I have copied below the text of the presentation that I delivered on Wednesday, December 9th, the first day of the enormously successful Philosophy, Disability, and Social Change conference. The chair of the session was Eric Winsberg who did a fantastic job. The presentation copied here is an abbreviated draft of an article that will appear in a special issue of International Journal of Critical Diversity Studies on the theme “Philosophies of Disability and the Global Pandemic” (Spring 2021). As you will notice, I have not added most of the references/citations to this version of the argument. Please don’t cite or quote this version of it.
Philosophy, The Apparatus of Disability, and the Nursing-Home-Industrial Complex
This presentation extends my investigations into the ways in which disability is naturalized in philosophy, that is, expands my analyses of how an individualized and medicalized conception of disability, according to which disability is a naturally disadvantageous characteristic or property of individuals, is naturalized in (for example) bioethics, ethics and political philosophy, philosophy of mind, and feminist philosophy.
By the end of the presentation, I will have indicated how this conception of disability informs the notable indifference of philosophers to the predictable COVID-19 tragedy unfolding in nursing homes and other institutions in which seniors and younger disabled people are placed and, in addition, I will have argued that philosophers must engage in conceptual engineering with respect to how disability and these institutions are understood and represented. Throughout the presentation, I will refer to these institutional settings in various ways, primarily using the unfashionable term nursing home rather than the more upbeat phrase long-term care facility. For I contend that the latter phrase is a misnomer, a euphemism designed to conceal the archaic and barbaric character of these institutions. My recuperation of the former term—that is, nursing home—is thus intended to make explicit that these institutions are outdated and should be rendered obsolete. Indeed, as I will show, furthermore, these places are neither a “home” nor a site of “care.”
Philosophers generally do not regard critical examination of disability as pertinent to research and teaching in social metaphysics and social epistemology; nor do they, generally speaking, appreciate the critical importance of philosophy of disability but rather remain resolute that philosophical inquiry about disability is appropriately and adequately conducted in the subfield of bioethics, a contestable subfield that both rationalizes and legitimizes eugenic practices. In my philosophical writing and activism in the profession, I have endeavoured to show how the naturalizing and individualizing assumptions upon which these practices of confirmation bias rely are inextricably entwined with the conceptual-analytical inquiries that philosophers pursue and the judgements that they make about faculty searches and hiring practices, journal submissions, curricula, conference lineups, and tenure and promotion. In other words, social metaphysics and social epistemology of impairment and disability must consider how claims that naturalize these ostensibly “biological” phenomena emerge; in what contexts these claims are mobilized and advanced; and for what social, economic, institutional, professional, and political purposes.
In this presentation, therefore, I do the following: I scrutinize claims made about COVID-19 outbreaks in nursing homes, group homes, psychiatric hospitals, and other institutions in which disabled people and seniors are segregated; I point out that disability is naturalized and depoliticized in care discourses about how these institutions are situated with respect to the pandemic; and I argue that philosophers must engage in radical conceptual engineering that construes disability as an apparatus of power, one of whose mechanisms is the “nursing home-industrial complex,” as I refer to it. An aim of the presentation is to convince you that ontology is always already political, that is, I aim to convince you that ontology and politics are mutually constitutive and mutually reinforcing. My presentation thus implicitly advances an argument for the erosion of the artifactual distinctions between theoretical philosophy and applied philosophy, ideal theory and nonideal theory.
The naturalization of an individualized and medicalized conception of disability in discourses about nursing homes is a form of structural gaslighting. Nora Berenstain (2020) has remarked that philosophers partake in structural gaslighting when they invoke epistemologies and ideologies of domination that actively and routinely disappear and obscure the actual causes, mechanisms, and effects of oppression. My argument is that the epistemologies and ontologies of domination within philosophy that persistently naturalize disability repeatedly sabotage attempts to improve the situation and status of disabled philosophers, in part because these epistemologies and ontologies facilitate the reconstitution within both the discipline and profession of deeply entrenched prejudices according to which disabled people are defective, unreliable, and suboptimal.
