The healthcare industry is class warfare. Its most basic level of care comes with a hefty price tag, and even when that price has been paid, services can be denied, pitting patients against insurance companies and providers in their scramble for profit. Across the political spectrum, many celebrated the recent assassination of the UnitedHealthcare CEO. Politicians, journalists, and authority figures wrung their hands over people endorsing murder, disregarding the ways in which private and public health insurance enable slow death.¹ In the time since Luigi Mangione was detained as the suspect, his manifesto, selfies, college experiences, and centrist politics have been a popular point of discussion. Reminiscent of summer 2020’s ‘black square’ phenomenon, or the ‘all eyes on Rafah’ trend of February 2024 that featured a machine vision-generated image of a refugee camp city in Southern Gaza, the focus on Mangione’s personality has overshadowed what people claim to care about. It has obscured the reasons that our material conditions must be changed, the potential that we have to change them, along with many current events that concern the very system—further perpetuating delayed knowledge. 

This syllabus moves away from such discourse and instead delves into the for-profit system that is ‘healthcare,’ along with the subject of reform. Together, we will look at knowledge production in a number of institutions through texts and films concerned with standardization, science and technology, trust, ignorance, surveillance, capture, access, and neutrality. Our approach will be Marxist. We’ll also consider some of what has been buried by the media in the U.S. in the last several weeks. 

Ask the following questions as you read and watch: Who is science for? Who is it against? Who remains neglected? How have the sciences attempted to integrate positionality, or social, cultural, symbolic, and political-economic issues? In what other forms do science and medicine instrumentalize disability or debility? Finally, how does capitalism inflect the distribution of justice across populations? What systems of reliance does it impose? Exactly how does this differentiate from what Mahdi Amel named the “colonial mode of production”? Let these questions guide you as we delve in.

1: not enclosed but in debt

read:

Dylan Mulvin, Living Proxies, the Standardized Patient Program, Proxies: The Cultural Work of Standing In, pp. 145-182

Maurice Merleau-Ponty, The Theory of the Body is already a Theory of Perception and part of Sense Experience, Phenomenology of Perception, pp. 235-241

Gilles Deleuze, Postscript on the Societies of Control, October, pp. 3-7

Hicham Safieddine, Introduction: The Anti-colonial Intellectual, Arab Marxism and National Liberation: Selected Writings of Mahdi Amel, pp. 3-9

Frantz Fanon, The ‘North African Syndrome’, Toward the African Revolution: Political Essays, pp. 3-16

watch: 

Michael Haneke, Caché

In his book Proxies: The Cultural Work of Standing In, historian Dylan Mulvin explains that the scientific, medical, and also philosophical function of diagnosis is to regulate the ‘normal’ body. With scientific racism and/or eugenics, medical professionals decide who is allowed to feel pain, whose illness they will believe, and so on. Mulvin looks at how the standardized patients program, as a technology and performance, effectively dispossesses people of the authority to determine how their own ailments are recognized.

Standardized patient programs began as a “curiosity” in 1963 and became “a necessary part of medical accreditation in Canada and the United States” for physicians forty years later. These programs hire actors who are not disabled to perform disability. Impairment is measured, while the actors teach the doctors-in-training about empathy, how to diagnose, and what to do in particular situations, such as an overdose. Mulvin emphasizes that for marginalized people, being treated with ‘good bedside manners’—  being believed with regard to their experience—is far from standard practice. Discrimination, not care, is the norm. This is enabled by proxies, although it does not begin with them.

If a theory of the body is also a theory of perception (Merleau-Ponty), measuring any sort of impairment will only ever give us part of the story. While impairment may be a relational concept, it is highly personal. What does it mean to perform disability, illness, and pain? What does it mean for a doctor to believe that a patient is performing? Who is most impacted by this? What predetermined understandings are activated and perpetuated within medical ‘rehearsal’ spaces?

Institutional capture, however, does not foreclose the emergence of class consciousness. Crucial here is the difference between the capitalist mode of production and the colonial. Class division in the west and in colonized societies is distinguished by “the struggle for national liberation” (Safieddine 5). Psychiatrist Frantz Fanon explicates how the settler doctor/Algerian patient relationship facilitated the imprisonment of Algerians. He also considers the relationship between the French doctor and Arab patient in France through the ‘North African Syndrome:’ a catchall pathology permitting French doctors to dismiss Arab patients’ ailment as false. Fanon attributes this pseudoscientific diagnosis to racism, and the patients’ sickness to the social alienation experienced by colonized people. As you read this week, think about the relationship that coalition building and armed struggle have to social and political economic reform.

