new blog

I have a new blog. Don’t read this one! look over here

https://snappalos.wordpress.com/2011/08/12/consumer-medicine-what-sort-of-power-do-we-have/ 

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Abraham Guillen on Crisis

Abraham Guillen was a spanish anarchist who fought in the revolution of 1936 as a member of the CNT and libertarian youth federation FIJL. Interestingly the FIJL held the same position as the friends of Durruti regarding the role of organization, though I’ve never found their positions in print. Guillen continued underground work against Franco until he was caught, imprisoned, and sentenced to death. He escaped to France, and made his way all over South America though mostly to Uruguay and Argentina. He was a founding member of the Federacion Anarquista Uruguaya, and continued to be one of their main theoretical influences. During the 60s and 70s he served as the military theorist and participant in guerrilla war throughout latin america including Brazil, Peru, Uruguay, Argentina, Dominican Republic, etc., and dodged dictatorships along the way. He worked primarily as an economist and journalist, and never abandoned his anarchist beliefs obtained in the spanish revolution, which kept him advocating for a self-managed socialism, and a social revolution against the state. He was an unorthodox anarchist however drawing from the marxism of his time (though not uncritically), and proposing a unity of mass syndicalist movements and armed revolutionary organization. Almost none of his writings are in English. This is a short excerpt of a section of his longer book Philosophy of the Urban Guerrilla, which despite the name is mostly about anarchist analysis and strategy of the economy, the world setting, and latin america.

This post is a placemaker for other articles I’m writing, and I keep loosing the passage so here it is.

“The apparently revolutionary or demagogical slogan “Let the rich pay for the crisis!” is negative, self-defeating and unsuited to a period of general depression, when both the objective and subjective conditions are present for a socialist revolution.

During a period of crisis it is pointless to demand from the capitalists what they do not have to give. It is demagogical and hardly revolutionary to demand that the bosses shoulder the burden of depression when the workers are being locked out or dismissed as supernumerary. A work stoppage is a consequence of the overproduction of wealth by an economic system based on the dictatorship of capital over labor. Among other causes, an economic crisis is produced because of disparities resulting from the social character of capitalist production for the whole people, but for the purpose of ultimately benefitting a few. This structural antagonism between social production and private appropriation sharpens the class struggle to the point of revolution: it becomes the principle motor for the transformation of capitalism into socialism.

In a capitalist regime a crisis is always paid for by the poor, i.e., the workers. Consequently instead of demanding the impossible, that the rich pay for the crisis, the workers should insist on a definitive solution through the socialization of the means of production and exchange. In times of depression the Marxist parties which understand what is happening, and the revolutionary trade unions which are not bureaucratized, must elaborate an economic, political and social program for moving the economy forward as the basis for introducing a socialist system and guaranteeing the right to work. In contrast, the Social Democrats and the modern revisionists, who practice the coexistence of classes, propose to nurse depressions instead of applying surgery…”

Guillen, Abraham. Translated by Hodges, Donald C. Philosophy of the Urban Guerilla. 1973. Morrow Paperback Editions, NY.

Consumer Medicine: what sort of power do we have?

In The Subject and Power, Michael Foucault lays out a framework for understanding relationships between how we are placed as subjects, power, institutionalized power, and struggles surrounding these issues [1]. In trying to understand these subjects, he looks at struggles against forms of power in his time that he felt illustrated these issues, for example: “…opposition to the power of men over women, of parents over children, of psychiatry over the mentally ill, of medicine over the population, of administration over the ways people live”. Medicine is an important example of power for two reasons. First, people overlook the ways in which medicine represents power held over others, particularly the popular classes. Second, our relationship with medicine has undergone some drastic revisions which both make understanding its power crucial and challenging.

Speaking about these struggles, Foucault notes,

“They are an opposition to the effects of power which are linked with knowledge, competence, and qualification: struggles against the privileges of knowledge. But they are also an opposition against secrecy, deformation, and mystifying representations imposed on people. There is nothing “scientistic” in this (that is, a dogmatic belief in the value of scientific knowledge), but neither is it a skeptical or relativistic refusal of all verified truth. What is questioned is the way in which knowledge circulates and functions, its relations to power. In short, the regime du savor“.

Whether or not we agree with the analysis, something important is discussed here. The power of medicine are connected to a few things: institutional privileges mediated by the state (qualifications), an ideological framework of knowledge which is the property of professionals, and that struggles against medicine focus on the relationships between the institutions, the privileges/powers of the professionals, and the subject. He recognizes components of these struggles as “…struggle against the forms of subjection-against the submission of subjectivity…”. That is, people struggling against the way in which Medicine makes them subjects.

Stepping back, medicine through its clinics, educational arms, hospitals, popular science, and media creates subjects through its relationships with people and it’s practices. The role grows up within capitalism, and is mediated and empowered by its position in relation to the State and capitalist business (which both constitutes and invests in its functions). Medical institutions are institutions of ideology and power, in a parallel manner to schools, prisons, the military, etc. They are important sites wherein ideology is reproduced.

This is obscured by the fact that in medicine, the ideology is not obvious as could be argued in say prisons or schools. Ideology instead is made up by the relationship of patients and family to physicians, the bureaucracy, other patients, etc. Patients at each step experience medicine through the prism of class, race, sex, sexuality, etc., relationships and the existing hierarchies therein. It teaches you to know your place, much in the way that schools are structured around and educational in learning one’s position in society. Healthcare is a vehicle to reproduce submission of one’s control over your body to professionals and institutions, whether literally in some cases or more often than not symbolically.

This is not to say that DIY-medicine is automatically liberating or a good way to go. Rather, everything we do in society is reflective of the dominant power relations created and reproduced through the relationships that make up capitalism and state hierarchy. There is not an “outside” where we could create a free medicine liberated from the bounds of power. Instead struggles around liberating healthcare need to occur around the constitutive power relationships that produce an industry of submission and subjugation.

However, the role of medicine that Foucault writes about here, and 20 years early in the Birth of the Clinic, does not exist. Today we find ourselves in a strange place where the prior obvious or naked power of the physician has been unalterably changed. With every day, patients have more and more power in a sense. As healthcare becomes increasingly consumer driven, advertisement laden, and funding tied to consumptive concepts, these roles are shifting. Yet the power healthcare consumers receive is not a power that liberates them from the poverty of healthcare resource availability, the domination by authorities over their bodies, or other such subjugation. Instead it becomes one of apparent choice and apparent freedom, which is increasingly determined by the market and indeed is leading to reduced standards of care.

Through the healthcare reform act, funding is now being tied to customer surveys by patients. Soon funding will be determined in part due to “outcomes” (hospital readmissions, overall health, etc). Such structural reforms by the state have already induced hospital management to revise how healthcare workers spend their time, towards giving patients the feeling of being well served. Hourly rounds aimed at giving patients the sense of people having enough time (while horribly understaffed) and being served like a hotel (at the expense literally of doing proper medical work to improve people’s health) are leading to large time shifts towards the manipulation of patient perception. This is a different form of subjectivity. When our relationship to our bodies and our families, increasingly is subjected to market psychology and competition, it is likely that people will find themselves more dependent upon a system that profits from their misery.

1. Foucault, Michael. The Subject and Power.  Critical Inquiry, Vol. 8, No. 4 (Summer, 1982), pp. 777-795