In the year 2042, an oral history of the then 25 year-old ongoing Revolutionary Participatory Society organization/project in the U.S. will be published. The book’s fifteen chapters will excerpt and arrange insights culled from eighteen interviews to present events and ideas in a sequential, encompassing way.
By unknown dynamics, the book’s introduction, its 18 source interviews, and even drafts of its chapters, have begun to appear via email in the present. The web site at http://rps2044.org presents more about the project, its aims, and ways to relate to it, and offers more of its substance as well.
In any event, the interviewer is named Miguel Guevara and the interviewee in this article is named Barbara Bethune. The year they meet is 2041. The interview is a virtually verbatim transcription. Also, as there are 18 interviews and since Guevara will seek to avoid undue overlap, no one interview serves as more than a facet of the larger whole.
–Michael Albert
Barbara Bethune, you were born in 1992. You became a medical doctor and researcher and from the start questioned your role and profession. Your early RPS involvement solidified your purpose as revolutionizing health care and you later became RPS shadow government Secretary of Health. Can you tell us to begin your participation in this oral history your path to becoming a doctor, and then into radicalism, and your medical activist involvements immediately after the convention.
I became a doctor feeling it was a good way to do social good and utilize my abilities in a manner I would be good at, fulfilled at, and able to maintain. I developed the ambition early in life, partly from doctors in the family and partly from the example of a doctor who treated me at a young age.
Frustrations surfaced, however, once I entered college, and they only grew as I progressed further. My medical school training pretty much ignored context, social causes, and prevention. Experiencing the anti social and anti health aspects of an internship at a major Chicago hospital sealed the deal. I was radicalized.
Being an intern did it?
Intern training pressured us to conform so as to enter the profession. We had to jump hurdles and not create enemies among officials. For aspiring doctors this dynamic was always present. It was like water surrounding fish.
Interns did not openly question the situation. We passively took it as given. We would whine to friends away from the job, but not challenge employers. Our silence let us graduate and feel successful. But is also made us ready and even eager to impose similar insanity on others who came after us. It made us act as though internship rituals had merit rather than merely enforcing unworthy social relations.
We would do the rituals and defend doctors rights and privileges. We would work long hours, soldier on, earn large incomes and great status, and never think to ourselves, wait a minute, this is wrong. To allow that thought would admit our acquiescence. It was easier, and certainly better for our careers, to embrace a slot in the system. Fulfill role requirements. Bludgeon those below. Teach them to do likewise when their turn came.
Whether due to orneriness, outrageous confidence, or prior familiarity with dissidence, I rejected quiet conformity.
I asked myself, what’s going on here? Why have interns work for thirty or forty consecutive hours and then handle patients? It doesn’t provide good health care. Intentionally created exhaustion inevitably does harm. So why compel it?
I decided it wasn’t because we would have to do that for the rest of our days, because I knew it was not how established doctors functioned and it wasn’t good preparation for the occasional crises demanding long work hours, in any event. Not to mention the main insight, why not just have more doctors work fewer hours?
So what was internship about?
The more I considered the question, the more I felt it was overwhelmingly about teaching conformity and limiting the number of doctors to keep up doctor’s income. We needed to learn but the teaching conveyed medical knowledge largely despite themselves. The core of the teaching was that we were joining a special and small fraternity of doctors, and we had to display appropriate fealty consistent with what our future roles required. We had to fit or we should move on.
I began to think interning was just sophisticated hazing and to test that impression I visited a military boot camp. I watched new soldiers undergo training and asked myself, what is boot camp about for them?
The answer was easy to see. It wasn’t only about learning to shoot or to work together or even to be prepared for dangerous situations. It had elements of all that, yes, just like interning had elements of medical learning, but military boot camp was mainly about removing residual social inclinations, removing residual moral inclinations, and producing good practitioners of war who were ready, willing, and even eager to unquestioningly kill on command and to follow orders above all else. It was about reeducating soldiers to raise no questions. It was about creating soldiers who could not even comprehend the idea of resisting, even in thought, much less in actions.
