Francisco Varela - Intimate Distances - Fragments for a Phenomenology of Organ Transplantation7/20/12 7:33 PM Intimate Distances - Fragments for a Phenomenology of Organ Transplantation Some two years ago, prior to writing this article Francisco Varela was battling with the worsening complications of Hepatitis C which had evolved over the years through cirrhosis, and then to liver cancer, and then to the necessity for a liver transplant. He describes the experience of the transplant and its aftermath in these notes written prior to his death on May 28th, 2001. He uses his own experiences very vividly to make some important phenomenological reflections on post transplantation life, personal identity, embodiment and many other important issues. This is an incomplete version of the text published in the Journal of Consciousness Studies, 8, No. 5-7, 2001, pp. 259-71. http://www.oikos.org/varelafragments.htm Page 1 of 30 Francisco Varela - Intimate Distances - Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM Francisco J. Varela CNRS, Paris, France Intimate Distances Fragments for a Phenomenology of Organ Transplantation L'intrus n'est pas un autre que moi-meme et l'homme luimeme. Pas un autre que le meme qui n'en finit pas de s'alterer, a la fois aiguise et epuise, denude et surequipe, intrus dans le monde aussi bien qu'en soi-meme, inquietante poussee de l'etrange, conatus d'une infinte excroissante. J.L. Nancy, L'intrus[1] I: 5.00 pm, Day 5 The scene is viewed from the side. The patient is Iying on his half-raised hospital bed. Tubes, sutures and drains cover his body from nose to abdomen. On the other side of the bed, two masked men in surgical outfits look at the screen of a portable scanner. The senior doctor explains and demonstrates rapidly to his apprentice, the probe searching around the right side under the ribs and over the http://www.oikos.org/varelafragments.htm Page 2 of 30 Francisco Varela - Intimate Distances - Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM stomach, in sweeping motions. The intern listens raptly, nodding repeatedly. The screen is turned so that the patient can also see it. It is J+5. I emerged from surgery with the liver of an unknown five days ago. My attention now shifts to the two men as they speak, I follow their conversation and wait expectantly for words directed to me. It is a crucial moment: if the veins and arteries have not taken to their new place, my whole adventure comes to a halt. The graft, from their point of view, represents hardly anything more than a successful fixture. I am short of breath as I pick up the doctor's overheard telegraphic comments: Good portal circulation, no inflammation.... Abruptly he smiles to me and says: 'Tout va bien!' I am now my prostrate body that feels broken up, in bits and pieces, aching from a visible incision that goes from right to left in an arching path, and suddenly bifurcates over the chest right to my sternum, almost immobile from the multiple intubations and perfusions. His reassuring statement oddly makes me feel my liver as a small sphere, as if I am carrying an infant (I remember the pictures of my last son's beating heart in his mother's belly); it is tinged with a light pain, it is definitely present. In the background, the brokenness of my body beckons me with an infinite fatigue, and a primordial desire to close my eyes and rest for eternity. Yet the screen is a few centimeters away and a simultaneous curiosity perks up unflinchingly. I can see my new liver, inside me. I follow the details: the anastomoses of the cava and the porta veins, the two large hepatic arteries, the II then the III lobule squished one into the other. I travel within, gliding inside and out of the liver capsule, like an animation. I listen with http://www.oikos.org/varelafragments.htm Page 3 of 30 And yet for me alone is echoed in multiple mirrors of shifting centres each of which I call 'I'. My sick liver was cut from its circulatory roots. 'Here is the best way not to miss the hepatic peduncle'. which expects a word. then rampantly turned into liver cancer.org/varelafragments. look at how best to catch the flow with the Doppler'. II: Contingency. An organ came tumbling down a complex social network from a recently dead body to land into my insides in that fateful evening of June 1. The http://www. We are looking at the scene from the side.oikos.Intimate Distances . you and I. human history remains mute. it goes swishhh. which is redoubled in a scanner's image. Obsolescence So there it is: some two years ago I received the liver of another human being. Ten years ago I would have died rapidly from my complications of Hepatitis C. I can thus pronounce a unique statement (with a few hundred people around the world) with all the sense of truth that is given to humans: I have received someone else's organ! Such an assertion has no echo in the past. each one a subject which feels and suffers. this time the object is lost to me in a sea of grey).Francisco Varela . swishhh now. a concrete fragment that seems to partake with me of a mixture of intimacy and foreignness. replacing the vital circulation by laborious suture of veins and arteries.