Hybrid reality: the body without organs and mental health

11Jun10

In a recent post that mostly served as a link to Levi Bryant’s commentary on the relationship of mental health to capitalism and onticology, Michael provided me with some reading material that he claimed was doing pretty much the same thing. It should be understood by now that I am not a professional philosopher, and at times my thinking can be sloppy and lacking rigour, and that I have very recently moved into the world of mental health. What follows is an examination of one of recommended pieces that I have been able to get my hands on.

In ‘Refracting “health’: Deleuze, Guattari and Body-Self’, Nick J. Fox address conceptions of health that emerge from a reading of D&G’s concept of the  Body-Without-Organs (BwO) and the various territorialisations that it undergoes, resists, incorporates and so on. Throughout his paper Fox is insistent that an approach to health through D&G necessitates the adoption of a collaborative perspective. For the purposes of this post it should be understood that while our conceptualisations of health are under discussion, I am primarily interested in focussing this on mental health.

To begin with Fox runs through a quick summation of two different, diametric methods of thinking about health that can be broadly defined as humanist and structuralist. On the humanist side of things Fox places interactionism and phenomenology but we might also add the kind person-centred approaches to therapy advocated by people like Carl Rodgers which have become the consensus model for counselling in Britain. Fox diagnosis these humanist positions of committing the cardinal sin of essentialism, the ontological assumption that some substantial self exists that can exert agency in the world without contextualisation in the social and cultural world that these selves find themselves in. On the other hand, Fox places the structuralist accounts that subsume individual agency within a totalised circuitry that fully determines them and therefore undoes any claims to agency at all. By now anyone with even a passing familiarity with continental philosophy will have an awareness of this impasse. It is in no small part this impasse which has revitalised metaphysics and returned philosophy to the terrain of the ‘great outdoors’ and given rise to a proliferation of new positions that have already left behind the name of ‘speculative realism’. To limit myself to considerations of health in the first instance we are met with preformed and free floating subjectivities that are privileged above all and any other objects or processes in the world and in the latter instance all there is are closed systems of which subjectivities (or the interiority of minds) are but epiphenomena.

Fox wishes to provide another account of subjectivity that can do justice to subjectivity without unnecessarily privileging it and recognising that it exists alongside its ‘relations to real things’. The emphasis on the term real is Fox’s own and points towards his paper’s possible position within and illumination of a realist ontology. In order to do so Fox approaches his discussion of health, counter-intuitively, through D&G by first emphasising the fact of embodied subjectivity.  Central to understanding this embodied subjectivity is the Body without Organs (BwO). Fox is quick to point out that the BwO is ‘not the physical body in any sense, indeed it is quite unlike what Deleuze and Guattari call the “organism” or the “body with organs”’.  We should be careful to note that the BwO is not set against or in contradiction to the physical body and that it has very little resemblance to the physical body. As such, the physical body is not disregarded or dispatched from consideration but instead we have to grasp that the BwO is not reducible to the body and that it differs from the physical. When the body is taken under the autonomic auspices of the medical gaze nowhere will we find the BwO nor will we find any hint of its being.

In A Thousand Plateus D&G discuss the organism as the Judgement of God, an ‘organisation of organs’ that is the basis of biomedical power, and as the result of an alienation of the BwO from its immanence. This alienation leaves the organism as ‘a signification, a subject’. This illustrates the organism as something cold and mechanical, a mere organisational form that some sovereign power has ossified from a much more expansive being. The judgement of God is the first order of a sovereignty that fixes the organism, in its organisation, as such and such a thing. The biomedical is a second-order sovereignty that speaks of the first’s work, discovering and articulating the anatomical and physiognomic contraptions that make it work. The eye is a mechanism to see, the brain a mechanism for making world-pictures. Of course, in alluding to the idea of God D&G make us think of the organism as almost something fallen, something disgraced and sinful. Yet as it is the BwO disavowed from its immanence it might be better to say that the organism is the abject body. Here there are obvious parallels to the biopolitical articulation of bare-life, except that for the BwO it is not so much the evacuation of the form-of-life as the ascription to one definitive (and, poetically speaking, dead) form.  That the organism is a signification means that it has an established meaning, that it is a subject means that it is a unity.  The abjection of the organism is its impoverished condition of being fully determined, fully actualised as such-and-such a unity. God makes this Judgement, the last judgement, and it remains for the organism to be picked apart and fully exposed by scientific elucidation. At the last, the organism is what the BwO is when it is exhausted, when it is made transparent, when there is nothing left. It has also been noted that the word organ derives from organon which means instrument. The organism is thus the abject actualisation of the BwO as it is exhausted by its instrumentalism. The organ is this and only this because the organ does this and only this.

