Raising the question of whether intentional communities of care can be a site of struggle, rather than just a place of support.
Yarrow, picture taken by the author in September of 2009 in Lolo National Forest, Montana
I have personal experiences in creating and expanding communities of care, street medicing, radical mental health, as an herbalist initially trained through an informal apprenticeship, and in radical clinics. One thing that occurs to me is that I, and others, have talked a lot about communities of care, how we create them, how we get them to grow, but, as revolutionaries, it seems to be that our only focus is how they serve as a support system for other struggles, never as a site of struggle themselves. I want to raise the dual question here of both how they serve as a site of struggle, and what potential there is for broadening those struggles.
First of all, any time we're talking about caregiving, we're talking about reproductive labor. The projects I have seen grouped under communities of care have either been a way to collectivize unwaged reproductive labor, or giving people who are denied access to paid reproductive labor (generally health care) that care. One of the ways in which reproductive labor being work is obscured is the way that it is both isolated and naturalized as part of "what women do". By coming together and doing it collectively, we not only reduce the overall workload, but we struggle against the structure of capitalist society and individual men in our lives who do not view our reproductive labor as work. Creating collectivized reproductive work as its first step necessitates recognizing that as work.
The first step communities of care often take is reviving the practices we have lost through our increasing atomization and isolation, and creating counterinstitutions where we can collectively ensure that those useful practices, such as watching each other's children, visiting each other when sick, bringing meals to the ill or elderly - all functions that more functional communities did as a matter of course - occur. Of course, the real challenge is to go beyond these more limited practices to ensure that elders do not have to be isolated away from the rest of their communities in nursing homes, that all parents can support their families and organize knowing their children are safe and cared for, and to both provide members of our communities who have no or limited access to the formal health care system with health care, both western allopathic and from alternative systems.
The struggle aspect is perhaps most obvious in advocacy, and this is also the place where it is most obvious on how our community struggles link up with potential avenues of struggle inside the workplace. Many groups are particularly vulnerable to mistreatment by the health care system (trans and gender non-conforming people, queer people in general, people with disabilities, people with uncertain immigration status or lacking papers), and often times the presence, even of a layperson, advocating for them can make worlds of difference in the care they receive. An effort to organize ourselves to make sure no vulnerable person has to go into a hospital or medical appointment alone, could, as it grows, quickly turn into a campaign to change how both health care institutions treat members of vulnerable groups, and by making strong connections with people working in those institutions, how workers are treated in those institutions. Clearly, a great deal of potential solidarity and expansion of struggles can arise out of these projects.
I'll hopefully have more formed thoughts on this by the time I finish my much longer reflection piece, but, many of us whose path into formal, waged health care work grows out of our desire to have more caregiving skills to give back to our community and in an attempt to get paid while we develop those skills eventually work our way on to health care roles in our work lives that require extensive education and training and have the corresponding high levels of debt. While these often give us a lot of skills and knowledge to put at the service of our communities, we end up limited to supply those skills in alienated ways. The do-gooder option state capitalism presents us with are non-profit community clinics that exist to serve underserved communities, but are in no way controlled by those communities. Not only do our high debt loads force us into working long hours, but, legal concerns with the licensing system can often make us wary of participating in counterinstitutions. While there is a lot that lay community members can do, if we truly wish for our communities of care to expand to the point that they destabilize the isolation and atomization of the reproduction of daily life in our society, we need to be able to offer more than dedicated lay people and short workshops.
Comments
One of the things to bear in
One of the things to bear in mind with this in terms of social care, speaking from the UK at least, is that a lot of the sector is basically sustained by the volunteering, extra-labour and un-paid work of compassionate individuals already. Here the struggle is not so much the collectivising the labour (as this often the case between the informal communities that already exist) but making sure that it is economically compensated, recognised as work that should be paid for and workers' rights are respected in spite of the often adverse nature of the work. So yes the model that care-providers use need to be radically and critically challenged but equally this is an issue of workers' conditions in a sector which is increasingly un-organised, privatised and has an atrocious record on abusing workers' rights.
Reproductive labour has an economic function and consequence. It reproduces labour power and, particularly in my case, frees up workers to be able to earn a wage outside of caring for their dependants. For me the issue of isolation and atomisation are more of a disciplining mechanism within this sphere. The fundamental issue is that this is labour that contributes to the production of value but is not compensated as such. I understand this is only an initial analysis, but I'm not sure how in the above these two things connect together.
