Life-making occupies the biomedical imaginary in late Western liberalism.1 Life-making encapsulates all those contemporary efforts to make people live more—to exponentially expand their capacities for life, to optimize and extend what counts as life, and to encourage people to pursue positive life-enhancing practices. This quest for more life can be seen across a range of activities, practices, and technologies that compose what we name biocultures in the United States: those cultural spheres where biomedicine extends beyond the formal institutions of the clinic, the hospital, the lab, and so forth and is incorporated into broader social practices and rationalities. Biocultures foreground the pursuit of life and are linked to contemporary biomedicine and public health, operating at the individual, collective, and institutional levels. Biocultures are enmeshed with the biomedical pursuit of fostering biological life—understanding, treating, and preventing disease—and, within biocultures, life is increasingly viewed through the lens of biomedical logics, innovations, and possibilities.
Biocultures thus highlight how biomedicine has become central to everyday life—our relationships to self and to others. For instance, we now track our steps, sleep patterns, and caloric intake. We survey and monitor ourselves for the smallest signs of illness or bodily anomaly. We anticipate potential futures of disease and take on broader health directives as personal pursuits. We share and compare our health status, and this status has become a key mode through which we understand ourselves and our relationships. As Nikolas Rose has stated, “biomedicine . . . has thus not simply changed our relation to health and illness but has modified the things we think we might hope for and the objectives we aspire to. That is to say, it has helped make us the kinds of people we have become.”2 These everyday understandings and experiences of health are shaped by the broader biomedicalization of the U.S. social landscape, where almost anything now is cast as a biomedical problem.3 According to Adele Clarke et al., biomedicalization involves a heightened focus on risk and surveillance, the increasingly technoscientific nature of biomedical practices and innovations, the privatization and corporatization of biomedicine, and the increase in production and transmission of health/medical knowledges across multiple arenas of society.4
The life-making pursuit within biocultures seems like a profoundly positive venture. However, this book insists that life-making is inseparable from relations of power. While life-making clearly affirms life, this affirmation of life—and the effort to make people live more—is regulatory. In other words, life-making operates as a regulatory politics of affirmation.5 Life-making governs by orienting people toward certain ways of looking after themselves, particular goals of health, and constrained understandings of body and self.
To examine the governing functions and regulatory nature of life-making, we draw on the work of Michel Foucault. Foucault uses the concept of government broadly to encapsulate various ways that humans are guided: rather than being restricted to management by the state or an administration, government also addresses “problems of self-control, guidance for the family and for children, management of the household, directing the soul, and other questions.”6 Foucault deploys the term life to refer to the conditioning of biological capacities of the individual and the population and how these capacities are inextricable from the logics of governing. Foucault does not propose an ontology of life; rather, his concern is how biological life comes to be known and conditioned through various mechanisms and techniques—power/knowledge relations—that constitute a specific modern form of power Foucault named biopower. Within biopower, “life” emerges as central to political strategies: biopower operates “to incite, reinforce, control, monitor, optimize, and organize the forces under it: [it is] a power bent on generating forces, making them grow, and ordering them, rather than one dedicated to impeding them, making them submit, or destroying them.”7 This biopower, as Foucault tells us, has assumed two basic forms.