If the BwO is not this organism, what is it? For Fox it must be understood as the product of the ‘”in-folding “ of the social and natural world’ that is not some mirror-stage whereby reality comes to be mimetised but as a ‘refraction’ that does not exist apart from those objects (physical, social, psychological, conceptual and so on) that it is refracting. In refraction a wave bends as it passes through the threshold of one medium to another. As light enters the eye the wave bends, its vector is altered while it passes through the eye as it is denser and therefore therefore a slower medium for the light to travel in. We have all seen what happens when a straw is placed into a glass of water ; there is an apparent ‘cut’ in the straw as if it had been doubled by being swan in two, yet we can still see the join;  there is a distortion, a disjuncture, a strange mutation. So if ‘in-folding’ is ‘refraction ‘ it is primarily this disjuncture.  As real things turn in upon themselves they become discontinuous with themselves. This discontinuity is lodged in the being which is subject to an ‘inscription’, that the image that this involution produces is disrupted by the medium through which it occurs. Where we are concerned with the (mental) health of human beings it is obvious that the things being inscribed and the disruptive medium is the human being.

As such the BwO is the resultant of a kind of reflexivity of being that produces an image of itself that is contaminated by whatever being is the vehicle for the process. As we here concerned with human beings in their relation to health Fox offers an example:

When a health professional ‘takes a history’ from a person with an infectious condition, she does not directly perceive the bacterium or virus, but apprehends through signs what that infective agent may be. Nor does she become the patient as she hears of the physical or emotional impact of the infection for the sufferer. Yet the health professional’s BwO is affected psychologically and emotionally by the natural and social elements in this consultation. She may locate herself as epidemiologist, or therapist, or carer, and her consultee as fellow-human, patient or public health risk. She may assign moral characteristics to her interlocutor and herself, she may empathise or sympathise with her patient, or feel fear, anger or disgust.

When health professionals take a history from a person, infectious disease or not, what is being undertaken is an attempt to piece together an history of the condition and (these days) a biographical narrative of that person’s sense of self. Already we can see how refraction might occur; the account(s) compiled and the source of the account, as well as the reality of that account as it is filtered, altered, lost, distorted through its enunciation, will produce all kinds of discontinuities. In my own clinical experience I have seen how this plays out. Someone with such and such a disease-process, who has lived such and such a life, is received by us not as they are but only partially. This distortion in the relationship means that we do not get at the person proper.

We can go on and imagine a patient who has presented to a health care worker with a diagnosis of HIV. We would like to think that nowadays such an illness would not produce aversion but despite an inability to perceive the HIV virus the healthcare worker may still read the signs that are given. In our example the infectious condition does not yet appear to be ascertained but the person with HIV and their medical records to date, as well as the history that offer, will be given. Our person with HIV may go to the doctor complaining that they have lost a lot of weight very quickly, that they have a persistent dry cough, a recurring fever, swelling around the armpits, groin and/or neck, persistent diarrhoea, blemishes on their tongue, a chest infection, purple blotches  on their skin and a hard time remembering things. This would all point towards the possible presence of HIV. Already that person is someone who is affectively HIV positive, without actually necessarily being so.

We can go on and suggest that our HIV positive person reports to their doctor that they are homosexual or that they share needles in drug use. Although HIV/AIDs is more prevalent in heterosexuals and increasingly so among those who don’t abuse intravenous drugs it is entirely possible that our doctor will already be making certain moral judgements about that person (ie; they are ‘bad’ or have ‘brought it on themselves’- a judgement common now in regards to people with obesity or smoking-related respiratory tract illnesses like COPD). Furthermore, this reaction will necessarily affect how that doctor will situate herself in relation to the patient.

This is all a long way to go to make the basic point that in the healthcare worker’s BwO is penetrated by the person before them and altered, and the person themselves, from the perspective of the healthcare worker, is altered. In their interrelation neither approaches each other as a static or fixed closed-system. The BwO of each party is ‘redefined…around new limits, opening up (or closing down) possibilities.’ This is a highly dynamic and complex system that exists in feedback with the various things that it encounters.

In this example the person with HIV is territorialised in at least two ways; first as patient, then as an HIV infected-organism. These are taken as the only element of their being to be considered under a biomedical practice of medicine. There may be those who would operate from the biopsychosocial, in which case the person biography, an account of their class, gender, age, housing status so on and so forth, would be required. In each instance they are exhausted by a simple listing. In filling in electronic documentation in my own clinical field all one would need to do to know a patient would be to read that documentation and apply it. These territorialisation, in the structuralist and humanist models (or even in the eliminativist and simple antireductionist discourses) are taken as the essence of the individual in question; the mutations in their BwOs is taken as the definitive accounting of their being, they are made abject organs.

