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Diana van Eyk's avatar

Thanks for this excellent explanation of anarchist thinking.

I think many of us already do this in self-organized groups. For example, I've often been involved in bulk food buying groups. I share the google doc and do the ordering, and others will pick up the order, then people pick up their food orders and pay me what they owe.

It's a lovely virtuous cycle, and no one is in charge, although I pay for the initial order which is delivered to my place, and people pick up from there.

And, with people so busy, it's a nice chance for a five or ten minute visit we wouldn't otherwise get.

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Ramona McCloskey's avatar

A very thought-provoking read, and I'd say the arguments are compelling.

All of this made me think how would anarchist organisation of healthcare affect the abuse of power at the hands of medical professionals. This is a very specific example, but here goes. Violence against patients, and particularly obstetric violence, is rampant, yet it's an issue that isn't openly talked about in the society, IMO because the state naturally creates an almost mythological narrative of an untouchable class of experts who can't be questioned and uncomfortable truths must be swept under the rug to maintain hierarchical power. I was at the receiving end of obstetric violence (within NHS) and it resulted in life-changing C-PTSD. Birth trauma is an utterly devastating form of dehumanisation. I've spent the last 4 years bringing attention to this issue and participating in different forms of peer support for those affected. Nothing is changing, in fact, maternal mortality rates are rising in many countries, with BIPOC women being particularly affected.

The biggest problem is that those at the bottom, who hold no power, get sucked into upholding this system of respecting the golden calf of expertise no matter what. Most people run away or even scream at individuals who try to start conversations on obstetric violence and how the whole maternal healthcare system is riddled with people who readily lie to patients and coerce them into procedures without consent, during pregnancy and especially during labour. I can't even count the number of times I was directly told to shut up, stop exaggerating, stop "accusing" doctors and midwives, suck it up because women give birth every day and don't complain, and even openly accused of lying and inventing obstetric violence. This culture of power abuse and the culture of silence that upholds it directly result in an unhealthy society - some research suggests that up to 1 in 3 childbirths are traumatic!

This is what I think of when you say "hierarchical organisations often have structural incentives to overlook or protect incompetent people who maintain the right connections or serve the interests of those above them." I've abandoned any illusion that the healthcare system nowadays still primarily serves its Hippocratic function; lived experience of violence and stats on just how dysfunctional the healthcare system and its outcomes are tell me otherwise, that any Hippocratic function is but a remnant floating on top of a toxic vat filled with profit-making, life-destroying practices. I don't think most people enter the healthcare system with an intention to abuse people - but evidently, hierarchy can make swathes of people drunk on power to the point where they start exercising dominance and dehumanising people who are below them. In that sense, medical system mirrors the state itself.

I think your ideas of horizontal organising would eventually lead to a dissolution of these power trips and (after a couple of generations) there would be a real chance for healthcare based on mutual trust, compassion and morals where untouchable subjects and silencing don't exist.

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