Colonial War and Mental Disorders
The Wretched of the Earth Chapter 5
This is a longer post because of the many reading recommendations. That means the bottom section may get cut off in your email. To read the full piece you can click the header to navigate to the web page.
Mini Review
Two years ago I read Cory Doctorow’s book, Radicalized, which was first released in 2019. I’m a fan of his and have read much of his work. The book is a collection of four novellas, detailing different near-future dystopian scenarios. I enjoyed the story of the kids in the slum apartment building hacking people’s toasters so they would no longer have to pay a subscription fee to toast their bread. They had to fight against the surveillance of the apartment building security and of the companies which charged fees to use all their appliances.
Another story centered on a group of wealthy folks who holed themselves up in a bunker/compound to save themselves from some sort of apocalyptic event. Turns out «SPOILER ALERT» they also cut themselves off from medical care and all died from some horrible illness. This story reminded me of the book Davos Man: How the Billionaires Devoured the World by Peter S. Goodman. Goodman is the Global Economics Correspondent for the New York Times and has spent his career interviewing and researching rich people and their companies. His insights into the sad and nonsensical world of the ultra-rich are illuminating. One core theme throughout his book is that the people he talked to (CEOs at multinational companies, Forbes top wealthiest people) know that they are destroying the world and harming democratic governance. For many of them, the goal is to make enough money to insulate themselves from the consequences of making so much money. Many of them have properties in Hawaii or other remote places that are equipped for apocalyptic scenarios. To make it perfectly clear, Goodman found that the ultrarich are doomsday preppers. These are the people with the most power and influence over political, economic, and climactic events who have decided to only save themselves and continue destroying the world in the process. Coincidentally, Semafor has an article from February 20th confirming just that, and the main buyers seem to be crypto-tycoons who want to ensure that they will continue to have a record of who owns a digital currency that will likely be useless after an apocalyptic situation.
The final story I want to discuss, which is the one I found most realistic at the time, is about a man whose wife is dying of cancer and he joins a darkweb forum of men in similar situations, many of whom are grieving the loss of children or other loved ones whose treatment was denied by insurance companies for being too expensive or experimental. The forum is a dark place and many of the grieving men encourage each other’s rage until they start to attack insurance companies in what the news initially reports as random acts of terrorism. This story was the one that stuck with me most, as it was the least futuristic of all of them, and could have already happened. Now, it’s all the more relevant in light of Luigi Mangione’s murder of the CEO of UnitedHealthcare. This is also an incident I couldn’t help but think of as I was reading the final chapter of Wretched of the Earth, as I’ll explain below.
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Reading Recommendations
Today’s reading recommendations are more focused than usual. Over the past several months I have come across many, many examples of the failures of the for-profit healthcare system in the U.S. and the criminal insurance company executives that face little to no consequences in our legal system. A few of these examples are below and I’ll start with a great piece from Inquest on the eugenic history of our dual justice system, which posits that there is a certain class of people (generally poor and non-white) whose crimes are attributed to a core part of their being and another class of people (generally wealthy and white) whose crimes are just an unhappy accident of entrepreneurship and business. Thus both groups are policed accordingly, the former through brutality, long prison sentences, and life-long consequences and the latter through regulatory bodies that sometimes fine their companies and rarely directly impact the actual decision-makers.
In one clear example of two justice systems. This report from ProPublica details the regular, systematic, and intentional illegal fleecing of taxpayers by a medical supply company. According to the piece, “No one has faced criminal charges for activity the government’s own investigators deemed fraud.”
As The New Republic reports, pharmaceutical companies’ excess profits are the main reason people still die from HIV. “The bad news is that for everyone else, the price tag is $42,000 per year. The Lancet reported that Australia was at a “distressing impasse” over the cost of injectables. And although countries in Eastern Europe, North Africa, and Latin America are still experiencing increasing numbers of HIV infections, many of them were left out of Gilead’s licensing agreement. Brazil is one such example, despite the fact it hosted clinical trials for PURPOSE 2 trials of Lenacapavir. To add insult to injury, recent research from Liverpool University in the U.K. revealed the injectable could be produced for as little as $40 per year. [emphasis mine]”
The New York Times reported on the closing of rural maternity wards because they simply don’t make enough money for hospitals. “The share of hospitals without maternity wards increased every year, according to the study, published on Wednesday in JAMA, a prominent medical journal. Maternal mortality (cdc.gov/maternal-mortal…) remained persistently high over that period, spiking during the pandemic.
