Indirect Action: Schizophrenia, Epilepsy, AIDS, and the Course of Health Activism by Lisa Diedrich (review)

The year 2017 has already declared itself to be one of elevated energies, of movement and mobilization. Historical and theoretical perspectives are as important as ever for medicine and health activism. It is therefore fortuitous that a scholar such as Lisa Diedrich has given us a new inquiry into ways of being and doing in relation to health, grounded in a contemporary experience of illness, but with immediately broader implications.

As Diedrich’s introduction makes clear, this project’s scope is ambitious. The author begins with ACT UP (AIDS Coalition to Unleash Power) as a reference point, querying the received history of this organization: that AIDS activism began with ACT UP in the mid-1980s, achieved its aims by the mid-1990s, and subsequently influenced such movements as breast cancer awareness. With stated intention to move between “illness,” “thought,” and “activism,” Diedrich complicates this narrative, formulating “indirect action of multiple forces operating prior to the emergence of AIDS” as having “made something like ACT UP possible” (1). The notion of indirection begins, for Diedrich, in Rachel Carson’s concern with chemical action on biological systems. The term soon outgrows this metaphor to become a flexible label for social influence: on experiences of illness, in modes of stigma and social control, and, by extension, in critical historical work.

The book’s main chapters, in sequence, deal with AIDS, the clinic, community medicine, ecology, epilepsy, and schizophrenia, with each chapter grounded in one or two primary texts. Between chapters and by way of conclusion, Diedrich includes “snapshots,” incorporating images and resonating with the main chapters, and an “afterimage” directly addressing AIDS activism.

The first chapter uses an academic listserv dialogue as the starting point for discussing the meanings of queerness as it pertains to both health/illness and critical work. One immediate implication is to rethink AIDS history, both temporally and institutionally, in a way that duly integrates women, particularly so-labeled feminists and lesbians, as participants in the response to the epidemic. Arguing for “an explicit connection between AIDS activism and the health feminism of the 1970s” (33), Diedrich moves in the second chapter to the history of clinics, particularly as they apply to women’s medical “self-help” and transversality (here associated with Felix Guattari, and concerned with patients’ relationships with the clinic). Readers might be surprised not to see incorporation of the community health center movement beginning in the 1960s (briefly mentioned in a footnote), or – more directly pertinent to ACT UP and AIDS in the 1980s – reference to the development of urban clinics functionally dedicated to providing health care to gay men in the 1970s.

The third chapter uses Michel Foucault’s Birth of the Clinic in juxtaposition with John Berger and Jean Mohr’s illustrated biography of rural community physician John Sassall, A Fortunate Man, as a basis for conceptualizing the gaze, medical witnessing, and their implications for health practice. Here as elsewhere, Diedrich asks: if the medical perspective is definitive, where does that leave the patient?

In the fourth chapter, Diedrich zooms out to the ecological level, as seen through the lenses of Rachel Carson and Lewis Thomas. Indirection emerges again as the basis of Carson’s death from cancer, and as an explanation of how her writing became a basis for future “narrative[s] of concern” (123). Concretely, the connection between pollution and breast cancer posited both by Carson’s research and by her death illustrates strains of the breast cancer movement that preceded AIDS and its activists – part of the “prehistory of AIDS” that Diedrich seeks to reveal.

Chapters five and six build on narratives of epilepsy and schizophrenia, as seen by patients’ families. “David B.’s” Epileptic, about his brother, and two sisters’ memoirs of their mother’s mental illness help to launch a critique of the ACT UP slogan “drugs into bodies,” including eventual comparison of protease inhibitors, anticonvulsants, and antipsychotics...