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM unabashed interest to the explanations to the intern ('Here. and the new one snugly fitted in. transformed into cirrhosis.htm Page 4 of 30 . as histograms display the parameters in charts and line drawings. ) Had it happened in ten more years it would have been a different procedure and my post-transplant life entirely different. to give us the insight and the lucidity to enter fully into this historical shift. From this narrow window I must (we must) reflect on and consider an unprecedented event.Francisco Varela . that no accumulated human reflection and wisdom has ventured into. Or from stem cells they will graft a new liver or kidney and preselect the cells that will colonize what was missing in us. In the thousands of years of human history. in a sort of permanent completion that can be extrapolated beyond imagination. my experience is a speck. into the obscene. Fragments. It is the multiple immunosuppressor drugs that prevent the inevitable rejection. redesigning the landscape of boundaries in the habit of what we are so definitively used to call distinct bodies. and soon enough. we will return to it. (A code word for a phenomenon specious in itself.org/varelafragments. no systematic analysis. We are left to invent a new way of being human where bodily parts go into each other's bodies.oikos.htm Page 5 of 30 .Intimate Distances . to live up to the challenge. order it to size by genetically modified animals. I would surely have been another kind of survivor. Opening up the landscape where we can borrow a piece from another. the growing know-how about human bodies. a lost cartographer with no maps. consider everything as only a tentative understanding. One day it will be said: I have a pig's heart. which knows http://www. This is the challenge that is offered to us to reflect on through and through. a small window of technical contingency in the privileged life of upper-class Europeans.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM surgical procedure is not what creates the novelty of a successful transplant. I take tentative steps. My life in its contingency mirrors the history of techniques. from antibiotics. In between lies the lived phenomenon.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM nothing about the lived-bodies that can and will come from it.oikos. all the work I must do is for a little window of history before it snaps out of focus and we are to re-start anew. as always. Technology. or else the simplicity of the doctors who remain set at the level of their technical prowess. Paradox As I peer inside me (but which me?) at the other's liver. These are the points where the transplantation situation can be carried to the sentimental extremes of either having being touched by 'a gift' (from somewhere. from 'life' or 'god'). All the more so now that the contingency of life.Intimate Distances . the entire reality of transplantation having changed the scenario from top to bottom. these reflections will probably be obsolete. Transplantation creates and happens in a mixed or hybrid space. stands as the mediation that reveals the interelatedness of our lives. the medical gesture explodes into a hall of mirrors.org/varelafragments. III: Frame. There are several subjects that are decentred by exchanging body parts. to work through the ramifications.Francisco Varela . as the http://www. or decentred as the 'team' that makes the technical gesture. or even further. that must be drawn out otherwise. In ten years. acquires a speed that impinges even on our ability to conceive. always at the doorstep of reflection on human destiny. to assimilate.htm Page 6 of 30 . Contingencies of life that accumulate in the history of body-technologies. to tailor-made drugs. to genetic engineering. in other parameters. it has an inescapably lived dimension that the word organism connotes already. Sentience. without remainder. Moreover. This intertwining can be grounded on the very origin of life and its world of meaning by the self-producing nature of the living. and thus has made it impossible to see the seamless unity between the natural and the phenomenal by making sure they are kept apart.Francisco Varela . and have an intrinsic intuition of life and its manifestations. 91). But this gets. p. because sentience has as its flip side the immanence of the world of experience and experiencing.Intimate Distances .Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM distributed network of the National Graft Centre who that fateful day decided it was my turn. experiencing the bodily indicators of pain and expectation. The only way is to mobilize here a re-examination of the very basis of modern science. has a double value or valence: natural and phenomenal. Given that the scientific tradition has construed the natural as the objective. too ambitious. where my body (and his/her now dead) are placemarkers. receiver and the 'team'. 1966.htm Page 7 of 30 . It is in this sense that 'life can only be known by life' (Jonas.oikos. in this sense. the biological details of the constitution and explanation of function. that the organism is a sentient and cognitive agent is possible only because we are already conscious. As if the centre of gravity of the process oscillates between an intimate inside and a dispersed outside of donor. Natural because sentience stands for the organism and its structural coupling with the environment. At the same time this is an embodied space. It thus includes.org/varelafragments. Phenomenal. no 'bridging' or 'putting together' would do the work. http://www. manifest in a detailed and empirical sense. the 'natural' basis for the study of lived events. an inescapable narrative. We can start with the embodied sentience of the organism. all of a sudden. instead.htm Page 8 of 30 . and the fact that in order to manifest such depth it must be addressed with a method in a sustained exploration. Little can be said about this lived dimension without the work that it requires for its deployment. It is this methodological gesture which gives the impression of turning 'inwards' or 'excavating'. contra the current prejudice that we are all experts on our own experience. (In a basic sense. The feeling of existence. as well as its intimacy (we are situated thanks to the feeling-tone and affect that places us where we are and of http://www. a term I borrow from Maine de Biran) as the core phenomenon here.org/varelafragments. or more existentially close. Embodied: on the one hand examining experience always takes us a step closer to what seems more intimate. In other words. can be characterized as having a double valence too. This is why it is appropriate to reserve the name of feeling of existence (sentiment d'existence.oikos. There is here a link between the felt quality or the possible depth of experience. more pertinent. in itself.Intimate Distances .Francisco Varela . it is this double aspect that is the source of depth (the roots of embodiment go through the entire body and extend out into the large environment). What it does. is to bring to the fore the organism's embodiment. a procedure. this is also close to the recent interest in 'firstperson' methods in cognitive science. Leib/Körper).) And therein resides its paradoxical constitution: our nature is such that this gesture needs cultivation and is not spontaneously forthcoming.