Illness under Capitalism
The Case for Health Communism...
What would you do if your psychiatrist was accused of terrorism? For members of the Sozialistisches Patientenkollektiv (Socialist Patients’ Collective, or SPK), this became a reality when in 1971, their founder Dr. Wolfgang Huber, was arrested for allegedly manufacturing explosives, forgery of documents, and supporting the Red Army Faction. A former psychiatrist with the University of Heidelberg, Dr. Huber, an anti-psychiatry advocate, believed in the revolutionary potential to create a classless medical society far from the asylum structure they witnessed but a self-described, red-faction army composed of patient workers. (Many SPK members were former patients associated with the psychiatric institute at the University of Heidelberg.) Their mission was to delegitimize psychiatry as they knew it. For some, this community offered a glimmer of hope and a less invasive intervention than what they were used to—electroshock therapy or, even worse, long-term institutionalization. At their height, the SPK had about 150 members, and by in large, they believed they could provide some reprieve for the “sick proletariat” to dismantle the doctor hierarchy. Yet, they are more understood for their terrorism.
When it comes to the anti-psychiatry movement, there is no shortage of dissidents—even from people trained in the discipline. Franco Basaglia, an Italian psychiatrist, advocated for Law 180, which abolished mental hospitals in Italy, believing it was a reservoir for the poor. David Graham Copper, a South African psychiatrist, established a revolutionary anti-hospital that housed people with schizophrenia. These men, educated in the post-World War 2 era, were treating patients in Europe and saw that the old methods were insufficient. Still, more than anything, their contemporary medical taxonomies or procedures were not working. Like many people of their generation, who sought to remove themselves from their elder’s errors, they wanted better solutions. In Germany, the SPK was part of this broader constellation of people who unceremoniously disrupted and disbanded the pillars of psychiatry. However, they were distinct in their commitment; they were revolutionary communists.
In his poem, “A Worker’s Speech to a Doctor,” the Marxist German playwright and poet Bertolt Brecht begins the verse with a simple declaration “We know what makes us ill.” A master of capturing the frustration of the proletariat, the lyric slowly reveals that illness is not just the state of being unwell but the conditions that create them. This incessant and cankerous poverty is manufactured under the capitalist state. Like Brecht, Beatrice Adler-Bolton, and Artie Vierkant, co-hosts of the podcast Death Panel, who believe the culprit for health is capitalism. So, it’s befitting that their solution is an antithetical philosophy, a case for communism. In their recently published book, Health Communism, they argue that the medical systems as we understand them are a “biological, fascist fantasy,” They propose a radical re-evaluation of how health should be defined. They want to move away from the language of scarcity and excise themselves from the vocabulary of “underserving” and “deserving” and, like some early anti-psychiatrists, build something different. For them, the capitalists are not just the pharmaceutical companies. They want to wield power away from capitalists—including the democratic socialist health systems, and towards a health utopia that none of us have ever witnessed. Before they define that utopia, they describe the origins of the modern health care system—which emerged during a working-class revolt.
Despite Otto von Bismarck passing the anti-socialist law of 1878, which barred social democratic meetings and newspapers, they became an indelible mark of imperial dissent. After an assassination attempt against the Kaiser, he established the Krankenversicherungsgesetz in 1883, making Germany the first to adopt a social health insurance program. In practice, this meant that people who were citizens of the state—not colonial subjects—were guaranteed health provisions. The German model has since evolved into a private-public conglomeration, where undocumented migrants, or even neglected unhoused people, often fall outside the welfare state as we know it. Still, the state provides far more of the main subject of Health Communism.
Adler-Bolton and Vierkant provided receipts for the people who have historically undermined the possibility of forming the health utopia they believe the world deserves. Like Germany, the US had socialists who demanded socialized medicine—though far less within the broader workers’ movement—but much more came in the way. The political milieu, insurance companies, and pseudoscientific doctors were far more adamant in the US and could stubbornly oppose, the authors argue, most forms of welfare. For example, Frederick Ludwig Hoffman, a statistician and eugenicist in the early twentieth century at Prudential Insurance Company, lobbied against implementing social health insurance, such as in Germany, fearing that physicians would provide false sick notes for workers, which he believed would undermine American productivity. On many levels, this is insidious and fails to acknowledge that people should and can rest. Not until after World War II would universal health care be retaken, when, in 1946, President Harry S. Truman’s National Health Care plan would have expanded public health services, trained more physicians, and created a national health plan for all Americans. To his credit, radicals such as the Congress of Industrial Workers initially supported Truman's health bill, but the legislation was subjected to fierce opposition.