Against the individualized and medicalized conception of disability that prevails in philosophy, I maintain that disability is an apparatus of power, in Michel Foucault’s sense. The structural gaslighting about nursing homes, which the individualized and medicalized conception of disability bolsters, is one strategy of this apparatus of disability. The exclusion of disabled people from the profession of philosophy and other positions of epistemic authority is another strategy of this apparatus. As Foucault explained it, an apparatus is an ensemble of (among other things) discourses, institutions, scientific statements, laws, administrative measures, and philosophical propositions mobilized in response to a perceived social need in a particular historical moment (Foucault, 1980, 194). The perceived social requirement to which the historically and contextually specific apparatus of disability responds is biopolitical normalization.
Philosophers have largely ignored the social, economic, and political circumstances that surround nursing homes and other congregate settings in which seniors, elders, and younger disabled people are put, preferring to understand these settings as politically neutral sites of care, love, and benevolence rather than understand and represent them as carceral environments that enable the segregation and management of certain populations deemed to be disposable. According to a New York Times report, 479,000 residents and staff of 19, 000 nursing homes in the United States were infected with COVID-19 by mid-September, while more that 77, 000 residents and staff of these institutions had, by mid-September, died of the virus. Residents and staff of nursing homes located in predominantly Black neighbourhoods of U.S. cities were disproportionately represented among these fatalities. By October 27th, 84, 136 COVID-19 deaths had occurred in nursing homes in the United States and 537, 446 COVID-19 cases were recorded in these institutions, figures that do not account for the COVID-19 deaths and cases in group homes, psychiatric hospitals and other institutions where seniors and disabled people in the United States are confined. Nevertheless, philosophers have had little to say about these COVID-19 deaths and cases and the conditions that precipitated them.
Indeed, philosophers, including feminist philosophers, seem to take for granted that the bulk of these institutional cases and deaths are attributable to a natural property or characteristic inherent to senior and disabled populations; hence, these cases and deaths, philosophers seem to imply, are in some sense unavoidable and thus are neither ethically nor politically troubling. Not even philosophers who advance proposals about how society should respond to COVID-19 have interrogated the relationship between the outbreaks in these institutions and the character of the institutions themselves.
This refusal on the part of philosophers to closely examine the social, economic, and political circumstances in which these COVID-19 cases and deaths have occurred has enabled the ageist, ableist, classist, and racist conditions that contributed to the causes of these infections and fatalities to remain obscured and unchallenged, including the ableist neoliberal socioeconomic conditions that made possible the very existence of the institutions. Hence, I call upon philosophers to pursue a form of conceptual engineering with respect to nursing homes; that is, to acknowledge that nursing homes, so-called long-term care facilities, group homes, and other institutions in which seniors, elders, and younger disabled people are confined constitute the fulcrum of a massive network of governmentality that I have named “the nursing-home industrial complex.”
This revision of our perceptions and understandings of nursing homes and their functions could be described as a process of “semantic amelioration.” Semantic amelioration, as Sally Haslanger (2020) defines it, involves the expansion and improvement of the resources available to us with which to understand phenomena. To illustrate this definition, Haslanger points to the movement from an understanding of the concept of race as a biological kind to an understanding of the concept of race as a sociohistorical kind. Haslanger notes that the distinct conceptual schemas available in the respective historical milieus in which these disparate understandings of the metaphysical status of race circulated have generated divergent understandings of the concept of race.
With my own terms of reference, I want to argue that the conceptual schema which currently generates perceptions and understandings of nursing homes and other congregate settings in which seniors and disabled people are put is a historically contingent mechanism of the apparatus of disability; that is, the conceptual schema that construes these institutions as paradigmatic sites of care and love, rather than as the linchpin of an industrial complex of governmentality, is an artifact, that is, a historically contingent mechanism of the apparatus of disability and other apparatuses with which disability is entwined.
