'Human Factors' relates to the roles and behaviours people play out in complex operational systems such as aviation, nuclear facilities and healthcare. this experimental documentary explores the relationships between health/care workers and the patients they will encounter, the performance of professionalism, care and capacity for the management of trauma both past and future, personal and institutional. ‘HUman Factors’ is the Winner of the Paul Watson Prize, awarded by Goldsmiths University and an Official Selection for the German Ethnographic International Film Festival 2024.

Produced and directed by Anna Dobos, in collaboration with goldsmiths university (anthropology department), Great Ormond Street Hospital for Children, Casualties Union and Lifecast Bodysim, with further research participation with PEARL UCL (Person environment activity research laboratory) and AVRT. The essay below elaborates the research and context around the film, and it is recommended that you explore this after viewing.

SIMULATION WARD

Rehearsing Crisis, Managing Complexity and 

Processing Trauma in Healthcare and Warfare

INTRODUCTION

In specialised hospital wards, doctors and nurses in training monitor the heart rate of plastic, robotic babies and assess the pupil dilation of life-sized manikins. These human facsimiles breathe and blink, the latest models capable of holding your hand and giving it a squeeze. These exercises, observed through one way mirrors and CCTV feeds, are designed to prepare students for clinical practice. Likewise, in parks across London and Surrey, search and rescue volunteers systematically scour the landscape for casualties, in this case, volunteers who are playing at being lost. Lightly dabbed with makeup and glycerin spray to simulate the physical pallor of dehydration, the role-players wait in their designated spots, sometimes for hours, as the exercise unfolds. Post COVID-19, the majority of real life cases are taken up with searching for those suffering from dementia and increasingly, acute mental health crises. Whether using manikins or actors, face-to-face role-play or VR, these staged interactions are inherently liminal and uncanny, a sort of rehearsal for crisis, in which matters of mortality and dignity play out in a heightened, professionalised interaction, where both affective and embodied performances of injury and vulnerability encounter performances of professionalism, care, authority and ultimately of institutional competence and capacity. In real life, such encounters lay bare both our physical and social fragility as much as our reliance on institutions of care for survival in the face of a neoliberal ethos of individualism, self management and personal accountability. Judith Butler argues that precarity in its most bare form is a feature of life, that all lives are vulnerable to being ‘expunged at will or by accident,’ (Butler 2009: 14), something that defines us as intrinsically social, our lives ‘always in some sense in the hands of the other’, notably a condition from which political demands and principles must arise (Ibid: xxv). For healthcare professionals and emergency services responders, often the agents of ‘case-management risk’ (Dean 2014:130), these encounters are part of a daily emotional and bureaucratic engagement with crisis from which there is increasingly little individuation, support, reflection or recovery, operating in the context of what many are calling a perpetual institutional crisis that encompasses healthcare, cost of living, mental health, transportation, housing, and the refugee crisis. It is in this context that I explore the practice of simulation, role-play and rehearsal as a form of social and institutional ritual for risk management and speculation, as well as the ways that these practices can unwittingly become strange loops; a prophylactic for uncertainty and a processing of trauma, both future and past. In addition, I explore parallels between the institutional and the cultural, looking at (popular) media as a form of speculative crisis simulation for the public at large, as pre-mediation, spectacle and escapism. 

SIMULATION

The foundational premise of using embodied action as a means of learning from the past to engage with the future ties into the theory of ritual; ‘older than Aristotle's theory of mimesis and as new as theories of mirror neurons,’ (Taylor citing Gallese 2009: 1889). In an institutional context, simulation is a vehicle by which we can better integrate experiences that are troublingly near or radically far or ‘other’ from our day to day, a way to play out complex, high risk scenarios in a controlled environment, with space for failure and evaluation, and a means to build empathy and relationality, which are vital for human survival. Scott Magelssen, who spent many years engaging in participant observation and fieldwork in human action simulation experiences across the US, categorises simulations in a variety of ways, but broadly under the contexts of recreating the past (time travel), empathic encounters of ‘the other’ through role-play and embodiment (witness) and rehearsal for the future (invocation, sandbox), which is what I will focus on. Several other scholars have engaged with future oriented simulation practices, including historian and professor of performing arts Diana Taylor, who looks at theatre and performance as a methodology co-opted by warfare (2009: 1887) and the scenario as a framework for thinking through ‘as-if’ hypotheticals ranging from catastrophic events to trauma management to peacekeeping. Performance scholar Natalie Alvarez (2018) also explores the uses of simulation in training for combat, focusing specifically on the stagings of cross-cultural interaction and immersion, while Tracy Davis (2007) examines the use of simulation on the level of the state, in the context of civil defence rehearsal.

