Concept of Illness

(From: SPK-Documentation Part 2)

In the following contribution the concept of illness shall be developed dialectically: illness of the single person and of society. Here a brief overview of how we want to proceed. It is necessary to go into the dialectics of

  1. Being and consciousness

  2. Production and cognition

  3. Production and needs

  4. Subject – object

  5. Illness and capital

  6. Symptoms

  7. Sexuality and anxiety

  8. Theory and practice

  9. Agitation and action

  10. Illness and revolution


1. Being and consciousness

Being and consciousness are moments of the process of production. Moments, not something independent, but mediating one another and mutually conditioning each other. From these initially abstract, because unmediated sides, we must develop conceptually the totality of the relations of production on the one hand; on the other hand, it is precisely this totality that is being presupposed, because it is indeed these two moments, being and consciousness, that are abstractions of this very totality. The whole (identical to production) can not be determined from the outside (because otherwise there would be something different to and outside this whole which it would be determined against), but rather this reality is processing in itself, is immanent determining of the parts against one another. The manifold relationship of the parts to one another and to the whole constitutes the content of the whole. Saying part means that the whole is being presupposed, though abstractly presupposed. It must arise as a result of its complete mediation. In this sense, it is inessential where you start from, because every beginning is abstract, unmediated, and the dialectical development proceeds indeed by reducing the unmediated, the absolute, to the mediated, the relative, to put it in its overall context. This context is the total context of capitalism.

Being is the category which is assigned to all and everything. Reality, though, is qualitative being; a being that, by its determinacy, is connected to all and everything, and different from all and everything, thus falling within the dialectics of determinacy and constitution, which constitutes the finiteness of all and everything. Being, therefore, is a pure product of thought; it is only as object of consciousness. Consciousness is conscious being, is knowledge of being. Consciousness is already posed in relation to the being, it can be only the consciousness of something that it is opposed to ("object"), of being. Being, therefore, is only through consciousness and consciousness is only through being. Knowledge is the first mediating that contains both moments.

These dialectics must be strictly kept to and neither consciousness nor being must be made absolute, must be hypostatised. Thus, neither the being precedes consciousness, nor does consciousness precede the being. Both categories are equally products and become meaningless within an un-dialectic "extrapolation". Being, which is supposed to precede consciousness and to be its absolute premise, is itself nothing but the product of this same consciousness; the idea [german: Vorstellung] of such a being originates from a certain level of the forces of production and is a category of the relations of production. In this sense, all history is but a production that can be comprehended only in the categories of the achieved relations of production. Likewise, the being, which is supposed to be independent from consciousness, is nothing but another determinacy of this "independent being", a determinacy of the consciousness and without any reality.

At this point, an objection must be raised against the vulgar reflection theory. If it is said that Capitalism produces the individuals it needs, then this is true only together with the other proposition that it is these individuals themselves who produce Capitalism. The term "reflection" entails already the fault that one of these sides is supposed to be the reality while the other is supposed to be only the image; however, the relationship between being and consciousness is living process in which both sides, as moments, are at the same time autonomous. Consciousness is not simply identical to being, but it is the other of the being, determined negatively against it, and in its limit identical to being (Hegel, The Science of Logic I, Quality).

The consciousness from which we started is as well an abstraction from real consciousness as is the being from reality. Real consciousness as well falls under the dialectics of determinacy and constitution, and by this it necessarily changes.


2. Production and cognition

Production is the in-itself-determined process in which life trespasses upon totality and preserves itself therein. Life is thus identical to and different from totality. It relates to something other, outside itself and makes it a moment of itself. It is essentially the dialectics of the individual and the universal, "the self-developing whole which dissolves its development and in this movement simply preserves itself" (Hegel, Phenomenology of Spirit, Self-Consciousness).

Cognition is result and condition of the production process under the determinacy of consciousness. The production process itself is the unity of the ideational and the material and constitutes the mediation of being and consciousness. This unity has to be developed as follows: Production presupposes, on the one hand, a totality of material conditions which carry their manifold possible relations as properties on them; on the other hand, it is the ideational presupposition that the distinct materiality is synthesised as the result (product), thus that the otherness immanent to the objects is there even before it exists. Each side, therefore, relates to the other and to itself. What now is there "in itself" realises itself in the process of production. The result is product and, at the same time, totality of conditions to a new production. These conditions trespass upon the consciousness (they produce consciousness) as well as the consciousness trespasses upon the things.

