The Death of the Clinic: An Anarcho-Organicist Approach to Health

This is a lightly edited excerpt from Benoît Loiseau’s The Death of the Clinic: Radical Experiments in the Art of Medicine, published this month by Fitzcarraldo Editions (UK) and Yale University Press (North America).

What would health look like if we could envision it beyond the authority of the medical gaze and the normal-pathological divide? What would become of the clinic if it were hijacked by the sick, the mad, the deviants, the unemployed, and the undocumented? “It is time to put Foucault on the crip-queer diet and write The Death of the Clinic,” says the philosopher Paul B. Preciado.1 Is it possible that the clinic is already half-dead? Better yet: undead—a zombie clinic—its core features hanging by a thread like rotting flesh clinging to a bone. The clinic is at once stillborn and still being born, again and again.

I had a philosophy teacher in Paris who liked to muse over what he saw as two distinct versions of life: Life with a capital L—the great phenomenon of life in all its metaphysical splendor—and life with a little l—our singular, individual lives. Of course, they are intertwined—continuously overlapping and shaping one another. The great Life is but a collection of little lives and organisms—whether animal, vegetal, or microbial. I like to think of the clinic in similar terms: There’s the grand tradition of the Clinic as a universalist fantasy envisioned by an elite few, and then there are the little, or “unexceptional” clinics, as political theorist Emily Apter might put it, doing their thing, some more compliant, others more rebellious.2

This book is about the agony of the Clinic—about the little clinics’ attempts to challenge, trouble, and, ultimately, kill its oppressive functions. Modern clinicism—born at the height of imperial expansion—produced a hierarchical body of knowledge by objectifying patients’ bodies, often at the expense of their agency. To imagine the death of the Clinic, then, requires imagining the ways in which clinics have resisted, disrupted, and, at times, dismantled the sovereignty of the medical gaze in favor of patients’ autonomy. Oftentimes, this resistance has taken shape through horizontal models of care, empowering patients to participate not only in their own treatment but also in the production of medical knowledge. The health workers in this book revolted against the modern clinic, ruled by priests of the body. They are the antiheroes of medical history, dissecting the Clinic as Bichat’s students once dissected corpses—searching, in the depths of death, the anatomy of a life worth living.

Spanning a century and six countries, the clinics in this book operate across distinct disciplines: sexology, preventive health, psychiatry, gynaecology, and virology. They emerged at the margins—outside hospital settings and state structures—driven by politically engaged individuals determined to challenge the order of things. Each one of them offers its own vision of health—defiant, radical, sometimes utopian, but always practicable. None represents a single school or movement—these clinics neither collaborated nor explicitly referenced one another. Yet, they sing the same song: one of resistance and solidarity. All sought to challenge authority, foster community, and empower patients while interrogating their own modes of operation.

Did they succeed? Sometimes. But every success seemed shadowed by the threat of downfall. It is hardly a coincidence that all but one of these clinics—La Borde—were ultimately forced to close under financial or political pressure. To kill the Clinic—by which I mean to dismantle the disciplinary regime upon which it relies—is a kamikaze operation. It involves the risk of self-destruction and effacement, of being taken too seriously or not seriously enough. Ultimately, like an act of matriphagy, it entails the risk of a double death: the newborn spider consuming its mother to secure survival and, in doing so, compromising its own long-term means of sustenance. In this book, I attend equally to the successes and failures of radical clinical experiments, for each represents a form of death: in some cases, the death of a dominant paradigm; in others, the death of its dissenters—the latter often following the former.

Drawing on feminist approaches to situated, embodied, and context-specific knowledges, the methodology of this book derives from what Jane Gallop has termed “anecdotal theory”—a mode of thinking and writing through anecdote, of “anecdotalizing” grand narratives in ways that honor lived experiences and take them seriously. “I want to theorize from a place where dreams cohabit with a host of other narrative forms, riddles, and stories, and play with language,” Gallop writes. “Not dreams as other-worldly but dreams as one opening, among others, where we connect to the here and now.”3 Following this lead, I often turn to the uncanny, the marginal, and the seemingly trivial to make sense of medical history, to fill in the gaps and attend to those figures and fragments obscured by the tyranny of universalism. This is my way of connecting to the here and now, of resisting the hierarchy of discourses.

