I grew up in New York City, the son of a physician. As a boy I had a Jewish friend who told me that his father was a Marxist, and, of course, I hadn’t the foggiest idea what that was. So I was very curious to meet this exotic man when my friend invited me to his house. When we sat down to dinner, I remember being somewhat intimidated by his remote father as my friend’s mother initially carried the conversation with very welcoming questions about what I was interested in and the like. But, after a lull in the conversation, he looked at me squarely and asked very pointedly what my father did for a living. Not knowing what to expect, I anxiously reported that he was a doctor. Much to my surprise, his demeanor entirely changed, and he became wreathed in smiles of approval, “Well then, Johnny! He’s one of us.” He didn’t elaborate on his enigmatic statement. I went home and told my father, who was very amused, and I think pleased by the comment, but, if he tried to explain it to me, I don’t remember it. My friend had no idea what his father was talking about either. But the incident hung in my mind for years until I got around to reading some Marx and figured it out. He considered that my father was a “worker” because he made his living from his own labor as opposed to exploiting the labor of others. Back then doctors owned their own labor.

Recently, having been retired from the practice of psychiatry for almost a decade, I went along with my wife’s mother to her doctor, and we chatted during the examination. He said that he had resisted being bought out by a large hospital-owned practice and was still on his own, to which I replied, “Yea, I’d rather be regulated than owned.” In fact, I pride myself that, during 35 years of practice, I had never been owned (excepted at the beginning on my career when I worked in a state prison). However, during the last decade of my practice I had occasion to talk to many doctors in my office about the alienation they experienced in response to someone else owning their labor. Alienation was Marx’s term, and as a psychiatrist, I am still taken with the penetrating power of his insight into the transformation that takes place when one’s labor becomes owned by a businessman:

Karl Marx and the Alienation of the DoctorsThe worker becomes poorer the more wealth he produces, the more his production increases in power and extent. The worker becomes a cheaper commodity the more commodities he produces. The increase in value of the world of things is directly proportional to the decrease in value of the human world. Labor not only produces commodities. It also produces itself and the worker as a commodity, and indeed in the same proportion as it produces commodities in general.

This fact simply indicates that the object which labor produces, its product, stands opposed to it as an alien thing, as a power independent of the producer. The product of labor is labor embodied and made objective in a thing. It is the objectification of labor. The realization of labor is its objectification. In the viewpoint of political economy this realization of labor appears as the diminution of the worker, the objectification as the loss of and subservience to the object, and the appropriation as alienation [Entfremdung], as externalization [Entausserung].

The doctor-patient relationship has a much longer history than capitalism. I see younger colleagues heroically resisting massive forces to “objectify” and “externalize” this most sacred, intimately subjective and interior human exchange.

Do not rule out the medical profession taking back our labor one day, perhaps when we fully realize that “we have nothing to lose but our chains.”



One Comment on “Karl Marx and the Alienation of Doctors”

  1. My father practiced medicine from 1968-1998, and he was a sole practitioner as an oral surgeon. I don’t know all of the in’s and out’s of what it took to run a private Oral Surgery practice at the time, but his involvement was definitely a “soup to nuts” proposition. My father administered anaesthesia as well as performed whatever surgical procedures that were appropriate for an office environment. He was his own boss, no doubt. He had privileges at several of the well-known local DC area hospitals, which I believe were largely “private” at the time. This was before ownership by MedStar, Johns Hopkins University, etc.

    At the end of the day, he would call the patients that he had seen that day, just checking up on their post-surgical progress. He was proud to carry the medical bag of not his father , but of his father-in-law, Dr. Aaron Nimetz.

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