is that communities organized along communist lines can become self-sufficient in a handful of years and quite affluent shortly thereafter. And it is affluence (along with lack of persecution from the outside) that is often at the root of their undoing. Affluence creates too many temptations, makes it difficult to distinguish needs from wants, and allows systems of mutual selfhelp to atrophy from disuse. But there are many ways to avoid the trap of affluence, provided its dangers are recognized early enough. One is to work less, by coming up with a long list of days on which one is not allowed to work, starting with Sunday and/or Sabbath and expanding the list from there. With a bit of effort the work schedule can be brought down to around 100 days a year. Another is to eat up the surplus by upholding certain unproductive but satisfying community standards, such as requiring fresh cut flowers on the table at every meal, high quality of polish and varnish on exterior woodwork, and intricate hand-woven banners flying at festive occasions. Another (popular with the Mormons) is to proselytize, recruit and spread the word; yet another, popular with the Hutterites, is to have lots of children and spread out over the landscape, gobbling up and reclaiming farmland degraded by industrial agriculture, splitting whenever a colony outgrows Dunbar's number of 150 in order to remain anarchic and to continue to self-govern by consensus. One more example: the Roma like to burn through fantastic sums of money by throwing lavish wedding feasts that last three days. The ways of burning off excess wealth can range from music festivals to theatrical productions to historical reenactments complete with authentic-looking props. The threat of affluence is a nice problem to have, and provided that money isn't allowed to pile up, creating a big temptation to re-privatize, it does not have to be damaging.

*** The benefits of communist production and consumption apply to both intentional and unintentional communities. For example, a dozen roommates start living together in a house in order to save money on rent. In the beginning, they all shop and cook food separately. If they do this, they will pay retail for the food, and it will all go bad separately, and get thrown away separately. But they could start to trade off on who makes dinner for the entire house on any given day. They could also specialize, so that one or two best chefs out of the group cook dinner for everyone in exchange for other types of help. They could do all of their food shopping together, pool resources, and buy supplies in bulk and at wholesale prices. They could share cars, and perhaps one or two members will specialize and become the drivers for the entire group, replacing a dozen cars with just a minivan and a pickup truck. They could organize child care, so that just two adults take care of all the children, trading off, and nobody ever has to pay for child care or babysitting. If they do all of these things, they will find that their money goes much further. In turn, these savings will enable them to spend less time working for money, and to invest more effort in various productive activities. They could do their own house maintenance, their own auto and bicycle repair and start growing and preserving food. They could start workshops that provide goods and services for the surrounding community on an informal basis. All of these productive activities turn out to be far more efficient than those conducted on a commercial basis, because they avoid taxation and most business expenses, such as accounting, marketing and advertising, and also result in higher quality, because the goal is to help people you know, and to entice them to help you in return, rather than to maximize profit. The intentional community gap At present, there is quite a gap between intentional communities and unintentional ones. Intentional communities can be something of a

boutique business, require a large up-front investment, and are sometimes indistinguishable from fancy condo associations with a few added benefits. They tend to be popular with people who want to experience more of a sense of community, but are not willing to sacrifice any of their individuality for the sake of the common good or to put the interests of the group ahead of their own. It is more a question of compromise and negotiation rather than unconditional surrender to the group. Such groups often struggle to find common ground. Various activities and initiatives—such as gardening, or alternative energy, or a weekly meeting and dinner—play a big role, but amount to little more than a set of high-status hobbies. They tend to become highly defined over time, allowing the members to draw various lines in the sand, sacrificing some of their prerogatives as individuals when it comes to installing solar panels or raising vegetables, but that's that. And this doesn't go far enough to realize the full benefits of communist consumption and production. Nor does this decouple the community from surrounding society, meaning that it can only make itself very slightly less fragile. Charismatic leadership At the other extreme, there are a few groups with very serious intentions. Some communities are formed around the ideals of social justice, environmental justice, world peace and defending the rights of certain oppressed groups. A few go overboard and into a fullblown utopian mode. There is a tendency for such groups to be led by a charismatic leader. Based on my research, there is a basic rule of thumb: if your movement is utopian in nature and is led by a strong charismatic leader, then it is doomed. It will survive for two generations at best, and that will be it. Charismatic leadership may be useful at the outset, because it is often the charismatic leaders who are able to articulate a coherent and compelling ideology, and to provide a foundational myth of heroic struggle and triumph against adversity and persecution through self-sacrifice on behalf of the group. But charismatic

leadership can also provide a convenient basis for authoritarianism, through instituting either a cult of personality or a managerial hierarchy, both of which eventually lead to a crisis of legitimacy, disenfranchisement and mass defection. One charismatic leader who was quite close to the ideal was Jakob Hutter. He was martyred just three years after starting his ministry. The Hutterites have existed since early 1500s, and for just three of those years Jakob Hutter was alive. Nevertheless, they still call themselves Hutterites. So, what kind of charismatic leader was that? One who articulated a powerful ideology, and then gave his life for it. He didn't live long enough to risk producing a cult of personality or becoming dictatorial. This is the best case scenario. Leadership roles There is certainly a need for people to take leadership roles within any given community, but in most of the successful cases the leaders do not accrue any special status by being leaders. They are thrust into a position of temporary command, and they are for a time burdened with additional responsibilities, which they generally dislike and look for the earliest opportunity to opt out of the leadership role. For example, in the Israeli Kibbutz movement, the process is roughly as follows. There is usually a committee that is supposed to recruit someone for some position of responsibility. The committee members go around and talk to prospective candidates, saying “Would you mind if we put your name forward?” And the person usually replies: “I am too busy, and I am much too stupid, and old, and I think it's a bad idea.” And then they say: “OK, we'll put your name on the list.” People who are burdened with responsibility in this manner do not accrue wealth, and gain only temporary authority in one area. They do not gain political power in any meaningful way, and dive back into the pool once the job is done. Ideology

In order to abide, a community must have a certain pragmatic element to it: the top priority must be making it possible, and attractive, for your children and grandchildren to stay within the community, or, better yet, to leave and soon come back of their own free will. You can also work on promoting world peace of saving the whales, but that can't be the top priority. The members' primary allegiance must be to each other, not to the whales. On the other hand, it is also essential for the community to have an ideology, a founding myth or two, and a spiritual element; it cannot be entirely utilitarian in nature. Ideology may seem like a strange word to use in this contest, but it seems to fit better than any of the alternatives. It describes a wide spectrum of beliefs, from earnest, deeply-held religious convictions to a set of more or less crisply defined moral imperatives that are perceived as valuable in themselves. Achieving a measure of self-sufficiency, as a goal, can be both practically useful and help build the community's selfconfidence. Moral imperatives can include such things as improving the environment and finding ways to live that do not harm life on earth. Many groups find great power in the idea of preserving a cultural legacy, in maintaining a level of learning and sophistication, or in speaking, reading and writing their own language or dialect and in teaching it to their children. Such desires, goals and rationales are all just elements, and there can be many others as well, but each community, in order to abide, has to have an overarching ideology to which everyone agrees to adhere more or less unquestioningly, as a condition for remaining a member. There should also be some founding myths—often a tale of trials and tribulations, of overcoming persecution and adversity. There might even be a few heroes, to serve as perpetual role models for the young. The ideology of the group should be explicit, and have a central theme. It cannot be a grab-bag of vaguely worded values and cultural nice-to-haves. And it should naturally give rise to a specific set of goals, which can be revisited periodically, to gauge how well they are being met. If a community does not abide by its founding myth or ideology in terms of meeting the goals that flow

naturally from them, then, chances are, it will not abide at all, because the loss of confidence will be too great. Lack of a unifying ideology can be an insurmountable problem. Suppose you have a community where some members have joined in opposition to the wider society's rejection of the (apparent to them) reality of UFOs. Another group of members believes in the power of historical reenactment to form alternative identities and get in touch with their previous lives. A third group believes in the mystical aspects of strict veganism; yet another believes that the sine qua non of their community is its off-grid living based on renewable energy sources, because to them burning fossil fuels is a crime against both nature and humanity. It would be hard to judge the success of such a group. Suppose the historical reenactments are held on schedule, but strict veganism causes health problems for some of the members, and they add eggs and dairy to their diets. The group is forced to buy firewood harvested using fossil fuelburning chainsaws and delivered in fossil fuel-burning pickup trucks. Some members dispute the reality of UFOs, and no UFOs show up in spite of strenuous efforts to attract them to their designated landing spot. How well is the group doing? Who is to decide which aspects of its disparate ideology are non-negotiable? Another insurmountable problem is an ideology open to dispute. People brought up in the Western mindset have a tendency to put great stock in their ability to think rationally and to analyze everything to death. It is considered fashionable to remain agnostic with regard to things that cannot be proven but must be accepted on faith. But it turns out that most successful ideologies are only part rational (there has to be a rational element to them) and are largely based on faith. The Mormons are an extreme example of this: they absolutely refuse to rationally examine the foundations of their faith, which is all based on revelation. It is not subject to any sort of discussion: if you are a Mormon, then you believe that it is all true. This sort of unquestioning obedience to fanciful, arbitrary mystical fiction is rather rare, as is the explicitly patriarchal, hierarchical structure of the Mormon Church.

(Most of the communities that abide are far more egalitarian and anarchic rather than hierarchical.) Yes, their model is successful (theirs is said to be the fastest-growing religion in the world) and it provides wonderful social benefits to its members, but there are other successful models as well. The Mormon approach to ideology may seem particularly unappealing to many of us. But the opposite extreme—of questioning the ideology, debating its merits and looking for opportunities to reform it—does not work at all. Once the ideology comes under doubt, it becomes unclear what it means to be a member of the community. The community may still hold together for a time, for pragmatic reasons or simply out of habit, but it will, over time, lose its group identity, its sense of destiny and its group cohesion, and will eventually dissolve into families and individuals. The ideology must be the basis of an explicit, voluntary choice: either you accept it—all of it—and become a member of the group, or you reject it—in part or in whole—and by so doing exclude yourself. It serves as the basis for forming consensus—not through being questioned, but through being interpreted. If you look closely, there tends to be a lot of discussions around the ideology—what some piece of it should mean in practice—but nobody questions the ideology itself, because to do so is to place oneself outside the group. A major danger lurks in practices that contradict the ideology. I once heard of a Permaculture course which fed its students a pasta and sauce dinner with the ingredients purchased at Walmart. Permaculture is (among other things) a system of local sustainable food production; Walmart is not. Practices that are an outright negation of your purpose in turn negate that purpose. So, for example, if you found a community around the principles of selfsufficiency and living in balance with nature, but then everybody drives to a corporate job, then your community has, in place of an ideology and a set of goals that are set by interpreting that ideology, an ardent but unrealistic wish and, at best, a hobby.

Therapeutic communities The goal can also be psychological well-being. There is a type of community that arises spontaneously: people who fall victim to natural disasters such as a tsunami or a hurricane, or man-made disasters such as the wars in Iraq and Afghanistan, often cling to each other for a long time afterward, unable to connect with anyone who has not shared in the trauma. Such people can best comfort each other. Such therapeutic communities can form spontaneously, but they can also be organized. This is currently more prevalent in the UK. These are communities designed to help people who are not able to make it out in the world, or simply don't want to. In a lot of cases these are organized as halfway houses, where people discharged from mental hospitals spend a while living with other people who are in a similar situation, with the goal of integrating back into the society that was responsible for causing their mental difficulties to begin with. And then they are released into the wild, and the cycle repeats. But in some cases such transient therapeutic communities can be fashioned into more stable situations, that include not just recently discharged patients but other people as well. The purpose of all such communities is to escape the madness of contemporary existence, and to find safety and a sense of psychological well-being in a smaller, familiar and stable group. The number of people who could benefit from such an environment is huge. Around a quarter of the population in the U.S. takes prescription antidepressants; many others self-medicate with illegal drugs and alcohol. Then there is a large population that revolves in and out of mental hospitals. The number of mentally ill people imprisoned in the U.S. is ten times higher than the number of people in mental hospitals. The prison experience, and especially the widespread use of solitary confinement (which is internationally regarded as torture) tends to make their psychiatric conditions untreatable. Finally, a large percentage of veterans discharged from the military suffer from post-traumatic stress and other psychological

ailments. There is every reason to expect that economic pressures coupled with the need for a psychologically healthier environment will cause many of these people to form communities. But it doesn't take acute psychological distress to make people want to form communities that can, to some extent, insulate themselves from the surrounding society. Another possible goal is to escape the alienation, isolation and loneliness that are so widespread, and to create a safer and more nurturing environment in which to bring up children. Yet another goal may be to create intergenerational communities—which have become a rarity—so that grandparents can help bring up their grandchildren, while, at the same time, everyone has peers outside their immediate family. Such groups of extended families were once the norm in most parts of the world, and represent a pattern that is quite normal and natural for the human species. Social stability A problem that has destroyed numerous communities has to do with transience and lack of social stability. If people come and go as they please, and it is impossible to predict how long somebody will stay, this erodes everybody's sense of commitment, and, after a while, nobody can depend on anyone else. A lack of commitment from individual members automatically translates into a lack of confidence in the community as a whole. At some point, a critical point is reached where mass defections begin. Urban communities Urban communities do not work very well either. They tend to dissolve rather quickly, because city living offers far too many distractions, making it difficult for the members to focus on the community itself. With so much external influence and stimulation, it becomes very difficult for the members to regard each other as central to their lives, and to put each other ahead of everyone else. In order to be viable and to persist as separate entities, communities have to be able to draw a circle around themselves, and to

unconditionally prioritize members above non-members. If they fail to do this, then the community is weakened and eventually dissolves. The city happens to be a particularly difficult environment in which to do this: there is simply too much happening, and too many opportunities that lie outside the community. For these reasons, a rural setting is a good predictor of success. A rural setting is a requirement for another reason: cities do not provide enough land to practice self-sufficiency. City living almost by definition precludes living off the land, going off-grid, and extricating the community from commercial arrangements based on wage labor. It may be possible for an urban community to grow all of its own food using intensive gardening techniques, provided they stay largely vegetarian, to venture out to the countryside during the warm months to gather more supplies, and to scavenge or barter for much else that they need. But such a lifestyle is likely to prove too arduous, and there is likely to be just one reason for choosing it: lack of access to land on which to settle. A community could start in an urban environment, where there is, advantageously, no shortage of potential recruits, and, by realizing the advantages of communist consumption and production, amass enough wealth to buy rural land on which to settle after just a few years of concerted effort. Such a community could maintain a toehold in the city, in order to be able to sell trade goods, acquire supplies, and recruit new members. What is a community that abides? Let us be clear on what characteristics are required for inclusion in our chosen category of communities that abide. We exclude monastic communities, retirement communities, involuntary communities (such as prisons) and all other public institutions. We also exclude lodges, orders, secret societies and clubs. Lastly, we exclude ad hoc communities that form around campgrounds, marinas, economic development projects and other such commercial venues. Included are multigenerational communities that persist from one generation to the next, and where most of the children choose to remain as part of the community. A key requirement is that the

community must have a stable sense of identity, based on an ideology, or system of beliefs, that are successfully passed on from one generation to the next without significant dilution or adulteration by the surrounding mainstream culture. It turns out that communities that abide, so defined, share a great many traits, which seem to be largely decoupled from the community's ideology. We have looked at a few very different examples, to make it clear that these common traits are across the board, rather than manifestations of a particular culture or persuasion. They are not dependent on what exact kind of community it is: whether it's ostensibly patriarchal or grants equal rights to women, whether it's religious or atheist, whether it's settled, migratory or nomadic, whether it consists of farmers or carnival performers, lawabiding or outlaw, educated or illiterate, whether it's homophobic or LGBT-friendly, vegetarian or Paleo... This sort of range should allow you to set aside any fears that whatever community you envision forming or joining might be excluded from the examples we examine here, because, given the very wide range of variations between these examples, finding an exact match to what you happen to like is, first, exceedingly unlikely and, second, completely irrelevant to uncovering the common traits that underpin their success. Our examples include religious communities—the Amish, the Mennonites, the Hutterites (all Anabaptist groups) and the Dukhobors, who are Russian refugees living in British Columbia; a large ethnic group, the Roma (a.k.a. the Gypsies); and socialist groups—the Israeli Kibbutzim. This sample is sufficiently diverse for our purposes. In comparing their ideologies, it is difficult to find any grounds for comparison. The Kibbutzim tend to be atheist— nominally Jewish, but then most Jews are in fact atheists. The Amish, the Mennonites and the Hutterites, on the other hand, are very religious, and religion plays a vital role in their lives. The Roma have a very distinctive ideology of ethnic and cultural separatism,

absorb a few elements from the dominant religion of the area, but put it to their own uses. Separatism All of these communities draw a circle around themselves: they are in the world, but not part of it. They are separatist, as are all successful intergenerational communities. This separatism is reflected in the way they speak—and they often speak their own language or dialect. The Roma speak Romani, which is related to the languages of Northern India, where the Roma once came from. The Amish and the Hutterites speak an archaic form of German. The Dukhobors speak an old-fashioned Russian. Within their language or dialect, they always draw a vital distinction between them and the outside world: if you are not Roma, then you are Gadje; if you are not Amish, then you are English; if you are not one of the Hutterite Brethren, then you are an Outsider. There is no way to get around this distinction. It is possible to interact with members of these communities, usually in specific, circumscribed ways, but it is impossible to move beyond these sanctioned, scripted interactions without becoming one of them, and that means signing up for the whole package of what it means to be them. Often this is not even possible. There are ways of penetrating some of these communities, but none of them are easy. The Hutterites do not proselytize at all, having given up on recruitment some time ago, instead choosing to concentrate all of their excess resources on rapid growth of their numbers through high birth rates and excellent agricultural productivity. The Amish and the Mennonites are quite insular as well, either marrying other people of the same faith or leaving the community altogether. With the Roma, a man can marry into a Roma family, and become what's called a “house Rom”—a man who lives with his in-laws, which is a subservient role in Roma society. But he is sometimes paraded before Gadje as the “Gypsy king.” Lack of hierarchy

All of these communities lack a multilayered hierarchy, and can therefore be defined, in a strict technical sense, as anarchic. Leadership is always fragmented down to a relatively small, local group, and is everywhere based on persuasion and discussion— never on coercion. Leadership generally does not confer status, only responsibility, and leaders are either drafted or self-selected. What does confer status is sacrifice, acting for the common good of the community, and putting the community's interests ahead of one's own. There is never any glorified process through which one ascends to the lofty perch of leadership. Leadership roles are generally temporary, or with a fixed term of tenure. It is extremely unusual for someone to die of old age in a position of leadership, because people are pressured to retire as soon as a younger replacement is available, to make room for the younger generation. Oral culture Some of these communities are very highly educated and encourage young people who are born into the communities to pursue higher education up to Ph.D. and professional degrees. The Kibbutzim are extremely literate and educated. The Roma (Gypsies), on the other hand, think that literacy destroys memory, and do not encourage their children to learn to read and write. The ones that do learn to read and write are treated as slightly brain-damaged, because often they can't recite everything by heart. Their culture is entirely oral, including their own, internal system of oral law. This may seem like a very large difference, but behind it lurks a similarity: all of these communities work from a code of conduct—a set of rules by which their communities operate—which is unwritten, and there is a universal insistence on the validity of unwritten rules. Very little that is important is ever written down. Conflict resolution There are vast similarities in their systems of social control, which are universally informal. The most important methods of social control are: gossip, ridicule, reprimand and scorn. These achieve the required results almost all of the time, and there is never any need to

resort to formal systems of justice or to violence. Most of these communities are explicitly nonviolent, and have taboos against aggression and the drawing of blood. Formal control upheld through the threat of violence is very expensive, and in practice turns out to be unnecessary. For a small community to put someone on trial, or lock someone up, or resort to an external system of justice is a very destructive and expensive thing to do. It undermines trust and morale, and it turns out to be absolutely unnecessary in most cases, because these communities tend to be internally crime-free and their members tend to be very cooperative with each other. Where there is a conflict, the threat of withholding cooperation is generally sufficient to induce someone to cooperate. All of these communities have a way of expelling or excluding someone who is uncooperative and can't be brought around, but mostly it is used as a threat, because that is generally sufficient to make someone relent. This is easy to understand: if everything you have is invested in your relationships with a relatively small group of people, then the last thing you want is to find yourself excluded from it. One common technique of conflict resolution is through temporary relocation. Familiarity and extended proximity often breed contempt, and even the most well-mannered and cooperative people can, over time, grow tired of each others' company. This is more or less inevitable in small groups. People can be on their best behavior and trying really hard, but still end up not being able to stand the sight of each other after a certain period of time, and need a change of scenery. In such cases, one of the parties can volunteer or be asked to temporarily relocate. To make this possible, it is helpful to have not just one community but a loose confederation or a network of similar communities in different locations, so that they can swap people through an exchange program. It may happen that two people are at each others' throats, or simply becoming increasingly alienated from each other, but if you ask them to pull straws to figure out which one of

them should go somewhere else for a while, and that person leaves and, a few months later, comes back, then everybody is happy again, because they have missed each other, are eager to catch up, and all is well once again. The ability to go somewhere else for a while is very important for young people as well. When they reach a certain age and they get restless, it is best if there is a place for them to go that is fairly similar to what they are used to. If they are immediately thrust into the big scary world full of alienated, troubled people, then there is a good chance that they will become confused and lose themselves in it, and might not ever make it back. Here, having an exchange program can work wonderfully. It can help people find mates, which can be difficult in a small community where an entire cohort is used to relating to each other as brothers and sisters. It is also a good way of achieving cultural cross-pollination between communities: if two communities are good at doing different things, and have taught their children well, then those children can teach each other as well. Justice There are times when informal conflict resolution fails, and conflicts need to be brought up before the group. All of these communities operate based on an open meeting, where everyone is allowed to speak, and where members settle questions brought before them. These meetings can sometimes take the form of formal proceedings. Different groups have this to various extents. The Roma, for example, have a tribal tribunal, called kris, which is ancient and quite complicated, based on a large corpus of oral law and precedent. It is unusually well-developed, but the principles on which it is based are quite common. First, everybody is allowed to speak. Second, there is no such thing as representation, no lawyers, and everybody pleads their case pro se. The judges and the jury are elected out of those assembled for the occasion, on the spot. The enforcement mechanism is unique: compliance with the court's decision is voluntary, but if someone refuses to comply, then that person is accused of some made-up crime before the external

authorities, and arrested. The case never goes to trial because witnesses vanish or refuse to give evidence, but the humiliation of being arrested is generally sufficient to compel good behavior. Children Different communities set different goals for themselves. Religious communities have the goal of achieving salvation; secular ones, such as the Kibbutzim, instead strive for self-realization and personal growth. All of them strive for social security and cradle-to-grave support. But really the most important function of all of these communities is bringing up their children. One across-the-board similarity is that they all practice participatory education. Education is not treated as something separate from the life of the community. Children typically start working alongside adults starting at age eight or nine. Most communities grow their own food, and children get introduced to kitchen-gardening at an early age. Starting around age fifteen they start being assigned serious responsibilities. For example, in a Hutterite community, a fifteen-year-old boy, once he is done with his formal schooling (to the extent that it exists) may be charged with maintaining a tractor. This is a serious responsibility: the tractor must start and run whenever it is needed, because the community depends on it. Education Rejection of public education is very common among these communities, most of which think of it as mental poison. The Roma are an extreme example: they will only send their children to school sporadically, to comply with official requests, and their truancy rate is, unsurprisingly, extremely high. Teachers quickly learn not to let Roma children take books home, because the books get used as kindling and toilet paper and are never brought back. The Amish have their own schools, which comply with state and federal regulations, while the Hutterites grudgingly accept English schools, up to age fifteen in the Dakotas and Montana, and up to age sixteen in Canada because Education Canada has put its foot

down. But they have what they call “German school,” taught by the colony's lay preacher, and it is this German school, which teaches all things Hutterite, that is treated as more important. The Roma prefer to remain entirely unlettered. There are some among them who can read and write, but they generally don't have much status within the community and play subservient roles. They are the ones who are asked to forge documents and to correspond with Gadje authorities, and this is considered particularly filthy, contaminating work. The Kibbutzniks are the exception; as do most Jews, they place a very large emphasis on education. A lot of the Kibbutz communities are now rich, and manage to put their children through Ph.D. or professional programs, but then it often happens that these children do not return to the Kibbutz. The community's money allows them to study to their heart's content, then go and tour the world. By the time they get back to the Kibbutz, they are in their early 30s, worldly and urbane, and have no idea what role they might want to play within the community. Why would they settle on the Kibbutz? And so the children of the Kibbutz become a sort of alumni association, and this is how a lot of Kibbutz communities are failing: through a combination of wealth and education. Teenage rebellion All of these communities make an explicit allowance for teenage rebellion, which turns out to be vitally important to their ability to retain their young people. They make no effort to classify their young people into the well-behaved and the rebellious categories, and simply assume that, being of that age, they need to be given the latitude to behave badly for a time. The Amish have the institution of Rumspringa, in which young people go out into the world, party, misbehave, and then come back, apologize for what they have done, and are forgiven and accepted back. The Hutterites allow their teenagers to move to town and get jobs. They use this opportunity to save up money, which they are allowed to keep and use to furnish their room when they move back in and take on adult responsibilities by virtue of being baptized. The Roma suspend all taboos, sexual

and otherwise, for children, until they are ready to marry (they marry young) allowing their children and young people to run wild and be as obscene and foul-mouthed as they wish. Rites of passage This is a universal trait: all of these communities have an explicit rite of passage by which one is granted adult status with all of its privileges and responsibilities. With the Anabaptist groups (the Amish, the Hutterites and the Mennonites) this event is baptism. They practice only adult baptism, because nowhere in the Bible is it mentioned that infants may be baptized. They treat infant baptism as something the priests invented, and believe that in order to be baptized a person should be old enough to be fully cognizant of what it means. To them, baptism implies being baptized into the specific community and entering into communion with it, to the exclusion of others. All adults that want to be part of the community have to be baptized. This normally happens between 19 and 22 years of age. People have to be baptized before they can marry. Everyone has the choice of opting out of being baptized, which means that they do not join the community. Thus, there is freedom of choice, such as it is, and that choice is explicit and consequential. With the Roma, the rite of passage is marriage. In general, they are fairly casual about marriage, and can divorce and remarry at will. They never go through the courts when they divorce and remarry, or celebrate remarriage in any particular way; most of the time, they simply leave one person and start living with another. It is only the first marriage that counts, but this is an elaborate feast that goes on for several days. Marriage feasts are the standard Roma way of burning off excess wealth. Only through marriage does one become a full-fledged member of a Roma community. In the case of a woman, she only becomes a full-fledged member once she gives birth to her first child. Before that she functions as a sort of intern or trainee, supervised by her mother-in-law. Code of conduct