One of the most vocal opponents to Truman’s plans were members of the American Medical Association, who denounced the program for fearing that it would undermine their professional sovereignty and that it was veiled Bolshevism. Adler-Bolton and Vierkant argue that the AMA’s opposition to the act is a conventional contradiction dilemma; doctors make decisions based on their class interests (upper class) or their profession’s theorem (Hippocratic Oath). The AMA was not alone. Time and again, US politicians, such as Hubert Humphrey and Ronald Reagan, have argued that sick people were a burden and that they saw anyone who did not fulfill their conception of productivity as a “drain on the economy.” Reading this history is a reminder of how much the ruling class—politicians, scientists, and some doctors—detests ordinary people.
More than the history of healthcare, the authors of Health Communism want to redirect people’s well-being outside of the biological categories that have been constructed, but instead, operationalize a social rubric of “who is a worker, who is property, and who is surplus.” But they don’t stop there; they want to integrate leftist theory and terminology into their manifesto by drawing attention to prison scholar Ruth Wilson Gilmore’s “organized abandonment” and disability scholar Liat Ben-Moshe’s term “carceral sanism.” Together, this intellectual landscape provides leverage to develop the political lens for them to unpack how the most marginalized groups in society are alienated in a late-capitalist state.
Through their combined efforts, Alder-Bolton and Vierkant develop their terminology and nourish the readers with their intervention, “extractive abandonment,” arguing that even countries with socialized medicine have not had health communism, and according to the authors, “routinely maintain their surplus populations with overt antagonism.” For the authors, the surplus population is the disabled people, the poor, and racialized are the sacrificial lambs of capital. And given this, the most marginalized should be the central focus of challenging the neoliberal health regime. They theorize about the political economy of the surplus population. But they don’t stop there. For the authors, a mental hospital is a way to rehabilitate idleness and instill discipline. Rather than addressing the core of the problem, psychiatry is meant to manage and suppress behaviors for the service of capitalism. As they rightly mention, there is a troubled history with reforms that have failed to provide healthcare for everyone.
In the twelve years since the Affordable Care Act was passed, the US has experienced a global pandemic. The US has reported over one million Covid-related dates as of this post. While the authors intentionally do not discuss Covid-19, one cannot ignore these deaths with the glaring reality that 33.2 million people in the United States remain uninsured. The movement for Medicare for All arose not as a fringe collection of people, as the SPK is a loose coalition of millions of Americans who have demanded a single-payer universal healthcare system. Yet, time and again, their efforts have fallen short, not for lack of trying, but of the ongoing rightward shift in American capitalism.
Adler-Bolton and Vierkant suggest that so long as there is a health system grounded on a political, economic system of profit, people’s productivity. By extension, their ability to contribute to the system will be considered. Even if there are mandates, such as the NHS, the discourse around debt burden, according to the authors, becomes a way to limit who has access to healthcare. Ultimately, they are challenging the frameworks that many people have come to accept, that society has abundance, that people should not be marked by their productivity, and that disabled people are not a burden to society. They call for an abdication of the terms, structures, and systems we know. And that’s seductive for those who have witnessed catastrophic problems.
While the text is noteworthy for pointing out the flaws in the health systems, the authors could have dedicated a bit more time to sit with the narratives of the oppressed. At times, we have presented the use of terms to describe a phenomenon without unpacking the historical specificity of the time. For example, when we do get horrific accounts of several patients, such as Mr. Frank #27967, a Black man who was held at the Willard Psychiatric center for nearly four decades for an initial public action where he was deemed to “act without reason” because he was yelling and kicking garbage cans outside of a restaurant in downtown Brooklyn. They note that Frank’s behavior was depicted as antithetical to the needs of society under capitalism, a hindrance to productivity, a burr on the otherwise smooth surface of “forward progress.” Rightly so, people who are deemed mentally ill are often perceived to be a burden to the state. But madness is more than what the state considers. The text could have been enriched with information about his family, his neighborhood, and the number of people—specifically, Black men, who were incarcerated at Willard at the time. But what was missing was empathy for this patient and their community. For anyone who has had a mentally ill relative, a significant issue can be the failure of these facilities to provide adequate care. The text straddles on dogmatism, and their argument could be better served if we had more perspective from the people they want to be at the center.