I work for a company that provides support to adults with learning disabilities (for context).
I think the US and UK terrain
I think the US and UK terrain are very different, as you note. In some ways, the UK situation is probably better for a lot of people accessing care (NHS versus the mess of health insurance in the US); I think another important difference is that there is very little in terms of social services in the US beyond what incredibly little is offered by the state, that things have to be either privately paid for, or the burden falls on families. I'd imagine there are still things like housework, large chunks of childrearing with small children, and so forth, that are still isolated in the UK, though the absolute portion of reproductive labor done in isolation is much less.
Isolation and atomisation are absolutely a disciplining mechanism - and one of the most important forms of that disciplining is obscuring the fact that reproductive labor is work. I think the alternative - especially right now a Wage For Housework doesn't seem to be a winnable short or medium term goal* - is to say "right now, what we're doing is isolated and atomized, rather than having a non-profit take it over and rely on unpaid volunteers to do it, let's organize ourselves to do it according to ability and need" (the advantage being that if a community that cares for each other is created, people who participate as caregivers know they'll receive care when they need it). Ultimately, without a revolution in the rest of society, that work is still contributing to the production of value, yes.
The advantage of this work already being done by volunteers or poorly paid workers is that it's already been rendered visible as work, and it's already collectivized - then the strategy looks like a much more traditional workplace strategy - to organize the workplace and have workers struggle directly and win short and moderate term gains. Of course, you want to reach out to clients, their families - but any good organizing strategy does that already :) I think the way what I'm talking about here is relevant is that communities of care outside of state and private institutions can link up and support struggles of workers inside those institutions.
I think if our moderate term goals are:
a) Everyone has access to all the care they need.
b) People get care without being isolated from their communities.
c) People provide care without being isolated.
d) A large social wage - forcing the state to give everyone enough to guarantee a decently comfortable daily life.
e) Control by clients/patients, their families and communities, and workers of caregiving institutions of the care provided and the facilities through which it is provided.
with the idea that these moderate term goals both strengthen our ability to struggle and that winning them will change how people think about things, then we're going to need strategies focused around workplace organizing and community organizing - they're two prongs of a larger strategy that do have potential to feed into each other as they build. I think that right now, (d) is not nearly in our immediate reach - I think we need to see a much more coherent, far more advanced place of struggle if we're going to do more than have defensive fights around a social wage.
Quote: as an herbalist
While I don't disagree with most of the ideas presented in the article, I strongly disagree with promotion of "herbalism" and "alternative medicine" in favour of real medicine. Simply because people don't have access to proper medicine doesn't mean that they should turn to a substitute where they will be exploited by a quack.
a) Where do I advocate for
a) Where do I advocate for herbalism or alternative medicine instead of (rather than in addition to) western allopathic medicine (what you're calling "real medicine" - the history of how that tradition became dominant is very important - read Witches, Midwives, and Nurses)?
b) There have been substantial research studies showing the effectiveness of herbalism, accupuncture, and other so-called "alternative medicines" - published in peer-reviewed journals. To pick an arbitrary paper, this paper from the journal Neurology lists butterbur as effective for migraine prevention, and feverfew as probably effective. Here's a paper from the Journal of Psychiatric Practice recommending meditation as a treatment for depression, anxiety, stress, and chronic pain, based on a review of previously done studies. I could crank out abstracts from peer-reviewed journals by typing search terms into PubMed pretty much as long as you'd like.
c) As someone who is in a nursing graduate program, I can say from personal experience, what you're calling quackery is at this point taught alongside western allopathy in both nursing and medical schools. Many nurse practitioners and medical doctors (the people who see patients, order tests, write prescriptions, and so forth) are going on to pursue programs of formal training in other medical systems and incorporating them into their practice. Broadly dismissing everything outside of western allopathy as quackery not only flies in the face of the scientific evidence, but it also shows a profound disconnect with the mainstream of medicine and nursing - at least in the US, and I know in the UK herbalists have scope of practice in the NHS.
This is very thought
This is very thought provoking! I look forward to your longer piece.
Don't have any great questions or comments... I work in childcare and fantasize about working childcare workers and families organizing together for free high quality childcare that pays good and etc. We could organize "babysit-ins" and move our centers into politicians offices - let them see first hand the work it takes to take care of babies and young children. Okay have to clock in!
Coming back to this, do you
Coming back to this, do you have a longer reflection piece? I really like where you are going with this...