Raw Thought

by Aaron Swartz

A Feminist Goes to the Hospital

In A Pattern Language, Christopher Alexander comments on the idiocy of trying to nurse people to health by locking them up in the land of the sick, but a visit to an actual hospital makes the point more vividly than logical argument ever could. The modern hospital is a place of nightmares, even visiting I cannot manage to spend more than an hour here without beginning to go insane. I cannot imagine how anyone ever escapes.

An island of white in an ocean of green, the modern hospital’s landscaping dangles the promise of verdant beauty while its insides are all white sterility. The hallways of identical doors twist and turn around so much that it’s impossible to find any room that isn’t carefully numbered, even after several attempts to try to discern the building’s layout. The muted colors and dreary duplication do not reward such attempts at investigation, or even mere attempts at life.

It seems like the building itself is ill. Odd pieces are blocked off with white sheets, larger ones with completely opaque walls. Bizarre machines with large tubes line the hallways, apparently standing in for broken parts of the building’s innards, while workmen wander around attempting to treat the other symptoms.

The rooms themselves are monstrous cells, tiny boxes with doors that stay open and walls that fight any attempts at individuality or privacy. The size makes entertaining guests awkward, while the lack of activities makes loneliness unbearable.

Were the large sign reading “Hospital” to go missing, one might easily mistake the facility as one for torture: men whose clothes have been replaced by dreary gowns slowly wander the halls in dreary stupor, their battered faces making them appear as if they have been badly beaten. They are not permitted to escape.

Were one, under such amazing conditions, to try to mount an attempt at fruitful work, it would quickly fail. Even assuming one was able to muster the energy to focus, the noises through the thin walls and unclosed doors would quickly distract. The beeps and buzzes from the assorted machinery would frustrate to no end. The screeching announcements from the loudspeakers would fast derail any trains of thought. And if one manages to get past all these things, well, it will only be a short while until a nurse or orderly comes to insert another needle or run some other humiliating and invasive task.

And so one simply watches the seconds tick away, as in some odd form of Chinese water torture. Sometimes the pain is made more vivid by the combination of very real physical discomfort, which incapacity makes difficult to alleviate. Itchiness, dirtiness, and restlessness are the orders of the day, with powerlessness coming in to make sure the others don’t escape.

Ostensibly this place is meant to cure things, the unimpeachable knowledge of science and the clean sterility of the building meant to combine to induce health. But, as before in history, the cure may be worse than the disease. Robert Karen has documented how early concerns about antisepsis led hospitals to keep children far away from their parents. The result, as was plain to anyone paying attention, was severe psychological trauma for the children, who assumed their parents had abandoned them, leading to mental problems that last a lifetime.

While modern hospitals induce problems apparently less severe, they are still problems. Again, the doctors that are supposed to help the patients seem less concerned about the patients as people than bodies, things to be measured and operated upon, puzzles to solve, problems to fix. They do not tell the patient what is being done to them, do not reap the benefits that could be received by engaging them in the search for the solution, but instead only share knowledge when forced by law and precedent, preferring to keep the real details private among the priesthood of doctors and nurses.

Barbara Ehrenreich and Deidre English note how well-off women of the pre-feminist era suffered from mysterious symptoms of inactivity, a condition they diagnose as the psychological result of their inactivity and powerlessness; society entrusted them with no responsibility and so their minds collapsed from lack of active use.

While women have made great strides in the years since, for many the problem is still quite real. And laid up in a hospital, with domestic and childrearing tasks undoable, they may find the responsibilities they had fade away, their condition stripped back to that of their afflicted forebearers.

And so patriarchical society and patriarchical medicine combine to strip all vestiges of humanity away. No freedom, no responsibility; no movements, no tasks; no privacy, no thought. The person becomes the body that the doctors treat them as.

Friends and family may try to visit, in an attempt to bring a bit of their outside world into this sterile place, but the awkward situation strains even the best relationships. Friendly conversations become hard when one party is lying in bed moaning, while strained family relationships are stretched further, surfacing their most disgustingly dysfunctional aspects. Family members, whatever else they may accomplish, somehow learn the remarkable skill of knowing just what to do to drive you up the wall. And as the hospital environment (along with the psychological stress of seeing you trapped in it) drives them insane as well, their presence quickly becomes more curse than blessing.

I’ve never seen an environment so effective at inducing such severe psychological pain. After just an hour, I feel like screaming, tearing, pounding, killing. I go “out of my mind” and yearn to get out of my body as well, running around in circles, pounding against the floor, with not even exhaustion appearing to cure me.

