For Health Autonomy

Horizons of Care Beyond Austerity—Reflections from Greece

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• Publisher: Common Notions
• Year: 2020
• eBook ISBN: 9781942173359
• Topic: Social Sciences
• Subtopic: Global Development Studies
• Index: Social Sciences

“Here, the treatment of pathologies—such as cancers or viruses—is considered as important as dismantling the causes of pathologies, including the social problems of debt, homelessness, police violence, and isolation. We must grasp how the de-individualization of care, what we might refer to as the communization of care, is central to fighting state and capital’s racialized and gendered forms of abandonment.”

For Health Autonomy: Horizons of Care Beyond Austerity—Reflections from Greece explores the landscape of care spaces coordinated by autonomous collectives in Greece, including clinics, social spaces for health, social kitchens, and safe spaces liberated from the state and capital. The significance of autonomous spaces is intensified in the very moment the state, capital, and their complicit institutions attempt to penetrate their power via austerity and state violence. In tandem with the broader anticapitalist movement, these spaces have ruptured the legitimacy of the state and capital, and reclaimed care beyond the limits of the biomedical, nonprofit, and capitalist frameworks.

The experience of Greek autonomous care spaces encapsulates care within, as well as beyond, the biomedical; where addressing pathologies, such as cancers or colds, are as important as dismantling the causes of the pathology, including debt, homelessness, police violence, and social isolation. The collected essays grasp how emotional and physical distress is preventable—where ensuring access to antibiotics, vaccines, or herbal remedies is as relevant as liberating unused space for housing or de-policing a neighborhood. The subjects of this collection include a network of users of psychosocial services, defending their right to autonomy within mental healthcare systems; a healthcare center organized and maintained by an anarchist collective; a worker’s clinic founded by a coalition of factory workers and healthcare solidarity activists; among others.

The Greek contribution to autonomous care work emancipates labor, space, and resources towards a form of life that sustains the bodies and well-being of the collectives directly involved in this process, and the broader network of autonomous communities that rely on such care spaces to reproduce other modes of noncapitalist life. Efforts to defend and expand the very elements necessary for the survival of our bodies and ecology are in tandem with efforts to rupture from hierarchies, profits, and institutionalized singularities. For Health Autonomy is a powerful collection of first-hand accounts of concrete alternatives that are replacing our need for police and prisons based on the collective power of communities and care workers. These reflections have merged from within and beyond healthcare institutions.

One—Elements of Care Work in Greece, CareNotes Collective

ONE

ELEMENTS OF CARE WORK IN GREECE

CareNotes Collective

Understanding how social movements transition from physical or emotional distress to collectivizing around distress is fundamental to autonomous care work. Such a process is not limited to dystopian reactions against Western medicine or individualist narratives inherited from capitalist life. It’s rooted in a polyvalent desire to socialize around distress, to liberate useful labor from wages, to recuperate our bodies and ecosystems in a moment where the most basic infrastructures supporting our survival—such as housing, healthcare facilities, and clean water supply—are becoming scarcities. The ability to collectively recuperate our bodies and ecosystems is dependent upon a horizon that is also able to disrupt the very instruments of class and power that reproduce our distress. Below we discuss in further detail how spaces, collectives, and analyses around disease and distress constitute some of the emerging aspects of autonomous care work in Greece and how these have emerged in opposition to, and beyond modern medicine, the state, and capitalist life.

The Crisis of the Biomedical and Electoral Models

The privatization of essential clinical services combined with the increasing demand for care by those suffering from intensifying capitalist life has led to a public health crisis in Greece. Rates of suicide, heroin addiction, HIV, and depression have escalated. These trends expose two fundamental crises at the clinical and societal level which simultaneously open new possibilities in care work.

At the clinical level, there is the inability of the biomedical model (the traditional clinical approach to diagnosis and treatment almost entirely centering biological factors) to observe, articulate, and intervene against the causes leading to the present public health crisis—austerity and migration. This is at first glance, correctly attributed to shortages in staffing and infrastructure following cuts in healthcare and social services. However, these budget cuts only expose more inherent limitations of the biomedical model to respond to larger-scale contradictions of capitalist life that manifest in so many forms of suffering.

A major inherent limitation of the biomedical model is rooted in the workflow of modern healthcare—from disease to waiting room, to doctor/patient encounter, to allocation of prescription, to consumption of pills. Commodified modes of Eastern or alternative therapies in the United States also mimic this flow—organizing suffering around the individual who, as a consumer, exchanges money with an expert healer. There is no encounter between suffering bodies in the architecture of the clinic; the doctor/healer diverts the potentiality of collectivizing around suffering to instead individualize disease with coded complaints and a prescription exchanged for a bill. Suffering = the biological = the commodifiable. There is no time to diverge from this flow or even consider alternatives to larger-scale crises such as austerity and migration.

Such a blind faith in the doctor–prescription–state-run universal healthcare structure forsakes our capacity to collectivize around suffering and reclaim the means to recuperate life as we desire. Alienation from our capacities to heal runs parallel with our inability to farm or feed ourselves due to the commodification of every facet of life. Thus, in the spirit of defending what we have and reclaiming what we need to build community, we defend universal healthcare as that desired by users and care workers, rather than politicians and CEOs; we also seek to reclaim land from mono-agriculture, abandoned buildings for housing and clinics, and so forth with principled acknowledgement of all those dispossessed in the original and ongoing histories of settler colonialism and racial capitalism.