2: disruption

read:

John Lee Clark, Against Access, McSWEENEY’S 64 – The Audio Issue

Sînziana Păltineanu, The Woman Without a Mouth, Makhzin

Taysir Batniji, Disruptions

Jasbir Puar, Postscript: Treatment Without Checkpoints, The Right to Maim: Debility, Capacity, Disability, pp. 155-162

Kate Crawford and Vladen Joler, Anatomy of an AI System: The Amazon Echo as an Anatomical Map of Labor, Data and Planetary Resources, Artificial Intelligence Now

Very often, accessibility doesn’t go beyond, or even meet, legal compliance, which makes use of a liberal, rights-based logic. These conditions are described by John Lee Clark, Taysir Batniji, Jasbir Puar, and Sînziana Păltineanu, where mere compliance is equated to precarity and/or a total lack of access for the individual. Kate Crawford and Vladen Joler, on the other hand, consider access through the assembly line. Supply chains have difficulty completing an audit of their very own networks because the production process is often unregulated and dispersed. 

As you read this week, reflect on the concept of disruption. Disruption of access, access that is perceived to be a disruption, and access that is thought to be standardized. Where should we differentiate between types of access (i.e. economic, technical or infrastructural)? When does the differentiation of access appear to be nonsensical or inappropriate? How might the act of participation still “prioritize neoliberalism, markets, individualism, and consumerism” (Ellcessor 6)? 

3: technical reserves

read:

Georg Simmel, Social interaction and exchange relations: money’s functions, The Philosophy of Money, pp. 173-178

Gil Eyal, Trust, The Crisis of Expertise, pp. 43-63

Fady Joudah, Carina, Rusted Radishes

Carolyn Lazard, How to be a Person in the Age of Autoimmunity

Bob Flanagan, Why? 

Shahd Alshammari, On Being Woman, Other and Disabled: Navigating Identity, Word and Text, A Journal of Literary Studies and Linguistics 8, no. 01, pp. 37-47

watch:

Walter Salles, The Motorcycle Diaries

“The body splits in two . . . I sought cure by any means necessary as if illness is a labor union that science must squash.” –Fady Joudah

With capitalism, money became a “function of exchange,” acting as a third party to mediate relations between people (Simmel 174). As a medium of exchange, money is invested with the abstract authority of ‘objective’ value. However, it also generates insecurity. Precisely how labor is converted into value remains abstract and unjust. Political-economic conditions can be terminal for individuals. Philosopher Friedrich Engels calls this “social murder.” 

Money transactions operate with trust, or even in place of trust. For sociologist Georg Simmel, the indescribable element of trust “is most clearly embodied in religious faith.” However, in the increasingly secularized and liberal society, symbolic capital held by institutions commands trust as well. 

“Talking about trust is [then] the inverse, the mirror image, of talking about expertise” (Eyal 43). Who defines the expert? The category of expertise, or the foundation of the ‘expert’ has been connected to a rise in liberalism, where governance is the domain of the expert, whose claim to exercise rational judgement is the strongest (Bratich). The professionalization of the ‘expert’ regulates who can make the claim to be objective, and therefore impartial. If expertise is not established, institutions will be doubted. Expertise can be situated in the politician, the scientist, the CEO, the teacher, or the journalist. 

Expertise is declared and reinforced in exchanges between experts. A layperson is produced, who holds positive and/or negative attitudes about the experts and the institution (Eyal 44). This can include agnostic or ambivalent relations with the healthcare industry (Lazard). Personally, I don’t exactly understand how my biologic immunotherapy works, but I understand how different I feel when it shoots into my blood every Tuesday. I can also understand that the majority of research that considers it to be favorable is supported by the drugs’ corporation, which just so happens to be a trend in drug related research (Eyal). I disagree with my provider on how I should live my life and Medicaid is the bane of my existence. But I still take the medication. I trust that it will sometimes alleviate certain symptoms that come with autoimmunity; that it may let me move and think, even if it brings many undesirable symptoms with it.

Pharmaceutical companies, ‘healthcare,’ primary secondary and postgraduate schools, prisons and governmental corporations all operate according to enterprise logic. Expertise is strategically deployed in the interest of profit. A popular subject surrounding distrust in the healthcare industry is vaccines. It is distrust for the profit incentive and government initiatives, rather than distrust in science, that frequently leads to vaccine skepticism. Yet, the distribution of vaccines in the west didn’t spring up as a monopoly. Although vaccine history is inseparable from enslaved labor and colonization, it originally wasn’t thought of as a technology for profit, but rather for the benefit of the people (Reich). Over two centuries later, marginalized groups have a long list of historical reasons to distrust vaccines. Still, being anti-vax is widely regarded as an imposition of eugenics.

