It all adds up

Steven Thrasher’s radical empathy

© 2007 Judy Seidman , used under a Creative Commons license

Steven Thrasher’s The Viral Underclass has a strong polemical streak, though I wouldn’t call it a polemic. He lays out lots of sobering and sometimes discouraging fact-patterns, and every few pages ties these up with aphoristic summaries, some of which could serve as the kind of Laws and Maxims that get play on political Twitter.

“Viruses are not evil,” one I just picked at random goes. “They don’t practice ethics or morals… but even if viruses themselves can’t act politically, the distribution (or withholding) of prophylaxis is extremely political.” Here’s another: “Incarceration and homelessness are linked in that people experiencing both are often perceived by those experiencing neither as disposable.”

But overall, Thrasher’s book has more of a literary than an argumentative character. For one thing, his point (as I understand it, anyway) is not reducible to a topic statement; as the subtitle “The Human Toll When Inequality and Disease Collide” suggests, it’s more about a landscape and history of harm than a discrete problem with a programmatic solution. Appropriately The Viral Underclass takes a multifocal approach, with several individual stories about those who beat back or were brought down by the meta-plague the book attempts to describe.

If you have even a passing acquaintance with how badly America handles public health — and with the many reminders that have come even since The Viral Underclass was published, such as the literal poisoning of Jackson, Mississippi’s water supply (and the substandard water service in black neighborhoods of which it’s a reflection) — you probably have some idea of the territory Thrasher’s covering. He gets into many of the familiar public health stories: COVID-19, HIV/AIDS, Ebola, swine flu, opioid addiction, and the health care aspects of our society’s traditional cruel treatment of sex workers, LGBTQ people, the disabled, and other communities without the full protection of majority power. The “viral underclass” (not his invention, Thrasher dutifully admits) encompasses everyone who should be offered protection and instead gets ignored or the back of the hand.

But the problem as Thrasher describes it is bigger than straightening out some unhelpful federal agencies; it rather goes to the question of how a national health system with near-limitless capabilities keeps fucking things up. Rank prejudice is obviously part of it, but so is an overall misunderstanding of what public health is for — and, when it comes down to it, what government is for, and what society is.

Some of Thrasher’s stories are about people caught in a system that treats infection as a moral or even a legal offense (as with Michael Johnson, aka “Tiger Mandingo,” whose trial and conviction for transmitting HIV Thrasher had covered previously). Others are about people who fight for the rights of those the system habitually betrays: the disabled (Alice Wong), AIDS patients (Bob Rafsky), LGBTQ people (Zak Kostopoulos), sex workers (Lorena Borjas), et alia. Part of their value as subjects is that they identify injustices by rising to meet them — like Borjas, for example, in her “black puffer coat and bright red lipstick, often sporting a necklace covered with writing pens,” pulling a shopping cart of paperwork and prophylactics for the aid of sex workers in Jackson Heights. In some cases these people also become victims of the forces they fought — like Kostopoulos, an Athens drag artist who inspired excluded and despised comrades with his performances and outreach, and was finally fatally gay-bashed, and Borjas, killed by COVID.

But this isn’t just a book of heroes and victims, and the stories inspire Thrasher to deeper contemplation. To Wong’s highly conscious activism, for example, Thrasher connects the fate of his and my mutual friend Ward Harkavy, the Village Voice editor who, after his long working life, was shunted into New York’s underfunded, underserved, and unprepared nursing home system where COVID rampaged and killed him. This puts meat on the bones of Wong’s idea of the “disposability” of those who, by reason of disease, defect, or age, are considered and treated as expendable.  