Military boot camp, I could easily see was a giant cauldron of fierce personal reconstruction designed to produce soldiers who would blindly obey orders and do extreme damage without raising the slightest question. Graduates of military boot camp would accept and even celebrate having no say in policies and actions. They would report whatever few deviations might occur. Military boot camp was more about joining a cult with blind loyalty to its role requirements than it was about being the best you could be.
And you felt that that was true of being an intern on the road to becoming a doctor?
I did. After viewing the military dynamic, I looked back at interning, and I saw it was to create doctors who would would defend their huge salaries and prerogatives against any challenge regardless of the health care implications for patients and for society.
Interning was about creating doctors who would accept and even abet and try to gain via pharmaceutical profit seeking. Doctors who would denigrate and otherwise keep nurses insecure and submissive to their exclusion from decisions and even to their exclusion from giving treatment they could render. Doctors who would defend their incredibly inflated incomes even unto regulating the number of doctors downward via insane medical school practices.
Medical interning was what I later understood to be a coordinator class recruitment regimen. It was not mainly about health. It was not mainly about knowledge. It was not mainly about preparedness. It was mainly about becoming a loyal member of a relatively dominant coordinator class for a particular part of that whole class – doctors. It destroyed equity and fairness.
Seeing all this made me curious about other professions so I looked and I found similar dynamics for lawyers and for many other professionals as well. I was lost to the cult of doctoring, though I was even more intent than before on providing health care.
Others go through this pattern of pressure, frustration, and anger, and have varied reactions. Mostly, at least before RPS took off, people becoming doctors would try to navigate and do good and be ethical but without challenging their role assignments. They believed, with good reason, that challenging their roles would fail and would also lead to personal loss. This wasn’t true just for doctors, of course, but also for nurses, custodians, and all medical workplace employees, just like in other workplaces, as well.
The role structures in hospitals like those in law firms, political parties, churches, and other institutions, tended to create an attitude of going along to get along. Anything else felt like a naive pipe dream.
Worse, complying with one’s role, over and over, day in and day out, eventually switched from something you did with a frown under duress, to being who you were. You know all the lawyer jokes, well, the same could be said for doctors, managers, engineers, and so on. Becoming the beneficiary of a monopoly on empowering work inexorably distorts one’s personality and values unless one revolts against the dynamics. Someone who retains sufficient humanity to resist even just the most egregious excesses seems like a saint.
And for whatever reason, I reacted a bit differently than the norm for those times, as did some others, too, though we were a small minority and, most important, we rarely knew each other. I wanted to keep doing medicine but I wanted to improve health for all and not just for a tiny few. I felt no explicit allegiance to a domineering class above workers, though I certainly understood the pressures and allures of their situation.
So when I went to the convention it was mostly a kind of Hail Mary gesture. I didn’t know if what was being attempted would provide me a good path forward or even made sense at all, but I would try. And I was glad I did.
Why was that?
When at the convention, I met other doctors, nurses, and medical workers from my own city and from around the country. To hide dissent much less positive aspirations from view in medical institutions was paramount for those institutions’ maintenance – so I had never seen any of that – but once the dissent and aspirations were made public at the convention, they turned out to be much more plentiful than anyone realized. To be at the convention, where the revelations were visible, helped me see what was out there.
At the convention, we arranged and held some sessions of our own. We met each other. We empowered each other by sharing our similar stories and desires. We talked about what kinds of change we could fight for in the short term to win worthy gains for patients and ourselves and to awaken desires for more change among fellow medical workers.
The ideas that gained greatest traction, as best I can remember, were seeking comprehensive single payer health care, fighting pharmaceutical companies to eliminate misuse of medicines and reduce associated financial and health expenses for society, bringing doctors to poor locales in appropriate numbers and supporting people in those locales gaining knowledge of their own, empowering nurses, changing the income structure of the profession toward more just allocation, and agitating for national campaigns for more responsible food production and dissemination.
While sincerely supporting all of that, I became especially active in the two parts where I thought my contribution might be most helpful – trying to battle the pharmaceutical companies, and challenging the harsh hierarchies of income and influence inside hospitals.