There is always an explicit and universally understood code of conduct, which is not any less explicit for the fact that it is usually unwritten. Adherence to that code of conduct is an absolute condition of membership. It is what makes the group cohesive. It is reflected in many aspects of behavior. It has an effect on people's language: what they can and cannot say and how they express themselves. It is expressed in dress: there is usually something resembling a dress code. It sets limits on how people express their individuality, forcing people to think about how they behave, express and project themselves rather than just “being themselves,” whatever that means. With the Amish, this oral code of behavior is called Ordnung (order), and it is slightly different for each Amish parish. Although most Amish communities seem to have much in common, in reality they are quite splintered, and there are few Amish parishes that are said to be in “full communion” with each other, because even minor differences between their Ordnungen preclude full communion, down to what specific color they can paint their buggies. Little elements of dress get in the way, such as whether buttons are allowed, or whether they are considered hochmut (vain) and hooks must be used instead. The Amish aspire to being plain—the opposite of vain. The Roma have a complex system of taboos that go under the general term mārime, which can be variously translated as pollution, defilement or contamination. In order to avoid it, the Roma have to follow a large set of practices. For example, the Roma cannot sit on a chair on which a Gadjo has set, or eat from the same plate. For this reason, in their dwellings they usually have a special Gadjo chair, for Gadjo guests, and special Gadjo plates which they smash and throw away after a Gadjo has used one. They may look like filthy beggars, but this complex code of behavior allows them to be ethnically pure filthy beggars. External observers are unlikely to be able to spot the difference. The Orthodox Jews have a large set of rules most of which are, for once, written. They have to remain Kosher. They can't work on

Sabbath, and that includes operating machinery and driving, but they have to go to Shul on Sabbath. That means that they have to live within walking distance of Shul, and this explains why Orthodox communities tend to buy up entire neighborhoods, in some cases completely taking them over, rather than spreading out. This compact living arrangement, in which everyone lives within a few minutes' walk of each other, makes their communities more cohesive. Common choices Many groups are quite specific about technologies and elements of surrounding culture that they choose to include or exclude. The Amish and the Hutterites outlaw television, radio and musical instruments. The Amish also outlaw cars, all electronics and electricity in the home, and a great deal more. Some groups insist on wearing home-made clothing. The Hutterites even make their own shoes while the Amish buy theirs. They buy bolts of cloth, as a community, and then cut it up and distribute the pieces. They sew garments based on agreed-upon patterns, and the result is something that looks very much like a dress code. The Roma used to insist that women not wear any store-bought clothing at all, but at this point it appears that most Roma communities have largely dispensed with this rule. Nevertheless, Roma women still tend to sew a lot their own clothing, as a matter of preserving a rather unique style that includes long pleated skirts and tight-fitting bodices. All of these practices are powerful reinforcers of group identity. Self-sufficiency All these groups have some definition of self-sufficiency, which is invariably defined as lack of permanent dependence on the surrounding society. They trade and otherwise do business with outsiders, but they insist that they will be able to fall back on their own resources even if these external trade and business relationships fail. The Roma, if their relationship with the surrounding

community threatens to turn violent, which it sometimes does, flee immediately. The disappearing act is one of their main survival tactics. Many communities see self-sufficiency as, first of all, self-sufficiency in food. The Amish and the Hutterites produce a large surplus of foodstuffs, and while their lives are in many ways austere, they always eat well. The Kibbutzim have always prided themselves on their agricultural successes, producing a large portion of Israel's produce. Those that do not farm do their best to lay by a large amount of food. For example, the Mormons have the institution of the bishop's warehouse, which may hold as much as a year's worth of foodstuffs for the entire community. Commitment How committed its members are to the community directly determines its chances of success, and there are informal mechanisms that reward the most committed and punish lack of commitment. Personal status within the community accrues to those who are willing and able to put the needs of the community before their own. If someone is placed in a position of authority but fails to put the needs of the community first, the result is an automatic loss of authority as everyone around begins to withhold their cooperation. The flip side of enjoying everyone's cooperation is one's personal surrender (with the understanding that others will surrender themselves for your sake). This is the definition of mutual self-help: the goal is to help yourself, but you have to do so by helping others, because you cannot help yourself directly. A common front All of these communities tend to have a specific way of interacting with the outside world. They almost always do so as a group, or as representatives of the group, rather than as individuals acting on their own behalf. Interestingly, in many cases the outsiders can't see this. The Roma are particularly interesting: in the U.S. they all take English names, such as Bob Jones and Cathy Smith, making it

rather difficult to discover the fact that they are Roma. Their tactic of presenting themselves to outsiders is one of hiding in plain sight: instead of hiding, they hide who they are. This is a very powerful technique. One way to help your community survive is to not tell anyone that it exists. Counterculture The term counterculture was once fashionable; not so much any more, although some people still equate it with being hip, edgy and cool. For a small community, it is very important for it not to be perceived as a counterculture. Being perceived as different from the surrounding culture is dangerous enough; being perceived as both different and in direct opposition to the surrounding culture is even worse. People commonly like those who resemble them, and automatically dislike those who do not. People who are not only unlike them but are also confrontational about it are likely to trigger fits of xenophobia. So, if you happen to be very much unlike those around you, it is a very good idea to pretend that, in fact, you are very much like them in every way. A common trick is to publicly simulate mainstream practices which you privately avoid. For instance, there are many people in Boston who will never watch a baseball game in their entire lives if they can help it, yet they own a Red Sox baseball cap and know just enough useless Red Sox trivia in order to qualify as part of “Red Sox nation,” strictly for the sake of blending in. For small, separatist communities such mimicry is even more important. And so they will speak like the rest, they will look like the rest and they will act like the rest, all to better hide the fact that they are not like the rest at all. Community standards We already discussed some common choices, such as choices of dress code and behavior. But there is more to it: as a general principle, communities reserve the right to accept and reject certain elements from the surrounding societies. They do not create their

own culture out of nothing or simply carry on forever with what has been handed down. Instead, they are always on the lookout for useful cultural elements they can adopt and adapt while rejecting the rest. Their choices often seem curious. For example, the Amish don't use cars or trucks, but they are perfectly happy to use diesel-powered water pumps. The rule is, if an internal combustion engine is on bolts, it's fine to use; if it's on wheels, it isn't. The Amish have a particularly long list of items from the surrounding society that they reject: cars, television, radio, higher education, politics, movies, jewelry, electricity, lawsuits, pictures, wristwatches, life insurance, musical instruments... The Hutterites ban magazines for entertainment, but are avid readers of trade magazines related to horticulture and agriculture, and stay up-to-date on the latest agricultural techniques and technologies. The Hutterites reject fewer things than the Amish, but they too reject television, radio, higher education, jewelry and musical instruments. The Roma reject literacy, but not numeracy and are often quite good at mental arithmetic, using words from the surrounding languages to count rather than counting in their native Romani, so as not to waste any effort on translation. They reject books, but they like movies, and they love jewelry and musical instruments. Such choices, or, rather, such limitations, and the willingness to impose them, may seem strange. But if you think about it, you too might see reasons to reject certain things. Speaking for myself, I have quite willingly rejected quite a few: most kinds of commercially prepared food, all factory-farmed meat, all commercial television, all for-profit financial institutions and privately owned cars. These groups may seem strange and different to you at first. Certainly they did to me when I first started thinking about them a few years ago, but now I no longer see the choices these groups made as all that different from my own. Because, you see, we are following the same process—of consciously accepting or rejecting elements from the surrounding

culture—and with the same goal in mind. And that goal is simply to minimize harm. The idea is to block out and refuse to participate in any of the things that are harmful rather than beneficial. We all do this to one extent or another. The difference here is we try to do this as individuals and families, and usually fail; these communities do the same thing but as communities and usually succeed. Wage labor Many of these communities reject the concept of wage labor: they do not work for money as individuals. Working for wages is a rather recent development and is largely a byproduct of industrialization. Before industrialization, the vast majority of people were either selfemployed craftsmen or worked in communal groups on such tasks as bringing in the harvest. The technical term for the process by which one becomes willing to work for wages—a rather unusual human trait—is proletarianization. Surrendering one's time, judgment and free will to a stranger's arbitrary authority in exchange for mere money is, if you think about it, halfway to enslavement. And if you do this to earn money to make payments against debt which you can never pay off completely, then it is enslavement. To enslave someone, start with a free individual who has the power to decide what to do on any given day, and turn that person into someone who is punished for not doing as he is told and rewarded for following arbitrary orders with blind, cheerful obedience. Any wages left over after paying taxes, rent, interest on debt, and other mandatory costs such as health insurance and auto insurance must be spent within the consumer economy, on a circumscribed set of products and services—ones that can turn a profit for the slaveowner. The wage slave may be fired or laid off at any point, without warning, and may or may not get severance or unemployment compensation. This arrangement is a vestige of the industrial revolution, in the process of which people were dispossessed, run off their land, and made to work in factories at subsistence wages. This process is called proletarianization.

Most of the communities we are discussing here refuse to be proletarianized. They will, of course, work, but only as work groups that are part of the community. There are variations and compromises: the Amish, for instance, will work in factories in order to make enough money to pay taxes; the Orthodox Jews will work for wages, but do their best to work for companies that are owned by Orthodox Jews; the Hutterites allow their young people to get jobs, to save up a bit of money and live it up a little. But, as a rule, even if they are forced to work for outsiders for a time, they refuse to treat such employment as a permanent arrangement. Some, like the Roma, refuse to take orders from outsiders, and will not bend to the will of a Gadjo boss. They deal with the outsiders not as individuals but as a nation, and this is a very large determinant of their success. Money Another large commonality is the communalization of money. Money generally does not circulate within the community itself: that is often considered taboo. Money may be allocated and distributed, and there is no internal trade or commerce, with gift and barter taking their place when exchanging personal effects and favors. Money that comes in from the outside normally goes into the communal fund. Individual possession of money is regarded as socially corrosive. One example showcases this effect particularly well: at one point in the history of the Kibbutz movement, reparation payments from Germany for the Holocaust started showing up. These were, in some cases, very large sums of money. The issue of what to do with this money quickly became divisive, because previously egalitarian communities had to cope with suddenly having a very rich person in their midst. Suddenly, there arose the specter of massive inequality. Of course, each community had to decide what to do about it in open meeting. The successful solution turned out to be to give such people two choices: hold onto their money and leave, or put that money in the communal fund and stay. And, of course, the next thing that needed to be decided is what to do with this money, because one of the most destructive things that can happen to a community is for it to become wealthy. Children become spoiled, adults develop

expensive tastes and bad habits, and the community becomes much less resilient when times change for the worse, as they always do sooner or later. The communal fund tends to be spent on wholesale purchases for the benefit of the entire community, although the members usually have access to some spending money. For example, the Hutterites receive on the order of $10 a month to go into town and spend it on knick-knacks, but they receive everything they actually need from the community itself, through wholesale purchases and home production. They buy cloth in bolts and sew their own clothing; they buy foodstuffs in bulk. They even make their own shoes. Retirement All of these communities have exactly the same retirement plan, and it is to retire as soon as a younger replacement is available. It is considered harmful to hold young people back, and the general rule is, if somebody younger is ready to take over what you are doing, then you have no business continuing to do it. The Amish farmers usually retire at fifty, but if they have sons that they had at a young age who can take over from them, then they retire even sooner. After that, the retired farmers continue to “live in” on the farm and act as advisors, making good use of their wealth of accumulated knowledge and experience. The Hutterites retire in their 40s, and have a very explicit rule that older people have to clear the path for young people to rise to positions of responsibility, to prevent them from becoming disgruntled and leaving. Early retirement is one of the key elements that allow a community to retain its young people. Whenever old people are found to be clinging onto their jobs, this should be taken as a sign of trouble. Of course, what makes such early retirement schemes possible is that these communities provide for their members regardless of whether or not they work. There is no concept of being “pensioned off”: retired people continue to work, there are always tasks for them, perhaps more interesting ones than the ones they had before, and they are never excluded from the life of the community.

Outward appearances Another commonality is the lack of outwardly visible trappings. Look at an Amish community, and you will not see any steeples. The services are held in houses, which tend to be large, every second Sunday. People within a parish trade off on who hosts the meeting, and there is often a special carriage which brings the benches from one house to the next. Similarly, if you look at an Orthodox Jewish shul, more often than not you will see a fairly nondescript building. Look at a Roma camp, and there is unlikely to be anything about it that identifies their residents as being Roma, because the Roma often take pains to obscure their identity. The fact is, none of these communities see any advantage in advertising their existence or putting themselves on display for all the world to see. Their identity faces inward rather than outward. They to restrict access to their internal identities by not showing them to the world, and instead presenting a plain and indifferent common front. Anthropologists often have a hard time infiltrating these communities in order to figure out what's going on. Their efforts are often further hampered by the fact that there are rarely any documents for them to examine, because the rules by which these communities live are unwritten. Persecution Community success seems to depend on some optimum level of persecution by the surrounding society. If a community's relationship with the outsiders is entirely copacetic, the chance of failure is huge. A good example of this are the Kibbutzim. Initially, they faced considerable opposition from the authorities. They were certainly opposed by the British authorities in Palestine. During the early days of the state of Israel they were opposed by the Israeli government as well, because they weren't nationalists. They were internationalist socialists and were more closely aligned with the Soviet Union than with the United States, which is where a lot of Israel's money has always come from. But eventually they succeeded in achieving mainstream acceptance and respectability, blended into the political system and... started disintegrating from that point on. Another

example is the Dukhobors, who faced massive persecution while they were in Russia. This group was at one point exported to Alberta, in a ship paid for by Tolstoy, the author of War and Peace, who championed their cause. They are an interesting group that can be characterized as Russian Orthodox Protestants. They had a lot of prohibitions against having explicit trappings of any sort, so they had no churches and no priests, they refused to take oaths, sign their names, or serve in the military. Tolstoy found them very inspiring, and so he took the honorarium from one of his novels and spent it on them. They were unable to stay in Alberta because the Canadians required them to take a pledge of allegiance, which their religion forbids, and so they moved on to British Columbia, where, for some reason, the government didn't bother them at all, and because of that over time they largely dissolved in the surrounding population. There are some 40,000 of them, but they are indistinguishable from the general population of British Columbia, which is very friendly toward them. And so it is generally the case that a history of persecution is very helpful in holding a community together. For a lot of these communities, their foundational myth is based on some traumatic event: definitely with the Hutterites, definitely with the Kibbutzim, definitely with the Dukhobors. Ready acceptance by the surrounding community causes eventual disintegration. The sort of persecution that appears to work best is a few dramatic incidents of persecution separated in time, serving as periodic wake-up calls, with intervening periods of relative tranquility and stability. Once in a while some event occurs that reminds the community who they are and why they are that way, and the rest of the time they are allowed to go on living peacefully. Nonviolence All of these communities profess nonviolence, do not arm themselves beyond a few simple defensive weapons, and refuse to serve in the military. The Kibbutzim are the exception—as citizens of Israel, they have no choice. In one of the founding episodes of the

Dukhobors, they laid down their weapons on the ground and burned them. They did this at a time when there was an army opposing them. Nevertheless, they decided to burn their weapons rather than fight, because they would have preferred to die to a person than to survive through violent means. Refusal to enter military service during World War I forced the Hutterites to leave the Dakotas and move across the border into Canada. Eventually they worked out an arrangement with the U.S. Forestry Service, according to which, if there is ever a draft, they will discharge their obligation to serve by working for the forest service, in jobs that do not require them to carry weapons. Splintering For all of these communities, splintering is a relatively normal process, to be expected when the community exceeds a certain size, or when its members find that they have developed differences significant enough to make it impossible for them to reach consensus on essential questions. In some cases communities splinter into families and smaller groups because of prosperity: they accumulate enough wealth to make it seem attractive to members to claim their share and leave. In other cases communities fall apart for the opposite reason: bankruptcy, which can happen because of high external costs, especially medical and legal costs, leading to the accumulation of unrepayable debt. Yet another common reason is dissatisfaction with the community itself, if it fails to achieve its goals or is forced to act in ways that contradict its founding ideology. These communities are often formed out of dissatisfaction with the larger society, and this dissatisfaction can wax and wane over time. There were over 60 communes, just in the U.S., in the second half of the 19th century, but then most of them disappeared. Then again, in the 1960s, during the Vietnam War, there was another spurt of similar activity, which again largely disappeared. Similar dynamics can play out within the communities themselves.

The XIII Commandments of Communities That Abide The term “commandments” is perhaps a bit too strong a word for describing this list. But it sounds better than “recommendations,” which is what these really are. Nevertheless, if your goal is to form a community that will provide your children and grandchildren with a safe and pleasant way of life, you should probably take these recommendations quite seriously. It is a summary that condenses all of the key commonalities shared by the communities that stand the test of time, retaining their character and their young people over multiple generations. These commandments are what all resilient communities are likely to have in common, and very likely, the only things that they have in common. I. You Probably Shouldn't come together willy-nilly and form a community out of people that just happen to be hanging around, who don't have to do much of anything to join, and feel free to leave as soon as they get bored or it stops being fun. The community should be founded as a conscious, purposeful, overt act of secession from mainstream society, a significant historical event that is passed down through history and commemorated in song, ceremony and historical reenactment. A classic founding event is one where the founding members surrender all of their private property, making it communal, in a solemn ceremony, during which they take on new names and greet each other by their new names as brothers and sisters. The founding members should be remembered and revered for their brave and generous act. This makes the community into a self-aware, synergistic entity with a will of its own that transcends the wills of its individual members. II. You Probably Shouldn't trap people within the community. Membership in the community should be voluntary. Every member must have an iron-clad guarantee of being able to leave, no questions asked. That said, do everything you can to keep people from leaving because defections are very bad for morale. One good trick is to give people a vacation when they need it, and one good way to do that is to run an exchange program with another, similar

community. There need not be a guarantee of being able to come back and be accepted again, but this should be generally possible. Those born into the community should be given an explicit opportunity, during their teenage years, to rebel, escape, go out and see the world and sow their wild oats, and also the opportunity to come back, take the pledge, and be accepted as full members. When people behave badly, the threat of expulsion can be used, but that should be regarded as the “nuclear option.” On the other hand, you should probably have some rules for expelling people more or less automatically when they behave very, very badly indeed (though such cases should be exceedingly rare) because allowing such people to stick around is also very bad for morale. III. You Probably Shouldn't carry on as if the community doesn't matter. The community should see itself as separate and distinct from the surrounding society. Its separatism should manifest itself in the way its members relate to members of the surrounding society: as external representatives of the community rather than as individual members. All dealings with the outside world, other than exchanging pleasantries and making conversation, should be on behalf of the community. It must not be possible for outsiders to exploit individual weaknesses or differences between members. To realize certain advantages, especially if the community is clandestine in nature, members can maintain the illusion that they are acting as individuals, but in reality they should act on behalf of the community at all times. IV. You Probably Shouldn't spread out across the landscape. The community should be relatively self-contained. It cannot be virtual or only come together periodically. There has to be a geographic locus or a gathering place, with ample public space, even if it changes location from time to time. The community should be based on a communal living arrangement that provides all of the necessities. A community living in apartments scattered throughout a large city is not going to last very long; if that's how you have to start, then use the time you have to save money and buy land. A good, simple living arrangement, which minimizes housing costs while

optimizing group cohesion and security, is to provide all adults and couples with bedrooms big enough for them and their infants, separate group bedrooms for children over a certain age, and common facilities for all other needs. This can be realized using one large building or several smaller ones. V. You Probably Shouldn't allow creeping privatization. The community should pool and share all property and resources with the exception of personal effects. All money and goods coming in from the outside, including income, pensions, donations and even government handouts, should go into the common pot, from which it is allocated to common uses. Such common uses should include all the necessities: food, shelter, clothing, medicine, child care, elderly care, education, entertainment, etc. Members who become rich suddenly, through inheritance or some other means, must be given a choice: put the money in the pot, or keep it and leave the community. This pattern of communal consumption is very efficient. VI. You Probably Shouldn't try to figure out what to do on your own. The community should have collective goals and needs that are made explicit. These goals and needs can only be met through collective, not individual, actions. The well-being of the community should be the result of collective action, of members working together on common projects. Also, this collective work should be largely voluntary, and members who are fed up with a certain task or a certain team should be able to raise the issue at the meeting and ask to be reassigned. It's great when members have new ideas on how to do things, but these have to be discussed in open meeting and expressed as initiatives to be pursued collectively. VII. You Probably Shouldn't let outsiders order you around. It's best if the community itself is the ultimate source of authority for all of its members. It should have a universally accepted code of conduct, which is best kept unwritten and passed down orally. The ultimate recourse, above and beyond the reach of any external systems of justice or external authorities, or any individual's authority within the group, should be the open meeting, where everyone has

the right to speak. People should only be able to speak for themselves: attempts at representation of any sort should be treated as hearsay and disregarded. You probably shouldn't resort to legalistic techniques such as vote-counting and vote by acclamation instead. Debate should continue until consensus is reached. To reach a consensus decision, use whatever tricks you have to in order to win over the (potentially vociferous and divisive) opposing voices, up to and including the threat of expulsion. A community that cannot reach full consensus on a key decision cannot function and should automatically split up. But this tends to be rare, because the members' status depends on them putting the needs of the community ahead of their own, and one of these needs happens to be the need for consensus. Decisions reached by consensus in open meeting should carry the force of law. Decisions imposed on the community from the outside should be regarded as acts of persecution, and countered with nonviolent protest, civil disobedience, evasion and, if conditions warrant, by staging an exodus. The time-tested, foolproof way to avoid being subjected to outside authority is by fleeing, as a group. And, of course, you probably shouldn't waste your time on things like voting, trying to get elected, testifying in court, bringing lawsuits against people or institutions, or jury duty. VIII. You Probably Shouldn't question the fundamental goodness of your community. Your community should have moral authority and meaning to those within it. It can't be a mere instrumentality or a living arrangement with no higher purpose than keeping you fed, clothed, sheltered and entertained. It shouldn't be treated in a utilitarian fashion. There should be an ideology, which is unquestioned, but which is interpreted to set specific goals and norms of behavior. The community shouldn't contradict these goals and norms in practice. It should also be able to fulfill these goals and comply with these norms, and to track and measure its success in doing so. The best ideologies are circularly defined systems where it is a good system because it is used by good people, and these people are good specifically because they use the good system. Since the ideology is never questioned, it need not be particularly

logical and can be based on a mystical understanding, faith or revelation. But it can't be completely silly, or nobody will take it seriously. IX. You Probably Shouldn't pretend that your life is more important than the lives of your children and grandchildren (or other members' children and grandchildren if you don't have any of your own). If you are old and younger replacements for whatever it is you do are available, your job is primarily to help them take over and then to keep out of their way. Try to think of death as a sort of bowel movement—most days you move your bowels (if you are regular); one day your bowels move you. As a member of the community, you do not live for yourself; you live for the community— specifically, for its future generations. The main purpose of your community is to transcend the lifespans of the individual members by perpetuating its biological and cultural DNA. To this end, you probably should avoid sending your children through public education, treating it as mental poison (as many successful communities do) because it has very little to do with educating, and everything to do with institutionalization. Also, if a child is forced to recite the Pledge of Allegiance in class, that creates a split allegiance, which you should probably regard as unacceptable. If this means that your community has to expend a great deal of its resources on child care and home schooling, so be it; after providing food, shelter and clothing, it's the most important job there is. X. You Probably Shouldn't try to use violence, because it probably won't work. Internally, keep your methods of social control informal: gossip, ridicule, reprimand and scorn all work really well and are very cheap. Any sort of formal control enforced through the threat of violence is very destructive of group solidarity, terrible for morale, and very expensive. You should try to enforce taboos against striking people in anger (also children and animals). Use expulsion as the ultimate recourse. When dealing with outsiders, don't arm yourselves beyond a few nonlethal defensive weapons, don't look like a threat, stay off the external authorities' radar as much as possible, and work to create good will among your

neighbors so that they will stand up for you. Also, be sure to avoid military service. If drafted, you should probably refuse to carry weapons or use lethal force of any sort. XI. You Probably Shouldn't let your community get too big. When it has grown beyond 150 adult members, it's time to bud off a colony. With anything more than 100 people, reaching consensus decisions in an open meeting becomes significantly more difficult and time-consuming, raising the level of frustration with the already cumbersome process of consensus-building. People start trying to get around this problem by hiding decision-making inside committees, but that is incompatible with direct democracy, in which no person can be compelled to comply with a decision to which that person did not consent (except for the decision to expel that person, but most people quit voluntarily before that point is reached). Also, 150 people is about the maximum number of people with whom most of us are able to have personal relationships. Anything more, and you end up having to deal with near-strangers, eroding trust. The best way to split a community in two halves is by drawing lots to decide which families stay and which families go. Your community should definitely stay on friendly terms with the new colony (among other things, to give your children a wider choice of mates), but it's probably a bad idea to think of them as still being part of your community, because they are now a law unto themselves: independent and unique and under no obligation to consult you or to reach consensus with you on any question. XII. You Probably Shouldn't let your community get too rich. Material gratification, luxury and lavish lifestyles are not good for your community: children will become spoiled, adults will develop expensive tastes and bad habits. If times ever change for the worse, your community will be unable to cope. This is because communities that emphasize material gratification become alienating and conflicted when they fail to provide the material goods needed to attain and maintain that level of gratification. Your community should provide a basic level of material comfort, and an absolutely outstanding level of emotional and spiritual comfort. There are many

ways to burn off the extra wealth: through recruitment activities and expansion, through good works in the surrounding society, by supporting various projects, causes and initiatives and so on. You can also spend the surplus on art, music, literature, craftsmanship, etc. XIII. You Probably Shouldn't let your community get too cozy with the neighbors. Always keep in mind what made you form the community to start with: the fact that the surrounding society doesn't work, can't give you what you need, and, to put in the plainest terms possible, isn't any good. Over time your community may become strong and successful, and gain acceptance from the surrounding society, which can, over time, become too weak and internally conflicted to offer you any resistance, never mind try to persecute you. But your community needs a bit of persecution now and again, to give it a good reason for continuing to safeguard its separateness. To this end, it helps to maintain certain practices that alienate your community from the surrounding society just a bit, not badly enough to provoke them into showing up with torches and pitchforks, but enough to make them want to remain aloof and leave you alone much of the time. *** This list of... um... commandments was put together by looking at lots of different communities that abide. It is not dependent on what exact kind of community it is: whether it's patriarchal or grants equal rights to women, whether it's religious or atheist, whether it's settled, migratory or nomadic, whether it consists of farmers or carnival performers, law-abiding or outlaw, highly-educated or illiterate, whether it's homophobic or LGBT-friendly, vegan or Paleo... The only commonality is that they all have children, bring them up, and accept them into the community as adult members. These are biological communities that function as tiny sovereign nations, not one-way social institutions where people join up and die, such as monasteries, retirement homes, hospices and suicide cults. This wide range should allow you to set aside any fears that whatever

community you envision forming or joining might be excluded, because, given the very wide range of variations between the communities I examined, finding an exact match to what you happen to like is, first, exceedingly unlikely and, second, completely irrelevant to uncovering the common traits that underpin their success.

