Ed Cohen

A Body Worth Defending: Immunity, Biopolitics, and the Apotheosis of the Modern Body

Acknowledgments ix Opening Up a Few Concepts: Introductory Ruminations 1 1. Living Before and Beyond the Law, or A Reasonable Organism Defends Itself 32 2. A Body Worth Having, or A System of Natural Governance 68 3. A Policy called Milieu, or The Human Organisms Vital Space 130 4. Incorporating Immunity, or The Defensive Poetics of Modern Medicine 206 Conclusion: Immune Communities, Common Immunities 269 Notes 283 Bibliography 323 Index 359

My self as an other: on autoimmunity and "other" paradoxes.

The rubric autoimmunity currently encompasses sixty to seventy diverse illnesses which affect many of the tissues of the human body. Western medical practice asserts that the crisis known as autoimmune disease arises when a biological organism compromises its own integrity by misrecognising parts of itself as other than itself and then seeks to eliminate these unrecognised and hence antagonistic aspects of itself. That is, autoimmune illnesses seem to manifest the contradictory and sometimes deadly proposition that the “identity”: body/self both is and is not “itself”. Based on the assumption that under normal circumstances “the self” ought to coincide naturally with “the body”—or at the very least the self ought to inhabit the living location of the body more or less unproblematically—this scientific paradigm depicts autoimmune illness as a vital paradox. Yet for those of us who have lived through the experience of an autoimmune crisis, the living paradox that we embody may also lead us to question the basis upon which these medical assumptions rest. This essay raises some of these questions.

The Paradoxical Politics of Viral Containment; or, How Scale Undoes Us One and All

Life is a window of vulnerability. It seems a mistake to close it. — Donna Haraway, “The Biopolitics of Postmodern Bodies” How do we contain viral disease? This question seems to obsess us of late. Not yet ten years into the third millennium the world has already weathered a bevy of actual or feared viral epidemics: HIV/AIDS, sudden acute respiratory syndrome (SARS), highly pathogenic avian influenza (HPAI), and now a novel influenza A: H1N1 (also known as “swine flu,” or “Mexico flu,” as it was identified in Israel since, as Israel’s deputy health minister, Yakov Litzman, declared, “pigs are not kosher” 1 ). While these contagious matters have received considered and considerable attention, the biomedically oriented responses that they have provoked also raise a few important conceptual questions about what we mean when we reflect on how to “contain” them. Despite manifesting genuine concern for the health and well- being of the world’s human populations — although perhaps not so much for the birds and pigs with whom we consort — these bioscientifically inflected reactions incorporate a paradox that subtends their control fantasies: the reason we (i.e., humans) want to contain such diseases is precisely because we (i.e., living organisms) already contain them. However, this overt paradox also indexes yet another, perhaps more insidious contradiction, that of the “we” itself. Indeed, the politics of viral containment relentlessly plays upon the contingency of the human “we.” It conceptually and materially confounds our understanding both

Immune Communities, Common Immunities

For the last seven years, the government of South Africa has been relentlessly condemned, reviled, excoriated, chastised, denounced, and ridiculed for its failure to endorse and implement a nationwide distribution of antiretroviral therapy (ART) for people with HIV/AIDS. At the most recent International AIDS Conference, held in Toronto in August 2006, the South African president, Thabo Mbeki, and health minister, Manto Tshabalala-Msimang, were regularly personified as recalcitrant and ignorant, if not pernicious and murderous, for their apparent reluctance to unambiguously affirm the doctrine: “HIV causes AIDS. Antiretrovirals are the only medications currently available that alleviate the consequences of HIV infection” (so read the open letter to Mbeki calling for Tshabalala-Msimang’s dismissal, signed by more than eighty of the world’s leading AIDS experts).1 The outgoing UN special envoy for HIV/ AIDS in Africa, Stephen Lewis, made his moral outrage explicit: “The government has a lot to atone for. I’m of the opinion that they can never achieve redemption. . . . I know that what it is doing is wrong, immoral, indefensible.” Though the South African government has altered its position over the past several years and now does offer ART, as well as Immune Communities, Common Immunities