For combating misuse of prescriptions, we used direct actions aimed at producers. Rallies and sit-ins made clear the magnitude of the problem, including the extent to which pharmaceutical companies, with complicity from doctors and pharmacists, were not only vastly over charging, but aggressively over prescribing, and massively over advertising. But we were pretty shocked to quickly discover that people already knew all that. Spreading that awareness wasn’t our key step. Our key step was convincing folks that the grotesque situation wasn’t inevitable and that we could win much better.
We brought a series of class action suits against pharmaceutical companies, by the young about misuse of mood altering medication, by the elderly against the exploitation of a weak sector to try to literally grab all their savings before they could pass them on to worthy recipients, and by everyone, literally the whole population, for the misuse of antibiotics leading to super bugs and potential pandemics. The campaigns not only challenged medical issues, but also the legal system which had strict rules that blocked legal action on behalf of people not yet suffering ill effects, even if they were demonstrably destined to suffer them in the future in the absence of change.
We also worked on a national boycott of the worst pharmaceutical culprits by medical professionals and the broad public. This was to give our efforts roots in the broader society and greater power.
My other focus was challenging various elitist dynamics inside hospitals and health care generally. Racism and sexism had been addressed with considerable progress, though more needed to be done, of course, but class division, which is what most attracted my attention, was not only previously unaddressed, but had never even been clearly raised as an issue. Medicine had become a luxury trade, rapaciously individualist.
First, we had to get people to talk at meetings, like I did in my workplace and others did in theirs. Initially it was just to discover widely held concerns and develop a sense of mutual aid. Then it was for nurses to organize for greater income, more influence, and access to more skills to help provide better care. For doctors, in contrast, it meant challenging our assumed superiority and sense of entitlement regarding our greater power and income, and trying to support more equitable values and relations, including supporting nurses and other medical workers as well as the more basic, non medical staff.
Barbara, as a doctor, how did you feel about nurses, then, and later?
It was hard to admit then, but now I can talk about it more easily. I was disdainful and dismissive. I paid lip service to equity and even tried to be supportive, but ultimately, reflexively, I thought of them as wannabe doctors, I guess, who couldn’t make the grade. I had friends who were nurses, not unlike earlier people saying they had black friends, or even slave friends. But at bottom, I thought of nurses as suited only to their position and lucky that folks like me were around to design for them, administer them, and care for them – and that is only if I thought of them at all which mostly I did not.
When I first encountered this issue, back at the convention, not least due to the questions Mark posed and the storm they elicited, I had a huge amount of trouble accepting it. It was incredible how many notions this challenged for me, and how radicalizing the ensuing insights were. For example, it revealed the gigantic volume of talents and skills our way of setting up economic life literally had to stifle in order to sustain existing social relations. And it revealed the incredible impact of my socialization and the effects of my work on who I was, things I did not want to admit.
The way I finally made myself able to really hear what was being said, was by using an analogy. I realized, eventually, just how much classism was like racism, which I had so often encountered. With racism white people had all kinds of advantages in income, wealth, upbringing, education, and so on. And they rationalized these advantages by thinking to themselves, we deserve our advantages, and those other folks – blacks and Latinos – do not. We are worthy, they are not. And I saw that there is really, in the general shape of it, very little difference between that situation and what the nurses were saying our attitudes were toward them.
The dominant group maintains its advantages and convinces itself those advantages are warranted by denigrating the capacities and even the morality of the subordinate group. Whites did it to blacks. I of the coordinator class, did it to nurses of the working class. It was a shocking revelation for me, and it changed me.
I began to think not that everyone could be a doctor or would want to do doctor things, but that everyone could and would want to do empowering things, complex things, challenging, and uplifting things if society didn’t squash such desires. And that most nurses, maybe all, could be doctors, but if being a doctor didn’t appeal to some, then they could do other empowering things. And I realized also that to organize society to have relatively few people do all the empowering tasks, and then to have them use their empowerment to aggrandize themselves, was disgusting.
It is funny to think of, and it may seem minor, but about the time it was all happening at the convention, someone played, in a musical moment, John Lennon singing “Working Class Hero.” I was visiting their house, and they put it on, and I listened, and I started to tear up. And well, at least for me, there it was. I weeped listening to him. “As soon as your born they make you feel small, By giving you no time instead of it all, Till the pain is so big you feel nothing at all.” I was part of doing that to people.