One form, which Foucault called biopolitics, focuses on the level of the population. It is “the series of governmental strategies centered on this new concept called ‘life.’”8 Biopolitics thus marks the historical rise of biological life as the object of state calculation and strategy, which takes “the totality of the concrete processes of life in a population . . . [as] the target of . . . security.”9 This modern and productive form of power historically entailed establishing regulatory controls over a range of biological processes (birth, mortality, disease incidence, and so forth) so as to regularize the population, curtail unpredictability (in terms of disease, disasters, epidemics, etc.), and achieve stability across the population. Biopolitics, then, refers to the series of techniques, technologies, relays, and operations that, in Foucault’s intriguing words, “make live.”10 In its most basic formulation, the function to “make live” within biopolitical operations concerns the managing and fostering of life in its generality. It is the calculated management of life that engenders and develops life in certain directions to produce and enhance capacities: “to improve life, to prolong its duration, to improve its chances, to avoid accidents, and to compensate for [its] failings.”11
The second form of biopower, which Foucault called discipline (or, alternatively, the anatamo-politics of the human body), operates inside institutions, focuses on individual bodies, and takes the individual body as a target to produce a docile, useful, productive subject.12 Discipline refers to that set of practices that endows the individual body with capacities and “‘makes’ individuals; it is the specific technique of a power that regards individuals both as objects and as instruments of its exercise.”13 Individuals are both the target of disciplinary power and its vehicles, in that they reproduce it through incorporating discipline into their formation of self. This body that is individualized, and the individual that is made, emerge in relation to sets of norms and normalizing technologies. In this emergence, the subject actively participates in forming the self in line with norms.14
Biopolitics uses, infiltrates, and embeds itself into disciplinary techniques15—obliging individuals to enter themselves into the discourses of “life” so that they can then be advised how—through discipline—to lead a life, conduct themselves, and care for the self.16 The “ends” of this form of biological governing concern the control, stabilizing, and improvement of life. In other words, to “make live” becomes a biopolitical—and then often disciplinary—imperative.17 The individual is reworked with respect to the population for certain normalizing (and standardizing) ends, as a living being that is prosperous and productive for society.18 Conversely, subjects become invested—entering themselves to this governing function of biopolitics—“if . . . [they] want to be protected, assisted, taken charge of—if, in other words, . . . [they] want happiness and well-being. . . . The state of prosperity will be the rallying cry of all the discourses and practices affiliated to this form of power.”19 Biopolitical “make live” logics are thus transposed into various forms of discipline.
In short, biopolitics affirms life through the imperative to “make live” and can thus be said to be a politics of affirmation. It orients the biological—living beings—toward life in a regulatory fashion. As such, this affirmation cannot be seen as neutral or liberatory; it is not necessarily “good.” Rather, it is crucial we recognize that life can only exist under certain conditions; it is contoured in particular ways; and some ways of living, not to mention forms of life, are valued above others. Foucault famously referred to the stratification of life-making in terms of a “make live/let die” relationship.20 Life-making is “known” and configured as ontologically good because affirming life has traditionally operated to protect the population from risk, to guide the health of individuals toward a standardized norm, and to foster the lives of the individuals who comprise the nation. However, the twin operation of let die reveals that such life-making actually augments social disparities and, in its extreme, kills. Not all forms of life are fostered equally; indeed, the life possibilities of some are produced through limiting the lives of others. According to Foucault, “letting die” is integral to the biopolitical imperative to “make live” and entails various operations of abandonment, negligence, and oversight: “in modernity, making live and letting die become logical correlates.”21 Owing to the vicissitudes of resource allocation and social stratification, some are made to live (more) at the expense of others.22 There are clear disparities in the possibilities for health and life produced through the structural and ideological workings of race, class, sexuality, gender, and other geopolitical and geographical specificities. Such inequities in the ability to pursue life or to have one’s life affirmed have been theorized in a range of ways—as social death, premature death, slow death, and—as we argue in this book—deadly life-making.23
This book uses the phrase deadly life-making to examine the centrality of “letting die” to “making live” and the unequal enhancement of life under biopolitics; it insists that we recognize death is always inside life and inextricable from processes of life-making. Three forms of “letting die” shape the terrain of the contemporary U.S. biocultures that we analyze throughout this volume: these are not discrete but mutually condition one another.24 First, life-making practices can obscure death: the very processes that affirm life can invisibilize the deaths that continue to occur despite efforts to make live; or, due to the focus on enhancing the lives of one part of the population, other segments of the population and their limited life chances are ignored. Additionally, those who live in the folds of death—vulnerable individuals or those facing imminent death—are often overlooked. Second, life-making practices can create deathly conditions (that might also be obscured), such as reproducing inequities in prevention, access to health services, and treatment—at policy, political economy, and institutional levels; addressing risk as a bodily property rather than as socially produced, thus allowing the causes to continue; and designating certain individuals and communities as higher risk and/or risky and therefore in need of separation, leading to inadequate or rationed care. Third, efforts to “make live” can produce death and/or death effects: the very operations that are ostensibly said to make people live can kill; certain individuals and communities are subject to even more precarity, leading to exponential deaths of some over others; taking a predominately biomedical approach to health obscures the political economy of health, which, in turn, precipitates more deaths. Importantly, our understanding of death here is informed by Foucault’s dictum: “when I say ‘killing,’ I obviously do not mean simply murder as such, but also every form of indirect murder: the fact of exposing someone to death, increasing the risk of death for some people, or, quite simply, political death, expulsion, rejection, and so on.”25
We look at these death-in-life dimensions in U.S. biocultures specifically in the context of what Melinda Cooper names “neoliberal biopolitics.”26 For our purposes, neoliberal biopolitics functions within the broader historical terrain of late liberalism and may be characterized by the following logics and practices: a declining welfare imperative, the increasing absence of the idea of society or of a collective social good, and a heightened individualizing of the administration and management of life and risk (in contradistinction to an earlier regularizing of life and collectivizing of risk). In this context, biopolitical operations continue to structure the politics of life in the United States, but often with specifically neoliberal rationalities and policies. While people are called on to participate in life-making as if it were unquestionably good, the operations of “make live” are attenuated and/or redirected: neoliberal biopolitics fosters health and life in relation to market logics, intensifies speculation in ways that gamble with life-and-death stakes of biological existence, and places the onus for health on the individual. The individual now is positioned as solely responsible for being healthy and maintaining health, and those who fail to “live properly” are often not supported and/or denigrated.
