Health Communism: A Surplus Manifesto

Product Information

They provide a couple of case studies of radical resistance to Health Capitalism, The AIDS Coalition To Unleash Power (ACT UP) in the US which formed in 1987, and the West German Sozialistisches Patientenkollektiv (Socialist Patient’s Collective or SPK), founded in 1970. They see both groups as exemplary if not perfect, and propose learning from their strengths and weaknesses to build an anti-capitalist movement to establish “all care for all people” (xii). I include a brief look at their description of the SPK below since that group is less written about in the historical record of left activism. BAB: Moving forward, we can’t simply say that we want to reproduce systems wholesale, we can’t hold things up to be heroic, when there are critiques that are teaching moments for how to not repeat the mistakes that we’ve already made. We’ve already made those mistakes. It’s up to us to make new mistakes, and learn from those. In the aftermath of the SPK, there has been ideological repression of radical critiques of capitalist society and concrete state repression of militant activism. Yet the contemporary moment sees more and more mainstream re-linking of mental health and politics, and the spectre of the unfinished business of the SPK still haunts us. The authors follow the core logic of the SPK, suggesting that illness under capitalism might be reappropriated and turned against the system itself, making illness a weapon against capital.

The authors are demanding the anti-capitalist version, but their portrayal of the different factions comes off as fair in my estimation. The call to revolutionise the political economy of health, is a call to revolutionise the left. To move from imperialist social democracy to a decolonial communism. Breaking with the hegemony of the Labour Party allows the opportunity to rethink the NHS, to rethink health, just as engaging critically with the NHS, from the perspective of health communism, provides an opportunity to weaken the hegemony of Labour and its workerist, racist politics. The myth of the Labour Party is at least in-part entangled with the history of the NHS. The invocation to save the NHS is not dissimilar to the rallying cry to save the Labour Party – but whilst the latter should be left to rot, the former shouldn’t be abandoned as a ground of struggle. Indeed, health communism is an expansive project that can coalesce multifarious struggles to come together and build a new society out of the ruins of this one. Whilst defensive measures to resist state violence are needed, health communism can link struggles together and provide a positive vision that we can fight for. I don't know enough to say whether or not some of the reformists were for winning reforms now with the long haul strategy of more radical change, but in the book some of the justification offered by reformers was getting whatever they could as people all around them were dying, even if it meant leaving the corrupt, eugenic, capitalist healthcare system intact. Why should we spend money for a fool, for a hopeless ill person, if I can do with the same money so much good for a poor peasant's kid..." Asylums are a paradigm of this intersection of care and carcerality. As institutions grew, they harnessed the labor-power of patients, from launderers to farmers to research subjects (this is the most harrowingly researched part of the book). Deinstitutionalization did not end these profit mechanisms but distributed them to the present American network of consumer-driven, “publically private” long-term care homes.Even so, the pharmaceutical industry had a big hand in shaping US colonialism via the creation of capitalist global trade regimes and laws that ensured corporate control over who could produce and profit from vital medicines as well as ensuring scarcity as needed to guarantee higher profits for pharmaceutical companies. Today this regime, known as Trade Related Intellectual Property Rights (TRIPS), means that “in effect, twelve corporations made public law for the world” (90). Those countries not willing to play by the rules of TRIPS may be excluded from trade in and access to life saving drugs and treatments. This “global rationing regime” marks “entire nations as surplus” (78). The emergency pandemic expansion eliminated the need for the constant and endless “recertification” steps to maintain membership and coverage. The hosts note this was hugely successful and massively increased the efficiency and reach of the program. A.V.: We do want that, actually. But we don’t want to just carbon copy what exists in the U.K. because the NHS actually is a perfect example of why doing universal health care but making it operate still under principles of austerity only accomplishes so much.

The position of the AMA, of the organized labor movement, and increasingly in the post-war era, of the American public, carries a lot of the eugenicist and Malthusian assumptions that the authors establish as key to capitalist health care. This is not to say most people are against socialized medicine, only that the assumptions of what that could be have been constricted by now dominant views of what is possible. Building on this is their concept of ‘extractive abandonment’. This is a synthesis of Marta Russell’s ‘money model of disability’ and Ruth Wilson Gilmore’s ‘ organised abandonment’. Adler-Bolton and Vierkant define extractive abandonment as: ‘the process by which [surplus populations] are made profitable to capital’. [11] Or as they put it otherwise: ‘In a political economy built on systems of extractive abandonment, the state exists to facilitate a capacity for profit, balanced always against the amount of extractable capital or health of the individual subject’. [12] BAB: SPK was a patient liberation organization that formed in 1970s West Germany in a hospital in Heidelberg and only existed for a very short period of time. There are people still using the name SPK today, but we are talking about their original historical formation. Two of the final chapters in the book, called “Care” and “Cure” are, to our knowledge, the most comprehensive English language account of the activities of this group, perhaps outside of their own manifesto. Their work marked an important moment, not only for disability history or patient liberation, but also in left political thought. We wanted to make sure to tell their story for what it is: a story of the pathologization of political dissent. Their manifesto came out in 1972 and is still not widely known, but many of their ideas are common in leftist thought today. They were talking about what we would now call the social determinants of health. They were saying, we have mental-health diagnoses, don’t put us in congregate facilities, we need supportive housing. We want to study ourselves and do self-directed therapy.

1%? Up yours! We need health workers' and patients' power!