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM Exploring the phenomenal side of the organism requires a gesture. the inseparable doublet quality of the body as lived and as functional (natural/phenomenal. the true flip side of sentience. a phenomenological method. This is expressed as a tension between two simultaneous dimensions: embodied and decentred. First. appearing as the depth of space.oikos. but not foreign.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM which the body is the place marker). Again the question: Which me? Foreign to what? We change all the cells and molecules of a liver every few weeks. Temporality. Decentred: on the other hand. I've got a foreign liver inside me.htm Page 9 of 30 . It is new again.Intimate Distances . and the always already mobile subject of enunciation and hence the mobility of the lived body's identity. This inescapable intersubjectivity (the 'team') of mental life shapes us through childhood and social life. This defies the habitual move to see mind and consciousness as inside the head/brain.org/varelafragments. especially in exploring the lived body. But it is also true in the organism's very embodiment. instead of inseparably enfolded with the experience of others. IV: Rejection. These parallel themes serve as the hidden scaffolding for the analysis here. experience is also and at the same time permeated with alterity. that is.Francisco Varela . and in the transplantation experience takes a tangible form as well. with a transcendental side. The foreignness is the unsettledness of the http://www. and the imaginary circles of the images that give this inside a metaphorical concreteness. of the intrinsically extensible nature of its sentience. the lived body as focus: the intrusion. the alien as flesh. the networks of dissemination playing in unison: the social network of the gift. Second. always and already decentred in relation to the individuality of the organism. as if the experience of a liver transplant was a private matter. looking steadily into my wife's face the only reference point in a disappearing quagmire. corroded by cirrhosis. the inescapable lot of transplantation. to date. As the rejection does not yield. the treatment mounts one step. and with an obsessive compulsion to repeat certain inner discourses. it was gradually becoming alien as it ceased to function. Immunosuppression is. nights spent in the corticoid desert are certainly a form of hell).Intimate Distances .Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM belonging with other organs in the ongoing definition that is an organism. I am treated with the 'heavy' means as the doctor says. One starts by special suppressive drugs and massive doses of corticoid (leaving the mind disjointed. The body-technologies to address rejection are absurdly simple: disable the ongoing process of identity. but the 'team's' strategy. that constitutes the intrusion. with no other than a suspended irrigation of islands of cells. The paradox of alterity is a paradox of the timing of hospitality. like an alien possession that left the me [who?] in a limbo of non-existence. In that sense my old liver was already foreign.Francisco Varela . (As I felt the effect coming in a few minutes.) http://www. it looks very sick'… … It is not the liver.oikos.htm Page 10 of 30 .org/varelafragments. for the body-technologies are out of synchronization with the temporality of the welcoming that is our basic condition. weaken the links between the components of the organism. the entire repertoire of immune cells is massively eliminated by a slow injection. which are then left to decay and wither away. Years before the transplant. As in napalm warfare. my whole body was swept by uncontrollable shaking. hallucinating. during a biopsy the surgeon came to see me: 'I saw your liver. and concern about opening windows. but makes me move for relief. just enough to let me know it is there.oikos.org/varelafragments. I stumbled into a web page addressed to transplantees. Immunosuppression is a walking stick. (Interesting: browsing through the internet. like a fist that presses my side from the inside. V: Touching the Lived Viscera According to my doctors I cannot feel my liver. cirrhotic one. stuck like an envelope of the hidden organ. There is no innervation for the organ. A new lifestyle of masks.Francisco Varela . as a travelling to destinations of unknown hygiene. careful watching for the slightest sign of fever. This becomes a life condition. but now simply being in the world is a potential intrusion. It is so tangible.Intimate Distances . It beckons my attention. the body is allowed to reconstitute.htm Page 11 of 30 . I do feel my organ right here. displaying a chat room where a dozen people gave the same account: we feel our livers. as the temporality of my somatic identity has been erased for a few days. In time. doctors say we shouldn't. its proud movement and agency shrivelled down. Weakening the links that are the backbone of the temporality of the lived-body. this alteration is experienced as a newly acquired attention to symptoms. I feel the world as through an extension. under my ribs. Eppure. I recover my assurance of my daily embodiment.) Such is the http://www.