Small Communist Communities: What Causes them to Fail Peter Kropotkin Some readers will venture to guess that it will be in organizing communal labor that the communists are likely to fail, thinking that this is where many communities have failed already. There are numerous books that express this opinion. It is, however, entirely erroneous. When communist communities failed, the reasons for their failure usually had nothing to do with communal labor. First, let us note that nearly all such communities have been founded with semi-religious fervor as their driving force. Their founders had decided to become “heralds of mankind” or “champions of great ideas” and, consequently, to adhere to strict rules of pettily restrictive morality, to be “reborn” thanks to communal life and, finally, to give all of their time, both during and outside of work, to their commune, living exclusively for its sake. However, imposing such requirements meant following in the footsteps of the monks and hermits of old, needlessly demanding of people that they become something other than who they happen to be. Only recently have there been founded communes (predominantly by worker-anarchists) without any such lofty strivings, but with the simple economic goal of putting an end to being continually robbed by the owner-capitalists. Another mistake made by the communists was in attempting to live as one family of brothers and sisters. To this end, they would settle under a single roof, where they were forced to spend their entire lives in the presence of these same “brothers and sisters.” But such cohabitation in close quarters is no easy feat: even two brothers, the sons of the same parents, don't always find it easy to share a house or an apartment. Besides, family life doesn't suit everyone. This is why it is always a grave error to impose the idea of living as “one big

family.” Instead, it is better to provide everyone with the maximum amount of freedom and the greatest privacy possible for the internal life of each family. For example, the Russian Dukhobors [in Canada] live in separate cabins, and this arrangement helps to preserve their semi-communist communities much more than would life in a single monastery. The first condition for the success of a commune should be to give up the thought of a phalanstère and to live in separate houses, as they do in England. Second, [let's be clear that] a small, isolated commune cannot last a long time. It is well known that people who are forced to live very close together, on a ship or in jail, and receiving very little stimulation from outside, after a while simply can't stand each other [...]. In a small commune it is enough for any two people to become rivals, or to develop an enmity toward each other, in order for the commune to fall apart. It is actually quite surprising that such communes can last for quite a while, all the more so considering that they often seek seclusion from others. This is why, when founding an isolated commune of just ten, twenty or even a hundred people, you should realize ahead of time that it is unlikely to last three or four years. And if it were to last longer, this would be regrettable, because it would prove that its members have either become enslaved by one of their number, or have become utterly depersonalized. But since it is possible to predict that after three, four or five years a part of the commune's membership will want to separate, it makes sense to, at the very least, have a dozen or two such communes bound together into a union. In that case, anyone who, for one reason or another, wants to leave their commune, can switch places with someone else in another one. Otherwise the commune falls apart or (as happens in most cases) falls into the hands of one of the members—the most shrewd and clever “brother.” Thus, to all those who are forming communist communities, I recommend very strongly entering into a union with other such communities. This idea did not come from theory, but from the experience of recent years, especially in England, where

several communes fell into the hands of certain “brothers” specifically due to the absence of a wider organization. Small communes which were founded over the past three or four decades have failed for another important reason: they shunned the outside world. But struggle, and life animated by struggle, are essential for any active person, more important than being well fed. The need to live among people, to dive into the current of social life, to fight alongside others, to live the lives of others and to suffer their sufferings is especially strong in the young generation. This is why [...] as soon as young people approach eighteen or nineteen years of age, they inevitably abandon their commune if it does not form part of the entire society. Youth inevitably flees communes if they are not united with the rest of the world and do not take part in its life. Meanwhile, the majority of communes (with the exception of two, which were founded next to large cities by our friends in England) seek first of all to flee into the wilderness. Really now, imagine yourself between sixteen and twenty years of age, trapped in some small communist commune somewhere in the wilds of Texas, Canada or Brazil. Books, newspapers, magazines, pictures tell you of large beautiful cities, where intense life pours forth like a wellspring—in the streets, in theaters, at public gatherings. “Now that's life!” you say to yourself, “while here we have death—or, worse than death, slow stupefaction! Misery? Hunger? So I'll experience misery and hunger; but let it be a battle rather than moral and mental degradation, which is worse than death.” And with these words you abandon the commune. And you are right to do so. And so we see the kind of mistake that was made by the Icarians and other communists who founded their communes in the wilds of North America. Taking land for free or buying it cheaply in places that had barely been settled, they compounded the difficulty of adjusting to their new way of life with all of the usual difficulties of homesteading in the wilderness, away from cities and major roads. As we have learned from their experiences, these difficulties are very serious. It is true that they obtained land for next to nothing; but the experience of the commune near Newcastle [England] proved to us

that, from a material point of view, a commune can provide for itself much faster and much better, by gardening (predominantly using greenhouses) and planting orchards, and not through field work. A ready market for their fruits and vegetables nearby provides the income to pay for the high land rents. Also, work in gardens and orchards suits a city-dweller far better than field work, especially when it involves clearing land in the wilderness. It is far better to rent land in Europe than to flee to the wilderness, and, all the more so, to dream of forming a new religious empire, as did the communists of Amana and others. Social reformers need the chance to struggle, proximity to intellectual centers, constant contact with the society they wish to reform, inspiration from science, culture, progress, which they cannot get from books alone. It goes without saying that governance of the commune has always been the most serious impediment for all practical communists. Indeed, it is enough to read Travels in Icaria by Cabet to realize why it was impossible that the communes founded by the Icarians would last. They required total annihilation of human personality in the service of the great archpriest who was their founder. [...] Alongside these experiments, we see that those communists who reduced governance to the lowest level possible, or had no governance at all, as, for example, the Young Icaria in America, succeeded better and lasted longer than the others (35 years). It is easy to understand why: the greatest animosity between people always erupts because of politics, because of power struggles, and in a small commune power struggles inevitably lead to its dissolution. In a big city we can live side by side with our political opponents, since we are not forced into constant contact with them. But how do you live with them in a small commune, where you encounter them every day, every minute? Political arguments and intrigues over power get carried over into the workshops, into the spaces where people congregate for leisure, making life intolerable. These are the main causes for the dissolution of communes that have been founded up until now.

[Translated by Dmitry Orlov, from Anarchy, pp. 253-260]

Appropriate Health Care for a World In Flux: A Strategy James Truong, MD Monday: Feed the family. Tuesday: Don’t get sick. When it comes to strategizing for life within smaller, more resilient communities, thoughts often turn to items low down on Maslow’s Hierarchy of Needs: food, water, shelter, etc. It is a common jumping-off point for many when they first recognize that the current “civilized” way of life may not be sustainable. Moving one tier up the Hierarchy, once the “prepper” movement has finished laying in their year's worth of hard red wheat and bottled water, they typically zone in on obtaining as many forms of weaponry as possible, presumably to fend off the impending hordes of zombies (metaphorical or otherwise) who might threaten their safety and security. However, if one moves past the notion that enclaves of bunkered-in, isolationist survivalists can make any kind of a stand in a changing, unstable world, the strategy must inevitably turn away from laid-in supplies and defenses against real or imagined threats and start paying much greater attention to the realities of our lives as biological organisms. Eating, drinking, sleeping and staying warm are fundamental biological needs, and they are, rightly, priorities when it comes to thinking about living in a changing world. But eating out of cans and drinking out of bottles doesn’t work well and certainly doesn’t work for long, regardless of how many “preps” are made in advance. This is why any reasonable discussion of resilient living has to start with considerations for food and water security, feasible agriculture and permaculture, etc. Only once these needs can be met should we even bother talking about creating a community. Once the bottom layer of Maslow's pyramid is secured... what's next? Let’s say that a hypothetical post-collapse community is identifying its priorities, looking to focus its effort and resources. Let

us assume, for the sake of the argument, that there is not an active nuclear conflict going on, and that the mythical Nazi Zombie Biker Hordes have somehow failed to materialize. In terms of threat analysis, where an event's impact multiplied by its likelihood yields a measure of the relative danger of various threats to an individual’s continued existence, boring health problems rate far greater than any exciting threat of violence. The problem is that within the current framework of civil society, we’ve spent about four generations not having to worry as much about illness. We started figuring out contagion in 1854, invented antibiotics in 1928, and the ride to a (relatively) disease-free, longer life has been downhill ever since. We’ve had plenty of time to lose our respect for sickness in general, to the point where now we don’t even consider it a threat (other than a financial one, and only in countries where proper health care remains a privilege of the wealthy instead of a human right). The change has been so complete that now our definition of “medicine” looks far different than it did to our great-grandparents. Ask an 80year-old farmer, and he is bound to tell you his health is okay if he isn’t currently sporting a broken bone, an open wound, can breathe easily and isn’t incapacitated with pain. But ask an average primary care provider what the majority of her caseload is on a given day, and she will rattle off a list: mood disorders, obesity (with all of its resultant complications), problems caused by lack of proper diet and exercise, and then the multitude of diseases of aging (including cancer) which, up until 50 years ago, weren't even treated. It’s quite a change that the allopathic medical system has undergone in only a century. And yet, we take it for granted that the systems we have in place today constitute “health care”. But they don’t. For starters, you can’t care for something you don’t already have to begin with. Therefore, for the sake of this discussion, we will concentrate mostly on that subset of the Healing Arts that address once-healthy individuals who have become ill or injured and then need help getting better again. Using allopathy to compensate for chronic, longstanding conditions (especially those that are self-

inflicted through lifestyle, diet or inactivity) is about as effective as using horticulture to turn a dying tree back into a forest. We fooled ourselves for a while, because allopathic drugs are so effective that they can produce an illusion of restoring a patient's health. Unfortunately, that is largely what it is: an illusion. We can break down all medical issues into a 4-box matrix for reference.

Benign

Acute AB:

Chronic CB:

Pain (the cow stepped on my foot) Minor infections (the cow stepped on my foot and broke the skin and manure got in) Minor trauma (the cow stepped on my foot and broke my third toe)

Adjustment reactions and acopia (“I lost my job, can’t afford the marijuana I use to get to sleep and my girlfriend was mean to me”) Lifestyle diseases (“…and now I can’t get it up.” erectile dysfunction, menopause, andropause, osteoporosis) Boutique diseases (memory loss, cosmetic problems, gender identity), Inactivity

All the things that might appear on the pages of Farmer’s Almanac

Dangerous AD: Trauma (the cow stepped on my kid’s chest and he’s stopped breathing) Infectious disease (my

The half of what currently appears in a typical family doctor’s office, and most of what appears in the pages of the “Health Care Special Edition” of Cosmopolitan CD: Obesity Smoking Heart disease Hypertension

kid has a fever of 106° Thyroid disease and is coughing and can’t swallow) All the things that should be addressed by a health care All the things that should provider of some sort in an immediately go to an outpatient setting. emergency room, and are sometimes addressed in a militarygrade survival field medic’s manual. Although it’s sometimes difficult to convince people, CB problems have a way of sorting themselves out. Loss of this quadrant of the health care field is inevitable (in fact, to a large extent this has already happened) and is inconsequential in the long run if we retool our lives appropriately. AB issues are the mainstay of first aid and home health care. We need to get better at redistributing AB care to take the load off the other quadrants, and to make individuals and societies more resilient. CD care can likewise be redistributed away from specialists and back to individuals, but doing so is not problemfree because of the element of danger: there are many legitimate diseases that can sneak up on us and there will always be a lot of misinformation and, worse yet, disinformation regarding illness. In a world with less centralized teaching and transmission of information, we stand to lose ground previously gained in the treatment of chronic illness. AD problems will need to be addressed first, but it is realistic to think that they will always be within the realm of the secondary (mobile, trained) healer or tertiary (fixed-location team of) healers to resolve. Even then, and especially in the case of a rapidly changing world, they may not be entirely fixable. In this essay I will try to use my professional insights to set up a framework for addressing health concerns as we move forwards. Let me declare my biases. I am an allopathically trained, “conventional” MD with a background in biochemistry and psychology, with dual specialties in both family and emergency medicine, working half of

the time in each. I work in Canada, so less of my day is spent worrying about bills and insurance and more of it is spent worrying instead about the scarcity of resources and manpower. I have a preference for eyes-open, non-paternalistic style of medical care whenever possible. Unlike other works on this subject, this one will not provide mechanistic, step-by-step How-To’s on medical care. If you’re looking for the important, base-level skills, they are available in book form or online. Everyone should acquire these skills. When you suspect that you have attained the level of medical self-sufficiency of the pioneers who set out on the Oregon Trail, you can probably stop and focus on other things. One suggestion is to read the manuals used by development workers and aid organizations during disaster relief missions. That level of knowledge is appropriate now and will be into the future, and will never not be applicable. Kindergarten teachers and call center workers will still need to know how to bandage wounds and where to dig a latrine. If, however, you find yourself wanting to become a healer by trade, I would suggest that you get formal training and on-the-job experience in whatever historically proven discipline appeals to you (I’m an allopath, but perhaps you would prefer a different skill set). Beyond the basics that everybody should know, not everyone needs to know how to extract teeth or diagnose congestive heart failure. To successfully navigate towards a healthy future once the current health care system fails (and if it doesn’t) everyone generally needs three things. Most importantly, they need the proper Mindset going forward; too many of us are wrongheaded about our own health, taking it for granted while we have it, insisting that it’s someone else’s responsibility to fix it when it falters, and failing a “serenity check” if and when we get sick or die despite best efforts all around. Building a proper mindset vis-à-vis our health is a lifelong endeavor, difficult even in the best of times, and I’m not convinced it can be taught so much as it needs to be acquired through experiencing life events. Still, we will try to address it.

The second thing we need to rebuild is our personal and familial Skill-set when it comes to addressing medical diagnostics and treatment. Again, I’m not asking people to, say... perform external version VBACs and extract digoxin from foxglove to cure granny’s atrial fibrillation (I would bet the average reader just said, “Huh?” To which I would respond, “Exactly!”). But the understandable yet unhelpful result of three generations of good allopathic care networks is that most of us gave up learning and practicing our home health care skills. We need to reverse that trend. Lastly, there is the minor but important issue of supplies and equipment. Even now I routinely bail out cases where patients simply didn’t have the materials on hand to deal with simple medical issues, skills aside. It’s often a matter of laziness, and the ER provides a path of least resistance to getting care. Today it’s an annoyance and a waste of resources. In a possible future where secondary medical care systems are unavailable, it’s potentially dangerous or lifethreatening. There are minimal essentials that every home, car, sailboat, what have you, should stock if it is to cope with the unalterable fact that we are squishy bags of protein and water. Let’s start with the easy thing, that requires the least attention but seems to generate the most interest: the Toolset. The Toolset When most people start thinking about meeting their medical care needs in an unstable future, they first think about acquiring “stuff.” Much as in the general prepper community, a whole industry has arisen around the provision of “stuff” meant to keep people healthy even in the absence of modern allopathic care systems and providers. And again, similar to bugout bag mentality of preparedness, this whole notion of buying a first aid kit and being ready for whatever happens is, at its best, woefully incomplete and oversimplified and, at its worst, a dangerous distraction from real health resilience and a false sense of security.

Put simply: we are conditioned to want to acquire stuff, and to attempt to buy our way out of any perceived need. A current or future lack of medical care is no different. It’s a flawed strategy, but it is also true that a trained individual is nowhere near as effective without the right tools. Since it’s an easy and appealing place to open the subject, we’ll start there. If you decide to explore the subject of the survival medicine toolset, a Google search on the topic will be quick to list commercial sites that are purveyors of one-size-fits-all emergency or first aid kits that are meant to replace visits to the hospital or physician. These kits tend to be overburdened with complex, single-purpose equipment (cricothyrotomy tools, gunshot wound bandages, intravenous lines and my favorite, snakebite venom extractors). They also tend to be undersupplied with common consumable supplies (tape, gauze, oral hydration supplies, pain medications, personal protection, cleaning and sanitizing gear). The fancy items are sexy, interesting and conjure up scenarios involving life-saving miracles. The common stuff is boring, bothersome to buy and maintain and (although it might be useful in any dozen life threatening situations) requires general knowledge and decision-making to use effectively. For example, an emergency airway kit comes with a two-page manual that even an experienced doctor should read again prior to using it, and it addresses exactly one, rare, life-threatening scenario. Even in that one circumstance, it is dangerous and frightening to use. At the opposite end of the spectrum, Band-Aids and clean water don’t come with instructions, and yet they get used every day in every setting, from the kitchen counter to the operating theater, and are incrementally responsible for changing the course of many injuries. Here is an illustrative story from early in my career. It happened just before the end of my medical training. It stands out in my mind because it represents some interesting aspects of life-and-death care that most people don’t get an opportunity to think about. We’ll use it first as a framework for talking about the contents of a realistic medical “toolbox,” but afterwards we’ll refer back to elements of the story when talking about skillset and mindset.

I was on the road during the late afternoon, travelling back from a community placement to where the medical school was holding weekend educational sessions. This is in an area of rural Canada where it can be 50 miles to the nearest hospital and 5 hours of fast road travel to get to the nearest high-level trauma center. It is a common experience for medical personnel to come upon motor vehicle accidents, and it is equally common to slow down, roll down the window, make introductions and ask if any assistance is needed; it’s a very safe, friendly part of the world, even though driving on a rural, high-speed, single-lane road might not be the safest way to travel. Usually the bystanders and those involved in the accident are appreciative but decline the offer of help. Most commonly the EMS are already at the scene, because response times even in this neck of the woods are relatively quick. On this particular occasion, though, I rapidly got the sense that it was going to be different. It was a two-vehicle wreck, head on, with glass, metal and vehicle contents scattered about on the road. Some kind of delivery cubevan versus an old-school, long-nosed four-door sedan from the eighties, which appeared to have crossed the median at highway speeds. My first clue that there was going to be trouble was the smoke or steam, which was still rising from the engines. Still, I performed the traditional pull-over and slow-down and, after checking my rear-view mirror to ensure that we weren’t going to get rear-ended and worsen the situation, I rolled down my window and poked my head out. There were two very burly, very panicked men running back and forth around the scene, checking inside the cabins of the vehicles. One ran over to meet me and, when I asked whether they needed the assistance of a doctor, blurted out a frantic, “Yes!” I got out of the car. The first thing I noticed, once I had calmed the two fellows down and quickly surveyed the scene, was that one of them had a new-fangled (for 1998) “mobile telephone” on his hip. At the time, I was already a fully-trained MD and was busy with my dual specializations in ER and family medicine, but I was yet to even use someone else’s mobile phone, let alone own one myself. Two-way communication technology, available to anyone anywhere! What a

novelty! Certainly with good medical applications, though the owner of the phone hadn’t realized that yet. The first thing I got him to do was ring up 911 and told him what to say about summoning emergency medical services. We got two ambulances mobilized and a helicopter readied, and then I proceeded to provide what care I could. The first survey of the scene revealed that the passenger car was a mess, with the engine block shifted backwards, pushing the dashboard partway into the front seat, trapping both occupants. The driver was a 70-year-old woman, probably a grandmother. Her chest was directly against the steering column and she was probably already dead or so close to it as to make triage irrelevant. A teenage boy, presumably her grandson, was in the passenger seat, moving but pinned by the wreckage against his left femur, which was folded upright at a 90-degree angle. He was twitching and mumbling, but unable to respond any more than that. There was no way to get either of them out for the time being, nor could I reach into the cabin enough to do anything more than take a pulse; there was no way even to attempt to tourniquet off the damaged leg. The oncoming van had less damage, but the load had shifted forwards into the driving compartment, flattening the driver’s seat and squashing the driver (who was still talking coherently) against the inside of the windshield. None of the side doors on either vehicle would open, but as luck would have it, the cube van was, of all things, a hardware store delivery vehicle with a full load of supplies in the back. I set the two fellows to unloading the van from the rear, and they soon cleared a path, and also found some very helpful tools including crowbars and hammers. I sent them to try to smash windows and pry open the four-door while I attended to the driver of the van. He was going to be easy enough to stabilize while we waited for other help, so he got my attention first. While rummaging through the contents of the van, I discovered an entire shipping carton of first aid kits! I cracked one of them open,

and rapidly realized that the contents were going to be laughably inadequate; a few one-inch gauze pads and Band-Aids, safety pins, a triangular sling bandage, paper medical tape and some sewing scissors. These are useful for things that don’t need to be fixed in the first place, and useless in cases where it really counts; I kept looking. Happily, I came upon some rolls of shop towels, duct tape and some plastic sheeting. Between those things, my Swiss Army knife and a penlight, I was able to stabilize the majority of the delivery driver’s injuries. He was a middle-aged fellow, who ended up having a punctured lung, various broken bones including in his face, a concussion and some bad lacerations, the worst of which was in his scalp. My medical care for him consisted mostly of getting gauze and pressure on the scalp, partly closing the chest wound and convincing him not to move much until transport arrived. The only two things I went back to my car for were my winter gloves (which served more as a blood barrier than to actually keep me warm) and my stethoscope, which was of little use except for confirming that the one lung was indeed deflated. Once I was able to leave one of the helpers attending to that fellow, I was able to turn my attention back to the other two. The grandmother was now more clearly dead, while the young boy had ceased to struggle around or respond. The growing pool of blood underneath the car suggested that he had simply bled out from the leg injury. EMS arrived shortly thereafter. As per my lead, the first thing they did was attend to the saveable driver. Unfortunately, they did make the slight misstep of trying to replace my jury-rigged duct tape dressings with standard surgical gauze, causing a colorful, exciting and thankfully brief loss control of the situation—for no good reason. Once he was safely away and we had waved off the helicopter, the fire crews spent the next hour or so using the jaws of life to chew open the sedan and extracting the bodies. Then I spoke to the police for a bit to provide information, and I was back off on my journey home with a dramatic story to relate to my fellow trainees. The story above is illustrative of many things. The first is that, although we have become familiar with high speed road travel and

take it for granted, mishaps can still kill you in an instant. Second, we also take for granted the complex and costly infrastructure required to mitigate these sorts of accidents and save the occasional life. The expense and expertise involved in pulling the one lucky survivor back from the brink was staggering, and only available within the framework of a very complex society. Without these adjuncts, it is unclear whether my initial treatment would have been enough to save the man. Therefore, in a simpler world, many of us are going to have to get used to the idea that even moderate injuries or illnesses may not be treatable, or at least not to the degree that we’ve all become used to. Based on the story, and within the theme of medical tool kits, I would like to make a few general observations: general use, adaptable tools are better than specialized ones things that are adequate and immediately available are much better than waiting while aiming for perfection you’re generally more limited by skills than equipment, but that being said… some pieces of kit have no real substitute People like lists. Without further ado, here is the starter toolset that I consider reasonable for emergency medical preparedness: Supplies 50x assorted waterproof Band-Aids 2x 75mL alcohol hand sanitizer gel 2x tissue paper 1x roll of paper towels 2x duct tape or other cheap, strong, water-resistant tape 6x 500mL clean water, in factory-sealed bottles or Mylar 1x bundle of absorbent fabric gauze. Recycled, clean cotton such as the material used to make pajamas is fine. A mass the size of a loaf of bread, pre-cut in squares the size of a slice of bread, is a good start.

2x rolls of stretchy fabric gauze. Commercial tensor bandages, rolls or stretch gauze. 4 inches wide by 12 feet is a handy size. 1x 2oz spool #006 (0.15mm) synthetic monofilament sewing thread, dark color Medications Over-the-counter medications: 2x 15g tubes of antibiotic ointment (Neosporin) 100x acetaminophen (Tylenol) 500mg 100x ibuprofen (Advil) 400mg 1x 30g tube of hydrocortisone cream (cortate) 50x dimenhydrinate (Gravol) 50mg, chewable if possible 50x diphenhydramine (Benadryl) 25mg, chewable if possible 50x Loperamide (Imodium) 2mg Rehydration Salts (home-made or 1 can of powdered energy drink) 2x 50g tubes of petroleum jelly (Vaseline) 1x 30g tube of clotrimazole (Canesten) Prescription medications: 2x 15x 500mg Ciprofloxacin (Cipro) 50x 5mg Prednisone Add to this list any medications that would be considered category 0, 1 or 2 for your family. When possible, leave medications in original containers with seals and desiccant in place. Rotate by using the full bottles in the med kit to replace what sits on your bathroom shelf, and immediately buy more on the next shopping trip. Equipment 1x LED flashlight with AA batteries and crank backup 10x disposable blades. Razor blades, box cutter blades or craft blades are fine. 1x blade handle

2x 10cc syringes for measuring fluids, rehydration, cleaning wounds, etc. 1x straight dressing scissors 1x expensive tweezers 1x angled EMT shears 1x needle-nosed pliers with wire cutter 1x butane lighter 1x non-battery powered thermometer 5x large sewing needles with eye to accommodate thread in kit Extras Functioning communication equipment Contact details for friend $20 bill Paper and pencil Note that in each category, the items have been roughly ordered according to what is most likely to find regular use, even in nonemergencies. For instance, in most households, the needles will only get used for removing splinters and draining blisters and boils, not sewing up wounds. Such a kit is meant to be accessed frequently, and doing so gains the users familiarity and comfort with the contents and their use. It is meant to be a central repository of useful “daily life” health items, and not just a catastrophic “bugout bag” kit. As a matter of fact, unlike many others who write on this subject, I don't advise that it be kept in a backpack at all. I prefer that it look and act like grandma’s medicine cabinet from the 1920’s, except that, like in my ER or clinic, labelled clear plastic drawers are a convenience and ensure that the contents stay visible and get used often. None of the above equipment needs to be sterile. Sterility suggests a difficult, time-consuming process of removing all bacteria and pathogens from an object and storing it that way. It is not practical or necessary in difficult conditions, or even in our current day-to-day life, for the most part. For example, modern emergency rooms no longer use antiseptics (iodine, chlorhexidine), sterile saline (factory-

made and sealed) or even sterile water (boiled and sealed) to irrigate regular wounds prior to closure. Like a lot of other dated medical dogma, it is ineffective, expensive, time-consuming and a needless distraction from the important business at hand. In my career, I am yet to see a field dressing done by anyone that is superior to what a pragmatic farmer can achieve using rags from the barn, some hemp twine and a splint made out of a piece of offcut lumber. Simply being “kitchen-clean” will generally suffice. Yes, in a big-city ICU where everything is micromanaged, sterility probably provides some small incremental benefit. But the list above would be woefully inadequate for a trained medical professional. We are not preparing ourselves to run an ICU or an operating room in our homes. We are making whatever easy, useful preparations we can, to become a little more self-sufficient in providing home health care, being mindful that we can successfully respond to imperfect scenarios with imperfect preparations and solutions. Medics, nurses and doctors already have a good idea of what tools are most useful for their trade. To them, rather than delineating separate lists of gear, I would propose that they rely on a simple heuristic: “What tools would you carry with you or use daily to practice your basic skills?” This simplifies things, and eliminates the nonsensical approach of trying to stock home kits with defibrillators, advanced surgical tools and such. The list ends up being surprisingly short. Here is another heuristic: if you’d have no idea how to use a given piece of kit or medication without an instruction manual, don’t fret too much about leaving it out. The hierarchy of medicines When discussing health care, attention inevitably turns to the medications themselves. When I say “medications,” it is shorthand for all pharmaceuticals, naturopathic remedies, herbals, vitamins, nutraceuticals and whatever other substances might have preventative health or healing properties. Despite being an allopath by training, I treat all these things with the same respect and skepticism. They all have both beneficial and harmful effects, and

weighing one against the other fairly is a life’s work in itself. The flagrant, willy-nilly overprescribing practiced by some allopaths is as dangerous a behavior as the over-simplification and overly optimistic advice from some naturopaths. In the end, it all comes down to this: throughout the ages, we have come to understand that the human body is a frail organism, and that sometimes it can be observed to benefit from a little biochemical boost in the right direction. I personally don’t mind what people use to get there, so long as it has been proven to be relatively safe and effective. There is a tendency to go on and on about what substances are good to cure a given illness or ailment. These discussions can get overwhelming, particularly if the reader has no previous familiarity with the subject. If you find the topic interesting, I would recommend that you get some formal schooling in it while also taking advantage of the vast resources on the internet detailing the uses of various drugs. The topic is vast. However, whether it be factory synthetic Big Pharma products or honey as dressing for burns and wounds, any “medication” can be roughly placed into one of six categories, based on how essential it would be to have available, regardless of whether we are talking about today, or in an austere and difficult future. The hierarchy of medicines contains six categories. Here are the descriptions of each of them. Category 0 This is a special group of medicines (they are all modern medicines) used to support conditions which were previously unsurvivable. The ailments addressed by these meds were universally fatal until quite recently. They amount to a form of life support, in chemical form. The conditions are individualized and specific, and if you happen to have one of them, your preparations for social instability need to be very specific to ensure even a modicum of resiliency. This category includes: Insulin (for type 1 diabetics) Oxygen (for severe emphysema, cystic fibrosis, etc.)

