Bodies on the Line

In the United States, the COVID-19 pandemic has brought the crisis of work and of care—of production and social reproduction—to new extremes. This summer, unemployment reached record levels. Essential workers were called on not only to tend to the sick, but to deliver groceries, collect trash, and drive buses—to perform tasks that have always been hard and undervalued, but now entail a health risk every time you clock on. Capitalist society depends on this essential work—carried out by nursing assistants, transportation workers, and caretakers—and its dangers are distributed unevenly, across divisions of race, class, and gender. For decades, socialist feminists have brought these realities to our attention; the pandemic has made their insights undeniable. For many, whether they are nurses in hospitals or parents trying to work full time while also educating children or caring for dependents, the labor of maintaining and sustaining life—paid and unpaid, public and private—is becoming too much to bear.

The pandemic has also confirmed and deepened the powers of digital technology companies. Google, Apple, and Salesforce are building contact-tracing software. Palantir is pivoting to the pandemic, winning contracts with the Department of Health and Human Services in the United States and national health services across Europe. Zoom enables the professional classes to work from home, and to see friends and family. Netflix and Hulu and Twitch provide entertainment. helps parents and children look for babysitters and home health aides. Google for Education lets (some) school age children keep learning (sort of). Uber and Lyft are available for those who want or need to avoid public transit; Instacart allows them to avoid stores. Amazon has hired hundreds of thousands of additional workers to deliver everything from textbooks to toilet paper, while continuing to sell much of the computing power that makes the system run. (Nearly half of the world’s public cloud runs on Amazon Web Services; Jeff Bezos has added $85 billion to his personal wealth since January.) The most powerful entities of our era are these platforms: more than just monopolistic corporations, they provide key social infrastructure and have become involved in vast rearrangements of our everyday lives.

The crisis has exacerbated existing divisions—between people who own stocks and those who don’t, between those who own and rent their homes, between those who do and do not have safe homes into which they can retreat, between those who do the bulk of domestic labor and those who don’t. It is also accelerating ongoing transformations of work and leisure. COVID-19 has created new opportunities for algorithmic management and domination. The technical mediation of work continues. So does the encroachment of tech firms into formerly public spaces, and with it the privatization of both public and personal realms.

These new conditions have inspired sustained political actions that are not novel in form but are striking in their longevity. The uprisings that mark the latest stage of the Black freedom struggle combine protests against the police and the carceral state, with its relentless exploitation, subordination, and murder of Black people and other people of color, with battles for community services. If we defund the police, we can better fund our struggling cities, protesters argue. This dissent takes place on the terrain created by work stoppages and massive unemployment, which is hitting Black communities especially hard. The rent strikes and the organization of mutual aid during the lockdowns join ongoing revolts in education and healthcare. At many levels of social and political life, there are new sites of contestation: unemployment benefits and furloughs, evictions, school and university openings. So far these have not prompted any major reform. Dreams of a bipartisan universal basic income collapsed with the pittance of the stimulus check, which sets a measly precedent for future basic income projects, relegating them to the policy toolbox of reaction. Far-right movements, including armed militias in the United States, are seizing the shutdowns and the ongoing movements for racial justice as occasions to foment violence. The New Cold War with China is escalating—with competition between U.S. and Chinese tech firms as a critical focus. At the time of writing, it is unclear how the epidemic will affect the Census, or the election in November.

Do these political conditions and conflicts confirm what we have long known, or are they a sign of tectonic shifts that we can’t yet understand? It’s still unclear whether the chaos of spring and summer of 2020 will give way to a more manageable public health and jobs crisis, a period of major depression and long-term unemployment, or something unprecedented. One thing we do know is that, for now, old frameworks are straining under new pressures.

