A Clinic the Size of the World

And, like the world, a lunatic asylum is a mosaic of the passions. 

—An asylum doctor in the Sarthe, 1837

Upon discovering an illness, it is customary practice for the pioneering doctor to give it his name. In an act of deindividuation, the clinician surrenders his name to the forces of abstraction, catalyzing a process whereby a signifier of individual and patrilineal identity is transformed into a constellation of symptoms. Such are the passions of science, its displays of love. And much like love, the clinician’s becoming-eponymous is both a territorial and self-effacing gesture, omnipotent and futile. How can anyone contend to carry so much pain under their name? More importantly, why would they want to? 

In Female Remedy, Leila Hekmat’s first institutional exhibition that closed in January, at Haus am Waldsee in Berlin, the artist did not grant her name to illness but to the institution that governs it. In a gesture of irreverence toward establishments both medical and artistic, Hekmat transformed the pastoral edifice of the villa turned exhibition space into Hospital Hekmat: “A facility for an illness which requires no treatment. A Malady for which there is no cure.” So went the opening lines of Symptom Recital: Music for Wild Angels—the theatrical performance that twice activated the gallery—alerting us immediately to Hekmat’s conceit: this is not a hospital like others, for it does not claim to treat nor cure. Given this foundational paradox, it is easy to disregard Female Remedy as being merely a metaphor (or parody) of that healing institution. Indeed, much of its critical reception has. 

Leila Hekmat, Female Remedy, Haus am Waldsee, 2022. Photo: Frank Sperling. Courtesy the artist and Galerie Isabella Bortolozzi, Berlin.

The current state of contemporary-artistic discourse surrounding health is largely unequipped to deal with creative interventions of Hekmat’s scope. Circumscribed by the sclerotic bounds of the medical imaginary, its conceptual frameworks have a propensity to reproduce modern medicine’s aesthetics and poetics instead of reinventing them. At best, this generates vital critiques of the medical-industrial complex and the violence it inflicts on disabled, racialized, poor, gendered, or trans people it deems surplus. Most often, however, the result is a stale and sterile replication of the medical institution within the confines of the gallery, where medical violence becomes rehearsed for the pleasurable consumption of the non-ill viewer. Notwithstanding their significant differences, what both these approaches share—and where they both fail—is their reification of health and illness along the terms of modern medicine. In this respect, Female Remedy was, and remains, a soothing balm. Nested beneath its sharp wit and wry humor is a radical proposal for how to rethink the ties between those registers we readily distinguish as “the critical” and “the clinical,” “the artistic” and “the medical.” 

*

Spanning a single story of Haus am Waldsee, the hospital exuded baroque lavishness with its floor-to-ceiling patterned drapery. Upon entry, one found the customary medical amenities: an operating room, a dormitory, treatment rooms, a chapel, a masturbatorium, a circle of toilet basins, and a bed of nails-cum-operating table inscribed with the invitation “trust me with your troubles.” Text like this appeared throughout, on walls, bedsheets, and uniforms. Language, in Female Remedy, felt very much alive, and where it was not written, it was voiced. Resonating across the hospital’s various rooms, the sounds of Symptom Recital—whose script and music had been recorded, collaged, and spatialized into a multipart sound installation—recounted the tragicomic stories of six Hospital Hekmat inhabitants. Replete with sing-alongs and patient confessionals, punctuated by periodical fits of laughter, these unnerving tales of woeful wisdom permeated the villa with an ambiance capable of transforming the most aloof of listeners into dilettante psychoanalysts.

Leila Hekmat, Female Remedy, Haus am Waldsee, 2022. Photo: Frank Sperling. Courtesy the artist and Galerie Isabella Bortolozzi, Berlin.