Anti-rejection drugs (for anyone with an organ transplant) Anticonvulsants (for severe seizure disorders) Category 1 These are substances that are meant to cure (not prevent) problems that are acute (not chronic), and are universal, inasmuch as anyone can make use of them in the appropriate situation, regardless of their preexisting health status. They are therefore quite useful and it is important for everyone to have familiarity with them. In the correct circumstance, any one of these can be a life-saver. The list includes: Antibiotics, whether synthetic and purified or natural, and whether systemic or topical. We have lived in the post-antibiotic era for three generations now, and have lost our respect for the dangers of infection. Anti-emetics, anti-diarrheals and rehydration salts. Gastrointestinal illness and dehydration are high level killers in underdeveloped or disrupted areas. Anti-allergy drugs and steroids. Sudden allergy and inflammation are often fatal. Blood products, which are life-saving in cases of trauma (but almost impossible to stock). Epinephrine, needed only if you or someone in your group has properly diagnosed anaphylaxis. Category 2 These are universal symptom relief agents, again, for acute, shortterm problems such as pain, fever and agitation. They still rate high on the scale of importance as they can be used by anyone. Transient symptoms might seem to the uninitiated to deserve a lower rating, but the very nature of healing arts began with the alleviation of temporary human suffering while waiting to see if the body would recuperate on its own. Some examples are: Acetaminophen (pain and fever) Ibuprofen (pain, swelling and fever)

Morphine (pain, agitation) Sedatives, including alcohol and marijuana, when used therapeutically for pain, sleep, agitation. Category 3 These substances are used to treat ongoing conditions in specific individuals who have already been diagnosed with a particular ailment—one that impairs their health and well-being. They are generally not meant to be used ad hoc, but rather after some consideration as to whether the diagnosis is correct, and the downsides of the treatment are outweighed by the benefits. They are more commonly intended for longer term use, making their sustainability questionable, certainly in an unstable environment but perhaps even in the current, modern day setting. To make it into this group, there has to be a real, objectively diagnosable disease that gets worse without treatment and better with treatment. There is often no “lifestyle fix” for the health conditions in question. This list could potentially be quite long. Some examples are: Anti-inflammatory medications (when used for progressive arthritis such as rheumatoid) Antidepressants (if being used for properly diagnosed depression, which is vastly less common than the public is led to believe, being far outnumbered by cases of “social woe”) Antipsychotics (for properly diagnosed schizophrenia, which was potentially an “unsurvivable” mental ailment in old tribal cultures) Cardiac medications of all sorts (specifically, the ones that address an existing problem. Digoxin or foxglove is a classic example) Asthma medications (Salbutamol or ephedra for example) Thyroid hormone replacement Category 4 Comprises a large share of allopathic prescribing in the Western world. These are drugs that may prevent possible future unwanted

health outcomes. Put this way, it sounds like a disparaging comment on what passes for good health “care” today, and that's exactly how it should be taken. When we speak about “preventative medicine,” too often are we referring to the strategy of taking pills to undo conditions that are either self-inflicted, could be alleviated by lifestyle changes, or both. This problem is dealt with in some more detail in section three (The Mindset). The flawed strategy of taking medicines to save us from diseases of aging, wear and tear and lifestyle is not perpetuated just by allopaths, but almost equally by naturopaths. With few exceptions, when one visits a practitioner within the holistic or homeopathic industry, one is just as likely to leave not just with health advice, but with a bag full of expensive substances to ingest regularly. It may be the case that many of these substances are, in fact, statistically proven to do something to reduce the chance of specific bad things happening. Yes, birth control pills prevent pregnancies. Yes, if we manage to lower the blood cholesterol of three hundred or so North Americans, one or two fewer of them will have strokes. But is the most reliable, efficient way to lower cholesterol ingesting a pill (or disgusting wheatgrass smoothies), or by refraining from ingesting processed foodstuffs that come in a box? What these strategies all share in common is that, since they are meant to be preventive, it follows that they must be taken continuously over the long term, ahead of the fact of any ailment, until another strategy becomes available. This is what has made these substances the darling of the allopathic and naturopathic medication industries: what better cash cow than a substance that needs to be bought and taken by the consumer forever in order to work? The logical corollary to this is that, should we find ourselves in a world with destabilized economics, manufacturing or supply chains, or with shifting populations that have bigger problems on their mind, this form of “preventative health care” will turn out to be entirely unsustainable. In any case some of the so-called preventative treatments popular in the current world include: Hypertension medications Cholesterol drugs Osteoporosis drugs

Dementia drugs Cancer-prevention drugs, whether proven (rare) or phony (common, especially in the so-called “alternative health” sphere) Almost all processed vitamins and nutraceuticals Birth control drugs (a controversial topic, as population control is one of the last ditch hopes for humans to achieve a soft landing as we busy ourselves with overrunning the resource base of the planet) Category 5 This last category is added for the sake of completeness. It has very little to do with “health” or “care” and it’s hard to predict how anything that's listed below would fit into a localized, simpler world where humans live in smaller groups. It includes boutique and lifestyle substances, often meant to “treat” conditions that aren’t actually diseases, ailments or injuries. Many of these didn’t exist 50 years ago, and 100 years ago, their corresponding “conditions” weren’t even recognized as health issues at all. In all cases, viable, accessible holistic alternatives exist that are preferable. It is unlikely that any of these things make us feel better, but at least it may be fair to say that some of them make us feel better ABOUT ourselves: Hair loss treatments Stimulants (caffeine, nicotine, cocaine, energy drinks) Chronic insomnia medications Memory and attention boosters Recreational substances (alcohol, marijuana, hallucinogens) Weight gain drugs (amino acid protein powders, anabolic steroids) Weight loss drugs (stimulants, cleansers, nutraceutical snake oils) Cosmetic products Fertility drugs Erectile dysfunction meds Anti-aging products

Buried in the six categories above, one can find many examples of substances that would be difficult to find and impossible to manufacture and sustain in the case of a systemic breakdown. That doesn’t change their place in the hierarchy, and serves as a sobering reminder of how reliant we have become on our complex society. The list has a noticeable allopathic bent, but it is easy to insert in herbal and natural options so long as we are realistic about them. There are natural alternatives that are tested and shown to work, but they are often time-consuming to make and not as effective. Anyone who has ever tried to eat willow bark for a headache will appreciate this. One of my favorite anecdotes regarding this comes from a friend of mine who is an accomplished wilderness trekker, lives on a smallscale sustainable farm and is well versed in forest lore and wild food gathering. He was at a deep-woods educational retreat with several other like-minded fellow enthusiasts a few springs ago. Many were suffering badly from allergies due to the pollen bloom. And despite the de facto abundance of herbs and plants in the middle of the forest, many were taking prescription-grade antihistamines to be able to get by. The bottom line is that some herbals work adequately for prevention and slow treatment of ailments, but in the current day, while we have options, everyone still relies on allopathy when they are badly sick or injured, because it simply works faster and better. That roots and herbs, harvested sustainably from permaculture forests and pounded into poultices, can cure what ails you, is a lovely and romantic notion. But to embrace it we need to temper our expectations and develop a pragmatic sense of how difficult it would be to pull off. Category 0 is being considered first, not because it happens to be the highest in the hierarchy, or the most important thing to massively stock up on for your survivalist bunker, but more because I don’t think we know yet where to put it. It’s more of a thought exercise than a planning activity. It’s a bit like The Fool in the 78-card tarot deck; it might be the beginning or the end when it comes to health care. Let’s pretend for a moment that your daughter had, at a young

age, needed a liver transplant. She would need lifelong access to anti-rejection drugs, at least until we invent something better. If we imagine said daughter in a medium-term problem scenario like getting jailed in a foreign country while traveling, a huge health problem would immediately arise. In this case, it’s not that medications make her illness better; it’s that not having them will make her rapidly worse. Through no fault of her own, her personal health is extremely non-resilient. In an austere future, hers is potentially a worst-case scenario. Contemplation of how to treat Category 0 health problems in John Michael Greer's The Long Descent or James Howard Kunstler's Long Emergency has less to do with laying in supplies and more to do with jumping straight to Section 3 of this essay. The same is true of Category 5. Many of the things we use pharmaceuticals for in the present day are strictly optional, based more on lifestyle and preference than on need. These issues would sort themselves out organically without preparation or intervention. It's just as when you shut down a household’s internet connection for 3 days and the teenagers in the house complain loudly for a few hours, but then find something better to do—and end up better for it. In Cuba, during the “Special Period” of economic upheaval during the 1990s, citizens lost about 10kg each without medical intervention. Cholesterol levels dropped as diets turned largely vegetarian and bicycle use increased. With the medications in Category 4 and below, we rapidly begin to lose efficiency, universality and feasibility. In situations where we can’t test people to determine who is at risk for what, how do we choose who to give the preventative medications to? And are we really going to put aspirin in the water supply to reduce the risk of heart attacks and fluoride in the water to prevent tooth decay? How about walking around and brushing our teeth twice daily? We have become used to a certain level of longevity and good health predicated on the artificial manipulation of our biochemistry. It is unfortunately the case that some people will walk around with dangerously high blood pressure and never get symptoms until they

have a stroke, and no amount of salt reduction and exercise will change that. Category 3 is the most problematic. Diseases treated at this tier are survivable, even without treatment. It’s just not very enjoyable or sustainable over the long term. Yet many of us have become quite cavalier about keeping a good supply of their personal Category 3 meds accessible. Few things bug me as much as someone arriving at my ER or calling my office saying they took the last pill of their critical heart pill that morning. Not doing a personal threat analysis and recognizing holes in your own resiliency plan is a recipe for disaster, medically or otherwise. I would advise that if you or your family happen to wear a diagnosis that requires a medication to stay healthy and functional, you do some thinking ahead and make some preparations to make sure that your access to that medication is somewhat resilient over the short and medium term. It might also be useful to explore alternatives. This is difficult for an untrained person to do alone, but it’s an important step to go through if you believe our society could end up in any situation where specialized medications won’t be available. As a quick thought exercise, let’s pretend that instead of preparing for an unstable future, we are military quartermasters preparing for the theater of war (I’ve been a military medical officer in the past, too). For a professional soldier, coming down with an ailment that requires Category 0 care is grounds for an immediate discharge. If you have epilepsy, you have no business being a combatant. I have a medical student who was rendered a paraplegic after a HALO parachute jump. He correctly chose not to become a “soldier” in a wheelchair behind a desk and instead retrained as a healer. In general, the military does not bring Category 0 meds into the field, except for oxygen, which in that case is only used in Category 1 situations, to save traumas. The bulk of what is stocked is Category 1 and 2 meds and equipment, both at the individual level and at the squad level with the squad medic, and their use is essentially preauthorized. Modern soldiers often carry a small personal supply of field expedient pain meds, etc. Beyond that, the field hospital or

medical inspection room will carry an array of Category 3 items, but they are only to be used on advice of the doctor, who is most useful when staying centrally in place behind the wire, where everyone has access to care according to need. Category 4 items are not relevant in theater of war; if the relevant medical conditions haven’t been eliminated during screening or training, again, that soldier needs to be released from any active combat role. Having a prepared medical toolset is about avoiding having to deal with medical problems in the field, not about stocking up to deal with medical problems in perpetuity. In this context, Category 5 items are not only useless, but even thinking about them is probably a dangerous distraction from the real problems at hand. In summary, when “kitting out” for an austere medical scenario, it is best to concentrate on Categories 1, 2 and 3, in that order, in the short term. This is how first aid kit manifests and lists on governmental preparedness sites like the CDC are generated, even in the present day. It is astounding how often people present to my emergency room under duress, having essentially no supplies in their own homes to take care of basic medical problems like fever, dehydration or pain. Home medical kits have less to do with 72-hour preparedness for a Hurricane Katrina-style event, and more to do with making individuals, families and neighborhoods more resilient and self-reliant. It is more important for families to the type of versatile medicine cabinet in their homes that our great-grandparents used to have, as well as the know-how to use it. And this brings us to... The Skillset Skills can’t be taken away; develop a skill, and it's yours to keep and use for the rest of your life. Of course, it is also important to have the tools handy, and there are many situations where you need the tools to properly apply your skills. But once past that hurdle, it is invariably the skills that save the day. Just as our great-grandparents had a well-stocked medical chest, they also had a level of self-reliance that was simply based on know-how, which we have lost over the last few

generations. I truly wish that there was some accessible, appealing version of what the Boy Scouts and Girl Scouts used to teach years ago, including basic woodland skills, tool handling of all sorts, and basic first aid. More to the point, I wish we lived in an era where people could give themselves the confidence and opportunity to use those skills more, even in the medical realm. A friend and patient of mine recently came to my office with his daughter, who had some nasty skin boils on the edges of her fingernails from chewing them. It was a simple issue getting them lanced and resolved, but the kicker is this: the family owns sheep, goats, a llama, 2 dogs and lives 20 miles from town. It was a long drive to get to me, and I’m pretty sure he has had to do the exact same mini-surgery on his livestock any number of times without calling a vet. In Canada, though, vets are expensive and allopathic MDs and hospitals are free (paid for through mandatory taxes). Yes, your daughter is not a goat, and the consequences are different, but I told him that I wouldn’t have faulted him for trying. Furthermore, I would have happily and non-judgmentally cleaned up his mess afterwards had he done an inadequate job of it. In general, even now, I consider every citizen the first line of medical care and see myself as simply a specialist or supervising subcontractor. Yet the number of times I meet people who don’t know how to bandage a wound or convince a sick child to drink fluids is quite astounding. Health consists of two broad arms. Firstly, there’s the big issue of long-term, preventative health care. A health care system should provide the means to stay healthy in the first place. The preventative aspects of health care should not be centralized, but should be distributed, as already mentioned. Many of these core concepts are so simple and so taken for granted today that we don’t even recognize them as “health care” per se, while as little as 200 years ago they were considered revolutionary. Since the stakes were higher back then, and the risks of engaging the actual treatment arm of medicine much greater, people paid far more respect and attention to never getting sick. There was an appropriately morbid fear of contagion. There was a recognition that risky activities are,

well, risky. And there was more respect for the limits of human physiology, as life-saving drugs and surgeries either did not exist or were terribly dangerous. Both back in history, as well as in an unstable future, naturopathy, holistic health care and simply keeping the body in good shape so that it can heal itself are all excellent approaches. I’m an allopath by training, but when I do refer to my naturopath colleagues, it’s generally for an item on the list below. At first glance, these may not even look like health care issues per se, but, trust me —they are. Any attempt to engage the second arm of health care, the treatment arm, is fraught with problems if these issues aren’t also put in order. Knowing when to use which system is the tricky part. Even currently, a lot of trouble can be had by applying the wrong arm of the health care system to a poorly diagnosed problem. There is a perceived rift between the allopathic and naturopathic styles of medicine available today, but it is greatly exaggerated. When things go wrong, what it boils down to is using a hammer when you should have used a screwdriver, or vice versa; the tools themselves are fine. But diagnostics, though difficult to learn, is the common thread between the two styles. It is too much to ask to teach the layperson proper allopathic diagnostic skills, but everyone can be taught to self-triage. One rule of thumb is to ask yourself if something went wrong with your health recently, or if it is something that wasn't right in the first place. If your organism has never really been right, and is spiraling down slowly, it’s probably time to take a holistic approach to your health before sounding the alarm. When questioning how your health maintenance strategy is shaping up, here are some points to consider. They are ordered roughly by their priority. Hydration Nutrition Sanitation and hygiene Shelter and security

Sleep and rest Exercise, fitness and avoidance of injury Healthy interpersonal interactions Meaningful work and remuneration Recreation This list can be taken as another form of threat analysis, but it can also be used at a time of relative health and perceived stability, to look for areas to improve. We can all do better on this list somewhere. Most of us tend to aim at items too low on the list, and have a tendency to act multiple times on the same items while ignoring the rest. As with all things holistic, we should strive for balance and compensate for our weaknesses rather than play to our existing strengths. I don’t intend to lead people towards learning how to improve their “skills” in providing these things for themselves and others; plenty has been written on these subjects already. I don’t have to talk to any of my Mennonite farmer patients about getting proper sleep—it just happens. I don’t have to remind bicycle mechanics to engage in meaningful work. And, when traveling in oppressively hot, mosquito-infested and tsunami-torn Sri Lanka, I didn’t busy myself with cautioning schoolchildren that they should drink enough water. As detailed in the excellent documentary, The Power Of Community, enforced simplicity and a back-to-basics rebuild of a society has a decent chance of taking care of many preventative health care problems. For example, if 80% of what we eat is locally grown vegetables—not because that’s what we’re choosing, but that’s because all there is to be had—cholesterol, diabetes, obesity and heart disease rates will fall on their own, no matter what else we do. I am reasonably satisfied that my part-time role as a family doctor would be greatly diminished in that setting, and I have no problem with that. I therefore won’t spend any of my time teaching what a simplified life will teach you on its own. But if your health was good right up until a week ago, and if you know you’ve been ticking off the boxes on the list above successfully, self-triage probably dictates that either it's time to pull

out your own set of treatment skills, or else you should see someone. My expertise and interest is in this secondary arm of the health care system, the diagnosis and treatment arm. Ideally, I would see only people who had applied all of the core preventative concepts, but something went wrong due to bad luck. That’s certainly not the case now, and it’s often the case that the prevention issues have been willfully ignored, but I’ve learned to serenely accept that and carry on with my work. Even in a simplified but stable future there can be hitches on the prevention side that still need fixing after the fact. To be sure, much of the underdeveloped world will always struggle with a lack of clean, accessible water, and people there will continue to get sick as a result and require salvage treatment. But even in a utopia people can get hurt or sick. That’s where diagnosis and treatment become necessary. The secondary health care system is a means to pull people’s fat out of the fire once they’re in that sort of trouble. And in these circumstances, allopath rules. From the number of alternative health practitioners who have come to me with broken bones, bad bacterial infections or surgical problems, I think that this statement is uncontroversial. This level of care probably needs to be centralized, because developing this skill set requires a lot of time and devotion. Just as not everyone knows how to use precision machine tools, not everyone knows how to use a scalpel. Scalpels (metaphorical or otherwise) are sharp and precise, but are known to slip and cut the wrong things. This inherent risk means that the moment we engage secondary care, it must come with a tacit understanding that the health situation has by definition become imperfect, and then it follows that any outcomes, regardless of the skillset being employed, stand to be imperfect as well. Revisiting the grim scenario of the car crash I related earlier: in post hoc analysis of the case, I think there was a slim chance that I could have resuscitated the young boy with the broken femur even without any more equipment than what I had in my car—if the two bystander

fellows came with an extended skillset. If, for instance, one of them had been a military field medic, I could have easily relegated the care of the delivery van driver to him once I had done my assessment, and the other could have assisted me in gaining access to the cabin of the destroyed sedan to tourniquet off the boy’s leg. Not easy, but possible, and even then, we might not have won. In the end, battlefield triage protocols had to rule the day and, working with the skills and tools we had, it was paramount to try to save the savable one first, and I don’t regret that decision at all. But more skills would have helped. Having seen how long it took for the Jaws of Life and six firemen to get that car open fully, I’m unconvinced that more tools would have been necessary, which is why I still don’t, to this day, carry advanced, ER-grade medical gear in my car. I find that obsession with getting better stuff (quick and cheap in our current era) sometimes becomes a dangerous distraction from learning things (a slow, arduous, ongoing process). In the end, the only lesson I left the two helpers with was this: next time an emergency comes up, get on the phone first. This was something they had been too shell-shocked to remember to do. Both now and in the future, the most important bit of knowledge, in any medical emergency, is to know to call a friend. For an actual in-depth discussion of health care related skills, a good start is the local Red Cross, or a first responder course. I prefer a ground-up approach; I don’t want people learning how to perform a tracheotomy if they don’t know how a heal a diaper rash. In all, I think that there are rapidly diminishing returns for ultra-advanced skills like treating bullet wounds and doing person-to-person blood transfusions. Despite what Hollywood and sensationalist books like Patriots: The Coming Collapse would have you believe, there is a truth that is well-hidden from modern day citizens: people get injured all the time, and when the injuries are severe, they frequently die despite best efforts. Many courses focus a little too much on cardiac care and trauma care in one-off, emergency scenarios. This is fine—to a point: as my car crash anecdote illustrates, these are important skills to have.

