Letter: A View from the Hospital Basement (2026)

Letter to the Editors from the March 2026 issue of the Socialist Standard

A View from the Hospital Basement

To the Editors,

I write to you as a 53 year old working class logistics porter for NHS Scotland, and someone who has recently come to terms with a lifelong reality: I am autistic. Having spent my younger years in the frantic ‘activism’ of the far left, I find myself now, in the quiet of my fifties, looking at the world through a lens sharpened by both my diagnosis and the consistent logic of socialism.

For the autistic worker, capitalism is not merely an exploitative system; it is a sensory and social assault. The ‘wages system’ demands a specific type of human raw material, one that is flexible, socially performative, and capable of enduring the chaotic, profit driven environments of modern industry. If you cannot ‘mask’ your traits, if you cannot navigate the arbitrary social hierarchies of management, or if your nervous system recoils at the bright, loud, and disorganised nature of the capitalist workplace, you are branded ‘inefficient’.

In my eighteen years within the NHS, I have seen the machinery of the state attempt to patch up a broken population. We are a class of ‘repair men’ trying to fix the damage caused by a system that prioritizes the accumulation of capital over human well being. My job as a porter relies on lists, logic, and routine, elements that suit my autistic mind. Yet, the overarching system is one of irrationality. We see the ‘crisis’ in our hospitals not as a failure of funding, but as a failure of a system that treats health as a commodity and workers as mere expenses on a balance sheet.

The Socialist Party’s ‘Impossibilist’ stance, the refusal to advocate for the mere ‘crumbs’ of reform resonates deeply with the autistic need for systemic consistency. In my youth, I chased the ‘immediate demands’ of reformism, only to find that every hard won ‘right’ can be stripped away by the next budget or the next shift in the market. For my daughters, one who shares my neurodivergent wiring, I have no interest in fighting for a ‘better’ version of their exploitation.

A socialist society, one based on the common ownership of the means of life and production for use, is the only environment in which the neurodivergent person can truly thrive. Consider the logic:

First, the abolition of the ‘interview’ and the ‘personality test’. In a world of voluntary labour, the social ritual of ‘selling oneself’ to a master disappears. An autistic person’s focus and ‘special interests’ cease to be a commodity and become a direct contribution to the community.

Second, the end of sensory exploitation. Capitalism builds cheap, high stress environments because they are profitable. A society producing for human need would, for the first time, design spaces for human comfort, accounting for the diverse sensory needs of all its members.

Third, the removal of social hierarchy. My alexithymia and my struggle with social cues are only ‘disabilities’ because capitalism demands a specific type of social compliance to maintain the master servant relationship. In a society of equals, where no one has the power to command another’s labour, the ‘unwritten rules’ of the workplace vanish.

I have stopped apologising for the way I am wired. I have realised that my autistic brain, with its preference for facts over rhetoric and systems over leaders. We do not need charismatic leaders to tell us we are exploited; we need only to look at the ledgers of our lives.

Socialism offers a ‘case’ that does not shift with the political winds. It is a list of principles that holds up to the most rigorous logical scrutiny. For the worker in Scotland, for the porter in the basement, and for the autistic child yet to enter the fray, the message must remain clear: the system cannot be mended. It must be ended.

Yours for the Revolution,

Pablo Wilcox

Scotland