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM Complete immunosupression does stop the rejection. makes the body into a life of withdrawal. slightly eccentric. and the connective capsule surrounding it is left with the old. Sometimes it stretches and speaks with a tension. as the immunosupression is milder. which is not quite pain. one of my hands touching the other is the very paradigm of the self-based experience of intimacy. dangling like the veils of a mummy. carrying them along as lost relatives. And when the new one comes to lodge. almost a cooperative agreement. It is not mine. 43-47).Intimate Distances . Maybe a dis-membered proprioception from the terminals left behind in the hole of my previous liver. but it is indissociable from me in this single centre of orientation.oikos. as a newcomer lays down to sleep in a warm bed. the feeling of one's own surfaces. a sudden breakdown brings this absent body back to its deeply present presence (Leder. It is the 'solipsistic' level of the lived body that Husserl finely describes (Husserl. wherein I can be. The touch afforded by the extended surface of one hand http://www. 1952. The intimacy is multiple. In the classical example. into a transparent mode while I am immersed in the world. senseless. They will have become entrapped into new fascia fibres that pull them.htm Page 12 of 30 .org/varelafragments.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM presence of the unfeeling liver. 1991). and the other I blended into the lost tissue fibres "driven as one by this bottomless desire for integration" we have reached a balance. Thus between this me (which one?) that imagines and thinks.Francisco Varela . They provide me the basis to dress the fantasies with flesh. It constantly reappears as the lived body disappears into the background. the lived body (corps propre) is the hallmark of intimacy wherein I am. There is also the touching that brings it out. an emotional upsetness. In phenomenology. and we give him the credit to manifest in this lived body. I imagine those connective tissue membranes that were left there. In time (I imagine) they will find their way into the new nooks and crannies of those new cells. sentientless. And then a pain. Tangent II. Husserl proposes an analysis of 'I feel my heart' (ibid. or over other sensitive skin. p.. the space of the body itself. the viscera. The organ responds with a heightened sensation. which show up clearly. I imagine this heightened sensation as also the mediation of those invisible dots of molecular agency which co-exist with my new liver.htm Page 13 of 30 . puis a la http://www.) All of this is 'given to myself as interdependencies in co-presence' (ibid. can be conceived as pure self-affection. and my fingers can awake in my right side the liver and its boundaries. To do so I stretch my palm over the heart region.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM over the other..l83-208). mais constitutivement hantee. as Derrida remarks incisively. pp. even in the ideal case of hand-to-hand touching this intervening space is already. and in fact with a tinge of pain as if inflamed. and press gently. the other. There is a heteroaffection that slips in place precisely because of the intervening space: cette experience est deja hantee.Francisco Varela . and constitutively. I touch through a surface. even in the 'pure' case of two hands touching.org/varelafragments. as an internal feeling that rests on itself alone. p. Likewise I can press through. 165). leads us directly to the experience of the darkened side of the corps propre. No exploration of the lived body. 2000. the innards. 166: für mich selbst in Kopräsenz zusammengehörig gegeben). par quelque hetero-affection liee a l'espacement. I can feel the boundaries up into the ribs and down into the abdomen. But.oikos. the presence of the foreign. (The persistent Hepatitis C virus surely creates a degree of inflammation. The inner sensation surges up and I close the link between the self that touches itself in the mediation of the distance. the distance (Derrida. au moins.Intimate Distances . forcing a temporality of foreignness. The alien and the foreign of the transplantation gesture is not a sharp boundary marker for how my body holds its place as the locus of intimacy. and visible even when the distance between the touching hand and the viscera is 'mere' skin and bone. I'hote. All sensing is an admixture of autohetero-affection.. That technology widens and slips into what is always already there. p. the gentle touch of friendship.org/varelafragments.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM spatialite visible: par ou l'intrus. It can also be the passage through which the body-technology forces open a wider space by an imposed shift to the body as subject of technique. The received notion of the solipsistic lived body appears incomplete in this light: it leaves aside the irrepressible presence of the alien. A horizon is not itself an appearance.Francisco Varela . that is. it mediates the relation between what is given and the anticipations of what is possible.htm Page 14 of 30 .Intimate Distances .oikos. This Other lodges the openness to a multiplicity: the image of a scanner of its 'inside'. Tentative conclusion: it is not the body-technology that introduces the alterity in my lived body as a radical innovation. un hote desire ou indesire. which makes the intimacy of the body possible. 205). but also the needful absence. but is always pre-given. un autre de secours ou un parasite a rejeter (ibid. Can I then say that the transplant makes me different? As if the propre of my corps was settled and pure? The appropriation http://www. But the constitution of the lived body presupposes in its heart the passage through the other as an outside and the Other as horizon. the mounting infection. as Korper. The exchange has the logic of a metaphor. One of a thousand scenarios that go through my mind. VI: Transference. of something standing in for something else. by a cancer eating up my cells.