While the scenarios I focus on are aimed at gaming for the future, there is a distinction to be made between prediction and rehearsal, the former being a means of speculation on the nature of outcomes in order to find the most likely, the latter attempting to prepare its players for all possible outcomes. But of course, these delineations become easily muddled; feedback loops, both cultural and technological, invariably surface, and distinctions between re-enactment and speculations likewise blur. There is, perhaps, an element of hyper-stition at play; a concept coined by theorist Nick Land, describing the positive feedback circuit between culture and techno-science, in which ideas function causally to bring about their own reality (Land 2009). The future performs the past; in simulation, this speculated upon future is a matter of policy, the possible becoming an observable and citable entity which the present must account for (Davis, 2007). Attempting to create resilience and predictability on a systemic level is a crucial practice of managing the modern state (see Giddens, see Beck) and simulation and role-play have historically been used by governments to prepare their citizens and institutions for survival (Davis 2007, Anderson 2010). ‘Like the empire’s map,’ writes Alvarez, immersive simulation ‘can serve a function that is central to statecraft—it makes societies legible’ (2018: 5). Speaking of civil defence rehearsals staged during the Cold War, Davis reflects on how acting was;

‘…the bulwark against nihilism, the motivation for belief, and the insurance of survival. Acting was the way to buy into the idea that civil defence could be efficacious; it was also, at the same time, the means to see how it did not work.’ (2007: 219) 

THE NHS

In the daily practice of clinical care and emergency services, uncertainty is the norm; ‘information is by turns limited, confusing, contradictory, lost, inaccurate and ambiguous…with complex comorbidities that interact in unknown ways’ (Door Avril Danczak et al. 2016: Preface). Illness, the failure of the body in circumstances both chronic and acute, has always been a catalyst for existential reflection, on what it means to exist, to degrade and eventually or perhaps quite suddenly, to no longer exist. The ways humans have managed sickness and death has always grappled with the illusions of control and attempts at understanding the management and repair of precarious life and the emotional and social fallout of death. While pandemics have been a scenario often gamed for by governments, health organisations and entertainment media alike, the actualities of COVID-19 became a testing ground for the management of a large scale health, economic and social crisis mobilisation that laid bare the fragility of the body-personal as well as the body-politic. While clinical training after graduation from medical school in the UK had once operated on an ethos of ‘see one, do one, teach one’ (Godden 2022: 40), clinicians are finding themselves expected to manage increasingly complex systems, technologies, and policies of care, with potentially heavy consequences for mistakes. Not only is failed medical care traumatic, it is also a massive financial burden on NHS resources (Godden 2022, Hunt 2022), especially when steep litigation payouts are considered. Less resources, whether from damage claims or economic policy, typically means more mistakes. Likewise, a shortage of staff due to burnout, means a higher workload on those that remain, leading to further burnout and further mistakes. In contrast to the positive feedback of hyper-stition, such negative feedback loops (cascading failure) are an inherent part of managing complex systems, whether they be a healthcare institution or the human body itself. In a system that is responsible for the health and wellbeing of an entire population and likewise employs the largest number of staff in Europe, the consequences of bad policy, both budgetary and managerial, are high stakes and difficult to game for. A population that cannot depend on safe and reliable medical care is a population that will become sicker, likewise demanding more of a system that is already failing them. Michael Marmot, clinician, researcher and Director of The UCL Institute of Health Equity states that ‘as doctors we are trained to treat the sick. Of course; but if behaviour, and health, are linked to people’s social conditions, I asked myself whose job it should be to improve social conditions’ (2015:8). New plans to aid a struggling NHS include doubling the amount of students studying medicine and nursing by 2032, to deal with staff shortages, and reforming the ways in which training and workflow are managed. Yet still, critical shortages are projected for the years proceeding this benchmark (The Economist 2023a) and the Royal College of Emergency Medicine estimates that up to 500 lives are being lost each week due to delays in emergency care throughout the UK (Cook 2023). 