The foundational divides of modern life—between work and home, public and private, production and reproduction—have been unsettled. Offices have been emptied, and many homes have been transformed into makeshift workplaces. The costs of social reproduction have been transferred from the public to the private realm faster than ever before. Meals once paid for by schools and air conditioning once paid for by companies have been offloaded onto households; like gig workers, all remote workers must now front capital costs for our employers. We upgrade our own internet, plan for endless video calls; the screen is never off. In the absence of regulation, the FAANG companies (Facebook, Amazon, Apple, Netflix, and Google), alongside others like Zoom, extend their subterranean power. Under a new tech feudalism, users live their lives on platforms and are tithed their data.

In this context, distance has become a new mark of privilege. At the start of the crisis, Jedediah Britton-Purdy described “the power to withdraw” as a sign of status in the class system under COVID-19. That privilege has only become more deeply entrenched as the months have worn on. The incipient trend of remote work is now a reality for many sectors (how long this will last is impossible to say). The question of withdrawal has been politicized in conflicts over masks and reopenings. But it remains mostly hidden and depoliticized in the realm of work, where getting back on the job for the sake of the economy continues to justify jeopardizing the health and safety of workers. The politics of withdrawal is a public politics about workplace rights and privileges, but it is a deeply personal kind of politics too—about who we are, what risks we can physically and psychically bear, and how our identities and capacities for risk are shaped by our homes, our workplaces, and the structures of power we inhabit within and outside them.

While both techno-pessimists and techno-optimists have long claimed that automation will end work as we know it, COVID-19 has also taught the inverse lesson: much work cannot be automated. The labors of the health and care sectors in particular show the limits of technology. The bodies that we bring to work—their identities and histories and desires—run up against these limits. This generates a novel political cleavage: between the embodied and the remote worker.

The difference tracks longstanding class distinctions—but not exactly. The work of doctors, janitors, and nurses is embodied, as is that of many journalists and university professors; that of medical coders, corporate lawyers, content moderators, and, for now, some teachers, is not. Both embodied and remote workers are likely to suffer new forms of insecurity. Remote workers currently have many privileges, as well as some novel freedoms and joys, but these are unlikely to become tangible benefits; instead, more and more programmers and professors will likely see their jobs broken up so that they can be deskilled or outsourced. While the most privileged workers may gain from remote working by increasing control over their time, the technologies they benefit from now will create new forms of domination later: surveillance that tracks familiar axes of oppression, and mechanisms sold by tech companies for better controlling workers on and off the job.

Digital technologies will continue to transform embodied labor too. Machines, after all, do not eliminate work, but rearrange it. These technologies will also alter our geographies. In the nineteenth century, the steam engine moved power away from rivers; trains brought cities closer to each other. Contemporary landscapes will be reshaped in ways we can’t yet see. Suburbanization entrenched the nuclear family, while the rise of the care sector allowed for private caring labor to be marketized for profit. For decades, re-urbanization and gentrification have produced rising real-estate costs, as financialization turned city centers into valuable, if vacant, assets. The businesses there that rely on proximity, like coffee shops and dry cleaners, are struggling; those that facilitate the right kind of distance—car rentals, delivery services, online retailers—are profiting. Now that those who can are fleeing cities for the country, the maps that divide many economies on class, electoral, and regional lines may be redrawn again.

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Traveling the Psychic c

Booked is a series of interviews about new books. For this edition, Dissent associate editor Lyra Walsh Fuchs talks to Rachel Aviv, the author of Strangers to Ourselves: Unsettled Minds and the Stories That Make Us (FSG).

Strangers to Ourselves opens with Rachel Aviv recounting her own institutionalization at the age of six, when she suddenly refused to eat. She was completely unaware of the term “anorexia” before her doctors—and the sisterly teenagers on her floor—spoke it aloud. By then, she avoided even saying the names of foods because it felt like consuming them.

Driven by the promise that if she ate her meals she would be allowed visits from her parents, Aviv eventually recovered and returned to elementary school. While she fared better than some of the girls she got to know in the hospital, the experience—her visit to what she calls the “psychic hinterlands”—stayed with her, as did her sense of the power of names and diagnoses. “It’s startling to realize how narrowly we avoid, or miss, living radically different lives,” she writes at the close of the chapter.