Moreover, rather than standardizing, normalizing, and protecting the life of the population, neoliberal life-making, in the context of biomedicine, customizes biological life—reworking it beyond its perceived limits—and, more broadly, capitalizes on the life opportunities of diverse populations and individuals. Such operations can be linked to changes in biomedicine itself. In contradistinction to an earlier welfare-oriented health arena, the latter half of the twentieth century—what is called the neoliberal era—has seen a modification and transformation of biomedicine: there is an increased focus on customizing the body rather than normalizing; there has been a rise of an all-encompassing and pervasive regime of “health”; and life has been geneticized and molecularized, leading to expanding opportunities to further individualize life and intimately govern everyday life. Moreover, we see an intensification of efforts to generate value through processes of both “making live” and “letting die”—particularly in relation to the corporatization of health care and biomedicine. Rather than warding off risk, precarity and the contingencies of life and death become opportunities for financial gain, cost–benefit efficiencies, heightened individual and group administration, and the hierarchical ordering of social groups. In short, under neoliberal biopolitics, health care and biomedical technologies are increasingly financialized and customized in ways that risk further stratifying life based on race, class, gender, disability, and so on.
This book foregrounds how these specificities of neoliberal biopolitics—particularly as they relate to biomedicine—contour both life-making practices and processes of letting die in key biocultures of the United States. We focus on the United States precisely because of the prominent ways that neoliberal rationalities and policies operate in/through biomedicine and health care provision in this arena—which models effects that are present or developing in other national contexts to varying degrees. Moreover, we are interested in life-making as a mode of governing in the United States because of the complex ways that “affirmation” works in the American context, which contradictorily advocates “freedom” and “happiness” as cultural goals within a larger endorsement of competition, scarcity, deservingness, and violence. In other words, U.S. neoliberal biopolitics imbricates make live/let die in complex ways that exacerbate inequalities and exclusions under liberalism. Finally, the diversity of U.S. biocultures reveals complex convergences of culture and biomedicine that scholars and students may find instructive when investigating non-American biocultural arenas—that is, potentially similar to and/or influenced by the United States in the geopolitics of global health policy and wider developments of biocitizenship on local to international scales.27
Our analysis features biocultures as an arena and methodology. Biocultures address a particular health issue terrain, and each is delimited by a set of knowledges as they are bound up in specific practices and relations of power. Each bioculture we examine here is structured through a central affirmation—an ostensibly positive “truth claim”—that regulates and intimately governs that sphere. That affirmation organizes the social in relation to that particular sphere (i.e., individuals, goods and services, infrastructures, etc.) and the biological materiality of the body that is the object of that sphere. Affirmations guide and discipline individuals, communities, and polities in relation to a particular biomedically framed problem or issue; each affirmation we look at affirms life, yet does so in a constrained way (precisely because it is a truth claim—a limited way of understanding something). Thus we look at the deathly dimensions of these affirmations as they operate in specific biocultural arenas: those related to cancer, racial health, obesity, stem cells, aging, and corpse disposal.
