Monday, November 9, 2009

invading socialist society of caring work?

 So much going on in my head, hoping this will come out clearly! I have been thinking about these questions but most recently, was directed by a friend to a conversation on What in the hell blog about caring work and the dynamics of workers mobilization, self activity and creation of new values, which helped me clarify my thoughts around this.

I have been very influenced by a book called "The American Worker" by the Johnson Forrest Tendency (JFT). The book was written in the 1950s, from the perspective of an autoworker. It was an observation and diary of the work process that him and his coworkers underwent, as well as the social dynamics, expressions against the top-down control of their labor by the foremen and management.

I have had some problems with the book, but for the most part, have been inspired by it because it lays out how workers who are at the point of production, that is, workers who are doing the everyday work of producing, creating value in the capitalist process, are the ones who know best how to work those machines and run the work process, more so than the bosses who yell at them to do shit from their office on-high, more so than those who claim to be more intelligent/qualified because they manage.
(For all The Office fans, Boys and Girls, Episode 15 Season 2 shows exactly this!)

There is a sense that workers do not need management to run their workplace. They know how to collaborate to do it together. This is not out of any special knowledge or skill particularly, but because of the "definite relations, which are independent of their will" that workers are thrown into in the course of production. The experience of being stuck at a machine, surrounded by pungent smells and oily layers that coat your skin, the jarring noises of pounding machinery etc, as one sits along an assembly line with his coworkers, working on the same objects/machines, churning out day after day of boredom, frustration and production, creates a kind of collective solidarity and teamwork. What is also unique about JFT is the emphasis on how everyday people and workers also have an inclination to express their creativity, intelligence and mastery of tools. These ingredients combine to create workers who have the potential and ability to run their shit without management, support and accommodate one another's strengths and weaknesses on the shopfloor, to have the potential to overcome racial and gender oppression on the shopfloor, etc and basically, become a proto-formation of the new society, or the "invading socialist society."

So here we have this dynamic relationship between two of Marx's quotes here and here. On the one hand, that "It is not the consciousness of men that determines their existence, but their social existence that determines their consciousness," ie. humans are products of our society and socialized as such. On the other hand, that "The coincidence of the changing of circumstances and of human activity or self-changing can be conceived and rationally understood only as revolutionary practice." That is, that revolutionary practice involves not just a changing of external circumstances, but also active human transformation, and self-changing -- which means people gotta WANT to be better human beings, requires WILL POWER, and AGENCY!

Here is how I am engaging with these ideas based on my experiences and observations:

These dynamics are specific to the nursing home industrial complex and my conversations with CNAs in other nursing homes; I dont know much about the division of labor in hospitals to be able to comment on that. Please chime in if you do!

1) Based on the current division of labor, we can't manage the workplace on our own. We need other expertise that we dont currently have, and those who have it are our immediate supervisors. Their monopoly of this knowledge is also their justification for our subordination.

Many of my co-workers who hate the working conditions of the nursing home get out by applying to hospitals (unionized workplace) or try to become Registered Nurses (RN) or LPNs.

We always say that the RNs who have never been CNAs before are the nastiest cos they have no idea how the work is done and it is a bunch of numbers to them.

Then there are also those RNs who have been CNAs before and then forget all about it and become the nastiest assholes on the floor cos they think they been there, done that and can now play boss to those who are left behind.

In many nursing programs now, we are expected to get CNA licensing, and for some schools, concrete CNA experience/volunteering experience, to stand a better chance to enrol in the program.

This requirement however, is different from having a holistic view of nursing. It is to weed people out, to make it more competitive, to create more loopholes for people to BECOME RNs cos of the funding shortage for RN programs, even though this country fucking NEEDS nurses

This is yet another dimension of how the reproductive labor of society, ie. caring for the ill, elderly, and disabled, is now placed on the individual to compete and jump through major hoops, and not on society through state funding for such programs.

A training program that values caring work would combine dimensions of RN and CNA work together so there isn't such a clear division of labor b.w mental and manual labor.

 2) Being a good care worker (nursing, teaching, childcare) requires skills that needs to be learned and mastered. It is not "natural." I know many of us with strong gender analysis will agree to this because this rhetoric of caring work being "natural" is often another way of saying it is "woman's work." However I think  many times, how people talk about the skills involved in caring work still feels very technical. The emotional aspect of caring work  that requires skills seems to be reserved only for the top echelon of care workers -- such as social workers, or therapists. Them learning how to relate, communicate, care for their clients is seen as legitimate skilled caring labor, but the caring labor that CNAs, or childcare workers need to relate to our residents and children, is still not seen as skills that need to be learned. You either are someone cut out to be a CNA/nurse/childcare worker, or you are not.

Of course I am not trying to say everyone has to have a vocation toward these forms of labor. Some people have a harder time than others relating to children, or the elderly.What I am saying though is that being a good care worker requires a process -- being able to de-escalate, or be patient, or not project your frustrations on those who are more physically and mentally vulnerable than you, needs to be practiced and learned. It is not instinctual to anyone. 