However, they need to be tempered with a realistic expectation of the outcomes. Even with unfettered access to the best tertiary care, the rates of recovery from cardiac arrest requiring CPR are extremely low. Over the course of my career, CPR alone has never saved a single person in the field if they didn’t get transported to a hospital. It is a cherished part of our current skillset and is overtaught, but in most scenarios it won't be that important. Rather, we need to envision which medical skills are going to see more application and therefore have more chances of positively impacting our future health. There are currently very few public courses on these sorts of medical skills: nutrition, sanitation, and care for basic wounds and infections. However, there are plenty of resources for wilderness and survival medicine scenarios, or better yet, for use in the underdeveloped world, and we need to look no further. Some excellent examples of this are available from the World Health Organization, Doctors Without Borders, and the Hesperian Foundation (hesperian.org). The book Where There Is No Doctor is a good treatment on the subject. There is also an excellent Australian publication specifically detailing the subject of “austere medicine,” which can be downloaded from http://www.aussurvivalist.com. I consider both of these to be excellent resources, and their focus on the skills required for mundane conditions (with less emphasis on trauma resulting from conflict) is a much more thoughtful and appropriate way to approach to creating a “distributed health care network.” Likewise, there are many online blogs and websites that go into some depth regarding medical skills, including http://www.doomandbloom.net and http://www.survivaliq.com. But no one site is perfect. It can be difficult for the layperson to evaluate the quality of medical information of any sort on the internet, doubly so if the intent is to actively teach skills rather than simply provide information. One general rule of thumb, which I keep coming back to, is the Grandmother Rule: If a site is advocating for a

skill that common folk exercised for themselves three generations ago, be it diagnosing or treating an illness, then learning it for yourself today is probably appropriate. Conversely, if it is something that has never been broadly adopted at any time during civilized history (be it home-brewing penicillin in your cellar or treating tuberculosis using colloidal silver), then it’s probably not worth your time. History is an inherent form of natural selection, and has a great way of sorting out truth from hogwash. Also beware of theorizing and anecdotes—cancer “cures” via tropical fruit ingestion; immune system cleanses. Most of these exist on the internet as means to get you to buy something. When re-skilling towards more resilient health care, most of what you need should be free. And, of course, if a skill seems too good to be true (kitchen table surgical skills come to mind), then, again, it’s probably worth skipping and focusing on the basics. Learn to stanch nosebleeds; don’t worry about gunshot wounds. And if the source you’re getting your info from advocates carrying Israeli Battle Dressings (and will sell them to you, no less) but doesn’t have a lengthy article on the management of pediatric diarrhea (which is an ever-present killer in the developing world), that source probably has its priorities backwards. Appropriate medical skills are seldom sexy. If they seem to be, beware: you may be reading a medicalized form of disaster porn. Especially if it comes with an online store in the sidebar. Taking a first pass at listing what the contents of a medical kit should be is fine, but I would ignore creating a medical version of a bugout bag altogether, unless you are concerned that there is a local disaster coming and you feel that you can outrun it by land or by sea. As a medical professional, I don’t go through my workdays toting my tools on my back; non-professionals should, in my ideal world, carry around all the skills to raise a family and keep it healthy, but they have no more business carrying around medical tools and supplies than I do carrying around a pipe wrench just in case someone might unexpectedly have a plumbing emergency. If today people come to you—for medical care or plumbing emergencies—then sure, keep your advanced skills sharp (but you probably already do, through regular use). But if today you go to someone else to get care—the

more common scenario—it behooves you to get some basic skills starting from the ground up. In doing so, you increase your personal resiliency, increase the skill redundancy in your family and your community, and decrease the chances of not being able to cope if there’s any kind of a disruption in the system we currently have in place. As with my friend whose daughter had an infected finger, maybe he wouldn’t have needed to trek out to see me unless draining it at home didn’t work. A final thought on medical skillsets: all skills have appropriate limits. I don’t expect everyone to be a master pipefitter, and I don’t expect everyone to use informal training to gain the skills of a trauma surgeon. We do all need to be more versatile than we are, but ultimately, specialization is not just for insects. There is no historical precedent for entire tribes of humans with each member possessing every skill, health-related or otherwise. When we look back on recent events—the Soviet collapse, Cuba, Argentina, etc.—there will always be health problems requiring access to a specialist, and there will always be someone around to help out if you ask. In a way, then, one of the first items in your medical toolbox is your community, and the quintessential meta-skill with regard to staying healthy is nurturing that community and knowing when to call on it for help. The Mindset The previous two sections were thought exercises about putting together the toolset and skillset to be able to provide resilient, realistic health care in a distributed fashion. But it won't do us much good if our expectations remain rooted in our successes of yesterday. Simply put, I do not hold the romantic notion that a simpler life—tribal, nomadic, isolated or very crowded—can come with better health, at least not as it is currently measured. Lives will be shorter; injuries and illnesses more likely to be fatal. The suffering from even a minor illness will be greater and more prolonged. That doesn’t necessarily mean that we won’t be happy; one of the cheeriest kids I met in 2012 was a skinny Sri Lankan kid crippled by vaccine-preventable polio. In fact, we may end up tougher, more

resilient and more introspective about our lives. These are things that modern health care hasn’t done a great job of building up. Instead, we’ve been given the luxury—and the curse—of not having to worry about our own mortality. This final section addresses some of my thoughts on how to re-synthesize our outlook on health care, should we have to return to an era where our own health once again becomes our own concern. The 1949 novel Earth Abides presents a thought-provoking and interesting picture of health care across the span of a generation in a declining world. Unlike Hollywood movies, where recovery from illness and injury is guaranteed for the protagonist, characters in the novel get sick, get hurt and decline into dementia. Two characters die suddenly without any definitive explanation; the others wonder if it was food poisoning, but the author doesn’t provide an artificially neat diagnosis, and the story goes on. It’s an enjoyable read if you are looking for a departure from the current crop of apocalypse porn. For a realistic view of simplified, tribal living, and its effect on health, it does a pretty good job. Fifteen years ago, I read an article on the subject of finance with the thesis that “In the future, the only constant is change.” Trite, yes, but it certainly rings true today when it comes to climate, economics and politics. Elsewhere, there have been discussions of “durable disorder” as a way to adapt to constant change. Durable disorder refers to a meta-adaptation where an organism adapts to be exactly that—more adaptable. It’s important to be psychologically at ease with the adaptations that will inevitably have to happen. It is not enough to change and be ever-changeable while yearning for things past. This is true for the individual as much as for society as a whole. The macrocosm of health care which we currently refer to as the Health Care System—comprised of hospitals, doctors, nurses, naturopaths, pharmaceutical companies, massage therapists, computer databanks and the person who safely trims the toenails of old, frail, diabetic people who are too weak to reach their own feet. That system is overtaxed and expensive and complex and

specialized and quite effective at addressing even the most esoteric of medical problems. For today. But even this modern Health Care System is still ruled by the Law of Eternal Change. Even if it weren’t overtaxed and unaffordable in the long-term. Even if the needs (as we currently perceive them) are rapidly outstripping our means, due to an aging population. This system has been allowed to become more complex than ever before. But, as Jared Diamond explained in Collapse and Joseph Tainter explained in The Collapse of Complex Societies, complex systems are resilient only up to a point, and when they fail, as they always do, they fail big—in proportion to their size and complexity. Our mindset must be prepared for this and able to cope when it does. The last two sections —Toolsets and Skillets—will help arm those who will navigate their way through the coming changes with, admittedly, imperfect approximations of what the Health Care System currently provides. But those who survive and perhaps build the next iteration of the health care system will also be armed with a Mindset that includes some pragmatism and serenity that come from the notion that things changed because they always do… because they have to. We’ve learned to take for granted an array of health benefits which will be hard to give up: Low infant and maternal mortality Emergency medicine for recovering from trauma High expected lifetimes, often into the 80s Easy recovery from infections Availability of surgeries to repair accidental injuries When it comes to an austere and unstable future, none of these are guaranteed. A shortcut to finding out what that's like is to talk to people who have lived in disadvantaged parts of the world. We once hosted an exchange student from rural Tanzania, who was flabbergasted the day we were driving to go see a movie and the entire roadway moved aside and stopped to allow an ambulance to

pass by. He had no idea that there could exist a free service for transporting sick people to a hospital, available with just a phone call. At the age of 20, educated in English since seven, the word “ambulance” wasn’t even in his vocabulary! As it passed by, he asked if the passenger might typically be a prominent businessman or a politician being brought to a scheduled medical appointment. He was even more shocked when we explained that it was more likely that the patient was relatively poor. One day at the hospital, a Jordanian immigrant family on vacation brought in their son, escorted by police rescuers. He had been swimming and was run over by a speedboat, which badly lacerated his abdomen. They were under the mistaken impression that the police were involved because it was the child’s fault for swimming near boats, and kept apologizing. They also seemed to think (and almost surreally, quietly accept), that we would simply administer morphine so that the child could die without pain. When I told them that the required surgery would take about three hours and that afterwards a helicopter transfer to the pediatrics center back in their home city of Toronto would be a good idea, they were, again, flabbergasted. Once the shock over their child’s imminent survival had passed, they began panicking about payment. There was none. I suggested that they take some strong tea and go to a quiet room to relax. Here we have: ambulances, a society that is trained to make way for them, life-saving surgery for all comers— these are all hallmarks of a successful health care system that is able to pull off miracles—by virtue of its complexity. But ask a Masai goat-herder or Middle Eastern war refugee, and you will soon find out that the Canadian level of health care is unimaginably more expensive than most of the world can afford. In Tanzania, there are limousines for the rich, but no ambulances for the poor. And in Jordan… well… that family had two other daughters and a newborn son. In such places, the people are mentally prepared for the outcomes of bad health and are unfamiliar with the notion that a complex health care system might bail them out. If we

imagine ourselves plunged into a similar setting, it behooves us to prepare our mindset along similar lines. When traveling, my mental trick to enjoying myself is the mantra: Prepare More; Expect Less. In a sense, that’s what we’ll all be doing as we move forward toward our disrupted future—traveling. Things get even more tricky on a personal level. It's easy to be philosophical when faced with the inevitability of change bigger than ourselves. Yes, we will run out of cheap energy some day. I will turn off the lights when I leave a room and do my best to carry on. It is much more challenging to deal with changes when they affect us personally. I’m not referring just to the indignation and grief— reactions we are all going to have the day we can’t personally find or afford a doctor. I’m referring also to the resultant effect that this will cumulatively have on our health and longevity. I’ve lost count of the number of times I have spoken to patients in dire medical straits (or worse yet, their unprepared families) who seem to have no understanding that Life is predicated on two absolutes, Birth and Death, and that you don’t get one without the other. The mental block is most surprising to me when the illness is chronic. I can easily empathize with parents who lose a child to a highway accident, and don’t ever bring up the (true, but inappropriate) observation that our lives are peppered with inevitable, lowfrequency, high-severity events. However, I remain perplexed when I have a kidney-failure patient on thrice weekly dialysis with heart failure, with one amputated leg and on home oxygen, continuing to smoke, who, when he starts to spiral down the drain, says to me, “You have to fix me, doc! I was fine yesterday!” It is worse yet if the person falls into a coma and their “seagull child” (who flies into town from their home on the coast, squawking at everyone and shitting on everything) demands that I, “Do everything! I didn’t get a chance to talk to him yet to find out what he wants!” What he wants? What does he want? Do you know? Do you even know what you want? And if you did, would knowing that give you the ultimate power to change things?

My MD training skimped on mind-reading skills. I did do some biology, anatomy and biochemistry, though. And the prerequisites to medical school included physics, where I learned about the second law of thermodynamics. Energy, molecules, organs and organisms don’t really desire anything, but they do behave in predictable ways. If you want to anthropomorphize it, then you can say that they want to behave in certain ways. And at the end of it, bodies want to fail and we die, whether slowly or quickly. I’ve got pretty good skills at rebalancing things temporarily, but the M in MD stands for medical, not magician. I can, if asked, build a tall, fancy-looking house of cards. But the higher I build it, the better the chance that any passing breeze or grabby two-year-old can knock it down. It is sometimes said that past a certain point when you’re climbing Mount Everest, your body is busy dying and the race is just to get to the top and get back down before it finishes the job. There can come a point of literal no-return, where, if the weather changes, or equipment fails, or you can’t descend fast enough, a return to base camp becomes impossible. Yet summit attempts continue despite a tacit understanding that some people are never coming back. I’m not suggesting that climbing tall mountains is appropriate for everyone, but in a sense we all do anyway, and the mindset when thinking about our own health should be analogous. There’s no point worrying about the fact that we can’t walk backwards in time, as a society or personally. It's enough to keep gazing ahead while choosing our footsteps with care, all the while recognizing that we’re climbing the only mountain we’ll ever climb, and that the air is getting thinner. The Emergency Room is a good setting for remembering how health care used to be done. Because we have to treat all comers (at least in those countries where payment is not an issue) we get a good cross-section of where needs lie. Certainly, this kind of free system does allow for a certain number of trivial problems to walk in through the doors. This can be because some patients either didn’t have the know-how (most common, and fixable with time and effort) or couldn’t be bothered to fix the problem for themselves.

But we also see patients in the worst health situations of their lives, and it is sobering to see how quickly and ferociously this affects them. It’s what I call “common denominator medicine,” and in my career I have noted that at the end of it all, everyone—celebrities, runaway teens, politicians and criminals in shackles—suffer and die the same way, by simple, common pathways, regardless of their riches, and, sometimes, despite their previous state of health. Yes, those in poor existing health spiral downwards more quickly and more often. But the general population is shielded from the notion that even healthy people can get serious and sometimes unrecoverable injuries and illnesses. It is these people that the current health care system excels at treating and supporting, giving us the false impression that the healthy are entitled to stay that way no matter what happens. Statistically speaking, that may be true for the population as a whole, but for the individual—well, at a certain point we’re still all just rolling the dice. Part of the appropriate mindset when it comes to our own health must be that it must be cherished, nurtured and enjoyed to a degree that we tend to ignore. One of the hidden benefits of a simpler society—where we won’t have artificial, allopathic adjuncts to make it possible to live on despite serious disease—is that we may all grow to live better and happier lives during the shorter period when we are well. In the ER, our stock in trade is Big Events, but anyone who survives in a career does so by recognizing that we don’t always win, and so we celebrate when we do. In the ER, it is understood that something unexpected and potentially bad is bound to happen before the day is out. A well-run emergency department is a good approximation of durable disorder: everything is changing, we knew ahead of time that it would do so, the changes has serious consequences, we’ve prepared as best we can and we’re going to try to get through it together. It not our job to shut the doors and ignore the problems as they pile up. We might not fix everything, but we have to try. By the time an ER is needed (and something like emergency medical services will always be needed), we need to be mentally past the notion of prevention and shouldn’t expend emotional energy grieving over its failure. I don’t tell my heart attack

victims that they shouldn’t have been smoking. That ship has sailed. All of this, summed together, represents a decent mindset as our world changes. Final thoughts I suggest people orient their minds more towards living in small communities and envision how their health needs can be met in that setting. There is no historical precedent for “bugging out” in a solitary, lone-wolf fashion. Humans are apes. Our biologically favored tribe-size might number in the low hundreds. The Road by Cormac McCarthy is an engaging piece of fiction, but its message has to do with how we succeed or fail at relationships, not with surviving and thriving. I would remind people to cherish community and the help of others, as they are the cornerstone of a resilient health care system. Other people are the best, most effective tool in your first aid kit. In Emergency Medicine terms, everyone knows (I hope) that the proper response to profuse bleeding is constant, direct pressure. You may know that but if you are alone it’s just that sometimes, you just… can’t… reach. I’ve sutured myself up twice (once without anesthetic) —both times out of necessity. I’m an excellent surgeon normally. But both times, the result was suboptimal and I would have done better with the help of my seven-year-old daughter. We need to get away from some of the taboos and hang-ups of our current medical model. One of them is the prohibition against treating people you know socially, friends and family. In a small town like mine, this is already difficult. In an even smaller community, it would be impossible. I would propose that it is undesirable in the first place. Some of the proudest care I’ve ever given, I’ve given to people close to me. I’ve laid on the bed with my dying, cancer-ridden neighbor, eating pizza and drinking wine while we told jokes, and, hours later, I was injecting him with morphine and checking to see if he was breathing. I’ve set the bones of my housekeeper in her own kitchen. And I’ve counselled my babysitter after she was raped by a co-worker. We tell ourselves the lie that it’s impossible to impartially

provide care to those we love. That’s not true. It can be difficult, but anonymity and distance can be dangerous too. And if we find ourselves in a situation where we are the only ones who can provide health care to the ones we love, then we’ve got to come to terms with that, and do it well. Take care of yourself first. This is known as the “airline oxygen mask doctrine”: In case of a cabin depressurization, put your own mask on first, then help those beside you. This seems counter-intuitive to prospective lay healers, but it holds true. If everyone adopted this policy, we would all be more self-reliant and resilient and more able to pass on a surplus of caring. In many places, healers have gotten stuck on the idea of financial remuneration. This is most prevalent in places where doctors already occupy the higher echelons of salary, where pay is poorly linked to any perception of being paid enough. Past a certain point, pay is not linked to happiness. I always teach my medical students that their remuneration (once their loans are paid off and their house is paid for) is forever afterwards measured in thank-you notes and healthy children walking away on their own two legs. To those reading this who are already healers by profession, I would suggest they reexamine any thought that they need more money. Start the way you wish to continue. If you entertain notions that your life would be better without the unnecessary intervention of nasty, expensive, side-effect-riddled allopathic medical care (as an allopath, I believe this to be the case), then you’d better start putting your money where your mouth is. There is no point thinking that you’ll live peacefully in a smaller, tighter-knit group of friends with whom you will share home-grown organic veggies if you don’t start practicing that now. Please don’t be the futurist or survivalist based solely on an excellent blog. To those who have become psychologically bleak from discussions of TEOTWAWKI (I've been there myself), I would say this. There is no historical precedent for the end of the entire world… but our local environs and own personal world—sure, that ends all the time, if

change can be considered an end of one thing and the beginning of another. This applies even when faced with the deaths of those around us, or even or own. While we still have a chance, it would be good to take the opportunity to listen and learn from survivors of The Holocaust, the Vietnam War, or more recent collapses, which turned out, in fact, to simply be re-toolings of society. Since those who tell these stories are, by definition, survivors, we can take away some serenity from their experiences and apply it to our own preparations for changes to come. We prepare for good births and good lives, but it takes a lot of doing to get my patients to prepare for a good death. It’s good to have a viable exit strategy, both for life itself, as well as the more interesting short-term concern of how our world stands to change in the coming years.

The Sea Gypsies: A Hidden Community that Abides Capt. Ray Jason On the one hand it's a community that almost doesn't exist, but on the other it might be the ultimate community. That’s because it is nearly invisible—a useful feature in these troubled and dangerous times. And yet it is right there if you know where to look—hiding in plain sight. Its origins were autonomous and spontaneous. Unlike many subcultures, it was not founded by a charismatic leader, nor was forming it the survival strategy of an ostracized sect. It has no bylaws or regimentation or commandments. It is organically bound together by shared interests and the spirit of helpfulness. There seems to be only one rule: “Don’t be a jerk!” Violate this rule, and you will be shunned and possibly scorned. It is most commonly called the “cruising community,” but I like to call these cruisers “sea gypsies.” There are tens of thousands of people who live aboard ocean-going sailboats, scattered across the wide waters all around the planet. Their boats can be found anchored in picturesque harbors, or tied to a marina dock, or tethered to a yacht club mooring. Although many have shiny, expensive sailboats, people who can only afford modest, inexpensive, fixer-upper boats find that there are plenty of them available. It is this extraordinary openness that makes it so rare amongst subcultures: anyone can join! Just arrive somewhere aboard your boat, and you will be welcomed by the sailors who are already there. And if you become a genuine contributor to the well-being of the community, you will not just be accepted—you will be cherished! ***

The cruising community is a relatively young subculture. Its roots can be traced to the invention of the mass-produced fiberglass sailboat. Unlike automobiles, ocean-capable sailing vessels are not built on assembly lines, and here “mass production” might refer to as few as 20 to 50 hulls made from a particular mold in a given year. By the early 1970s there were many boatbuilders to choose from, their rising sales figures greatly aided by the growing popularity of sailing magazines. These publications, which had previously emphasized racing, began to also sing the praises of long-distance live-aboard cruising. During its first few decades, what attracted people to the cruising life was exotic travel and wild adventure. But in recent years many people have been drawn to this footloose way of living because they are fed up with the daily conditions of life in the so-called “real world.” They have become sea-going expatriates. Unlike the more common landlubber-expat, who moves to a home or an apartment in another country and then generally stays put, the cruiser can easily abandon a location if conditions there turn out to be less then ideal. This is an enormous advantage for anyone with a low tolerance for governmental over-reach, police state bullying and Orwellian surveillance. I describe the phenomenon of the cruising community not as a disinterested theoretical observer, but a practitioner and a genuine insider. I have lived aboard my boat full-time since 1992 and have accumulated about 30,000 sea miles—most of them single-handed (sailing without a crew). I have paid close attention during my sea wanderings, and my observations have convinced me that if conditions throughout the world deteriorate significantly, the cruising community has an excellent chance of being able to survive them. The mobility of the sea gypsies will provide excellent resilience if societal disintegration picks up its pace. If there are minor or slowmoving upheavals, a sailing family needs only to sail off to a place that is not wracked with problems. And if there is a much more significant, global meltdown, the ocean-going sailboat is close to an ideal survival platform.

Because vessels that cross oceans have to be completely selfreliant, they are equipped with highly advanced survival systems. Solar panels and wind generators provide the vast majority of electrical needs, while their diesel engines with high-output alternators provide an excellent back-up power source should the sun god and the wind god ever decide to go on vacation at the same time. Most deep water sailboats have large freshwater tanks, designed to provide enough water for long passages. The tanks are often augmented with a reverse osmosis water-maker that converts seawater into drinkable fresh water. In most cases these devices are so efficient that the crew can enjoy freshwater showers even on lengthy voyages. Another, simpler and much more affordable option is to devise a rain catchment system. I have made open-water passages of up to 30 days and have never suffered any water deprivation. Boats carry cargo, and even medium-sized sailboats have significant cargo capacity, making it easy to carry aboard half a year’s worth of food, with plenty of room left over for spare parts, tools and… how should I phrase this?… security enhancers. But besides these basic necessities, a sailboat can also provide plenty of creature comforts, as well as entertainment in the form of books, films and music. Communications equipment aboard ocean sailboats is usually far more advanced, and more autonomous, than what the typical landlubber uses. Of course, a sailor can still have cell phone service in whatever country he is visiting, and some form of internet access is now widely available in most parts of the world. But what sets the cruising fleet apart are their two main off-the-grid radio resources. For short distances we use VHF radios, while for long distances we use single-sideband or HAM shortwave radios. These are far less vulnerable to grid failure, governmental shutdown or surveillance. ***

Now that I have given you a cocktail napkin sketch of some of the best aspects of an ocean-ready sailboat as far as surviving various worst case scenarios, let's discuss the stealth aspect. The sea gypsy community does not pose much of a threat to landbased communities, making the NIMBY factor far less problematic. If a town has to choose between a 200-acre commune and a few dozen picturesque sailboats anchored off the shoreline, you can easily guess which is more likely to meet resistance. A more serious aspect of stealth is more accurately called “ability to vanish.” To paraphrase an old cliché: “When the going gets tough, the tough go sailing!” If there are empty grocery shelves, no electricity, rioting in the streets and police morphing into goons, being able to sail over the horizon is a comfortable strategic position. And once you are over the horizon, you might as well not exist: finding you would involve search planes flying grid patterns for days while a team on land scans satellite images. *** Allow me to entertain you with some of the more likely apocalyptic scenarios and demonstrate how a well-equipped sailboat is arguably the best approach to dealing with them. Pandemic! The contagion spreads like wildfire wherever large masses of people are jammed closely together, while sailors out on the ocean enjoy a disease-free environment. Electric grid failure! A sailboat is a floating power plant with a wind generator, solar panels and a diesel engine for back-up. Nuclear war! The missiles target population centers and military installations, not the sea. Plus much of a boat’s surface is under water, with the ocean acting like a giant radiation sponge, so the nuclear fallout risks are much more easily handled. Famine! A typical sailboat can easily carry a half a year’s supply of food on board, with the ocean providing fish, shellfish and seaweed.

Flood! Needless to say, this is hardly a concern if your house normally floats up and down on the tide. Tsunami! If you get enough warning and sail out to deep water, you are still fine. Since I am already dealing with life-threatening scenarios, please allow me to elaborate on this a bit more. If we assume that there are 10,000 cruising sailboats scattered around the world, how many of those are inhabited by true collapse-ready sea gypsies? My guess is that they number around 1,000 vessels: this is the small fraction of cruisers who have actually examined the possibility of societal disintegration and have made the appropriate plans. My vision is that this sea gypsy tribe would spontaneously coalesce into small bands of sea-going kindred spirits. For example, of the 100 sailboats in La Paz, Mexico at this moment, there are probably ten that have been prepared to serve as worst-case scenario escape pods. These people need to find each other, get together and finetune their plans. Then, if things turn ugly, they can sail out to a prearranged rendezvous point away from the madness on land and wait it out, while monitoring the situation using their long-range radios. If the emergency resolves itself, those boats would return to La Paz, drink cervezas and yarn about their time bobbing around out of harm’s way. But if events turn catastrophic, these sea gypsies, thanks to their ability to hide from the chaos on land, may be one of the few communities that manages to abide. As one of the few remnant groups, they would suddenly have the immense responsibility of attempting to rekindle some semblance of civilization, shouldering an immense burden of retaining the best of what humanity had achieved. Civilization has produced both magnificent benefits and grotesque horrors. How do you preserve Mozart but not the mushroom cloud? ***

If I were a sea gypsy elder (which I sort of am) giving my tribe suggestions on how we could embrace the best of civilization and discard the worst, these would be my recommendations: Be cognizant of humanity’s place in the scheme of things. We have tried to elevate ourselves above all the other creatures on our planet, claiming that we are human beings—but we are actually just human animals. We have further deceived ourselves by claiming that life is a pyramid, and that we humans inhabit the apex and must therefore dominate and control everything else—including all the other creatures, the land, the water and the air. We must return to the understanding that our hunter-gatherer ancestors clearly had: that all of life is a web. Damage one strand, and you damage the whole! There must be limits to growth. Only a buffoon can believe that infinite growth, which requires infinite resource extraction, is possible on a finite planet. Beyond the absurdity of this proposition, there are the atrocities it helps rationalize. The few dozen indigenous tribes still surviving on our blighted, techno-industrial planet view the rivers, forests and mountains as their living neighbors. They don’t see them as commodities—rivers as sources of hydro-electric power, forests as board-feet or mountains as open-pit mines. Gaia should be enjoyed, cherished and protected—not destroyed! Economic growth is always a negative-sum game: every step of the way, we destroy more than we create! A surplus of technology cannot be fixed by adding more technology. The Luddites in England and the last Samurai in Japan were correct: the seductive benefits of techno-industrial civilization would be shortlived. But the horrors that they spawned will last forever. The 443 nuclear reactors in the world are a testament to this: it takes about 10 years to decommission each one. What will happen if the power grid goes down swiftly and all those cooling ponds dry up? We should abandon our addiction to “the latest gadget” and embrace low or appropriate technology. A basic ocean-capable sailboat is a great example of such technology. It is a bridge across time to the old ways. The path to the future leads to the past!

Immersion in nature is a necessity and not a luxury. None of the 8090 indigenous tribes still living in their native habitats suffer from mental illness, requiring psychiatric intervention or gobbling psychoactive drugs. Our Paleolithic operating system is designed for living in the wild, not in paved-over concrete jungles. I spend long periods alone with the creatures of the sea and the sky, and to me this is not a vacation—it is a vital psychic centering. Come home to the wild! Hierarchical societies are horrible societies. Tribal societies are small bands where everyone knows each other and they work together for the good of the community. There are no rulers and ruled, no rich and poor, no inequality between the sexes and no chiefs living in splendor while the rest live in squalor. Hierarchical societies suffer from all of those injustices. And despite the propaganda, those who rise to power in hierarchies are not the “best and the brightest”—they are the most ambitious, ruthless and despicable. The “dominant” cultures they create spew death and destruction across the planet. Treat hierarchy as a disease! Capitalism must capsize. A system that places profits ahead of both people and the planet is a disaster for both. An economic model that worships greed cannot possibly serve the common interest or the greater good. The tribal model has provided fulfilling lives for 2 million years without destroying the environment. Shouldn’t we try to dismantle the capitalist system, which only enriches a tiny elite, and in just a couple of centuries has gone a long way toward destroying the ecosystem on which we depend for our very survival? Stop feeding the beast! Churches and states stay buried in the ashes. The most obscene atrocities in human history have been committed in the name of god and/or country. There is nothing wrong with striving for spiritual joy, but institutions that demonize other groups and command their annihilation should never be allowed to reemerge. Humanity had existed contentedly for 2 million years without them, but in just

10,000 years since their arrival we have massacred hundreds of millions of people. Leave them buried for all of eternity! *** Such enormous changes must seem radical to most people. But keep in mind: these proposals are designed for a future scenario where there has been a cataclysmic societal collapse and the survivors are attempting to rebuild a civilization that is a bit more enlightened than our current version. My intention with this article is not to alarm you, but to describe a potentially successful approach to developing a worst-case scenario survival strategy. To restate this a bit more poetically, my true, heart of hearts desire is that this little essay will launch a fleet of a thousand Thoreaus. [Please visit theseagypsyphilosopher.blogspot.com to find out more.]

Lifeboats: A Memoir Albert Bates During the early days of The Farm, 1971-1973, we learned a number of lessons that will be useful again now that a rapid petrocollapse scenario is likely to come to pass. The Farm spiritual community emerged from an 80-bus caravan of 320 Haight-Ashbury refugees fleeing hard drugs, exploitation and counterculture tourism. After a year on the road the gypsy vagabonds pooled inheritances and purchased 1050 acres (450 hectares) of land 80 miles (130 km) from Nashville. It was US$70 per acre. The Farm grew to a standing population of well over 1000, with 20 satellite centers, then, in the early 1980s, declined and decollectivized, bringing its population to under 200. Since then it has experienced something of a renaissance, finding new popularity amongst permaculturists, ecovillagers, and roving students. But let’s begin at the beginning, when our group landed in Tennessee. Living in remodeled school buses was quite an adequate introduction to “roughing it,” especially for those of us who had never gone camping as children. By the time they first stepped off the buses, the pioneer settlers had become well acquainted with “honey pot” latrine buckets, mosquito-proof backpacker tents, canteens, flashlights, storm lanterns, and two-burner Coleman stoves. The land itself was barren of amenities save a small log cabin, a horse barn and a line shack, and so the first order of business was setting up facilities for bathing, sanitation, cooking and sleeping. I’ll skip over the organizational aspects here because they would require a lengthier and more nuanced discussion; suffice it to say that circumnavigating North America in an 80-bus caravan required a degree of organization similar to running a rock-and-roll band tour. That’s enough organization to get you started in designing and constructing a settlement, although perhaps not enough to keep it intact for very long.