Did all this affect your views on economics more broadly?
I had encountered the RPS economic ideas earlier, and scoffed at them as ridiculous. Balanced job complexes, income for duration, intensity, and onerousness of work, self management? Come on. Get serious. I was okay with the idea that owners were a drain on social possibilities. Hell, they drove me up the wall. And so, yes, I wanted an end to profit seeking by owners and even an end to the economy being organized for what was then called the 1%, meaning the owners. But I saw the alternative as smart capable people like me – that was how I saw us – taking over. Owners would be gone. But workers would still be below us because that was where they belonged. They couldn’t accomplish more. It was the order of things. There was no need to think about it. Like we don’t think about the sun coming up daily. The rote worker would and should obey people like me.
I remember a moment well along in the first convention after the meeting with nurses that so impacted me. There was a talk about RPS type economics and after it anded, I walked up to the speaker, and I said, “I am sorry.” He wondered what I was talking about, of course.
“Why,” he asked. And I answered, “For years now I have dismissed as silly and impossible your kind of economic vision. I didn’t think about it. I didn’t evaluate it. I just ignored it. I dismissed it without engaging it. And I now realize that the underlying reason I did that was my own class position, my own class interests, and the biases and assumptions that they gave me. So I am sorry for that.”
The speaker said how he had never heard anyone acknowledge that so directly before, and he thanked me for doing so. He also said we are all twisted and fed by our upbringings, schooling, and social roles, and it is no sin to imbibe elitist or submissive habits – it is only a sin, once we see what we have become, to cling to such habits after we understand them. I stopped clinging, and in time I also let the guilt go.
I have heard you have a kind of rare disability, I think it might be termed, and I wonder if you mind if I ask what it is, and whether it has had any impact on your political commitments?
It is true, I do, yes. It is even a little hard to describe and people often don’t believe it. You see, I have no mind’s eye. I can’t see anything inside my mind – nothing but black. I see with my eyes okay. But I can’t put a number in my head and see it much less put two numbers there, like you would on a piece of paper, and then add them in my mind that way. I can’t even see a triangle in outline, much less a blue or a green triangle, much less a scene I have experienced, a memory of a place or person, or anything I might imagine. Just black.
And it isn’t just images that I can’t put in my head, though that is most striking, I guess. I also can’t experience, say, an odor – a smell – in my mind, or sounds either. I look at you, I see you. I even recognize you. If you looked different than yesterday, I would know. But if I turn away, I cannot see your face in my mind, much less remember and see it tomorrow or next week or in two years. I can see you a thousand times, and the same thing holds. I can listen to music, hear it, love it, but I cannot play it back later, in my mind. I can sing along, when it is playing, but not hear it in my mind when it isn’t playing. I can recognize familiar people, for the most part, but I cannot see them in my mind. This has lots of effects, at least in my case, crippling memory, and so on.
But the thing that is most striking is that I didn’t know that I was different in this regard – I think it is about 1 percent who are as I am, maybe less – until I was about forty. I can’t explain and I don’t even know the different ways that I do things that you do with your mind’s eye, but I do. Once I became aware of the situation, I spent some time asking folks what they could do, to get a feel for what I couldn’t do. But then I realized something amazing, at least to me.
I had deluded myself for decades. That is, if you look at TV and movies, read fiction, pay attention to sports, and so on, there are countless indicators that people have and use a mind’s eye. I was oblivious to all of that. I suppose a deep desire to be normal and certainly not markedly different caused me to ignore all the signals. I could ignore them because I could manage well. But still, I was censoring my perception and thought to maintain my self image as being healthy like everyone else. What I learned from that was the incredible power of unstated and even unperceived agendas to bend my thought and perception. I got more tolerant of the phenomenon of self delusion, which is often caused by things entirely different than biology, such as personality or ideology, due to seeing it afflict me too.
And I learned, as well, another thing. What might be the range of attributes that people have? I mean here was a really large difference, and it was for a very long time not even known, not named, not perceived as even existing, even by those who had it. So, how many other big qualitative differences are there in the mental apparatuses different people have? It seemed to me, where there is one thing, there are probably many more and I don’t know what to make of that observation, even now.