Then there were Symptom Recital’s protagonists: Hospital Hekmat’s patients and nurses (Krankensisters, as the cursive embroidering on their uniform indicated). The life-size mannequins populated the infirmary’s rooms and corridors flaunting chic pastel uniforms and questionable wigs. Choreographed into small groups, they leaned in and out of one another with postures suggestive of flirtation, leisurely gossip, and conspiratorial scheming all at once. Their yearning faces were collages of disjointed affect, each printed on ill-fitting masks. A leitmotif of Hekmat’s, these portraits—piecemealed from multifarious archival sources, including feminist zines and 1970s genre films—remarkably convey the complexity of psychic lifeworlds. In addition to adorning Hospital Hekmat’s ten mannequins, they graced its walls and ornamented its linens in a display of constellated subjectivity. Here, the hospital had failed to impose an anonymizing architecture on its patients. Marinating in their mosaic afflictions, Hospital Hekmat emerged in the image of its patients instead. 

One patient had the bruised, black-and-white skin of a cadaver. Large blue orbitals encasing maroon irises had been stitched onto her face, where a lonely eyelid was painted with mascara, and rotten teeth peered out in a smile. Facing her was a girl who might have been her friend, lover, or comrade in illness, a trepanation hole drilled slightly above the brow perfectly demarcating her sagittal axis. Patient Cecil and Patient Randy were their names, or so we were told by the image list. Minor oddities aside, they seemed perfectly endearing.

Leila Hekmat, Female Remedy, Haus am Waldsee, 2022. Photo: Frank Sperling. Courtesy the artist and Galerie Isabella Bortolozzi, Berlin.

Leila Hekmat, Female Remedy, Haus am Waldsee, 2022. Photo: Frank Sperling. Courtesy the artist and Galerie Isabella Bortolozzi, Berlin.

For nearly a decade, Leila Hekmat has been exploring femininity and its discontents within the far reaches of her interdisciplinary practice. Her aesthetic is unequivocal: the intoxicating mélange of musical theater, visual arts, and film, interspersed with scenographic affinities descending from the commedia dell’arte and the Theatre of the Absurd. From 2016’s The French Mistake—a cabaret-inspired meditation on genius—to 2021’s Crocopazzo!—a teledrama on sisters waxing Oedipal about their infanticidal patriarch, Mother—Hekmat has been modeling archetypes of feminine pleasure and suffering into installation and performance works worthy of early therapeutic psychodramas. Consider Crocopazzo!’s meditation on the family cell as a unit whose walls are better suited for bottling in the world’s pain than keeping it out. Already in this work, Hekmat’s idiosyncratic characterizations of psychic suffering and Laingian clinical musings (“Life is a sexually transmitted disease, and the mortality rate is 100 percent”) are in full effect. In this regard, Female Remedy and its case studies of hospital dwellers are closely related to the work’s predecessors. Except for one important difference: while the specter of illness haunted Hekmat’s prior works, in Female Remedy it came to the fore as an object of analysis and transformation.

It is therefore disconcerting, when reading reviews about Female Remedy, to notice the ease with which its foundational engagement with matters of health and illness is dismissed as a placeholder, a mere premise to invoke frustrated femininity. See, for example, ArtReview’s critique of Female Remedy, which eclipses the work’s engagement with illness by reducing it to a metaphor for society’s misogynistic failings. As if the kingdom of feminine suffering could only and either belong to the sanctified realm of the social or the individual crevices of the organic. As if its very etiology wasn’t this slippage into the interstices of civilized society kept agape by binaries of mind and body (“little Cecil’s found her lick, she revels in being sick,” mused one nurse’s disembodied voice). History has seen so many female martyrs it no longer perceives them as contradictory.

But there is more. For as much as the effacement of illness at the heart of Female Remedy can, and must, be attributed to the thorny interrelation of madness, badness, and sickness in feminine suffering, it must also be situated within its wider context: the arts. In this respect, the critical appraisal of Female Remedy is not an isolated case. It is the symptom of a contemporary artistic climate that prioritizes shallow deployments of clinical aesthetics and signifiers over meaningful engagement with the conceptual entanglements of the clinical and the critical. 

Leila Hekmat, Female Remedy, Haus am Waldsee, 2022. Photo: Frank Sperling. Courtesy the artist and Galerie Isabella Bortolozzi, Berlin.

