1/// DISEASE AS SPATIAL SEGREGATION: THE CASE OF WEST POINT IN 2014
On August 20, 2014, the Liberian government ordered a 21-day quarantine in the West Point neighborhood of Monrovia over the fear of an outbreak of the Ebola virus. For ten days, the 70,000 inhabitants of this poor neighborhood were split from the rest of the city and left to worry about potentially becoming infected. Some of these inhabitants tried to break the police blockade surrounding the neighborhood, but they were met with teargas and live ammunition, which led to the death of a 15-year-old boy named Shakie Kamara. Viral diseases in particular feed into the fear of otherness, as they allow for fantasies of contamination between bodies in an invisible realm. When this antagonism is paired with an already existing one directed at the lowest social class of a given population, the resulting segregation can be particularly violent, as it was in West Point.
The main concept through which we usually approach quarantine is that of “quadrillage” (quartering surveillance), as used by Michel Foucault in his description of cities affected by the plague. The term is multifaceted in the sense that it indicates a production of information: as Foucault describes, public inspectors would visit each house, each day, summoning each of its inhabitants to inquire about the status of their health. An immobilization and imprisoning of these bodies is enforced in order to effectuate their administrative control and for this information to be produced. In the case of West Point however, the Monrovia police were not operating through “quadrillage,” but rather through a siege on the neighborhood, surrounding it and preventing any of its inhabitants from leaving the urban sector. When a quarantine takes the form of a siege, the segregation is based on the exclusion of the immobilized bodies: they are contained in order to separate them from what are assumed to be ‘more valuable’ bodies (i.e. the rest of the population). In the case of the siege-quarantine, the contained population is considered an expendable sacrifice for the sake of the rest.
The idea of sacrificing a population in the context of a disease usually targets the same bodies as any other city’s apparatuses of population exclusion based on social and/or racial status. Of course, there is a noticeable difference between the actual quarantine of an entire neighborhood, preventing access to and exit from its territory, and the more common processes of segregation experienced in most cities by the territorial advantaging of richer and/or whiter populations. Authors like Albert Camus in The Plague (1947) and Eugene Ionesco in Rhinoceros (1959) are certainly not innocent in their dramatizations of disease as allegories for the rise of fascism. In their texts, the viral contagion symbolizes an ideological one, yet it materializes in an absolute essential difference between one body (healthy) and another (sick). The city being the space where the logic dictating social relationships is at its most intense, the neighborhood surrounded by police yet left on its own to manage its daily functioning and internal security (health or otherwise) can be seen as the spatial paradigm of social segregation, with its simultaneous mechanisms of exclusion and containment.
2/// THE BLACK PANTHER PARTY’S ALTERNATIVE HEALTHCARE IN THE 1970s
In her book Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination (University of Minnesota Press, 2013), Alondra Nelson introduces us to the history of an alternative healthcare created by the Black Panther Party in the 1960s and 1970s. This program was part of a larger one, involving what she calls the “social health” of African American communities in the United States. In a podcast interview with the Funambulist in 2014, Nelson explains that the Black Panthers “understood health as being not just the absence of infirmity, but also having a fulsomeness of economic, spiritual, bodily, and social health.” Similarly, the Black Panther Party understood the structural violence deployed against Black people in the United States as not merely the periodic “barrel of a pig’s shotgun,” but also through “inadequate housing […] or from inadequate medical attention” (The Black Panther, May 15, 1971, quoted in Body and Soul, 2013).
Just as some chapters of the Party decided to take up arms to defend Black communities against racist crimes (like in Oakland, CA for instance), its self-defense strategy against the slow violence of “inadequate medical attention” consisted of creating alternative clinics, which became systematized for all Party chapters of the country in 1970. These healthcare spaces offered more than medical care; they were also centers for mental health, food banks, employment assistance offices, and political schools (Body and Soul, 2013). These clinics were stocked in various ways; often through donations, like the spare medical equipment from the 1969 Woodstock Festival that was ultimately donated to the Harlem chapter.
This political and health struggle is part of a dialogue with others in the United States: the Women’s Health Movement of the 1970s, ACT UP in the 1980s, as well as current protests against the over-regulation and/or prohibitive monetization of health services, in particular for women (see Lori Brown’s article, pages 26-31) and populations struggling with economic precariousness. As demonstrated through the research project entitled “Black Mold” by Whitney Hansley published in the fifth issue of The Funambulist Magazine (Design & Racism, May-June 2016), the slow violence of inadequate housing combined with inadequate medical attention is still operative in a significant part of the African American community nowadays. In a political context in which the state exercises a precise control over the lives of all bodies, negligence cannot be mistaken for passive politics; it should be seen, on the contrary, as an active non-doing, and be held responsible as such.
For more about the Black Panther Party’s alternative healthcare, you can listen to The Funambulist podcast, “The Black Panthers’ Struggle Against the American Politics of Health: A Conversation with Alondra Nelson” (New York, April 14, 2014).