Because its data runs only through 2022, the study does not account for the additional challenges that hospitals have faced since the Supreme Court case that overturned Roe v. Wade that year and led many states to restrict abortion. States with abortion bans have experienced a decline (nytimes.com/2023/09/06/…) in their obstetrician work force.”
In a somewhat more positive piece that’s still an incredible indictment of for-profit healthcare, North Carolina implemented a program to reduce medical debt. “The average cost for treating acute leukemia, for example, in the first 12 months is right around half a million dollars,” Culp said. “That cost burden is so great that we know that over 40% of cancer patients deplete their entire life savings within two years.” After spending their savings, Culp said, many cancer patients begin to accumulate medical debt”
In another example of dual justice systems, CBS reported in December last year that McKinsey settled a lawsuit after "turbocharging" opioid sales after crisis was in full swing. “Three Purdue executives pleaded guilty to misbranding charges in 2007 and the company agreed to pay a fine. The company pleaded guilty to criminal charges in 2020 and agreed to $8.3 billion in penalties and forfeitures — most of which will be waived as long as it executes a settlement through bankruptcy court that is still in the works.” These are, of course, people who knowingly lied to doctors and the public about the danger of a medicine which has now led to tens of thousands of deaths. Fortunately for public safety, this is just a consequence of the corporate leaders’ competitive and entrepreneurial nature and nothing that would need such severe punishment like a real murderer might face.
This 2024 New Yorker piece written by a doctor is chock full of examples of the harms of for-profit healthcare and how executives profit off the pain and suffering of others while leading to worse and more expensive care than most developed nations.
“during a five-year review period, the hospitals stayed open and their workers stayed employed. A few months after the period ended, however, Steward started selling the land on which the hospitals stood. A $1.25-billion-dollar deal, in 2016, helped to finance more acquisitions. Many facilities, asked to pay rent on land they’d previously owned, struggled...
In May, Steward filed for bankruptcy. It has closed two hospitals and plans to sell thirty-one others. Steward’s C.E.O., Ralph de la Torre, who in 2011 purchased a forty-million-dollar superyacht, was subpoenaed by a Senate committee but failed to show up; he was held in contempt of Congress and resigned from his position...
Meanwhile, in some places in the U.S., private-equity firms now own more than half of all medical practices within certain specialties. “We are being picked clean by private equity,” a New Jersey-based radiologist said at a recent meeting of the American Medical Association...
according to the Medicare Payment Advisory Commission, a nonpartisan agency that counsels Congress, private Medicare Advantage plans will cost the federal government eighty billion dollars more per year than if those patients had been in the traditional Medicare program. “You might as well flush most of that eighty billion dollars down the toilet,” Berwick told me.
Monopolization of healthcare leads to higher costs -
"Employer-sponsored health insurance (ESHI) costs in the U.S. have increased fourfold since the 1980s, accounting for 10 percent of the average firm’s labor costs in 2019.1 Given that these costs are workplace-financed, a natural question arises: how has the striking increase in ESHI costs impacted U.S. firms and workers? By raising labor costs, an increase in ESHI costs might depress wages and employment. And because firms pay a fixed cost toward each worker’s health plan regardless of income—incurring the same cost for a low-paid janitor as for a highly-paid executive—lower-income workers may be disproportionately affected. One potential contributor to rising ESHI costs is consolidation in the private health insurance industry. At the same time as ESHI costs have steadily increased, insurer mergers have likely led to less competitive and more concentrated markets. These trends may be causally linked, as reduced competition could drive up health insurance premiums by strengthening the bargaining leverage of insurers during negotiations with firms"
Finally, while the proposed solutions are not so bad, CNBC reported in 2018 that a Goldman Sachs report asked if actually curing patients was a good business model. The issue is that in a concentrated healthcare industry, there is less incentive to “constantly innovate" than there is to extend patents and mini-monopolies as much as possible.
“GILD is a case in point, where the success of its hepatitis C franchise has gradually exhausted the available pool of treatable patients,” the analyst wrote. “In the case of infectious diseases such as hepatitis C, curing existing patients also decreases the number of carriers able to transmit the virus to new patients, thus the incident pool also declines … Where an incident pool remains stable (eg, in cancer) the potential for a cure poses less risk to the sustainability of a franchise.”