I am not saying this to justify any form of abuse that takes place in nursing homes, or childcare. These forms of abuse are not acceptable at all, but I also find it a huge problem that the State, or management has no conception of how being a good care worker requires good external conditions and environment. It cannot be blamed simply on the individual when they snap after a long repressive day at work. Being able to learn how to be a good care worker requires community and accountability, not just individual expertise and personality.

Folks from the What in the hell blog have discussed, how do we think about the refusal to work as a legitimate form of resistance in factory work (where you are working with inanimate objects) vs. caring work (where you are working with human beings whose well being will be affected by the care worker's refusal to work.) Is that immoral? When does legitimate workplace resistance end and immorality begin?

I think this question cannot be separated from a few things:
i) that if we talk about class struggle also as struggle for creation of new values, and transformation of self and society, then we also have to think about disabilities struggles alongside class struggle. just like we would have critiqued male workers rebellion that take place at the expense of the women/poc proletariat, likewise, care workers rebellions should not take place at the expense of the surplus/displaced proletariat. 
i think we can apply Selma James' thesis from Sex Race and Class, that caste is the expression of class. under capitalism and the fetishization of a certain set of commodified, profit-generating productive traits, people with disabilities and children fall under a caste that arguably become a class phenomenon -- lack of access to material resources.

ii) care work has so much potential because, far from being auxillary, it is the core of capitalist society -- if there were no more future generations, there would be no more kids; if there were no more healthcare, there would be no more continuous stream of skilled labor. caring work allows for a high degree and complex form of capitalism to take shape -- imagine if everyone died at age 35 because  of lack of medical services to care for rehabilitation -- what would happen to Microsoft? what would happen to the state?
Without heatlhcare, capitalism cannot reproduce itself, and neither can it generate highly advanced productive forces.
the point about care work having so much potential is that caring workers have the power to mobilize large segments of the community to support their struggles. we are at the point of reproduction of the entire society, not just of our immediate residents/patients/children.

iii) being able to de-escalate, not let out our frustrations on those who are vulnerable, is a skill that our future society needs. it is the roots of struggle against any form of oppression -- and caring workers are at an important place to push forth these values in the presence of community and fighting organizations. my point is that this demand cannot be individualized, cannot be blamed only on an individual careworker's moral capacity. the capacity to not take out anger on those who are more vulnerable requires effort, practice and support that EVERYONE needs training in. it does not come automatically.

Kind of feel like I am going all over the place...excuse the randomness of this post! at some point I will brush this up more:P

3) As a woman of color, an immigrant who speaks with an accent working in an all-white nursing home with folks who have been veterans of WW2, I feel at times, that my dignity is under attack.

My coworkers and I have racist slurs yelled at us by residents with dementia and alzheimers. The interaction is racialized, and it is also classed. 

I feel anger at times, but remember that these people have dementia and are the products of their era, not individual racists. I recognize that I am an abled person, and they are not and I cannot fault them for being a product of their society.

However, it is not easy to always have such a distance from my initial emotions after someone yells: Go back to where you come from, or slaps me as he shouts "I wanna shoot all the Indians", or address my coworkers as "colored girls." We do the work that noone appreciates -- wiping buttocks and cleaning up pee. And it is a constant struggle to see this work as important, dignified work, even as the racial assaults rain down.

I need a community space to process these moments -- a community space that consists of care workers, anti-racist people with disabilities, people who are compassionate, and also anti-racist, and who most importantly, dont individualize, or blame me and my coworkers when we feel anger, or feel underappreciated. People who wont pathologize our anger. People who will see that our work is valuable and that our struggles at the workplace is also tied to a struggle for a society that wont create racist monsters who spout white supremacist bullshit when they get dementia.

4) Accountability for safety is now so tied to management control. Everytime my coworkers and I chide each other on giving better care, we always start off by saying: "I am not trying to boss you, but...."

I imagine at times, no one wants to be a snitch even things might not be done right.

If accountability, safety, werent so tied to management and our repression, and the loss of our own dignities as individuals, then it would be alot easier to hold one another accountable. 

Gotta go now, have more more to say, but hope this makes sense so far!!


  1. Totally makes some sense. I wrote a response to a small piece of this at my blog (ha!)

    There is a lot more I will try to respond to later! I look forward to talking about this stuff more with you!

  2. Great post, I'm glad to have a place to discuss these issues and am glad you took the initiative to develop and raise them.

    RNs vs CNAs- It's complicated. Where I work nearly everyone in the hospital are immigrants or 2nd or 3rd generation immigrants (its the nature of Miami). Many if not most RNs came from the working class and some from peasantry and underclass in their home countries. We have strange scenarios where peasants from Haiti are RNs working over creole landlord CNAs on occasion though that's probably a rare instance. Relationships can be pretty bad, but it's not so much about not having done that work as it is about class. RNs are solidly working class (i can speak for the hospital) and have virtually no power over anyone else's work except for influence. I can pressure a CNA say but only my supervisor could really do anything, not even the charge nurse could discipline a CNA. The difference I see is about three things: class consciousness, personality, and class identity.

