The person I was passed away in early 2008. At that time, I was diagnosed with a type of illness that has a statistical rate of survival of 40 percent. I underwent medical treatment and a transplant at the end of that year and I have been in remission since then. For the past few years I have been reflecting on the meaning of a life lived in remission, its sense of overwhelming loss, and its gains.
Is this an afterlife? What is this temporality lived between life and death? In the light of the fact that medical science does not define a cure, but instead makes reference to a remission, how can this type of liminal form of life be conceptualized as an open- ended, uncertain afterlife?
The person I was passed away in early 2008.
The state of emergency is here an obvious reference, with expert and popular discourses referring to the return of the body to a healthy state after a state in which the norm is suspended and the pathological prevails. In relation to this, how do political metaphors of war and occupation play a key role in our romantic understanding of the subjects of illness, of patients, as well as of technologies of cure; from individual medical treatment to humanitarian interventions which often combine military maneuvers and technologies of health?
Military metaphors reverberate along a chain of signification that within public discourse connects illness and medical treatment to questions of war, attack, struggle, survival, antibodies, and defenses. Immunity has thus moved from its initial context in law and diplomacy to the realm of biology understood as war.
Why is the cure of a life-threatening illness considered as survival? The language of catastrophe, evoking randomness, does not seem to encompass the actuality of bodies interacting with their milieu, of bodies internally dying all the time, within a continuum of life that is not linear, not a matter of death or survival, but rather of oscillations and interactions.
The language of war and occupation reinforces the individualistic, atomistic sense of immunity of an isolated organism heroically or desperately fighting a long struggle for survival. These metaphors that link health to models of security preclude a view of the body in constant, necessary interaction with other intersecting bodies. A remission, which might be considered a cure after several years, is a collective process and not an individual struggle or lone survival.
Military metaphors reverberate along a chain of signification that within public discourse connects illness and medical treatment to questions of war, attack, struggle, survival, antibodies, and defenses.
The language of survival, couched as a supposed fight against illness, does not make much sense in the context of an autoimmune disease, where subjectivity appears split in the situation of a body attacking itself. Metaphors of war, struggle, and afterlife do not make much more sense in a context where recovery of health cannot be considered a type of transitional justice after a civil war waged within the body
What is the relation between social history and an individual medical history? Wherein lie the poetics and the politics of illness and healing?
I was born in Buenos Aires in 1969. I spent my childhood in the context of military-enforced terror, implemented by a seven-year-long dictatorship (1976–83). Blurred childhood memories of joy and happiness appear in a whirlwind of color and sepia: distorted faces, endless echoes of laughter, mild derangement, and a certain atmosphere of intimate oppression, of surveillance, of something not moving along, of something not being quite right; secrecy, unfolding, uncovering the elaborate yet clumsy ways in which reality was effaced from a child’s curious eyes. My immediate, close family was in no way affected by the violence and horror of the regime; I was privileged. And yet, years later, I would come to recognize those childhood years as the birthplace of an accentuated sensation of dread, of anxiety, of a feeling of asphyxia that emerged from yet unknown sources.
With the excuse of the palpable concrete threat of violent "subversion" of order, the military regime implemented a widespread system of general political and cultural repression. As in a sad, ironic reiteration of the Bertold Brecht poem, soon after the coup, the armed forces regime had annihilated the oppositional guerrillas, then during the next few years, they incarcerated, kidnapped, and killed thousands of mostly young activists, workers, artists, students, and almost anyone who could be suspected of holding any progressive views of society. Then they killed and repressed neutral bystanders.
What is the relation between social history and an individual medical history? Wherein lie the poetics and the politics of illness and healing?
As a kid I grew up amidst the most paradoxical environment of knowledge and occlusion, of intuition and denial. Most of all it was a mixed context of terror and love. The affective world of a kid, or the world of an equipment of care, as perceived by the eyes of a child, was blurred by the feeling of imminent threat, by all the things that went unsaid, the words that could not be uttered in the darkened light of fear and loss, of dread, vanishing, and disappearance.
Return to Buenos Aires after illness—unexpected plaque on the street. Localized memorials for the disappeared, the living dead, the never found, never returned, never buried, never mourned, prisoners. Plaques and monuments located throughout the city, in the site of former detention camps.