Through this mode of theorizing—or theoretically inclined mode of storytelling—I trace two key modern influences that intersect in generative ways across radical clinical culture—anarchism and organicism—outlining a paradigm I refer to as “anarcho-organicism.” For Plato and Aristotle, anarchía represents the absence of government and laws: It is a negative state. In the mid-nineteenth century, however, the French politician and philosopher Pierre-Joseph Proudhon reversed this tradition, turning anarchism into a positive concept—no longer an absence of government but a counter-government. “Anarchy is order without power,” Proudhon affirmed.4 In modern anarchist thought, the only order worth pursuing is that which emerges freely and consensually. That is why it tends to view central governance as essentially oppressive. “Anarchism,” the philosopher Catherine Malabou notes, “is first and foremost a fight against mechanisms of domination.”5

The clinics in this book interrogate medical authority much like anarchists interrogate state power. Not unlike the Paris Commune—the anarchist model par excellence—these clinics fashioned themselves as little societies of their own: self-governed spaces for living, working, thinking, and healing. In fact, many of their protagonists sustained meaningful dialogues with leading anarchist figures, from Emma Goldman and Gustav Landauer to Herbert Read and François Tosquelles. In many cases, anarchist thought provided a template for these clinics to envision antiauthoritarian models of care. This is perhaps most evident in the case of the Peckham Experiment, a laboratory of preventive medicine in interwar London, which empowered its patients (or rather, “members”) to use their Center’s facilities as they saw fit. “I was the only person with authority,” its medical director, George Scott Williamson, once told the London Anarchist Group, “and I used it to stop anyone exerting any authority!”6 Both the psychiatric clinic of La Borde, in the heart of France, and the feminist health center Le Dispensaire des Femmes, in Geneva, disrupted medical and professional hierarchies through a task-allocation system that disregarded status or qualifications. Even at the Institute for Sexual Sciences, in Weimar Berlin, it was not always clear who was the doctor and who was the patient.

Organicism, on the other hand, is a biological paradigm that emerged in the first half of the twentieth century. Simply put, organicism is the notion that living systems—including human societies—are organized as independent yet interconnected wholes. In biology, this current developed in response to the longstanding tension between vitalism (the belief that life is driven by a special, nonphysical force) and mechanism (the belief that living organisms function like machines). It was a dichotomy that organicism sought to transcend. “Organicists,” as Donna Haraway has noted, “reject the reductionistic approach primarily because they refuse to see the world in single terms.”7 In other words, organicism introduced biological principles of integration and organization that emphasize the value of the whole organism: It challenged traditional hierarchies in favor of a relational politics in which parts and wholes are in an ever-changing dialogue with each other and their environment.

The roots of organicism can be traced back to Aristotle’s Politics, in which he claims that the whole is prior to the part, and that the polis exists “prior to the individual.”8 Kant revived this idea in his Critique of Judgement (1790), describing living beings as self-organizing and purposeful, with each part depending on the others and on the whole they form. Building on this tradition, the term “organicism” was introduced to the biological realm by the Scottish physiologist John Scott Haldane who, in 1913, claimed that the fundamental unit of biology is the organism—inseparable from its parts and the environment. Scientists throughout the twentieth century would go on to elaborate what organicism is and does, from Ross G. Harrison to Paul Alfred Weiss, Joseph Needham, and Kurt Goldstein. Not unlike anarchism, organicism took various forms, and while it is beyond the scope of this book to analyze their particularities in detail, I am interested in contextualizing this current as a source of intellectual and conceptual tools for considering the relational aspects of health.