3/// THE HOSPITAL: A SITE OF DISPOSSESION FOR THE BODIES
In one of the lectures he gave in Rio de Janeiro in 1974, Michel Foucault described how the paradigm of the hospital as an institution radically shifted in the 18th century. During the centuries preceding this change, the hospital was a place “where patients were sent to die,” or, to be more precise, an internment center for the ailing poor, from which the diseases that killed them could not escape. For Foucault, the 18th century was a time when all institutions (hospital, prison, government, education, etc.) started to base themselves on a mode of sovereignty no longer centered on the binary opposition of life and death, but, rather, on the management of life and its attributes. This new mode of sovereignty that is applied to the subjects of these institutions is what he names “biopolitics,” a key concept throughout this issue.
As institutions change, so too does their architecture. The hospital thus becomes a place where one comes to be cared for and restored, and the architectural environment participates in this bodily endeavor. Instead of a tomb for the still-living, it is “considered as a mechanism to cure, and of which the pathological affects it causes must be corrected.” This implies a hygienic architecture within which sick bodies can be easily administrated.
The hospital, as a site of production of bodily knowledge, often aims at helping, if not ‘saving’ lives. Nevertheless, the production of knowledge as it was effectuated in hospitals between the end of the 18th century and the beginning of the 20th century dispossessed these bodies in order to use them (dead or alive) as experimental instruments, in the sanctified name of scientific progress. Grégoire Chamayou’s book Vile Bodies (2008) examines the linguistic, material, and legal processes that attempt to legitimate such experimentation, in particular when they sacrifice the physical integrity of bodies in favor of the production of knowledge. These processes tend to depreciate bodies in order to refuse them the fundamental rights which make their status fully “human.” Such links between medicine and the absolute dispossession of bodies can be also found in the experiments of the Nazi concentration camp regime, as well as in the pathological psychology of colonialism, as Frantz Fanon, a revolutionary and practicing psychiatrist, showed repeatedly in his writings.
The television show, The Knick (Steven Soderbergh, 2014), although fictitious, offers a vision of a New York hospital in 1900, where technological and epistemological progress is realized each day by a crew of ambitious surgeons. But the architectural frame in which this progress is produced is not passive: the surgical room, in particular, is an amphitheater where numerous experts sit to witness medical history in the making. The operated body itself is made in its anesthetic sleep to become only an assemblage of living matter, the experimental object through which surgical knowledge is produced. We would be mistaken to believe that clinical architecture is only an accompaniment to the institutional politics described by Foucault. The latter admittedly precedes its architectural materialization, from a strict chronological standpoint; however, architecture then directs the evolution of the politics of organizing bodies in space. Examining these politics without examining the space conditioning their implementation would thus only constitutes a partial vision.
4/// THE FORMER FRENCH-MUSLIM HOSPITAL OF BOBIGNY, FRANCE
The hospital is not only a site where knowledge is produced about bodies, it is also an architecture dedicated to their control — whatever the motivations behind it. Such control becomes particularly prevalent when the very function of the hospital is associated closely with policing. In this regard, the former Hôpital franco-musulman de Paris (French-Muslim Hospital of Paris), opened in 1935 in the northeast banlieue of Bobigny, was a materialization of these two functions. Later renamed the Hôpital Avicenne, after the 11th-century Persian doctor and philosopher Avicenna, to designate the institution’s shift to a non-specific clientele, the building was originally designed to accommodate the entirety of Muslim patients in the Paris region. The orientalist portal was designed by Maurice Mantout, the architect of the Paris Mosque.
The goal was to segregate North African patients from their white counterparts following the dubious policies, formed under racist social pressures, of the Council of Paris president at the time, André-Pierre Godin — which finds a clear echo nowadays. The hospital was managed directly by the Paris police prefecture and the “North African Indigenous Protection and Surveillance Service,” a group tasked with controlling an Arab population often recruited from abroad by the State itself, only to work as a sub-proletariat.
The state collusion of paternalist protection and surveillance could not be more clearly expressed than in the functioning of this hospital. In Policing Paris: The Origins of Modern Immigration Control Between the Wars (Cornell University Press, 2006), Clifford Rosenberg explains that while the care itself was of good quality (including translation services if need be), the hospital’s distance from the center of Paris and the fear of being administratively monitored prevented a certain amount of immigrants from using its services, leaving them without healthcare. After World War II, the hospital gradually started to accept non-Muslim patients from surrounding municipalities, and thus regularized its function.
In an era in which many countries are building camps to accommodate new populations of refugees fleeing from physical and economic violence, the French-Muslim Hospital of Paris demonstrates that the association of healthcare with the segregation of territories, as well as immigration control, is not without precedent. Whether these camps are designed to provide optimal health conditions for the bodies they host, or to actively discourage their permanent settlement (like in the container camp of Calais), the architectural typology that they mobilize — to which the hospital can also be associated — forms a fundamentally policeable space, in which bodies are monitored and dispossessed of their agency.