The idea of an “industrial complex” has a distinctly American lineage with multilateral implications. In 1961, during a televised speech broadcast into the living rooms of a predominantly white middle-class America, President Dwight D. Eisenhower introduced the idea of an “industrial complex” by invoking the term military-industrial complex. Eisenhower’s use of the term military-industrial complex was intended to warn this sector of the American public about “the unprecedented conjunction of an immense military establishment and a large arms industry.” Eisenhower was especially concerned about the potential of the arms industry to influence government policies and budgets, that is, concerned about the potential of American arms manufacturers and manufacturers of other military-related items to coerce the U.S. government to finance military aggressions abroad that would serve their own economic interests.
In other words, Eisenhower coined the term military-industrial complex to articulate this concern: that the more money that could potentially be made at home from military aggressions abroad, the more that military aggressions abroad would be made, and the more money at home and wars abroad that were made, the more influence that American manufacturers of military-related items could wield over elected U.S. government officials in the states in which the items would be produced.
After Eisenhower, Angela Davis introduced the term prison-industrial complex to describe the system through which prisons have become a mechanism of racial segregation in the United States and a primary source of profits for many American manufacturers and multilateral corporations (also Ciurria 2020). Likewise, I use the term nursing-home industrial complex to refer to an expansive socioeconomic network that comprises nursing homes and other so-called “care” facilities, medical clothing and linen suppliers, health-care and administrative temp agencies, professional associations and trade unions, prepared food companies, medical equipment manufacturers, pharmaceutical corporations, and other entities that benefit financially from the segregation of senior and disabled populations in nursing homes and other congregate settings and the ableism with which this exclusion is co-constitutive.
Indeed, the nursing-home industrial complex has increasingly come to hold the coercive economic influence over elected officials about which Eisenhower had forewarned. Note, for example, that the term nursing-home industrial complex aptly describes the relationship between the American nursing home industry and U.S. politicians, as was starkly evident when, early in the summer of election year 2020, U.S. Senator Mitch McConnell initiated legislation that would grant legal immunity to the owners of American nursing homes for liability related to COVID-19 deaths and any other fatalities that occur on their premises (Pauly 2020). By early July, in fact, twenty-two American states had already adopted such immunity laws, beginning with the state of New York, thanks to a clause in Governor Andrew Cuomo’s annual budget.
As a mechanism of the apparatus of disability and, ultimately, neoliberalism, however, the nursing-home industrial complex traverses across the borders of the United States, extending far beyond them, with the nursing-home industry now an integral part of the economies of Australia, Canada, France, Hong Kong, Italy, South Africa, South Korea, Sweden, and the United Kingdom, while seeking new markets in Latin America, the Caribbean, India, and elsewhere.
Since early March of this year, discourses about COVID-19 cases and deaths in North American nursing homes and other institutions in which elders and disabled people are segregated have unravelled in the North American mainstream press and on social media. In the terms of these discourses, the COVID-19 cases and deaths in these institutions have been largely naturalized and medicalized, represented as an inevitable consequence of a “vulnerability” inherent to the residents of the institutions, due to their age or an apparently intrinsic characteristic now commonly identified as “an underlying condition” or, in more technical terms, “a co-morbidity.” Only sporadically has the succession of COVID-19 outbreaks in North American nursing homes been attributed to the very nature and functioning of the institutions themselves, including their architectural design, the scarcity of supplies and resources that beleaguers them, the isolation and disciplinary regimes that characterize them, and the transient nature of the labour that sustains them, all of which elements constitute the economic bottom line of the nursing-home industrial complex and the individualizing and totalizing power that conditions it.
By late April of 2020, more than 1000 of the 1350 COVID-19 deaths that had, by that time, occurred in the Canadian province of Quebec were tied to nursing homes. In May, the Progressive Conservative government of the province of Ontario issued a call to the Canadian Armed Forces to assist with the emergency in Ontario nursing homes, following the lead of the government of Quebec which had already done so a month earlier. For, by May, the situation in Ontario nursing homes had likewise spun out of control, with a rising number of COVID-19 cases and deaths amongst residents and staff, most of the latter of whom were racialized and newcomer women. By June, more than 80% (MacCharles 2020)—that is, more than 6,000—of the total number of COVID-19 deaths in Canada by that time had occurred in nursing homes (Ha 2020).