Thus, there is no separation between "objective" and "subjective" cognition; or rather, you can only separate what is connected. The immediate precondition to cognition are the senses. (It will become evident that the senses themselves are products.) Recognition, therefore, begins with sense-certainty (Hegel, Phenomenology of Spirit), with the very abstract singularity. Cognition, however, is a social matter (language), and this way it must proceed to perception, looking at the single object under the condition of universality. Now things (and a thing is anything that possesses properties) present themselves as being characterised by the essential contradiction of determinacy and constitution. The properties, however, are indeed the result of the production process (a thing changes with its properties). Cognition is now the act of recognising the inherent, lawful contradiction of the things as both the (pre)condition for new and the result of past production.

Laws, however, are contradictory themselves and stand in contrast to their reality. Reality conceived as based on laws is a production of consciousness and therewith concept, namely the universal relation of determinations, which are abstractions themselves, as an in-itself-contradictory whole. Therefore, the concept is subjective just inasmuch as it is objective. The development thus turns into the abstract self-consciousness; abstract, because self-consciousness is a social matter and still must develop its social determinations. This is the dialectics of master and slave, which has, as its result, the reversal of this relationship in the product. (Because from the relationship between master and slave follows that the slaves are the ones who produce; therefore it’s them who confront themselves with the objective and material reality, it’s them who have a grip on the production process. It's them who maintain the living process. Therefore, the masters totally depend on the slaves and, moreover, they are redundant.) That’s the dialectics of wage labour and capital.

Whereas the senses were initially the precondition of cognition (according to the sensualists there is nothing in cognition that was not previously in the senses), that relation is now reversed: the distinctions which are made by the senses and by which the senses are determined are abstractions of the production process, they are products themselves. Thus, there also is nothing in the senses which was not previously in the intellect.

Now, briefly, to the concept of nature:
Nature is the being-outside-itself of the idea. That means, nature is spatially and temporarily separated from its concept and identical to it, because nature can not be determined as "objective" unless it has been conceptually comprehended. Dialectical relation: nature, in turn, is the precondition of the concept. The categories, the intellectual forms in which reality is conceptually comprehended and transformed (such as nature, existence, objectivity, …), are results of production. In general, one can characterise the dialectical relation of nature and society roughly as follows: each side is a part of the whole (of the production process); however, if separated like this, each side itself is the whole determined in itself and contains the other side as a moment. Just like society can be considered as a part of nature (Marx: In nature, man himself operates as a force of nature; Economic and Philosophical Manuscripts), nature is a part of society (without which the latter can not unfold any of its determinations).

Another point with regard to those who call themselves "materialists": The concept of matter. Basically, Lenin writes (in Empirio-Criticism) that matter, in the process of its scientific penetration, has lost all the determinations which were once attributed to it (such as hardness …) and, after all, can only be determined as "something existing outside consciousness". Thus, consciousness is called on to define matter; matter as a pure product of thought. The "vulgar materialists", who assume to start from matter, in reality start from a quite superficial sensible appearance and, therefore, they take the futile, the disappearing for the most real.

Our concept of dialectical materialism is that of the materialisation/objectivisation of the production process as the "beyond" with respect to being and consciousness. The qualities that are based on the quantification (working time), that make themselves an object, are determining these as matter.


3. Production and needs

Need is the sensation of scarcity, scarcity of an object of some sort; the living trespasses upon something else and, at the same time, it has therein its barrier: Something ought to be that is not. In the barrier as unity of being and ought is entailed that it must be trespassed, that it must be negated. The consciousness is negative to the barrier, by knowing it as barrier, and it has to become practical, it must act.

Needs are the base of production, whose aim consists in making available the object that is needed to overcome the scarcity. However, needs, in turn, depend on the products: because any need is the sensation of scarcity of a certain produced object. Needs, therefore, are products themselves, results of the immediate production process.

The capitalist dialectics of use-value and exchange-value as reflected in the needs can be described as follows: The needs are the precondition of qualitatively determined labour, of use-value. Private property and division of labour, however, are necessarily generating the production of commodities, of exchange-value. In exchange-value labour is considered only as quantity, the qualitative side, though necessary, is inessential. The exchange-value that is producing and increasing itself is the capital, and for the capital, use-values are merely waste products of the production of surplus-value. But with regard to the needs which are of qualitative nature, that means that these are being quantified, measured, compared, traded; that they are commodities which are important to their owner merely as objects of exchange. Thus, speaking of manipulation, in any case, is only moral in character.