It needn’t be this way, for there is a cure: the joy of life. Sanity can be restored through attempts at music, channeling the fundamental disorder into form and elegance, focusing the energy toward good. Art, especially the art of nature, as Alexander suggested, is likely another cure. But hospitals aren’t built for that.

Bonus: Life in the Hospital

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September 27, 2006


I wrote this largely in one sitting, on my phone, while slowly going insane at the hospital. I’m amazed at how well it came out.

posted by Aaron Swartz on September 27, 2006 #

I recovered from an emergency appendectomy in a hospital much as you describe. I felt like clawing at the walls the whole time. A recent stay with my little boy in Portland’s Doernbecher Children’s Hospital revealed that not all hospitals are so. Nevertheless no hospital is a replacement for home. In Spiritual Midwifery Ina May Gaskin shows how much better midwifery serves mothers and newborns in a home setting. The book is a wild read with a description of a child (Ira) born without a skull. The sad part of Ira’s story though is that after they rushed him to the hospital the nurses and doctors there chose not to feed him since the condition was fatal.

posted by Michael Thomas on September 27, 2006 #

hey Aaron—

Howard Zinn also gives a good overview of the severely depressing ennui felt by pre-feminist era women, in A People’s History. It wasn’t until some women created ad-hoc, underground support groups for themselves that they began to realize they weren’t alone in their symptoms— the boredom, the spontaneous crying, the emptiness. I think these support groups in turn formed the foundation of the movement.


posted by Carl Tashian on September 27, 2006 #

An architect friend in Chiapas, Mexico, Kees Grootenboer, has recently created an amazing hospital in Altamirano, Chiapas. The San Carlos clinic, which mostly services rural peasants from nearby municipalities, and is staffed by nuns, has quite a constrained budget, and the construction is of local materials. The construction cost was quite low, and the building uses several interesting techniques to minimize energy consumption.

But the amazing thing about the hospital is its feel. Unlike any other hospital I’ve ever visited, its exterior walls are bright blues and yellows. Rooms have large windows which look out on green spaces. Walls are round and there are few corners in sight. The result is truly incredible. I’m sorry their website (designed by my 20 yr. old friend Gamaliel Grootenboer), hasn’t been put online yet, as it has some nice photos.

Obviously, the constraints are completely different than those in large cities where horizontal space is at a premium, and hospitals need to be 20 stories tall and fit into rectangular shapes. But we could definitely do more to make our hospitals places that evoke life and movement, instead of cold white sterility.

posted by Jacob Rus on September 28, 2006 #

The term hospital was, infact, initially used for houses where the poor, the insane, the criminal and the sick were collected, out of the sight and out of the mind of “decent” people. From this prisons, asylums, and hospitals in the modern sense were later developed, following a similar pattern of surveillance as a design principle. But also schools were developed following this pattern, once the effects of such surveillance were discovered. This development is studied IIRC in Discipline and Punish by Michel Foucault, and at least the Foucault Reader has some relevant excerpts.

posted by tuomov on September 28, 2006 #

Thanks my dear Aaron, For flying in to be with me (it was the one shining moment of my hospital stay when I looked up and saw the unexpected surprise of you coming into the room) and for staying all week despite the horribly pervasive atmosphere of that hospital.

I began to refer to it as The Dead Zone. I was in for 6 days after an emergency surgery and seemed only to get more ill as time went on (part of I blame on the nutrition zealot doctor who deemed I needed intravenous nutrition packets—TPNs—which required inserting a PICC line and testing my blood sugar 6 times a day and giving me insulin shots—which I have never needed—to balance out the sugars in the TPNs), I sank into a depression so unexpected that by the 5th day I was sure that I had already died and the hospital was the level of hell to which I had been permanently consigned. I pathetically begged everyone who entered the room, “It’s all right…you can tell me…I’m dead already, aren’t I?”

The very walls of the hospital seemed to suck the life out of me—painted in puke yellow—and the window, which did look out at some trees, unfortunately framed a week’s worth of grey, rainy weather. The floors and walls were filthy (I won’t even mention the bathroom); the furniture old, chipped and stained; the framed artwork (like an old puzzle drawing out of Boy’s Life magazine with faces and animals and broomsticks hiding in the trees) faded; the food rancid, stinky and inedibly heavy and overly sweet. I seldom saw the doctors wash their hands or use the Purell dispenser on the wall (I began to fear catching some super hospital germ infection). When I could finally walk the halls in my hideous hospital gowns and infantilizing slipper socks, I was tethered to a top-heavy pole with bad wheels, which made dragging it over any bumps or turning corners an exercise in futility. I begged to be let out, to be sent home where it was clean, where I could have simple healthy food and take a shower; I begged the residents, the doctors (when they came on rounds) to take the tubes out of me. And they just made me feel idiotic, patronized, weak and helpless.