Health also unfolds in between life and death, as a transitional space. The state of emergency of the medical treatment triggered memories of which I had been unaware: memories of growing up in a protected environment yet within the dreadful context of a totalitarianism. Memories of the political spring, the dream of democratic transition in the immediate postdictatorship moment, alongside the uncovering of the horror of counterinsurgency. Of the absent dead bodies. Of the disappeared. Of the impossible mourning of those remains. And the law, the potential of justice, the trial of the juntas, and my own striving for exodus and exile, the need to "escape," to move away, to live in another place, to become somebody else.
And now I remember all this, terrible, singular, yet so quotidian, straightforward, common. So much has passed in so little time. What do I intend to convey through the metaphor that says that now I am a new being, in a new organism; that I have, somehow actually become a different person?
Health also unfolds in between life and death, as a transitional space.
In an essay on the concept of health, Georges Canguilhem quotes, among many philosophical and popular references, a striking sentence by René Leriche: "Health is life lived in the silence of the organs" (2008, 467).
After my experience, I perceive today that health unfolds in between life and death, as a transitional space. Health takes place between silence and deafening sound, between stillness, emptiness, and white noise.
Health is life lived in the silence of the organs.
This statement has a particular echo for me, besides its profound, evocative tone and manifold senses. During my childhood, the totalitarian regime had developed a discourse of mute signs and oblique words that soon infected the collective quotidian public language. I have always thought that a certain language of double meanings, dark humor, and veiled, occluded senses, pervasive in the Argentinean public sphere in the past decades, even if it might have existed before in some form, stems to a large extent from the censorship and deathly repression implemented by the military regime. This program toward the murder of meaning had to do with the predicament of truth and silence under totalitarianism.
When I was eight years old, a peculiar sign was placed all over my city. I remember it being located in particular downtown, on the rotunda around the main symbol of the city, the white obelisk that stands on the intersection of two main avenues. The sign carried the shape of a car horn on a white background, crossed by an oblique red line. The caption read: “Silence is Health.”
The sign, ostensibly referring to the prohibition against blowing horns and the need for lowering urban noise levels as a question of public health, was a not so veiled statement about censorship and a threat against voicing dissent in the public sphere.
"Health is life lived in the silence of the organs," quoted Canguilhem. The regime’s canny propaganda linking life and death posited health as unfolding alongside a very narrow path, as a silent expression, as a pantomime. To stay alive in the state of exception one must be quiet. Health is silent, or, silence means health.
Health is life lived in the silence of the organs.
Then, in my childhood, there was also that old song by Paul Simon, which I learned as a kid in Buenos Aires, a lyric about sounds of a kind of silence that grows "like cancer." Terror operates in that way, as the metastasis of silence, disseminating uncertainty and the cold fear that paralyzes the senses. As the internal enemy gathered in cells of "terror" is killed in the "dirty wars" of counterinsurgency, silence must spread throughout society, which then becomes a desert of signs. A whole society is silenced, a large assemblage of individuals, with each one of them inserted in a small compartment, devoted to exercising a minute task, apparently connected to others by several links, but in reality, separated, increasingly isolated by webs of muteness and incommunication.
The military dictatorship established the Real as that "army of metaphors and metonymies" that Nietszche uncovered as the definition of truth. The medical-military regime of counterinsurgency, the totalitarian system of defenses and immunity against the propagation of the political cancer, posited the interrelated questions of the control of the body through violence and through language, spectacle and terror. The dictatorial regime itself had deployed the metaphoric language of illness and health. The regime bombarded the psyche of the population with an artillery of metaphors related to disease: an imagery of the cancer represented by the "subversion" of leftist guerrillas linked to alleged international conspiracies, a metaphor of illness encompassing a large part of the population, perceived as potential threat.
The scientific knowledge of the body poses the question of illness understood as either truth or as metaphor. My experience of medical treatment, with the acknowledgment of unknown causes and forces, the brutal administration of poisonous chemicals, and the trial and error technique of accounting, led me to question the "real" that science—medical knowledge—confronts through its concept of health.
The scientific knowledge of the body poses the question of illness understood as either truth or as metaphor.
