Lacanian Discourse Analysis – notes

SEMINAR FEB 2017:There’s the unconscious and then there’s what becomes ungraspable as meaning i.e. becomes non-sense. What does become ungraspable depends on the structure – the alienation from our real existing conditions – social relations is an extra level of alienation and Lacano-Marxism might say this is something unique about our – capitalist block.

The urge to rejuvenate may be ancient but in this capitalist block this has become a major medical problem – the moral assumption that a good med should have no distance from a possible future suffering.
With the university discourse S1 is the access of science to the in-itself. So what then becomes unconscious is the impossibility of any technology having access to the in itself, the illegitimacy of the sovereign state of exception that is of the Law but can break the Law. We behave as if something is not true – as if the power of the truth of S1 is not illegitimate – and this means that that its illegitimacy is made unconscious – we make sense of the non rapport by believing S1 has the power to see the in itself or that we are immortal.
The four discourses: what is unconscious is not the same as non-conscious. To repress with some conscious effort – to be unconscious – does not involve conscious effort – it’s an effect of the psychic structure form – in the master structure – it is the structure where the Master knows all that makes his own inconsistency/weakness/limitless acquisitiveness unconscious – I see this as emerging from the non rapport from S1 to S2 where S2 is the slave who holds all knowing imposed on the discomfort that is due to alienation that causes the masters inconsistency to be unconscious as it has no signifying place in this particular symbolic structure and at the same time to make sense of this alienation – the suffering and jouissance – there is posited a Law Maker – a transcendent God – it is possible for religion here to act in a master role and insist on the power of S2 if it adopts a fear of death prompted by even the thought that is the sin as in Christianity, or the sin presumed if another accuses you as with the Salteaux Indians. So some of the work to knot the structure is a sinthome that may be a confessional self flagellation.
The Subject of the master discourse knows he is mortal, this doesn’t operate in the problem of alienation in the non rapport. The non rapport lack in the master discourse resides in the earthly power/weakness of the master. A God outside of this structure has power over the timing of our inevitable though still feared death and makes and watches over our obedience to our symbolic structures that includes totems and taboos, sometimes inciting confessional traditions and forms of sacrifice. See Mauss.
The desire to know how to be the subject desired by the other is stereotypically feminine – hysteria and the demand to known how to exercise the demand made by the Other is stereotypically masculine and obsessive.
The evidence is in contradiction and conflict in EBP – e.g. Baum and Statins – the economists and NICE.
If to begin with we start with the divided subject – and this alienation is within the psyche of the individual as he forms an identity that requires he makes sense of himself in the line of the imaginary – but that is always a misrecognition because of what he is not capable of knowing. His thought is in language which is a symbolic structure with rules that are also independent of the individual and which is limited by these rules and so can only speak in limited ways that again prevents full self awareness. “I think where I am not and I am where I do not think.” So our subjectivity is a void in flux.

So even presecular subjectivity requires an imaginary and has an unconscious domain within the symbolic in which meaning is lacking but persists in its effects. This presecular subject may be an exploited slave who works as if he knows it is the natural order, but may suffer, who may repress his knowledge of the weakness of the Other e.g. His master, because he is ordained to obey the masters orders. The slaves work may need to include confessional material to appease his guilt and threat to his longevity. He may confess to

a transcendent God, but this is not an operative factor in the make up of his subjectivity in a master slave economy.

With capitalism there is a profound shift – Now, the certainty of mortality is made unconscious – mortality lacks meaning as a signifier – I can say I know very well but always behave ‘as if ….’
You can say “I know somethng” – like “I’m going to die someday” which is a kind of intellectual knowledge (or ‘intellectual insight’ as Freud described his inability to share Roland’s perception of eternity as an oceanic feeling, in Civilisation and its Discontents) but your psychic structure renders this signifier meaningless and it enters the unconscious (as if a space but not the same as non-conscious, because it now has no graspable meaning as a signifier) it becomes an unknown known – not consciously disavowed – but made unconscious – it has lost the power to have meaning in our symbolic language network but still lurks within that symbolic structure and will emerge from time to time in non-signifier ways …. an admonishment “Unless you believe … ” or “you might have cancer we haven’t found yet …” or “I daren’t open the letter ….” For example, the fear of fear being the fear of knowing that that which stabilises your identity – ‘that’ object of desire: to experience the surplus jouissance by having a fatal cancer exposed – a face off with death itself – may be forbidden to you by the Other.
From theory to analysis to mechanism in practice to implications to further analysis

The migrant worker as Surplus is like the Body as Surplus: qv ODX – where does this fit into narrative: the subject of the capitalist discourse is a Body as Surplus.