There is a growing literature on disability as a method, which centers the individual as the locus of expertise in their own disability. Concurrently, the medical model of disability relies on the exercise of the scientific method, even if its ‘experts’ have eroded patients’ trust. Trust and mistrust shape one’s relationship to the body as well, and by extension, the self. To what extent can I trust my own body? How do I attempt to control it? What is the relationship between trust and control? In what ways must I rely on others when I can’t trust my own body? What about the state? Where do I refuse to trust others? When do I feel apprehensive, and what information does that contain about trust?

4: “the new army reserve of labor?”

read:

Marta Russell and Ravi Malhotra, Capitalism and Disability, Capitalism and Disability: Selected Writings by Marta Russell, pp. 211-228

Tega Brain, Sam Lavigne, and Johanna Hedva, Get Well Soon Archive 

Liz Jackson and Rua Williams, How Disabled People Get Exploited to Build the Technology of War, The New Republic 

The Industrial Revolution defined disability through the labor economy. “With the advent of capitalism, people were no longer tied to the land, but they were forced to find work that would pay a wage—or starve; and as production became industrialized people’s bodies were increasingly valued for their ability to function like machines” (Russell and Malhotra 212-213). In the collection titled Capitalism and Disability, Marta Russell’s essay with Ravi Malhotra understands disability to be “an outcome of the political economy.” 

The title for this week, the new army reserve of labor? comes from Russell’s play on Karl Marx’s reserve army of labor, which attributes the surplus worker as a necessity for the capitalist mode of production (Marx; Russell). The ‘new’ army then includes the disabled person who is excluded from some labor, yet is included through rationalizing neoliberalism. As forces and relations of production created the rationale for confinement, disabled people incapable of ‘productively’ joining the workforce were understood as a group to be excluded from the public sphere, limited to “a variety of institutions, including workhouses, asylums, prisons, colonies and special schools.” However, these institutions also became sites for labor, as Liz Jackson and Rua Williams explain through their discussion of sheltered workshops and the 1938 Wagner-O’Day Act in the United States. The ruling class in the U.S. responded in a few ways. Many employers continued to think of disabled workers as too expensive, while others understood disabled people as potential profit or tax write-offs. Russell and Malhotra refer to the latter as a “corporate solution to disablement.”

Institutions that confined disabled people grew increasingly unpopular as more soldiers were disabled during World War II. This led to social legislation in the heart of empire, the west, further intertwining institutions such as education and ‘healthcare’ with the state. Specific types of institutional capture were established, favoring economic expansion. For example, welfare reform in the west made eligibility requirements more inclusive. More people could then enroll in the segregated sheltered workshops, enroll in redlined housing, and gain access to additional discriminatory, compromised provisions (Russell & Malhotra 213). This boosted the west’s economy while strengthening patriotic and nationalist sentiment. Simultaneously, exceptionalism works to misrepresent and erase those who expose the conditions of violence enforced by the economic machine—both inside and outside its borders. 

Seven days after the Americans with Disabilities Act (ADA) was effective on 26 July, 1990, the Gulf War began, killing hundreds of thousands of people and displacing millions over its duration. In his honoring of Marta Russell’s legacy, Yanar Hashlamon points out that Russell’s “economic critique is limited in its imagination of disability when it exceeds US borders.” What does it mean to discuss war only through economics “rather than the killed and maimed” (Hashlamon)? Through resistance?

5: “death by regulation”

reading:

Russell Maroon Shoatz, Death by Regulation & A Message from a Death Camp, Kersplebedeb

Kaleem Hawa, Like a Bag Trying to Empty: On the Palestinian prisoner and martyr Walid Daqqa, Parapraxis

Angela Y. Davis, Foreword, Disability Incarcerated Imprisonment and Disability in the United States and Canada, pp. vii-viii

Layan Kayed, The Prison As a Text, Translated by Roba Alsalibi, Wasafiri, pp. 4-9

The Bad Side, Jordan Neely and Daniel Penny: Five Points on the May Day Murder

“The end of labor. The end of production. The end of political economy. The end of the signifier/signified dialectic which facilitates the accumulation of knowledge and of meaning, the linear syntagma of cumulative discourse. And at the same time, the end simultaneously of the exchange value/use value dialectic which is the only thing that makes accumulation and social production possible. The end of linear dimension of discourse. The end of the linear dimension of the commodity. The end of the classical era of the sign. The end of the era of production.” –Jean Baudrillard

