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Markdown
78 lines
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title = "Maddening Rhythms"
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has_factors = ["scientificmanagement.md", "MTMinItaly.md", "Noxiousness.md"]
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# About Maddening Rhythms
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The aftermath of WWII saw a number of struggles for health to become recognised as a common good. Many people fought for health practices to be supported via the public sector, and for care to be made available universally and for free at the point of use (that is, paid for through general taxation, rather than via a single payer model).
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Some of these struggles were more successful, other were less so, but whenever change came about it was not a top-down decision, but a result of complex mobilizations that often created transversal connections between those affected, organizers and professionals.
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In our current research, which we present here in form of a growing zine and library, we focused on one of such struggles for health that took place in Italy in the 1960s and 1970s. We believe that reactivating some of the stories, techniques and imaginaries that came out of it can be a useful exercise in our present days, in the aftermath of the Covid-19 syndemic, an event with a death poll that could have been, in large part, preventable.
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We focus on Italy not only because it is our context of origin, but also because during the decades 1960s and 1970s, it was an extremely lively political laboratory that became significant beyond its own context, including by inspiring a number of working class’ mobilization for healthcare in South America, for instance.
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Italy in these decades was subjected to a fast industrialization that deeply altered the life and work patterns of many. Assembly line work, organised according to the principles of scientific management, was brutal, dangerous, poisonous and mentally alienating. It should come as no surprise therefore that the struggles for health were largely working class struggles, addressing simultaneously question related to conditions of labour at the workplace, environmental degradation, gender roles in the home and the desirability of technological innovation.
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The title we chose for this zine is our English translation of the one of a newspaper article - RITMI DA PAZZIA - which denounced how in the factory workers are subjected to a constant accelleration in the name of profit. These rhythms are maddening in the sense that were making people furious and push them to organize for change, while at the same time they also provoked many to experience negative mental health conditions. As we shall see, burnouts, depression and psychosis were widespread experiences linked with chain work.
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# Italian Healthcare struggles
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In the aftermath of the decade-long neoliberal crisis of care and the more recent pandemic, many political imaginaries related to the protection of collective health rely on mutual aid and solidarity networks. Many of the initiatives that want care to be more accessible and inclusive are set up as self-organzised practices. Many activists and organizers are loudly critical of public healthcare provisions which are perceived as negligent and over-bureaucratic at best, incompetent and punitive at worst.
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Looking back at the Italian struggles for health of the 1960s and 1970s is a relevant tasks today as this history reminds us of a different possibility in orienting our political imaginaries. Rather than presenting autonomous and self-organzied practices as the opposite of languishing public infrastructures, they remind us that these very different alignment of forces is possible, as these struggles led to the creation of a public health care system in 1978.
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The pressure for creating such public health care system was born from an unprecedented alliance between left political forces, advanced experiences renewing medical practice, radical health activism, struggles by trade unions, workers’ groups, student and feminist movements. The 1978 reform was a universal, public, free health service, offering a wide range of provision outside the market, largely modelled on the British NHS and reflecting the definition of health spelt out by the WHO in 1946.
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Abandoning the tradition of a corporatist health system with its limited coverage of separate professional groups, Italy’s reform introduced a public and universal health service, financed through general taxation, freely available to all.
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The link between the self-organized struggles and the new public system becomes apparent in the way it was designed in its original conception (albeit soon corrupted by a series of reactionary modification to the law). In several areas – mental health, occupational health, women’s health, drug treatments - new knowledge on illness prevention, new practices of service delivery and innovative institutional arrangements emerged, with a strong emphasis on territorial services addressing together health and social needs. The movements' legacy was palpable in the integrated vision of health – physical and psychic, individual and collective, linked to the community and the territory – that emerged. The struggles were clear in their proposal: a new, less hierarchical type of doctor-patient relationship was needed; healthcare should be linked to territories and, as much as possible, conducted in participatory manner; preventive approaches, rather than curing, were central in this vision. This political strategy viewed health as combining a collective dimension and an individual condition; collective struggles were therefore needed to address the economic and social roots of disease and public health problems. This approach was paralleled by the feminist movement in addressing women’s health issues, including the important experiments in self-organized health clinics. As Giulio Maccacaro had argued in 1976, the strategy was a bottom-up “politicization of medicine”, challenging the way industrial capitalism was exploiting workers and undermining health and social conditions in the country.
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# Politicizing Expertise, Over and Over Again
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The Covid-19 pandemic brought back at the centre of attention the relationship between medical-scientific knowledge and political strategies in the field of healthcare, the very same relationship that has been the core issue in the historical struggles around healthcare that we have been encountering in the archives centred on 1960s and 1970s' experiences in Italy.
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During the pandemic, the dynamics of decision-making regarding the management of the health crisis were characterised by many difficulties that brought to the surface some key aspects of the relationship between the governed and the governors, the so called 'experts' and those who are not; in other words, the crucial and essential nodes of democratic order.