Is scientific discourse metaphoric, or is it revealing a truth of the body, positing the question also of the subject itself as metaphor: a detour around itself? Susan Sontag develops a reflection on these questions. Following her arguments, we can ask: What is illness if it can be conceptualized as metaphor or understood as a fictive detour of the body? What does illness translate or transfer as a detour, a deferral of the body?
Canguilhem: "The recognition of health as truth of the body in an ontological sense . . . must admit . . . the presence of truth in the logical sense"(ibid., 477). Beyond metaphor, it is a matter of a certain transparent speech. "More honestly and more purely speaks the healthy body" (ibid., 470). Canguilhem quotes Charles Daremberg: ". . . in health one does not feel the movements of life; all functions are accomplished in silence." (ibid., 467–68).
If illness is a constant white noise in the background of life, how does scientific metaphoric discourse work toward a "cure"?
Derrida refers to the metaphysical status of the claims of metaphor. All language is metaphoric. There is an economy invested in the surplus of meaning that circulates through language and that always escapes the restricted strictures of sense. There exists a surplus value of language, beyond the mirror game of words. Can the subject be conceptualized as that surplus, and if so, should it be understood as truth or metaphor?
In 1978, when I was nine years old, Argentina hosted the football World Cup. In a country where this sport occupies a central place within popular culture and everyday life, the military dictatorship in power organized the event as a large propaganda campaign directed toward both national and foreign publics and audiences. It was aimed at showing the international community and media a country pacified by the totalitarian regime after the political crisis of the early 1970s and the left-wing guerrilla insurgency. With regard to the national community, the regime utilized the sports event in order to launch a large nationalist campaign touching upon all kinds of popular emotions and affects, to boost chauvinism, identity, and to unify a majority of the population around countering what the regime labeled the "international anti-Argentine campaign," allegedly run by global communist networks, which consisted of organizations that denounced human rights abuses and clandestine counterinsurgency operations.
Argentina won the World Cup in 1978. The scenes of jubilation and mad happy celebration, with multitudes, color, flags, horns, and endless confetti were reiterated in every large city and small town across the country every few days after a new victory on the pitch. The final apotheosis took place when Argentina won the final in the River Plate stadium, and the crazed delirious crowds congregated in the evening around the obelisk, in the main central alley of downtown Buenos Aires.
If illness is a constant white noise in the background of life, how does scientific metaphoric discourse work toward a "cure"?
I was one of thousands of happy, moved children, celebrating the victory after each game. After every game I asked my father to take me to the very center of the street to join the "triumph," to blend with the small crowds and people with flags and horns, jumping, chanting, laughing, screaming, getting off their chests who knows what anxiety or pain or joy by celebrating the win over a foreign sports team, among all the military-like marches and anthems that the regime broadcasted constantly, as soundtrack of a month of passion, emotion, and pride. I remember all this with trepidation and sorrow and a distant, never dormant fear.
The football World Cup that Argentina hosted and won took place at the height of the counterinsurgency operations of disappearances, kidnappings, executions, and torture that ravaged the country in the second half of the 1970s. The city was crowded with clandestine, subterranean, hidden centers of detention and torture. The main and largest one, headquarters of the repression, was located very close to the stadium in which the final game of the Cup was held, not far at all from the fifty thousand voices that cheered, sang, and celebrated with every goal that sealed the victory.
This memory is mired within a collective, national sentiment of dread, guilt, and joy conjoined around the collective carnivals of self-deception that a people might hold as their highest celebrations.
Health, illness, memory: another critical event of violence through which I lived many years later, also triggered memories from my childhood.
I was living in New York on 9/11; the airplanes, the flags on the balconies, the people gathering at night on the corners, the bus stops with photographs of the disappeared, the blackouts. Visiting Ground Zero.
Was that event, that attack by secret foreign cells, and the political reaction to it, as well as the expansion of security and surveillance an autoimmune attack on democracy? Are we living in the aftermath of this autoimmune illness of the social? Is democracy the political equivalent of living in remission?