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM of intimacy as interminable.An organ is transferred. If we listen to the Greek roots.htm Page 15 of 30 . professional and kind. (I see a young motorcyclist sprawled next to the autoroute. At some point the abstract idea of the transplant becomes specific as the transfer is decided and the metaphor on its way. it is said.) http://www. his brains spread over the tarmac. it's an organ in excellent condition. One can say that the whole is so impossible to enunciate in its totality that we can grapple with it only as a metaphor.org/varelafragments. the nurses at the reception. and the paramedics frantically calling the family to get their authorization for taking the organs. A new something is standing in. marking the place. as at the same time possible and impossible.' This mere suggestion is like the skeleton onto which the imagination unleashes the full contents of the transfer-metaphors. with a finite horizon for the disappearance of identity). Metaphor . I will never know.oikos. a limp piece of tissue packed in ice standing in for a gift of life. let out: 'It's coming from Marseille. as that which speaks the unsayable and the apophatic.Francisco Varela . As I arrived in the hospital after the crucial phone call stating that a donor had been found for me (paradoxical myself. altered as I was by the nearness to death. we can say it was metaphoros from somewhere into me.Intimate Distances . a complex arrangement put in place over many years by the National Graft Centre for centralization and re-distribution. a gift is an event-action that belongs to the symbolic order. Since then.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM That is. Part I).oikos. I was not alone any more in my spontaneous representation of myself: there was the donor. The key of the gift is its reciprocity: what is given is returned.Intimate Distances . canonical interpretation. In its place there is a mediation between the family who authorizes. and the gift has become strict exchange or commerce. Once a donation is made in absentia. sealing a pact. The Maussian account of the don has been both refined and contested (Godelier. within our immediate circle. the beginning of the relation with my donor.org/varelafragments. During the interminable wait. Was X in Marseille a donor? The core of giving is that one is personally addressed. Being http://www. replaced by a quality of possibility lacking a direct address. and ponder the almost tangible contingency of my life (if I survived) within this arrangement. It so happens that the Graft Centre is located not a block away from my apartment in Paris. and have lost the power to be the ground of social links. our modern life has evolved to constitute other social norms. Since Marcel Mauss. like the philanthropist to a common cause.Francisco Varela . Gifts exist now in the personal sphere. its nature is profoundly different. the gift remains a key for the understanding of early human societies. Yet by law the donor is to remain forever anonymous. Saying that there was a don. the source of the don. 1996. according to a received. to a general population.htm Page 16 of 30 . In spite of ever-present refinements. that other X whose path had ended one afternoon somewhere in Marseille. The personal touch is lost. I used to take walks in front of it. then. also says that there was a gift. as if joining a total stranger in too short a time to make acquaintance. And in his position as middle man. He thus represents a unique link between us. at the Centre where I went for my reflective walks.Intimate Distances . And then. at the end of the day. and at the same time binds the entire network from donor to recipient in a single stroke.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM inscribed on the waiting list is already a matter of decision. tired technicians coming after dinner for all-night surgery around that emblematic figure.htm Page 17 of 30 . This triangle is emblematic of the strength of the imaginary social link that makes the transference possible. and thus to arrive without clash. surgeons are entirely oblivious of http://www.oikos. the hurried trip to the hospital. the assembling of the medical team. the chief surgeon. a meta-instance who holds the key to a riddle that must be kept secret by an unbreakable ethical code. as an aside) that I am on top of the list. done locally by the 'team' to which I was never privy. After months I was requested to carry on me at all times a dedicated portable phone. to welcome.Francisco Varela . their conditions being more threatening. the surgeon is the only one who knows both the donor's and the recipient's identities.org/varelafragments. as the decision is made (will I ever know who or how?). The local list somewhere reaches a central list. and whether other patients are or are not put ahead. Weeks without end. but this still depends on the city and blood group. and to never be far from the hospital. the phone call. I trusted my surgeon who seemed to have taken a liking to me (but what is this feeling in the riddle of the acceptance of a life-death?). At some point I am told (in confidence. In my experience. every minute the pressure of my portable phone as witness awakening me to the immense fragility of my life and the tenousness of my identity in this tangle of deferred causalities. it was up to me to deal with the enormous alterity in which I found myself. This translates on the imaginary level to the presence of the donor in the gift itself. I said. Or to a wood and make an http://www. I am partly another. to seal a pact with the anonymous donor. the links established are of a personal nature. His business centred on the techne. in anthropological studies one constant is the stable nature of the rights of the giver over the gift.htm Page 18 of 30 . it is commonly said. it feels as ancestral and ancient as the compulsion to bury our dead. Even as modern Western subjects. as if in a distant echo. In fact. And the longing to find the source of this don of life is clearly present. They go to a cemetery and offer flowers to an unknown grave. 