Consider another art hospital: Sick! The Psychoanalytic Field Hospital (2018), a work by psychoanalyst Jamieson Webster, self-titled “philosophical investigator” Todd Altschuler, lawyer and artist Vanessa Place, composer Alec Hall, and the late scholar and philosopher Eric Anthamatten. Sick! was a purportedly “immersive” theatrical performance in which guests were invited to enter an environment and subject themselves, according to the description of the work, to “stupendous levels of bureaucracy, psychiatric diagnostic labels, insurance adjustment panels, and the like.” Administering this battery of tests, twenty psychoanalysts dressed in white coats (that psychiatrists, let alone psychoanalysts, do not wear white coats matters not) loomed over their guests as they were made to lie down on examination tables under the blare of baking lights. The takeaway was self-evident, not to say unimaginative: when life under capitalism makes us “crazy,” the world becomes one large mental facility. Albeit replete with clinical signifiers—doctors, diagnoses, white coats, the hospital—Sick! showed no intention of destabilizing these, reenacting wholesale the tropes of institutional medicine’s dehumanization to deliver its diluted critique of societal alienation. 

Whereas Sick! deployed illness as a vehicle to address an abstract society’s abstract suffering, the exhibition Kingdom of the Ill at Museion in Bolzano, Italy, pigeonholed its critique by way of myopic focus on the medical-industrial complex. Curated by Sara Cluggish and Pavel S. Pyś, it is but the latest group show (having run from October through last March) to gather—under the now worn-to-death aegis of Susan Sontag’s Illness as Metaphor—artworks codified as health-adjacent with the explicit intention of “politicizing” illness. Its aesthetics of modern medicine were painfully immediate: painted pill bottles, uncapped and overflowing; 3D prints of molecular chemistries floating alongside screenshots of scientific medical articles; hospital curtains turned ready-made; full-body X-rays; silk-screen prints commanding “VACCINATE NOW.” Aided by exhibition designer Diogo Passarinho, Kingdom contented itself with recreating the modern technocratic hospital within the confines of the artistic institution as a substitute for the critical exploration of its worthwhile clinical concern: “how can we question common definitions of good health?” 

Through their labored reification of the same, overdetermined signifiers of clinical medicine, projects like Kingdom and Sick! actively dampen our imagination toward the intricate ways in which living and aesthetic processes interact to shape concepts of health and illness. Tirelessly restaging their non-dialectical confrontation, such exhibitions and performances simultaneously indulge in the inadequacy of our present clinical forms to hold suffering, while obfuscating art’s capacity to render forms anew. For as long as contemporary art keeps its explorations of health and illness tethered to medically legible categories, it will reinforce the exclusion of those sufferings—whether ambivalent or opaque; Black or feminized—that form medicine’s constitutive outside. Throughout his extended writings, the French philosopher Gilles Deleuze traced a theoretical blueprint for resisting such reductive frameworks, as he explored the potential for art to not only critique but create clinical knowledge. In 1967, heralding his seminal critique of the literary turned psychiatric concept of sadomasochism, he prophesied that the critical and the clinical “may be destined to enter into a new relationship of mutual learning.” 

*

In his 1967 book Masochism: Coldness and Cruelty, Deleuze asserts that Richard von Krafft-Ebing, the psychiatrist lauded with the “discovery” of sadomasochism and its edification into psychiatric taxonomy, made a diagnostic error. By equating the psychic characterizations of Austrian writer Leopold von Sacher-Masoch and the Marquis de Sade, Krafft-Ebing allowed what he correctly identified as an alliance between pleasure and pain to overshadow the most determining—which is to say, damning—symptom of masochism: the desire to institute slavery within a contractual relation. Per Deleuze, the suturing of sadomasochism within the clinical realm begets a cruder, more confused syndrome than the symptomatological portraits originally isolated by Sacher-Masoch and de Sade. It is a casualty of the clinician-reader’s unrefined eye.  

