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Intersections between Medical Humanities and Gothic Studies
Sara Wasson

Gothic Studies
The Ceremony of Organ Harvest in Gothic Science Fiction
Sara Wasson

In organ transfer, tissue moves through a web of language. Metaphors reclassify the tissue to enable its redeployment, framing the process for practitioners and public. The process of marking off tissue as transferrable in legal and cultural terms parallels many of the processes that typically accompany commodification in late capitalism. This language of economic transformation echoes the language of Gothic ceremony, of purification and demarcation. As in literary Gothic s representations of ceremony, this economic work is anxious and the boundaries it creates unstable. This article identifies dominant metaphors shaping that ceremony of tissue reclassification, and examines how three twenty-first century novels deploy these metaphors to represent the harvest (procurement) process (the metaphor of harvest; is itself highly problematic, as I will discuss). Kazuo Ishiguros Never Let Me Go (2005), Neal Shusterman Unwind (2007), and Ninni Holmqvists Swedish novel Enhet (The Unit) (2006, translated into English in 2010) each depict vulnerable protagonists within societies where extreme tissue procurement protocols have state sanction. The texts invite us to reflect on the kinds of symbolic substitutions that help legitimate tissue transfer and the way that procurement protocols may become influenced by social imperatives. In each text, the Gothic trope of dismemberment becomes charged with new urgency.

Gothic Studies
Tissue transfer in literature, film, and medicine
Author: Sara Wasson

This book is a shadow cultural history of transplantation as mediated through medical writing, science fiction, life writing and visual arts in a Gothic mode, from the nineteenth century to the present. Works in these genres explore the experience of donors or suppliers, recipients and practitioners, and simultaneously express transfer-related suffering and are complicit in its erasure. Examining texts from Europe, North America and India, the book resists exoticising predatorial tissue economies and considers fantasies of harvest as both product and symbol of ‘slow violence’ (Rob Nixon), precarity and structural ruination under neoliberal capitalism. Gothic tropes, intertextualities and narrative conventions are used in life writing to express the affective and conceptual challenges of post-transplant being, and used in medical writing to manage the ambiguities of hybrid bodies, as a ‘clinical necropoetics’. In their efforts to articulate bioengineered hybridity, these works are not only anxious but speculative. Works discussed include nineteenth-century Gothic, early twentieth-century fiction and film, 1970s American hospital organ theft horror in literature and film, turn-of-the-millennium fiction and film of organ sale, postmillennial science fiction dystopias, life writing and scientific writing from the nineteenth century to the present. Throughout, Gothic representations engage contemporary debates around the management of chronic illness, the changing economics of healthcare and the biopolitics of organ procurement and transplantation – in sum, the strange times and weird spaces of tissue mobilities. The book will be of interest to academics and students researching Gothic studies, science fiction, critical medical humanities and cultural studies of transplantation.

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Bodies dis(re)membered: Gothic and the transplant imaginary
Sara Wasson

This introduction considers tissue transfer as a boundary practice in multiple senses, unsettling conventional distinctions between self and other and between life and death, and challenging the limits of the body's capacity to transform and the ethical limits of scientific practice. It reviews how Gothic tropes and intertextualities have characterised representations of the processes from the nineteenth century to the present. It also reflects on the critical conundrum that attends this historicist reading of Gothic as hallucinatory mimesis, of reality become fantastic in its horrors, and offers an analytic framework for working the terrain between imaginative representation and the suffering that it indirectly refracts: the coinage bodies dis(re)membered describes four ways that Gothic can conduct ambiguous cultural work within these discursive borderlands. I identify Gothic narrative tropes in historiography of transplantation science and immunology, and review how vulnerable bodies, strange time and confining spaces of a Gothic mode may help to express biopolitical dimensions of particular transfer milieux. Finally, I defend the value of work in fantastic modes for medical humanities and comment on how transfer Gothic responds to calls in the critical medical humanities for attention to the distributed nature of health-related practice, in a nexus both global and local.

in Transplantation Gothic
Medical and ethics writing of death and transplantation
Sara Wasson

This chapter explores affective and epistemological challenges posed by the novel diagnostic entities of ‘whole brain death’, ‘brain stem death’ and ‘controlled circulatory death’ as they developed within transfer milieux in the UK and US. Life support technology enabled cyborg hybridities of machine and flesh, and I draw on Annemarie Mol’s concept of diagnosis as assemblage and Giorgio Agamben’s concept of ‘bare life’ to analyse how writing in medicine and ethics manages the ambiguities of the new deaths. I coin the term ‘clinical necropoetics’ to convey how Gothic imagery, intertextualities and narrative strategies are marshalled to variously express uncertainty or unease or, by contrast, to manage doubt and normalise. Gothic facilitates contradictory meanings, communicating troubling affects and conceptual ambiguity, or eliding these very things. Gothic representations may ‘give a voice to the silenced dead’, in the words of Sarah Webster Goodwin and Elisabeth Bronfen, imbuing a dead body with social meaning. At the same time, Gothic can be part of a process of silencing the dead, reducing the dangerous superfluity of meanings that such bodies may bear.

in Transplantation Gothic
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Uncanny assemblage and embodied scripts in tissue recipient horror
Sara Wasson

