[...]by late June many junior doctors will already have had to sign the new contracts or decide to do something else with their planned medical career. How many will resign and not become specialist trainees? That may be fewer than this week’s sound and fury suggests.The expropriation of the strike weapon by the doctors' professional association has further developed the intrinsic contradictions of bourgeois governance. Historically, the Enlightenment has sought to simultaneously realise the incompatible forms of planning state and free market within the same domain. But the medical establishment's intervention, undertaken on behalf of the historical 3rd estate's project of realising the Enlightenment state, has radicalised the eternal tensions underlying social reproduction (the strike itself a mediated representation of the proletarian pole of the structural antagonism of labour and capital from a position of class domination). It is possible, when considered with other recent shifts in the bourgeoisie's perpetual revolt against itself (recent successes of leftist political parties and continued state intervention within a failing economic recovery) that this indicates a governance-level switch from 'neoliberalism' to some form of social contract ideology (to be eventually realised through a state managed universalised 'basic income' in a context of technological runaway). The BMA is not a 'health workers' union but a powerful sectional interest group integrated, through the NHS, into generalised social reproduction. Doctors are not workers, they are, like other social managers, technicians of bourgeois ideology Their organisation's adherence to realising a universalising public health programme as a tool of social engineering has drawn it further into compliance with the state's implementation of population-wide data harvesting initiatives. The increasing orientation of the public health apparatus towards quantitatively-based preventative medicine and screening as a means of adapting the mass individual to their toxic environment reconfigures medicine as a tool for transforming populations into an industrial resource. Clinically led population management locates its objective in realising a neutral/non-political 'health' interface, situated beneath the threshold of ostensible class conflict. The objectives of governmental institutions are networked through a 'health' framework with an enhanced 'workforce' characterised by its higher productivity and lower cost. The reproduction of health compliant workers discloses the NHS as the institution par excellence of privatisation. Its historical purpose is the systematic medicalisation of those conditions which previously appeared as indicators of social antagonism; the discursive conversion of the existential and political into symptoms of individuated pathology is purely ideological. The individual must carry the burden of responsibility for maintaining their health metrics; by their own effort, individuals must refuse the mountain of sugar dumped into their life-world. The medical category of depression as an illness, locating problematic disconnects within individual adaptations, has the effect of subverting the impulse towards collectivity and refusal. Increasing use of chemical mood enhancement, and the preemptive indexing of blood values to abstract health benchmarks is integrated into wider strategies for managing compartmentalised existence. The blanket prescription of statins creates a population in accord with the prerogatives of possessive individualism - self-monitoring, risk averse, conservative beings seeking to maximise the span of a form of life that is otherwise absolutely devalued. The unintended consequence of the ideology of wellbeing is revealed in a differential diagnosis: individuals consuming only saturated fats, sugar, tobacco and alcohol are more antagonistic to their conditions. Health production, as a means of incorporating the potential negativity expressed in unhealthy lives, is integral to the project of the re-emergent planning state in a circumstance where the community of capital seeks an exit from itself as it is presently constituted in terms of the constraints of labour. The state form is searching for a particular form of escape from its own historical determinations which also permits it to conserve the momentum accumulated within the forces of production. The party of 'Capital' desires to abolish the wage relation but also maintain historical continuity as a mode of production - to survive it must revolt against its own limits, it must burst the fetters of the Value form and achieve a system of abstract signification that is not dependent upon living labour. The alternative proposition, that the resurgence of the planning state is a deathly flaring situated at the point of its subsumption by 'capitalism' would depend upon the ongoing viability of the profit imperative in its present form. But the expulsion of labour from the productive apparatus seems to have passed a point of no return, taking the totality beyond the corrective mechanism of deliberate value destruction, and thus reducing the centrality of the productive relation as the mechanism for creating quantities of significance in the world. The crisis of value production is therefore situated in the possibility of a world without labour. But then, the formulation of 'communist' ideals seems always to precede their immediate realisation on the most unfavourable of environmental terms. The abolition of work (where work is recategorised as an ineffective source of the abstract form of post-value signification) will be implemented against a background of 'full automation', and the state secured existence of its dependent populations (via a neo-monetised social voucher scheme).