The deinstitutionalization and antipsychiatry movements of the mid-twentieth century would concurrently lead to more disabled people ending up in prison and more people debilitated by prison (Davis viii). This coincided with an increase in prison labor, along with scientists in the U.S. testing new methodologies for ‘behavior therapy’ in the penal system, learning from what has and has not worked in cases of war and armed struggle (Shoatz 4). Anyone opposing colonial and/or capitalist order was deemed legally unfit for society through penal psychiatry.² Epithets were formalized as diagnoses: opposition could be discredited if its actors were  “emotionally or psychologically disturbed” (Davis vii; Foucault 12). Additional methods of control were established in prisons to break prisoners down: the use of psychotropic drugs, civil confinement, exposure to radioactive gas radon, insecticides, extreme lead poisoning, forced sterilization, control units, and radiation poisoning caused by body scanners, to name a few. It is through the writings of Russell Maroon Shoatz, Angela Davis, Layan Kayed, and of Walid Daqqa, whom we arrive at via Kaleem Hawa, that we read about psychic torture throughout the U.S. and its proxy in occupied Palestine. Through The Bad Side, we address “mental hygiene” as legal lynching. Integral to these texts is the abolition of prison; death to empire. 

Hawa asks questions about how people interact with images of the Palestinian genocide. Engagement with these images can function in several ways. “Most of the discourses in English on image-making during the ongoing genocidal war adopt a fatalistic framing; they are convenient and comfortable in their depiction of the Palestinians as victims.” Engagement can be a spectacle or a way to stay informed. It can also point to the ways we fail to engage with resistance to colonialism (Hawa). This isn’t a surprise when the mode of production is preoccupied with simulation and simulacra. 

On the same day that Luigi Mangione was detained, Daniel Penny was found not guilty on all charges associated with lynching Jordan Neely on 1 May 2023. Penny’s defense team attempted to disprove the fact that Neely died because of Penny’s chokehold. They claimed that the death resulted from “‘the combined effects [of Neely’s] sickle cell crisis, the schizophrenia, the struggle and restraint and the synthetic marijuana’ that was in his system,” referencing documents such as witness statements and videos, police body camera transcripts, and psychiatric records. During Penny’s trial, NYPD Sergeant Carl Johnson exclaimed that he didn’t want his officers to resuscitate Neely once they arrived on site at the F train, where Penny had Neely in a chokehold. He worried that they would get “hepatitis or AIDS.” Jordan Neely was lynched by Penny, the bystanders on the train car and the NYPD. The criminalization of blackness and homelessness is ongoing. Such misrepresentations of hepatitis and AIDS by figures of authority are deadly too. As expressed by The Center for HIV Law and Policy concerning the Nushawn Williams case, “. . . we have one branch of New York government encouraging people to get tested for HIV and telling people you can live a healthy normal life while living with HIV; while another branch of New York government relies on inaccurate characterizations of HIV as ‘highly infectious’.” 

Angela Davis’s essay brings us to the subject of the state instrumentalizing those it once deemed unfit for society. In 2023, Davis accepted an award honoring her “as a scholar-activist, and her life-long service and commitment to issues of economic, racial, gender, environmental and social justice, and prison abolition” by Atlanta City Councilman Jason Dozier at the 20th Annual Walter Rodney Symposium. The award was met with protest chants against the Atlanta City Council’s destruction of the Weelaunee Forest to build cop city. Shortly after its receipt, Davis returned the award and addressed her own limitations in not speaking out against cop city. In doing so, she recognizes how detrimental this institution would be and urges more people to join the Stop Cop City movement. As of July 2024, there are over eighty cop cities being built throughout the entire U.S., which, if indeed built, will serve as further collaboration between the states and the Israeli occupying forces. 

6: delayed knowledge

watch: 

Kassem Hawal, Return to Haifa

listen: 

Meesh Sara Fradkin, ثورة 

read:

Ruha Benjamin, Technological Benevolence, Race After Technology: Abolitionist Tools for the New Jim Code, pp. 95-108

Robert Proctor, Agnotology: A Missing Term to Describe the Cultural Production of Ignorance (and its Study), Agnotology: The Making and Unmaking of Ignorance, pp. 1-33

Zhanpei Fang, Ghost in a rhetorical machine, Reboot

Neoliberalism presupposes investment, and with investment comes optimization. Optimization entails finding solutions for inefficiencies. Often, what is labeled as inefficient is neither broken or wrong; nevertheless, from the perspective of profit maximization, it must be fixed. Profit maximization can also take the shape of reforming what should be abolished. For example, prisons have begun to implement ‘technocorrections,’ a strategy that makes use of shackles to deal with overcrowding. 