The first casualty of war is truth. The first casualty of truth is war. I learned this in my childhood, and my memory kept it guarded in some unconscious realm until this knowledge was reactivated during my hospitalization and medical treatment. Within that space of war, defenses, and counterinsurgency, truth and falseness, memory and forgetting got blurred. In order to heal, is it better to know the "truth"? Is it better, then, to remember or to forget?
Is cancer an illness of memory? No one knows the true causes. Myriad scientific hypotheses are tested and discarded constantly. Billions of dollars spent in the war on cancer seem as ineffective and futile as invasions of Middle Eastern republics or raids into African secret compounds, where the cells keep splitting and proliferating. And yet, I constantly remind myself that I am alive, that the lottery of life and death has so far played in my favor.
Cancer is considered an illness of memory, related to kinship, relatedness, and inheritance.
Cells can be seen as storages of memory, as reservoirs carrying information related to the past. Cells are memory traces, repetitions of a singular event. When I was diagnosed and they started conducting all kinds of tests on me, they constantly asked me about my medical history, previous illness, ailments, and malign effects. Then I was immediately questioned about the past, my background, and family histories of illness, especially precedents of cancer occurrence.
Cancer is considered an illness of memory, related to kinship, relatedness, and inheritance. Genealogies are drawn. Family trees intersect clinical records. Cancer can be inherited, and even if from one generation to the next the disease might not emerge, it could surely reappear later, linking generations of descendants: a family affair.
The genetic mutation is somehow programmed in the memory of the system, imprinted within the organism, in a genetic communication between generations: in anticipation. Diagnosis and prognosis unfold in the register of genealogy.
The cells as traces, left by no one. Traces as nonoriginary beginnings, as synthesis of temporalities, past and future, which never allow for a location of a single instant (of appearance) in a chain of events. Cells are always transforming themselves disseminating, moving, the cell as future trace of a past that never occurred. The mutation of a cell is an involuntary memory. It is a remembrance of an event that never took place.
Despite its location in the genetic equipment—as inheritance—the illness must not be understood as collective genealogy or individual memory. Not being a genesis, the nonoriginary beginning of illness must be located, then, in a certain trace: a cell. How can a cell be malignant? How can a cell, all of a sudden, mutate and turn out to be an immanent threat?
Cancer cells disseminate, change location, mime other cells, transform their identity and occlude it, and go undetected. What elements in mind, in biography, in body, in corporeal matter, might anticipate this illness, as narrative, as metaphor?
If cancer is an illness of memory and genealogy, it also shows black holes, impossible voids, blind spots.
If cancer is an illness of memory and genealogy, it also shows black holes, impossible voids, blind spots. Cancer is absolute unemployed negativity that refuses to work. How can the organism be hospitable and transform the illness into a part of a community instead of fighting it under the military metaphor of war and defense, instead of the juridical notion of exception, as immunity.
This reflection is triggered by the memory of what I used to call my sick part, a side of my personality that I related to illness, to some darker part of myself always haunting me, devouring me from within, assaulting me from nearby, in an ambush, an obscure presence that I always associated with something in myself, my sick side: Only death seemed to be able to liberate me from that sad effect. How was that a memory, as well? Was it a recollection of an event that had never taken place? A blind spot in my consciousness?
Cancer reveals that the illness is time itself, devouring the body from within, consuming life from the inside. Time splits the body in two, nothing ever can occur "at the very same time." There is always a delay of perception, of communication, of comprehension. The split body produces time, gives time, yet it is also constantly consumed by it. Cancer is an illness of memory, an ailment of time.
Consider the role that memory plays in the process of health and illness, in the liminality of remission and cure, in the mutual contamination of life and death; ailments of memory and cures of remembrance. We can envision the memory of the body as collective memory. Whose memory is it?
References
Canguilhem, Georges. 2008. “Health: Crude Concept and Philosophical Question.” Public Culture 20 (3): 467–477. doi:10.1215/08992363-2008-007
Derrida, Jacques. 1974. White Mythology: Metaphor in the Text of Philosophy, translated by F. T. C. Moore. Baltimore: Johns Hopkins University Press.
Nietszche, Friedrich. 1896. “On Truth and Lies in a Nonmoral Sense.”
Sontag, Susan. 1978. Illness as Metaphor. New York: Farrar, Straus, and Giroux.
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