“‘So far as the economy of the metropolitan country is concerned, migrant workers are immortal: immortal because continually interchangeable. They are not born: they are not brought up and they do not age: they do not get tired: they do not die.’”
The hospitality of the story teller and Berger’s story about the GP and distance from suffering being very different from distance from future life of the patient.

A fortunate man 1967 Dr Sassal GP who committed suicide – how does this relate to today’s necropolitics of medicine and the clinicians distance from the patient’s future life where too much compassion becomes a hegemonic moralising.
“At the heart of such labour, Berger tells us, was a quest for recognition of one human being by another.”

The rejection of NICE guidance / is this ethical?
A cell of resistance – follow new interventions and guidelines for their ICERs. 1) for, say, GPs, a survey of interventions in primary care – health checks, statins, early cancer diagnosis, 2) The nature of lifestyle advice – including eg for addictive, OCD, fitness/weight issues 3) focus on addiction – motivational interviewing, moralising, and Lacanian approaches, dangers here. 4) socio-cultural critique – economic-ethico-moralising dilemmas and discourse analysis at social level: destruction of healthcare, destruction of the consultation – media critique: R4 and Health – digital genomics and subjectivity.
The Motto of the RCGP
The motto is the problem – is medicine compatible with Lacan? Is the dominant Western school of General Practice compatible with emancipating the subject of capitalism from its slavery and medicalisation or does it only act as an alibi for the problem of its own actions – covering up the cracks and solidifying or reifying its de-humanising destruction.
Cum Scientia Caritas

The motto is Cum Scientia Caritas(Compassion [empowered] with Knowledge).

Whilst I see problems with responsibilisng the ruling classes (its practitioners and ideologists, clinicians and teachers) as a kind of tyranny of the proletariat that is the mirror image of what capitalism does when it responsibilises us all; and the dangers in a programmatic response that risk dogmatism, however I can see a rationale, if you like, for offering clinicians analysis for their symptomatic craving to diagnose pre-symptomatic illness e.g. By exploring attitudes to scientific evidence, regulation, overdiagnosis, sacrifice, population vs individual etc. And mortality – as Iona Heath has done but to directly relate these to possible Others: NICE, colleagues, recognition, competition, prestige, money, power – and perhaps at specialists at risk of silo-solipsism.
Is it possible to be an agent for a discourse of the analyst – as discourse analyst to address predictive medicine in capitalism with it sinthomes – e.g. Fantasy of immortality – making non-sense of signifiers of mortality – insisting on minimal distance with the future suffering of another by discursively constituting the body as Surplus – limitless precaritisation and rejuvenation. No growing old gracefully here.
Beyond caritas – Beyond the logic of Care. (See AM Mol too), and being less than personal but more than impersonally regulatory following capitalist inspired scripts and truth regimes. Providing a platform for the patients subjective division to express itself. Relation to Heroin or Crack – the others desire to consume S1 becomes the imperative from within. Can link this to practice. More ambiguity. Should I care? Is an ethical question. Does traditional caritas, or well meaning empathic caring get in the way of a more emancipatory mode of communication that provides a platform on which the patient can place and see his divisions – his unconscious at work on his relations to his Other and its desire or demands. Should this be a starting point for clinicians in relation to their object of desire – the S1 produced by S2. Do clinicians have a symptom requiring psychoanalysis too?
In the USA – the capitalist discourse at even state level removed evaluation of cost effectiveness, no longer need for doubt, S1 ‘is’ the answer, sell it, buy it!
Man’s Capitalist Sin

