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The Sick Proletariat

Health Communism calls for a return to radical patient organizing

In July 1970, 150 members of the Young Lords Puerto Rican activist group stormed Lincoln Hospital in the South Bronx. Armed with baseball bats and nunchucks, they barricaded the doors, staking out specific floors and exits. “We had to impress upon the New York City police department that if you came in, there was gonna be blood,” one member recalled in a recent documentary on the takeover. 

The Puerto Rican flag was planted on the roof, and signs sprouted from the windows reading “Bienvenidos al hospital del pueblo” and “Welcome to the People’s Hospital.” After a twelve-hour standoff, as the NYPD prepared to breach the building, the activists donned scrub coats and stethoscopes, blending in with the health care workers leaving the building. The resulting media attention, in combination with the death of patient Carmen Rodriguez during an abortion around the same time, finally led to significant change for the neglected hospital known as “the Butcher Shop.”

This wasn’t the first time the Young Lords took drastic actions to improve health care. A month earlier, the group had commandeered a mobile chest X-ray unit and taken it to East Harlem to test the many residents affected by tuberculosis. This type of militant radical health care activism flourished in the 1960s and 1970s and was undeniably influenced by the Black Panthers, who made health a cornerstone of their activism. The Jane Collective also formed during these decades, performing illegal abortions, and in the 1980s and 1990s there was ACT UP, which hosted “die-ins” and performed other acts of civil disobedience to highlight governmental inaction in the face of the AIDS crisis. Across the Atlantic, in West Berlin, a lesser-known collective called the Sozialistisches Patientenkollektiv (SPK) created ripples in the world of mental health care, disrupting assumptions about patient autonomy beyond the burgeoning anti-psychiatry movement as large mental hospitals began to close.

Beatrice Adler-Bolton and Artie Vierkant’s Health Communism reclaims SPK’s history as a guidebook for organizing. Their book is itself a blueprint, in the (roughly translated) words of SPK, for turning illness into a weapon.

The authors of Health Communism host the political health podcast Death Panel, which covers public health and health care policy, alongside Phil Rocco, Jules Gill-Peterson, and Abby Cartus. They were first galvanized into action by Adler-Bolton’s difficulties applying for Social Security disability benefits in 2015, after she lost her job following a series of emergency surgeries. Since then, Death Panel has covered the CDC’s response to Covid-19, the privatization of Medicare, and trans health care, developing a theory of the U.S. health care system as a bureaucratic defense of eugenics. Health Communism is an exploration of this thesis in written form—and a call to action.

Throughout its 240 pages, Health Communism highlights the relevance of the militant health care activism of decades past. Two chapters, Care and Cure, focus on the story of SPK. SPK was born out of radical patient groups, facilitated by Dr. Wolfgang Huber of the University of Heidelberg, which were offered as an alternative form of care during deinstitutionalization, when lower class communities were often left behind by the new policy. When these patient sessions, a form of group therapy called “agitations,” were promptly shut down by leadership at the university in 1970 following concerns about the political nature of the meetings, the patients rebelled. They demonstrated outside the home of the university’s clinic director, which subsequently led to police beating the “vulnerable patients on the posh suburban lawn” in Health Communism’s retelling. Afterward, the patients decided to organize as the Socialist Patients’ Collective. “Their project constitutes the closest direct ideological precursor to what we have termed health communism,” Adler-Bolton and Vierkant write.

Their critique of capitalism was driven by a militant commitment to left liberatory politics. . . . Unlike their contemporaries in the anti-psychiatry movement like Cooper, Laing, and Szasz, who rejected the use of certain therapies and pharmaceuticals, SPK radically and wholly embraced treatment, and felt that, above all else, care should be self-directed and synergetic: a dual dialectic between doctor and patient working in collaboration and producing forms not just of care but also of solidarity. 

SPK, who often cited Marx in their work, organized the “Patients’ General Assembly” in the psychiatric clinic of the university in February 1970, drawing up a list of demands. Weeks later, about twenty patients and twelve “doctor-collaborators” occupied the office of the chief of the psychiatry clinic, Dr. Walter Ritter von Baeyer, and held a day-and-a-half-long hunger strike. Official reports of the group weren’t flattering: as the SPK’s actions carried on for nearly two years, they were deemed “armed madmen” and wannabe “saviors of the mad and poor” with a Robin Hood complex by the national media. Still, Von Baeyer, who was already facing criticism for his focus on social psychiatry over asylums, negotiated with the group, agreeing to offer them funding and honor Dr. Huber’s drug prescriptions for the patients.