Aviv is now a staff writer at the New Yorker, and in her first book, she profiles five people wrestling with their mental health and their various treatments and diagnoses. An empathetic and deeply researched book, it is at once timely—50 million Americans are currently experiencing mental illness, according to one conservative estimate—and part of a long tradition of texts attempting to understand the mind. In this conversation, which has been edited for length and clarity, we spoke about healthcare, motherhood, anti-psychiatry, and more.

Lyra Walsh Fuchs: Strangers to Ourselves is not an explicitly political book, but there is, certainly, a politics in its insistence that peoples’ minds are shaped by the environments that they develop in—and also that every person deserves dignity. How would you describe the politics of the book?

Rachel Aviv: Mental health is a space that doesn’t align with one particular political school of thought. But there’s something wrong with a society that funnels so many people who are mentally ill into the prison system, and then goes one step further and takes some of the most mentally ill people in the prison and funnels them into solitary confinement.

And it’s worth noting that it might feel very different for a white, upper-middle-class person to be told that their mental illness is biological than for people who have struggled with poverty or discrimination all their lives. Their response to this explanation might be, “You’re ignoring the way that all of these things have pushed me to a point of crisis.”

Walsh Fuchs: To that point, you write about how some people find meaning in a diagnosis, and how for others—or maybe even the same people at different times—a diagnosis becoming “a defining fact” of their lives ends up being harmful. What do you think about the way that the healthcare and welfare systems demand diagnoses?

Aviv: Diagnoses are necessary: we need them to communicate. They serve a purpose that is non-negotiable. But the dictates of managed care endow diagnoses with disproportionate importance. In order to be reimbursed for care, doctors need to give a diagnosis, often after just meeting the patient. I do wonder if, once the diagnosis is given, there is a failure to recognize how subjective and provisional it is, and it may discourage curiosity, both on the part of the patient and the doctor, in terms of seeking suitable, individual answers to what is really going on.

The role that diagnoses play feels even more disproportionate when it comes to disability benefits: people can get locked in a kind of “illness career” because they need that diagnosis to get support from the government. The scholar Helena Hansen describes this as the “pathologization of poverty”: when the government cut back on welfare benefits in the late nineties, medical claims became the new avenue to qualify for government benefits—there were suddenly bureaucratic pressures to qualify for a psychiatric diagnosis in order to financially survive.

Walsh Fuchs: Are there any solutions to that problem?

Aviv: There’s been a lot more advocacy among patients—most prominently perhaps the Hearing Voices Movement—who have argued that experts should pay more attention to what the patient is saying about what is causing them distress. People in the Hearing Voices Movement will argue that sometimes the side effects of medications are more disabling than the voices, and, if a patient can learn to live with voices, they should be allowed and even encouraged to make that choice. They will argue that there is a wide spectrum of voice-hearing experiences, and, if hearing voices is not getting in the way of the person living a fulfilling life, they don’t necessarily need to be treated or deemed pathological.

Walsh Fuchs: The majority of the book’s subjects are mothers. Mothers have always played an outsize role in the development of psychology and psychoanalysis. In your book, the doctors at the Lodge, a residential treatment facility, are described as “substitute mothers.” Was it a coincidence that you ended up writing about so many mothers?

Aviv: I think it largely was. But it was also a way to express how mental illness spills over from one generation to the next. There are so many ethical questions about what it means to be a mother who has a mental illness, how it affects the child, whether you are doing something selfish by having a child, and how the child responds to seeing a parent who is mentally ill. I also am a mother of young children, so maybe I was more attentive to the pain of wanting the best for your child and worrying that you can’t achieve that for many reasons, some of which involve the way your brain works.

The chapter about Naomi focuses specifically on Black mothers, a population that psychiatry has not served well, in part because Black mothers have been seen as playing this role of carrying everyone’s burden. They are not often given the option of being depressed. Alternatively, there’s a long tradition of white mothers being the ideal target of psychiatry: these figures who are fraying under the pressure of trying to “have it all”: competence as a mother and wife, and a professional career, too.