SIMULATION WARD

The simulation ward at Great Ormond Street Hospital for Children (GOSH) is a collection of office spaces and staging grounds, most notably a mock hospital room that primarily houses a manikin baby and young boy during sim. There is a control room behind a one way mirror in which sim techs observe students, operate the vital signs of the manikins and field calls from role-players. Students are put into small groups for rotation through the simulation, while the rest stay in a room designated for remote observation via CCTV. The ways that students and healthcare professionals react to and engage in role-play, especially with manikins (which are widely acknowledged to sit in the uncanny valley) varies a great deal from person to person. Some have what Simulation Psychologist Gareth Drake refers to as a ‘high cringe factor’ and struggle to suspend their disbelief. Others can carry on with little to no difficulty. The stress of performance anxiety collides with the amusing theatricality of the process, which in turn contrasts what is being role-played, namely traumatic scenarios that would often be life-changing if/when actually experienced in the real world. Such highly constructed and observed stagings and the contradictory sensations they illicit are quite appropriately liminal, both in the term’s original anthropological framing of thresholds and rites of passage (Van Gennep 1960) as well as the cultural association with uncanniness, often relating to uncertain boundaries between the real and the hyperreal (see Baudrillard). Such constructed, transitory spaces, both real and simulated, might also be considered ‘heterotopias’, a concept coined by Foucault, referring to places that are somehow 'other': contradictory, transformative, or disturbing, with crisis heterotopias reserved specifically for those in a state of crisis (1986). 

Role-play simulation, by its very aspirations for immersion and realism, does not easily accommodate filming, but a surprising amount of material exists on YouTube of sim wards, largely by hospitals and educational institutions aiming to showcase their technology and capacities to other institutions. Likewise, many of these recordings are done with 360 cameras, sometimes placed on the manikin itself, creating a surreal experience in which the viewer can simulate being a patient while clinicians role-play care, creating an invitation to a wider, unknown audience to partake in a perspective that is critically vulnerable and yet explicitly non-human. Performance and liminality have long been interconnected by the work of Victor Turner, who considered the liminal a place of ‘potent temporality, a “realm of pure possibility” (St. John 2008: 1), yet it is also worth noting that in such invitations at immersion, the manikins are generally caucasian in appearance and often male in biological terms, trends that repeat throughout simulation scenarios and medical practice as a whole. Appropriately to the structure of Gennep’s Rites of Passage, the transitory liminal stage of simulation is given context and meaning through the pre-liminal briefing presentation and the post-liminal debriefing session, where such cultural factors and risks of bias tend to be addressed, if not always remedied.

Debriefings are handled with care; decisions, observations and feelings are discussed and reflected on, while individual blame is critically avoided. Briefings, undertaken before sim, include real life anecdotes of patient care gone wrong, often through highly affective filmed re-enactments and interviews with the families of those impacted. One such widely cited example is that of Elaine Bromiley, who passed away in 2005 after what should have been a routine operation. Her husband, Martin Bromiley, had been an airline pilot and it was partly due to his campaigning for answers and accountability that led to the widespread adoption of ‘human factors’ training in the NHS, something long utilised by the aviation industry. As stated by Martin, it is important to emphasise that such failures are typically systemic and cultural;

The protocol was not clear, rehearsed or briefed; the use of equipment not well rehearsed and understood; techniques for maintaining situational awareness were not explicitly understood or encouraged; leadership skills and the dangers of fixation were not experienced or understood by the team; and at no stage was open communication explicitly encouraged by the organisation or clinical leaders at the moment of the emergency. (Bromiley, The Clinical Human Factors Group)