Live Thinking, or the Psychagogy of Michel Foucault

On the penultimate day of his penultimate series of lectures at the Collège de France, titled The Government of the Self and Others, Michel Foucault considers the role of psychagogy as a philosophical and political practice, a practice that links politics and philosophy in a relation of intimate exteriority. Focusing on Plato’s Phaedrus—in which Socrates famously distinguishes between rhetoric and philosophy as competing practices—Foucault recognizes in Socrates’s discourse a “double characterization” that binds both speaker and listener in relation to each other, to themselves, and to the truth. This soulful bond is Socratic philosophy, Foucault argues, insofar as it simultaneously and inextricably engenders both dialectical and psychagogical effects:

Dare to Care: Between Stiegler's Mystagogy and Foucault's Aesthetics of Existence

Philosophy is, for me, before anything else, to learn to repeat repetitions that are good. To learn ways that the pharmakon, which is always that which repeats, does not destroy me or render me indifferent by its repetitions, but rather takes care of me (me soigne). That is to say, individuates me, distinguishes me, differentiates me, . . . in order to permit me to discern in myself—to distinguish—alterity, difference [differance?], . . . the future. Philosophy is undertaken in order that these repetitions make a difference. —Bernard Stiegler (2014a)

Self, Not-Self, Not Not-Self But Not Self, or The Knotty Paradoxes of ‘Autoimmunity’: A Genealogical Rumination

Autoimmunity is a rubric currently used to comprehend 60-80 different symptomologies that effect diverse tissues and cells of the human body. By some estimates they may affect up to five percent of the populations of industrialized nations. Autoimmune conditions currently include: Multiple Sclerosis, Myasthenia Gravis, Lupus Erythematosus, Type 1 Diabetes, Rheumatoid Arthritis, Alopecia, Addison’s Disease, Grave’s Disease, Hashimoto’s Disease, Scleroderma, Ankylosing Spondylitis, Ulcerative Colitis and Guillain-Barré Syndrome, among others. For the past fifty years, the prevailing bioscientific paradigm has posited that autoimmune illnesses result from an organism’s deleterious immune response to its own vital matter or, as immunologists might put it, from a ‘loss’ or ‘breech’ of ‘self-tolerance’. According to the paradigm’s latest incarnations, autoimmune diseases seem to arise in genetically susceptible individuals when their responses to environmental challenges catalyze ‘immune dysregulation’. Alas, despite significant advances in characterizing the biochemical and genetic intricacies that both subtend and animate immune function, the reasons why harmful selfreactivity occurs remain mysterious. Thus, even though biomedicine increasingly invokes autoimmune reactions to explain a myriad of bodily phenomena (not all of them adverse, for example the recycling of effete, dangerous or damaged cells), it does not fully understand why or how any of these phenomena exist, let alone why or how they persist as pathological conditions. Indeed, even as immunology has refined its representations of immunity’s biomolecular processes to the point where lay readers might mistake them for occult texts of an esoteric religion, it still offers no consistent explanations for autoimmune pathologies.

Opening Up a Few Concepts: Introductory Ruminations

One day when the whole family had gone to a circus to see some extraordinary performing apes, I remained alone with my microscope, observing the life in the mobile cells of a transparent star-fish larva, when a new thought suddenly flashed across my brain. It struck me that similar cells might serve in the defense of the organism against intruders. . . . I said to myself that if my supposition was true, a splinter introduced into the body of a star fish larva, devoid of blood vessels or a nervous system, should soon be surrounded by mobile cells as is to be observed in a man who runs a splinter into his finger. This was no sooner said than done. There was a small garden to our dwelling . . . [and] I fetched from it a few rose thorns and introduced them at once under the skin of the beautiful star-fish larvae as transparent as water.