This week in people of interest: Marta Russell

Marta Russell proposes a theory of disability that rejects arguments about culture and identity, instead charging that specific systems and values embedded within capitalism are the primary driver of (and justification for) legal frameworks sanctioning the institutionalization and economic exclusion of disabled people. A key question for Russell was: What do systems of production and wealth accumulation gain from the way in which disability certification frameworks are constructed and public benefits allocated? Centered in an analysis of means-testing, war spending, administrative burdens, and underfunded social safety net supports, Russell’s work showed how a society obsessed with optimization, efficiency, and cost-benefit analysis had created a vast network of laws and institutions that worked together to perpetuate what she called “the money model of disablement,” better known as “the money model.”

The money model, best articulated in Russell’s 1998 book, Beyond Ramps: Disability at the End of the Social Contract, posits that disabled people are not, as they are often framed in dominant culture, a “burden to society,” but are actually a valuable resource. As Russell explains: “…persons who do not offer a body which will enhance profitmaking as laborers are used to shore up US capitalism by other means.” Disabled people are a nexus around which the capacity for surplus labor power can be built (often financed in part by federal money)—whole sectors of our economy have sprung forth from the money model, which has normalized the commodification of things, systems, and places that maintain disabled bodies in pursuit of squeezing profit from the money which passes through disabled people towards their survival and care. For example, nursing homes, Russell argued, are not places of rest and comfort, but a strategy for commodifying the “least productive” so that they can both be “made of use to the economic order” and free up the labor supply of those who love and wish to care for them. This system benefits neither the workers nor disabled people, only what Russell called the “owning class.” US disability policy, instead of being oriented around supporting the needs of disabled people, sanctions and facilitates the capitalist capture of nearly all aspects of disablement, impairment, chronic illness, and disability, including the way that “reasonable accommodations” are commodified (as explored by Ruth Colker in her essay for this symposium).

Russell was not just a theorist but also was a long-time disability rights activist. Throughout the 1980s, 1990s, and 2000s she was involved in disability advocacy and organizing with ADAPT, Not Dead Yet, and the ACLU. Her efforts focused on policy interventions like assisted suicide laws and SSDI cuts, campaigns that challenged the many stigmatizing portrayals of disabled people sold to the public via the charity industrial complex, and more formal organizing and direct action with ADAPT agitating for home and community-based services as alternatives to nursing homes and other institutions of warehousing. As Nate Holdren argues in his piece for this symposium, Russell’s significant contributions to both disability theory and Marxism were crucially informed by her work in social movements. This connection between theory and praxis is reflected not just in the subject matter of her work, or in her citational practices, but also in the empathy, clarity, and rage with which she argues for the need for the left to begin to engage in a broad refusal of the economic valuation of life.

Russell’s political writing was extensive, covering the topics she organized around as well as more explicit political economic analysis of US policy and critique of the disabling effects of the then-expanding criminal justice system. Russell’s work was also highly critical of the liberal disability rights movement, arguing that disability rights discourse would benefit from embracing leftist thought and political economic analysis. Russell’s approach rejected the court-oriented civil rights strategy that was widely celebrated by liberal disability organizations and activists in the post-ADA era. This strategy, she argued, only sought to tamp down the violence caused by the ways that the state interacted with disabled people; instead, she focused on the political economic, not merely the “cultural” forces, driving systemic oppression of disabled people—an approach on which Jules Gill-Peterson expands in her essay for this symposium.

The lack of exposure that Russell’s small yet incredibly powerful body of work has had cannot be overstated. Her books are hard to find, there is one major printed collection of her essays, and one important book of essays about or incorporating her work. Until Capitalism and Disability: Selected Writings by Marta Russell was published by Haymarket Books in 2019, no comprehensive volume of her collected writings existed, nor was there broad citation of them within disability studies or law. Three years prior, when legal scholar and her former collaborator Ravi Malhotra edited Disability Politics in a Global Economy, an important anthology dedicated to Marta Russell’s memory, it was one of the first times Russell’s work was broadly celebrated within a purely academic context.

— from The Law and Political Economy Project.


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  • Wertheimer [any]
    ·
    1 day ago

    You said "people who get migraines are 3x more likely than the general population to have a stroke" - and if I remember correctly the likelihood is significantly higher for migraines with aura than those without. Goddamn.

    Sexual activity is a migraine trigger for many people. If the doctors refuse to understand what asexuality is, maybe instead they'll believe you if you tell them that sex is a known migraine trigger and you already refrain from that so as not to have another stroke.

    I'm sorry, I'm grasping at straws. I don't know how these people think, so I don't know how to persuade them ... I'm just trying to think of what I'd say to my doctor if they were attempting to force me into unwanted medication. I did have a somewhat similar (but not comparable, what you're going through is something else) experience with a neurologist a while back. They refused to refill my rescue medication (which helped) if I stopped taking their preferred preventative medication (which made things worse, and also made me want to die). I had to go without, and find a new doctor. I don't know what I would have done if I were in a more risky situation. It's horrible, when they start holding you hostage like this. I hope they let you appeal.