Similarly, Kostopoulos’s murder gets Thrasher thinking about the austerity factor — how, when the services and opportunities that make people feel secure are removed, their mental and physical health suffers, miring them further in need and lack. He cites Kostopoulos’s friends’ acceptance that his murder, like a lot of street violence in Greece, is a symptom of the fact that “people are just depressed after ten years of [IMF-enforced] austerity,” and from there Thrasher’s mind reaches to Appalachia, where he talks to health care workers and law enforcement officers about the Oxy plague that rages there as jobs dry up and nothing replaces them. When Thrasher realizes that an HIV harm-reduction protocol he’d learned about in Athens, one that used community-based interventions instead of a strict law enforcement approach, had been picked up by some caregivers in Huntington, West Virginia, he remarks:

I got chills as he told me this; how connected our struggles are! Like homophobia and stigma, austerity is a plague around the world. Debt shapes our options in life, making it hard to build community and shelter. When this happens, viruses and addiction flourish freely.

And that revelation also reveals the problem: Our broken health care is both part and paradigm of the all-encompassing injustice that for some reason we’ve committed to as a society. While holding itself out as “a nation defined by its lack of pathogens,” America pursues policies that make sure its out-groups and enemies can’t escape infection, because the system and its psychology mandates their punishment and perpetuates their outsider status. Overpoliced and under-protected minorities are intimidated out of seeking medical help and impoverished into working the most medically risky jobs. When they weaken and fall outside the law, they’re thrown into jails and prisons rife with disease. (Among the many grim facts ornamenting the book: “in November 2020, 80 percent of the 230 people who died of COVID-19 in Texas correctional facilities had never been convicted of any crime.”)

All this will naturally enrage anyone with a sense of justice, but Thrasher is not just looking to goad outrage, though he’s willing to use it to focus our attention. He wants us to know that none of this wasteful, cruel, and counterproductive belief and behavior is necessary, and we can escape the trap if we recognize that disease is not a moral judgement but something to which we are all subject and which we can only effectively fight together.

That idea is bigger than it looks and requires thinking more expansive than some of us are used to. Discrimination against HIV-infected and at-risk people is certainly due to homophobia, for example, but in addition to acknowledging that we have to understand that, we also have to recognize it’s a symptom of our apparently boundless need to protect favored classes — not just straight hegemony but also our for-profit health care system, among other things.  

We also have to ask whether the current system actually gives the “protected” a real advantage, either. (The white addicts of West Virginia probably never thought of themselves as anyone’s underclass, viral or not.)  The COVID-19 response is a meaningful example. Thrasher notes that the failure of many people to vaccinate — when the mutual protection of us all depends on it — is largely due to our screwed-up public health and economic systems:

…But many people who hadn’t gotten jabbed were interested but unable to do, because they were low-income workers who were afraid to lose a shift, food insecure, had responsibilities as the caregivers of family members didn’t have a car or get to a vaccine site… Of course economic precariousness and the warping mentality of poverty affect the infrastructure or who can access the prophylaxis of vaccination.

Thrasher also bids you think about the people you might more easily discount (I know I do): those who reject vaccination on philosophical grounds. It may be that they and the rest of us have more in common than is immediately apparent — specifically, the “ownership mentality” that atomizes us from one another. In his bold closing, Thrasher examines the shift from demanding abortion “as part of universal health care for the entire society” to considering it “in the context of privacy and choice” and what it implies:

…With an “ownership mentality,” if one owns one’s body, one is also freed from all social obligations to and from others…

It can also lead down the path to believing, I also don’t want to be taxed and forced to pay for schools for someone else’s kids.

Or toward feeling that If I am buying bottled water — or if I am brave and I choose to drink tap water knowing its risks — why do I need to be forced to pay for treating the water in Flint, Michigan?

And it can mean, If I don’t want to wear a mask or get a vaccine, that is my right, and repercussions of this on those around me don’t concern me.

All this may strike you as overthinking things because even in a better system people will get sick and some people will be better placed than others to avoid it. But, even to the extent that I share that perspective, I must also admit that what is most attractive about our usual Good Luck-Bad Luck paradigm is not its morality but its lack thereof — that it absolves us from social responsibility and action. And, if you take even a cursory look around at the grotesque spectacle of a rich society in which millions sicken and die to preserve a system no one really believes in, it’s obvious that absolution from that responsibility is the opposite of what’s needed.