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The Beat Goes On, 2013 Two small active speakers and mp3 player, two black wool serge hearts, elastic and clips. Run time 25 mins.

The two speakers hang/sit in two black wool serge hearts, the hearts are approx 2ft across, and the whole work spans 9ft. A work mixing hospital sounds, with a variety of drum beats waxing and waning in intensity, with broken voices that read a text called Hybrid Bodies: a paper first given by Prof. Margrit Shildrick in 2004 in Amsterdam, at the SSLA conference; a profound text that describes the issues arising around Heart Transplant.


Hybrid Bodies: the psycho-social significance of heart transplant surgery

Dr. Margrit Shildrick, Sociologist - Philosopher (Linkoping University, Sweden).

This paper will outline some of the issues arising from my current research project into the significance of organ transplantation, and more particularly the issue of why many heart transplants that are initially clinically and physiologically successful subsequently develop unexpected complications or fail. The empirical element of the collaborative project will follow several cohorts of differential recipients over a 5 year period to assess not simply their physiological well-being – which is already the focus of intense and ongoing scrutiny – but more importantly their psychic response to the dramatic changes that are effected on their bodies. The speculative assumption is that the 2 elements are irreducibly linked for reasons that this paper will investigate. It is already apparent from existing research and scattered anecdotal evidence that the ability of recipients to sustain and in-corporate mechanical or donated organs over time is at least correlative with their negotiation of questions of self-identity, bodily integrity and corporeal hybridity. Given that following transplant, the recipient’s sense of self as a bounded and unique individual is necessarily disrupted, it is becoming increasingly clear that an outcome favourable to extended life expectancy cannot be read through clinical measures alone. There are I suggest many other factors in play that might be usefully approached through a variety of theoretical resources relating to that strand of cultural analysis that interrogates and rejects the modernist self-other paradigm, and each will be investigated in the wider context of the project. For the purposes of this paper, however, I shall largely restrict my comments to the phenomenology of embodiment as proposed by Merleau-Ponty.

My own starting point is perhaps indicative of what is at stake. A couple of years ago I was asked to speak on a panel addressing the corporeal cut. I – predictably - approached the issue through my existing research on the psycho-social significance of conjoined twinning and its suspectibility to bio-medical intervention, and was surprised to find myself in a highly productive conversation with another panellist, a cardiologist, who is the clinical director of a well-known heart transplant unit.i What rapidly impressed me was that just as issues of intercorporeality could be thought through the embodiment of cojoined twins to raise the question of the status of the normative split between self and other, it was equally *productive to start as it were from the opposite position of a pre-existing split that is then troubled by the process of in-corporation. In short, the cutting apart of concorporate bodies is paralleled in its theoretical implications by the stitching together of previously separate body parts. In both instances the verb ‘to cleave’ would be appropriate, for its double meaning of ‘to divide by force’ and ‘to closely unite’. Derrida would have loved the richness of that indication of différance, for it is undoubtedly that sense of hybridity, of in-betweeness that is at stake whichever morphology provides the substantive base. The sense of ‘the body which is not one’ is the motivating force of both recent feminist theory that insists on the fluidity and intercorporeality of all embodied being and the earlier strand of phenomenology that stresses self-becoming as a matter of living-in-the-world-with-others. In place of the rigid and normatively framed sovereign self for whom the body is a possession that gives rise to property rights and questions of alienability, the phenomenological self is inseparable from, and indeed only exists in virtue of, her others. Her parameters are provisional and to an extent fuzzy for as Donna Haraway asks ‘why should the body end at the skin?’.

In its mainstream form, the phenomenology of going out towards an-other concerns an exterior and interdependent relationship between self and other that relies heavily on the tropes of the visual and the tactile. It is for sure about close encounters, but it nonetheless preserves a sense in which although bodies may come together, they do not merge as such. For all that ‘one cannot move without the other’, as Irigaray puts it, that other remains always recognisable in her otherness. And as Merleau-Ponty understands it, the ‘flesh’ of the world is a living web of dynamic connections not an amorphous mass in which all traces of individuality are lost. But does that necessary preservation of some grounds of self-identity preclude a yet more nuanced understanding of the relationship between self and other that may switch to an apprehension of the interiority of otherness? Certainly the phenomenon of heart transplant deeply troubles both identity and identification by reason of its very staging within the body, but it does not I think require us to give up the search for a practically and theoretically meaningful deployment of the term ’I’. It brings into sharp focus not the need to think the redundancy of ‘I’ but rather the excessiveness of that signifier. Within poststructuralist thought – and I’m thinking particularly here of Derrida’s wonderful evocation of the otherness within in his texts Of Hospitality and Y – the threshold of the self has always already been crossed by the monstrous stranger, the outsider who resides at the core – the heart – of the self. The question of who or what is alien is not so easily settled by recourse to the traditional binary, and yet that binary continues to exert its power, as the experience of transplant recipients makes all too clear.

The literature surrounding the procedure tends towards a bioethical slant which poises questions of the permissible, or to a psychological analysis that seeks to understand the hopes and fears of each recipient almost as though the body itself and their accounts of it were self-contained. In contrast I want to think through a more strictly philosophical analysis that takes seriously the recent rethinking of the nature of the embodied self. What does it mean then for a recipient to assent to a procedure that at the most fundamental and symbolic level disrupts the integrity of the ‘I’. Let’s be clear, however, that for the majority of potential transplant patients what matters is the preservation of life in the face of imminent and certain death, and the capacity of their bodies to recover from the major trauma of the operation itself. At the clinic in which our project is situated, all potential recipients are provided with an extensive manual that outlines in more or less detail the practical social arrangements and adjustments that patients must negotiate, the rigour of the post-operative regime for recovery that extends not to a few months but for life, and the clinical context and biomedical explanation of the operation itself.ii All patients have a compulsory psych consult, but they are nowhere alerted to, nor encouraged to reflect on, the half-hidden anxieties and fears that many of them falteringly express with respect to the incorporation of what is essentially an alien organ. All will be told again and again that they will have to take immuno-suppressant drugs for life in order to circumvent rejection, but neither the question of alien DNA nor psychic alterity is explained. Indeed when I discussed the issue with the chief clinical nurse she commented that she had never thought about the DNA herself.


Dr. Margrit Shildrick, Sociologist - Philosopher (Linkoping University, Sweden).