There exist a number of fixes—racial fixes, fixing diversity, technical fixes, fixing ‘health’—all of which involve surveillance and technological redlining (Benjamin). This can also look like the utilization of machine learning to sift through prospective applicants to a job, apartment, or insurance claim—a tactic that alleges to make for less discrimination in the workplace, housing, and healthcare. Software produces a loophole to The Health Insurance Portability and Accountability Act (HIPAA). It automates the creation of customer profiles for healthcare hotspotting. Also standardized are medical techniques that make use of race science and environmental racism, such as the spirometer, in order to measure workers’ compensation qualifications (Benjamin).  

Fixes encode ideology. Attempting to conceal bias, institutions will engage in the politics of visibility through the implementation of technology. This perpetuates structural inequalities, while data is used to accumulate capital. Discriminating along the lines of race, ethnicity, class, impairment, and gender is intrinsic to both analog and digital design. With machine listening, discrimination extends to depression detection, accent, and whether someone takes hormones or not. There is no technological neutrality. The impartiality of the machine mystifies the oppressive partiality of its designers. As such, Ruha Benjamin urges those who value justice to “avoid falling under the spell of techno-benevolence, for which ‘revolution’ is a marketing catchphrase used to entice investors” (Benjamin 106). 

Agnotology, coined by Robert N. Proctor, is the study of ignorance. Proctor indicates that while there have been many epistemological considerations—that epistemology has been institutionalized—the study of ignorance remains narrow. Why don’t we know, and where does this negligence come from? Ignorance is manifold. It is through ignorance that censorship functions, as well as liberal states and the scientific enterprise. But, as Proctor suggests, “the public seems to be awakening to the fact that in the midst of the ‘information’ explosion, there has been an ignorance explosion as well.”

If humans create ignorance, the technological apparatus reproduces it. This can be understood as the pen, the computer, language, or the prison (Agamben 14). The theorizing of ethics and exceptionalism that overwhelms technology discourse is ignorance-production. This enables what Zhanpei Fang refers to as “the act of violence in the age of its mechanical reproducibility.” In the case of Palestine, the violence of technology is misrepresented by its supposed autonomy, which provides zionists with yet another opportunity to appear less responsible for genocide. 

Delaying public access to information is crucial for culturally sanctioned ignorance. Military classification of nuclear technologies and climate change are examples of this. Not only did delayed knowledge penetrate science and “affect nearly every branch of knowledge,” it catalyzed the destruction of the world. Proctor asks, “why have so few Americans heard about the Nakba?” This delayed knowledge has permitted the death and maiming of millions of people throughout West Asia and North Africa, while fields of knowledge entertain the simulated liberation struggle of zionists. As I write this, the Nakba continues. People disappeared by the Assad regime are reuniting with their loved ones. Fascist mercenaries backed by the west in Syria have affirmed that they will invade China next, while zionists terrorize even more people. As if it was not clear three weeks ago, the goal of the U.S. and its ‘decolonial’ puppets is to make the Levant and Arab world a pawn for zionism. “But whatever happens, there is no doubt at all that at every stage in the development of a process, there is only one principal contradiction which plays the leading role. Hence, if in any process there are a number of contradictions, one of them must be the principal contradiction playing the leading and decisive role, while the rest occupy a secondary and subordinate position . . . Once this principal contradiction is grasped, all problems can be readily solved” (Zedong). We must return to Marx and Amel here. How does history repeat itself? Today, the principal contradiction of any process is located within dear Palestine. 

1. Cultural theorist Lauren Berlant refers to slow death as “the physical wearing out of a population and the deterioration of people in that population that is very nearly a defining condition of their experience and historical existence.” ↩︎
2. Psychiatry formed its relationship to law in the early 19th century, linking madness to crime not with science but through what Foucault calls a symbolic representation (Foucault 8). Through a personification of the body and an understanding of “public hygiene” and “social danger,” psychiatry insisted on its relevance to the practice of law. “It is not enough to invoke some sort of imperialism on the part of psychiatrists seeking a new domain for themselves, or even the internal dynamics of medical knowledge attempting to rationalize the confused area where madness and crime mix. Crime then became an important issue for psychiatrists, because what was involved was less a field of knowledge to be conquered than a modality of power to be secured and justified. If psychiatry became so important in the nineteenth century, it was not simply because it applied a new medical rationality to mental or behavioral disorders, it was also because it functioned as a sort of public hygiene” (Foucault 6). Penal psychiatry also brought with it the possibility to address “social conflicts, class struggles and political confrontations, [and] armed revolution” through this new understanding of danger (Foucault 12). ↩︎