At the end of September, COVID-19 deaths in Canadian nursing homes accounted for in excess of 82% of the close to 9,500 COVID-19 deaths in Canada by that time, with almost 2,000 of these deaths occurring in nursing homes throughout Ontario. On October 9thof this year, more than 60 nursing homes in Ontario were in lockdown due to COVID-19 outbreaks. By mid-October, in the Canadian capital city of Ottawa, Ontario, 30 nursing homes were in the grip of outbreaks, leading to the deployment in these institutions of more than 600 Red Cross workers (CBC News 2020). By October 20th, there were outbreaks in 87 nursing homes in Ontario. By November 14th, that number had climbed to 100, with 26 nursing home-outbreaks in Ontario’s capital city of Toronto and surrounding areas alone (Draaisma 2020). By December 4th, the number of outbreaks in Ontario nursing homes had reached 117. Indeed, by October 24th, almost a fifth of the COVID-19 deaths in Canada had occurred in Ontario nursing homes. Despite these ghastly figures, however, Ontario’s neoliberal Progressive Conservative premier, Doug Ford, has consistently refused to launch a comprehensive and transparent public inquiry into the circumstances surrounding these COVID-19 cases and deaths. On November 16th, in fact, Ford’s provincial government voted unanimously in favour of Bill 218, legislation similar to McConnell’s, and that now ensures retroactive legal immunity to nursing homes against lawsuits brought forward due to COVID-19 deaths that occur on their premises.
By no coincidence, Michael Harris, the current Chair of the Board of Directors of Chartwell, the largest owner and operator of for-profit nursing homes in Canada, is a close advisor to Premier Ford and, is himself, a former Progressive Conservative premier of Ontario. Harris’s annual salary of CAD $230, 000 for his parttime position as chair of the board of Chartwell, his holdings in Chartwell of an estimated CAD $4,500,000 to $7,000,000 (McQuaig 2020), and Chartwell’s relationships with provincial governments across Canada are, in combination, integral elements of the nursing-home industrial complex in Canada. When Harris served as Ontario’s premier from 1995-2002, his neoliberal government, like Ford’s, slashed public spending on health care and other social services, relaxed regulations and public oversight of nursing homes, removed nursing home staff minimums, and significantly expanded privatization of these institutions by redirecting provincial public funding to privately-owned, for-profit nursing-home corporations (Malek 2020).
The majority of COVID-19 deaths in Ontario have indeed occurred in for-profit nursing homes (Ireton 2020), resulting in public outcry and demands for the Canadian federal government to “take control of long-term care,” despite the fact that funding and oversight of nursing homes in Canada falls under the jurisdiction of the provincial governments, not the federal government. This public outcry and these demands became more insistent, nevertheless, after military medical personnel deployed in more than a dozen Ontario nursing homes with outbreaks released a whistleblower report about health and safety violations in five of the facilities, four of which are for-profit nursing homes (Carter 2020). These violations included: cockroach and rodent infestations, verbal abuse of residents, dirty linen or no linen on residents’ beds, inadequate cleaning and sanitizing of their rooms, fecal contamination, lack of PPE, lack of hygiene, understaffing, and lack of staff training with respect to infection control.
Let me underscore that these sorts of infractions are not unique to the unprecedented circumstances of the pandemic, as Ford and others in his government have both insisted and denied. On October 22nd, in fact, the Canadian Broadcasting Corporation’s news program Marketplace aired a segment in which it reported that 85% of the more than 600 nursing homes in Ontario have, over the past five years, repeatedly broken laws with incidents of abuse and neglect of residents, failing to provide residents with enough food and water, and medical errors such as distribution of the wrong medication. As David Common (2020), the host of the Marketplace segment, pointed out, furthermore, an astonishing 30, 000 such infractions have, during the past five years, occurred in these institutions with no repercussions for any of them.