From a medical perspective, organicism considers disease in relation to its environment rather than in isolation. “The total environment and the milieu intérieur constitute a multifactorial system,” notes the microbiologist and proponent of organicist medicine René Dubos, “each component of which must be studied with regard not only to its own characteristics but also to its effects on the other components of the system.”9

This expansive understanding of health—which helps reconcile the long-standing tension between multifactoriality and specific etiology, between Hygeia and Asclepius—runs through the clinics of this book. The Institute for Sexual Sciences advanced a form of “milieu therapy” prescribing that queer people socializing in queer spaces was far healthier than isolation; the Peckham Experiment was modelled after a social club, with governance in the hands of its members; La Borde, instead of confining patients, allowed them to roam freely as part of an effort to treat the psychiatric institution itself; Le Dispensaire promoted self-help methods to empower women to better understand their own bodies and, in turn, gain autonomy from the medical establishment; and New York’s Community Research Initiative designed its own clinical trials, enabling people with AIDS and their doctors to access potentially life-saving treatments for myriad opportunistic infections while generating new data at a grassroots level. However distinct, these strategies all sought to integrate patients’ subjective experiences into the therapeutic process, confronting the social conditions of disease and cultivating environments that would support and sustain community well-being.

At first glance, the relationship between organicism and anarchism may not be obvious. Yet both share a focus on autonomy and self-regulation—biological in the former, political in the latter. In fact, the twentieth century was ripe for such an ideological encounter, thanks in part to the Russian anarchist and naturalist Peter Kropotkin. In his book Mutual Aid: A Factor of Evolution (1902), Kropotkin deplored that Darwin’s theory had uncritically adopted the Hobbesian notion of a violent and competitive state of nature in which species, including humans, were locked in constant struggle for survival. Instead, Kropotkin argued that solidarity and cooperation were just as—if not more—prevalent in the natural world. “Sociability,” he wrote, “is as much a law of nature as mutual struggle.”10 With the concept of mutual aid, Kropotkin laid the groundwork for a radically productive encounter between anarchy and biology: a way of thinking about the living and the social not merely in terms of competition but, rather, in terms of cooperation. In this light, anarchism and organicism complete and echo one another.

Anarcho-organicism is, above all, a struggle for autonomy and against authority. It is an autopoietic impetus striving to outgrow the existing order of things: a relational force—wayward, abundant, rhizomatic—that values both the whole and its parts as they inhabit an ever-changing environment. As a mode of creative self-governance, anarcho-organicism resists domination while promoting mutual aid. Put simply, anarcho-organicism is both a concept and a method: an approach to the living world that resists predetermined hierarchies in favor of self-regulated equilibrium.

From a medical perspective, an anarcho-organicist approach to health favors horizontal, egalitarian, and antiauthoritarian models of care. It challenges the traditional doctor-patient dyad in favor of community-based research and knowledge. Ultimately, anarcho-organicism offers a concept through which to envision a counter-clinical culture: a health system grounded in freedom, consent, and solidarity. It is the framework I use to situate and understand the clinics of this book—one that I hope can also help illuminate the health challenges of our time.

I like to think of anarcho-organicism as a clinical methodology for a radical art of medicine in the age of modern sciences. Since the modern scientific turn, unlike in the days of Hippocrates, “art” and “medicine”—like “anecdotal” and “empirical”—have been at odds. Today, an art of medicine is, at best, perceived as the stuff of witches and quacks, while scientific medicine is presented as an unbiased and objective practice. Yet, as the professor and historian of medicine Kirsti Malterud suggests, the modern divide between scientific medicine, concerned with observable and empirically verifiable matters, and the art of medicine, focused on subjective experience and humanistic matters, is a fantasy that ought to be scrutinized and demystified.

The art of medicine, instead of being pitted against scientific medicine, “should rather be defined as the successful interrelationship between the biomedical and the humanistic perspectives in clinical practice,” Malterud affirms.11 It should help us trace the contours of a new medical epistemology—“a revised map of the territory included by medical research”—which considers the social, cultural and political aspects of one’s clinical experience.12 In other words, a radical art of medicine should help us reconcile medical science with lived experience. It should allow us to see that patients themselves have valuable contributions to make.