For pumped water, an engine was lifted from a Volkswagen Bug and set on blocks in a springhouse. A well-used and rusting 5700 liter (1500 gallon) water tower was purchased for scrap value, repaired and erected atop a hill above the springhouse. This required minor welding and auto mechanics, as well as a continuous supply of petrol. Some years later, when power lines came in, the VW engine and springhouse were replaced with a submersible pump and well. Today it would have been built with photovoltaics or wind power, but such technology, while already available in the 1970s, was well beyond the reach of a community that subsisted on average per capita cash income of US$1 per day for its first 13 years. After the first winter, a second, larger water tower was erected near a 100 meter (330 foot) well with good aquifer recharge. The tower was salvaged from a railroad company for a purchase price of US$1, but moving and erecting the tower and tank required a crane. From the towers, water was delivered to homes in 20 liter (5 gallon) jugs by horse wagon. While the buses provided initial shelter, with more than 6 residents per bus on average, after 8 to 12 months of living on the road most people wanted to get out into better housing as quickly as possible. At the time, the government of the State of Tennessee held monthly auctions of surplus property, and Korean War vintage army tents could be bought for as little as $15. These formed the basis of our first foray into home construction. With salvaged materials from construction sites and dumpsters, they morphed into “touses and hents.” Going into a partnership with a nearby sawmill allowed us to add some beautiful timber-frame buildings and D-frames. Common buildings such as the community kitchen, motor pool, canning & freezing, print shop, clinic and school sprang almost entirely from salvaged materials. Scraping mortar off cement blocks and straightening nails become well-practiced skills. There was limited electricity to the site, and for an entire decade almost all of our electricity came from 12-volt DC systems powered by car batteries. Initially the batteries were charged by switching

them through vehicles every day, but full discharge cycles make for short battery life, so after trying novel methods of pedal power, bamboo wind generators and other wacky ideas, most houses went to a “trickle charge” system — a long copper cable run through the trees to a central power center that borrowed its electrons from the Tennessee Valley Authority (although we always sent them back in the next hundredth of a second). At one of these power centers, where we did our canning and freezing, we erected walk-in coolers and freezers. Refrigeration was a necessity that is as difficult to avoid as it is to achieve. A few of the buses came with propane-powered fridges and they were a blessing. Most of the households relied on a system of 5-gallon (20 liter) buckets that rotated to the walk-in coolers and freezers near the cannery. Buckets with tight lids were obtained from dumpsters behind the McDonalds in town. The other essential item was a Flexible Flyer wooden wagon with slatted sides. If you couldn’t get your parents to give one of those to their grandchildren for Christmas, the next best thing was to weld a bike trailer or pushcart to get your buckets to the neighborhood cooler. Buckets were also employed to carry diapers and laundry to a communal laundromat, which was set up near another trickle-charge node. Salvaged coin-op equipment was purchased in bulk, the coin slots replaced with toggle switches, and a large diaper rinse and centrifuge baby-manure extractor installed. The grey- and blackwater flowed to a constructed wetlands and rainbird, creating what today, 40 years later, are some of the richest soils on the property. Communal unisex showering facilities were constructed in places with good supplies of water and a way to heat it: downhill from the original water tower; beside Canning & Freezing and the Farm Store; at the Farm School and print shop. A flour mill took over the tack room in the horse barn. Initially we used a small stone mill to grind corn meal. Later we bought a larger, 3-break steel feed mill and set it up in the line shack, connected to 3phase AC power. Arrayed around the roller mill were Clipper seed

cleaners, sifters, a coffee roaster, an oat huller, and bagging racks. Within a year the mill was churning out a ton per day of wheat, corn, soy and buckwheat flours, pastry flours, corn meal, grits, groats, mixed cereals and porridges, horse feed, soy nuts, popcorn, coffee, and peanut, soy nut and almond butters. Transportation and communications were priorities, because our sustainability depended on commerce, and without good transportation and communications any attempts to create a business would have been hampered. Bear in mind that for the first 13 years the experiment was communal, meaning shared purse. Just as many societies throughout history, we have found that in times of difficulty a reversion to communal economics provides greater survival advantages than the exercise of individuated private property rights. After achieving stability, most drop the communal form in order to stimulate greater enterprise. This was the path taken by Amana, Oneida, many kibbutzim, The Farm, the People's Republic of China, and, now, Cuba. Any group that can cross the country in 30-year-old school buses will learn something about automotive mechanics. Our motor pool and junkyard became one of the technology hubs for The Farm, a place where anything from a hay rake to a fire truck could be machined and rebuilt, nearly from scratch. The first two teams of horses, black Belgians and white Percherons, were acquired from neighboring Old Order Amish. They laughed at our feeble attempts, as vegans, to replace leather harness with more hippy-kosher canvas and Naugahyde. “How’d you raise that nauga?” they’d ask. Interesting koan! Communication was accomplished through a rapid succession of home and business devices. The log cabin became the business center with two phone lines. On $1 per person per day, personal long distance charges were unaffordable, but one of our caravaners was an Eagle Scout with a ham radio merit badge, and he made a radio shack in the horse barn and began training ham radio operators to staff an amateur band Farm Net. Before the Internet I was WB4LXJ.

A 12-volt telephone system was installed to link every bus, tent, home and business. The dial tone was replaced with a Grateful Dead or reggae melody or a public service announcement (1000 jars of catsup planned today, canners needed; line at the laundry is now 90 minutes; bean shucking and banjo at horse barn 7 p.m.). The dial itself was replaced with a pushbutton that you used for Morse code to signal where you were calling. Four shorts meant “all points.” It was a party line, but there was a second carrier band, the “Hot Line,” used for emergencies. A toggle switch flipped you over to that band where an operator was always on call, sitting at a phone console to summon fire, police and ambulance and to assume management of the emergency. This pre-dated most emergency telephone services. Emergencies were taken seriously, and fire marshals, gate and patrol security, and emergency medical responders were treated as actual jobs from the very beginning. Each became more sophisticated as the body of experience grew. Naive hippies learned to adjust to the rigors of self-reliance, which could sometimes be terrifying, such as when a kerosene lamp tips over in a canvas tent, the Ku Klux Klan rides up to the front gate or a deputy sheriff wanders into the marijuana patch while hunting deer. Finding additional uses for the copper wires we passed through the treetops, we sent a TV signal through the phone lines, and could download direct network feeds from a 12-foot (3.7 meter) dish made of pine 2x4s and chicken wire. We watched the Watergate hearings that way. We produced our own shows, too, sent from the Bandland Studio tent to 12-volt TVs in tents and buses. If you were within 30 feet of the phone line, you could pick up the signal on channel 3. We watched Greenpeace work out its chess moves with the Spanish Navy in real time, using a slo-scan ham TV transmitter installed on the bridge of the Rainbow Warrior, sort of a proto-Animal Planet pilot. Eventually, when CB radios became popular, we were able to install them in our vehicles and interface them with the ham radio and “Beatnik Bell” phone system. Free international calls became possible. Our “Extra Class” hams grew in proficiency and could link

to satellites, monitor police, military and Secret Service sidebands, and bounce audio, digital and TV signals around the world to an expanding Farm Net. A weekly newspaper, Amazing Tales of Real Life, began coming out of the print shop, along with a host of do-it-yourself books that turned into a brand. The Big Dummy’s Guide to CB Radio sold more than a million copies, which rescued the community from the brink of a bankruptcy incurred by tomato blight. A brisk traffic in daily visitors, more than a hundred some days, required tour crews and a large hostel tent, but also supplied nearly free labor for the fields. From the very first arrival of the buses and through the first 5 years a community dining facility was an essential efficiency, and one of the main reasons that living could be so cheap. Milk was made from soybeans, which became tofu, mayonnaise, yogurt, sour cream and ice cream. Soybeans were also made into coffee, tempeh, soysage (from okara), soyburgers and stroganoffs. A bushel of dry soybeans (35 liters) cost $3 ($7 today). The protein needs (with all 8 essential amino acids in good proportion) for a hard-laboring farm worker can be supplied on less than a pound (450 grams) per day, rehydrated and made into gourmet vegan cuisine. The US and Canadian Recommended Daily Allowance for protein is 46 grams for women and 56 grams for men, or 100g for an average adult couple. Soybeans remain 17% complete protein after cooking, so two people, buying soybeans today, can meet all their protein requirements for a week on $2.40. Thinking of storing food for emergencies? Include soybeans. Tracing back down memory lane to my experience then: a young man of 25 arriving at The Farm in 1972 with just a backpack; being greeted by the Night Sentry and shown a place to sleep; going for a breakfast at the Community Kitchen, porridge and sorghum molasses, soysage and corn biscuits; then to the field in a horse wagon; harvesting sorghum cane with a machete and piling it into the wagon; at the end of the day returning to my assigned, dirtfloored army tent lit by candles; supper of bean soup and cornbread

with pickled jalapeños; guitars and song around a fire under the canopy of stars; abiding sense of harmony in the world; community.

Laos: Resilience in the Face of Genocide Jason Heppenstall “It was by staying sane that you carried on the human heritage.” [Winston Smith, in George Orwell’s 1984] My time spent in Laos ended with a bang. I was sitting in the back of a tuk-tuk with my wife when the bomb went off. At that moment we were passing under the Friendship Bridge that links the country to Thailand across the Mekong, about to pull up at the immigration office and pay the fine for overstaying our tourist visas. But the immigration office was not there any more. Where it had stood moments before there was a pall of white haze hanging in the otherwise clear air. A soldier waved us back and told us to remain where we were. “What’s happened?” I asked a group of Laotian men who were looking on at the scene, nervously sucking on cigarettes. “Bad people,” one of them replied. We stood and watched with them. This was the country’s main border crossing. Someone had just walked up to the immigration desk and placed a holdall on it before walking away. The bomb had killed the two young male clerks and put shattered glass into a group of Thai businessmen, who were now sitting on the tarmac and wailing loudly like babies. There were no sirens, no flashing lights or police lockdowns. Just a handful of bashful soldiers, not much more than teenagers, throwing the bodies into the back of a pickup truck and apologizing for the delay. If I’d arrived on the scene 30 seconds earlier, I’d have been standing at that same desk waiting to pay my fine. The fact that I’d paused to buy a Pepsi Cola from a street hawker a few minutes before might have saved me from being in the back of the pickup truck with the two clerks. The Friendship Bridge would have been a bad place to die. After a month of lotus-eating in a small village beside a fast-flowing river, this new bridge was an ugly visual reminder of the mad rush to modernity that had already got under way when I was there in the

year 2000. To those of a certain persuasion it represented a bold new future for this small, land-locked nation that was resigned to being cited as the poorest nation on Earth. But to me this peaceful and gentle country seemed like the last frontier on the border of suicidally growth-addicted China, and the glitzy double-or-quits ugliness of modern Thailand with its bright lights and bar girls. The modern banality of the bridge held a whiff of evil about it. “You must pay your fine in that building,” said the official, a young man wearing mirror sunglasses. The smoke had cleared to reveal a blackened but otherwise intact immigration office. A gaggle of American backpackers had turned up, and one of them had begun to berate the border guard with the importance of her travel plans. He insisted that the bridge was now closed to foreigners, but others began to surround him and noisily demand that they should be allowed to pass. And so we were ushered into the still smoldering office. We trooped in, stepping gingerly over the broken glass and holding our hands over our noses to suppress the acrid smell of burned plastic. A large crater was missing from the counter top and the erstwhile clerks’ computer monitors had melted in situ into surreal and blackened shapes. One of them was still on. Bits of paper and passports were strewn everywhere, and other than a large pool of blood beside a knocked-over office chair there was nothing unusual about the office. The surviving four or five staff were still seated at their desks and smiled at us, beckoning us to sit down. We went through the reasons why we had overshot our visas, explaining that we had been staying at a small village in the north of the country, and duly paid the small fine. The woman processing our paperwork had an air of calmness about her, as though two of her colleagues had not just been blasted to pieces in front of her. I cleared my throat. “I’m sorry about your colleagues,” I said. She looked at me briefly, and in that moment there was a flicker of something behind the bureaucratic steeliness. “Thank you,” she said, giving the customary tip of the head and the prayerful hands flattened together. And then it was back to the paperwork.

Later that day, drinking a cold beer in a Thai bar while a whiskyswilling businessman belted out off-key songs on a karaoke machine, I reflected on what had happened earlier. The incident was being reported on the news, and the official version was that a wallplug had caused a small fire but that nobody had been injured. I called the BBC from my cell phone and reported what I had seen. It seemed the right thing to do. The news desk took down the details and said thank you. The story could be found if one looked hard enough for it, but otherwise it was not considered very important— just one more little bomb in the most heavily bombed country on Earth. “Probably the Hmongs,” opined an expat American I met later who lived and worked in the region. “They were on our side in ‘Nam and have spent the last few decades living there, some of ‘em. They know it ain’t communism any more in Laos and they want a piece of the pie. Probably some kind of threat against the government, but who knows?” People had said “Go to Laos before it’s too late.” I knew what they meant. They meant go there before the remnants of its culture are swept aside by a tsunami of casino money and consumerism. I had seen it happen in Thailand; the mad, all-devouring dash for growth. One year it was all water buffalos and bicycles, the next year everyone seemed to be driving a Mercedes-Benz bought on credit. A sleepy island village I knew and loved had gone from being able to accommodate 50 backpackers in waterside huts to being able to accommodate more than 20,000 hotel guests in the space of five years. Laos, they said, was next in the firing line. *** In the next six to eight years people will see a new face of Vientiane as Don Chan Island along the Mekong River develops into a modern urban area complete with a pedestrian zone. CAMCE, the Lao-Chinese joint venture developing the area, plans to invest over US$600 million to turn 42 hectares of Don Chan Island along the Mekong River in Vientiane into the first international residence area, the first international business center, as well as an

international cultural and tourist center where Lao people can take their family, friends and loved ones to shop, dine and enjoy local and international movies. The company will create for the public a shopping paradise, a food paradise, an entertainment paradise, as well as a travelling paradise. The shopping mall will be built alongside a pedestrian street and will accommodate Vientiane’s first international-standard cinema. All of these facilities will show the glory of Laos. The mega real estate development project will give Vientiane a new face. For the first time in hundreds of years the Lao capital will have modern and tall buildings as in many other cities such as Bangkok, Singapore and even New York. [Promotional literature of Vientiane New World Glory project] It was impossible not to like sleepy Vientiane. Not so much a city as a collection of villages strung out along one side of the Mekong, in Vientiane it was still just about possible to imagine you had stepped back in time a few decades. Straight-backed schoolgirls glided sedately by on their bicycles along the dusty roads, each holding a bright parasol aloft to keep the sun off their heads. The whiff of French baguettes and good coffee could be discerned in the air mingling with the scent of hothouse flowers. In the evening you could sit at a riverside shack with a cold Beerlao and watch the fishermen cast their nets upon the slowly churning waters of the Mekong as it turned into a river of pure gold before your eyes. There was none of the honking aggression of more metropolitan cities, and nobody seemed to be in a rush. Maroon-robed monks filed in and out of the ornate wooden temples and chickens pecked in the dust around the riverside shacks. There was no mobile phone signal. But things were changing. The ubiquitous SUVs of the foreign aid agencies were competing for road space with the bicycles, and outside the center of town on the way to the giant golden stupa of Pha That Luang, high walls topped with barbed wire indicated the presence of newly-built bank headquarters. These financial institutions were the forerunners of the New Economic Mechanism (NEM)—a national program of economic reform that aimed to drag Laos by the scruff of the neck into the international arena of modern

capitalism. Quite revolutionary in its scope, the NEM was needed to rid the country of its backwardness and give birth to a new Asian tiger cub. It was a tough project, even by ASEAN’s reckoning: Laos is among the least developed group of countries (LDC) and relies heavily on donor assistance. Social indicators are among the poorest in the region and 34% of the population are living below the poverty line. Estimated average life expectancy in 2008 is 63.2 years. A large proportion (around 80%) of the population relies on subsistence agriculture (largely peasant farming) and agricultural development is constrained by a lack of modern skills, inadequate infrastructure and capital. Laos has no railways, a basic road system, limited telecommunications and electricity is only available in urban and some rural areas. [ASEAN - Australia -New Zealand Free Trade Agreement report] In other words, they had their work cut out for them. At the time of my visit, not only was there very little modern infrastructure, but there was no airport and the only factory in the country was the national brewery. Small and land-locked, Laos has a population of some six and a half million people, the majority of them Lao. The Lao people are considered to be closely related to the Thais, a Southeast Asian people spread far and wide, with most residing in Thailand. But Laos also has a rich tapestry of other tribes, including the Hmong, the Khmu and numerous others, each with its own distinct culture and way of seeing the world. As a country, what is now called Laos was stitched together by the French from three distinct kingdoms. It seems ironic to the casual observer that, for such a seemingly peaceful and pleasant land, the country’s history is a maelstrom of war, colonial barbarism and bloodletting. In its modern history it has been occupied by the French and the Japanese, has fallen under the protection and ideology of Soviet and Chinese communism, and has been bombed almost to oblivion by the Americans. Its forests and minerals are being ruthlessly extracted by multinational companies, and for the past 20 years it has been subjected to the great neoliberal experiment of our times. But despite all of this, many of its more traditional peoples survive and even thrive. How could this be?

Travel beyond the prefecture of the capital Vientiane and into the hilly territory that makes up the north of the country at the crossroads of Thailand, Burma, China and Vietnam, and you get an idea of how people have managed to retain their traditional way of life and their culture. For a start, transportation infrastructure is either poor or nonexistent and the hilly terrain makes it very difficult, or very expensive, to situate industry there. In the south of the country, in the flat lands that run beside the Mekong, I saw large areas of forest being cleared by bulldozers in readiness for industrial expansion, and a new road (financed by Japan) was being laid down to replace the potholed, meandering old one. Flat undeveloped land, combined with new roads and a sudden influx of credit, tend to create vast expanses of strip malls, golf resort hotels, casinos and industrial parks, especially when they are in proximity to other, wealthier countries. In contrast, the rugged north, which was where we travelled, has none of the usual bait to attract foreign investors, and I therefore began to form the hope that it could expect to escape the most rapacious forms of development. But the northern and central parts of Laos have their own problems. Glancing back at the turbulent and complex history of Laos, it becomes apparent that this area has been fought over for thousands of years. The Plain of Jars, which now covers the Xieng Khouang Plateau, but was once considered to stretch over much of central Laos, got its name from the thousands of giant stone urns dating back some 2,500 years. These jars were thought to contain the remains of past emperors from the Lao Phoueun civilization, or else they were used to store monsoon waters and thus enable long distance travel—nobody seems quite sure. Whatever their use, evidence of such complex civilizations in what would be considered Megalithic times by European temporal measures suggests that the local area was rich enough to provide an economic surplus that enabled a flourishing civilization. But civilizations tend to attract invaders, and Laos was no different. Yet despite all of the subsequent wars and invasions, the peoples of this area learned to survive, based on their ability to negotiate their way out of trouble and retain a way of life that avoided the accumulation of riches—

beyond those needed for survival. Of course, this survival strategy only succeeded until the U.S. bombers showed up, and then the local people found out that they could not negotiate with flying machines which the age of “automatic warfare” brought to them. *** “People like you are hypocrites of the worst order,” said a sketchylooking man who happened to be a fellow passenger on a pirogue as we sped up the Nam Ou River one evening, swatting bugs out of our hair and doing our best not to look at the submerged rocks which the teenage boatsman was skillfully avoiding. He was talking to Jon, a backpacker we had met, along with his girlfriend Paula, in Luang Prabang. They had got on a train in south London, arriving in Laos some six months later. Muang Ngoi, they said, was the best place they had discovered so far (the worst being Belarus). They had already spent a month there, teaching at the village school. It wasn’t quite Conrad’s Heart of Darkness, but we were on our way to Muang Ngoi, which had been isolated from the modern world by a lack of roads and the kind of infrastructure the NEM was supposed to be providing. As we sped against the rushing waters, we passed by numerous small villages, and were invariably treated to acrobatic displays of laughing children—naked as the day they were born— who would leap off rocks in delight as we passed. In places there were rapids and submerged rocks, but at other points the water level was low and at times we had to get out and push the long-tailed boat over sand banks. After the denuded hills of the south, it seemed like we had finally arrived somewhere more or less untouched by the Vietnamese logging companies. The man disagreed. “Do you know the mortality rates of these children?” he asked pointedly. He wasn’t talking to me but to Jon, who was sitting in front. “What they need is hospitals and schools and decent roads. And if they want McDonald’s and supermarkets, then who are we to deny them that?” It was a question that I’d heard so many times before and the dark root of its logic may well be the leitmotif for our entire civilization. To

save a place, a culture, a way of life, we must first destroy it and render it meaningless in anything but our own terms. He and Jon had started off having a relaxed and peaceable conversation, but the man quickly resorted to sound bites when Jon had suggested that, perhaps, the way of life that we were observing was in some ways better than our own. The man—who was dressed oddly in smart clothes and office shoes and was accompanied by a high-heeled wife who would not have looked out of place at a diplomatic reception—had reacted with sputtering indignation which seemed to be out of all proportion. Jon’s response was to sit back, light a joint and watch the spectacle of the acrobatic river kids. “Typical,” said the man, whom I would later see presenting a travel program some years later, having modelled himself as a modern-day adventurer and explorer. “There’s no point arguing with these people,” Jon told me later. “They believe what they want to believe and you can’t ever change it—it runs too deep inside them.” Much of northern Laos is a thickly wooded mix of gentle hills, clear flowing rivers and patches of reasonably level farmland. Villages tend to spread out along the rivers and seasonal vegetable gardens appear on the muddy river banks, fertilized by rich deposits of sediment. Once we reached Muang Ngoi, we stayed in a bamboo house that had been converted into a guesthouse by a man called Auhern and his wife, whom he said we should call “Mama.” Mama was tiny—not much over four feet tall—and looked like she could have been eighty years old. By contrast, Auhern was much taller and looked about 40 years younger than his wife, although he insisted that he was older. Neither of them said they knew how old they were, but Auhern said he had been a teacher during the bombing years. The village consisted of a strip of compacted earth with houses clustered around it. Frangipani trees added a splash of vibrant color. There was a temple, where some very young monks lived, and a school. All in all there were probably about three hundred villagers, most of them small-scale farmers. No roads connected the village, and all traffic in and out was by way of the long-tailed boats which plied the river during the rainy seasons when the water level was

high enough. The buildings were mostly of rattan, made of bamboo and caked mud. On Paula and Jon’s last visit there had been no electricity but now, a few weeks later, a generator had been brought up from Vientiane to provide some lighting in the evenings. Paula pointed out a small tin shack, its roof still shiny. “That’s new,” she said. It turned out to be the village cinema, and each evening it was packed with men (standing room only) watching a booming television set. After each presentation the men would file out with serious expressions on their face. We never found out what they were watching because women, children and foreigners were not allowed in. Looking further around the village, we noticed something unusual about the foundations of the houses: bombs! They were everywhere! Huge steel casings were used to prop up houses or as walkways over gutters, or as troughs for pigs. One house across the street from Mama's had a row of shells embedded tip-down as a kind of decorative fence. Other bombs were used as pots and had flowers growing out of them. But these were the safe bombs—the ones that had been successfully defused and turned into useful scrap. Most shops and noodle houses in the village contained, on a wall somewhere, a set of three or four posters that indicated in cartoon form what to do upon finding an unexploded bomb. The figures on the posters were shown tilling fields with buffalo, hoeing earth, planting rice, washing in streams and digging up plants. In each environment a piece of unexploded ordnance (UXO) was in evidence. One picture showed a farmer trying to defuse one, and the next frame depicted a spectacular explosion which had one of the man's arms flying off and a gory eyeball, complete with stalk, shooting skywards from his head. All the village children knew what to do with UXO, in the same way that children in England are made to learn the Green Cross Code for safely crossing roads. Walking off the trails in the surrounding hills is strictly forbidden, to falangs (foreigners) at least. Unfortunately for the people of Laos, UXO continues to be a daily menace, and some 20,000 have been killed since they returned to their villages after the bombing. Many of these are children, and even in the course of writing this article in April

2014, I saw news reports of two boys being killed by unexploded munitions. Bombing records indicate that 8,470 square kilometers were carpet-bombed, and that around 280 million cluster munitions, designed to maim rather than kill, were dropped. The bombs were everywhere. For several years the warplanes carpet-bombed the area around Muang Ngoi. Many of the bombs they dropped were huge and the scars on the faces of some of the surrounding limestone peaks were still visible, although they were now partially filled in by scrub vegetation and trees. Auhern told us, with a cheery smile and some amateur pantomime, of a Vientiane woman who had come to teach at the village school, and of how a bomb had landed on her, and how she had died. Everyone in the village had lost a mother or father or brother or sister to the bombs. Sometimes entire families had been obliterated, he said. But that was then. Now village life, at least on the surface, seemed uncomplicated. At dawn, women squatted down in the street and cooked large bowls of noodles and cabbage over smoky fires made from sticks. Afterwards there was work to be done. Rice paddies were tended, the river gardens watered, buffalos herded. Men plodded slowly up and down a hill collecting clay, which was then formed into bricks and left in the sun to dry. People performed the various tasks at hand in an unhurried way, and there was neither solemnity nor gaiety as they worked. The village swarmed with children who ran around gleefully, hanging around us foreigners, to whom Mama also referred as “children”. The children helped out too —when they weren’t busy playing. Some of them carried bricks, while others helped the adults in the fields. The seasonal vegetable gardens down on the river bank seemed to be the preserve of two girls of about ten or so called Aun and Olid. These two girls fetched water in pails from the river to irrigate the beans and the maize. Having watched them for a while, I couldn’t resist helping out, hauling the cold and clear river water up the bank while they giggled and made funny faces at me. I asked them what they were laughing at, and although neither spoke any English, they managed to communicate to me that they had never seen a foreigner do anything

useful. Because of this they gave me the nickname Nam Falang or “Water Foreigner,” which became my name among the village children. School for these children seemed to be something to do when there was nothing else on offer. They went around in large groups, with the older ones taking care of the younger ones, and often played boisterous games down by the river. They were bright, too, quickly mastering the rules of the various card games we played each day, and sometimes beating us. Like all children, they could be cruel, and one young girl gleefully showed me a nest of baby rats she had discovered, taking obvious delight in popping their heads between her thumb and forefinger. Others threw stones at birds and, when the time came for a young buffalo to be killed, the children were keen to witness its final moments. The seeming delight in witnessing acts of cruelty is something that may not rest easy with many Westerners, but it has been a facet of life in Southeast Asia since time immemorial. The travel writer Norman Lewis had witnessed ritual buffalo slaughter at a Moi village in Vietnam in the 1950s and, having seen it first tied to a sacrificial stake and driven to a state of frenzied terror by the villagers, described it thus: What followed was a most distressing spectacle. Two of the fathers stood out. Carrying coup-coupes (the Moi weapon which is half knife and half axe), they approached the animal from behind. They succeeded after several false attempts, when the heavy knife struck home with a hideous chopping sound, in hamstringing first one leg, causing the animal to hop about on a single back leg in a frantic effort to avoid the blows, and then the second leg, when it collapsed on its hocks, its rear legs bent uselessly under it … The subsequent tragedy was long, drawn-out and incomparably bloodier than a bull fight, when until the last moments of its life the bull is majestic and incalculable. … No particular technique, it seemed, was demanded of the killers, and they had a good half-hour in which to pursue their prey with desultory proddings and stabbings. Finally, with a frightful shuddering groan—the first sound it had uttered—the animal expired and was immediately dragged away and thrown of a brushwood fire,

where it was left to scorch superficially for fifteen minutes. [Norman Lewis, A Dragon Apparent, 1951] This was written at the time when the French were the colonial power in the region they called Indochina. Lewis asked a local government official why such cruel practices had not been outlawed by the French. He responded saying that the “natives” would put up with a lot but would not tolerate their customs being interfered with. If anything, the various local customs had regained a new importance and were being practiced with a renewed fervor, in direct proportion to how abhorrent they appeared to the colonialists. If this was so, then perhaps it was another manifestation of the kind of passive resistance to control that others have noted as well. *** Why don’t we people love one another? Why don’t we live together in equality? Why don’t we build happiness and progress together? To kill one another like this! Human beings whose parents brought them into the world and carefully raised them with overflowing love despite so many difficulties. These human beings would die from a single blast as explosions burst, lying still without moving again at all. [Nang, a 30-year-old refugee from Xieng Khouang, 1970] It may sound trite but it’s the only war we’ve got. Do you realize that this is the only place in the world right now where you can drop live bombs? … The Russians are going nuts over what we’ve learned over here. They’re dying that they can test their stuff out too. [Bomber pilots at Da Nang Air Base in South Vietnam 1970.] (Both quotes from Voices From the Plain of Jars, by Fred Branfman) The Secret War on Laos remains one of the most shameful episodes of the 20th century. New York Times columnist Anthony Lewis called it “…the most appalling episode of lawless cruelty in American history.” For six years there was a news blackout that kept Americans from knowing that their government, both Republicans and Democrats, were dropping bombs on civilian targets in Laos.