This post is the final one on the book The Wretched of the Earth, by Frantz Fanon. In each prior post I analyze a different chapter of the book, starting from the introduction. If you want to catch up, you can find the links to the introduction, one, two, three, and four here. Each post should stand on it’s own, but together can provide more context for a deeper understanding of what Fanon was writing about.
Colonial War and Mental Disorders
But the war goes on. And for many years to come we shall be bandaging the countless and sometimes indelible wounds inflicted on our people by the colonialist onslaught (p181).
In the final chapter of The Wretched of the Earth, entitled Colonial War and Mental Disorders, Fanon compiles a series of case studies based on his own experience treating patients at a psychological hospital in Algeria during colonization and the fight for independence. As I mentioned in a previous post, most of the radical books I have read provide firm evidence for their critiques of current systems. What makes them “radical” is their critique and questioning of the current state of things. In fact, they are serious reflections on the state of the world and how it could be different that often reveal a deeper truth than thinkers hemmed in by the status quo are able to uncover.
Along those lines, what I found most interesting in this final chapter is that Fanon spends almost as much time describing the ill effects of colonization and war on the perpetrators of the violence and oppression as he does on the victims of it. This is a common theme throughout the book. He is speaking directly to Africans, but he is always cognizant of the common humanity of Africans and Europeans in a way that intentionally subverts the colonial proclamations of Europeans. As he states in chapter one, “Decolonization is truly the creation of new men… The ‘thing’ colonized becomes a man through the very process of liberation (p2).” But the colonized are not the only people who are made human through decolonization. The violence and degradation that colonizers enact daily on the colonized also degrades their own humanity as the colonizers feel viscerally, even if they ignore its origins. By ending the violent system of colonization, or apartheid, or segregation, we are restoring humanity to both the oppressed and the oppressors. As Fanon warns, people, and indeed, culture, is created through the process of liberation. Ending the context of violence may restore some humanity to the oppressors, but their full humanity can only be restored through their own struggle and own commitment to liberation of themselves and their fellow humans.
The first example Fanon provides of the effects of the war is actually outside of his collected case studies. It is that of a former resistance fighter from an already liberated African nation. Every year he suffered many symptoms around the date when he had placed a bomb in a café known to be frequented by racist colonizers. After independence, he became friends with people from the former colonizer nation who were great supporters of his country’s fight for liberation. Though the nation was eventually liberated, the fighter recognized that he had no way of knowing whether anyone killed in the blast was like his new friends. “The militant, who never for a moment had thought of recanting, fully realized the price he had to pay in his person for national independence.”
I note this episode because it is a perfect encapsulation of the rippling waves that violence causes across a society and to individuals. The perpetration of violence and suffering from violence both cause lasting harm, even when they can be justified for a greater purpose. This episode also recalls a scene in the movie The Battle of Algiers, where colonizers are dancing in an ice cream shop and a resistance fighter leaves a time bomb under the counter. The camera focuses on a young boy eating ice cream for a long moment, forcing the audience to reckon with the innocence being destroyed in this act of violence, which is itself one small and specific moment responding to the systemic violence enacted by the colonizers.
Among the other case studies recounted, Fanon notes two specific examples of European police torturers suffering the consequences of their brutal treatment of prisoners. One had trouble sleeping because he could hear the screams of his victims every night when going to bed. The second is an officer who turned violent toward his wife and children since he began to torture others.
The present problem had occurred since “the troubles.” “The fact is,” he said, “we’re now being used as foot soldiers. Last week, for example, we operated as if we were in the army. Those guys in the government say there’s no war in Algeria and the police force must restore law and order, but there is a war in Algeria, and when they realize it, it’ll be too late. The thing that gets me most is the torture… Sometimes I torture for ten hours straight (p197).”
Instead of leaving his job, “he asked me in plain language to help him torture Algerian patriots without having a guilty conscience, without any behavioral problems, and with a total peace of mind. (p199)” This pain of the conscience is a necessary part of being human. For both the resistance fighter, whose use of violence was more justified, and the colonizers, the mental anguish is a key factor emphasizing the cost of violence and the need to constantly weigh its necessity against its harms.
To conclude the discussion of the case studies, there was a case of a young woman titled: “Case No. 3 - Anxiety disorder in a young French woman whose father, a senior civil servant, was killed in an ambush (p204).” As Fanon describes the situation, she was raised in Algeria and made friends with and played with Algerians as a child. In her words,
My father was a senior civil servant… As soon as the troubles broke out, he threw himself like a maniac into a frenzied manhunt for Algerians… I watched helplessly as my father slowly changed (p204).