Biocultures are composed of numerous actors—the “subjects” of the bioculture—such as clinicians, policy makers, health care providers and industry partners, media and advertisers, social organizations and community actors, activists, artists, and other individuals. Biocultures operate across scales, from the individual biomedical subject or consumer to broader biomedical logics and governance. Within biocultures, specific technologies and techniques—that is, clinical directives and protocols, policy goals, economic formulas and tools—are deployed to speak about the subject or self of the particular bioculture and to structure/govern its existence, giving rise to counter–truth claims that contest these dominant technologies and techniques. In looking at biocultures, this book prioritizes an intertextual reading between various kinds of cultural products, knowledges, practices, and “the real.” Our readings cross scales of analysis and spaces of investigation—from the cellular to the body, the clinic, and national public policy—because the affirmations that we examine traverse and govern these sites. In doing so, we refuse a distinction between the “bio” and the “cultural,” instead highlighting that the body and culture are never separate and that the biomedical arena and cultural practices are linked and mutually influential.28 As we note further in this introduction, Deadly Biocultures engages with the growing literature on biocitizenship, biosociality, bioeconomy, biovalue, and biofutures; our focus on biocultures—their affirmation of life and attendant deathly effects—both draws on and contributes to these already circulating conversations that analyze ways of being and new regimes of governing through the lens of bio. The bio- prefix simultaneously refers to the biological material body and the ways this materiality is inextricable from broader political economic relations and social transformations.
In the chapters that follow, we consider the deathly conditions of contemporary life-making through investigating five key affirmations that circulate in particular U.S. biocultures: the affirmation to hope, the affirmation to target, the affirmation to thrive, the affirmation to secure, and the affirmation to green. Each individual chapter of this book takes a particular life/death arena as its point of analysis and charts how that sphere is contoured and governed—in terms of neoliberal biopolitics and discipline—via one of these particular overarching affirmations. We demonstrate that the affirmation at work in these biocultures simultaneously affirms life and produces deathly conditions or death itself—to limit, curtail, forestall, or inhibit life. Given the imbrication of death-in-life—specifically in life-making practices and techniques—the five chapters call for a politics that is attentive to death, wherein death and forms of death-in-life are recognized as both the product of life-making practices and rhetoric and a potential social platform from which to affirm a different ethics or way of living. Coupled with the analysis of deadly life-making, then, each chapter also considers a politics or ethics that would be more attentive to the way life is disproportionately arranged and questions who is being “let die” and on what terms. Each chapter proposes how to activate that recognition of death-in-life as a vehicle for social change. This includes what we call alternative biocultures/biofutures—other ways that race, class, gender, age, sexuality, and disability might be mapped onto or intersect with biomedicine—and resistant individual practices and social forms that range from what might be thought of as abolitionist biomedicine to performances of irreverent vulnerability.
Chapter 1 explores how the affirmation of hope is used to orient individuals and the population more broadly toward vigilant survival following cancer diagnosis—to persist and affirm life through the individual and collective deployment of hope. Specifically, we argue that hope is framed as the principle affective means through which to fight cancer. Our central claim is that such fighting through hope, as seen in the endless pursuit of the biomedical cure and the “war on cancer,” is never simply benign. Instead, dominant affective conventions of hope—that is, the perceptual, emotional, and corporeal modes of managing and responding to events—perform an intimate governing function within biocultures, at the scale of both biopolitical management and individual discipline. We argue that hope conditions (disciplines and regularizes) responses to bodily vulnerability and uncertainty and affirms life in ways that reproduce dominant bodily norms and that exclude or preclude the acknowledgment of vulnerability and the reality of death.
We ground these claims in an investigation of cancer activism and treatment and mark the ways the affirmation of hope has shifted from earlier national protection efforts to an individualized/biologized disposition and activity—specifically in relation to breast cancer. We show that in late liberalism, hope has become simultaneously commercialized mass spectacle and an optimistic—and at times militant—enterprise. The chapter details how hope is actively made and maintained within cancer-related biocultures—via what we call spectacles of hope, infrastructures of care, and bioethics of faith. Through case studies of practices and enactments of hope—from hospital architectural aesthetics to cancer-simulated video gameplay—we show that individuals who do not (or are not able to) embody dominant modes of hope, and thus fight cancer in a way that resounds in popular discourse, are framed as failed or negligent and invisibilized or abandoned within the cultural realm. Moreover, the insistence on hoping for the biomedical cure precludes a social justice approach that would actually apprehend the environmental, class-based, and racialized causes of cancer incidence and deaths. The chapter concludes by considering how individuals find other ways to live with and die from cancer, not through forsaking hope but through developing and practicing alternative hope tactics—“hoping for other things”—in relation to cancer.