This can be seen more clearly in mental health with the case of dementia. Fox offers another example, that of pain, which I think can easily be treated as almost identical to what occurs with a diagnosis of dementia and I here produce an altered piece of text that Fox has quoted from elsewhere: “a narrow medicalised view of dementia ignores or minimises the broader significance of dementing; the loss of self”. This altered quotation (replacing suffering with dementia) is typical of the attitude that continues to dominate perceptions of those with dementia. The common ideas are of people undergoing a ‘living death’ or most explicitly that they have lost themselves. This attitude is not at all uncommon even within people working in the dementia care environment. Yet this conception, seemingly held by structuralist and humanist alike in many instances, is based on the idea that there is some essential self to be lost. Here there is no question of dementing, once a person has reached a stage whereby they illicit adverse reactions (fear, sympathy, anger, disgust) they are demented. The self is lost; the dementia is the self. The diagnosis exhausts and renders an organism; hence the abjection.

In Fox’s reading of D&G this is precisely what the BwO cannot allow as the ‘anatomical body is not the carapace of the self’. The self has not died, disappeared or been lost in any other melancholically romantic swooning. Instead our lived physicality and experiencing self are refractions that result in our BwO. When a biomedical approach reduces a BwO to an organism, as when a person is reduced to a diagnosis, we are witnessing a specific territorialising movement. This is to say that in our understandings of health we deploy a particularly strong brand of identitarianism.

If the BwO is the resultant of physicality, experience and the various modes of territorialisation (which affirm or deny it) then it is clear that it is not an object but a process, a process of ‘reciprocal crossing between everything and everyone, the endless molecular flows from one composite body into another’ (Bifo). In effect D&G present the BwO as what cuts across and through all objects, a transverse relation that in his slim volume Chaosmosis, when speaking of chaos, Guattari defines as ‘breaching on all sides individuated identity and the organised body’. We should note though that is does not negate, destroy or otherwise dissolve. Rather, this chaotic  or grostesque body is what drills holes in things, forcing them out of an utter privation. Of course human beings, objects, concepts and so on have their private interiority but they do not remain fully sunken. If it hasn’t become clear already then it is beginning to be apparent that the kind of ontology underlying this discussion of health is not completely object-oriented but seems to be processual.

Fox notes this when he goes on to write that if the BwO is not reducible to the physical-functionalist accounting of its biomedical territorialisations then we are not discussing the anatomy of the body but it’s possible and actual relations. As suggested above when a BwO is not reduced to a wholly organised state it is able to open up new avenues, new ways of its body to exist, different modes of actualising itself, it can draw upon different potentialities stored within it that are provoked upon contact with another object that can make the necessary defraction. In giving itself to a new relation the BwO offers itself to a distortion of its sunken being. In terms of theories of health it means that we  treat health and illness as  ways to “rewire or place yourself in ‘molecular proximity’ to other forms of being”, to “induce a rehybridisation” (Bennett). This hybridity  points to the fact that at any moment a body could be more than it is, that a body is, perhaps, infinitely plastic.

This plasticity suggests almost inexhaustible becoming that is utterly ambiguous. The fact of the distortion in all of this means that no rewiring is ever perfect, no hybridisation can be totally controlled from within or without, subjected or commanded. This also means that ‘subjects become agents of their symptoms rather than patients of their symptoms’ as in all this relationality there are still bodies at work, still self-reflexive and lived embodied agencies (Bryant). The BwO  is  a virtual field of capacities or powers to act that gives itself to relations outside itself in order to create new attachments and therefore draw out  novelty and an increase in agency through differentiation.

Yet here there is something strange about the BwO. It appears itself to be a process and yet we have seen that it is that which is subject to territorialisation. It is akin to a medium through which things traverse. It can be expansive, open and recombinatory or it can be severely delimited and reduced to the state of an organism. It is that plastic thing that is inexhaustible and provides subjects with the ability to increase their power to act, it exists at the point of (as Fox has it) “confluence” or coming-together of various elements (body, experience, reflexion and so on, and so it appears as though the BwO is also a site of action. We have also said that the BwO is a kind of surface for inscription. We have also spoken of two BwO relating to one another via the bodies, signs, biographies, diseases and social significations of the patient and the doctor (we could add more to this list). It is beginning to look as though the BwO is not simply a process.