I have been asking folks if they could tell us an event or campaign that particularly moved them personally, during the emergence of RPS, so, can you please?
You might think it would be something in my broad area, for example, the inspiring and very effective pharmaceuticals campaigns and protests or the hospital occupations. And of course those, and many other health related events and campaigns did powerfully affect me. But the truth is I am and have long been a fan of movies and Hollywood, so I have to admit attending the movie Next American Revolution and then later enjoying the famous Oscar presentation and then most of all, the Hollywood Strikes left me incredibly inspired.
I think it was partly admiration and just my general interest in all things filmic, but it was also the incredible class dimensions of it, including addressing matters of coordinator/worker division and job definition and my feeling, while admiring it, that we ought to be able to do as much, if not more, in the health areas. And, indeed, I don’t think it is an accident that the Hospital Renovations Movement came just a couple of years after the Hollywood Strikes. I suspect I wasn’t the only medical person dramatically moved.
Barbara, if we could switch gears, a but, I would like to ask about your take on the shadow society approach of RPS I have heard about in some other interviews. What impact did this approach have? How did it interact with more direct campaigns?
It had pretty much the intended effects, I think – though not every attempt panned out. Each successful shadow or alternative project educated those involved and also those who witnessed it or interacted with it about what a new society would entail and mean. As the efforts grew and diversified, they revealed and even tested potential features of a new society. Likewise, when a Shadow or Alternative institution was working well, it would benefit its consumers and workers in the present, and its product might contribute to social change more broadly.
Why did some efforts work, and others, as you say, not pan out?
The recurring reasons were not so different than what plagues any start-up firms in a market system. Lack of resources and constant pressure of financial shortfalls hurt. Limited visibility rooted in the tendency of the mainstream to ignore or ridicule such efforts hurt. Pressures on participants deriving from lack of experience and confidence hurt, too.
The miracle is that so many of the efforts succeeded. It is one thing to establish equitable remuneration and balanced job complexes throughout an economy. It is quite another thing to do it in a small part of an economy that in sum worships personal material advance and offers options to get such gains, albeit options that deny others the same opportunities.
If you have training and skills and knowledge, you can get a job paying a lot and for which you have only tasks that are empowering. Or, you can take a job in a fragile start up where you will earn a lot less and have to do disempowering as well as empowering work. Imagine you have family and friends who perpetually warn you that the alternative endeavor is insane. Sticking with doing it is a hard choice.
It is also very different to participate in an established, large, classless institution or in a quite small one. In the former, there will be plenty of people, and among them, plenty who you will like and take support from. Likewise, there will be a wide range of tasks so creating desirable balanced jobs will be pretty simple. In a small operation, in contrast, you may not have friends and jobs will be harder to define and more likely to contain elements you do not wish to do.
Finally, projects have to operate in the existing world, with markets constantly compelling behavioral choices contrary to what you hope to achieve.
All this is difficult rather than only fulfilling and delightful. Don’t get me wrong, there were many benefits to establishing a desirable workplace even in the earliest days, but for doing so to be relatively stress free and secure required projects becoming more prevalent and larger. Now such firms are in high demand. Even folks who might fancy themselves so worthy that they should be paid more and allowed to avoid all disempowering tasks have considerable reason to compromise on those desires in order to enjoy a congenial workplace without class conflict.
There are other factors too. Suppose you have a big firm and two members get in a fight, or they have a relationship and it breaks up. Separate the folks involved and the fallout will dissipate. But if you have a small operation and the same thing happens, on-going awkwardness or outright hostility can be quite poisonous and separation impossible.
Ironically most critics think alternative institutions are easier, and even only possible, when they are small. But the exact opposite is true. So for all these reasons, the earliest projects were by far hardest, most vulnerable, most demanding, and most tense. It was the pioneers, often never acknowledged, who did the most difficult work, not those who unfurled banners of great victories much latter. There was nothing wrong with enjoying the latter, but it would be nice if somehow we could have more respect for unknown trail blazers.
Barbara, what about in hospitals? What seeds did you plant there?