Chapter 2 addresses the affirmation to target within the context of race-based health. Target technologies are ostensibly deployed to affirm life: they are said to enable the tailoring of biomedical attention and are advocated as the means through which to biopolitically foster the health of particular populations. While the chapter highlights the history of race-specific governing of health, we focus on two contemporary target technologies: the first race-based pharmaceutical—BiDil—approved by the U.S. Federal Drug Administration in 2005 and marketed as a drug specifically for self-identified black subjects that suffer from heart failure, and medical hot-spotting, a practice that began in Camden, New Jersey, in 2007 and that uses GIS technologies and spatial profiling to identify populations that are using health care resources at exorbitant rates (i.e., “super-users”) to facilitate preemptive care. We argue that, despite efforts to ameliorate health disparities, targeting further subjects racial minorities—and specifically black subjects—to enduring inequities/iniquities and the cost–benefit logics of the U.S. health care system.29
We examine this argument across two scales: the administrative biopolitical level, where racialized bodies are demarcated in space as targets requiring biomedical intervention, and the embodied level, where individual bodies and communities are disciplined through these technologies to racially target themselves and to embody race as a biological ontology. Our central claim is that race-specific pharmaceuticals and medical hot-spotting position race as a proxy for corporeal/genetic truth, geopolitically delimit life, and threaten to make health and other social inequalities even worse. In the case of BiDil, race is ontologized as/for a market; accumulation is achieved through customization. Medical hot-spotting, by contrast, ontologizes race in/as space to secure cost efficiencies in the U.S. health care system and minimize uncompensated-care debt. While these target technologies are said to promote the life of vulnerable populations, they also limit how that life can be lived—whether through logics of spatial apartheid or of structural abandonment. What is called for is an “abolitionist biomedicine” that recognizes and seeks to challenge the multifarious ways that race is ontologized as a corporeal and/or spatial truth while attending to the very real embodied effects of structural racism.
Chapter 3 analyzes the affirmation to thrive in relation to fatness/fat and the accompanying “economy of fat” in two biocultural domains. First, we look at biomedical and public health practices that work to eradicate fat from the body—wherein obesity is framed as resulting in an individual’s “failure to thrive.” Various neoliberal biopolitical and disciplinary techniques—from healthy school lunches to fitness campaigns and surgical interventions (gastric banding, bypass, or sleeve surgeries)—are lauded as both reducing surplus fat and helping people to thrive: to live more. As we show, however, biomedical and public health approaches can simultaneously advance and compromise obesity reduction. They generally fail to address the structural conditions that produce obesity and make it an “unequal opportunity disease.” Furthermore, in not addressing structural conditions, these approaches can sustain (and are at times complicit in) the prevalence of obesity and industry/private-sector exploitation of fatness—where the fat body is commodified as a source of value with infinite cash-generating potential, whether through the fast-food or the diet and fitness industry.
Second, we examine the rise of fat harvesting in regenerative medicine. In this domain, fat (adipose tissue) is harnessed and instrumentalized as a form of biovalue that can generate more life, precisely because it has been identified as a rich source of multipotent stem cells that can be directed to grow into bone, cartilage, and tissue. As such, fat promises to become the “gold standard” in corporeal repair and is being cryopreserved (in the form of fat banking) in anticipation of future applications. Yet, while the thriving of fat—through stem cell proliferation—represents a new horizon in the biomedical fostering of life, only those already privileged within circuits of capital can access these technologies. Moreover, cells might proliferate too well, and their excessive vitality might result in the material emergence of cancer. The fat cell, as we see, is differently valued according to the body in which it is located. Furthermore, it at once represents the impediment to and means through which to thrive, and in both domains, fat kills or is said to kill—but offers the material ground for exploitation. We explore what ethical avenues might be available for recognizing the death effects of the affirmation to thrive and call for more inclusive and socially accountable ways to thrive.