76. even after the first weeks and months of the transplant. Since gifts are never detached. he has little time to listen to the relentless production of imaginary contents. it surges forth from roots too old to be conscious.Francisco Varela . I found myself spontaneously desiring a reciprocity. I have another in me.. attached to it. pp. It is here that there is a more appropriate use of the term 'gift' in the anthropological sense. to like animals) as a direct manifestation of this spirit that came with the gift. we experience.oikos. Transplant patients routinely find personal ways to deal with the impasse of the search for the unfindable donor. the marks of our ancestors.org/varelafragments. between individuals that engage with one another. the social imaginary link is intense and gripping. and following its transferences.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM their place and role as transferential passageway.Intimate Distances . Some report having acquired new dispositions (to eat meat. In the early temporality of the experience. and the gift is the representation of their obligations (ibid. At best he receives with a nod what the patient says as personal thanks. 94). Giving Pointing to the field of intersubjectivity here is also a way of pointing to a shift in our understanding of the gesture of organ donation (so-called). regaining the equilibrium from the brutalness of the technology. the imaginary elaboration of this intrusion that was willed and wished. is just as much the key as the exchange. And what is kept is what is sacred. As the days went on.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM offering to the spirit of the deceased donor. It is clear that only a strict regulation of anonymity stops this strong urge from becoming a delicate dealing with the misplaced forms of gratitude-driven obligations. in the gesture of organ donation.org/varelafragments. Having the gift in me did not make me become another in any way that experience could attest with any stability. what is kept and not given. one follows the long trail of the recognition proper to the gift. The offering is not mine "that would bring it into the realm of commerce" but just 'taken' from an open field.Intimate Distances .oikos. which 'primitive' societies manifest so clearly. In the world of gifts. The offer proposes to us that we keep it. what we are concerned with is more an offering. The images began to disappear. VII: Offering. the acceptance of this new form of alterity in spite of immunosuppression. it was the work (again) of temporality that became central: the welcoming. the sudden emotions for the dead giver gave way to a decentring into a larger field of intersubjectivty. from whom or how I do not know. But here. On the contrary. a passing without exchange or with the hope of receiving back.Francisco Varela . In the statement: I give to you.htm Page 19 of 30 . the fantasies began to fade and to lose sense. making the http://www. What I keep as an offering is special. it is to be kept safe. 2000. the DNA fingerprinting.Francisco Varela . are transmuted as part of the constant alterity. VIII: The Image. the disappearance of its ways of being present (Derrida. A gift is an offering when there is. in gestures that extend into putting into full view not only the hidden but the ultimate microscopical. In the temporality that is proper to accepting and keeping an offer. It comes to me from nowhere. there is no presence of the donor in it. the biochemical profiles. which seemed so present in the gift. the imaginary exchanges. in the greatest intimacy.oikos.org/varelafragments. Our times have renewed the visible and the explicit as a preeminent presence. then. by the law. compared with times in which only the rarefied world of pure ideas and Logos was supreme and the image http://www. It's yours for keeps. We must thus distinguish the gift from the offer. the withdrawal of the gift. at the heart of the gift. is not a gift but an offer. disappear. It's to be kept close to you. p. if only I could keep it. the immune cellular probes and markers.Intimate Distances .htm Page 20 of 30 . the ongoing alterations that are the very nature of this me-ness. a gift which has been 'withdrawn' as such by death. Modern man has since been rendered somatically transparent.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM gift possible (Weiner. especially for seeing the insides of the human body. It arrived for keeps. the Touch Modern medical imaging accomplishes what began in the eighteenth century as a desire and a search for illuminating every dark corner. Donors should be called offerers. by the social mediation. 112). 1992). The liver I have. or better the offer within the gift. now transformed into weightless apparitions. These gestures are always considered supplementary: only the images and the charts speak the reliable truth. as return to an embodied presence. habit has transformed them almost into a selftouching. me-ness. and he touches my liver region. The image holds the bond at just the right distance: sufficiently close in liking to be a habitual part of my intimacy. the larger medical world. with virtual persons existing as bytes in optical fibre ready for multiple displays. The touch reestablishes an older intimacy through his touching hand. having captured the essence of the story. I experience it as a relief. Increasingly we communicate with images of people.org/varelafragments.Intimate Distances . The new body is constantly on the verge of losing its seemingly invincible spatial and temporal http://www.Francisco Varela . a tribute to the force of the image: I can feel those black and white patterns on the screen). I am disseminated in image fragments that count more as the relevant interface than this presence (my lived body then. Occasionally in one of the check-up visits the clinician asks me to lie down. These body-techniques seem to stand for all that was haptic. tangible and ready-to-hand. 1993). sufficiently detachable to introduce a wide space wherein the intrusion of otherness arrives massively every time I go back to the stretcher and raise my shirt. The radiologist looks at his echography machine. and the probe glides over my abdomen (in these situations. touching/ being-touched the paradigm of oneness.