Contrary to the methodologies taken up by aviation, such mistakes had too often been covered up by hospital management in a climate of blame and litigation, leaving no space for reflection, assessment, or an opportunity to improve future care (Hunt 2022). Medical simulations are one such way to rehearse skills in ‘human factors’ much as flight simulators are used to train pilots. As such, simulations, especially those that are patient focused, are a vital practice not merely in finding the source of an illness but in developing confidence relating to performance and risk, managing communication skills between patients, peers and superiors, and engaging with infrastructural systems, technologies and hierarchies. System failures in simulation scenarios often also provide feedback into how operations are managed in real life. As observed by Jowsey et al, performance as evaluation and performativity as testing ground exist in parallel in such stagings, looking not only to ‘the end product—competence—but also [exploring] language, structure, behaviours and context to elicit meaning during the process of performing’ (2020: 5). It is likewise an opportunity for students to role-play ‘as their desired future professional selves’ (Ibid: 12) and test out embedded notions of ‘what students understood to be appropriate ways of acting like a health professional’ (Ibid: 9), such as ‘moral duty of care, integrity’ and ‘patient-centred approaches’ (Ibid: 11). 

CIVIC ROLE PLAY

The use of simulated patients and scenarios for training in medical contexts dates back to the Second World War, developed by the British civil defence in 1941, when the bombed out ruins of St. Andrew’s Convent School became the staging grounds for a ‘Rescue School’ where aide workers could practice techniques for safely extracting casualties from bombarded buildings (Davis, 2007:199). Within a year, the school rebranded itself as Casualties Union, a volunteer organisation aimed at training civilians in acting, makeup and staging crisis scenarios to aide the training of first responders, police and emergency workers. During peacetime, Casualties Union engaged in competitions, tournaments and demonstrations, while the Cold War era spurred more involvement in civic defence rehearsals. These events drew large numbers of spectators, intrigued by the morbid theatricality of their stagings, occasionally placed in observation bleachers but likewise as non-actors amid the scenarios (Davis, 2007: 218). These spectacles are described by sociologist Guy Oakes as ‘full-scale annual rehearsals for World War III,’ going on to say that ‘these yearly rituals enacted simulations of nuclear attack in an elaborate national socio-drama that combined elements of disaster relief, the church social, summer camp, and the county fair’’ (Davis citing Oakes, 2007: 2). While the primary aim of these events was to train responders in triage and resource management, they played a key role in demonstrating the consequences of under supplied medications, blood plasma, and personnel; ‘a rehearsal of what citizens should expect when their governments’ plans for them were put to the test’ (Davis, 2007: 217). Once the effects of the hydrogen bomb became better understood by the public at large, these rehearsals became seen as unrealistic, an empty civic pantomime in the face complete annihilation. More commonly, war games of high level crisis management were taken up by the Pentagon and the RAND Corporation, and by 1982 a confirmed 363 simulations, exercises and models, ‘some so complex that they had taken seven years to develop’ (Allen, 1989: 253) had been executed. 

WAR GAMES

Meanwhile in the US, massive war-game manoeuvres were staged at Fort Polk in Louisiana in preparation for World War II, using 500,000 soldiers and locals playing the part of civilians (Sasser 2007). Likewise, Fort Irwin, a stretch of land in the Mojave Desert bordering Death Valley, was decommissioned after WWII and re-oriented in 1981 after the Arab-Israeli War as a new training ground for staging rehearsals against the Iraqi Republican Guard, which ‘allowed the real Iraq to be taken in one hundred hours in the first Gulf War’ (Magelssen, 2014: 158-9). Diana Taylor emphasises that phrases like "theatre of war" and "theatre of operations" have roots dating back to the Napoleonic Wars, stating that “war cannot be conceptualised without theatre models…that prepare politicians, soldiers, and the various publics to imagine, rehearse, and participate in militarism” (Taylor, 2009: 1888). Likewise Desert Storm is often cited as an operation of cold precision and technological finesse; what Jean Baudrillard dubs a non-war – an ethereal conflict whose existence unfurled predominantly through screens, pre-mediated, curated and packaged. CNN and Time Warner both instantaneously collated ‘published text, unedited correspondents' reports, photos and maps’ from the war into a documentary and CD-ROM disk respectively, dubbed a ‘first draft of history’ (Baudrillard, 1991: 3). This abundance of data from the Gulf War was quickly incorporated into SIMNET, the ‘first “shared virtual reality” distributed simulation system’, created in 1983, sponsored by the Defense Advanced Research Projects Agency (Miller and Thorpe 1995). The 3-D landscape of Kuwait could now be viewed from any angle during any moment of the operation. The Gulf War's tank and smart bomb driven precision, however, proved inadequate in readying US forces for the chaos and complexities of asymmetric warfare that would plague the Iraq War in the aftermath of Saddam Hussein's downfall over a decade later. The demands on US forces had been ever increasing in complexity and scope in response to insurgent and ‘three-block-warfare’ as noted by Alvarez (2018: 24) and Der Derian, citing a lance corporal abroad who might ‘rehydrate a starving child, mediate between members of warring clans, handle the media, and use a global positioning system with a satellite linkup to call in a gunship attack,’ (2001: 87) all within a day. Failure to manage these roles lead to grave errors committed by coalition governance and local command culminating in the Abu Graib scandal (Magelssen, 2014: 157), spurring the use of Fort Irwin as a staging ground for acclimating new recruits to the landscape, both physical and cultural, of their deployment; a conduit for instilling the "warrior ethos," with promises of minimising collateral damage and fostering improved U.S.-Iraqi relations (Ibid: 155-6).

