Ann Burlein, "The Molecular Body and the Christian Secular"
(page 5 of 7)

One might be tempted to dismiss the rhetoric surrounding the impersonality of molecules as merely the usual 'faith' that the West places in the scientific method. This dismissal—while mistaken—involves a claim that is, I think, true: contemporary medical technologies do require researchers, physicians, and consumers to inhabit different relations toward the body than the modernist relations of abnormality and pathology.[67] Take a non-molecular example: the very different way we regard surgeries which break the skin and surgeries like video endoscopy (which insert a small video camera attached to a television cable into the body). When the body is cut open, its interiors are personal; it is shaming to see it and health care professionals go to great lengths to ensure that patients do not see their own insides. In the words of surgeon Richard Seltzer, when a patient glimpses their own viscera in the surface of the operating lamp, "I quickly bend over his opened body to shield it from his view ... I am no longer a surgeon but a hierophant."[68] In contrast, when there is no (or minimal) cutting of skin, affective relations change. The patient often watches the video screen along with the doctor. According to Jose van Dijck, such surgeries are more routinely shown on European public TV. These changes lead van Dijck to suggest that, "[t]he once-private inner body" (produced through the strengthening of religio-moral sensibilities regarding sexuality and shame) is being transformed "into a public sight-seeing space" whose visibility via technology entails no shame.[69]

If van Dijck is right, this is a huge change in how we inhabit certain dimensions of our body. (I say 'certain' because the molecular body over-layers the body of pathological anatomy; it does not simply replace it). These changed dynamics are only amplified as medicine targets molecules through a touch so small it becomes 'smart.' Molecular medicine shifts away from relying on and producing affects like shame and stigma in favor of inculcating an impersonal ethics of stewardship/consumption in which we are incited to take up this flattening of the body's truth by seeking to optimize its capacity for capacity. Consider anthropologist Kaja Finkler's interviews with women with breast cancer and adoptees. Finkler notes:

One might have anticipated a degree of fatalism among the sick, but curiously the ideology becomes reinterpreted in such a way that it moves people to act on the belief that to comprehend the reasons for one's affliction is to prevent it .... In the case of adoptees, the very consciousness of genetic inheritance moves them to act by searching for their birth parents.[70]

Finkler expected her interviewees to express anger or blame at family members or ancestors who might have transmitted breast cancer to them. None did. Asserting that "they could not have known," these women were more likely to see "the ideology of genetic inheritance [as] giv[ing] meaning to the randomness inherent in genetics, to the 'luck of the draw,' by supplying a reason for suffering and thereby making it more bearable."[71]

The question remains, of course, regarding how this sense of 'meaningfulness' might change if technology develops sufficiently so that family members 'could have known.' (Think of the blame heaped upon older women who decline amniocentesis and then bear a child with Down Syndrome). That said, no parent could test for every possible genetic mis-coding—there are too many. In the molecular, differential variation is the norm. In terms of the body's genetic sequences, none of us are normal, no, not one. "Most, if not all, of us suffer from molecular errors that are potentially correctable."[72] Hence critics worry that we might all see ourselves as inhabiting a 'spoiled' identity that subjects us to lifelong medical supervision. Yet even this kind of expansion of 'the sick role' would mean that medicine could no longer inhabit the modernist horizon of pathology and normality in the same way. Because genetics focuses not on deviant individuals but on molecular anomalies that are found in each one of us (at least in theory)[73], Nikolas Rose argues that clinical medicine is developing logics of variation without norm, anomaly without abnormality.[74] Such logics enable different expectations regarding the human body and its truth, and thus make possible different formations of 'personhood.'

As Paul Rabinow has commented:

Fate it will be. It will carry no depth. It makes absolutely no sense to seek the meaning of the lack of a guanine base because it has no meaning. One's relation to one's father or mother is not shrouded in the depths of discourse here; the relationship is material even if it is environmental: Did your father smoke? Did your mother take DES? Rest assured they didn't know what they were doing.[75]

But don't rest for long. The point of knowing whether you carry genetic mutations is less to understand them than to change them (if only by intervening in their expression through avoiding lifestyle triggers). While medicine is still centrally engaged in preaching sermons about sexuality, its contemporary sermons call us to live the fate of familial inheritance—an 'identity,' to use an older term—through the practice of somatic individuality: "To be a 'somatic' individual, in this sense, is to code one's hopes and fears in terms of this biomedical body, and to try to reform, cure or improve oneself by acting on that body."[76]

Molecular medicine accelerates the scientific rejection of illness as punishment for sin in favor of seeing sickness as a disease which one is not at fault for having—but which (unlike tuberculosis in the nineteenth century) is not to be embraced as the lyrical source of one's individuality either.[77] In the molecular body, even a fatal logic is not a fatalism.[78] The force of molecular twists of fate is not backward looking but forward pulling. Echoing the revolutionary language that animated the clinic's birth and extending arguments from the 1950s, today's genetics offers itself as a way to end social oppression and biological determinism. While individuals are still called to take up particular identities in the present, these 'identities' are 'taken on' as risk factors.[79] Somatic "[i]ndividuals seek to anticipate and shape 'nature' before it actually comes to pass, based on the risk that what is presently a non-event might actually occur ...."[80] Identities serve here as differential technologies by which to shift a fate that, as somatic, is not personal. In Foucauldian terms, the 'impersonality' of molecules works less through perverse implantation via notions of instinct obscurely rooted in some secret past, and more through inciting individuals to pre-empt possible futures. In a way that can at first seem quite paradoxical, fate has become more determining—but therefore also, fate has become more open to human acts of pre-emptive selection that seek to erase certain kinds of somatic risk while maximizing others.

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