Metaphor and Alienation

A. David Napier, The Age of Immunology: Conceiving the Future in an Alienating World. Chicago: University of Chicago Press, 2003. 328 pp.

The times, some say, are a'changing. In 1985, I found myself in a hotel room rented by a bunch of medical students from the University of Nebraska, in Chicago's aging Palmer House, lying on the bed next to an unhappy and possibly inebriated Dr. Benjamin Spock. We were at a conference of the American Medical Student Association, and the baby doctor whose book had helped raise me was lamenting the lack of political commitment among young Americans. We were stuck, selfish, and uninspired; we lacked vision, or courage, or both. Spock called out to the assorted medical students wandering the hotel's damp corridors, asking if any of us had a redeeming sense of social and political vision. But some one had put on the music, no one was listening, and the answers the few of us would-be visionaries offered didn't impress.

I had forgotten this odd moment; David Napier's The Age of Immunology brought it back. Not only does Napier open with insights into the aging Spock (Napier, as a working-class Pittsburgh kid with spasms, was one of the good doctor's research subjects) but he sets out to answer Spock's challenge, offering a diagnosis of what is wrong with us and, through a genealogy of the "not-self," the possibility of a cure. Part ethnography of the medicine of auto-immune disorders, part wide-ranging cultural critique, and part self-help book (or as Napier would insist, critically, a "nonself help" book), The Age of Immunology is medical anthropology in a very particular, arguably Nietzschean, sense of the term. As its response to Spock's demand takes immunology (as both specific practice and dominant tropology) as its critical object, I preface my reading with a review of recent American conversation on immunopolitics.

Immunology as the site and metaphor of new articulations and assemblages of reason and power entered anthropological conversation with sustained reflection on the AIDS epidemic in its first decade, before the state of emergency was normalized into a new global order of pharmaceutical triage. Donna Haraway's 1989 essay "The Biopolitics of Postmodern Bodies: Determinations of Self in Immune System Discourse" and Emily Martin's 1994 book Flexible Bodies: Tracking Immunity in American Culture from the Days of Polio to the Age of AIDS, each relying not only on distinct methods and units of analysis but on fundamentally different theories of trope, seemed nonetheless to make a common case for a palpable shift in the United States in the structuring of self and of social life.

Haraway contrasted an easily recognizable modern order of health—centered on the individuated organism and its reproduction and preservation through hygiene, microbiology and its magic bullet therapies, and eugenics—with an emergent postmodern imaginary organized around the play of code and its replication and recombination through stress management, immunology, and genetic engineering. Tuberculosis was an exemplar of the former order; AIDS of the latter. Haraway focused her discussion on what she proposed as a shift in immunological understanding correlating with a "late capitalist" episteme: the turn from a passive, defensive, hierarchical self awaiting invasion from foreign bodies it then sought to identify and destroy, to an active network endlessly producing all possible forms of recognizable difference within itself, anticipating as it were any external threats by constant self-monitoring. Both imaginaries are warlike, but there is an intensification from the clear battle lines ("Second World War") of the earlier moment to the dispersed and panoptic "Star Wars" of the later one.

Martin's argument is lengthier and her data complex, but it parallels Haraway's in differentiating a Before (the time of polio, in which Cold War metaphors of defense dominated immunological thinking) and After (the current time of AIDS, in which neoliberal metaphors of flexibility and intricately linked systems dominate). Both authors take the truth games of the...