The total functionalisation of the producers, the reduction and degradation of the needs to a relative, inessential and produced moment can only be removed by fully unfolding and developing the "bad" side of the contradiction, namely the fact that the needs are products themselves. That means: we consciously and collectively take the production of needs in our own hands, or, in other words: consciousness relates to itself as product and as producer.

At this point, something must be said about the non-dialectical distinction between primary or basic needs and so-called secondary needs. Usually, hunger and sexuality, perhaps even heat (shelter and clothing) are reckoned to be among the primary needs. However, this only means that life is reproducing itself, that there is a relation of production. Specific relations of production are, for their part, necessarily producing the corresponding needs, and each of these needs is created from the same necessity.


4. Subject – object

Subject is what deploys and unfolds itself freely in its distinctions. Object is what constitutes itself in the deployment and unfolding process of the subject. To take something as an object, therefore, requires several presuppositions. “An Object”, says Kant (Critique of Pure Reason), “is that in the notion of which the manifold of a given intuition is unified. But all unifying of representations demands a unity of consciousness in the synthesis of them. Consequently, it is the unity of consciousness which alone constitutes the connection of the representations with the object and therewith their objective validity …” (Hegel, Science of Logic II, Subjective Logic).

However, what can deploy and unfold itself freely in its distinctions in bourgeois society is the capital only, which thus determines any detail. The single individuals are merely objects of the necessities of the capitalist exploitation and valorisation process which is the subject that determines everything. The relations of the single individuals to each other, therefore, are object-object-relations; you can not call it free will, for the will is merely how the necessities of the capital represent themselves in each single individual.

But the capitalist relations of production are themselves product of these single individuals, because, by acting as an object, they are maintaining the relations of production. So, with regard to the relations and conditions they are the producers, their cooperation without consciousness of the context itself is the necessity they are subjected to. Therefore they themselves are, in this passive manner, subjects; however, in their activities, they are total objects.

The dialectics of subject and object, by consequence, turn into their opposite the moment the single and isolated objects recognise themselves as collective subject and make the societal relations, as their product, their object. The necessity of this inversion objectively and subjectively lies in illness. The political identity of the consciousnesses that is needed to make society one’s object can only be developed from and through illness.


5. Illness and capital

Illness is life broken in itself, life contradicting itself; thus life that, in the process by which it is preserving itself, at the same time, is destroying itself. Since Marx it has become evident that the societal relations are characterised by the fact that production is immediately identical to the destruction of the productive forces. Because the exploited ones are forced to sell their labour power, that is their body and mind, thus their life, in order to live a life which, for them, is no life at all. Products are valuable because they contain the broken life, the wear of the exploited, their labour power. That’s why they are murder weapons and valuable because there is blood sticking to them. The exchange of products is thus identical to the exchange of life, murdered piece by piece, or illness.

But in order to be capable to produce for the capital under these murderous conditions after all, to surrender oneself to the relations of exploitation, life contradicting itself = illness is already precondition. Hence, illness is the force that maintains the conditions and likewise produces each single product; the products themselves are the materialised accumulation of the illness of the masses. Illness is productive force, and like the capital it is processing and proliferating and expanding; illness is the subject. Societal relations, in which production = destruction, relations that contradict themselves, are ill.

Faced with the overpowering societal relations, the single and isolated individual has no other choice to preserve his life than to surrender it to the process of production, which means to destroy it. In this process of production the producer himself becomes a product, a commodity (also according to Degenhardt). The life that the single and isolated individual wants to preserve is identical to the needs according to which life refers to objects; in order to live, or, what is the same, to satisfy his needs, he must produce; that means, however, to give up his life = needs in capitalist production. And under the murderous production of surplus value, with the waste products the corresponding needs are produced; needs, however, are once again the starting point of this continuous process, thus contradicting themselves and they do not contain any possibility of satisfaction, but only the necessities of the capital.

Since the societal relations present themselves to the single and isolated individual as forces of nature and as unchangeable, he cannot recognise illness as being produced socially or the society as being sick. He appropriates illness as individual suffering, as personal misery due to his own fault, that must be managed individually. Doing this, he definitively takes his self-destruction in his own hands.