A hysteric’s conversion on the road to Damascus creates a form of epistemological fundamentalism.
The alternative and ‘answer’ to State/NICE sponsored innovative venture capitalist asset stripping might be this:
“Unless (you’re a sinner and) you believe that human consciousness really can access the in-itself for-itself, then a positivist EBM as a basis for healthcare will deprive patients of effective traditional cost effective forms of care for suffering today – causing net harm and deprive patients of ‘caritas’, always resulting in doctors and patients overestimating the benefits of treatments and accelerating the process of too much medicine.”
This is because in capitalism the trick that causes the ‘power in the gift’ (MAUSS) where the exchange value always magically exceeds its use value (it’s congealed labour power) is also the trick that provide innovative medical interventions with the power to magically have an exchange value in the consultation (or in the commissioning process) that exceeds their actual use value in terms of producing surplus (longer life).
Relentless propaganda that highlights and exaggerates biological security threats (surplus jouissance), whether they be from terrorism or cancer, creates more anxiety and discontent and may eventually enforce consumption with one of several possible responses for the anxious hysteric being to transform his or her subjectivity into the structure of the capitalist discourse. In two stages then, firstly, in which radical uncertainty — based on irressolvable desire and a fear of fear which is really the fear of the thought of not having a desire satisfied, of confronting the possibility of satisfaction of the desire only to find you fail — is exacerbated by your excessive investment of your identity in the desire of the Other – i.e. the object you desire, which may be that have a curable but otherwise fatal cancer – the unbearable (jouissance) of the thought of that desire actually being resolved. In the second stage, If confrontation is eventually railroaded then this unbearable jouissance may flip into a need to be certain that the object of desire for the commodity, the solution to precarity, S1, is always certainly resolvable, it is ‘the’ solution, and must provide Cure (and is the route to paradise). Twice I underwent attempts at conversion in Palestine, Christian and Islamic. Healthcare also has its enthusiastic converts e.g. for cancer screening – and uses celebrity to advertise the need for its consumption. Your desire should be to be the kind of subject that desires what they desire – I should desire the desire of the famous! You must be certain that this test is the one. But having had the test the power of your demand for solutions has increased because you have been indoctrinated by increasing your stock of solutions to increase your valuation of and the belief in, (a surplus jouissance due to surplus knowledge) the power of overall accumulating scientific knowledge S2 to provide more solutions for your now perceived heightened precarity. You become both more enticed by S2 (you have seen the light), experienced its Power to Cure as you felt it, and at the same time become more aware of life’s fragility unless ‘cured’, so more precaritised. You feel more discontent $, and demand more S1s. This is sustained and fuelled by celebrity narratives (Vanheule) and narratives of progress through innovation (NICE), which sustain authority.
“Be Screened!”
The celebrity desires that you too must have a cancer like mine – detectable with the new S1 (clever scan) better than the last S1 (not quite as clever scan) – and, what’s more it’s curable too because we found it so early because we went for screening!
The Human over values the new scan S1, because of its apparent power to generate surplus life for no cost, or life worth more than the cost, to the consumer. Thus Industry can over price the commodity S1 and Health professionals will over sell its benefits. Naturally, according to surplus profit imperatives industry/state doctors and over sells the evidence. The state over values innovation and both demand and commissions S1 despite the expense. Older innovations or existing but undervalued-because-concrete-non-abstract-and-direct like home nursing services are cut to assuage immanent bankruptcy. Many patients are potentially harmed through indication creep, and excessive demand for tests in increasingly low risk cases. Trials are deeply flawed but innovation persuades. Indeed in a Master discourse where the agent is the State – S1, $ its truth which might be ‘honest and trustworthy government’ where what is repressed is the intrinsic dishonesty of both political government, venture capitalists and the manifacturers of consent through scientific ‘evidence’.
For students we might look at a survey of scientific study conclusions for discourse of values that seem to uphold intellectual insight whilst repressing other values as non-sense.
So ‘Beyond Caritas’ we have healthcare in capitalism and its industries and sciences producing more S2 all the time, and as a result we have conversions into subjectivities of epistemological fundamentalism based on Logics of Cure powered by commodity fetishism and a fantasy of possible immortality.
Is this a kind of Damascene conversion that cured St Paul of his hysterical persecution of Christians in the name of a transcendent God, to be touched by the power of earthy miracles and a transcendence made immanent – the fetishisation of the earthly confessional in which penance for your presumed debt – the congealed labour that inheres in the product of your labour i.e. your sins, is exchanged for surplus grace by God made man which psychically speaking prefigured capitalism.
Surplus Profit is Gods gift to man and the Free Market is God’s Will. A trigger warning – A metaphor only perhaps.
Clip of advert for prostate cancer screening.
Examples of resistance at local level – Statins – screening health checks – can refuse; re align our relationship with NICE – friend of the ruling classes. Building resistance? Anarchic questions.
A paradigm shift is needed but won’t come from within the ruling class (Marx) – doctors. However theoreticians who are doctors can point to what may help. A revolution in praxis by doctors at a grass roots level that rejects intensification of predictive and early diagnostic interventions unless a) not for profit, i.e. nationalised and b) if not highly cost effective, or expensive are tied to an identified disinvestment that is the next least cost effective.
If a) above is difficult to imagine – then what else? Pushing for higher levels of proof or greater level of ‘honesty/transparency subjects many ‘patients’ to harm in trials and merely intensifies subversive industrial efforts to doctor the product. Pushing for appreciation of the nature of the fetishism of the products, firstly by doctors and secondarily by patients, and the communal sacrifice required to benefit the few won’t work because patient and doctor are both labourers caught up in their division of labour, as doctors selling a type of product they admire beyond its use value, and as patients caught up in their complex shifting subjectivity as both apparent free owner of their bodies and also labourers working on the body, unaware of the dispossession of the body when they agree to exchange their body (for money, directly or through tax) for the promise in the result and their labour on their body and test result for apparent sustenance but for free in the labour-time that makes profits for the owners of the test – the ruling class (industry, state, ideologists of the state and clinicians).
“Beyond Caritas” – boundaries to health science and subjectivity in capitalism:
‘Beyond Caritas’ lies structures of discourse that shape consciousness, our desires, demands, beliefs and actions. Beyond this consciousness of caring compassion, ‘Beyond Caritas’, there lies the unconscious that enables us to make sense of our sense of ourselves. Beyond caritas lies productive forces and forms of intercourse shaped by material conditions for life, for most in advanced capitalist relations, but for many in forms of intercourse shaped by slavery, destitution, permanent unemployment that is useless or unproductive, or even in non-capitalist communes of one sort or another. The productive forces and forms of intercourse that rule health’care’ are predominantly capitalist. We can trace the impacts of this on the psyches of doctors and patients.
Beyond ‘caritas’, (as if waiting to, if not already imposing its impersonal, as if fortuitous and accidental will) is the capitalist psychic structure of discourse for a subjectivity that is perversely certain, in constant fear of unsolved precarity, an automatic consumptive psychopathology. It’s pathological because it invites self destruction and destroys social bonds too.