Finally, in the middle of one sleepless, endless night spent staring at the walls, being sure the clock was actually moving backwards, it occurred to me with perfect clarity that the patient is never going to win the battle with the doctors…because the doctors have all the weapons. Just then the door slammed open, yet another nurse threw on all the lights and jabbed me with a needle, filling me with some other substance she refused to identify. Oh god, it was the most horrible hospital experience I have ever been through. And the scariest part of it is that this hospital is on the list of the 100 Best Hospitals in Illinois. Imagine what the others not on the list are like.

I know the hospital atmosphere adversely affected my family and yet they were kind enough to visit me every day; Aaron slept over in my room one night. It was hard for them all sitting there in that horrible place, trying to think of things to talk about, trying to help. I know I was cranky and not very easy to deal with, hardly a scintillating conversationalist. And yet, when they left at night, I would cry, so afraid to be alone in the hospital, so afraid of what the staff could do to me in the night when I was unprotected. These are modern times; this is a modern hospital. I’m only in my 50s and I’m not insane—how much worse must this experience be for an older person? How much more terrified must they be by all the impersonal interventions that happen to them in a hospital, with explanations (when they are explained) that they can’t understand? Or how is it for children for that matter, though, luckily, times have changed and parents can stay with their children now pretty much around the clock.

My brother has a theory. You go into a hospital to have something fixed but they immediately take you totally out of your normal environment: off your normal food and caffeine, off all your regular medications, etc. They do the surgery (or whatever) and invade your body with all sorts of foreign substances (IVs, narcotics, oxygen, TPNs, blood thinners, insulin, etc.) Then, as they gradually withdraw the foreign substances they have assaulted you with, they declare you “cured.” Then you are eventually allowed to go back home and resume your normal routine. Odd.

posted by Mom on September 28, 2006 #

It’s true that not all hospitals are this bad but most of them are. A few weeks ago I had to spend 8 hours in the Philadelphia hospital when my dad was undergoing a procedure on his heart.

It was remarkably comfortable… it was the first time I ever ventured deep into a hospital successfully just by reading the signs, never having to ask for help. Everything was well lit, well-marked, colorful and bright. There were other touches — my dad had a private room with a large bathroom, even though he didn’t request one (it was standard); he had a window; there were comfy benches out in many of the hallways, the people (even orderlies and maintenance) were friendly. One of the nurses even gave me her cell phone number in case I got lost getting back out of Philly (I got lost coming in). There were computers with internet access in the waiting room! The food in the cafe was also almost on the level of a “casual dining” place like Quiznos or Panera.

And, best of all, the guys doing the work on him came out from time to time to let me know how it was going, because it was taking sooo very long. I appreciated that most of all (that, and the internet!).

It was still torture but so much less so than any other experience I’ve had with hospitals.

My father and I both felt more secure even before the operation, and much better afterwards, than the previous time in Harrisburg. I would bet that a hospital like that one has a better recovery/success rate than others. There are probably studies somewhere, but it’d be hard to adjust for other variables.

posted by Amy Hoy on January 22, 2007 #

Reading your article brought back bad memories of my grandfather�s stay at the hospital. The doctor made a diagnosis: heart attack. We were all shocked! There were no symptoms, he�s never had any heart problems. He was an elderly, and yet strong and healthy man. He was put into a ward with 3 other men and told he had to stay there for a few more days. I know it sounds terrible, but I had to force myself to visit him. I simply hate hospitals. Whenever I get inside I become pale and feel nauseous. I cannot stand that repulsive smell of sickness, all these sounds of people suffering not only from different kinds of diseases but also loneliness and powerlessness. When I saw my grandpa that day, I didn�t notice that strong and healthy man that he appeared to be any more. I saw a woeful, life-tired man, surrounded by wires, tubes and machines, who couldn�t move without doctor�s permission. He had to share a room with other moaning men, who seemed to be much older and left by the relatives to their own fate.

Within one minute a person whom I�ve known all my life, suddenly became so distant. I was speechless. But what struck me the most, was the moment the doctor informed him that he had to stay in the hospital over Easter. My grandfather, a 75 � year old man cried like a baby! How desperate and miserable he had to be to weep in front of the whole family, not to mention the staff and other patients. He begged us to take him home, not because of Easter, no. Because he felt worse and worse behind these walls, instead of recovering. He said: �I�d rather die at home than stay in this place a minute longer�. We took him home the same day, although the doctor disapproved of our decision.