The university stalled on these concessions, but eventually, on July 9, 1970, SPK was formally established as an academic institution. Their victory was short-lived. In September, the West German minister of education banned the university from formally incorporating SPK, and all of their funding was revoked. In 1971, rumors started to spread that the Red Army Faction (RAF) or Baader-Meinhof Group recruited patients from SPK after suffering a series of casualties (Adler-Bolton and Vierkant believe this to be inaccurate). The West German police later claimed the SPK had planted bombs, and the U.S. government eventually formally classified SPK as part of the RAF. In June 1971, under the suspicion that SPK had become a “revolutionary fighting group,” police carried out targeted arrests of the members.

Critiques of psychiatric control should be focused on the austerity that leads to the choice between medication or incarceration.

Despite their discrediting by governments and media, SPK’s struggle has largely been vindicated by history. While the widespread closure of asylums in the West, starting around the 1960s, was generally considered a societal victory, the result simply switched up the method of punitive care, as Dr. Huber saw at the very beginning. Today, the number of people with mental illness in prison is staggering, and long-term mental health care units are arguably asylums by another name, especially for those subject to extended solitary confinement. The use of compulsory treatment orders, while now more widely known thanks to Britney Spears’s conservatorship battle, remains high. Then there is the persistence of social determinants of poor mental health that get people into these systems in the first place, like abuse, poverty, and illness. Barriers to timely mental health care are a global problem, whether long wait-times in countries with more affordable systems like the NHS, or the Sisyphean task of finding an affordable therapist in profit-driven, insurance-based countries like the United States.

Instead of a resurgence in patient-led activism around these concerns (bar a select number of groups), there has been a very profitable market for self-help books. At the same time, one less useful notion of the 1970s that has returned with vigor is the idea that capitalism causes mental illness and, by extension, without capitalism, we wouldn’t have mental illness. Madness is always political, but that doesn’t mean that in a hypothetical ideal political environment, there is no madness. This oversimplified argument isn’t new: in Health Communism, we see that many practitioners of the anti-psychiatry movement, while initially supportive of SPK’s anti-capitalist stance, distanced themselves once they realized patient autonomy was about more than rejecting drugs: “Thinkers once associated with the anti-psychiatry movement began to reject the label, fearing that the radical mass energy was attracting negative attention to their cause.” At the same time, reactionary libertarians like Thomas Szaz were all too happy to mobilize very real concerns around the control of those deemed mad to further their cause (see: theories that mental illness did not exist, and, later, Scientology).

Recently, debates over mental health have focused incessantly on the dangers of TikTok mental health diagnoses rather than the inability of people to access appropriate, affordable care or the expansion of coercive measures. Instead, as Adler-Bolton told me in an interview, critiques of psychiatric control should be focused on the austerity that leads to the choice between medication or incarceration. “If that’s not your critique, then you’re not actually doing anti-capitalist critique, you are just dressing up capitalism as radical,” Vierkant elaborated. “Disability, illness, mental illness, madness—accepting them, embracing them, and building a society that supports and allows all of those people, and anyone who identifies as those things, to flourish: that’s liberation.” 

Of course, it isn’t just mental health care that has remained stagnant or worsened over the last half-century. Fifty years on from the radical health activism of the 1970s, public health, like wealth, is barely trickling down, and in the middle is a gurgling mess: gaps in Medicaid coverage; high copays if you’re lucky to get that haloed private insurance through work; private equity’s death dance with nursing homes; Amazon’s foray into selling medical devices; the abundance of psychiatric drug startups like Hers; disabled people being paid $1.50 an hour for the privilege of putting labels on dog chews in so-called sheltered workshops meant to provide job training; and, of course, the contracting out of public health care services.

The gutting of the already-scant U.S. welfare system since the early 1990s has resulted in a number of private-public partnerships in health care provision: currently, 48 percent of Medicare recipients are enrolled under the privatized Medicare Advantage program, which recently was revealed to have overcharged the government by millions. This figure is set to tip to 50 percent soon, according to Vierkant: “This huge thing that the Democratic Party stakes practically its entire fucking identity of having created, the golden age of when we passed Medicare, is going to be half-privatized by next year.” The trend isn’t restricted to the United States: in the UK, the NHS has increasingly outsourced services to private contractors since 2012, and in Canada, health authorities have spent millions on contracts with private health clinics.