Symptoms, then, are slippery and sinuous. Most important, they are the business of all: they form a common ground for the clinical and the critical insofar as they appeal “to a kind of neutral point, a limit that is premedical or sub-medical, belonging as much to art as to medicine,” as Deleuze writes. Through their cultivated percepts, the artist, like the hysteric, is more readily capable of attuning themself to the world and its painful idiosyncrasies, displaying in their work what the hysteric does on their body. The artist is, according to Deleuze, a creative “symptomatologist”—as the lot of angels in Hekmat’s Symptom Recital handsomely demonstrated.

“My symptoms are like this woman’s face: queer, gray, intangible … and very hard to look at.” Whispering in the dormitory at Hospital Hekmat, the voice was buoyed by Roman Ole and Roman Lemberg’s composition for the organ, pendulating indolently between jig and dirge. It continued: “Sensational highs and lows, struggle, monumental struggle, without any great stupendous happenings. I would not say that I’m better”—then paused for a moment’s introspection. Upon its return, a glimpse of hope: “But I’m not getting worse. That’s one of my all-time favorite diagnoses.” 

Unlike Deleuze, for whom the work of the symptomatologist is to herd symptoms into novel constellations, Hekmat intervenes at the level of language by redefining what counts as a symptom. Throughout Female Remedy, the aseptic language of medicine (which is overwhelmingly the everyday vocabulary of suffering) was superseded by a compassionate elegy to fraught haecceity—individuality and its psychic tolls. By way of poetic intervention, Hekmat’s hospital allowed suffering to take on forms both singular and ambiguous, immanent and ambivalent—forms defined by expressions like “when you have given up but not yet given in” and “an appreciation for the nothingness that being ill allowed her to enjoy.” Whether through patients relating their ills (anamnesis) or nurses doing so on their behalf (epicrisis), Hekmat’s radical symptomatology shores up a new psychic, sexual language for all those ensconced in the cold embrace of clinical dialogue. 

Leila Hekmat, Female Remedy, Haus am Waldsee, 2022. Photo: Frank Sperling. Courtesy the artist and Galerie Isabella Bortolozzi, Berlin.

As such, Hekmat subverts the critique most commonly directed at medical discourse: that it erases the subject behind the symptom. Hekmat’s symptomatology (what Deleuze might have baptized as Hekmatism) is as singular as its subjects, generating medical narratives that effectively neutralize the perils of diagnostic overdetermination. To this aim, Hekmat does not limit herself to the semantic realm. Untethering the symptom from its embodied subject, she further destabilizes it through its spatial commoning. When symptoms are splattered across walls, grafted onto bed sheets (“says she’s a goth hippy that hates hippies”), and atomized into acoustic clouds of giggles, the weight of their burden becomes simultaneously the task of all and none. It is, as one nurse’s voice in the dormitory recounted, a question of solidarity: “The obsession with healing becomes a common struggle of the patients and the nurses alike—so they all fall in love with each other and yet soon everyone suffers from the same delirious illnesses.” Expressed here is the dialectic that all radical societies of care must needle, whereby the collective struggle for the health of some might lead to the dis-alienation of all. This is the delusion we must nurture to preserve our sanity in a world gone mad. That folie à deux, trois, quatre …

* 

In 1941, a group of psychiatric practitioners spearheaded by the Catalan insurrectionist François Tosquelles published a manifesto chastising the carceral model of the asylum. They called for a hospital without walls, practiced a therapy without borders, and dreamed of a clinic the size of the world. Hospital Hekmat was one such clinic, where the suffering otherwise exiled to the margins of medical reality was afforded a place to dwell and a language to speak. Unlike a great deal of conceptual art that claims to address matters of health and illness, Female Remedy does not barter in the prepackaged signifiers of Western medical institutions. Instead, taking up Deleuze’s project for an art both clinical and critical, Hekmat intervenes directly into the signifiers of illness and their deriving subjectivities. The result is poetic, generative, and healing to the extent that it permits the maintenance of a life process irreducible to the terms of present forms. In the words of one of Hospital Hekmat’s nurses, “It’s simply called surviving.”