From the university discourse presented by the state-doctor there may be 2 consequences (and possibly others) the patient or doctor, unable to fully repress mortality, becomes excessively desirous of cure so much so that the thought of being confronted with the incurable becomes unbearable and a test is refused, or the knowledge of mortality is so totally repressed faith becomes certainty – the subject’s discontent $ with bio-security drives the consumption of solutions S1s, to the threats,but these create surplus jouissance (an ever greater valuation of surplus life) that plagues increased discontent.
The more knowledge S2 grows, more S1s are generated – discontent with the level of bio-security drives the certainty that S1 is the solution (repressing into the unconscious its failure to ‘care’); each consumption of S1 provokes surplus jouissance (the fetishistic power of S1 that triggers more desire, because of the apparently magical creation of more life from life itself, surplus life) that plagues the divided subject – his/her discontent – not enough security, wealth, longevity, prestige, driving the consumption of more S1. This is ‘the curious copulation of science with capitalism’ (Lacan). EBM is beyond caritas – its S1s, each speciality is in its own silo, and communal bonds across healthcare are broken.
We don’t see the sacrifices we force on others as our gaze is purely on our own individual S1s.
The Other and discourse of the hysteric – what if the desire of the Other is that you have cancer? Is this a message some may receive? The letter is something you deprive yourself of even though you never lose it.
And what if the subject receives this as an object of unbearable pleasure?

Or, less crudely, the other desires that you have a curable or even incurable cancer.

The necropolitics of Too Much Medicine in capitalism:

Mapping narrative with Lacan’s structures of discourse:
Spinoza’s monism provides an ontology for the subject of capitalism vulnerable to the fetishisation of the body as the means for surplus life. Normal ‘perfect health’ is a zero-signifier that mobilises Evidence Based Medicine’s scientific symbolic chain. Narratives that construct the subject are mapped onto Lacan’s structures of discourse to reveal fuzzy boundaries for health knowledge and subjectivity that warn of a solipsistic necropolitical future but also confronts us with alternatives.

Science has two faces – industrial/neoliberal that manipulates the grey margins of uncertainty and leads to argument without end, calls for transparency and regulation – good luck with that. The system encourages deceit and doctors of the product, like flour, for Marx.
So my tack is to expose the necropolitics of state agencies like NICE, in the production of state sanctioned guidelines that bankrupt healthcare and the manipulation of the psyche of docs and patients by discourses of Cure in the face of repressed overdiagnosis.
Critique – ?Latour, ?should not be de-bunking the delusions of others ?needs to be affirmative, emancipatory and hail the transgressive potential for the human or post Human.