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM mere appearance (Stafford. not at me.oikos. but again the question of which one?).htm Page 21 of 30 . The image becomes the inevitable mediator between my lived intimacy and the dispersed network of the expert medical team for which the images are destined. IX: Intimate Distance From the place where I now write. shaking from cold and fear as nurses made conversation. But there was. It was done. then naked under a sheet so that the nurse could shave me entirely in a form of nudity that seemed to reach me under the skin. the alterity is constitutive.Intimate Distances . drowned in anaesthetics (which I? certainly there was presence. there has been. Then transferred to a wheeling stretcher. which approached closely over the years. the impossibility of grasping onto anything. waiting in a room. I have a minute or so to let anything that was left of me go as if in an involuntary flight. the image rides on this doubling as a thorough mediation.htm Page 22 of 30 . anchored in the lived body. The descent was slow. Never had I felt more acutely my fragile ontology. parked in the surgical room. I suffered). http://www.oikos. The anaesthetist comes. First. the encounter with the radical alteration of death. I was not there. It would be idle to set up an opposition of correct/incorrect between these pervasive images and the contrasting sense of touch. We witness a push and counterpull between depth and imaginary surfaces that become a new identity in post-transplantation life.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM structure. then getting undressed and covered with a hospital gown. takes the perfusion tube and perfunctorily injects the first wave of anaesthetic. Even in touching. the old new alterity of the distributed selves has re-acquired its own temporality. and then finally made its irruption in all the brutality of a night when my chest and abdomen were laid open.org/varelafragments.Francisco Varela . Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM a living dot suspended in a space that goes so beyond anything representable. sutured back and left to function in http://www.org/varelafragments. I have. I see that the night when death travelled through my open body is to remain indelibly. It is there each time somebody looks at my torso. Then they opened me up.Intimate Distances . X: Which Life? The life retaken. is taken differently. forever changed (but to whom shall we attribute this change?) by a triple movement: the one that led to being on the waiting list. like a sack of merchandise). From then on the trace of death has set its own agenda. and proceeded to rebuild me again back into a normal body. which never lets me slip by this memory that is not a memory. in fact. nothing left but gaping gap for intrusion. replaced it by machines. took the organ from an ice pack. become another never entirely re-done after being so meticulously undone. and I see their eyes darting quickly down to check the trace that crosses from side to side and up the chest with suture point (with big stitches. Or that is what they say. This is the living reality of transplantation. but rather a feeling of recognition of its presence.Francisco Varela . of an inevitable guest whose movements are way beyond anything within my reach. The utter loneliness for which there is no utterance.htm Page 23 of 30 . Deprived of any intimacy. It's death's trace. Awakening into my new state. the one that led to an organ to be transferred. my entire identity grazed profoundly by the opening to death. and the one that leads me into my present condition. cut the circulation. its own rhythm to my life.oikos. The virus is. In fact. the overload of the kidneys to verify. A telling metonymy of my condition).htm Page 24 of 30 .org/varelafragments. of travel always present in its medicine bags. Soon the traces of the last movement began to enter my life as multiple foreignness. for the accumulation of liquid around the liver that needs extensive examinations. Then the drugs themselves. There is also the return to the hospital for a sudden explosion of viral activity. There is first and foremost the drug treatments. And of course the repetitive medical controls.Francisco Varela . immunostimulated to avoid the virus. The effect on the stomach. for effectiveness it must be a bitherapy with ribavirine.oikos. degrading the new liver. the enzyme levels to keep track of. which leads to anaemia. But the only known antiviral treatment is inteferon. Changing symptoms http://www.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM the world with a 'new' life. and we know it to be back in full action. It is an imaginary circle: I am back from where I started from. producing sometimes uncontrollable diarrhoea that in all its undignified presence overtakes my life. the most mysterious of my foreignness. It must also be suppressed and controlled. and that mark the temporality of the day. which induce a diabetes needing careful checking three or four times a day. intertwined with these amazing dots whose molecular structures I sometimes contemplate in awe of their twisted proteins and minute RNA. so that the body is pushed on opposite sides at the same time.Intimate Distances . The cortisone and immunosuppressors. Oddly. which produces a permanent feeling of fatigue as if one has a budding cold. an immunitary stimulant. (A constant paradox: immunosuppressed to avoid rejection. which are prescribed in quantities and taken by grammes per day. we all knew it. the immunosupression to avoid rejection is exactly a counter move to interferon. still with me. bulky and obtrusive. blood samples so often my veins seem to expect the needles. bringing up death's trace.Intimate Distances . an existential space where I adapt slowly.. The body itself has become a constant. this time as the guest of that which I did not arrange. I know.htm Page 25 of 30 . It produces an inflexion in life that keeps an open reminder from the trace of the scar altering my settledness. and before seems distant and abstract). Echographies. ex-ports me in a new totality. then. The phenomenon rests: transplantation has made the body a fertile ground of opposed. makes me face a twilight language. The expression of it all. It is my horizon.org/varelafragments.. ongoing source of foreignness altering itself as in echo. Nancy goes further: Je le sens bien. coincidental intrusions.