    The nurses who treat CNAs particularly well tend to have solidarity with the other coworkers on the unit AS coworkers, or out of a general friendly and respectful personality (which is sometimes coupled with "professionalism"
    ). The nurses who tend to treat the CNAs poorly tend to fall into two camps: people who are absorbed their own sense of knowledge and skill as "professionals", and those who seek out class differentiation. Nursing thrives on the illusion of class escape. In some people this encourages a narcissistic sense of capability and believing everyone else is an idiot and incompetent. I was surprised to find how judgmental many nurses are even relative to MDs. The other factor is that if you came up from the bottom, fought hard, earned a degree., etc., some of these folks want to set themselves apart from the other workers in the hospital. It all varies by unit. I personally set the tone on the unit by going out of my way to help the CNAs, training new nurses to respect them, and sometimes intervening if I see a nurse get out of line.

    Healthcare self-management- It sounds like you're writing primarily from the perspective of CNAs? If we think broadly about the wage workers (and even some MDs are wage workers in a way), healthcare facilities are more than able to be self-managed. Beyond the unit directors, most of the administrative work is related to research, standards ,legislation, billing, etc. All the technical aspects of that work are already handled by RNs, social workers, and MDs and in a revolutionary situation could be easily delegated, elected, rotated, etc.

    I'm not sure if you've seen it, but during the Spanish revolution the anarchists collectivized a number of hospitals with physicians. While the context is pretty different it's still instructive.

    A larger issue (and not really written about or developed to my knowledge) is whether we need these institutions at all. A deeply flawed and biased exploration of this is Ivan Illich's medical nemesis (basically an argument against the need for healthcare in a pretty extreme form). It's a problematic book, but the big challenges it poses helped me orient to what I want to do as a revolutionary healthcare worker.

  3. Briefly, I think the system of healthcare exists as a means of satisfying both the legitimate struggles for care across the centuries by workers as well as an industry for the recuperation of wages. The centralization of disease in hospitals, nursing homes, etc., should be an open question. In another society with more free time, resources, and education, it might be possible to care for loved ones at home and to be compensated by society for providing such social work. The professionalization of healthcare and it's existence as a mass industry is certainly necessary to a degree (we need capital intensive facilities for strokes, heart attacks, trauma, whatever), but that sidesteps the real questions which are about quality of living, the right to understand and self-heal, a popular right to health in the community, and the organization of society for human health. I believe that healthcare as an industry (socialized or not) comes into conflict with such perspectives, and so would be one of the industries in need of deep transformation in a revolution.

    Naturalness of caring work- Whoa! synchronicity. I just read this, funny that I sent you my draft about the same topic just yesterday. Neat.

    healthcare as the reproduction of capital- This ties in with the critique of healthcare. In part I think some of healthcare is actually not necessary for people or capital. Consider retired people. They are actually a drain on society. Many retirement homes act largely as human storage facilities with little outside contact where people go to spend severely restricted years before they die. In many ways capital would be better off not providing for these people's health at all, though the political fallout would be too great. I think shortly though we will see attempts at pushing elderly people back to work until they are unable and cutting as much aid as possible.

    When people are young they are mostly healthy, though certainly sick workers is a drain on the economy, capitalism has existed with minimal healthcare before and there's no reason it can't now. I don't want to diminish our work, but I think we need to situate it within a larger framework, perhaps the fordist extraction of wages through purchasing of services. What we've seen in the last few decades with the rise of capital intensive mass hospitals, work rationalization, toyotaism in hospitals, etc., is the dismantling of the fordist employer-health insurance system with it's community hospitals and primary care, and it's replacement with austerity. It could go either way. Healthcare will continue to be a signficant industry, but I think the economic role of our care is torn between many worlds (the productive capital of drugs/machines/finance etc, the burden of society placed by such, and the human demands for care).

    racism and abuse as a healthcare worker- working in healthcare has oddly made me much more tolerant and nonjudgmental. Most of my coworkers seem to go the other direction and become convinced they understand others and can make reasonable judgments about them morally. We have to deal with thousands and thousands of people in probably every scenario possible in their lives. That volume of situations creates a dizzying array of experiences, pressures, sharing, and abuse. What has helped me is withholding judgement. I find that accepting the limitations of my understanding and trying to care for people where they are is somewhat therapeutic. With things like the vile racism, sexism, physical sexual and emotional attacks we receive you can only take so much, and you have to find ways to challenge that and draw boundaries when possible. I don't know I try to see the human in these people and look a lifetime of domination and abuse and look for the best.

  4. Selma James read your blog and is interested to be in touch with you. Could you please get in touch with her via email or or by calling our Women's Centre on 0207 482 2496. Many thanks.