The Gesundheit! Institute: A 45 Year-Old Communal Hospital Experiment

Posted on September 1, 2016 by


I entered medical school in 1967 to use medicine as a vehicle for social change. I immediately saw that hospitals were expensive, hierarchical, frantic, unhappy places easily causing burnout to all levels of staff. I saw nothing “healthy” about a hospital setting. There were high levels of racism and sexism where the rich “elite” were treated so much better than the disadvantaged poor. I decided to spend my four years in a medical school studying hospitals with the idea upon graduation to create a hospital that addresses all the problems of care delivery, not as the answer, but to show that answers to these problems are possible. Two years into medical school, in 1969 I went to visit the Twin Oaks community. After having wonderful words with Kat Kincade and others, I realized I was a communal person—part of the great tribe called human.

When I graduated in 1971 no one gave us a hospital, so I decided to form a commune that was a hospital open for 24 hours a day, seven days a week for all manner of medical problems from birth to death. For 12 years we did this experiment, mostly with 20 adults and our children (three were physicians) in a large six-bedroom house. In the peak years we had 500-1000 people in our home with from five to 50 guests a night. We did not distinguish the patient from the “non-patient.” Instead, our focus was to try to have a relationship with everyone who came. If one came “as a patient,” our ideal was to have a three- or four-hour-long initial interview (instead of the 7.8-minute one we were taught) and to visit their home. By 1980 we had gathered enough resources together to purchase 321 acres in West Virginia (the least served state for healthcare).

Everything was given freely. We didn’t feel like a charity since our focus wasn’t on helping the “poor.” We simply didn’t want people to think they owed us something in return. We wanted them to be excited to belong to something called community, a nest of care.

In this same flavor, we never heard anyone praise insurance companies. They are, after all, one-quarter to one-third of the cost of care created by the practice of medicine. So, we never had anything to do with them. One can never know before a treatment what the effect of that treatment would be, so we need the right to make a mistake, so we are the only hospital in the United States that refuses to carry malpractice insurance.

In medical school, we never had a single lecture on health and so had to discover how to spark interest and give examples of exercise, diet, love, and spirit. For example, we would host all-night dance parties, and yoga sessions during the day, as examples of exercise. For dieting, we kept extensive gardens and learned to feed lots of people. We showered everyone we met with love and affection; my longest hug was 12 hours! To encourage spiritual growth, we allowed all practices to show themselves, and generally feel that spiritual means love in action.

At this time the only complementary medicine that was legal in our state was chiropractic medicine, so we welcomed it. Then, we broke the law by welcoming acupuncture, homeopathy, naturopathy, and so many more—even some that others may think are profoundly strange.

We were all so well known for our integration of human and play that others began calling us “the Zanies”! For me, it was so thrilling and enchanting to be alive every day for those 12 years.

Since those early days I have been constantly, relentlessly raising the funds to build a hospital. This ideal hospital will be a technologically modern hospital that will show a happy, funny, loving, cooperative, creative, and thoughtful atmosphere. A hospital that will run at only 10 percent of typical operating costs.

In those early years, we never asked for money. And so, we ran with little support for those 12 years. In fact, our staff had to work outside jobs—imagine having to pay to practice medicine! And yet, no staff left in the first nine years. I believe this is because the playful, deep, friendly practice of care is such an enchanting experience that it is worth paying to do. No one was making a sacrifice to be there. Love, play, and care are so seductive of appreciation.

All these years later, I’m still raising money for our dream hospital—even though a majority of financial promises have fallen through, and we may have asked over 1400 foundations for a grant. With all the setbacks, we still look to the successes that have sustained our effort.

We are a political project. And, as a political project, we realized that our style had become so intense, we would soon run the risk of burning out many people. It was then that I realized that to continue our project, we have to build a communal ecovillage to protect this dream of a hospital. It became clear that every staff person must have a room for their own and the other projects that hold their interest (like the arts). The way we had been was no model to show possibility—we had to actually have a hospital, albeit our style of hospital. We had refused publicity up to this point. We realized that if we were to raise the millions of dollars we need to build and endow our hospital, we would have to bring in publicity. In order to raise this money, I would become some sort of a celebrity. So, we closed our doors in 1983 and held a press event. Shortly after we closed the hospital, I was invited to lecture and perform all over the world. We tightened up the communal home for six to eight people for the next 15 years—waiting for that chance to build our fantasy.

