An article exploring the impact of institutionalization and the barren conditions of medicine for people who must live with the care of others.
It’s said that a society is to be judged by how it treats its weakest. Many forms of involuntary bondage are justly infamous for their abuses once people are put into chains, metaphorically or literally. Employers physically, sexually, and emotionally abuse workers on a mass scale. Workplace injuries, chemical exposure, and disease remain a top killer worldwide. Prisons are rampant sites of constant abuse, trauma, and disease. Soldiers in the military are subjected to cruel experiments, chemical and radiation exposures, violence, rape, and carelessness with the bodies that the military discards after their term is served.
Yet other violence and violation of people on a mass scale goes largely unnoticed because the people are socially invisible. Through the course of life, natural and unnatural, a section of the population encounters illnesses and conditions which render them unable to function independently without the direct care of others. Soldiers, prisoners, and workers are present here because of their inherent dangers, however we all face these dangers irrespective of our vocation or situation. Today’s society has dealt with people who have lost their full independence by creating institutions that concentrate resources and people to allegedly reduce cost. The reality is stark. Beyond the effect of the concentration of disease in institutional settings (which is massive since medical errors alone are the 3rd top killer), the human impact is rarely discussed and alternatives are even more scarce.
It is a fact that millions of people in the United States live in conditions where they may not have conversations with others of any length for weeks if not months or years. There is little resources or capacity for them to create, engage others, or interact with society. Overburdened staff are worked to the bone and often literally lack time for an uninterrupted 10 minute conversation. For people who haven’t spent a lot of time in these scenarios it’s difficult to imagine. The default is minimal access to television. Yet what does it mean that millions of people are removed from society, and held in conditions where there is no engagement of their emotional, social, and spiritual lives? What does it do to a human being to be placed in limbo with active barriers impeding their ability to contribute to society, create, and interact with others? Can any of us not in those situations imagine the effect say of lying in an empty room for decades? The break down of family and community bonds makes such cases disturbingly common.
Health is typically thought of, because of the tradition of medicine primarily, as the absence of disease. The dominant way of practicing medicine continues to be an analytic method in which patients have diseases and diseases are reduced to their treatable components. Fix the broken components, and you fix the person. Still there have been movements towards a medical holism that tries to look at people and societies not merely as diseased or healthy, but for their broader well being. Holism has become more popular because of the rise of nursing science (which formed around a holistic conception of health and people), but also because of scientific advances in our understanding of living systems themselves. Practitioners will readily acknowledge the role of environmental and psychological factors in the health of patients and societies.
Still these understandings of health are too narrow, because they ignore the deepest sense of health that we should have; purpose. People’s health is not only their ability to carry on, but their capacity and exercise of their desires, creativity, and interactions with others. Imposed social isolation and the reduction of health to treating components of our bodies is a form of social violence in which people are robbed of their agency by a society unwilling to allocate resources to keep these people integrated into society when it is fully possible. What does it say of a society that the people who faced the most difficult challenges a person can face must for the rest of their life pay penance? With all the unending cycles of violence in American society (workplace, community, institutional), is it just to institutionalize its victims in social isolation? If we view health from the perspective of the full moral, social, and personal development of individuals and their societies, then our conception of health and the social institutions of health perpetuate the same violence and illness which that afflicts patients.
Mikhail Bakunin attacked the idea that societies like our own are free because of alleged political liberties. He critiqued false liberty where people are on paper able free, but are unable to exercise their capacities because of the political and social organization of society. He called himself a lover of freedom by which he meant “…the only freedom which is truly worthy of that name, the freedom which consists in the full development of all the material, intellectual and moral powers which are found in the form of latent capabilities in every individual”.
By socially failing to take up the full humanity of each other we are doing great harm to everyone. While the violence against the institutionalized is the easiest to see, these errors are repeated everywhere in society. People are forced into mind-numbing labor that represses their creativity and capacities. Our intellectual and spiritual development is compressed into entertainment aimed at generating profits rather than social enrichment and engagement. The vast wealth of this world is taken out of circulation and enjoyment and move to sit unused in the banks, warehouses, estates, and holding cells of elites who are just as miserable as the people whose lives they are ruining. How rational can a world be when the majority of humanity suffers for the benefit of people who are largely unfulfilled and depressed anyway?
Everyday we see that people are defined by certain periods of their life (youth, fertile years, etc) and when they act in socially valued capacities (workers and family members). When we broaden our view, we see all that society hides, and the violence it enacts on those who do not serve the interests of power. We retain who we are outside of the roles society rewards us for, but yet we are punished and repressed when we must leave (as literally every human must) them. People are made into human surplus.
Against this madness we must organize and advocate for a more beautiful existence. A true social health puts the development and meaningful engagement of people at its center. If at all possible, people must be kept integrated into our social fabric and given the resources necessary for a productive and fulfilling life. Part of healing society will be dismantling the institutions and relationships that keep us isolated and deprived, but it goes deeper than that. We need to build a society where our flourishing is our daily business.
 Bakunin, Mikhail. (1871). The Paris Commune and the Idea of the State. http://robertgraham.wordpress.com/bakunin-the-paris-commmune-and-the-idea-of-the-state/