When the news eventually did leak out, many Americans were outraged over what was being done in their name. But by then it was too late and 2.1 million tons of high explosives had been dropped on the villages, farms, temples and schools of this neutral Buddhist country. Laos had been declared neutral in Geneva, and although the U.S. wanted to pursue Vietnamese fighters inside the country, it was unable to do so without breaking international law. The way around it was to use bomber planes whose pilots, code-named “Ravens” took off from bases in neighboring countries. This new way of warfare was dubbed “automatic warfare” in that it relied solely on technology and might, with minimal risk to service personnel. It would become a model for future warfare, most recently using drones, and was termed the “Laos Model.” Villages were bombed since they were the only targets visible to the pilots, and local people were forced to flee into the forests, emerging at night to farm their fields. Because the bombing was secret, there was no need for restraint, with whole areas being reduced to ashes. Once the villages had been destroyed, the buffalos, horses and other livestock became the new targets, and farmers were strafed by machine gun fire as they fled their fields. Because the villagers hid in the forests, the planes came and sprayed defoliant to kill the trees. The only place left to hide was the caves that riddled the limestone karst landscape of Laos, but these too were targeted with laserguided missiles by the hotshot pilots. Once all of these options had been exhausted, there was nothing that the surviving villagers could do other than begin the trek south and become refugees in the camps set up around the capital, where they awaited the end of the war and a return to their fields and forests. There were, even in 2000, quite a few of us foreigners staying in the village, and three guesthouses had been built to accommodate us. One was filled with demobilized Israeli soldiers, who spent their days in a haze of opium and marijuana and kept to themselves. Other than that, we were an eclectic bunch of foreigners from all over. At our guesthouse was an American, just setting out on a career as an actress, she said. She reeled off the TV series she had already

appeared in, but I didn’t recognize any until she got to NYPD Blue. “That’s my city,” she said. “I’m from New York. Normally I play murder victims—I’m pretty good at it,” she said, doing a momentary impression of a corpse by rolling her eyes back and lolling her tongue out. “When I get back I may have a talking part lined up,” she added hopefully. I asked her what she was doing in Laos. She seemed a bit too chirpy to fit in with the stereotypical stoners, travel junkies and Buddhists seekers we had encountered along the way. She frowned slightly, as if a dark cloud had just passed over her thoughts. “I saw a film about Laos and it totally blew me away,” she explained. “I mean, what we did to these people—all the bombing, you know? I just wanted to do my part to make amends.” As if to prove it she produced a fabric bag which was filled with hundreds of fridge magnets that said “I ♥ New York.” “I brought them to give out to the people so, you know, so they could see that we weren’t all bad.” I pointed out the fact that nobody seemed to possess a fridge in Laos. “Yeah. How was I to know that?” she laughed at the absurdity. “So I give them out anyway and tell people to keep them for when they get fridges in the future.” I had seen one of the fridge magnets on display in the cooking area of a nearby house. It was stuck onto a large bomb that had been stood upright, partially bolstering an upper floor. Hooks fixed onto it supported a collection of pots and pans for cooking. I leaned in and looked at the bomb, which was several feet long and hollow. A tin label on its side stated “Loading date Nov 1969, For use with [followed by a serial number],” so I was able to ascertain that Muang Ngoi had not escaped the escalation in bombing which began around that time. A month before this date the Deputy Chief of Mission Monteagle Stearns had explained to a US Senate committee that the cessation of the bombing campaign in Vietnam by President Lyndon Johnson meant there was a surplus of bombers in the region, with bored crew members. “Well, we had all those planes sitting around and couldn’t just let them stay there with nothing to do,” he explained at the time.

If a community could make kitchen units out of bombs sent to kill them, I began to wonder what else the villagers of the hilly regions of Laos could be capable of that has allowed them and their culture to thrive more or less intact despite everything that has been hurled at them. Apart from the aforementioned geographical barriers (a not inconsiderable advantage if one wants to survive a cultural onslaught) the people of Laos also enjoy one other benefit conferred on them by circumstance: relative poverty. With their terrain too hilly and difficult for building golf courses and luxury hotels, and far enough away from the tax inspectors and other bureaucrats who would want to impose top-down reforms on them, the locals are more or less left to themselves to carry on with life as they have done for centuries. To do so, of course, they have to ask very little of the external system—which they want to avoid at all costs—and here they are lucky too because they can rely on their cultural wealth, the majority of which remains intact. Medicine men and women know which plants to gather in the forests, which herbs to grow in the hollowed-out bomb shells that serve as plant pots (the four stabilizer fins are excellent at keeping the “pot” upright), and, if things get really bad, village shamans know a range of elaborate ceremonies to aid with prolonging life. Agriculture continues to provide sustenance in much the same way it has for centuries, with rice paddies, water buffalos and wandering pigs and fowl. During my time there I began to develop the idea that perhaps the peoples of upper and middle Laos were an example of humanity living in balance with the environment. The subject of human ecology has dropped out of favor in recent years as the age of cheap oil continued to run its course, but here surely was an example of a population living as a dynamic part of its environment without destroying it. Rivers were kept clean, forests were left mostly intact. Disease, natural disasters and small-scale war kept the population within the region’s carrying capacity. And the people loved the land. Fred Branfman conducted interviews with refugees fleeing the bombing, published in his book Voices From the Plain of Jars, and time and again the one recurrent theme among the survivors was that they had left what for them was paradise and could not wait to

return. None wanted to live in the city or to become wealthy; all they desired was the chance to farm their fields, be back in their villages and live among their families. Indeed, during the bombing raids the people used to dispel their fear while working in the fields and forests by singing songs such as this one, composed by a 16-year-old girl (from Voices from the Plain of Jars, by Fred Branfman). The land of Laos, the country of Laos Built strong by the Laotian people From long ago The splendor, the beauty of The mountains and great forests, So gorgeous to gaze upon It is our sustenance and We Laotians love this Lao country As if it were a part of us *** My family and I lived in the jungle about 18 miles from Xepon for eight years… The heaviest bombings were in 1965 and 1966. During that time, much of the land was destroyed by defoliants sprayed by the planes. When the spraying took place it looked as if everything had been burned by a fire; every leaf fell off every tree. The defoliants got into the drinking water and the vegetables, and some people died from that. There was much vomiting and there were skin diseases and many people couldn’t eat. [Lahoun Maphangvong, from The Lands of Charm and Cruelty by Stan Sessner.] During my stay in Muang Ngoi, Auhern offered to take us to the cave where the villagers had lived for many months. It was situated about a thirty-minute walk from the village along a path through a lush forest ringing with the calls of birds. Large blue butterflies rested beside a stream at the entrance to the cave, and Auhern warned me not to step off the path because the area still, 30 years later, hadn't been cleared of the unexploded ordnance (UXO) which lay buried just under the soils and still killed people on a daily basis. Inside the

cave it was dark and damp. The entrance was wide but we had to clamber over boulders to get inside. Auhern told us that the roof of the cave had collapsed with the whole village inside it during an attack by an F-16 fighter plane, which managed to thread a missile right into the mouth of the cave. The roof collapsed, burying many of the villagers under the rocks, where they remain. “We had no idea who was flying the planes or why they were killing us,” he added. Remarkably, Auhern bore no grudges against the pilots or the Americans in general, dismissing such ideas with a smile and a shrug. “They were only doing what they were told to do,” was all he would say. His attitude was a common one and I never met anyone in Laos who seemed to harbor resentment or anger. Perhaps this was a way of staying sane, by choosing not to dwell on negative emotions and instead letting go of the past. Indeed, perhaps this offered a glimpse into the deep inner strength of these people: surely an invaluable strategy in the face of overwhelming odds. Here is another: Laotians in general seemed disenamored with our idea of working any more than absolutely necessary. Traditionally, Lao farmers grew only one rice crop a year, although two are possible even without chemical fertilizers, and spent the rest of the year relaxing. It has only been in recent times, as part of the NEM, that tax increases have forced many of them to grow two crops a year. To get a better perspective on Laotian character, I got in touch with Fred Branfman. JH: “I don't know if you would be good enough to give me your opinion, but in your experience, what traits of character/culture do the Lao (focusing on the peoples from the north, rather than the various tribes) possess that might enable them to weather the current onslaught against their culture?” FB: “Well, I can’t really answer this question in the present context… I feel I can’t really answer the question because my experience with Laos was in the middle of a war, and I don’t really know how they have weathered the current onslaughts against their culture, or

indeed if they have done so. If they are able to weather them, I suppose the predominant trait that would enable them to do so would be their adaptability. It is a cliché, but perhaps an accurate one, that they have over the centuries been conquered by one nation after another, and yet have retained their unique culture not so much by fighting back as by a kind of passive resistance. Accommodation. Acceptance up above, continuing their ancient ways below. “I don’t know what Lao do who are kicked off the land they’ve farmed for centuries, but don’t have title to, by ruthless Chinese, Thai and Vietnamese businessmen, aided and abetted by the current Lao government. Maybe they are forced into the cities. Maybe they retreat further away and continue subsistence level farming. I had an interesting talk with a Lao friend of mine, a businessman who employs a lot of Lao, last time I was in Laos. He said he couldn’t tell his workers what to do. If he tried to order them around, they’d just quit, even forfeiting a paycheck.” This ambivalence towards participating in a system that promises much but delivers little might prove to be a saving grace for the traditional subsistence farmers of Laos. At a point in human history where the modern paradigm—of putting the economic growth horse before the environmental integrity cart—is dying a messy death, the Laotian subsistence farmer is surely further ahead of the game than the most devout Western permaculturist. Cultural integrity surely plays its part. Traditional dress is still worn in many villages and there are distinct art forms, such as forms of embroidery or batik, that help identify the uniqueness and individuality of each tribe or region. Religion plays a part too. Although Laos is nominally a Buddhist nation, ancient forms of animism including a belief in local spirits seem to play a greater role for at least half of its people. I was provided with some first-hand experience of the importance of this blend of Buddhism and animism when I inadvertently picked up a horoscope in a cave full of Buddha statues. I couldn’t read the script, and so I stuck the horoscope in my wallet and forgot about it. Then

there was a wedding in the village that had lasted for two whole days and nights, and it was while I was recovering from it that somebody handed our horoscopes to Mama. Mama read my wife Michelle’s first, cooing all the time and emitting high pitched squeals of delight. By the end of it Mama's face was aglow with delight. Clearly she had a good horoscope. An American named Mitch, who possessed a Lao/English dictionary, managed to translate some of it, and it had something to do with Michelle's “voice rising vertically”—a quality which is considered auspicious. Jon was next. Mama read his scrap of paper and her brow furrowed ever deeper with each line she read. She sucked air in between her teeth, like a plumber about to give you a quote, and shook her head sadly. By the time she reached the end there was no question about it. Jon was doomed. Paula and I came last. By coincidence we had the same horoscope and the results, as interpreted by Mama, did not bode well either. Again there was much shaking of the head and little sharp inhalations as though she were being jabbed by pins as she read. By the time she had finished Mama began to look truly worried about us. What had started as a bit of a joke was clearly being taken seriously. She retreated to the kitchen, shaking her head and muttering. The news of our bad omens seemed to spread and before long I sensed that people were keeping away from us as if we had some sort of contagious illness. One woman, having found out about my horoscope, came and looked me in the eyes (keeping her distance from me at the same time) as though I were about to be executed. Later on that day, down by the river, some children came up to Jon and pointed at his throat making slitting actions and laughing. Mama became stern with us. Something important was going to happen the next day, she said, and told us to go and rest. That night someone stood outside our ground-floor window until dawn, and I could hear mutterings and the sound of pouring water. At one point I heard some men whispering and, given the earlier throat-slitting

warning Jon had received, I spent the rest of the night in a cold sweat, ready to escape out the window at a moment’s notice. As the hours crawled slowly by, the more active part of my imagination came to the conclusion that some of the local men, perhaps veterans of the bombings, were right now sharpening their knives to exact their revenge. Early in the morning I went downstairs and discovered Mama's diminutive figure crouched over an oil candle. She was surrounded by burning incense sticks, putting biscuits into little plastic bags and sealing them with the flame. She did not seem to be in a very good mood. I asked her if she had made any coffee, and she scolded me sharply, telling me that I was possessed by bad spirits and it was no time to be thinking of coffee and breakfast. Furthermore, she said, I had brought these spirits into her house, and I would therefore need to undergo an exorcism. If I didn’t agree to it, she said, that would be the end of me. She told me to get ready and come to the temple with her. I went upstairs and roused Jon and Paula. They too had to be exorcised. They came downstairs and we solemnly waited for Mama to finish her preparations. We had been wrong. She had not wanted us to go to the temple but to go out into the street outside into the dawn twilight. We did as we were told, and soon a procession of child monks being led by an elder appeared. I recognized one or two of the young novices as those who go around the village pestering falangs for cigarettes. Mama shoved pewter bowls into our hands and ordered me to kick off my sandals as she hustled us out to the street. Jon and I had biscuits; Paula and Mama had sticky rice. We crouched barefoot on the road and placed the food into the monks’ bowls as they filed past. Mama said something to the elder and the procession halted. I realized that most of the village had come out to watch, and faces had appeared in windows all the way down the street. We were told to get down on our knees in supplication and, with the bowls on the floor and our hands pressed together as in prayer, incantations were made as the novice monks wafted incense over us. After what seemed like a long time the incantations ceased

and the monks moved on to receive alms from more of the villagers. But it wasn't over yet. Mama rushed into the house and came out with some bowls of holy water which, I then realized, she had spent all night preparing. The four of us squatted in front of the guesthouse and slowly poured the water over the earth while Mama said prayers. After this she moved around the house with us, splashing holy water around our rooms and in the dining area—in fact, any place that our unholy presences may have polluted. When it was all over Mama cheered up again. The evil spirits had been sent away, she said, and our deaths had been averted. Paula said that she felt an immediate sense of relief. We celebrated with a cup of coffee and a condensed milk and banana pancake. The sun came out and everyone began to smile at us again. Weeks later, when I narrowly avoided being caught in the bomb blast on the Friendship Bridge, I couldn’t help but wonder whether Mama was instrumental in my good luck. I lost contact with Paula and Jon when we left Laos, but hoped that they too would avoid whatever fate awaited them. *** It would be churlish of me to pretend to have gained a deep insight into the lives of Laotians and what makes them tick during a visit that lasted only a few weeks. But what I experienced on that trip opened my eyes to the whole idea of “development” and the dirty deeds that are done in its name. In the intervening fourteen years I have continued to watch Laos from afar and take an interest in developments there. As time progressed, it seemed more and more obvious that we should take note of the way traditional cultures, such as those found living in the forests and hills of northern Laos, have managed to hold onto their unique identity and way of life in a world that is growing ever more homogenized. So what is it that the villagers of Laos, and, by extension, the tribespeople and subsistence farmers of the surrounding countries, could teach us about getting by in a world of fewer resources at the end of the age of fossil-fuelled capitalism on steroids? Could it be

simply that they represent a model of sustainable living—a way of coexisting with the environment without turning it into a paved, toxic concrete jungle? If so, then perhaps we should listen closely. We may think that their way of life is “simple,” but isn’t simplicity the better part of beauty? Finance and property rights are simple in that there is not much in the way of what we call “money” or “property” in a traditional Laotian village. Each village makes do mostly with what can be grown, hunted or gathered in the surrounding area. If a family expands and there is no room anymore in the original dwelling, then a new one is built close by. Nobody “owns” the land, so it is a simple case of selecting an appropriate spot and putting up a new house on it with whatever pieces of bamboo, sun-baked bricks and bits of scrap metal (including bombshells) that may be lying about. The new house will be sanctified by the local shaman, or blessed by priests from the local temple, and the only debt incurred is the debt of gratitude to the neighbors who helped build it. Power structures in tribal villages are simple in that it is the tribal elders who hold the power. Simple systems of proportional justice are in place, and it is usually the village headman who has the last say in anything. Villages are not democratic, but neither are they authoritarian—such concepts cannot be readily applied to smallscale communitarian communities in which people rely on one another for survival. The Khmu people, for example, are governed by a village chief while spiritual and medicinal duties are the responsibility of the shaman and the medicine man (or woman). Rice is grown and harvested communally, and other staples, such as bananas, corn and sugar cane, are grown and added into the village food mix. The Khmu, who are animists, possess their own language, and stories are passed down orally by recitals around fires during the various festivals that take place throughout the year. Everybody knows their place in this system, and the rules and boundaries are clear.

Money does have a part to play in traditional village life, even if it’s a bit part. Many villages used to cultivate poppies for the production of opium, which is used not just for recreation, but also for anesthesia and religious ceremonies. It’s an eminently tradable commodity and has been cultivated for that purpose for at least 500 years. But with various international programs aimed at stamping out the practice, many opium farmers face having their main source of income cut off. The Akha people of northern Laos are one such group, and as a result they are abandoning their villages en masse and migrating to the plains around Vientiane where life is quite possibly easier, but where, if they want to survive, they must take part in a modern financial economy. Seen as part of a modern workforce, villagers who possess unique farming and survival skills, but have never set eyes on a computer screen or stood on a factory floor, are pegged as unskilled workers, and whatever money they send back to their communities is poor compensation for the resulting loss of resilience. This is what being “lifted out of poverty” often amounts to. Others find themselves being drawn into the orbit of the system involuntarily. Taxes imposed by central government are one of the easiest ways to suck them in, and villages are forced to send off their youngest and brightest to earn the cash necessary to pay the tax bills. Many village elders are now appointed directly by the government, and it does not take a great leap of imagination to realize that it is usually the most compliant and “modern-minded” that are selected. The more resourceful villages are finding other ways to earn a bit of cash, such as taking in backpackers or offering riverboat rides to tourists. But perhaps the timing will be key here. The Laotians have a big advantage over their neighbors in, say, Thailand, which went all-in for turbo capitalism a few decades back. A certain amount of resilience still exists in Laos, and because the Laotians can still manage to survive without air conditioning, refrigerated food and eight-lane highways crammed with SUVs, they may have a key advantage over others for whom these things have become necessities. The vast majority of investment money pouring into Laos comes from China, and it’s not hard to foresee that China’s gargantuan credit bubble—put at $23 trillion in 2014—will burst

messily and cause untold misery for its citizens and those of the other Asian “tigers.” When it does so, and the brave new world that economists and politicians have promised is stood on its head, would you rather be living on the 20th floor of a tower block in a Chinese city, or in a bamboo village hut in the Laotian forests? The people of Laos have suffered more than most at the hands of aggressors, and yet they have managed, for the most part, to persist with their ways of doing things. Some people who regard themselves as liberals in the Western world are appalled by the “backward” practices of some of the more remote tribal communities. But that is just noise; what surely matters most is the fact that the Laotians have managed to survive for so long and over such a tumultuous period of modern history. Whether or not they will be able to do so over the coming years and decades is very much a matter for debate, and it pains those who have allowed themselves to be charmed by this softly-spoken collection of long-suffering peoples to see them lined up for assimilation and fed into the gaping maw of 21st century capitalism. Perhaps all we can do is observe this diverse collection of cultures with respect, gain wisdom as we do so, and hope that they may continue to abide long into the future.

Village Medicine Peter Gray, MD I am a family physician in Canada with an interest in what the future of medicine in Western societies might look like. I don’t subscribe to the mainstream narrative of ever more technically exotic and complex medicine, such as nanosurgery, individualized genetic medicine and growing replacement body parts in the lab. I think it is more likely that as we move past peak energy production to a world in which energy and resources are scarcer, society will decomplexify and medicine will follow the same overall trajectory. I chose the title of this essay with some care. Initially I was going to call it “post-collapse medicine” but that brings to mind images of biker gangs roaming a post-nuclear wasteland and that wasn’t really the tone I wanted to set. Then I thought about “kitchen table medicine,” but this essay goes into the subject in rather more depth than that. So finally I settled on “village medicine” because I wanted to describe how a village healer in a post-collapse community of a few hundred people, with some basic knowledge and simple tools, might make a positive difference to health, illness and suffering in that community. Health warning: you should seek the best available medical care at all times. This means that, generally speaking, where allopathic (conventional) medicine is available, you should use it. The tools and techniques described in this essay are only to be used in scenarios where conventional Western medicine is unavailable. I can’t cover the whole of village medicine in this short chapter, so I’m going to refer to a some texts which are freely available for download from the Internet, and comment on the following areas which are likely to be particularly important or useful: Keeping healthy Stockpiling medications

Insulin-dependent diabetics Immunization Psychological medicine Herbal medicines (legal and illegal) Surgery Making difficult choices Keeping healthy The way many Westerners believe they can keep healthy is by visiting their physician once a year for an annual physical, during which the physician examines them from head to toe, orders for bloodwork and other tests, prescribes medication to keep them healthy and generally tunes them up like a car engine. This model of healthcare is promoted by medical boards and colleges, medical associations, guideline writers, medical advocacy groups such as diabetes associations and pharmaceutical companies. But it is very expensive and inefficient, and of questionable value in keeping people healthy. From my personal observations as a family physician, the patients who show up at my office regularly tend to be the least healthy, while the patients who remain healthy well into their 80s and 90s are seen rarely, if at all, and are usually on minimal or no medication. The main problem with the “doctor knows best” narrative is that it places the responsibility for staying healthy on the physician rather than the patient. This type of health care is a luxury we can barely afford even in today’s affluent, technologically advanced society, and it will not be available in a post-peak village community. Maintaining your health in the future will probably come down to just this: Look in the mirror. Are you obese? Are you undernourished? Do you smoke? Do you drink to excess? Do you engage in risky behavior? People know these things for themselves without needing a physician or expensive tests to tell them. Nor should they need expert help in providing themselves with clean drinking water, sanitary human waste disposal, adequate shelter and warmth, and in

avoiding preventable accidents (for example, gun, fire/stove and horse/animal safety). These are probably all the preventive health care arrangements which are will be needed and, coincidentally, the only ones likely to be available. There are numerous books available on keeping healthy—so many that it is impossible to list them all—but most of what they have to say is common sense. Eat fresh food, not too much, mostly vegetables, take regular physical exercise and don't spend too much time worrying about your health. Stockpiling medications Like beans, rice and ammunition, it makes sense to stockpile important medications during good times for use during bad times. This section is intended to give you some guidance on shelf lives of medications and on what you can stockpile and what you can't. Most medications have an expiration date stamped on them. The first and most important thing to understand is that this expiration date bears little if any relationship to the length of the medication's effectiveness. It has more to do with limiting the manufacturer's liability and with maintaining stock turnover and profits by unnecessarily replacing older medications with newer ones. I am going to explain expiration dates in more detail below, but here are some important general principles: Dry solid medications in pill, capsule or powder form have a very long life if stored in a cool, dark, dry place (like rice and beans). Many of them will outlive you. Wet medications (solutions or suspensions) decay much more rapidly, and in this case the manufacturer's expiration date really is a useful guide. If you need to store children's medications which are usually in syrup or suspension form, ask the pharmacist to give you the dry powder and say that you will add the water yourself (normally, the pharmacist adds the water just before dispensing).