Walsh Fuchs: “Mommy’s little helper.”

Aviv: Yes, I found that parallel really striking. There’s the white mother who can take medications to have it all, and the Black mother whose suffering is not taken seriously from a medical perspective because, according to the stereotype, she’s facing so many genuine obstacles in her life that there’s no need to look at biology.

Walsh Fuchs: In your book, you write about how the court said that Naomi was paranoid because she was afraid of being gassed—but she had in fact been gassed while she was incarcerated. That example was so striking. Do you have a sense of whether she is currently finding it useful to understand her experience as postpartum psychosis?

Aviv: Yeah, she does find it useful. Seeing it in medical terms was especially useful because she had such incredible guilt about what she had done to her children when she was psychotic, and what do you do with that guilt? Understanding it as a disease helped with surviving that guilt.

Walsh Fuchs: Did that help her to continue to do the sort of political thinking she wanted to do?

Aviv: Well, in a way, taking medications allowed her mind to be clearer, to become more open to other interpretations. She began reading literature and discovering a tradition of Black mothers struggling through the kinds of experiences she’d had.

Walsh Fuchs: There seems to be a rise of anti-psychiatry right now. Writers like P.E. Moskowitz are sounding the alarm about overdependence on psychiatric drugs, withdrawal, and overidentification with diagnoses. How do you see your book relating to this anti-psychiatry tendency?

Aviv: It’s unequivocable that there’s over-prescription and that psychiatric medication is too often used as the only solution. But there’s a way in which anti-psychiatry can be reductive and diminish the real disability that people experience. I don’t know why it has to be an either/or: that it’s either within the person, or her society—it is also about the relationship between the person and the society. People do have really damaging experiences on medication, but people are also living lives that wouldn’t be possible without medication. I think both truths have to be acknowledged at the same time.

Walsh Fuchs: It strikes me that a lot of the criticism is about a lack of education about how to taper off medication. You’ve written about your own experience with that. That’s something I have also struggled with.

Aviv: After writing that piece in the New Yorker [about withdrawal from psychiatric medications], I worried that my story was going to make people go off their medications, which I did not want. But then I was also aware that the fear of this is part of why there has been so little public discussion about withdrawal, because doctors and policy leaders are scared of people not taking medications when they need them. That’s its own kind of paternalism—to not give people the full scope of information, because you fear that they won’t handle it properly.

Walsh Fuchs: Do you have a sense of any clinicians or researchers who are coming up with a helpful way to talk about this?

Aviv: There’s a psychiatrist named Giovanni Fava who has done a lot of work on antidepressant withdrawal. He’s the only person that I know of who has dedicated his career to studying this issue, because he felt like this was a phenomenon that wasn’t really being acknowledged, and too often it was being misread and misclassified.

Walsh Fuchs: I don’t know if you’re on TikTok, but there is a fair amount of self-diagnosis and videos where people say, “You might have dissociative identity disorder if you zone out.” Some of it describes what seems to be common human experiences that, while unpleasant, aren’t necessarily cause for concern. But these videos are resonating with thousands of people.

Aviv: I have always been interested in the historical moment when multiple personality disorder proliferated. It was a certain kind of woman in a certain era in a certain moment in American history, and almost nowhere else in the world. It makes a lot of sense to say that it’s good to talk about mental health to destigmatize it. But then what if talking about it reifies the idea of the illness, and makes people identify as sick in a way that limits them? Because it does seem like mental illness, regardless of the diagnosis, often coincides with a sense of suggestibility: losing one’s sense of confidence; losing a sense of boundaries—these things can make people more dependent on what others say and how they see you.

Walsh Fuchs: If we’re thinking about the left in particular, on the one hand there’s a commendable consciousness of centering peoples’ disabilities, and then on the other there’s people who say, “Well, of course you’re depressed; it sucks to live under capitalism.” Or, “You’re not depressed, you’re just a capitalist subject.”

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