The ensuing surreal phenomenon of Fort Irwin’s replicated Iraq is explored in depth by Magelssen and is the basis for the 2008 documentary film ‘Full Battle Rattle’. At the time of filming, Fort Irwin hosted eleven fake Iraqi villages, referred to as The Sandbox, inhabited by Arab Americans, many of whom had fled Iraq in pursuit of asylum in the U.S. Over the course of two weeks in the simulation, soldiers had to build trust with civilian populations, mediate communal and sectarian conflicts and avoid the sorts of critical cultural mistakes that generate insurgent backlash (Ibid: 155-6) while also dealing with ‘snipers, bombs, riots, and bad press from the simulation's equivalents of CNN and Al Jazeera, which televised their every move in the villages’ TV screens (Ibid) creating a surrealist, self contained feedback loop between action, media and policy. The same sandbox techniques have been used in Canada and the UK, as explored by Alvarez (2008) in the staging of Afghan villages. The paid actors playing Iraqi and Afghan civilians had a variety of reasons for their involvement, ranging from a hope that such exercises would truly help mitigate harm committed by US forces, to enhancing their prospects of attaining asylum in their host countries. As noted by both Magelssen and Alvarez throughout their fieldwork, ethical and emotional factors in representing minority bodies and experiences as they engage with hierarchies of power have the potential for transformative inter-cultural exchange and knowledge as much as they can be sites of reductionism, the re-affirmation of stereotypes and re-traumatisation. In turn, the notable absence of diverse experiences and bodies in medical or emergency care simulations, whether due to a lack of resources or unconscious bias, creates a blind spot in the construction of competence, an imaginary of care and crisis in which both the vulnerable and the professional look and act the same way, whereas in real life, they often do not. Despite best efforts, war-games likewise do not truly involve the opposing side in the enactment, as such, argues Taylor, the enemy is always ‘one of us, an extension of our fears and fantasies’ (2009: 1890). I argue, perhaps cynically, that this reductionism, at least on the level of the soldier in training, is often considered by the ‘Military-Industrial-Media-Entertainment’ complex (Der Derian, 2001) to be a feature, rather than a bug.

The 2008 financial crash coincided with the inauguration of the Army Experience Center in suburban Philadelphia, a massive "virtual educational facility”, stationed with active duty recruiters, which had offered a variety of experiences, including a Black Hawk Simulator equipped to immerse participants in a video game tour through an ‘Afghan mountain village while shooting at enemies’ (Elder 2009). Magelssen calls this a “loop” between video games and the action of war, which soldiers increasingly describe as “being like a video game” (Ibid). Much has been said of first shooter games in the context of American gun violence, regarding both civilian and police driven shootings. Many such military oriented games are ‘dual-use’; co-produced by the armed forces and video games industry, released both commercially and for the purpose of combat training (see Der Derian 2001), the most notable being ‘America’s Army’, a game funded by the US military, which enables participants to train using models that actually prepare them for combat engagement, complete with the option to enlist on completion ‘by clicking on a button’ (Taylor 2009: 1981). Moreover, games like Call of Duty incorporate data—ranging from personal to tactical—from recent conflicts to enhance realism and, more crucially, to imbue the games with a sense of authenticity, a valued element heightened by the games' close connection to real-world military practice, shaping the portrayal of conflicts, troops, weaponry, and military hardware.

