Philosophy of Disability, Conceptual Engineering, and the Nursing Home-Industrial-Complex

The writing below constitutes an excerpt of the penultimate version of my article “Philosophy of Disability, Conceptual Engineering, and the Nursing Home-Industrial-Complex,” which will appear in Philosophies of Disability and the Global Pandemic, a special issue that I’m guest editing for The International Journal of Critical Diversity Studies. The issue should be out by June 2021.

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COVID-19 and Vulnerabilized Populations

The COVID-19 outbreaks that have occurred in nursing homes and similar congregate settings across Canada and 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.

Foucault (1977) introduced the term carceral archipelago to refer to the ways in which forms of power that condition the management and organization of the modern prison have come to characterize the management and organization of contemporary society more generally, that is, contemporary society beyond the prison. Foucault was concerned to show that social space beyond the prison has become increasingly partitioned with barriers, borders, boundaries, and checkpoints through totalizing and individualizing disciplinary mechanisms—classification and categorization, registration, practices of differentiation and ranking, and observation and surveillance—whose apparently mundane implementation and exercise render populations more manageable and governable, keeping some people within certain spaces and between certain walls, while keeping other people out of these spaces and beyond their walls. In the carceral archipelago, as Foucault envisioned it, institutions (such as nursing homes) and other sites that are not usually associated with the prison, the carceral, and the punitive, are in fact “islands” of the carceral whose architecture, routines, schedules, and purposes mirror the physical and conceptual design and functions of the prison. As Foucault sardonically asked, “Is it surprising that prisons resemble factories, schools, barracks, hospitals, which all resemble prisons?” (Foucault 1977, 228). Throughout this article, I have attempted to show how the COVID-19 pandemic has thrown into relief the ways that nursing homes are like (rather than unlike) prisons. Indeed, I contend that nursing homes, like prisons, must be abolished, that is, the nursing-home industrial complex, like the prison-industrial complex, must be dismantled.

Many feminist philosophers (for example, Kittay 2020) and some disability theorists (for instance, Ben-Moshe, 2020), rather than embark on a path of sustained critical examination of the concept of vulnerability, have worked to redeem the allegedly prediscursive status that is customarily ascribed to vulnerability and simultaneously disparaged. The apparent self-evidence of the ontological status of vulnerability is, however, 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’s term eventalization refers 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” (Foucault 2003, 249). The edifying character of genealogical inquiry notwithstanding, one need not search for these sorts of historical exemplars of eventalization in the distant past. Consider, for example, that the efforts to defund police forces which gained momentum throughout North America and across the globe in the summer of 2020 constituted acts of eventalization designed to undermine the allegedly self-evident necessity of these “islands” (namely, the police) of the carceral archipelago. As activists and authors who continue to advance these efforts argued, no one is a criminal, but many people are criminalized. Likewise, I have argued that 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 elders, disabled people, and prisoners—are made vulnerable, that is, are vulnerableized,

Contra the implications of racist medicine, epidemiology, and popular public discourse that have circulated throughout the pandemic, residents and staff of nursing homes located in predominantly Black and Brown neighbourhoods of American cities are not disproportionately represented among COVID-19 cases and deaths because Black and Brown people are somehow innately vulnerable to COVID-19 in ways that white people are not. No one is more naturally vulnerable (“at increased risk,” “high risk,” etc.) to COVID-19 than anyone else nor is anyone (or because no one is) more naturally immune to the virus than anyone else. The naturalization of vulnerability and risk in the context of discourse on COVID-19—which has typified medical, philosophical, bioethical, mainstream media, and legislative responses to the pandemic worldwide—is both individualizing and totalizing.

That is, this ableist and racist naturalization of vulnerability and risk in the context of COVID-19 is individualizing, insofar as it attaches vulnerability and risk to the bodies of certain subjects, ensuring that they will be regulated and disciplined by virtue of this individualization and, in many cases, enlisted to become self-regulating and self-disciplining. In addition, this naturalization of vulnerability and risk in the context of COVID-19 is totalizing, insofar as it creates “risk groups,” statistical subpopulations whose respective natural(ized) gradations of susceptibility to the virus cover over the systemic structural and institutional mechanisms and apparatuses—such as the nursing home-industrial-complex—that breed transmission of COVID-19 amongst marginalized people, fostering their vulnerability to it and thus positioning them under increased scrutiny, surveillance, quarantine, and other forms of control. Seldom has this naturalization of vulnerability and susceptibility to COVID-19 led to increased social assistance, the expansion of paid sick leave, job and housing security, and the other forms of economic and institutional change that would systematically and socially distance these people from the virus.

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—with its attendant naturalized assumptions about vulnerability and risk—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

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