5/// MEDICAL EXPERTISE MOBILIZED FOR IMMIGRATION CONTROL
In France, undocumented minors are authorized by immigration legislation to remain within the national territory, while adults are subject to evictions. The method used to determine if a child is a minor or not consists of a radiography examination of the bones of the hand. The examination, developed between 1931 and 1942, uses the Greulich-Pyle bone age scale to determine whether young subjects still have cartilage around their hand bones. The legal fate of the immigrant body is thus dependent on the expert reading of the presence or absence of this cartilage.
Such a method is highly problematic for numerous reasons. The first and most obvious is in the assumed simultaneity of legal maturity with anatomic maturity. A body becomes legally mature, regardless of its development, when it crossed the threshold of its birthday. On the other hand, the presence or absence of cartilage in the hand bones is gradual, and cannot possibly correspond to a precise legal age. Doctors estimate that the margin of error for these examinations is about two years. This means that an actual 16-year old body could be determined as no-longer minor. Furthermore, the Greulich-Pyle method was calibrated to a survey of American middle-class youth in the 1930s. One does not need to be anatomist to understand that immigrant bodies, often coming from precarious origins in South Asia, Eastern Europe, and Africa, are necessarily different from the bodies tested in the original study. Once again, the normative body imposes its characteristics on others.
However, the most important question that this method raises is not related to its reliability. Insisting too much on this issue legitimates the examination de facto, since it implicitly asserts that if the test was indeed reliable, it would be a valid method for determining the legal fate of an individual. Rather, the most important problem here is the collusion of medical practices with a nation-state’s control of borders and populations; in this case, a control materialized by the potential expulsion of bodies from the territory in which it is exercised. To put it simply, when doctors are required to perform this examination, they are acting as legal experts, and the fate of the migrant is absolutely determined by their report. Whatever this report might be, and whatever choice these doctors make — even in falsifying their results — they exercise a power over a body that is not and should not be a part of their profession.
The notion of expertise is highly problematic in that it gives the individual that exercises it a position in society that can potentially be highly consequential on other bodies. In this regard, a medical expert always has to go back to the primary question of the profession: is my expertise being used to benefit the body subjected to its power? In the case of the examination of an immigrant’s hand bones, the answer is simple: no, it is not.
6/// PAUL B. PRECIADO: “MY TESTICLES ARE A SMALL BOTTLE IN MY BACKPACK”
On October 23, 2015, Spanish philosopher Paul B. Preciado published his monthly column in the French newspaper Libération. Its title, “Une autre voix,” (literally “Another Voice,” but also potentially “Another Way” when read aloud) refers to the gradual change in his voice as an effect of the regular doses of testosterone he has been administering to his body since he started his gender transition. “Each morning, the tone of the first word that I pronounce is an enigma,” he writes, surprised by the transformation of what he is reluctant to call his “body,” favoring instead the term “somatheque” (a diffuse receptacle of the various corporeal organs).
Preciado does not only retrace (or, rather, refuse to trace) the limits of the body; he also redefines the property of the body from an essentialized and privatized entity to a collective and relational assemblage. This echoes the rest of his work, in particular when it comes to the regime of control and production that characterizes our era. Onto the 18th century disciplinary regime examined by Michel Foucault, he superimposes a “pharmacopornographic” regime that manages and controls the various aspects of bodies’ biologies and sexualities. To resist the logics of this regime, he invokes the need to invent “dissident organs,” (Vacarme, 2013) as transsexual micro-communities have, thus further redefining a relationship to the social category of gender.
In the following excerpt, Preciado describes one of these dissident organs: the little bottle of intramuscular testosterone that he carries in his backpack, which performs the role of testicles. As ‘simple’ as it sounds, acquiring this particular molecule remains a difficult administrative and medical struggle. Gender still operates as one of the most crystalized normative categories, and contravening it means navigating both the difficulty of attaining administrative recognition and the verbal and/or physical violence often deployed against trans bodies.
“In the same way that the pill induced a technical separation between heterosexuality and reproduction, the Ciclopentilpropionato, the testosterone that I inject intramuscularly, induces a separation between hormonal production and the testicles. In other words, “my” testicles — if by testicles we mean the organs that produce testosterone — are inorganic, external, collective, and dependent partly on the pharmaceutical industry, partly on the legal and medical institutions that grant me access to the molecule. ‘My’ testicles are a small bottle of 250 mg of testosterone that travels in my backpack. The point is not that ‘my’ testicles are out of my body, but, rather, that ‘my’ body extends beyond ‘my’ skin, to a place that cannot be thought of as simply mine. The body is not property, but relationship.” (“Une autre voix,” 2015).