Chapter 4 explores the affirmation to secure the life of the aging subject and to secure against aging and decline. In biocultures of aging, to “secure” refers to safeguarding individuals against the ravages of old age. But aging and old age have long been associated with dependency, pathology, and declining productivity and are tethered to ideas of fiscal burden and national decay. Aging therefore functions as a broader security problematic for biopolitics, inspiring strategies that enhance the population and the individual’s capacity to live more and age successfully, and that separate out bodies in decline and secure against the costs of dependent aging populations.
The first part of the chapter examines efforts to secure “aging well.” On one hand, this entails the interrelated promotion of longevity, independent living, and functional aging that ostensibly enable individuals to maximize “third age”—a life-phase/stage in which older individuals are able to partake in an active, personally fulfilling, healthy life after the constraints of work and child-rearing. On the other hand, we observe the biofinancialization of old age: reducing life to a funding problem through economic thinking to assess the burden of “age-related decline” and preempt the cost of age-impaired states of the population. While by no means an exhaustive account of the dynamic biocultural arena of aging, these cases map how the affirmation to secure “aging well” supports and organizes particular kinds of aging and life maintenance; we highlight the social costs of promoting third age and ways that biofinancializing old age may discount and imperil certain lives.
For the second part of the chapter, we consider forms of “governing decline” that stretch into the very last moments of life and structure expectations of “what should be done” for and to the elderly. We examine two key areas of the governing of age-related decline: first, the relentless biomedical efforts to extend the lives of ailing older individuals—the logic of “more life at any cost” and its limitations—and second, the economic rationalities that condition the treatment of older individuals and the regimes of care in the extrabiomedical environments of nursing homes and hospice care. We argue that rather than securing the lives of those on the event horizon of life, these extrabiomedical sites can be considered “shadowlands,” where those in deep old age are subject to forms of “deadly care” and often abandoned. Concluding the chapter, we ask, what alternative biocultures of aging might exist or be imagined to reaffirm aging based on more positive understandings of dependency in older age and vulnerability as integral to life and social relationships?
Our final chapter shifts to the neoliberal biopolitical relations of life-making and “letting die” in what may seem at first an unlikely biocultural arena: the afterlife of the dead human body. Chapter 5 thus moves more fully into extrabiomedical spheres to critically survey contemporary disposal technologies and commemorative efforts that seek to “green” the dead human body, from recycling body parts to returning the corpse to nature. These practices—operating under what we see as the affirmation to green—extend the biomedical truth discourse of affirming life by affirming the “afterlife”: as an opportunity to generate new markets and efficiencies through bioremediation of the body and through the production of legacy for some. The body after death offers an expanded field of material possibilities to convert corporeality into forms of value. In one instance, the body/parts are converted into financial value, and in the other, the corpse becomes a material input for nature and a vehicle for legacy/commemoration that validates the value of a life lived. For our first empirical case, we observe efforts to create new efficiencies in corpse disposal and new markets centered on the material vitality of the dead body. For example, we look at carbon-neutral cremation, orthopedic implant recycling, and body expungement following medical donation/scientific gift. Together, these practices exemplify the pursuit of “no remains” within late liberal biocultures. For the second case, we look at a range of examples—from green burial to eternal reefs and transgenic tombstones—that endeavor to redeem the dead body’s decomposition as natural and reimagine/resituate the body as part of the natural world.
Bioremediation ostensibly demonstrates an ethical and/or economic commitment to affirming the greening of afterlife. At the same time, valuing bioremediation on the basis of greening actually obscures a long history and present application of bioremediation of minorities, women, the mentally ill, the poor/indigent (for instance, the experimentation on racial minorities, biopiracy, the contemporary clinical labor of nonwhite and non-Western subjects). Efforts to put the dead body to work in new ways risk orchestrating efficiencies that legitimate a predatory death industry and the status quo characterized by excessive consumption. Moreover, in the case of greening the disposal of one’s body as a gift to nature and/or sustainable legacy, the underside of this bioremediation is that it further entrenches social position in life: only those privileged in life have control over their own human remains and material traces after death. It is also an act haunted by a legacy of mass disappearance, disposability, and violent human–nonhuman and person–thing social divisions. In response to these practices, we explore an environmental ethics of human remains that contributes to rather than eclipses environmental justice and civil rights projects.