If the possibility to manage illness individually is not given – and this possibility is necessarily taken away from him; because the conditions and relations that the sick single and isolated individual creates in order to appropriate illness, depend totally on the power of the capital that strikes as a socially increased force of nature whose necessities smash the illusions that the single individual surrounds himself with – hence, if this possibility is not given, from the unconscious unhappiness develops necessarily the unhappy consciousness that recognises the identity of capital and illness. The pressure of suffering as the subjective necessity of change becomes political, the sick individual is a patient (from Latin: pati = tο suffer).

It is therefore clear that the sick individual reflects in his illness, in his inner contradictions, the reality in an adequate manner. This reality-adequate consciousness of the exploited is therefore a thing outside of them, the illness.

At this point usually the objection is raised that not every illness is socially conditioned or caused, but that there were certain natural conditions of illness that could not be solved socio-politically. This can easily be dealt with. Because

1.      the fact that in the existing dominant conditions certain manifestations of life are called ill is based on the economic structure of these conditions and depends on the exploitability of this single and isolated individual. That he drops out of society and gets separated from it is not due to nature but due to capital.

2.      Not only the body and the mind are totally determined by capitalism but the existence of every single and isolated individual itself is the result of economic conditions. Even before his birth each and everyone is a product of the capital.

6. Symptoms

Symptoms are the manifestations of the societal illness in the single and isolated individual associated with the pressure of suffering. Although socially produced, they are individually managed or appropriated. That means, the sick individual is not capable to situate himself in the context; they are likewise alien to him. Seen in context, however, symptoms are protest against the fundamental structures of society; but the social context produces the symptoms exactly as if they were without any context, isolated, individual – or, the protest is inhibited. From the attempt to an individual solution to the suffering results only a bad infinity, that one symptom is replaced by another one, until the sick life is finally devoured by the capital.

Here, at this point, a brief clarification that should prevent misunderstandings: ill is not the opposite of healthy, but of life. Healthy is a term of the rulers meaning simply that the symptoms are situated in such a way that the sick fits in with the process of exploitation without difficulties. By consequence, healing is the process of alienation, expropriation of illness, and being healthy means being dead alive.

The significance of the symptoms is that they are the individual unconscious expression of the social contradictions, sensuous-supersensible things. They are the inhibited form of a communication adequate to reality, thus relation to others and, at the same time, isolation.

The symptoms of the single and isolated individual are analogous to the symptoms = crises of the economic conditions; their cure, the crisis-management, operates at the surface just the same, without touching the inner contradictions.

An outstanding example of life broken in itself, of the production of symptoms, is the dialectics of sexuality and anxiety.


7. Sexuality and anxiety

Sexuality initially is determinable only as an abstraction in order to develop, then, how sexuality appears in capitalist conditions. In consideration of its general characteristic, sexuality is productivity in the sense of an expansive release of energy; because it must be assumed that the living organism produces tension states; for their relaxation it has to expand to objects beyond itself. The satisfaction of needs produces at best, beyond the dissipation of displeasure, qualities of experiences that are referred to as pleasure gain. Another determination of sexuality is reproduction as procreation. Sexuality detached from master-slave-relations, abstract, unlimited and unrestricted has its barrier in itself – see, at this regard, W. Reich’s notion of self-regulation. None of the existing moral criteria is therefore capable of deciding what sexuality is and what it is not, but the criterion is provided by sexuality itself, namely the production of pleasure and the possibility to transform subject-object-relations into subject-subject-relations in the act of the release of pleasure.

However, it is only theoretically that one can abstract from the social constraints. Being totally controlled by the economic process, sexuality can only be transformed to the specific phase of self-regulation by completely smashing the economic apparatus in its actual form and order, an apparatus that guides and controls sexuality from the outside and constitutes human alienation. Compared to the present order structures, namely the laws, state formations and control mechanisms of social violence, that are alien to the self-regulating sexual behaviour, the social form of self-regulation can only be an anarchist one.

Anxiety is more than just the opposite of sexuality; at the extreme, it is identical with sexuality, i.e. we find anxiety in place of sexuality. Anxiety is retreat and contraction, withdrawal into oneself, thus a movement analogous to (expansive) sexuality, but, in contrast to the latter, total reversal of the direction. Assuming that life necessarily manifests and expresses itself, this manifestation stands in contrast to the societal  conditions; it “bounces back” to life itself and is directed against life. But life itself with all its manifestations is a product of society; this contradiction immanent to every manifestation is anxiety. The relationship is reversed by directing this contradiction against society, hence that the revolutionary side of the dialectics of being-produced and producing, that is the producing, is fully developed. To come to life, it must be put at risk in the struggle; once this decisive anxiety has become clear and has been comprehended, any other form of anxiety can be resolved.