In April, the organizers of the Campaign for New York Health, which is pushing for the passage of the New York Health Act, a law that would provide universal health care for residents of New York state, returned to the site of the 1970 Young Lords occupation. The rally was part of a bike ride beginning at Bellevue hospital and ending at Lincoln, demanding that the Act be passed this year. Dr. Oliver Fein—whose wife Charlotte Phillips was a primary organizer of the Lincoln Hospital Pediatric Collective, also formed in 1970, and helped set up community clinics with the Black Panthers—attended and spoke about the legacy of the Young Lords occupation. In an interview, Fein expressed concerns about the increasing influence of Medicare Advantage insurers who “act as middlemen between the Medicare program and the doctor and patient”; the impetus to save money is reflected in denial of care and mandatory prior approval for diagnostic exams. “It is not popular with doctors because we have these denials of care and we have to fight them,” he said, “it takes time and staff, and there are hospitals that refuse to take Medicare Advantage.”

Health Communism argues that “the political economy demands that we maintain our health to make our labor power fully available, lest we be marked and doomed as surplus.” This “surplus class”—which includes but is not limited to those with disabilities, the chronically ill, and the mad—is otherwise “turned into raw fuel to extract profits” for the health care industry, Adler-Bolton and Vierkant write. Unions have long been used as a vehicle to secure affordable health care coverage, but Health Communism’s authors highlight the limitations of this strategy. For individual labor unions, “most of their time is spent trying to retain or protect existing benefit structures,” Adler-Bolton said. And for those who are not in the workforce, whether because of illness, disability, or age, this type of workplace-focused health care organizing simply leaves them behind. “Pushing for something like Medicare For All not only allows the creation of a bargaining unit of patients. . . it also frees up unions to apply the time and energy they are already spending organizing into forcing increases in wages, which are often sacrificed in order to retain benefits, or increases in worker’s safety.”

But as the Covid-19 pandemic started to spread across the United States in early 2020, it seemed like the Medicare for All momentum wilted—Bernie Sanders withdrawing from the presidential primary as dead New Yorkers were piled into mobile morgues really drove this home. Ongoing death, disability, and the privatization of health (especially during the pandemic) continue unabated, however, even in countries widely accepted as having socialized health care. The need to revive radical health solidarity is more urgent than ever. And, as Health Communism’s authors argue, for all its virtues, Medicare for All doesn’t go nearly far enough. Adler-Bolton said that “people talk about health care as ‘baby leftist’ stuff or as an on-ramp to leftism,” and Vierkant agreed: it’s viewed as “something to do on the pathway to revolution.” But, Adler-Bolton continued, “Medicare for All is not anything close to baby socialism. It is actually one of the most aggressive non-reformist reforms that has even been born in the United States.”

The need to revive radical health solidarity is more urgent than ever.

When she first heard of the project, Adler-Bolton’s grandmother, who was born in the 1930s, initially responded, “You’re Jewish, you cannot publish a book called Health Communism. Don’t you understand what Stalin did?” “I am like: Grandma, that is not what we’re talking about,” said Adler-Bolton. “This is about caring for each other, this is about what we owe one another, this is about central planning and reorganizing our resources to redistribute both care and wealth and security and actually building a feeling of safety and comfort.” For her and Vierkant, this means a separation of capitalism and health. They argue that capital uses health “as a shield, a reason for its behaviors,” and true change will come from centering health in all forms of direct action.

The Black Panthers, the SPK, and the Young Lords, among other militant organizations, understood the need for this kind of action decades ago. In 1970, a department head at Giessen University who tried to mediate the disputes during the SPK occupation commented that “a direct struggle on the basis of group therapy for the mentally ill would be an absurdity.” SPK disagreed; they called for a mobilization of what they dubbed the “sick proletariat,” and Adler-Bolton and Vierkant are doing the same all these years later. Back then, solidarity often looked like creating free alternative clinics to mainstream health care, and there are echoes of the Black Panthers’ free medical clinics in places like Oakland and Minneapolis today. But, as Dr. Fein noted when speaking about the New York Health Act, decades ago there wasn’t a real consciousness around single payer health care in the United States.

At the heart of the activism of SPK, the Young Lords, the Black Panthers, and Act Up was a DIY sensibility, an acknowledgment that the government wasn’t coming to save people, and in many cases was actively harming them. While there are hints of a return to this type of radical, patient-led activism brewing, a coherent strategy that joined free community clinics in the intermediate term with projects fighting for Medicare for All, or an even more radical restructuring of the capitalist health care system, could build on this new consciousness around single payer health care—and elevate members of the “surplus class” as leaders of the movement, not just symbolic figureheads.