The book’s coda considers the overarching effects of insistent life-making and how we might pursue creative ways to resist/re-work the intimate governing operations of affirmation. We elaborate on what a politics attentive to death might mean and meditate on possible avenues for “living on”—enduring—in the context of deadly life-making.
Throughout these chapters, Deadly Biocultures is in conversation with a rich field of research literature on biomedicine and the integration of the biological body with social, political, and economic relations. As we noted earlier, such research corresponds with what has been a proliferation of conceptual frameworks tied to vocabulary with the bio- prefix in recent decades. For example, Nikolas Rose and Carlos Novas deploy the term biocitizenship to describe an active form of citizenship that has emerged in late liberalism, one that produces new forms of belonging, claims to knowledge and expertise, and access to resources predicated on biological factors.30 Paul Rabinow proposed the concept of biosociality to mark how individuals have now formed social relationships and produced collective notions of identity based on shared genetic or biological conditions.31 Catherine Waldby developed the term biovalue to explain “the yield of vitality produced by the biotechnical reformulation of living processes.”32 She focuses specifically on how biotechnology intervenes between certain living and nonliving systems such that “new and contingent forms of vitality can be created, capitalizing on life.”33 Rose later uses the term somewhat differently, to refer to “the value to be extracted from the vital properties of living processes.”34 Alongside the notion of biovalue, Kaushik Sunder Rajan and Melinda Cooper have independently explored the concept of biocapital and enriched our understandings of the imbrications of biology with contemporary conceptions of life and life-forms.35 The proliferation and uptake of these terms indicate the critical importance of understanding the operations of biomedicine and biological materials and new modes of being, socializing, valuing, and governing within society and politics. Each of these terms is a practical tool of thought supported by discipline-specific methods and empirical work as well as cross-disciplinary and cross-professional conversations and research.
Deadly Biocultures moves within these critical traditions to take a broad approach to analyzing the biomedicalization of life. At the same time, it offers a methodology that is distinct from other important accounts of emerging regimes of governing biological life. As we previously described, the book investigates what we call biocultures in late liberalism. This allows us to take an expansive view to the ways life-making operates through linkages between biomedical protocols and practices, social movements, cultural norms around health, and individual choices.36 Our interest in biocultures as a methodology seeks to widen the analysis of neoliberalism and biopolitics beyond a topical concentration on biotech and biomedicine; our aim is to provide a critical tool to examine how biomedical rationalities extend across scales and circulate in wider cultural domains within the United States.
This book is also aligned with contemporary theory and scholarship that addresses the politics of life and death. We draw on empirical case materials that span public policy and campaigns, to drug-sponsored advertisements and video games, to apprehend the messy entanglements of life and death. Our approach focuses on contemporary efforts of life-making that are bound up with forms of death. A number of biopolitical theorists have been attentive to the presence and operations of death in the politics of life. Roberto Esposito, for instance, has argued that biopolitics is characterized by an inherent thanatopolitical logic. Death, according to Esposito, is a structural necessity in the advancement of life, and the protection of life necessarily reverses into the production of death: the advancement of life and its elimination are opposing dimensions in Esposito’s view, and defense and death are key features of modern politics.37 Giorgio Agamben likewise centralizes death in his understanding of biopolitics. He proposes that the politics of life is predicated on a binary or distinction between zoe (bare human life reduced to merely being alive) and bios (the life of humans as rights bearing/as lives worth living). Importantly, for Agamben, bios can be reduced to zoe (where life is abandoned and exposed to death) through operations of sovereign power in states of exception.38 Additionally, Achille Mbembe has provocatively advanced the notion of “necropolitics” to describe the enactment of sovereignty in cases where “the generalized instrumentalization of human existence and the material destruction of human bodies and populations” are the central project of power.39
While acknowledging that sovereign power (as an absolute form of dominating power) may become established (and exercised) through a political order focused on life, this book refuses the idea that life and death are binary or oppositional or that death is exceptional. Instead, it explores how death is folded into life through intimate and often mundane forms of governing. Distinct from efforts to theorize life or death as an ontology and state of being, our methodological attention to biomedical rationalities and modes of governance accounts for the ways different practices of life-making and affirmations of life often produce deathly conditions and obscure death and diverse forms of “letting die.” Thus we follow the more Foucauldian line to focus on death as the contingent underside to the very means of pursuing and maximizing life, where the powers of death are exercised in the “exigencies of a life-administering power.”40 We focus, then, on such contingent operations: forms of vulnerability, death-in-life, and death effects that regularly accompany insistent life-making in liberal democratic regimes.