The key concepts developed by the authors are those of ‘surplus’, ‘extractive abandonment’, and ‘health communism’ itself, which is contrasted to its contemporary counterpart, ‘health capitalism’. Heath Communism is not "well-behaved": It is not interested in sober consideration, dry pontifications. It thrives through a sense of optimism. There is a joy to a manifesto that sits alongside its anger. If it is birthed from complaint and fury, these emotions are funneled through a hope that things could be otherwise-most of all, an optimism for a new collective. Jon Venn, Full Stop The authors’ key claim is that regimes of biocertification are arbitrary and inconsistent, reducing individuals almost entirely to their capacity to work. Following Marta Russell, they view disabled workers as ‘canaries in the coalmine’, whose treatment is a sign of what threatens others after a workplace injury or a shift in what is deemed ‘healthy’ within society.

David Stark Murray, Why a National Health Service?: the part played by the Socialist Medical Association (London: Pemberton Books, 1971), 78. In this way they went beyond most of the contemporary anti-psychiatry movement that tended to be reformist, with left and right wing political iterations. On the right, US libertarian Thomas Szasz promoted the idea that psychotherapy was mostly fake, but that it’s value was subjective and should be determined by the free market, meaning those who could not afford it were not a major concern to him (134). Beatrice Adler-Bolton and Artie Vierkant argue that capital ‘ resides in health, as its host’. [1] Health Communism develops a comprehensive critique of the political economy of health. It does this whilst seamlessly moving through race, class, gender and disability. Health is not commonly imagined as ground for revolutionary struggle. Its radical organising potential is overlooked and instead health is reduced to a technocratic category, whereby ‘health’ is assumed to mean something coherent and obvious. Imagined actions, for a socialist project, are to undo the privatisation of the NHS, invest in healthcare and extend democratic reforms. However, Adler-Bolton and Vierkant contend that we can further, that there is ‘revolutionary potential’ in severing capital from health. As the Sozialistisches Patientenkollektiv (SPK) invoke we can ‘turn illness into a weapon’ and strike at a neglected weakness and sever capital from its host.The authors claim that they offer one of the most comprehensive accounts of the SPK in the English language. Indeed, their historical account of the SPK, and their revival of the group’s relevance and political concepts, is one of the book’s greatest strengths. Though the SPK originated as a collective of psychiatric patients and doctor collaborators, the authors emphasise their unitary theory of health, making no differentiation between the physical and mental, rather seeing all illness as the result of social and political determinants. I’m grateful for the way you resist exceptionalizing COVID. And I think the show is key for looking at how pandemic discourse is produced and to what ends, and how this fits into a longer history of health capitalism. In Health Communism, you write that “health functions as capitalism’s host body.” Could you elaborate? What is “health”? This seamless book fills an urgent void in leftist theories of illness...the achievement of such a concise yet cogent framework (aided by the fact that the past years have only confirmed its conclusion) is a marvel. Selen Ozturk, PopMatters Health capitalism is a system where health is an impossibility: a state one cannot get to, but to which one must always strive. It refers to the way capitalism has intertwined itself so completely with health to make the two seemingly inseparable; its definition of health as ‘able to work’ seemingly unquestionable.

The current pandemic, during which Health Communism was written, is wholly and deliberately excluded. None of the Covid pandemic’s “lessons” were unknown, and none of its effects (save for the most menial) were unforeseen. They have only affirmed the authors’ socially determined view of health: housing is healthcare, working conditions are healthcare, food is healthcare, and clean air is healthcare. To attain it is to center on our demands of the current system and the surplus population that it creates and extracts. In Health Communism, Beatrice Adler-Bolton and Artie Vierkant first identify and provide an overview of the methods and ideology that have solidified into modern Health Capitalism. There are multiple ways the state rations care and humanity. One way this is enforced is through the carceral-sanist state and the threat of institutionalisation. Adler-Bolton and Vierkant state that: ‘carceral sanism is a preference for deprivation in the face of need, for confinement over care, a violent and dispassionate way to enforce social and biological norms.’ Incarceration might take the form of refugee detention camps, prisons, psychiatric hospitals – the state has many carceral forms to apply to those it deems unworthy of humanity and care. A recent example being the awful death of a young autistic woman who was deprived of care and humanity at a psychiatric hospital. Nearly 60% of people in inpatient mental health hospitals are autistic with an average length of stay of more than 5 years. Written by cohosts of the hit Death Panel podcast and longtime disability justice and healthcare activists Beatrice Adler-Bolton and Artie, Health Communism first examines how capital has instrumentalized health, disability, madness, and illness to create a class seen as "surplus," regarded as a fiscal and social burden. Demarcating the healthy from the surplus, the worker from the "unfit" to work, the authors argue, serves not only to undermine solidarity but to mark whole populations for extraction by the industries that have emerged to manage and contain this "surplus" population. Health Communism then looks to the grave threat capital poses to global public health, and at the rare movements around the world that have successfully challenged the extractive economy of health.

Review: They can't kill us all: Ferguson, Baltimore, and the new era in America's racial justice movement

Huber was critical of the American model of psychiatry, especially the way it failed the lower classes. He saw capitalism itself as a hurdle to patient care, with the class system dividing patients and doctors, but also precluding access for those who could not afford it. The model of treatment he developed with his patients was called “therapeutic political education” a blend of anti-psychiatry and anti-capitalist politics (140). Health Communism is dedicated to the Socialist Patients’ Collective (SPK). For readers who maybe aren’t familiar with the group, what was SPK what is their legacy? How does your book draw from their work? Death Panel has an amazing aesthetic, from the show images to the merch to the ending music. These component parts are great in and of themselves, but they really come together to create a very coherent, intentional, and effective aesthetic. Before we go: How was this aesthetic developed, and how would you describe it?