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On this terrain, all the critical signs characterising the current processes of depoliticisation that the neoliberalist governance has generated during last decades have become apparent.
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Let's be clear: the contribution of experts is relevant in order to make decisions in the most informed way possible, all the more so in situations of health emergencies; however, the massive recourse to them runs the risk of taking the place of the responsibility of politics and institutions, the risk of presenting solutions as unquestionable, just because they are 'technically' founded, without a common discussion on what is needed and which are priorities.
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During the pandemic, this exclusion defined at least two different models of care, of taking care of the emergency. On the one side, the care proposed by governments, that has been often rhetorical and sectorial. Let's think for instance on all dispensable bodies who were put in charge of the growing necessities of care, without receiving back any increase in wage, or at least an increase of the safety conditions in which they worked. On the other side, we have the model of care promoted by solidarity and mutual aid collectives, neighbourhoods and groups, whose aim was to redistribute the resources needed to face the emergency as much as possible, while at the same time denouncing the extremely dire conditions in which public services versed, due to decades of strategic disinvestment.
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How is then possible to reconcile the needs of politics and democracy with the expertise of the experts? From our point of view, the answer cannot be found in the abstract, but must sought out by delving into the merits of different political priorities, the quality of different democratic processes and the knowledges that different expert can bring to the table.
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The Italian history of healthcare struggles during the 1960s and 1970s offers a lesson that is still of great interest, highlighting how the issues involved in decisions concerning public health – the health of everybody - are mainly political in nature, thus, they always involve decisions that require not only technical judgements.
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A significant turning point for a new health paradigm, capable of keeping together scientific knowledge and political planning, occurred in Italy in the 1960s and the 1970s, when the figure of the expert became an expression of the Gramscian synthesis 'specialist + politician'. The movement for healthcare service reform was an expression of this renewed paradigm.
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Indeed, during those decades an unusual assemblage came together, in which specialists and non-specialists, intellectuals and workers could meet, study together, denounce and constructe a different way of conceiving production, of conceiving technology and science.
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Health was considered as a sphere of life as well as the activity of taking care of people. In this context, care took on a meaning that was opposite to the therapeutic medicalisation of society, to became the terrain of new mobilisations, in which a number of social and political actors got involved, including students, feminists, intellectuals, professionals and politicians. This connection generated new collective fields of research, new knowledges, and original forms of struggle and institutional experimentation. And the resulting cross-sectorial and transdisciplinary synergy in turn re-defined the terms of encounter between science and politics.
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Medicine and science had to be rethought both in their connection with society, the environment, and the productive sector; as well as in relation to their overall aims and founding values – disentangling themselves from a logic of profit to pursue the possibility of health and pleasure for all.
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In this context of struggles, the topic of power relations was understood in the perspective of a modification of relations between classes, of a growth in the rights and faculties of every human being, and of new relations between the experts and the general population. The function of the expert was understood as the most relevant for the fate of the workers' and democratic movements. Based on new demands from society – both in terms of the rejection of the practice of 'delegation' around health matters and of the overcoming of the separation between specialists and workers – a possible alternative function of the expert was envisaged.
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Of particular importance was what happened in the field of work medicine and healthcare provisions within the factories. Thanks to new methods of co-inquiry, trade union practices found a new lively terrain of politicization, aimed at building new relationships between workers (committed to reducing harmfulness within the factory) and technicians, doctors and chemists.
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Workers' subjectivity and experience became an instrument for building collective knowledge and, at the same time, the crucial node through which technicians started thinking about possible transformations into the reality of work and society at large. Consequently, a new language was constructed, a language that was able to connect the protagonism of the workers with that of the medical / scientific community.
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In order to intervene in the problems connected to the production cycle, new techniques were needed, new political and value-based instruments that would allow for transformations in the workplace as well as in healthcare provisions, inside and outside the productive cycle.
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Health struggles in the workplace, therefore, extended their claims to the conditions impacting the environment at large, by linking the psycho-physical wellbeing of workers with that of the rest of the population and other living beings.
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# About us
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Maddalena Fragnito and Valeria Graziano collaborated for the first time on the research  (2019). A year later the co-writing of the syllabus of  (2019) and then of , a project born with the outbreak of the pandemic (2020). With to the support of Memory of the World, in 2021 they collaborated for the digitization of the books series  (Medicine and Power), edited in the '70s by Giulio Maccacaro for the publisher Feltrinelli. Currently, they share the artist residence Matrice Lavoro (curated by Base Milano and the ISEC Foundation), which allowed them to dig into the archives in search for the forgotten stories related to workers' struggles for health in Italy (2022).
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# [Printable PDF VERSION here](https://pages.sandpoints.org/zine/print/)
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(best in Chrome)
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