Old medications do not decay into something dangerous: they just decay into something less effective. For several reasons, there is little point in diabetics trying to store insulin. These are the basics. Here are the details: The Shelf Life Extension Program (SLEP) is a secretive US Government program which was set up to conduct research into whether pharmaceuticals which have passed their expiration date are safe and/or effective to use. Conspiracy theories aside, here is an example of an actual, non-theoretical conspiracy by certain selfinterested parties to keep important information from the general public. The secrecy surrounding this program is illustrated by the following notice about SLEP which is posted on the US Army Medical Department website: As a reminder, all testing and extension data provided to the Shelf Life Extension Program (SLEP) by the Food and Drug Administration is considered For Official Use Only and cannot be shared with anyone outside the user's organization. SLEP Administrators have fielded several calls recently from individuals wanting to share this information with local, civilian counterparts. That is not permissible, as it is not only a violation of the terms agreed to by the FDA but also a violation of the Memorandum of Agreement each participant organization signs prior to entering the SLEP program. SLEP website accounts of violators will immediately be terminated and inventories may be eliminated from the program, pending notification of the parent organization. Additionally, non-SLEP organizations that use SLEP information are in violation of Federal law that governs misbranded pharmaceuticals. Questions on this topic may be addressed to SLEP Administrators through the website. SLEP Admin When I discovered this I became curious about it. Why would the government apply such draconian penalties to disseminating what appears to be harmless information? After all, national defence and security are not threatened, government revenue is not affected, and

if the research shows that certain pharmaceuticals are safe past their official expiration dates, why should this information not be allowed to enter the public domain? So I did a little reading around it and came up with the following explanation, which is part evidence and part hypothesis. In 1985 the US government became concerned about the cost of replacing expired pharmaceuticals which had been stockpiled for civilian emergency and/or military purposes. The replacement costs in 1986 totalled $2.5 million (a large sum of money 26 years ago). Discussions took place as to how these costs might be reduced, and one suggestion was to test the products to see if they were still safe and effective to use, and if they were, to keep them instead of replacing them. Accordingly, in 1985-1986 the SLEP program was born. However, savings and loss of profits are opposite sides of the same coin. The government was happy to save $2.5 million, but the pharmaceutical industry was no doubt unhappy to be losing the same amount in sales. The government needed the cooperation of the pharmaceutical industry to conduct the testing on the expired pharmaceuticals, and the pharmaceutical industry needed the cooperation of the government to ensure that the resulting information was restricted to as few organizations as possible, preferably only the medical procurement part of military. The last thing the pharmaceutical industry wanted was for the information to be released to, for example, civilian hospitals and pharmacies, and for them not to replace their pharmaceutical stockpiles, because not throwing away perfectly good medications would hurt their profits. Almost certainly, there then followed several weeks or months of backroom horse-trading and saber-rattling between the government and the pharmaceutical industry, until the following deal was hammered out. The pharmaceutical industry would cooperate with the SLEP program provided the data was restricted to pharmaceutical companies and government departments. The government would enforce the restrictions by making it an offence

under Federal law to disclose SLEP data to any unauthorized organization. That is the situation as it exists today. Currently, the SLEP data exists as a database which is continually updated as new information becomes available. Access is restricted as per above, but occasionally small amounts of it leak out in the form of research papers published in scientific journals. Overall, the available evidence suggests, as stated at the start of this chapter, that most solid pharmaceuticals (capsules and tablets) are safe and effective to use long after their official expiration date provided they have been stored in cool, dark and dry conditions. The same cannot necessarily be said of liquids or of pharmaceuticals which have been stored in sub-optimal conditions. The maximum length of time for which pharmaceuticals can be kept is uncertain, but I understand that some pharmaceuticals which have been kept from the start of the SLEP program in 1986 may still be effective. In terms of SLEP access restrictions, I have not heard of Federal law being used to enforce them, and think that it is unlikely to be used except in case of very gross violations. The US Government doesn’t really care who has access to the SLEP data, and the pharmaceutical companies probably don’t really care either as long as it doesn’t hurt their profits. Insulin-dependent diabetics This brings me to the special case of insulin, which Type 1 (insulindependent) diabetics need in order to stay alive. Without it, they will slip into a coma and die within days or weeks. Insulin, like vaccines (see below), can only be manufactured in a specialized laboratory backed by the resources of a complex technological society. If the complex technological society goes away, so will the insulin. Should diabetics therefore stockpile insulin in the event of a societal collapse? There are several problems with this. First, the vast majority of insulin is sold in liquid form. Liquids, as explained above, decay relatively quickly even under optimal storage conditions. Second, it has to be kept refrigerated. In the refrigerator, a bottle of

insulin may last for up to 18 months depending on its expiration date; at room temperature it will decay much more quickly. Third, there are practical limits to the amount of insulin that can be stockpiled. Even if it were possible to store insulin for long periods (see below) it would not be practical to accumulate and store a lifetime's worth of insulin. If you are a 20-year-old Type 1 diabetic you might need enough insulin to keep you alive for the next 60 years. It is possible to get insulin in dry form, although I have never encountered it in my medical practice. It is used as a reagent in some laboratory processes and can be used by diabetics as a dry powder inhaler as an alternative to insulin injections. If you find a way to obtain it, it might be possible to store it for longer periods in dry powder form than in the more usual aqueous solution or suspension form. However, this still would not overcome the other difficulties mentioned above. Regrettably, therefore, I have come to the conclusion that it not worthwhile for insulin dependent diabetics to attempt to prepare for a societal collapse. It is prudent to have extra insulin in stock for short term emergencies such as floods, hurricanes, fuel shortages, heavy snowfalls or localized civil disorder, when you might be cut off from your normal sources of supply for a few days or weeks. But long term, we have to accept that in a societal collapse, not everyone can be saved, and the default position for most of humanity's existence has been that Type 1 diabetics do not survive. Immunization Every schoolchild knows how immunization started, but in case you’ve forgotten I’ll remind you. In the 1790s in England, Edward Jenner observed that milkmaids often caught cowpox from the cows they milked, but rarely caught smallpox. Working on the theory that catching cowpox protected against smallpox, he inoculated many patients with the cowpox virus with good results. The two viruses are similar, so once the body has come into contact with the cowpox virus, it produces antibodies which are also effective against the smallpox virus. Cowpox is a mild disease, while smallpox is a much

more serious disease with a high fatality rate, so it is worth while catching cowpox in order to be protected against smallpox. Inoculation with cowpox was simple: Jenner just took pus from cowpox blisters and scraped them onto the skin of uninfected patients. Fast forward to the 21st century. Here is how a modern vaccine like the polio vaccine is made. Three wild virulent strains of polio are grown on monkey kidney tissue culture and then inactivated with formalin. Very careful quality control has to be maintained during all the steps of this process to ensure that no unwanted viruses or bacteria are grown on the tissue culture, that all the virus particles are then inactivated to avoid accidentally spreading the real disease while vaccinating, and that the vaccines are highly purified remove all unwanted chemicals and virus components to avoid causing reactions. There must be an unbroken chain of refrigerated transport and storage every step of the way from the manufacturing facility to the end user. Sterile syringes and needles are needed to administer the vaccine. These processes can only be undertaken in the context of an advanced technological society with access to highly specialized tools and reagents and highly trained and specialized personnel. You cannot replicate any of this in your kitchen or workshop, just like you can’t make a microchip. Jenner was lucky to stumble across a “Goldilocks” virus: cowpox is not too mild, not too virulent and closely related to the target disease. His method cannot be replicated for any other disease because there isn’t an equivalent “cow-polio” or “cow-measles” virus which would produce the desired antibodies. The bottom line is that if advanced technological society goes away, vaccines will go away too. They are all made by similar high-tech processes. Many more people will die of preventable diseases than do at present. The reason why I’ve gone into this in some detail is not because I wish to be pessimistic or defeatist, but because I feel it is important to make a realistic assessment of what can and can’t be done, and to act accordingly. The best that can be done is to pay

attention to infection control and hygiene, and to get everyone vaccinated while the stocks last. Psychological medicine The factors which are likely to cause the most serious and widespread illness and mortality going forward are not physical but psychological. We had a sneak preview of what to expect during the Soviet collapse of the late 1980s and early 1990s. Following the breakup of the Soviet Union in 1990 Russia, along with some other former Soviet republics, experienced a sharp spike in many causes mortality and a decline in the birth rate which, coupled with mass emigration, resulted in an overall decline of the population. It went on for several years. The reasons for it are not entirely clear, but many of the deaths appear to have been alcohol-related or suicides, pointing to the important role played by psychological stress caused by social disruption, high unemployment and the “shock therapy” of widespread and often criminal privatization. A large proportion of the population of North America (probably around 15-25%, although precise figures are unavailable) takes antidepressants, anti-anxiety and/or sleeping medications—and this is during the supposed “good times”! We can expect to see this figure increase in the coming years as more people become subjected to acute psychological stress. What causes the psychological stress? There isn’t a simple correlation between psychological stress and living standards. For example, people in present-day “poor but happy” countries such as Costa Rica, with a much lower material standard of living than we do, enjoy happy, fulfilling, purposeful lives. It’s difficult to tell whether people today are generally happier than people in the past, but judging by our antidepressant and tranquillizer intake, this seems unlikely. The main factor seems to be the direction of change in living standards rather than the absolute level. People don’t seem to like change, especially change for the worse, and especially when they are unprepared for it. If this is the case, then if we are psychologically prepared for a fall in living standards, we may respond better if and when it comes.

Right now, we are not even remotely prepared for it. We don’t even have a dialogue about it in our political or academic institutions or in the media. The mainstream narrative is that every day, in every way, things will continue to get better and better, and economic growth will continue forever. If those things do not appear to be happening any more, we either manipulate the statistics so that we can continue to tell ourselves that they are happening, or we tell ourselves that we are experiencing a temporary setback, a mere speed bump on the road to ever greater prosperity. The village healer’s toolkit is therefore going to need some tools to relieve psychological pain, whether through counselling (perhaps working alongside a full-time counsellor) or by using herbal medicines. Herbal medicines My heart sinks when I open a herbal medicine textbook and read the words “Herb X was believed by aboriginal people to be a cure for illnesses A, B, C, D, E, F, G, H, I and J.” I know immediately that the author of the book has made no attempt to fact-check his material— he has just copied it from another source—and it is very unlikely to be true because, generally speaking, one drug (whether herbal or conventional) doesn’t cure multiple diseases. Please don’t interpret this as disrespect for aboriginal traditional knowledge. I believe we have a lot to learn from First Nations peoples. I just think that traditional knowledge, including traditional knowledge of herbal medicines, should be a starting point rather than an end point. We should certainly ask “What did aboriginal peoples use to treat this condition?” but we should then also ask “Does it actually work?” Modern pharmaceuticals are produced using complex processes which cannot be replicated outside a specialized laboratory (see Immunization, above). If modern technological society goes away, then modern pharmaceuticals will probably also go away, and we will be forced to rely on herbal medicines as in times past. I have looked into peer reviewed research papers into the effectiveness of herbal medicines which have been published in mainstream scientific

journals and have come up with the following three short lists, which are not intended to be exhaustive: Herbal medicines which probably work Herbal medicines which probably don’t work Herbal medicines which definitely work but are illegal to produce without a government licence A few general words about herbal medicines: they are plant extracts which may contain tens to hundreds of active and inactive substances. Their potency is generally milder and more variable than pharmaceuticals because much depends on the genetic makeup of the plant, the way the plant was grown and the way the extract was obtained. In addition, there may be genetic, environmental and psychological factors in the patient which make some patients more responsive than others to some herbal medicines—but this is also the case with pharmaceuticals. Because there is less funding for research into herbal medicines than pharmaceuticals, the research tends to involve smaller numbers of patients, be less rigorously conducted and the results are less reliable. With those caveats out of the way, here are the lists: Herbal medicines which probably work Harpagophytum Procumbens (Devil's Claw) for pain relief Salix Alba (White Willow Bark) for pain relief Capsicum Frutescens (Cayenne) for pain relief Berberine for Type 2 diabetes Ipomoea batatas for Type 2 diabetes Silybum marianum for Type 2 diabetes Trigonella foenum-graecum for Type 2 diabetes Kava for anxiety St. John's wort for depression Valerian for insomnia Echinacea for common cold symptoms Black cohosh for menopausal vasomotor symptoms Ginseng for angina pectoris and erectile dysfunction Garlic for hypertension

Tea tree oil for acne Herbal medicines which probably don’t work Colloidal silver for ulcers and wound dressings Glucosamine for osteoarthritis Cinnamomum cassia for Type 2 diabetes Saw palmetto for benign prostatic hyperplasia Herbal medicines which definitely work but are illegal to produce without a Government licence I have devoted extra space to this category of herbal medicines because they are the most potent and effective herbal medicines and are therefore the most restricted. After all, there would be no point in restricting a placebo. Nothing in this chapter is intended to encourage people to break the law or to use herbal medicines for recreational purposes. (On the other hand, all evidence points to the fact that nothing will stop them either.) These herbal medicines which have been used for thousands of years, and have only been made illegal in the comparatively recent past—the last century or so. They include pure alcohol (ethanol), opium and marijuana. Governments tend to be quick at making restrictive laws but not so good at repealing them once they are no longer appropriate. For example, when the Western Roman Empire collapsed in the 5th century, most of the Roman laws remained theoretically in effect even though there weren't any Roman officials left around to either enforce or repeal them (the Visigoths saw to that). What this means for our society is that as our energy supply contracts and our society spontaneously decomplexifies, a large number of laws will remain on the statute books but will be enforced with decreasing frequency. Some may never be formally repealed. A non-contentious example of this might be the common prohibition on drying clothes on clothes lines. People have been doing this ever since they started wearing clothes about 100,000 years ago, but in modern industrial society there are tens of thousands of local jurisdictions which have banned the use of clothes lines for esthetic reasons. If there is a widespread

and prolonged electric grid outage, people will very quickly go back to using clothes lines, but the silly laws will remain on the statute books for many years, perhaps forever, because people will have more urgent matters to deal with than repealing irrelevant legislation. We can expect to see a similar situation arising with regard to some herbal medicines which are currently illegal. Practitioners of herbal medicine should therefore use their judgment to decide whether and when to use this category of herbal preparations. Opium Opium has been used for pain relief for millennia. The poppy plant was cultivated in ancient Persia, Egypt and Mesopotamia. The main active ingredient in opium is morphine, which was first isolated in 1804. Morphine is on the World Health Organization's List of Essential Medicines. It became a controlled substance in the US in 1914. Opium is the dried latex obtained from the opium poppy (Papaver somniferum). There are several varieties of poppy but only this variety produces significant amounts of opium. Seeds can be bought by mail order from specialist suppliers, from garden centres (as ornamental poppies) or shaken out of dried poppies from a craft store. Once the poppy plants have grown and flowered, the opium is harvested by making vertical cuts in the immature seed heads. A brown resin oozes out and can be scraped off after a few hours. The opium can be smoked, eaten, drunk as tea or given in suppository form. Opioids today are widely abused by addicts and traded on the black market. They include morphine, diamorphine (heroin), oxycodone and hydromorphone (Dilaudid). All are chemically related to opium. So, in a societal collapse, what will happen to the addicts? Nobody knows for sure, but my guess is that some of them will be forced to go without for periods of time, but that the problem of opioid addiction will not disappear, since no previous societal collapse has produced such a result.

In order to survive as an opioid addict, you need a society which is willing to support you and your habit. Some opioid addicts hold down jobs and contribute to society; most don't, and depend on welfare payments and doctors handing out free prescriptions. If the welfare payments and free prescriptions go away, the opioid addiction will not spontaneously vanish with them, and some other way will be found to continue feeding the habit. Withdrawal symptoms from opioids can be quite uncomfortable uncomfortable but are rarely dangerous—rather like having flu for two or three weeks—but few addicts will quit voluntarily. While most addicts will not have the skill or patience to cultivate their own opium poppy crops, the vast underground economy which invariably materializes in the course of a societal collapse will no doubt provide it for them. [Further reading: Opium for the Masses by Jim Hogshire] Marijuana In Canada, until the law was changed recently, licensed medicinal uses of marijuana included severe arthritis, HIV/AIDS, terminal cancer, spinal cord disease and multiple sclerosis. The medical licensing requirements for marijuana vary from one country to another. Hemp fibre has been used to make ropes and clothing for thousands of years. The first recorded evidence of medical marijuana use appeared over 4,700 years ago in the pharmacopoeia of Shen Nung, one of the fathers of Chinese medicine. In the 1800s marijuana preparations were widely used in many proprietory medicines. In the early part of the 20th century, legislation was passed in many countries making the use of marijuana illegal, even for medicinal purposes. This roughly coincided with similar prohibitions on the use of alcohol in some jurisdictions, particularly the United States. The alcohol prohibition laws were lifted after a relatively short time; the marijuana prohibition laws generally remain in place. The growing and harvesting of marijuana plants is quite simple—the plant is a hardy weed—although achieving superior potency is

something of an art. The plant is thought to have originated in India. It thrives best in hot, dry climates but it can be grown in most places in the world. Contemporary books on marijuana growing tend to emphasize indoor growing under artificial light, but in a post-collapse scenario this would probably not be relevant as outdoor and greenhouse growing would be the only option, with the likelihood of prosecution growing increasingly low. The flowering tops of the female plant contain the highest concentrations of resin and tetrahydrocannabinol (THC), the main active ingredient. [Further reading: The Cannabis Grow Bible by Greg Green is a 429 page volume which contains all you need to know. It is available at multiple places on the Internet.] Ethanol Useful for disinfection of skin and wounds by topical application. Historically, it has also been given orally to patients before painful procedures such as amputations. For example, during the Napoleonic wars, officers were given rum or brandy before an amputation, while enlisted men were given a piece of wood to bite down on. However, I really wouldn't recommend it for this purpose. It is unlikely to be effective for pain relief except in doses so high that it would endanger the patient's life. Vomiting and aspiration of vomit are significant side effects. A safer and more effective choice for pain relief would be opium. The first recorded instance of distillation of alcohol was by Arabian alchemists around 700 AD, but distillation had probably been performed in Arabia and Egypt much earlier. Distillation was made subject to registration of stills and payment of taxes in the 1790s in the USA, and in most other jurisdictions at around the same time. Failure to comply with these requirements after this date constituted a criminal offence. Construction and operation of an ethanol still is a traditional art practiced in many parts of the world. The basic principles are as follows: vegetable material such as potatoes, corn or fruit is

fermented using yeast (the “mash”) and ethanol is produced as a byproduct of the fermentation process. In order to separate and purify the ethanol, the mash is heated to just above the boiling point of the ethanol, at 173.1°F or 78.37°C. The ethanol vapor rises into a tube, is cooled and turned back into a liquid by means of a condenser and drips down into a second container. There is a widespread belief that drinking homemade liquor from illicit stills may lead to death or blindness from methanol poisoning. Examples of this can be found in the media (“Homemade liquor kills 48”, Associated Press, 8 July 2009), PubMed (“Serious methanol poisoning from home brewed alcohol”, Crit Care Resusc, March 2012) and popular fiction (“Invasion,” Foyle's War British TV detective drama, Series 4 Episode 1). Surprisingly, the idea that home distilled ethanol can cause widespread accidental methanol poisoning appears to be a myth. Home distilled liquor (variously called “hooch”, “moonshine” or “poteen” depending on the country) is produced using a fermentation process. In this process, traces of methanol are produced along with ethanol, but the quantity of methanol is generally too small to be harmful. Methanol also occurs naturally in trace quantities in beer and wine. Methanol, also known as wood alcohol, is produced in industrial quantities by completely different techniques such as catalytic processes acting on coal or natural gas, or the destructive distillation of wood. It is not produced by fermentation. It is true that methanol is a potent neurotoxin and can cause death, blindness and other neurological effects. There are numerous case reports of methanol poisoning on PubMed and it is a serious public health problem in some parts of the world, particularly India and Indonesia. However, as far as I can establish, all cases of methanol poisoning have resulted from the deliberate adulteration of fermented liquor with industrial methanol. Ethanol produced for automobile fuel is often deliberately adulterated with methanol to discourage people from drinking it.

The only theoretical way in which you could get methanol poisoning from an ethanol still would be to save up and drink together the first few drops of distillate from multiple distillation batches. This contains the naturally occurring methanol mentioned above, but in a high concentration, because methanol is more volatile than ethanol and evaporates first. The first few drops from the distillation process should therefore always be discarded. A good technique is to bring the still up to the boiling point of methanol (148.5°F or 64.7°C) for a period of time, discard the distillate, then bring it up to 173.1°F or 78.37°C to distill ethanol. There are many good books about small scale ethanol distillation available for free download on the internet, but one which I found particularly readable was Making Pure Corn Whiskey – A Professional Guide For Amateur and Micro Distillers by Ian Smiley. [For a quick and easy method, search for “Grandpa Orlov's Vodka Recipe.”] Surgery There are many different types of surgery which a village healer might be expected to perform, from minor surgery such as digging out thorns and splinters to major surgery such as amputation, appendectomy or Caesarean section. The former is within most people's comfort zone, the latter probably not so much. I am going to talk about amputation, not because you will be doing it often, but because it illustrates some important points about post-collapse village medicine. When might you need to perform an amputation? Most people would probably think first about crush injuries, gunshot wounds and bomb blasts, and indeed, these are all situations when an amputation might be necessary. The average person would probably not immediately think of diabetes, and yet this very common disease will probably account for the largest number of amputations going forward into the next few decades of the Long Emergency.

Diabetes is the most common reason for lower limb amputation today. One third of all foot amputations are performed on diabetics with foot wounds or ulcers. The reason why so many diabetics need amputations is because high circulating blood sugar levels over many years cause damage to the interior of blood vessels, making them them narrower and less efficient at delivering blood and oxygen to where they are needed. As the condition progresses, the flow of blood and oxygen drops below critical levels, at which point the tissue dies. Let's look at a few statistics (from American Diabetes Association) and try to project them into the future. Percentage of the population with diabetes: 10% Size of US population: 313 million About 65,700 nontraumatic lower-limb amputations are performed in people with diabetes annually (180/day) Therefore, the number of diabetic amputations per head of total population per year is 0.0002. This might seem a small number. But suppose you are a village healer looking after 500 people in fairly isolated conditions for 40 years. The number of diabetic amputations likely to be needed in your community during your working lifetime is four. But then the future years are unlikely to resemble the past years. If modern pharmaceuticals become unavailable, we will have a large number of untreated diabetics developing complications much faster than they would have previously. The numbers are difficult to estimate, but let's say that the number of amputations needed may increase five-fold. Then, instead of looking at just four amputations in a working lifetime, you may now be looking at 20 amputations—one every couple of years. Whatever the exact numbers may turn out to be, there will be a significant number of these procedures needed. Ideally you will be able to refer your diabetics to a surgeon at a hospital who has the necessary expertise and materials to perform these procedures. If this is not possible due to lack of funds, lack of transport fuels, lack of available personnel or some other reason,

there are only two options: the patient slowly dies as the dead tissue putrefies and leaks toxins and bacteria into the bloodstream, or you perform the amputation yourself. Here is a quick guide to the general principles of performing an amputation under austere conditions. Try to make the patient as comfortable as possible. A glass of whiskey and a piece of wood to bite on are helpful, but we should be able to do better than this. A good dose of opium will not be as good as a modern general anesthetic but will be better than the brandy or the piece of wood. Give enough to relieve pain, but not so much as to suppress respiration (an important side effect). Strap the patient down securely, because most people react badly to having their limbs sawn off. Choose the level at which to perform the amputation. The aim is to remove both dead and compromised tissue. The latter, although not dead, has a poor blood supply and is unlikely to heal. If you try to be too kind to the patient and perform too low an amputation, the stump may not heal, necessitating a re-amputation at a higher level. You need to cut back to healthy tissue. Tell the patient what you are going to do, why you have to do it, and the risks of either undergoing, or not undergoing, the procedure. This is called “informed consent.” Not undergoing the procedure means almost certain death; undergoing the procedure still carries about a 25% risk of death (American Civil War statistics). If they do not give consent, do not operate. Maintain conditions as close to sterile as you reasonably can. Wash your hands, the limb to be amputated and all surgical instruments in hot soapy water, then swab them with ethanol. Use sterile gloves. Use a bone saw, but if you don't have one, any fine-toothed saw will do. Make sure that it is both clean and sharp. You will also need a scalpel or a very sharp knife, some suture material (sterilized fishing line), a piece of tubing to act as a drain, and lots of clean towels. Think about what end result you are trying to achieve. You want the end of the bone to be covered by a reasonably thick layer of skin,

muscle and fatty tissue. You can't just cut the limb off square as though it were a piece of timber: you have to cut the bone an inch or so shorter than the surrounding tissue, smooth off the end so it doesn't have any sharp or jagged edges, then close the soft tissues over the top of it. Tie off bleeding blood vessels as you go. Place a tube in the operation field as you close up to drain blood and infected materials away. You don't want them building up in the end of the stump because this will lead to infection. The tube will be removed in a few days once the wound has stopped oozing. Suture the soft tissues together over the end of the bone to make a rounded stump. After the operation, change dressings regularly, watch for signs of infection (fever, redness or swelling around the operation site, drainage of pus). If any of these signs occur, start antibiotics if available. This concludes the section on surgery. There are many other surgical procedures which may be needed in a post-collapse village medicine scenario. Cesarian sections and appendectomies, for example, are not too difficult to perform (not really any more difficult than an amputation) and may be equally life-saving. The description of amputation is intended to illustrate some important lessons about post-collapse community surgery including: It is possible to do simple surgery successfully and humanely, even in the absence of a complex technologically based society If preventive medicine (e.g. drugs to control diabetes) goes away, then rescue medicine (e.g. amputation) is likely to be needed more often Some types of surgery may be outside the comfort zone of both the person performing the surgery, and the patient, but if the patient is almost certainly going to die without it, then neither of you have much to lose by trying

Some herbal medicines (opium, ethanol) can be a great help and should be stockpiled well ahead of the time when they may be needed Surgery: suggestions for further reading These materials can mostly be downloaded free of charge from the Internet. I suggest you do this now, rather than waiting until later, because the Internet isn't going to be around forever and you need to have local copies available. Where there is no doctor by David Werner Where there is no dentist by Murray Dickson Surgery for victims of war (International Committee of the Red Cross) Surgical Care at the District Hospital (World Health Organization) The Survival Medicine Handbook by Joseph Alton Giving Birth In Place (American College of Nurse-Midwives) The Occasional Vaginal Delivery by Katherine Miller Making difficult choices In today's society, most of the choices we make are fairly inconsequential. Should I buy an SUV or a Prius? Should I order chicken wings or a hamburger? Should I watch the news or the sports? None of these are life-or-death decisions. In contrast, many of the choices we make in the future may be much more significant. I have given one example above: Should I allow an untrained person to amputate my gangrenous leg without a general anesthetic, or should I succumb to gangrene? Other possible choices may include: Should I submit to the authority of the local warlord, even though he wasn't elected, or should I die for my high principles? Should I encourage my children join the military in order to battle to the death for access to ever-dwindling fossil fuel resources, or should I prepare for life without fossil fuels? Should I kill other people in order to survive a bit longer, or should I sacrifice

my own life so that others may live? There are no clear right or wrong answers to any of these: the answer is always “It depends.” These are the kind of choices which our ancestors had to face, and which we will no doubt have to face again. The era we are entering into has been called “the Age of Limits.” It might as well also be called “the Age of Difficult Choices.” Good luck.