This also closes down an avenue of critique – in which perhaps we should strive to take pleasure in a mutant subjectivity in relation to knowledge – to take pleasure, of sorts, in being out of our depth even as we strive to draw this map. Desire for Surplus knowedlge should be the critic’s sinthome?
The objet à can function in 4 possible conditions but it always is a kind of ambiguity or uncertainty, as a result of non rapport, and e.g. In the analytic structure can even demand something of jouissance – the disturbance of a non rapport, possibly sexuation. The ‘a’ is an alienating signifier – of either the effect on, or suffering of, an alienating remainder.
What counts as narrative? And how should narrative count – for a divided subject always never completely self aware. What does this mean, why is it so and what are the
Taking narrative as a signifying chain without a fully self aware subject – a nomadic subject taking pleasure in seeking mutant values?
Subjectivity in the clinic.

The social-political discursive structures condition a libidinous corporeality within limits set by … and the body is dispossessed with both emancipatory and oppressive potential.

But … power now is in the hands of a commanding agent, e.g. NICE.

From subjective distress or apparent willing servitude – to conditioning discourse to the search for the master signifiers that eventually digitally repress the certainty of our mortality. The InCEST taboo, the QALY as modern zero-signifier – banned by the USA. Marks a turn to fascism – ?

What is at stake is access to the in-itself – an epistemological question – radical immanence or a transcendence in immanence as a form of unconscious domain of repressed idea as ‘word things’.
In the imaginary

In capitalism – Sustains ideological fantasy that sustains authority.

Intentions remain inaccessible even to the speaker.