How is the crisis of the biomedical model linked with that of the electoral? In Greece, the decades-long economic and political crisis has been met by some communities and healthcare workers not only reclaiming clinics to offer healthcare, but in the process, inspiring users and care workers to collectivize around economic and political causes of suffering. Such a desire to collectivize and politicize suffering relates to a larger-scale crisis of electoral or representational politics following the election of Syriza. This process—of collectivizing and politicizing suffering—has occurred entirely autonomous from capital while also in resistance to a self-proclaimed “progressive” state that has only escalated police violence against anarchist or migrant squats, healthcare workers, and educators resisting closures, tenants facing evictions, among other care workers and users suffering from austerity.

In the Greek context, we see three trends:

1. A revitalization of community and worker-run spaces as being crucial for the reproduction of autonomous life. This includes housing squats, care-work spaces via social clinics and recuperated hospitals, social kitchens, gardens, and
safe spaces.

2. A rupture of care processes from institutionalized healthcare and emergence within spaces traditionally demarcated for noncare functions, such as factories, commercial buildings, and parks. In other words, we see social kitchens entering the plazas, squats turning into community self-defense committees against the police and mafia, or the integration of care work within a recuperated factory.

3. City, regional, and national networks of autonomous and anarchist care spaces and collectives sharing their experiences, pooling knowledge, and coordinating solidarity efforts against the sustained assault of the police, media, and state.

Liberating Care Work from Healthcare

Presently in Greece, care work has already been transferred from a profit-driven model to assemblies of care workers and community members that sustain a horizontal and participatory structure. Such assemblies abandon traditional frameworks that embrace the state, capital, institutions, and experts as mediating the collective ownership of modes of care reproduction, and instead recuperate spaces around need as it is defined emotionally, medically, and politically by care workers and users.

The possibility of shifting from healthcare to care reproduction would not be possible, however, without the transformation of identities among participants in radical care spaces. The potential to provide free healthcare services for an occupied clinic, recuperate clinics at risk of closure as a collective of healthcare workers traditionally separated by hierarchies and salaries, and collaborate with care workers not institutionally trained in care work, are some of the many ruptures of radical care work versus traditional healthcare emerging in Greece. Such outcomes are dependent on two significant and overlapping processes.

The first, and most obvious, of these processes is the deconstruction of biomedical authority and decommodification of care work provided by doctors but also nurses, therapists, social workers, and other workers. Second, the encounters within radical care spaces between healthcare workers and collective members who lack formal training in healthcare yet are indispensable to the growth of the care space. Both processes further liberate the de-institutionalization of care. However, the methodical rupture of institutionalized relations between participants of care collectives is based on broadening the understanding of care work as defined by need, as well as theoretical analysis. For instance, in Haris Malamidis’ description of the Workers’ Medical Center at Vio.Me Self-Managed Factory, three-member teams consisting of a doctor, a mental health specialist, and a third member potentially lacking formal training are together critical in treating “each human being as psychosomatic-social totality.” This transformation from volunteer healthcare workers to care workers is further shaped with bi-monthly assemblies and a theoretical and practical training for every participant joining the Workers’ Medical Center.

Decommodifying Care: From Waged Healthcare Worker to Volunteer, to Care Worker, to Deterritorialized Care Participant

Assemblies of radical care spaces mostly consist of participants with no formal training in healthcare but were core to the regular functioning of spaces. Assemblies often struggled to involve more doctors, nurses, and traditional healthcare workers with the assemblies or the upkeep of spaces. Nonetheless, the exchanges between traditional healthcare workers, nonprofessionalized participants in care spaces, and individuals receiving care are each crucial in the conception of more radical forms of care work.

The process in which peoples’ identities transform from–to–between doctor–nurse to healthcare worker to care worker to deterritorialized care participant is not a linear or phasic process. It emerges out of need and articulates itself in singular or overlapping roles. For instance, the radical doctors we spoke with working in a traditional hospital unit could also participate in a social clinic assembly and fully embrace the political potentialities of both spaces. Similarly, while some participants in social clinics were dedicated to expanding access to herbal therapies in the social clinic, they would also join community self-defense collectives to confront police and mafia violence in their neighborhood when needed.

Waged Healthcare Worker

Healthcare workers are often e...

Table of contents

• Copyright Page
• Contents
• Foreword—The Common Is Us, Silvia Federici
• Introduction—The Autonomy of Care: From Healthcare to Care Work in Greece, CareNotes Collective
• One—Elements of Care Work in Greece, CareNotes Collective
• Two—A Different Medicine Is Possible in Our Global Economic Crisis: Reinventing Healthcare in Greece (and the United States, Cassie Thornton
• Three—Details About the End of the World: Living and Fighting in the Frame of the Greek Public Health System Crisis, Hobo
• Four—Workers’ Medical Center at Vio.Me Self-Managed Factory: Exceeding the Radical Boundaries, Haris Malamidis
• Five—Accessing the Greek Healthcare System: What About the Right to Health?, Marta Perez
• Six—Social Solidarity Clinics in Greece, Marina Sitrin in conversation with Ilektra Bethymouti
• Seven—Updates on the National Solidarity Clinic Assemblies, CareNotes Collective in conversation with Ilektra Bethymouti
• Eight—Solidarity Beyond Psychiatry: Defending People’s Autonomy in the Greek Mental Health System, Hellenic Observatory for Rights in the Field of Mental Health
• Nine—The Ongoing Process of Self-Organization of Health in Petralona, Social Space for Health of the Neighborhood Assembly of Petralona, Koukaki, and Thissio
• Ten—Reflections on Social Solidarity Clinics in Crete, Oktana Anarchist Collective
• Notes on Contributors
• About CareNotes Collective
• About Common Notions
• Become a Monthly Sustainer
• More From Common Notions