Title: Is There a Doctor in the House?
Topics: DOPE, health, hierarchy
Date: Winter 2020
Source: Dope issue 12 - https://dogsection.org/doctor-in-the-house/




Anarchists are against hierarchy – but what does that actually mean?

Pop philosophers and liberal commentators think they’ve scored an easy goal when they pull off a little number like this: “Anarchists don’t live in the real world. They wouldn’t let their neighbour perform brain surgery on them, so they recognise expertise, but expertise is hierarchy.” Anarchists have actually been studying and analysing hierarchy for more than a century, so it shouldn’t be a surprise that we’ve answered this exact question many, many times.

The confusion is little more than a word play, conflating the definitions of three very different terms: rank, expertise, and hierarchy. Aside from populists who pretend that all forms of power are the same so they can continue to justify the very worst, most oppressive uses of power, the waters have also been muddied by psychologists with an individualist bias or animal behaviouralists who created overly simplified schema for social groups by studying animals in captivity. They were drawn to the term hierarchy, even though (or perhaps because?) that term was originally applied to human society and was being developed by anarchists to distinguish between just and unjust forms of social organisation.

That meanings change over time and across contexts is a fundamental fact of language, but the effect of those changes is far from neutral. There are changes that destroy meaning, that make it easier to manipulate people and harder to speak with clarity. And, for whatever reason, English is particularly vulnerable to such changes – perhaps because it’s the language the advertising industry was invented in, or its abundance of both homonyms and synonyms, or the prevalence of puritanism in the culture.

Whatever the case, we can assert that the aforementioned uses of hierarchy are incorrect, not just because of the term’s original meaning but because those uses make it impossible to analyse oppression and coercion in human societies, which in many cases is the very reason centrists have tried to steal the term from anti-authoritarian theorisations.


Ranking is simply a comparative, linear ordering of elements. This could range from someone having favourites, to an athletic competition, to rating people’s skill in a specific activity. This football team is better than that one, she has the best aim, I like grits better than Cap’n Crunch. The criteria are infinite: there are millions of skills or preferences to compare, and millions of ways to compare them. In the absence of a social hierarchy, ranking does not confer you power over anyone else. Having a high rank can give you status, which can certainly play a role in true hierarchies, but it is not in and of itself a hierarchy. Being #1 at something doesn’t necessarily give you an advantage elsewhere.


Expertise is the social recognition of knowledge and capacity. That recognition can be informal – you ask your neighbour to help fix your car because everyone knows she is a great mechanic – or it can be formal, as in the licensing of doctors. When it’s formal, that means a group of experts has organised themselves to confer recognition and perhaps also decide who can practice the profession. This recognises that knowledge is collective and expertise takes a great deal of effort. People are in fact not all equal and in some cases being better or more experienced at something gives you more legitimacy to do that thing, like fly an airplane or mediate a serious conflict. Questions of oppression come into the mix when people are denied access to the education they need to become experts in their chosen field, or when someone’s experience or ability is not recognised because they come from a marginalised group. Again, both of these forms of exclusion require the existence of a social hierarchy, and are not innate properties of expertise itself.

Anarchists won’t have any trouble imagining a society in which professional groups organise their own training, guaranteeing free access and assurances of quality and safety. If you’re going to get surgery, you want to make sure the person performing it is good enough or, if they’ve been dangerously negligent in the past, they won’t be able to do so again. A formal institution that gets to decide who is chosen for training, especially if they have a monopoly in their field, certainly has an authoritarian potential that anarchists would want to watch out for, but there are plenty of ways to organise such institutions to prevent that authoritarianism from manifesting.


The original meaning of hierarchy is “rule by priests.” It is a social order in which a closed organisation with internal ranking decides who can join and how they must ascend the institutional ladder. The higher up, the more power they have, over both initiates and the masses of people outside the organisation. In other words, a hierarchy allows a small elite to control an organisation as well as the values of broader society, getting everyone (inside and outside the organisation) to participate in their domination. Even the elite are not completely free. Though they have the most agency, they still must uphold the logic of the institution that produces the power they wield, and that power tends to accumulate over time, meaning the organisation’s traditions may be stronger than its individual members. In the end, members of a hierarchy are only free to increase the hierarchy’s power, with disputes over how best to do that resolved through the relationship of how much power the hierarchy can mobilise and how much power specific members of the hierarchy can utilise for their own ends against their opponents.

In other words, the President or supreme ruler of a very powerful hierarchy might not be able to win a power struggle against lowlier members of the hierarchy if it means going against tradition (including institutional structures) or the perceived interests of the hierarchy itself.

Conversely, a dictator or supreme ruler who is able to command most of the power produced by the hierarchy may end up destroying it if they dedicate it to irrational pet projects that weaken the hierarchy’s basis.

A further consideration is the role of the people at the very bottom of the hierarchy, external to the institution yet vital to the hierarchy itself. With the weakest hierarchies, like the religious orders that formed some early states, they are not captives but spectators, and technically they could walk away. In these cases, the hierarchical organisation has captured some symbolic central ground, and walking away means people would lose their culture, their social relations, and access to spiritual rituals that had become important to them.

In the case of stronger hierarchies, like all modern states, the people at the bottom are captives. We do not give our consent, we cannot walk away, and the hierarchy of the state can inflict whatever decision on us that it wants, backed by the force of its police and military.

This is what anarchists oppose, and with good reason. And with good reason, apologists for the State try to muddy the waters, because when the involuntary nature of the State is laid bare, its only justification can be brute force.