Some advocates for elders and disabled people argue that public ownership of nursing homes and so-called long-term care facilities would resolve the widespread problems that prevail in these institutions. Note, however, that only about 60% of these institutions in Ontario operate on a for-profit basis, although, as I’ve noted, 85% of Ontario nursing homes have been repeatedly cited for abuse, neglect, and medical error. I want to emphasize, therefore, that the problems that persist in nursing homes and other institutions where seniors, elders, and younger disabled people are segregated constitute irreducible aspects of the institutions themselves and are indeed functional to them.
The outbreaks that continue to occur in nursing homes and similar congregate settings across Canada and indeed globally are also not due to an inherent characteristic of seniors and disabled people, that is, not due to some inherent vulnerability of the senior and disabled populations who live in these institutions that public ownership, better funding, and adequate staffing would manage and control. On the contrary, the thousands of COVID-19 cases and deaths in nursing homes and other so-called long-term care institutions across the world, like the thousands of COVID-19 cases and deaths in prisons, are testament to the insidious nature of both the institutions themselves and the carceral archipelago of our societies to which they increasingly contribute. In short, COVID-19 has thrown into relief that nursing homes, like prisons, must be abolished; that is, both the nursing-home industrial complex and the prison-industrial complex must be dismantled.
Many feminist philosophers, rather than embark on a path of sustained critical examination of the concept of vulnerability, have worked to redeem the allegedly prediscursive status that has customarily been ascribed to vulnerability and simultaneously disparaged. However, the apparent self-evidence of the ontological status of vulnerability is an artifact of structural gaslighting; hence, the concept of vulnerability, too, should be the target of a feminist project of conceptual engineering. Rather than a prediscursive inherent human trait, vulnerability is a contextually specific social phenomenon whose politically potent and artifactual character could be recognized and acknowledged if feminist philosophers (among others) were to take up Foucault’s idea of “eventalization” (Foucault 2003).
Foucault (2003) used the term eventalization to refer to a breach of self-evidence that exposes the singularity of a given practice or state of affairs. Eventalization aims to show that things are not as necessary as they seem. As Foucault remarked, “It wasn’t as a matter of course that mad people came to be regarded as mentally ill; it wasn’t self-evident that the only thing to be done with a criminal was to lock him up; [and] it wasn’t self-evident that the causes of illness were to be sought through the individual examination of bodies” (249). No one is a criminal, but many people are criminalized. No one has a race or a disability, but people are racialized and disabled. No one is “a vulnerable” (to use Eva Kittay’s  term) but many people—including seniors, disabled people, and prisoners—are made vulnerable, that is, are vulnerableized,
Even well-kept, adequately staffed nursing homes and long-term care facilities cannot be the proper response to the question of how societies should provide to elders and younger disabled people. On the contrary, such apparently genteel institutions should rather be recognized as the window-dressing of the nursing home-industrial-complex, which is a carceral network of power that contributes to the reproduction of ableism, ageism, and racism, while underwriting a neoliberal political and social environment in which productivity and profit are steadily prioritized.
A comment that African American feminist legal scholar Dorothy Roberts recently made about the futility of care ethics for work on prisons and so-called child welfare systems also captures the futility of a care ethics approach to nursing homes and other institutions in which seniors, elders, and younger disabled people are incarcerated. As Roberts put it, “You can’t fix prisons (or [so-called] foster ‘care’) by training their agents to be more caring. The very logic and design of these systems are antithetical to care” (Roberts 2020). I want to argue, likewise, that the eugenic logic of neoliberalism, which provides the impetus for the nursing-home industrial complex, makes a mockery of care and concern. To quote Roberts again, “The only way is abolition.” In short, my argument is that we should regard up-scaled regulation and renovation of nursing homes and other institutions in which seniors and younger disabled people are confined as a kind of gentrification of apparatuses of power, gentrification designed in part to ease the minds of the community-at-large about the segregation and dehumanization that these institutions facilitate; in other words, gentrification that effectively expands the scope of apparatuses of power and the systemic injustices that they constitute and comprise.