In the twelve years since the Affordable Care Act was passed, the US has experienced a global pandemic. The US has reported over one million Covid-related dates as of writing this article. While the authors intentionally do not discuss Covid-19, one cannot ignore these deaths with the glaring reality that 33.2 million people in the United States remain uninsured. The movement for Medicare for All arose not as a fringe collection of people, as the SPK is a loose coalition of millions of Americans who have demanded a single-payer universal healthcare system. Yet, time and again, their efforts have fallen short, not for lack of trying, but of the ongoing rightward shift in American capitalism.
Today, the SPK's unofficial but definitive website presents itself like an older 4-chan website. In one section, the page notes, “Weaponizing disease is the first glimpse of a future to be manufactured, stripped of (final solution) names, rulers, health factories, and so on. We call it neuropathy.” Reading this, it is hard to have anything but antipathy to the movement for its lack of intellectual seriousness commitments, even if there are elements of its philosophy that warrant merit. While significant for challenging how we define health and healing, their legacy can provide the fodder to alter our worldview; however, as it stands today, the SPK does not appear to offer much revolutionary model. Community-oriented health collectives like the Black Panther Party, which Alondra Nelson’s Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination, have stood against the consumer logic of healthcare that has become ubiquitous in the US. So reducing health communism to SPK’s approach alone may elide other healing models that center the sick and disenfranchised.
In a moment when people are detached from some movements, or even dislodged from a significant win, vision matters, and manifestos have their place to enthrall, embroil, and move people when there are deficiencies in society. More than anything, revolutionaries have a place in the world for questioning the idea that we have to accept that we live under scarcity. As much as Health Communism hinges on dogmatism, it is also filled with a relevant message. “Our responsibilities to collectivity and care do not end at the edge of a map,” Adler-Bolton and Vierkant write with exacting passion. Underpinning this declaration, even in its simplicity, is the sense that we owe each other more than mere slogans and that we have to contemplate how we can exercise empathy—not through verbal platitudes or applause for health workers, but something more drastic—health that provides unwavering care.
An Announcement
My Guardian Long Read, ‘Infertility stung me’: Black motherhood and me was selected for the Best 20 Guardian Long Reads in 2022. I highly recommend reading the other articles if you’re interested in the theory of evolution, written by Stephen Buranyi, or a cartel and murder in the Netherlands, by Jessica Loudis.
A Word
Recently, I made a confession about my relationship with the church, a declaration that proceeded well before the death of Pope Benedict XVI. In We Plot to Undo the World, which was published in Public Books, I wrote:
When I was a child, I never had much to say about a Sunday church service, except that I didn’t want to be there. Enduring the dragging hours and unadorned Southern heat, I tried to avoid the redolent church ladies with satyr faces who scowled at anyone who didn’t praise their Lord as they deemed fit. On and off for 12 years, like many other children in our congregation, I read the Bible in French, sang the hymns in Creole, and spoke rebelliously in English.
Luckily, by my own will, this all came to an end, mostly because I was too precocious for my good, constantly questioning the world around me and shedding any belief that there was a God to begin with. So, I stopped going to church at 13 and with that, lost access to a weekly gathering of Black people who were committed to singing, dancing, and dressing their best.
My rejection of Christianity as a spiritual practice is something my mother—though not my agnostic father—continues to criticize me for today. This is mainly because I tipped the spiritual divide in our home toward the heathens; on one side stood the pious, my mother and sister, and on the other stood the unbelievers, my father, my brother, and me.
The article focuses on an event, not the church itself. I attended Simone Leigh’s Loophole of Retreat in October. An extension of Simone Leigh’s US Pavilion exhibit at the Venice Biennale, the retreat gathered artists, activists, and scholars from all over the world. Curator Rashida Bumbray and Professors Tina Campt and Saidiya Hartman probed attendees to focus on Black women’s creative and intellectual labor.
In Looking at Berlin’s present through its past, written for Aljazeera English, I review the exhibition Trotz Allem: Migration to the Colonial Metropolis Berlin, featured in Kreuzberg. A modest exhibition in the German capital shines a light on the city’s relationship with non-European migrants – both past and present.
By the way, if you’re ever inclined to read my work, you can either visit my website or my linktree.
A Read
Recently, I finished Animal Joy by Nuar Alsadir, which details the immense parallels between psychoanalysis and being a clown. As someone who has been in psychoanalysis for years, I was intrigued by the links and envisioned myself dedicated to the fine art of miming my way through life. As a reader, I was hoisted into a world where cultural criticism was engaged and deeply invested in frank humor, which left me wondering, shall I make a joke in my next psychoanalysis session?
With Radical Joy,
Thanks for sharing Edna! I'd like to read the "Health Communism" book.
with radical joy upon reading,
Nathan