D&G themselves write that each BwO is ‘an enormous undifferentiated object’ that is ‘the unproductive, the unengendered, the unconsumable ‘.  The BwO thus appears to be that virtual part of an object that has not yet been organised into specific territorialisations and which persistently resists any attempt to fully and finally territorialise it. It is an object that is not anything but which is not nothing, being both full and empty. The best way to think of this in my view is with Brian Massumi when he states that we ought to

“Think of the body without organs as the body outside any determinate state, poised for any action it its repertory; this is the body from the point of view of its potential, or virtuality.” (Massumi)

The BwO exists in a dual state as an object and a chaos of relations, as both a closed and an open system, in a non-relational and relational state. It is, to place Graham Harman’s words in a position that is definitely asking for trouble, both a substance and a complex of relations, how else could it be both the egg and the desire? As a body that is unproductive, unengendered and outside of determination it is at the same time that which generates various hybridisations as it comes into contact with other objects. It is not quite true then that it is a nonrelational object but it is certainly not an object that is exclusively and definitively defined by its relations; whatever such an object would be it would not be a BwO. It is an object  in process, a substance that exists through and as relation, potentiality or virtuality, as a field generative of choosing this (set of ) relation(s) over that, which communicates itself through its qualities which are enacted as relations, a verbs, all of which are variously inter-penetrations. In this regard territorialisations appear to be very close to Levi Bryant’s notion of actualisation of in its local manifestations; both seem to me to be very close, in a poetic sense, to the Stirnerite idea of the creative nothing (an idea I have to admit I’ve not been able to shake since I first read of it). There is a break in the transmission that transmits nonetheless.

To relate all this to (mental) health, I return to the Fox paper in which he states that ‘a risk to health from some environmental factor leads to a change in behaviour; an illness or impairment forces a person to adapt and exploit unused potentialities’. I would return again to the topic of dementia, which itself cuts the physical-mental, nature-culture divisions, in highlighting that it is typically people who resist their dementing process that dement sooner whereas those who embrace their dementia tend to find ways of adapting to it and in some cases enjoying it. Of course dementia is still a terminal disease that will eventually lead the body to its termination in death but while people who  have dementia are still able to reflect and engage in a social world. In one of his more speculative moments Tom Kitwood, who wrote the book Dementia Reconsidered: the person comes first which is widely credited with having radically altered dementia care, writes that there are;

those who have an intense and poignant awareness of what is happening to them, and who remain highly open to their experience, without evasion or blame; and it is likely for them that their experience will be relatively benign. There is even a little evidence to suggest that those who are most open to experience may be less liable to develop dementia, whereas rigid and obsessional personaliy traits may be dementogenic.”

Kitwood is no romantic when it comes to dementia. He has worked with people with dementia and known them to suffer and to die, he also has a thorough grasp of the neurological process of cognitive deterioration as the organic structure of the brain actually alters. Yet these are all organ-ic concerns. In excess of the organism, the body with organs, the dementing person is not identical to their physical disease process nor to any physical disease entities that might be present (Lewy-bodies, most often). If we view the dementing process as a deterritorialisation then it is possible to think of the disease as something other than a decline, a deterioration, or rather it is possible to acknowledge that it is not exclusively an organic deterioration. There are modes of adaptation and of exploitation that coexist this process that allow for the agency of the person with dementia to reterritorialise themselves, along with the aid of others (who could not but also be reterritorialised themselves) and retain the ability to act in the world. This reterritorialisation can in some cases result in a temporary ‘rementing’, wherein lucidity if not egoic consistency are returned to the person.

Kitwood has also written about the way in which our current territorialisation of personhood is too narrowly enacted and that the dementing process reveals to us a version of humanity that is not enthralled to its higher cognitive functions at the expense of all else. That is;

contact with dementia or other forms of severe cognitive disability can- and indeed should- take us out of our customary patterns of over-busyness, hypercognitivism, and extreme talkativity, into a way of being in which emotion and feeling are given a much larger place.

This is not to say that dementia should be viewed as a reminder that while we are undoubtedly brain-minds we are not simply brains. To repeat myself from a previous post in dementia there is a loss of cognitive ability, of orientation (that is, of one’s place in the order of all objects) and, as the disease progresses, their is increased deterioration in memory. Yet there is still the affective and emotive abilities. Communication between persons becomes less, in Kitwood’s words, a hypercognitive affair and more one of transmitting meaning through subtler codes: the person with dementia dwells in a world of tone, of pitch, of posture and gesture, of facial expression, tactility. This is not an abject subjectivity; it is one that is as rich and subtle as any. As the dementing body experiences a diminution in certain capacities and withdraws from a particular set of relations it also enacts another set of capacities that, for the most part, remain underdeployed in the rest of us. If we speak of relations again as attachments then we can say that the dementing-body enacts itself by relating to and through the affective dimensions of our being. If this can affect our own way of being, our own modes of engagement in the world, then far from eradicating our powers of reason I would hope that they would loosen us from the grip of a strange calculative or opportunistic rationalism that is everywhere engaged in any activity it kind find to plug the excessive-void of our own BwO; our own virtual core.

—-

This seems like a good place to conclude for tonight. It is gone 1 am and as ever I have to be awake in the morning. As ever this might all be utter nonsensical misreading. Still, if I am to continue to pursue my interest in realist philosophies (of both object-oriented and relational kinds) and maintain my commitment to those with mental illnesses then I have to study both at the same time in one project. I also apologise for the continuous misspelling of diffraction.

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