In the process, the two moments sexuality and anxiety constitute, on the one hand, regressive manifestations such as morality, property fetishism etc., while, on the other hand, they constitute the necessity that every manifestation of life must focus on the objective of a social-revolutionary change. The only form of sexuality to release energy expansively is the revolution.


8. Theory and practice

Theory is a system of concepts that grasp reality in its inner contradictions and include how this reality can be set in motion; since we do not have a hold on the historical process, theory is necessarily incomplete, and the consequential action is wrong under certain circumstances; any error, recognised as such, is however moment of truth, which itself is the entire process in that the action enters and disappears in. By this the theory becomes more complete, more comprehensive. The limits of theory are thus sublated into action, into practice, and equally it is only on the basis of practice that a complete theory can be built upon; who does not proceed from the position that from the respective developed theory one has to precede to practice, never arrives at an adequate theory of reality, and thus never at practice.

Just as the practice is a corrective to the theory, a theory of the context is, inversely, the precondition for a consequent practice. Thus a theory must from its very outset encompass each and everything; a theory that can explain only partial systems of bourgeois society, either becomes radical in practice – i.e. it pushes itself forward to the basic antagonism between the productive forces and the relations of production, that determines everything, and by that comprehends the partial system in the total context, that determines it in the first place – or the theory fails, i.e. it integrates into the bourgeois separating system of the reactionary partial sciences.


9. Agitation and action

Spinoza says: “I say that we act when something takes place within us or outside of us whose adequate cause we are, that is, when from our nature anything follows in us or outside us which can be clearly and distinctly understood through that nature alone. On the other hand, I say we are passive when something takes place in us or follows from our nature of which we are only the partial cause.” (Ethics, III, Concerning the origin and nature of the emotions).

From what has been stated so far, it follows necessarily, how the action must be developed from the suffering. The needs of the single and isolated individual are taken up and accepted as they are produced; they cannot be measured by a scale which is applied from the outside, but by collective work the contradictions are developed that are inherent to the needs. By this these contradictions are driven beyond themselves and so the subjective necessity of the revolution of the existing conditions for each single and isolated individual is worked on and produced. This way it must be developed that the relations between the individuals are object-object relations; that mind and body are capitalistically pre-programmed; that the individual misery is identical to the societal contradictions; and that the shift from object to subject of the historical process can be achieved only collectively. This way the inhibition of protest, protest that is represented in the symptoms, is resolved into the dialectics of individual and society; coming from the inhibited affects of the patients (i.e. those consciously suffering) the energies of activists are released and the very explosive material is armed that will smash the dominating system of permanent murder. So agitation as such is itself action, it sets in motion the unifying and coherent process of the revolutionary transformation of both consciousness and reality.

In the SPK (Socialist Patients’ Collective) we are performing this work in an expansive practice for more than one year; a critique of this practice can only be immanent critique coming from one’s own practice, a critique based on our concept of illness.

Agitation and action are thus identical and different in accordance with the dialectics of being and consciousness. An agitation that becomes effective in this manner necessarily provokes the action of the class enemy and by this is driven beyond itself.

The class enemy must be defined precisely by the fact that he mobilises, in public and based on laws, the police apparatus, bureaucracy and armies against those who consequently develop their activities from their (socially produced) individual suffering.


10. Illness and revolution

As we know from Marx there exists a historic necessity urging that from the contradictions of capitalism must result socialism. This necessity, which constitutes an intrinsic factor in each single and isolated individual, is illness, the subjective suffering, the inner contradictions that alter consciousness and urge to act. The necessity is the need of the individuals consciously and sensuously suffering.

On the one hand, illness is productive force, on the other hand, as identity of production and destruction, illness is the concept of the relations of production. The basic antagonism between productive forces and relations of production, therefore, must be thought of as illness as the all-encompassing necessity that produces its own complement, the revolution. Ill people, thus, are by themselves and, as consciously suffering, for themselves the revolutionary class. Class warfare, therefore, represents the process of life itself and produces the revolution as its only future use-value.


Socialist Patients’ Collective, 26.06.1971




MFE Greece, MFE craencStw

Final editing:



Socialist Patients' Collective / Patients' Front, SPK/PF(H), 20.09.2016


The complete concept of illness