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About This Issue
Health care is an important problem worldwide. The articles in this issue on health care range from concrete struggles in the U.S. to alternatives in other countries to theoretical analyses of the problem.
The article on institutional oppression of women and the proposed Worcester, Mass., Special Consultation and Treatment Center for Women was written by a collective of women that is directly involved in the struggle against institutional violence and the ideology that legitimizes it. The article shows that the “Worcester Ward” would not be a rehabilitation center as claimed. Instead it would be another of the many women’s prisons that are designed as political weapons to suppress the angry reactions of women striking out against a system of male-dominance and oppression. The article exposes the role played by psychiatric-medical ideology in legitimizing a concept of “normality”. By defining as “abnormal” behavior that threatens the status quo, this ideology serves the interests of those holding power. The theory and practice of psychotherapy are, consciously and unconsciously not aimed at enabling people to lead fulfilling lives. Rather, they are aimed at constraining and altering patterns of behavior that do not conform to the societal norms which support a system that ignores the needs of most of the people. The institutional violence committed in prisons like the Worcester Ward—violence including not only physical abuse but confinement and various forms of psychological torture—is justified as therapy necessary to rehabilitate “sick” and “violent-prone” inmates. Groups like the Coalition to Stop Institutional Violence are using every means possible, including legal and legislative, to stop concrete manifestations of institutional violence such as the “Worcester Ward.” They demonstrate that such prisons are not “aberrations” but are logical results of the existing social order.
Howard Waitzkin ‘s article shows how a Marxist analysis of medical care grows out of the study and critique of social relations. Rather than simply reducing ill-health to the malfunction of physiological proceslies or the invasion of microbes, a Marxist analysis sees these physical events are interacting with social, political, and economic events. Thus, it points to change in social relations as an important way of improving people’s health. Although largely theoretical, the review raises questions of practice, particularly the issue of reformist versus revolutionary social change, which are central to the problems facing the Left today.
John McKnight’s article on the struggle of an impoverished Black community in Chicago to improve its health concretely illustrates one way of working for a people’s science. The local community organization discovered that the conventional health care facilities were not effectively dealing with the causes of ill-health. They saw the causes as social rather than physiological and began a grassroots effort to enable community residents to improve their OWI;J. health. The struggle was progressive in that it attempted to educate people about the inherent problems of a professionalized, self-serving medical system and to show them through practice that they were capable of taking control over various factors that affected their lives. Such a process of education and empowerment is a prerequisite to revolutionary change.
Yet, there are dangers connected with the type of reform work described in the article. One danger is that the achievement of some progressive changes will obscure the limited nature of the reforms they achieved and the ways in which the existing political and economic system poses obstacles to further reform without profound and widespread social change.
Another danger is that the “self-help” nature of the reforms may lead to cooptation in the form of victim-blaming; i.e., those in power will claim that the success of the people in improving their own lives shows that they were responsible for their problems in the first place. This type of cooptation can be undercut by educating people about the true roots of their problems and about the limits these place on their ability to improve their own lives within the context of the present system. The contradictions that exist in all types of reform work cannot be denied, and they are difficult to overcome—as the histories of many initially progressive struggles show. Yet, revolution is unlikely to occur in the near future, and in the meantime ways must be found that both politicize people and enable them better to fulfill their day-to-day needs within the present system.
Following independence from British Colonial rule, the government of the newly formed Tanzania proclaimed as one aspect of its path of socialist development a commitment to improving the health of all the people. The article by Walter and Gail Willett is a first-hand report on the philosophy, organization and techniques of health care being currently promoted and practiced in Tanzania. In this underdeveloped country, most of the people are rural subsistence farmers. Thus, in addition to the need to develop medical resources, there are serious logistical problems associated with improving health care. Many of the Western-trained physicians have either left or are unwilling to practice in rural areas. Tanzania has adapted much of the Chinese approach to health care both because of similar economic and physical requirements and restraints and because of similar political positions on the role and practice of health care.
All of these articles in this issue have a common theme of health care, and raise questions of the strategy and tactics of social change and the improvement of health. While progressiv~ in the short run, can the gains made by the Chicago community group lead to further changes of a more revolutionary nature or will they inevitably be defused and coopted by a capitalist Class unwilling to give up its power and control? Without having undergone a socialist revolution, can Tanzania rid itself of capitalist ideology and social relations not only as they are manifested in health care but in other areas as well? How can we take the analysis of the Worcester Ward article and use it, not only to inform people and change their thinking about the purpose of such institutions, but to begin to see it as part of a larger political-economic system of exploitation and oppression that must be overthrown? Indeed, the underlying issue raised here is the debate over revolutionary versus reformist socialism. It is our hope that these articles stimulate that debate.