As I finished writing a book about trauma in India and the conditions of overload and injury that government hospitals in Mumbai confront, I often returned to Omar Dewachi’s research. But as I began writing my response to Ungovernable Life for this Forum, with trauma as my main point of comparison, the world pivoted. Questions of overloading hospitals have become generalized in the face of coronavirus. Will there be enough masks? Enough doctors? How do we think about the work of medicine amidst large-scale calamity, when medicine already is a practice of calamity management? How can a fragile healthcare system sustain demands, and what sorts of resources — and at what costs — are going to be marshaled and mandated to keep it going?
My comments here come from multiple standpoints, the jostling of feet on uneven ground to reflect on “the collapse” as a historical form, and on medicine as its condition of possibility.
Ungovernable Life offers a staggering portrait of the struggle to survive in Iraq in the face of wave after wave of imperial violence. What strikes me the most is the book’s insistence on the doctor as a specific historical form, not figure. Dewachi challenges us to think of doctors as infrastructure (25), and more specifically, of doctors as literally patching together the wounds of war while the state is “dismembered” (151). When doctors do manage to evade the restrictions on their departure from Iraq, and eventually arrive to settings like the UK, the tangles between the Iraqi state and British medicine deepen in new directions.
Dewachi shows that there is striving amidst the precarity, calling our attention to medicine’s practice being lived out in each physician’s own trajectory. The singularities of doctors’ lives after departing Iraq and seeking asylum elsewhere are riveting. Doctors like Hasan, whose story Dewachi details in Chapter 7, reflect on the impasse of life in the UK, caught in the flux of entrance exams, taxes, and family sustenance. Hasan applies for thirty jobs a week only to be told that he must have “UK experience” in UK hospitals. In his frustration, he tells Dewachi, “I am really waiting for a miracle to break this chain” (166). What is this chain, ultimately? Dewachi argues that it is the pathology of imperialism itself.
At the heart of this pathology is a tension that is both specific to the book’s case study and simultaneously pertinent to all of us in this moment: the vexed relationship between the mandatory and the medical. For Dewachi, much of this tension has to do with a doubled form of movement. On the one hand, there is the movement of sending doctors to the West. And on the other, there is the movement of deploying doctors to rural settings in Iraq. The fabric of this double movement is made of a conundrum, and it is here that mandated medicine’s social practices and hierarchies are evident. Discourses about unruly peasants connect to revolutionary projects; and doctors find themselves maintaining the healing dimensions of a regime they criticize.
Dewachi shows us how these tensions materialize principally through the rubric of the experiment. “Bio-experiments” can open the conditions for “an ecology of collapse” (181). His theory of structural violence is original in this way; he unfixes our attention from the collapse itself, and moves it back to the experiment. An experiment is, in theory, a controlled opening. Building on scholars who have described experiments a way of life (Haraway 1997), as a delineating of geographies of capital and power (Petryna 2009), and as a mass treatment form (Nguyen 2009), we learn in Ungovernable Life, that an experiment can also be the grounds for the production of disarray. What is required analytically, Dewachi suggests, is “displacing the gaze” from the result of ungovernability to the experimental conditions of ungovernability’s production. With sharpened attention to the conditions of production at work here, we can see the intersecting movements of medicine and violence through clearer eyes. In other words, here medicine is not static but rather a type of movement – a movement toward and in dialogue with critique.
Seeing medicine as movement to understand life as a form of collapse seems more necessary than ever. Displacement and exile are not just things that happen to doctors and patients; movement and mobility are medicine’s critical grounds. After all, movement is always-already social, as scholars of mobility attest. Seeing medicine as movement will require revisiting existing frameworks that make medicine seem static, and it will require crafting new frameworks as well. Ungovernable Life offers a good place to start. Following Canguilhem (1989), we would do well to grapple with the politics of life itself the way Dewachi does, by noting difference as not a comparison of fixed types, but rather as a difference in the forced mobility and immobility of bodies, states, and survival.
References
Canguilhem, Georges. 1989. The Normal and the Pathological. New York: Zone Books.
Haraway, Donna. 1997. Modest_Witness@Second_Millenium. FemaleMan© Meets_Oncomouse™: Feminism and Technoscience. New York: Routledge.
Nguyen, Vinh-Kim. 2009. Government-by-exception: Enrollment and experimentally in mass HIV treatment programmes in Africa. Social Theory & Health 7: 196-217.
Petryna, Adriana. 2009. When Experiments Travel: Clinical Trials and the Global Search for Human Subjects. Princeton: Princeton University Press.