Clinical understandings and policing of diagnosis being prioritized over Mad and disabled testimony is, by no means, a new mechanism of violence; it is, however, something particularly critical to grapple with given the eugenicist and ableist rhetoric made more visible by the COVID-19 pandemic. An ongoing public health crisis that has disproportionately harmed and killed multiply marginalized people, COVID-19 has gradually witnessed a calculated “exile”. The fact of the matter is that the threat posed by the pandemic persists, as demonstrated both by still-accruing infection and death rates, as well as the millions of people who have acquired Long COVID. In these times, it is disabled people who are most vulnerable, but also most intimately familiar with being abandoned and subjugated in crisis. Since the very beginning of the pandemic, disabled people have shared crip wisdom of interdependence and care as means of navigating COVID. Disabled people envisaged the longstanding havoc that would be– and has been, and continues to be– unleashed by government-sanctioned dismissal of the pandemic. Disabled people have offered their lived experience and continue to urge all to stand in solidarity by taking protective measures, even as the government has declared such measures unnecessary.

Contemporary perceptions of health– and the politics therein– are especially hostile toward those who have been oppressed throughout time. Leaning into interdependence and embracing community care practices are much-needed interventions and acts of sustaining each other. As late-stage capitalism and hyper-individualism tighten their grip, it is more important than ever to organize for a world that is radically different from its current state; informing that revolution with crip wisdom and care work paves the way for collective liberation. Health is often situated as an individual trait, contingent upon the decisions and efforts of each individual person; however, health is constructed by societal values and standards on a broad, population level. Health must no longer exist as something that can only be bought through wealth or notions of “deservingness”-- it must be deprivatized and recentered to prioritize total care for all people.

Health Communism, penned by Death Panel podcast hosts Beatrice Adler-Bolton and Artie Vierkant, calls for a radical recasting of healthcare and the political economy by which we approach medicine and capitalist notions of wellbeing. While not commentary on the current pandemic, the book provides highly applicable insight into histories of Mad and disabled rebellion within healthcare systems. Adler-Bolton and Vierkant present a compelling manifesto that traces the contours of health as defined by the capitalist state, encouraging readers to tread past their own perceived limitations of global left politics by embracing internationalism and imagining a total health justice that is wholly disentangled from capital. The text presents and enacts a new framework– “health communist”-- for community solidarity and liberation from our host-body relationship with capital.

Drawing a lineage of anti-capitalist movements and uprisings, Health Communism speaks to over a century’s worth of political agitation and radical activism. The co-authors pay homage to the historical resistance of activist collectives– primarily that of Sozialistisches Patientenkollektiv (shortened as “SPK”) and the anti-psychiatry movement.

A concise history of the function of SPK is necessary for framing and analyzing Health Communism. Sozialistisches Patientenkollektiv formed as a collective within the Heidelberg University psychiatric hospital at the tail-end of the 1960s (Spandler, 1992), assembled by Dr. Wolfgang Huber and a number of patients and students who believed that “as the result of capitalist relations of production, illness in its developed form as protest of life against capitalism is the revolutionary productive power par excellence for all human beings” (Huber, 1993, p. 17). Positioning psychiatric conditions solely as products of the capitalist state, Dr. Huber aimed to cultivate a class consciousness among Heidelberg patients by means of introducing them to Hegelian dialectics and implementing community care practices that recognized the effects of the violent, oppressive architecture of capitalism (Spandler). SPK protested psychiatric medicine, participating in collective “agitation” sessions that “more closely resembled political rallies than conventional group therapy meetings” (Durakov Warren, 2021). SPK held teach-ins, study groups, and sit-in occupations as a means of informing and equipping the sick proletariat to resist the capitalist state. The collective also focused on building a robust network of care and kinship, offering free childcare for SPK members who were working parents, tutoring students, helping each other secure medications, and assisting members in navigating housing and labor disputes (Durakov Warren).

In February of 1970, Huber and a large group of patients in the collective were removed from the Heidelberg psychiatric hospital for their radical organizing. Huber was forced to transition out of medical practice, but continued to lead SPK. Just months subsequent to SPK’s removal from the clinic, a compromise between SPK and the university allowed for patients to continue organizing and gathering within an allocated workroom at Heidelberg University, separate from the clinic. Usage of this room was granted in tandem with the promise of financial support from the university and permission for SPK to access the Heidelberg clinic’s dispensary so that Huber could continue to write prescriptions for patients to fill despite being removed from the hospital (Spandler). On July 9th, 1970, SPK became formally affiliated with Heidelberg University (Huber, p. 35). This agreement was short lived, however, due to negative press and backlash from Heidelberg’s Faculty of Medicine and most of the West German state, and the group received an eviction notice on November 14th, 1970 that ultimately severed the group from Heidelberg University (Durakov Warren). SPK continued in the homes of individual members following its public denunciation, and still continues to operate under the title of “Patients' Front”.