Speaking again of precariousness as a feature of human life, Butler reminds us that ‘there is no thinking of life that is not precarious-except, of course, in fantasy, and in military fantasies in particular,’ as those classed under ‘opposing forces’ in such contexts are by nature de-humanised and stripped of their personhood, that in such situations ‘the shared condition of precariousness leads not to reciprocal recognition, but to a specific exploitation of targeted populations’ that are ‘”lose-able," or can be forfeited, precisely because they are framed as being already lost or forfeited’ (Butler, 2009: 31). For all the realism and authenticity that military games can provide a player, they rarely ever address the true realism of ending another human life, and the repercussions that follow, whether they be personal, social, political or legal. Inside the closed world of first shooter games, by design, the aim is self preservation, with no consequences for the recklessness or brutality of victory. 

This military-entertainment culture is woven deeply into the American social and political ethos, most notably during the Bush Administration in which ambient international conflict, patriotism and terror management defined an era, the mentality of which have inevitably trickled down to law enforcement, which has ‘long been organized in a paramilitary, bureaucratic fashion…characterized by specialization, division of labor, vertical authority structures, and extensive rule systems’ (Stanislas referencing [Willis et al. 2004], 2015: 373). This ethos is often in conflict with community policing standards, especially with the proliferation of SWAT units and the use of paramilitary hardware, even in smaller towns with low crime rates (ibid: 375), and the ‘use of warlike tactics in handling disorder and petty offenses, such as drugs and homelessness, often under the umbrella of ‘zero-tolerance’ or ‘quality of life’ policing (Ibid). The effects of these policies on police violence, particularly against racial minorities and other vulnerable populations, have been grievous. In response, technology has been sought as a solution. Body cameras, along with the increased use of virtual reality (VR) and immersive screen simulations, have emerged as tools for rehearsing conflict resolution, de-escalation tactics, and digital surveillance as a means of evidence collection and accountability.

Transgression and violence are less serious because they only contest the distribution of the real. Simulation is infinitely more dangerous because it always leaves open to supposition that, above and beyond its object, law and order themselves might be nothing but simulation. (Baudrillard, [1981] 1994)

But in what ways are the lived personal accountabilities of bloodshed managed and processed? Technology and simulation is again invoked, with the rising use of VR headsets and immersive experiences as tools for trauma therapy (Blum 2021).

STRANGE LOOPS

Though not accounting for the majority of simulation work, Gareth Drake, Psychologist in Simulation at Great Ormond Street Hospital, notes “what we’re doing is learning for the future, whereas in fact there’s something about not quite having worked through the past happening in the recreation of it.”  Likewise, as observed by Alvarez, for the Iraqi or Afghan role-player inhabiting a mock village for combat training, these simulations are not a preparation for the future but a lived, theatrical re-enactment of a traumatic past, ‘in what for them were not “theaters of war” but homes devastated by the ravages of war’ (2018: 30-3). As Taylor argues, ‘the past performs the future…so participants are trapped in a tautological circle in which the assumptions about who they are and what they are doing are not examined’ (Taylor 2009: 1890). It’s hard not to speak of the ‘compulsion to repeat’, first observed and theorised by Freud in regards to survivors of trauma who continually seek out the same behaviour that induced the trauma to begin with (Van Der Kolk, 2015: 23). When a situation or experience becomes more overwhelming than our ability to process it, the memory tends to fragment, in terms of timeline and events, in order to protect the psyche. As a result, agency is lost and the narrative is muddled, leaving the brain and the autonomic nervous system to run the experience in loops (flashbacks) in an attempt to seek resolution. Freud had theorised that such behaviour stems from an unconscious attempt to regain control over a distressing event, leading to not only resolution but mastery (Ibid). Others have outlined this as dangerous territory for re-traumatisation.