By 1985 I was feeling such an emptiness from not being able to do direct care that I started our clown trips to foreign countries. This was a second wonderful exploration of communal living because the clown trips were a totally random collection of people. People have ranged in age from three to 88, from over 50 countries, and many come with no prior experience. We started in the Soviet Union and we have gone there usually with 35-40 people for two weeks. Our Russia trip is now in its 31st year! Using the same six qualities—happy, funny, loving, cooperative, creative, and thoughtful—complete strangers become a coordinated team of beautiful clowns. Over 150 trips have happened since the initial outing, involving over 6000 people; maybe only five or six did not work out.

Of course, the big trick was that all were going to human suffering with love and fun, which extracted these six qualities out of whoever came. The trips have been universally enchanting. Twenty-three years ago we were touring some orphanages in such an unhappy state that we were overjoyed when we met our astonishing friend Maria. Maria began work that has continued all these years with over 600 orphans, exceeding our wildest dreams.

In these years we’ve taken clowns into war zones, many refugee camps, and horrible disasters all over the world. Eleven years ago we were touring the Peruvian Amazon with a group of clowns when we came upon an unsettling number of children (ages three to five) that have been afflicted with gonorrhea. Our shock has emboldened us to return there every year since then and help out in any way we can. Now we team up with 100 clowns from all over the world for a two-week extravaganza filled with humanitarian projects and clowning for all. We will return this August! For this past year we have also maintained a year-long presence in the area with four women who moved there to see what can happy: a doctor, a psychologist, and two musicians. A similar project was started in Nepal eight years ago by our dear partners, Ginevra and Italo.

In 1999, Hollywood released a film about my life called Patch Adams. I agreed to do this foolish thing because they promised to help us build our hospital. The film made hundreds of millions of dollars—but we made no money from the film. We are here to end capitalism after all. However, the film did make my speaker fees go way up, and so another kind of communal project developed where I could give a talk, and with volunteers we could build a clinic or school in a poor country. The fees also made it possible to build three beautiful buildings on our West Virginia property in preparation for the big buildings we want for the hospital. In the last few years, through three bequests and some sweetly eccentric people, we have received such donations that as I write we are putting the roof on our first big building.

In 1987, at a conference of the International Cybernetics Association, I met a radical group of artists and activists who put the conference on, and I instantly felt a connection. The next five years we got closer and they changed their name to the School for Designing a Society ( We invited them to do the school in the summer on our land in West Virginia because it was like the missing piece for our project. We are here to teach and show social change. So right was this union, that we decided that the first big building we would build will be a school building. We had agreed from the beginning that our medical and clowning work would be free, and our educational work would be how we would raise our funds. By educational work, I mean lectures, speeches, workshops, and classes. Here was an in-house way to raise funds and to teach nonviolent revolution. What may be interesting to communal societies is that we have combined our communities, but kept the styles for each community as they are. The School has also created clown trips that have clowning in the morning, and education in the afternoon and evening. They have annual trips in Ecuador and Costa Rica. They have also returned recently from a clowning event in Mexico.

So yes! We have failed to build the hospital that I began in 1971, and was sure it would be funded in four years. Imagine my glee when I realized that the delay has been a great gift! The design of the hospital is a lot more intelligent now than we ever dreamed at the beginning. For example, environmental consciousness and desire have really progressed these 45 years. So we will have 120 staff, all living together in our communal ecovillage. This will eliminate 85 percent of the village’s ecological footprint. Permaculture and other ideas have leapt into our concept. With our global outreach and fame we are connected all over the world in our project, and those of other countries. It is thrilling! Clowns are now going into hospitals in over 130 countries, and in Argentina laws have been passed to require pediatric departments in every hospital to hire clowns. I lecture 300 days out of the year, and have done so for over 30 years in 81 counties, spreading seeds of a love revolution of enlivening community and a call to end capitalism. I have corresponded with letters to 130 countries so it feels like a global family—each with their own special directions of care.

I have never been discouraged; in fact the pursuit has given me a vigorous life. The smartest thing I ever did was be communal. This was the sweetest gift to myself. The hospital, the clown trips, the lectures and correspondences have made me feel that the earth is my commune, and all of us are truly brothers and sisters. Let’s get to work!

Our funding must be right around the corner!

In Peace, Patch

Patch Adams, M.D., founder of the Gesundheit! Institute, is a doctor, clown, activist for peace, justice, and care for all people, and lifelong reader of Communities magazine (since its birth in 1972). See

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