In this way, our work resonates with research on the racializing dimensions and politics of difference within liberal governance, neoliberal capitalism, and/or biomedicine, such as that offered by Anne Pollock in her analysis of race-based pharmaceuticals as pharmakon—both remedy and harbinger of danger within contemporary marketized healthscapes—and in the emerging literature on the uneven incorporation of marginalized subjects into neoliberal reproductive imperatives.41 Exemplary of the latter is Grace Kyungwon Hong’s work, which focuses on how select modes of minoritized life are invited into reproductive respectability in neoliberal times, precisely to disavow the ongoing and exacerbated production of premature death for others.42 Such analysis complements this volume’s focus on the ways subjects are called on to affirm life and participate in life-making protocols and activities that perpetuate inequities and frequently obfuscate their deathly effects and consequences. More generally, we draw inspiration from Orlando Patterson’s important conceptualization of “social death”43 and see this book connecting with such work as Lisa Marie Cacho’s examination of the ways personhood and rights-based politics normalize social and literal death, specifically “the unchallenged devaluation of criminalized populations of color”;44 Lauren Berlant’s formulation of “slow death” as the “destruction of life, bodies, imaginaries, and environments by and under contemporary regimes of capital”;45 Henry Giroux’s discussion of the “biopolitics of disposability” and abjected racialized populations marked for death; Matthew Sparke’s diagnostic of “biological subcitizenship” and the embodiment of ill health under austerity conditions; and Ruthie Gilmore’s key theorization of racism as “the state-sanctioned or extralegal production and exploitation of group-differentiated vulnerability to premature death.”46
Finally, this book considers alternative biocultures and “living on,” by meditating on death and actions/activisms, policies, and practices that affirm other ways of living and dying—that are unfaithful to the governing logics that we analyze. Our ethical stance is focused on challenging modes of agency and how we are governed—through acknowledging, exploring, and valuing possibilities of “living on” within death-in-life. In contrast to studies of “affirmative biopolitics” that seek to reclaim the power of life from governmental structures—“flipping” the negative diagnosis of the violent and authoritarian potential of biopower—this book examines affirmation as a governing operation that is not inherently good or emancipatory: we do not reinterpret biopolitics affirmatively as a strategy of scholarly ethical intervention but rather scrutinize the complex relationships between “make live” and “let die” through the concrete case studies we present.47 Additionally, an outflow of literature focused on “life” has implemented vitalist or “new materialist” approaches that problematize the boundaries of life and death, the human, nature, and so forth.48 This project intersects with these approaches, in that we are interested in cells, the afterlife of dead bodies, or the vitality of cancer; however, we track the administration of materiality and politics of life—not vitality as an ethical base of life or affirmations of life outside the human. We similarly recognize the reverse ethical move of embracing the “death drive,” such as that presented in Lee Edelman’s work on the refusal of reproductive futurism, and/or rejecting the call to “make live” on the grounds that it produces deathly effects.49 An example of the latter approach is Alastair Hunt and Stephanie Youngblood’s edited volume, which proposes a humanities-led refusal of cultural affirmations of life. While the overall critical position of “against life”—to refuse to theorize collective politics under the sign of life—is important to consider, the effort potentially limits political engagement to a matter of “choice” (i.e., choosing to reject life) and assumes equal access to that subject position without addressing forms of death-in-life.50
In what follows, we do not privilege the life–death dyad but instead seek out the ways that life-making creates better chances for some and affords some people the capacity to pursue or reject more life. The core ethical imperative of this book, then, is to enhance our understanding of the ways people are positioned unequally within biomedicine and its logics, and of how extending more life (for some) obscures deadly inequities. Advancing ethics as a form of critique, in ways that seek to refashion the normative terms of existence, we ask, how might we endure in the contours of deadly life-making?