Now, when my grandpa has fully recovered and feels fine, I know that it was a very good decision. I also know that when it comes to hospitals, it is sometimes much better to listen to your heart, not the voice of reason.

posted by Geovision on May 24, 2007 #

Reading your post put me in mind of Charlotte Perkins Gilman, whose bout with post-partum depression eventually became the very influential short story ?The Yellow-Wallpaper.? For one thing, your prose is every bit as evocative. For another, your essay, like her story, concerns the very real mental damage that ?cures? can often cause for their ?patients.? But perhaps most telling was your brief section on the situation of women in relation to hospitals. When my daughter was born, my wife developed heart complications. As a result, shortly after the C-section birth, she was moved to the heart ward. I stayed with her for the week she remained afterwards, and I would describe very little of the experience as conducive to becoming well (and I wasn?t even the one who was sick). In addition to the fact that nurses come in at all hours of the night to wake you up (isn?t sleep important to recovery?), the first several night nurses had no idea my wife had given birth and kept asking her if the bloody bandages were the result of her period. But the best of all was the fact that infants are only allowed to stay in the hospital four days. So, while my wife had to continue to lie in bed recovering from surgery and watching her heart blip on a monitor, we had to send our four-day old daughter home to her grandparents.

posted by games on July 13, 2007 #


I don’t understand what your comment about “to search games” while the article is about hospital?

posted by on August 16, 2007 #

You guys are a bunch of paranoid idiots… If you could step in the shoes of a physician just for one day, you would realize how much good is done in such places. The overwhelming majority of physicians and nurses are intelligent, compassionate individuals who give it their all to care for others. Hospital-buildings themselves are often not much to look at, however, that’s not what really matters most, is it?

posted by KPK on August 16, 2007 #

Wow. I saw one intelligent reply from a doctor here, the rest of you are elitist fear mongerers (I love writing garbage like this!). Anyway, here’s a good option to avoid the woes of our modern health care system…DON’T USE IT! There are hundreds of millions of people that would kill for their child to be “traumatized” by our burn centers, or themselves “driven up the wall” by our oncology wards.

You people (I use that term loosely) need to eat more red meat and join the team. Or, quit your job, move to the Arizona desert, build an earthsip, convert to Christian Science (no doctors or hospitals), and live the dream! The fact of the matter is this: We are quickly being overtaken as the “best” in just about everything that’s measurable. So, look at third world health care and relish in the fact that we will have that in about 40 years along with the decline of our wealth and society. At that time, all of you can yell “hooray, no more invasive surgeries in drab, depressing hospitals” as you brush the flies away from the eyes of your suffering child. Yay!!!

posted by Nestles White Chocolate Rain (Man) on September 3, 2007 #

I nearly died in a high-speed rollover near Palm Spring CA. I did die actually. Several times. This near death brought me to Desert Springs Trauma Center, where because of wonderful doctors and nurses, I’m still in this dimension.

My body was horrible trashed - badly broken back (T3,5,7 burst fractures) and my face was partially pulverized.

I hated that I had to be there, but thank goodness that’s where I was! I love and appreciate everyone who cared for me - the doctors and nurses are extremely overworked, esp. with shitty paperwork. They are very caring and wonderful human beings.

Of course no one wants to be in a hospital, but if you ever need one, you’ll think differently about them perhaps.

Sure there are ways they could be better, I could list a few from a patients point of view who was incapacitated there for several months, but unless a benevolent benefactor gives them alot of money, frills like artwork, though healing and inspiring, just can’t be in most hospitals.

aloha and again, thank you to the paramedics, nurses and doctors!

posted by Suzanne Westerly on February 7, 2008 #

Well being from third world country, i can only laugh at people meaning the world and quality of life on basis on GDP per capita. While i dont want to tell you the secrets of an argicultrual country with less capital sitting in banks, what is nice in eastern countries is relatives and people who come into picture when one is ill. Reletatives travel to another cities just to see the patients and spend time with them while they are in hospitals.

We all going to die either first world or third world. But your life in first world countries is pathetic and people are mentally sick (talking out of first hand personal expereince of first world countries). just like a comment before, a small town had a better hospital.

People stay stupid………

posted by usman on February 16, 2008 #

“The smell of hospitals always makes me think of death. In fact I think hospitals are exactly what graveyards are supposed to be like. They ought to bury people in hospitals and let sick people get well in the cemeteries.” ~Paul Zindel, The Pigman


posted by PJ on February 26, 2009 #

“I’ve never seen an environment so effective at inducing such severe psychological pain.”

I always found public schools far worse. At least at the hospital, they (ostensibly) want you to survive; I often did not get that impression at school.

posted by Ken on March 4, 2009 #

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