It takes a certain amount of fortitude to read labor historian Gabriel Winant’s book The Next Shift, especially if you live in Pittsburgh. The book details how the comprehensive healthcare benefits won by the Steelworkers union in the postwar era, the way working-class families were molded by the steel industry, and the long deindustrialization of the Steel City combined to produce our modern healthcare system, its economic irrationalities and its dependence on a vast low-wage labor force.
It’s a story not confined to Pittsburgh—the cities that used to be most closely associated with mass production industries, mostly in the “Rust Belt” but also in New England, the Mid-Atlantic and California, all now find their economies dominated by healthcare. As capital gradually disinvested from and then discarded unionized manufacturing plants throughout the 1970s, ‘80s and ‘90s, they left behind an “aging, ailing, [but] well-insured population.” In the absence of a strong welfare state, retiree health benefits were called upon to manage the social, economic and psychic wounds left behind by deindustrialization.
One of the book’s central points is that the modern US healthcare system developed, in large part, as a political solution to the problems caused by the incomplete welfare state, as it struggled to deal with the consequences of capital’s flight from the geographies where unionization had won a half-decent life for the working class.
The book’s vivid portrayal of the social lives of steelworker families, especially their gendered and racial dimensions, tells another tale that also seems almost foreordained: how the steel industry also created the healthcare workforce. In the heyday of union power, Pittsburgh was one of the places in the country with the highest percentage of working-class women who did not do paid work outside the home, only unpaid care work within it. Their labor power (especially that of Black women) was an abundant resource, ready to be sucked into low-wage care jobs in the growing healthcare industry as their fathers, brothers and husbands, their bodies and spirits often broken by work in the mills, were spit out by the dying steel industry.
The Next Shift begins with a quote from Frederic Jameson: “History is what hurts.” Jen Soriano’s book Nervous explores the hurt that her history, both individual and generational, has left as a legacy in her nervous system: mysterious pain (“My hands smolder and my wrists feel riddled with broken glass”) and, well, nervousness (“I startle at the sound of my name. I enter rooms searching for exits.”)
The book is masterful in both structure and style. Soriano weaves together personal narrative, history, and science in inventive, yet always eminently readable, ways. The opening chapter, “A Brief History of Her Pain,” tells two stories in parallel: Soriano’s quest (since 1996) to treat her chronic pain and medicine’s attempt (since 1900 BC) to grapple with mysterious pain suffered by women, often labelled as some form of “hysteria.” The chapter “381 Years,” written in alternating paragraphs or fragments on the left and right side of the page, and in sections titled after parts of the body (“Crown”, “Throat”, “Back”, “Belly” and “Feet”), interpolates the centuries-long and bloody history of colonization of the Philippines with the ways Filipino culture, and Soriano herself, have formed a body of resistance and survival, of both pain and transcendence.
Soriano does an excellent job of rooting her narrative in neuroscience, explaining clearly the concepts of neurogenesis, neural pruning, neuroregulation, neuroplasticity, and neuromimicry (which structure the sections of the book), but the book is also about science in the word’s earlier meaning, when it simply meant knowledge, and especially collective knowledge. Soriano recounts a masseuse at a neighborhood healing studio telling her she heard the word “remorse” emanate from her shoulder; visiting a practitioner who calls himself “the Bone Whisperer”; immersing herself, post-college, in a vibrant Filipino activist community in the Bay Area; finding modern versions of a traditional Filipino ritual called a “bayanihan”; becoming the singer in a band; joining a festival of resistance at a river in the Philippines; summoning two close friends from halfway across the world to help her confront her tokophobia (fear of pregnancy) while carrying her son. In each case, being touched by a collective praxis, one substantiated in bodies and physicality, brings Soriano greater insight into her pain and the generational, historical trauma connecting her to a history of colonization and violence.
There is a small but fascinating nexus between The Next Shift and Nervous: Soriano’s father was a neurosurgeon and did his residency in Pittsburgh, in the 1960s, at the University of Pittsburgh Medical Center (UPMC). UPMC plays a key role in Winant’s story, leading “the conversion of health care from a social good to a commodity,” in the approving words of Jeffrey Romoff, the businessman appointed to lead the academic-healthcare conglomerate in 1992. That conversion transformed Pittsburgh’s healthcare system—originally a web of community hospitals built on an ethic of service and caring for whole people (which Winant notes was “exploitative but also with real resonance”)—into the industry we know today, where a focus on “high-value” specialist operations—like neurosurgery—has led to consolidation, the closure of community hospitals, and an increasingly stratified workforce, with a gendered and racialized occupational hierarchy.
After his residency and some time in New York, Soriano’s father moved to Chicago, another city ravaged by deindustrialization in the 1980s and ‘90s. Soriano was born there and grew up in an upwardly mobile family, but suffered emotional and physical neglect which she believes has contributed to her chronic pain and complex PTSD.
Her father treated “a lot of gang-related gunshot wounds to the head” at a trauma center on the city’s South Side. Soriano writes that “This was the nervous system my father was trained to heal. A nervous system in acute crisis from physical trauma and also, as I now see it, from racialized economic divides.” He was very good at preventing that kind of trauma from killing people quickly; not so good at recognizing the ways other kinds of trauma kill people slowly.
In Soriano’s book, her father is a tragic figure. He escaped the poverty and violence of the Philippines by embracing Western ideals of scientific education, upward mobility, and conservative economic values (a signed photo of Ronald Reagan held pride of place in their house). He tried to keep his daughter “wrapped in a cocoon or locked in a cupboard, dusted and protected like bone china,” but could not understand, much less heal, the wounds to her nervous system, which Soriano believes stretch back to the history of violence and colonialism that he sought to escape.
Read next to Winant’s book, you recognize that he was tragic in yet another way: his journey from periphery to center, from colony to metropole, coincided almost exactly with capital’s decision to move production to the periphery; the profession that brought him here would find itself having to manage the social contradictions caused by that decision; and the specialty that he chose within that profession would call upon him to face, over and over again, the most acute crises and traumas caused by those contradictions. History is what hurts, indeed.
This essay originally appeared on Jonathan Kissam’s substack, “Domestic Left.”