There were two main sites of direct medical struggle, clinics and hospitals. The clinics we changed were sometimes already established, and sometimes newly created. Just as with media, in the latter case it was possible to create the new institution in the mold of RPS values and norms right from the start. The main issue was finding employees who desired that type workplace. The benefits were in the quality of relations employees and patients enjoyed, and in the showcase effect wherein each newly designed clinic prodded and provided insights for other clinics to get going.
With already established clinics, a subset of employees would want to transition but others – typically the doctors and administrators who enjoyed higher pay, better conditions, and greater say – would not want to. The dominant dynamic was that once there were many successful newly designed clinics, resistance to change in old clinics grew much more difficult to justify. You couldn’t claim the proposed changes would harm patients so you couldn’t claim the motive for rejecting proposed changes was to protect patients. Since the new clinics worked better for patients, opponents of change had to argue that the huge disparities in income and influence they wanted to preserve were morally warranted, which, as you can imagine, grew steadily more difficult.
Changing hospitals was more complex. Hospital struggle had people on both sides. Some wanted change. Some defended past practices. Nurses typically wanted more say and more training to deliver more medical care, and typically welcomed doing a fair share of disempowering work. They were eager to be the kind of collectively self managing worker a new RPS style hospital required. Doctors typically argued against such changes, and owners and boards of directors did so as well. Most staff sided with nurses, but often hesitated for fear of repercussions and, it must be admitted, due to buying doctors’ claims of superiority.
It took major struggle to win modest steps on a new path. Winning open budgets, new pay rates, review boards composed of employees and the right of employee assemblies to make many decisions, much less winning steadily enhanced on the job training programs and reapportioning tasks into new job definitions, all involved strife and struggle. We held consciousness raising activities. We invited advisors from transformed clinics. We organized patients and communities, too. We held strikes and sit ins.
There was, decades back, way before RPS, a slogan about “revolution within the revolution.” I don’t even know what it meant then. But now, to me, it was applicable. The RPS process had many aspects but one was a kind of mini revolution inside each institution. Hospitals were but one example.
Barbara, what about social policies, insurance, and pharmaceutical policies?
This was different because the public, as consumer recipients of health care, played a much greater role. The first step was winning single payer health care for all. Then came a similar victory around all dimensions of insurance. But the really profound confrontation – because it was with some of the most powerful corporations in society and provoked much broader debate and conflict – was to gain control of pharmaceutical production and distribution, which had, after all, become among the most blatantly and egregiously harmful industries in society.
You might think, if you get free medical care and single payer coverage what difference do the prices of the medicines as set by the pharmaceutical companies make? Well, the answer was, just because the individual patient was no longer paying for the medicines, the government still was with funds that should have been spent on valuable projects rather than funneled to pharmaceutical owners charging inflated prices.
But what could we do? Tell people to boycott medicine? Not a very appealing stance. Have workers in medicine manufacturing workplaces cut off the flow of medicines? That would destroy the sick to save them. The owners would legitimately claim we couldn’t survive without what they provided. People would suffer immeasurably without medicine. If we were going to win the battle we needed an approach that would steadily build support, win gains, and eventually fully win. What could that be?
We started “medicine for health not profit.” We demanded that the government impose price controls on pharmaceutical companies and that it take over any company that violated those controls. Corporate fear of this, well before the left had gotten anywhere near calling for it, had been at the heart of elite rejection of single payer health care all along,
Still, our problem was how do we mount sufficient pressure on the government for it to impose such requirements on pharmaceutical companies, especially without boycotting the companies or calling for work stoppages at them?
The answer was wide public campaigns that pinpointed company heads and owners and other decision makers, revealing their hypocrisy and calling on them to alter. We did this to raise consciousness, and to win gains, too. Plus we enacted campaigns to force the government not just to adopt health care for all, but, as the single buyer of medicines, to use its bargaining power to continually force lower prices at threat of nationalization if the companies did not comply.
But what pressure could get the government to act in such a way? Partly risk at the polling booths. Partly realizing that to ignore the ongoing and growing struggle against the pharmaceutical companies would not only cause the movement to grow even stronger, it would also cause it to enlarge its focus beyond health care. Of course, on our side, our task was to have our movement do just that in any event, once the policies were won, which we successfully did.