This theory is one such basis for virtual reality induced prolonged exposure therapy, in which the triggering event is re-created in a digital landscape and followed through to its resolution, in a managed environment, in theory over-riding the previous experience with one of control and safety. Initiated as a form of therapy aimed at Iraq War veterans suffering from PTSD, VR therapy is now being looked at for the treatment of frontline workers in the aftermath of COVID-19 (Blum 2021). In both the US and UK, the rise of chronic stress, burnout and PTSD among frontline and healthcare workers during and post COVID has been well documented (see Hennein, Mew, and Lowe 2021). A report commissioned by the Health and Social Care Committee has found that workforce burnout is at its ‘highest in the history of the NHS and care systems’, posing ‘an extraordinarily dangerous risk to the future functioning of both services’ (Ibid: 3), resulting from excessive workloads brought about by shortages in staff, lack of adequate pay or institutional support, shrinking funding for general practice doctors and likewise more patients being funnelled into hospitals, inundating emergency services and compounding wait times. The disruption, isolation, economic uncertainty, grief, housing insecurity and a surge in domestic violence during lockdown has exacerbated mental health in the population at large, especially among young people (Public Health England 2020, Mind 2021, Blum 2021), leading to a chronic mental health crisis that has left many within and outside of the frontlines managing without proper resources, both material and emotional. In what ways can you simulate and process the patients or relatives who have died in hospital corridors or inside ambulances while awaiting treatment? Such situations feel like scenes from a war film. 

THE CRISIS IMAGINARY

What can we ask of the polity in apocalyptic, plague-ridden times, when the worst of such times has manifestly arisen out of the decisions of the polity itself? What can we ask, or rather what should we be asking, of ourselves? (Rose 2023: 3)

The only weapon of power, its only strategy against defection, is to re-inject the real and the referential everywhere, to persuade us of the reality of the social, of the gravity of the economy and the finalities of production. To this end it prefers the discourse of crisis…’ (Baudrillard, [1981] 1994; 22)

There seems to be a collective sense that we are living on the cusp of cascading failure, in the ‘perpetual end times’, both real and imaginary. But in what ways does the collective social and media driven crisis imaginary interact with the more mundane, dissociative and normative experiences of crisis at a distance? In what ways is crisis framed and managed as simulation, spectacle, as never-ending state of play, as escapism, as political tool? While Steven Pinker (2011) argues that violence has steadily declined, our perception of risk, uncertainty and precarity has stayed constant, if not increased. Ulrich Beck’s conception of the ‘risk society’, which stretches back to the middle of the previous century, attributes this phenomenon to a rise in threats that are simultaneously intangible and unlikely and yet existentially devastating, complex, and open ended, such as nuclear annihilation or climate collapse (Beck 1992), what Susan Sontag refers to as a state of ‘unremitting banality and inconceivable terror’ (1965). When catastrophes unfold, even when they are natural disasters, they are no longer entirely the ‘acts of God’, but inevitably the outcome of human action, what Giddens calls the ‘double-edged character of modernity’ (1965). Devastation is perpetually near yet inconceivable; wars, fires, shootings, and outbreaks are tangibly experienced by those directly affected; in parallel, they are experienced by most others as tragedies that happen in the imaginary, mediated by screens.

There is a dual and contradictory consciousness that spans the act of role-play (embodying acute crisis in a state of make-believe), and the experience of global crisis at a distance, through images ‘over there’ and yet in our hands, much as disasters play out in the imagined worlds of Hollywood films while audience members sit in the cinema or in their homes. In the immediate aftermath of the attacks on the World Trade Center, bootleg DVDs of 9/11 ‘films’ could be found in Chinese markets with titles like “The Century’s Great Catastrophe”. Exploring these films for The New Yorker, Peter Hessler (2001) discerned an unsettling familiarity in certain clips, finding that news footage had been spliced with Hollywood films, stating that ‘the effect was unsettling: a flicker of ambiguity between fact and fiction. The collapse of the towers was followed by a scene from “Godzilla” (ibid). In early 2023, footage from a new first person shooter game called ‘Unrecord’, appeared online. The high fidelity of the artificial body-cam graphics left many commentators unsure if the visuals were real or fake, looking ‘too good to be genuine’ (MacDonald 2023). Meanwhile, clips from hyper-real video games such Arma 3 are being amalgamated with, and subsequently passed off as, eyewitness reports from the Ukrainian frontlines (Chopra 2023), proliferating most prominently on TikTok, going on to be shared by government and news outlets (Ibid), a grim portent for our ability to discern the real from the fabricated; Baudrillard’s hyperreal as hyperstition.