Adler-Bolton and Vierkant disidentify with the ethos of SPK which asserts that any form of health is unattainable and unassimilable[PJ1] , even in anti-capitalist frameworks, by proposing an original lens “by which health is reclaimed not just for workers but also for those marked as surplus, for all people: ‘health communism’” (Adler-Bolton & Vierkant, 2022, p. xii). Analyzing the means by which capitalist understandings of health have been leveraged to oppress the surplus class, the co-authors craft a proposition that centers this class in the reclamation of a health unbound from capital. Adler-Bolton and Vierkant posit that Mad and disabled people are held solely as a point of fiscal and social burden, namely those who cannot work; containing this group and continuing to exclude those marked as “surplus” from left labor and health struggles defeats solidarity. While health is most definitely not attainable under capitalism and an increasingly privatized healthcare system, it is attainable in a re-imagined, transformed economy. After all, as things stand, most everyone will come to be marked as “surplus” at some point in their lives.  A[PJ2]  focal point in this disidentification follows: “It is not necessarily the case that we are all sick. But none of us is well” (Adler-Bolton & Vierkant, p. 183). The authors cite American sociologist Talcott Parsons’ The Social System[PJ3]  to shed light on longstanding notions of disability and welfare posing a threat to society. Parsons wrote this text to reason in favor of the white patriarchy, and in doing so, he birthed the concept of “sick role”. Parsons attributed disability and illness with aberrancy and “reprieve of social activities including labor, work, duties owed to the traditional family structure, and other normative behaviors” (Adler-Bolton & Vierkant, p. 181). Parsons, in his work, goes on to describe physicians as managers of those in the “sick role”, claiming that separating the sick from each other by keeping them occupied by physicians creates a scenario in which the sick “become a statistical class and are deprived of the possibility of forming a solidary collectivity” (Parsons, 1951, p. 321). Adler-Bolton and Vierkant further explain that “[they] do not believe in the simplicity of dialectics” (Adler-Bolton and Vierkant, p. 182) but that they do agree with Parson’s implication that consciousness and solidarity of the sick is a threat to capitalism. The Parsonian and SPK-asserted ubiquity and undesirability of a disabled/ill/sick existence respectively stem from entirely different origins and political realms, as SPK used sickness as rebellion against capitalism while Parsons used “sick role” to contain those who pose a threat to the capitalist state to maintain the capitalist order. These ideas do not apply universally to each individual marked as surplus, as disabled bodyminds are deliberately marked as waste and categorized as deviants that are unworthy of life so long as they have not “rehabilitated” from disabled/ill/sick to cured. The social stigma geared towards disability specifically oppresses disabled people, and that stigma can (and does) manifest within the surplus class. Not every individual in the surplus class is sick, but the conditions of the surplus do not yield wellness.

This disidentification from SPK is one that can be put into conversation with that of Dr. Sami Schalk’s “Coming to Claim Crip”, in which she disidentifies with crip and within disability studies as a “nondisabled, fat, Black, queer woman” (Schalk, 2013). Schalk’s disidentification with/in crip and disability studies stems from feeling akin to disabled folks as a fat, Black, queer woman due to parallels in pathologization, social-construction, and erotic segregation of these identities and their intersections (Schalk). In this personal and academic disidentification, Schalk speaks to the value of coalitional theories, “​​I believe being crip-identified is an enactment of solidarity which can be beneficial politically, socially, and academically for multiple minoritarian groups . . . While I recognize that there are limits to identity-based arguments, terms like crip and queer—especially queer as used by queers of color—offer us fluid concepts that work both with and against identity, pushing the boundaries of these categories and opening them (and us) up to one another'' (Schalk). Expanding this thinking and disidentification with/in crip and disability studies lends itself quite well to the ideas posed in Health Communism, and a synthesis of these two disidentifications (disidentifying with SPK in health communism and disidentifying with crip) paves potential for greater degrees of cross-movement liberation within the health communism framework.