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM that emerge and subside. Compensation to the decompensations that multiply in a hall of mirrors. like a guest of nobody's creation. This time. A life with its own temporality to put together and live with the multiple manipulation that technology demands (once again the historical contingency of the body-technologies: in ten years more I would have been some other kind of survivor).Francisco Varela . The transplant ex-poses me. not a coming back to where I was (but I was already alienated by the disease for long years. weight control. touching every sphere of my waking life. eludes me. Transplantation is never in the past.. the foreign has made me the guest. the alteration has given me back a belonging I did not remember.oikos. c'est beacoup plus fort que'une sensation: http://www. This is the life that I have survived for. The suffering varies from one person to the next in its extremes. Thus the foreignness of the grafted liver is less and less focused. perhaps even pushed to an extreme that both sharpens them and moves beyond their initial scope.36). 2000. Yet these classical themes re-appear under a new light.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM jamais l'etrangete de ma propre identite. ne m'a touche avec cette acuite. for a human being which will be 'intrus dans le monde aussi bien que dans soi-meme' as the epigraph says. 2000. p.htm Page 26 of 30 . 43).oikos. Perhaps we are all (the growing numbers that have entered into the sphere of this transference) 'les commencements d'une mutation' (Nancy. body-technologies and ethics. the unalienable alterity of our lives. It is this urgency that drives this examination of the ancient ethos of the human will to power re-expressed as transplantation. p. et l'irreconciliable d'une irmnunite contrarie (Nancy. qui me fut pourtant si vive.Intimate Distances . The radical novelty pushes our analysis into new steps. Even if my own window is narrow in time and fragmented in understanding. we would do well to consider every sentence of it.Francisco Varela . http://www. the key ground of temporality. il y eut toujours de l'espacetemps: mais a present il y a ltouverture d'une incision. XI: Inconclusion Old themes from phenomenology have reappeared throughout this analysis: the lived body and its exploration.org/varelafragments. Where the body technologies will and can redesign the boundaries ever more rapidly. 'Je' est devenu clairement l'index formel d'un enchamement inverifiable et impalpable. Entre moi et moi. I can see it: all of us in a near future being described as the early stages of a mankind where alterity and intimacy have been expanded to the point of recursive interpenetration. htm Page 27 of 30 . Stafford. Nouvelle Revue de Psychanalyse. ~Le corps evocateur: une relecture de l'immunite'.Francisco Varela . Weiner. MA: The MIT Press). Nancy.Intimate Distances . A. (1989). 'Second generation immune networks. References Derrida. Body Criticism: Imagining the Unseen in Enlightenment Art and Medicine (Cambridge. III (The Hague: Martinus Nijhoff). Le toucher. A. L'Enigme du don (Paris: Fayard). Husserl. H. 12. A. Inalienable Possesions: The Paradox of http://www. (1966).Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM Somewhere we need to give death back its rights.159-67. F and Cohen. pp. F and Coutinho. w. Maurice (1996). ed. Varela. Zweites Buch: Phainomenologische Untersuchungen zur Konstitution.oikos. (1992). L'Intrus (Paris: Galilee). Leder. The Phenomenon of Life (Chicago: University of Chicago Press).' Immunology Today. 193-213. 40. Godelier. Drew (1991). Varela. Jonas. Jean-Luc (2000). Ideen zu einer reinen Phainomenologie und phanomenologischen Philosophie. Jean-Luc Nancy (Paris: Galilee). Jacques (2000). The Absent Body (Chicago: university of Chicago Press). (1991). Automne. Barbara (1993).org/varelafragments. siemel' Husserliana Vol. pp. Edmund (1952). I believe. Francisco J. 2001. p.oikos.Intimate Distances . Notes 1 Jean-Luc Nancy (2000).Francisco Varela . ---------------------[back to the text] Home | Ecology of Mind | Mind-ing Ecology | Co-ordination Page | Books | Search Bateson | Kelly | Maturana | von Glasersfeld | Laing | Antipsychiatry | Links Ecology in Politics | Eco-logising Psychology | Sustainability | Environment & Nature http://www.Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM Keeping-While-Giving (Berkeley: university of Califomia Press). This brief but profound text is. the only extant attempt to grapple head-on philosophically with transplantation from a lived perspective. in the loving embrace of his family. ************* Editor's Addendum On May 28. He died calm and at peace. 45. The impact of Nancy's work is present throughout my own exploration here. Varela passed away at his home in Paris.htm Page 28 of 30 .org/varelafragments. org/varelafragments.htm Page 29 of 30 .oikos.Intimate Distances .Francisco Varela .Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM http://www. Intimate Distances .oikos.Francisco Varela .Fragments for a Phenomenology of Organ Transplantation 7/20/12 7:33 PM http://www.org/varelafragments.htm Page 30 of 30 .
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