But what is spoken – enacts and points to social structure and intentions.
Seminar paper for February – also for Oxford conference – and for publication. Kordela’s Spinozist , Capitalism and Healthcare. Bringing together political theory, philosophy and psychoanalysis – the normative accepted boundaries for concepts of healthcare, science and the human subject are challenged. This provides an anthropomorphic perspective on a post Human Humanism that identifies a disavowed Other for EBM – vulnerable to an apparently protective biotechnology of predictive analytics – unaware of its oppression through commodity fetishism, a pre-contractual debt of original disease, and normative discourses. Concrete examples of biopolitical discourse identify master signifiers that provide an opportunity to recognise and acknowledge our interdependence with the other(s). and to foster a differently caring and ambiguous relationship with our mortality. The necro-bio-politics of a digitalised repression of the certainty of our mortality through predictive genomic tests and Fact-taboos and the InCEST taboo are key master signifiers that normativise excessive medicine and its oppressive consequences. An identity for a capitalist subject requires a transcendent in immanence Other and this marks the (inadequately) self aware human species being as distinct psychologically from the other animal and non-animal living matter with whom we have material unity. The Spinozist subject manifests absolute Potentiality as a plentifude of matter and the irrecoverable lack of consciousness. The mind body dualism is revoked, human is at one with other living matter but the humans self consciousness also marks a distinguishing and irrecoverable lack – identity is through the desire of the Other – but this can be a nomadic subjectivity – the normative desire of the Other for capitalist medicine is surplus Life – or immortality – biogenetic technology and predictive analytic commodities foreclose any certainty of mortality and insist on a radical uncertainty – a treadmill of railroading negotiations with endless gazes. The nomad may able to negotiate a different object of desire that recognises our co-dependence on the other, including our inter-dependent relations with the environment and (bio-genetic) technology. Caring about other living mattter and ecology. Others alongside as well as in front of us.
The TMM (Too much Medicine) campaign misses out of the dimension of the unequal distribution of vulnerability through biological categorisations in socio-economic normative exploitative regimes. And that this works through the ‘I’ and can be resisted by the ‘I’ in conjunction with other precaritised groups. Bio-Slaughter in the name of protection and Bio-Neglect hidden from sight. The interdependency of the saved and the overdiagnosed but the social context intensifies and deludes –
We can ask the question – what makes good people do bad things and then: explore values and ask: who would you sacrifice to save your life? Who owes you their life?
Discourse as structures – method to elaborate the mechanisms that drive the currere – the running between positions. Foucault and biopower through subjectivisation but where the body is constituted as Surplus – a field of both motor ‘libidinous corporeality’ (Vanheule) (in unity with living matter), a non-rapport, a left over contradiction that feeds back to ‘agent’; and product – limitless mined – as life mining. And as Surplus both powers and resists the structure that creates the unequal distribution of vulnerabilities (Butler). And as Surplus is an essential component of structures that form an immanent unconscious – extimate – that enables fantasy to entrap us and makes us feel like free masters apart from the disturbance as knowledge is imposed on jouissance – the feeling that this is not quite ‘it’. Creating distress, dissatisfaction, more pain, overdiagnosis, TMM, and TLM for the ungrievable. This perfect storm ahead may be cause for a glimmer of optimism.
Mapping narrative onto structures as analysis
Insight 1: the transition from transcendent divinity to immanent divinity and from Master to University discourse.
NICE, EBMers, and Clinician – function as earthly Gods, in a ‘state of exception’ – where those who exist because of the Law also make/break the Law and are not bound by it. God had to, or at least has, become earthly because capitalism’s fantasy structure based on the trick of commodity fetishism required an agent in the structure who isn’t a commanding S1, (authorised by a transcendent God), but is ‘all knowing’ S2, the agent who knows the things to be known, an earthly God. In other words the agent’s authority is no longer sustained by a transcendental God who guarantees, from outside the structure, the symbolic structure of the Master discourse (kinship structures of pre-secular times, and tribes) but because of capitalism this agent,as God like authority now immanent to social relations, as part of the symbolic structure of social relations, and the psychic structure of the subjects within them, has to be sustained by the trick of commodity fetishism that hides surplus through exploitation, and hides the illogicality of Descartes’ cogito.
Simultaneously, inter-alia, the hidden (apparent) truth (always a misrecognition that provokes crisis) that drives this agent is no longer the Master’s contingent inconsistency, $, but is now the enunciation S1 represented by the a) cogito – the primacy of mind over matter, (now man seems to stand in for God), and b) surplus value (profits from apparently fair economic market exchange, and apparently meaningful social relations – that in turn (in a doubling of deception for the subject) hide exploitation of labour economically and semantically as deceived slave). As surplus value became the apparent truth or driver of agency in capitalist society so the agent then had to be fantasised as ‘all knowing’ in order to sustain authority to maintain the fantasy that sustains the ‘trick’ essential for capitalism.
At the same time jouissance is no longer S2, the slave who knows how to do the things ordered by the master, whose jouissance is due to a repressed awareness of the Master’s weakness, (his ruthless dishonesty, limitless acquisitiveness, boundless zest for life, Nietzsche’s Blond Rulers of ancient times) but is now ‘a’, the narratives of fantasy of limitless Surplus linked to jouissance because of repressed awareness of its impossibility and which produces no longer the product of the slave but instead, in the University discourse, the subject divided who knows very well the impossibility of the fantasy but behaves and acts, all the same, as if the fantasy is true. This divided subject is the compliant doctor, at this societal Based level of mapping.
Doctor can replace NICE, and patient replace doctor for a consultation level mapping.

Insight 1

For didactic purposes: we can follow the transition from master to university discourse triggered by capitalism. We can put them side by side, and frame jouissance as the disturbance that is due to the repression of the awareness of the agents truth, and surplus jouissance as the temporary semantic stabilisation of identity that results from this repression and continued compliance with the structure, e.g. As knowing slave, (Master discourse), or deceived slave (University discourse).
Insight 2:
Both the USA at the societal level, and Diane, may illustrate the potential for a further transition to a capitalist discourse – which may stabilise ‘fear’of fear, provide a faith in certainty of outcome for those suffering austerity, or a fear of fearing a loss of wealth, or someone perhaps like Diane, who fears fearing cancer in a kind of society induced hopeless poverty of spirit, (or for some a kind of perversion brought on by wealth, or excess demand for wealth) and so turns to a perverse certainty and misrecognition that her poverty of spirit is the fault of her own body’s always existing cancer, the immortal corporeal immigrant invasion (Berger, J), and demands tests that will find and cure it. Just those in hopeless poverty of austerity in the USA and elsewhere misrecognise their austerity as being due to invasion of their own class by immigrants and demands policies like Trumps that will turn to and identify scapegoats in the certain knowledge that their extermination will cure their austerity.
In the USA in the medical field the capitalist discourse is exemplified by the Law forbidding use of cost effectiveness evaluation to determine commissioning decisions for budget limited state funded healthcare. This was achieved by falsely representing the QALY as a tool to discriminate between kinds of people rather than between kinds of treatments for the same people. As a result limitless commissioning does indeed discriminate now between people.

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