While it is true that health communism includes all people in its purview, a particular focus on crip in health communism would be beneficial. Schalk describes disidentification with crip as something more nuanced, personal, and powerful than mere allyship– something that enables disabled and nondisabled people to forge meaningful connections to Disability Justice and the crip wisdom birthed by disabled culture and lived experience. Disability is often characterized as an ailment– particularly in a capitalist context. Reclamation of disability through disability studies, crip theory, and Disability Justice has worked to turn the pathologization of disability on its head. It is not enough to recognize the socially-constructed nature of categories and move on, however. Celebrating disabled identity, then, is a means of resistance against the capitalist state that marks disabled bodyminds as waste. As a domain of inquiry and identity, disability has been embraced, celebrated, and utilized as a framework for critically analyzing the ways in which hegemonic forces of compulsory abledness interpret and inform the lives of disabled bodyminds. Nondisabled individuals can still come to realize structural oppression and violence against the disabled community without previously personally experiencing the same access barriers. This is a critical component in forging interdependence and creating expansive networks of care. In the context of Adler-Bolton and Vierkant’s proposed framework, ensuring that disabled QTPOC activists are at the forefront of organizing and that Disability Justice principles are upheld in the trek toward reaching health communism is of utmost importance. In Skin, Tooth, and Bone: The Basis of Movement is Our People, Sins Invalid highlights “leadership of those most impacted” as one of its guiding tenets. “Leadership of the most impacted” speaks to ableism’s entwinement with other forms of oppression and avows that “to truly have liberation we must be led by those who know the most about these systems and how they work” (Sins Invalid, 2016, p. 268). Those most impacted by the capitalist state are multiply marginalized, as respective forms of oppression leverage each other in order to thrive. Existing at the intersections of these identities is an inherently anti-capitalist form of embodied resistance. To accomplish total liberation and transform the political and economic state, we must liberate those most impacted.

In the capitalist state as it stands, “socialized medicine” programs simply tout minor progressive reforms that still obstruct the surplus from receiving care. Health Communism describes conditions under some of such “socialized” medical systems: 

Our trans comrades have fled the UK to continue their hormone therapy, in the face of artificial barriers imposed by the NHS’s Gender Identity Clinic system. Our disabled comrades in Canada hold disdain for the social democratic politicians in the US who point to the Canadian Medicare system as a panacea that should be reproduced, rather than the engine of austerity and repression that they experience it as (Adler-Bolton & Vierkant, p. xiv).

It is not until we supplant the capitalist state that true socialized medicine is achievable. What is possible under health communism is far more expansive and equitable than anything we could conjure under “socialized medicine” systems that are situated within a capitalist society. Redistribution is important, but what does redistribution address in this state? Many argue that it aims to address and care for our needs; however, the surplus is not allowed to determine its own needs. Ellen Samuels describes the systems of biocertification that ultimately decide who qualifies as “in need” and whose needs are truly needs as perceived by the capitalist state, “These fantasies of identification seek to definitively identify bodies, to place them in categories delineated by race, gender, or ability status, and then to validate that placement through a verifiable, biological mark of identity” (Samuels, 2014, p. 2). Discourse over supposed disability fakery and fabricated illness is so prominent, particularly in cases of invisibilized disability. What cannot be immediately seen by physicians and nondisabled individuals is often called into question, and disabled folks are often chastised for trying to “take advantage of the system” or receive “free handouts”. Under health communism, needs would not be called into question; abundant care would be available to all without any consideration of cost-benefit analyses. Any need declared by an individual would be met without speculation of whether that need is truly something worth providing.

One of the initial steps toward this vision of total health justice is intervening with sociological inquiry of disability and the social determinants of health as they are currently understood in the academe of public health. Revising current theories of disability and chronic illness in medical sociology would reject the social deviance paradigm, thus ensuring that forthcoming studies surrounding the sociology of disability and health are framed in a way that wholly accounts for social complexity and intersectionality of identity (Thomas, 2012). Social determinants are factors that influence one’s health that exist beyond what is typically considered “healthcare” and include things such as socioeconomic stability, housing, education, and one’s built environment. These factors build the foundation for health communism, but lack due criticism of how the capitalist state functions and inhibits our capacity for health justice. Calling for a cripping of public health would include doing away with ableist metrics such as Disability-Adjusted Life Years (DALYs) that aim to determine the remaining quality of one’s life in terms of capitalism-necessitated “productivity”. A cripping of public health would reevaluate the current central focus on encouraging independence rather than interdependence. A cripping of public health would disrupt for-profit healthcare and abolish carceral systems and forced treatment. Public health exists in a sanitized, depoliticized, ineffective fashion when it fails to address the oppressive state of capitalism. Cripping public health would set the stage for health communism to flourish, as it would bring us to reckon with the state that informs our conditions in order to produce genuinely equitable outcomes.

Health Communism addresses and aims to dismantle carceral logics of biomedicine, outlines the remnants of an otherwise erased history of Sozialistisches Patientenkollektiv, and describes a process for decommodifying and reclaiming health. Framing Adler-Bolton and Vierkant’s work through principles of Disability Justice and crip theory effectively separates health from capital and places emphasis on the existing work of disabled activists and scholars while enabling readers to envision a holistic, global network of care and solidarity in which crip identity and liberation are cherished.