The Political Clinic

Carolyn Laubender examines cases from Britain and its former colonies to show that clinical psychoanalytic practice constitutes a productive site for novel political thought, theorization, and action.

All advanced health care systems face severe difficulties in financing the delivery of today's sophisticated medical care. In this study David Wilsford compares the health systems in France and the United States to demonstrate that some political systems are considerably more effective at controlling the cost of care than others. He argues that two variables--the autonomy of the state and the strength and cohesiveness of organized medicine--explain this variance. In France, Wilsford shows, the state is strong in the health policy domain, while organized medicine is weak and divided. Consequently, physicians exercise little influence over health care policymaking. By contrast, in the United States the state is weak, the employers and insurers who pay for health care are fragmented, and organized medicine is strong and well financed. As a result, medical professionals are able to exert a greater influence on policymaking, thus making cost control more difficult. Wilsford extends his comparison to health care systems in the United Kingdom, West Germany, Italy, Canada, and Japan. Whether the private or public sector finances health care, he discovers, there is now an important trend in all of the advanced industrial countries toward controlling escalating costs by curbing both the medical profession's clinical autonomy and physicians' incomes.

For decades, psychoanalysis has provided essential concepts and methodologies for critical theory and the humanities and social sciences. But it is also, inseparably, a clinical practice and technique for treatment. In what ways is clinical practice significant for critical thought? What conceptual resources does the clinic hold for us today? Carolyn Laubender examines cases from Britain and its former colonies to show that clinical psychoanalytic practice constitutes a productive site for novel political thought, theorization, and action. She delves into the clinical work of some of the British Psychoanalytic Society’s most influential practitioners—including Anna Freud, Melanie Klein, Wulf Sachs, D. W. Winnicott, Thomas Main, and John Bowlby—exploring how they developed distinctive and politically salient practices. Laubender argues that these figures transformed the clinic into a laboratory for reimagining race, gender, sexuality, childhood, nation, and democracy. By taking up the clinic as both a site of inquiry and realm of theoretical innovation, she traces how political concepts such as authority, reparation, colonialism, decolonization, communalism, and security at once informed and were reformed by each analyst’s work. While psychoanalytic scholarship has typically focused on its intellectual, social, and political effects outside of the clinic, this interdisciplinary book combines history with feminist and decolonial social theory to recast the clinic as a necessarily politicized space. Challenging common assumptions that psychoanalytic practice is or should be neutral, apolitical, and objective, The Political Clinic also considers what progressive clinical praxis can offer today.

The Impossible Clinic explores the conundrum of evidence-based medicine’s (EBM) attempt to translate evidence from medical research into recommendations for practice. Ironically, when medical institutions combine disciplinary regulations with EBM to produce clinical practice guidelines, the outcomes are antithetical to the aim. Such guidelines fail to increase individual physicians’ capacity to judge – as EBM promises – because they externalize judgment while imposing disciplinary control. The Impossible Clinic is the first book to interrogate the history, practice, and pitfalls of EBM and how it persists due to intersecting relationships between professional medical regulation and liberal governance strategies.

From the personal and political upheavals of the Great War, through the Churchills’ ‘wilderness years’ in the 1930s, to Clementine’s desperate efforts to preserve her husband’s health during the struggle against Hitler, this is the inspiring but often ignored story of one of the most important women in modern history. Without Churchill’s inspiring leadership Britain could not have survived its darkest hour and repelled the Nazi menace. Without his wife Clementine, however, he might never have become Prime Minister. By his own admission, the Second World War would have been ‘impossible without her’. Clementine was Winston’s emotional rock and his most trusted confidante; not only was she involved in some of the most crucial decisions of war, but she exerted an influence over her husband and the Government that would appear scandalous to modern eyes. Yet her ability to charm Britain’s allies and her humanitarian efforts on the Home Front earned her deep respect, both behind closed doors in Whitehall and among the population at large. That Clementine should become Britain’s ‘First Lady’ was by no means pre-ordained. Born into impecunious aristocracy, her childhood was far from gilded. Her mother was a serial adulteress and gambler, who spent many years uprooting her children to escape the clutches of their erstwhile father, and by the time Clementine entered polite society she had become the target of cruel snobbery and rumours about her parentage. In Winston, however, she discovered a partner as emotionally insecure as herself, and in his career she found her mission. Her dedication to his cause may have had tragic consequences for their children, but theirs was a marriage that changed the course of history. Now, acclaimed biographer Sonia Purnell explores the peculiar dynamics of this fascinating union.

In The Occupied Clinic, Saiba Varma explores the psychological, ontological, and political entanglements between medicine and violence in Indian-controlled Kashmir—the world's most densely militarized place. Into a long history of occupations, insurgencies, suppressions, natural disasters, and a crisis of public health infrastructure come interventions in human distress, especially those of doctors and humanitarians, who struggle against an epidemic: more than sixty percent of the civilian population suffers from depression, anxiety, PTSD, or acute stress. Drawing on encounters between medical providers and patients in an array of settings, Varma reveals how colonization is embodied and how overlapping state practices of care and violence create disorienting worlds for doctors and patients alike. Varma shows how occupation creates worlds of disrupted meaning in which clinical life is connected to political disorder, subverting biomedical neutrality, ethics, and processes of care in profound ways. By highlighting the imbrications between humanitarianism and militarism and between care and violence, Varma theorizes care not as a redemptive practice, but as a fraught sphere of action that is never quite what it seems.

This book uses political and socio-anthropological theory to examine the relationship between power, interest, and agency within population and family planning discourse across Africa, with particular emphasis on case studies from Tanzania.

Income, education, employment, housing, the wider environment, and social supports; far more than the actions of physicians, nurses, and other health care providers, it is these conditions that make the greatest difference in our health. Drawing on his experiences as a family physician in the inner city of Saskatoon, Mozambique, and rural Saskatchewan, Dr. Ryan Meili uses scholarship and patient stories to explore health determinants and democratic reforms that could create a truly healthy society. By synthesizing diverse ideas into a plan for action based on the lived experiences of practitioners and patients, A Healthy Society breaks important ground in the renewal of politics toward the goal of better lives for all Canadians.