To address both of these problems, CIG wants to replace two-thirds of its 3,000 workers with machines this year. Within a few more years, it wants the operation to be almost entirely automated, creating a so-called “dark factory.” The idea is that with so few people around, you could switch the lights off and leave the place to the machines.'Full automation', driven by the impetus of accumulated past labour, infers systemic continuity established through a post-work, not an anti-work, principle realised as a fully extractive environment. Where work has become a fetter on production of the abstract, it will be supplanted by the environmental facilitation of interactive enjoyment, if this affords optimisation of points of contact between living flesh and social process. The first principle of technological rationality is improved efficiency in the conversion of tangiblity into units of abstract significance; all impediments to this principle, including labour, the wage relation and even the historically specific value form, must be exceeded. Humans will not go to work, they will effect their preferences in accord with the natural rhythms of their crypto-castoriadisian institutions. They will not register the direct but painless harvesting of the 'organs' of their presence. They will not know alienation. '“Stay in touch,” he wrote. “We will make the dark factory happen.”' The reconfiguration of instituted nature as a system for uploading significances into abstract form will be driven by the humans' participation in their own lives. The everyday will be milked directly from their sentience, as from an endlessly renewable energy source, and thence converted into nectar for robots. The medicalisation of human presence is one further position achieved in the continuum of abstraction. 'How did you go abstract?' 'Two ways. Gradually, then suddenly.' 'But, if history engenders the abstract, how is history refused?' 'In two ways, firstly as a sudden and systemic collapse, and then tentatively, hesitantly, as if pushing off from an old jetty in a slowly rotating coracle.' There are, in history, fixed points of departure that have formed, like middens, from the detritus accumulated at particular crossroads. There is no way out, except from these designated jetties set perversely, absurdly but also incontestably, within particular historical forms. How is it, that the site of the departure from history is set so particularly, as if through a fire exit in a derelict factory located at the edge of a provincial town? If it is agreed that the point of departure from the history of nation states is formulated as abolish all others first, and Israel last, then flight from the territorial form of processive rationality appears in the formula: let all institutions collapse, the rest first, the NHS last. These are not the forward-most positions of history, not the most developed, nor the most advanced or progressive. They are not to be 'defended' for their own sake. If they are departure points, decrepit jetties, they are not the point on the historical runway at which momentum is converted into lift - these are not places for 'take off'. They are points of departure, in their different ways, because they are the last expression of their conditions, they are defined by their unsurpassable, knotted and contradictory form. They are exits as a result of their irreducible complexity, there being no 'way forward' through them. They are last in the sense that they may not develop further, either under existing conditions or under any conditions, they have become fixed, eternalised in the wavering behaviours of their captured populations, where every permutation of internal structure is exhausted and every modification attempted and abandoned: 'In addition to ‘transition’ (‘A to B’) and ‘transitional’ (‘between A and B’), trans can also mean ‘A as well as B’ or ‘neither A nor B’ – that’s to say, ‘transcending’, as in ‘above’, or ‘in a different realm from’ both.' Masses surge and flood against the border to their moment; without the capacity to effect their own escape from their conditions they have become reliant upon the systemic failure of the electric fence containing them. Give up again. Drawn in again. Fail again. Fail worse again. The explosive release of populations from dependency upon the mechanisms of their own exploitation, as Dionysus bursting the restraints of Pentheus, must end at last delicately in a therapeutic process of deceleration; of decommissioning and disengagement; of unbuilding and de-escalation; and in the relaxation of all accumulated industrial pressures and constraints. The vacated space, the de-occupied zone, may only be departed from in a spirit of relinquishment of, and reconciliation with, the acquired violences of the past. Under pressure of expulsion, errant subjects migrate along pathways towards uncovering in themselves, and in the world, these last places of convergence, the dilapidated jetties and broken down 'points of departure', where they assemble like crustaceans around marine outfalls.
A parent text: http://www.lrb.co.uk/v38/n09/jacqueline-rose/who-do-you-think-you-are