She no longer stayed at home and eventually stopped visiting because he directed the torture of Algerians in his basement. She was even “frightened and embarrassed” to look at him. She went on to say,
You see I’d lived for a long time in the village. I know almost all the families. I had played with the young Algerians of my age when we were little. Every time I went home my father would tell me a new batch of people had been arrested… Deep down I knew the Algerians were right. If I were Algerian I’d join the resistance movement (p204).
“The funeral sickened me,” she said (p205). She observed so many people speaking well of her father and of his morality and righteousness while she realized it was all a lie. Her anxiety stemmed from this experience, the changes in her father, and, likely, her inability to stop him. This particular case struck me, and when I first read it, the case of the UnitedHealthcare CEO had just occurred. In no way do I wish to make light of the suffering of his family and friends. I feel great sympathy for them and the sudden loss they experienced. At the same time, I think the above case provides a parallel to understand why someone might resort to such violence.
As I noted in the reading recommendations, the for profit healthcare system causes daily harm to many people across the U.S. We have created corporate and legal structures which divert accountability so many times that ultimately no one is considered accountable for the death and illness that results. A CEO is the ultimate decision-maker, but isn’t always involved in day-to-day decisions. They often indirectly influence corporate culture and, more directly, corporate practices. UnitedHealthcare is responsible for many cases of defrauding Medicaid and Medicare and also for denial of services which leads to sickness and death. Shareholders may pressure corporate leaders to seek more profit and that pressure filters down from the CEO to the staff and to the daily practices like denying claims. All of this by design makes answering the question of “who is responsible” for the harms caused by for profit healthcare and health insurance very difficult. Ultimately, perpetual profit-seeking causes the harm, but that is blaming the economic system of capitalism which everyone participates in (willingly or not). Proximately, the individual employees who deny claims are responsible, but they have little power and would likely lose their jobs if they didn’t follow guidelines handed down by their employers.
As I noted in my last post, a proper analysis of power is important to understand any situation. An analysis of power shows us that the CEO and major shareholders are then the ones with the most control and therefore the ones who should hold the most blame for harms that are caused by their business practices. However, such an analysis is further complicated by the fact that many wealthy people donate some of their money, or their companies provide grants or other support to nonprofits to help people. Cutting through the noise and justifications reveals that the only way for them to accumulate such an excess that they can give away, much like in the colonial system Fanon describes, is through systematized forms of violence, both direct and indirect. There is the extraction of value created by employees to enrich shareholders and CEOs (a milder form of harm), and there is the more direct violence of denying claims to care, either forcing patients into poverty to maintain their treatments, or sentencing them to death or injury to increase profits. This is so widespread that an accounting of the total harm caused by one company is well beyond the scope of this post.
Suffice it to say, we need major change in this country, and around the world to reduce these harms. I feel for the family of the CEO and I sincerely hope that no one else goes through what they go through. I also feel deeply for the millions of people impoverished by our healthcare system and those who die due to lack of care, are driven to suicide because they don’t see a way out of their cycle of debt, and constantly confront a faceless bureaucratic system designed to degrade the humanity of both the insurance providers and the people seeking care. We can only restore our collective humanity by fundamentally changing the power dynamics entrenched in our healthcare system (and economy as a whole). As I quoted from Fanon last week,
We believe the conscious, organized struggle undertaken by a colonized people in order to restore national sovereignty constitutes the greatest cultural manifestation that exists… This struggle, which aims at a fundamental redistribution of relations between man, cannot leave intact either the form or substance of the people’s culture (p 178).
Every neighbor of mine who cannot receive healthcare in the wealthiest country in the world is indicative of a deep degradation of our own humanity in this country, a degradation that harms everyone involved. The only way we can restore our humanity is through a collective struggle for the liberation of ourselves our neighbors, and eventually all of our fellow humans across the world.
Purchase the Book
If you’d like, you can purchase some of the books mentioned in this post from bookshop.org. This is a way to support local bookstores (or me if you use the link below), and avoid the Amazon monopoly.
Here is the link to my store page, with all of my recommendations.
You can also use the store locator and select a local book shop for the profit of your purchase to go to. According to the website:
When you select your local bookstore on the map above and visit their Bookshop.org page, we place a cookie in your browser that identifies you as that store's customer, and the store will get the full profit from all your Bookshop.org purchases (30% of the book's list price).