It is no longer possible to fabricate the unreal from the real, the imaginary from the givens of the real. The process will, rather, be the opposite: it will be to put decentered situations, models of simulation in place and to contrive to give them the feeling of the real, of the banal, of lived experience, to reinvent the real as fiction, precisely because it has disappeared from our life. Hallucination of the real, of lived experience, of the quotidian…but without substance, derealised in advance, hyperrealized. (Baudrillard, 1981: 124)

Crisis media is arguably a form of what new media scholar Richard Grusin calls ‘pre-mediation’, a way in which the experience of future trauma is nullified by ‘generating and maintaining a low level of anxiety as a kind of affective prophylactic’ (Grusin 2010: 46), much the same way that simulation acclimatises professionals to the stress of emergency care and complex warfare. When the real world ramifications of disaster ripple out through the rest of the world, they put chronic and consistent strain on institutions and the economy, manifesting further as inflation, unemployment, homelessness, strikes and backlogs, leaving more individuals vulnerable and thus more in need of critical resources and services. The average citizen experiences tangible impact and yet feels ultimately powerless; we have no media-spectacle blueprints for such a state of play, making our expressions of it increasingly fractured, disoriented and nihilistic. Bogna M. Konior (2019) outlines the ways in which these crisis imaginaries filter through the media landscape, such as the subreddit r/collapse, which runs a monthly thread in which ‘users note down the signs of downfall around them, from crumbling infrastructure to rising unemployment’ (Ibid).

The acute crisis on screen is thus both lurid and alluring; citing Sontag, Martin Walter argues that apocalypse films have not only ‘rendered the devastation of western cities a common sight but have also established a new fascination with the aesthetics of destruction’ (2019: 133). In lieu of engaging in complex and seemingly futile social work, both Sontag and Walter argue that such media can function as manifestations of a desire for a more familiar, simpler crisis in which the stakes are whittled down to survival over annihilation, a way to role-play heroism and enact personal agency. Likewise the post-apocalypse imaginary provides a pastoral fantasy, a blank slate from which both neoliberal and communal ideologies about self organisation can arise in the absence of bureaucratic or political oversight. Notably, the average citizen would not survive such collapse. 

Imagine the amazing good fortune of the generation that gets to see the end of the world. This is as marvellous as being there at the beginning…let us therefore apply ourselves to seeing things—values, concepts, institutions—perish, seeing them disappear. (Baudrillard 1997: 33)

Possibly happening in parallel to the clinicians reading synthetic vital signs in the simulation ward, over 950 officials from local and central government engaged in a three day simulation that gamed for the outbreak of an H2N2 virus that had spread to the UK from Thailand, causing 400,000 deaths. Taking place four years before COVID-19, Operation Cygnus was an attempt to rehearse the sorts of decisions ministers would have to take regarding ‘population triage’ and the execution of emergency powers (Hunt 2022: 145). In spite of or perhaps due to being so thoroughly pre-mediated and gamed for, the pandemic and subsequent lockdowns meant that all space seemed to take on the characteristics of the simulation ward; the uncanny, the liminal, the crisis heterotopia, in which emptied streets, hazmat suits, conspiracy theories, closed borders and supermarket looters played out alongside furlough hobbies, Zoom pub quizzes, Tik-Tok memes and the ensuing boredom and existential absurdity in the extremes of our existence. Sales of Albert Camus’s The Plague surged in conjunction with rising death tolls (Rose 2023: 19), as did re-watchings of Contagion (2011), as people sought out blueprints for what felt like a lived apocalypse film that nobody had quite written before. Like returning to daylight after engaging in an escape room experience, lockdown has already receded to the social imaginary, but its consequences continue to cascade. Solutions will not be simple or easily simulated, yet we must expand our imaginary to speculate alternative futures rather than escapist fatalism. As with crisis both personal and systemic, spectacular and bureaucratic, Taylor reminds us that ‘there are no non-players…everyone participates in social dramas.’ (2009: 1893) 

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