Care Under Capitalism : the work of health and sex

“The economy of desire and the economy of health are structured by the same inhumane architecture of oppression that structures all markets. And even so they are enduringly human, with an intact possibility to breach that architecture.”

In healthwork and sexwork there is something the same – both roles require the careful procurement of the story of bodies. Give yourself to me, partially, so I can work on you. The wide, raw quality of this is equivalent. As a practitioner, the requirement is that you coat your own body with an aura of protection, a complex array of signals as light radiates off metal. In health work, and sex work, it is: there is nothing I couldn’t see. It is also: I am clean of my own story so I can receive yours, I am here in a professional capacity, I am non-expectant, I am capable of holding you, I’m going to touch you. This signalling requires calling in of the same archetypes, a healer, an unyielding authority, the bowl that endlessly receives and feeds. 

The intrinsic honesty of the body exists in both spaces. This isn’t to say people don’t lie, but that the body can’t help but reveal itself. Despite the pretence that characterises sex work, the same transaction provides parameters that cocoon the pretence in a wider context of truth: you need this sort of touch, a specific attention. I need to give this sort of care, whether for money, selfhood, a politic, a prayer. In both spaces, the body provides its own context — one of need, enfolded into the experience of being alive and so, moving toward death. Sex work and health work respond to need with a precise skillset, which is old, honed. The technocracy around both roles, in which fucking and fixing are professionalised, belies how closely related they are to being. They are how we survive. They are a mirror to the family, both sacred and tedious, smelling of skin, fluids and industrial cleaning products. They are full of humanity so multiple that the faces of violence and intimacy within are not countable. 

The professionalisation of these roles speaks to our relationship to violence. A space is enclosed within which trust can build, and in which certain harms are sanctioned. I see daily into labyrinths of pain and pleasure with trust given for the length of our meeting. It runs through our knowing each other, in and out like thread. My regular at the strip club who shows me photos of his children but not his wife, the daughter of our ICU patient who blanks me in the cafeteria, obviously uncomfortable to be witnessed outside the ward with her grief, quietly eating her Subway sandwich. The young guy with Crohn’s who tells me about his sweet girlfriend as I inspect his peri-anal drains. I also share a part of myself with my own clients and patients. I am curious with these moments of slippage, to what limits there are when professionalising a space so thoroughly human. 

I am careful when I speak about this, because when I was a child a doctor took my underwear off behind the modesty curtain; because when I was a teenager a doctor asked if he could drive me home after the appointment and I saw straight into the darkness of his intent; because of every story I hear of unwanted touch; because of every doctor that has taken too much interest in the sex we have, what is between our legs, push an unnecessary exam. Because of the daily dissolution of the autonomy in the hospital, the physical and chemical restraints on wards, the locked door, the forced sterilisation and the privileging of the doctor’s word. Because of the casualness with which the surgeon reaches over our patient with a tube of lubricant and says, “feel his prostate cancer,” with the full expectation I will enter this unconscious person’s body without his consent in the name of my learning. How easy they blur okay into not okay. In the same manner, the hand touching you where you told him not to, a strike of fear when a client clocks you outside the club, the annoying insistence on knowing your real name, a choking patriarchy ever present despite its concurrent subversion. The tyranny of capital in both worlds, of who can make the most. The incessant minting of pain into profit. 

There is dimensionality here, a presumption of, and entitlement to, harm, manufactured by the supremacy of the medical class, of whiteness, the grip of colonialism, cis-maleness, of the mythic non-disabled body. As much as healthcare provision can never be about sex, sex work is not necessarily sexual. They are an encounter with the same operations of power. Despite the varied expression in either space, there is something similarly resonant. In troubling the limits of professionalising these professions, I am not troubling the need for boundaries to insulate against violence, as a check against power. I am not troubling the policy, the rituals of etiquette we use against each other, to hold each other better.

I want to consider what it means to be a worker. The economy of desire and the economy of health are structured by the same inhumane architecture of oppression that structures all markets. And even so they are enduringly human, with an intact possibility to breach that architecture. As Indigenous knowledges globally attest, as our species’s survival attests, care came before work. Irene Silt writes on sex work as an anti-work proposition, given a worker’s conceivable ownership of their labour, the simple, untraceable transaction, and the self-determined clock it keeps. It is anti-work in its subversion, the possibility to extract back some of the capital taken from those marginalised by a capitalism built on our commodified bodies. In the hospital, I am almost on this same temporality, and I am seeking a similar subversion. I seek to care for illness inflicted by oppression, and this underscores the paradox of care-working within an industrial complex born from the source of violence. This work changes its meaning constantly, multiples it infinitely. Is the doctor who wrote on the 8th day of the Al-Shifa Hospital siege — I went through death in love — undertaking the same work? I see the nurse, working over the torn feet of a child as if he himself were a god and I think, what greater divinity could there be? How gifted we are that touching can mean healing, to have someone dance on you can cut through loneliness. And I see then the trafficked worker, the wielding of a cruel science to devalue life and I think, what greater darkness? 

It is work, as a verb if not always as a construct. It is hard work in ways I am thankful for – we are intimate with life, how precious this exchange of trust is, and because you use your body. And it is hard in ways I resent, that confuse me. Sex workers and healthcare workers are unionised, because we are so efficiently exploited. There is a necessity to protect our rights as workers, as essential. I will return here to the limits of professionalising, because it is again at this limit we move both toward and away from intimacy. You are asked to dissolve your boundaries to receive the institution, and to act on it’s inanimate will: do more overtime than hours in the day; stay past closing; drink one more drink; push hard; wake late full of worried thought, the image of a patient or a client hovering close. 

I have always struggled in jobs that manufacture urgency. I don’t want a manufactured urgency, I want the urgency that comes when you work with life and sex. I don’t want to use my body for earning in a space where the body is disappeared, profoundly quiet beyond what its intangible value it can produce. In medicine, it is present because to know a patient’s body, and to approach it with a tender non-judgement, I have to have a body. In sex work, my body makes the meaning, it is the site of work. I perform these roles in the way we perform all work, calling on parts of myself that add value to the relationship. It is a calling in of knowledge and experience, like how I was with my grandparents, like how I was at five and fourteen and twenty-seven years old, like how I speak to a stranger, like how I make food, like how I care for my niblings, like how I am gendered, like how I don’t know, how I have been in love, how we have resisted, how I sometimes struggle to be kind, like how I am, in an active and non-institutional sense, a student. I pull it from me as an offering, I give it to you like something we can eat. An incantation: it could sustain us.