This chapter examines texts which imagine dead donor transfer tissue changing recipients. ‘Possession’ transfer Gothic is influenced by contemporaneous discourses of race, class and gender, but what also emerges is the sense of all human tissue as uncanny, including the recipient’s own pre-transplant’s body. Each text in this chapter resists the trend in transplant commentary to downplay any sense of the received tissue as alien or to elide recipients’ imaginative work or distress. The concepts of intercorporeality (Catherine Waldby), ‘absolute hospitality’ (Jacques Derrida) and ‘assemblage’ (Gilles Deleuze) offer a repertoire of strange relationalities between recipient and donor. I consider works from the pre-transplantation era including Frank Kinsella’s The Degeneration of Dorothy (1899), Arthur Cheney Train’s Mortmain (1907), Maurice Renard’s Les mains d’Orlac (1920), Robert Wiene’s film Orlacs Hände (1924) and Georges Franju’s film Les yeux sans visage / Eyes Without a Face (1958), and compare these with postmillennial representations of recipient experience of surgery and aftermath, autobiographical essays by Jean-Luc Nancy (2000) and Francisco Varela (2001) and Claire Denis’s film L’intrus (2004). In the latter works, Gothic tropes and intertextualities may express recipient acceptance of the fractures and contingencies of the post-transplant body, unsettling the language of either ‘possession’ or ‘self-possession’.

in Transplantation Gothic
‘Machines of social death’ and state-sanctioned harvest in dystopian fiction
Sara Wasson

Metaphors for transfer tissue help to normalise transfer process, and procurement protocols are influenced by a society’s values. This chapter examines dystopian fictions of state-sanctioned coercive harvest in which discursive work performs its own violence alongside the scalpels. While the fictions are fantastical, covert hierarchies of life value are also in play today, as are metaphors for transfer tissue (waste, gift, natural resources and vegetation). I contrast works from the early days of transplantation around the time of the emergence of neurological criteria for death – Cordwainer Smith’s novella ‘A planet called Shayol’ (1961), Larry Niven’s A Gift from Earth (1968) and Dennis Etchison’s ‘Calling all monsters’ (1973) – with twenty-first-century novels, Neal Shusterman’s Unwind (2007), Kazuo Ishiguro’s Never Let Me Go (2005) and Ninni Holmqvist’s novel Enhet (The Unit) (2006). All six texts imagine people reduced to ‘ungrievable lives’ (Judith Butler), no longer recognised as quite human; these characters are consigned to social death and dismemberment for organs. Yet the twenty-first century works also show characters’ internalising these metaphors in ways that reinforce social hierarchies. Hints of resistance emerge in what might be called ‘queer’ time (Elizabeth Freeman), in which a person marked as socially non-normative dreams of interpersonal connection.

in Transplantation Gothic
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Corporate medical horror in late twentieth-century American transfer fiction
Sara Wasson

This chapter explores 1970s American literary and cinematic fantasies of institutionally mediated organ theft, in hospitals influenced by corporate and profit imperatives. Blood and tissue ‘banking’ developed rapidly during the twentieth century, and both the vocabulary and the processes were shaped by trends in neoliberal late capitalism. Through this lens, this chapter examines Robin Cook’s novel Coma (1977), Michael Crichton’s 1978 film adaptation, Robert Fiveson’s film Parts: The Clonus Horror (1979), John Hejinian’s novel Extreme Remedies (1974) and Dennis Etchison’s ‘The dead line’ (1979), and also science fictions from subsequent decades which further develop the trope of corporate transfer Gothic. These works comment on period concerns around organ procurement practices and critique a political economy that erodes compassion in healthcare. To communicate these perils, these fictions use spatial conventions characteristic of Gothic, staging their action in disorienting infrastructural spaces which seem claustrophobic and hallucinatory, through the lens of the protagonists’ vulnerabilities. These fictions also dramatise how tissue transfer can morph into finance’s intricate secondary forms including a language of mortgages, repossession, inherited debt and futures trading. The texts make visible the brutality concealed in the spectralising, deferred logics of neoliberal late capitalism.

in Transplantation Gothic
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Writing wounds
Sara Wasson

This coda considers a woodcut from Andreas Vesalius’s De Humani Corpus Fabrica (1543) depicting a flayed human body in motion. The image distils a preoccupation that has run throughout Transplantation Gothic: a focus on bodies opened, their incisions not closed, yet life ongoing. This book is concerned with bodies wounded in ways that are not yet finished. It respects stories that do not end or stories that do not end neatly: the wounds of donors that spread to include intangible wounds like reduced earning capacity, pain or stigma, and recipient wounds that keep the body open for more changes – immunosuppressant pharmacology, the medical gaze, and interventions. This book is concerned with extended durations of time and affect, the slow violence of long legacies of health inequality and the long aftermath of care.

in Transplantation Gothic
Transnational harvest horror and racial vulnerability at the turn of the millennium
Sara Wasson

This chapter considers turn-of-the-millennium fiction and film of transnational and intra-national organ sale, in which racial inequalities characterise donor pools and access to transplant. Texts from India, the UK and North America which engage inequalities around transfer access and clinical labour, informed by legacies of colonisation and slavery. Read at a figural level, these texts also symbolise ‘slow violence’, as Rob Nixon defines it, in which time itself is a force of ruination. Works discussed include Manjula Padmanabhan’s play Harvest (1997), Stephen Frears’s film Dirty Pretty Things (2002) and four works of African-American harvest horror from the US and Canada: Charles Gardner Bowers’s short story ‘The black hand’ (1931), Dennis Etchison’s ‘The machine demands a sacrifice’ (1972), Walter Mosley’s short story ‘Whispers in the dark’ (2001) and Nalo Hopkinson’s novel Brown Girl in the Ring (1998). This chapter uses Elizabeth Povinelli’s concept of a durative present, the protracted violence of quasi-events under neoliberal regimes, to consider how fictional texts present precarity and a durative present of horror. Each site’s transfer economies differ but each text engages pre- and post-surgical durée, and each resists the exoticisation of dysfunctional transfer as distant from American or European contexts.

in Transplantation Gothic