    • DisabledAceSocialist [comrade/them]
      ·
      1 day ago

      Thanks so much for the support. I think I need to try and write a letter explaining my position. Maybe someone here could give me some tips for writing it?

      It's so infuriating as well because I haven't had sex since 2006. The only reason I even did it before that is because I had never heard of asexuality. I couldn't understand why all my friends were so sexually active but I had no interest. I thought there was something wrong with me, I only tried it to see if that would get me into it. It did not. Quite the opposite in fact. I haven't had any type of sexual contact in 18 years now, and never want to again. On top of this, I think I started going through the menopause this year. My previous regular, heavy painful periods have become light, painless and erratic. I don't even want to tell the doctor I think I'm going through the menopause in case they try to force me to have more medical tests, go on HRT or whatever. It's not bothering me and I'm happy to let nature take it's course. Basically there is no chance in hell of me getting pregnant unless god decides I'm to birth the next messiah, an immaculate conception happens, and if that happens, I'll have an abortion.

      This fight against the doctor is just the last thing I need, I already have far more on than I can cope with.

      • dustbunnies [she/her, comrade/them]
        ·
        1 day ago

        I don't even want to tell the doctor I think I'm going through the menopause in case they try to force me to have more medical tests, go on HRT or whatever.

        this might be the key to make them not try to get you to take contraceptives – peri- and post-menopausal estrogen is dangerous for people who get migraines with aura, because it greatly increases the stroke risk.

        I did a bunch of research on this a few months ago – if it would help you to have links to the studies I found, please let me know ❤️

          • dustbunnies [she/her, comrade/them]
            ·
            5 hours ago

            sorry for the delay – I coulfn't find the list I made, so I searched again 🤦

            this PubMed article is the most comprehensive thing I found:

            Hormonal Contraceptive Options for Women With Headache: A Review of the Evidence

            most relevant section:

            Does Combination Estrogen-Progesterone Contraception Increase Stroke Risk in Women With Migraine?

            No studies have been adequately powered to directly compare stroke risk in migraineurs with aura taking combination estrogen-progesterone contraceptives with that of migraineurs without aura taking combination contraception. Many studies have reported increased odds of stroke in migraineurs who use combination hormonal contraception, particularly among active smokers. Reported ORs for ischemic stroke in migraineurs using combination contraception range from 2 to nearly 14, compared with nonusers. A recent systematic review and meta-analysis of 9 studies found that the pooled RR of ischemic stroke in women age < 45 years with migraine ± aura was 3.6, and the risk of ischemic stroke was further increased to 7.2 among women currently using oral contraceptives.

            A case-control study by Tzourio and colleagues compared 72 women aged 18 to 44 years presenting with first ischemic stroke with 173 hospital-matched controls. They found the odds of ischemic stroke were nearly 14 times higher in migrainous women using oral contraceptives. In a pooled analysis of data from 2 US case-control studies, Schwartz and colleagues studied 175 women aged 18 to 44 years with ischemic stroke and 1191 controls. They found that women with a history of migraine and current low-dose contraceptive use (< 50 µg estrogen) had twice the odds of stroke compared with nonusers of combination contraception. Chang and colleagues compared 291 women aged 20 to 44 years with ischemic, hemorrhagic, or unclassified arterial stroke to 736 age- and hospital-matched controls. They found that women with migraine using low-dose oral contraceptives (< 50 µg estrogen) had nearly 7 times the odds of ischemic stroke, and this risk increased nearly exponentially if the women were smokers. Another case-control study by MacClellan and colleagues examined the effect of smoking on stroke risk in migraineurs, comparing 386 women ages 15 to 49 years with first ischemic stroke with 614 age- and ethnicity-matched controls. This study found that migraineurs with aura who were current combination contraceptive users and smokers had 7 times higher odds of stroke compared with migraineurs with aura who did not smoke and did not use oral contraceptives, and 10 times higher odds of stroke compared with women without migraine who did not smoke and did not use oral contraceptives.

            sadly, in a section about progesterone:

            Although studies are limited, there is no evidence to suggest that progesterone-only contraceptives increase the risk of stroke, even in women who have multiple risk factors (including age µ 35 years, tobacco use, and migraines with aura). The World Health Organization (WHO) considers progesterone-only pills, implants, intrauterine devices, and injectables to be Category 2 for women who have migraines with aura, regardless of a woman’s age, smoking status, or comorbidities. There is general consensus that progesterone-only contraceptives are safe for use in women who have migraine with aura, even in the presence of other risk factors for stroke.

            and this other article (that I didn't come across in my previous search) asserts that

            Combined hormonal contraceptives are contraindicated in women who have migraine with aura, in whom these drugs can increase the risk of ischemic stroke. However, this contraindication is based on data from the 1960s and 1970s, when oral contraceptives contained much higher doses of estrogen. Stroke risk is not significantly increased with today’s preparations, many of which contain less than 30 μg of ethinyl estradiol. Further, in continuous regimens, ultra-low-dose formulations—those that contain less than 20 µg of ethinyl estradiol—may help prevent menstrual migraine and reduce the frequency of aura.

            so it might not be as dangerous as I thought. ReadFanon's suggestions about saying the side effects are intolerable might be a better route 😞 sorry to let you down.