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Diedrich Diablog Summary

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Hey Reina and everyone! It's time for a Diedrich Diablog Summary! Here I'll take a moment to recount my experience of diablogging.

I actually really enjoy the process of diablogging. I feel that although all readings should be close readings, the diablog forces me to account for my close reading in a particularly productive way. Because we had to post a summary of the reading that attempted to do justice to the complexities and nuances of the arguments of the book, I think I spent more time with the reading thinking about it and generating questions.

It was also really fun to have a discussion on the blog with you, Reina. I wish I'd had more time on Monday to respond to everything and ask more questions, but I feel the discussion was productive and really helped prepare us for class discussion. It also honed me in to different things in the readings I'd missed, or hadn't paid enough attention to, and discussing a reading with others always contributes to everyone's understanding of it, I think. Although it might have been fun to do the diablog with more people, I also liked only doing it with one other person. I think it was more challenging to explore the text with only two people and I feel it pushed me to try to know it better.

It would be really interesting in future to experiment with having a preliminary class discussions about the readings on the blog before the in-class discussion, especially for difficult material. It might help to generate questions about the text and make in-class discussions more lively.

In Diedrich's conclusion, she ends with a discussion of an ethics of the experience of failure (body, conventional/alternative medicine, and/or language) that she reads through two illness narratives. The first is Atul Gawande's Complications that focuses on the doctor side of the doctor-patient binary and the next is Gillian Rose's Love's Work, from the patient's side (148). Diedrich borrows from Lyotard and Scarry's respective works to highlight the "experience of pain" that attempt to draw out methods for "idioms which do not yet exist" (148). Diedrich also lends significant attention to Croce's "the undiscussable" (148-149) as she aims to highlight her own "undiscussable"-the possibility and reality that doctors and their patients may "get things wrong" and thus may not have a language or an ethics of getting it wrong (149). Lyotard's "differend" becomes important in Diedrich's discussion of "unstable states" where something cannot be put into language or phrases. An example of this differend, for Diedrich, is the hyphen that separates the two subject positions in the doctor-patient relationship (150).
Diedrich begins her discussion of the ethics of failure with Gawande's focus in Complications that medicine is an "imperfect science." Gawande's experiential statements assert the "fallibility, mystery, and uncertainty" (150) that surround western medicine. Simply by questioning the credibility and power of medicine, Gawande opens up the discussion to allow for failure. Pointing to the "undiscussable" and "messy" and "uncertainty" that is a reality of medicine, Diedrich calls Gawande's narrative a "differend" (151).

In chapter five of Treatments, Diedrich questions the possibilities and impossibilities of illness narratives to write and read the body. She begins by asking a series of questions about the relationship between language and embodiment within illness narratives. Diedrich asks,
"Is the experience of embodiment determined and structured by language? What is lost in the attempt--the urgency even--to bring the body to language? Can we encounter the body outside of or prior to language? Can we tell stories and bear witness, not only about the body but also through the body?" (115)
The chapter centers on the "telling and listening" and "language memoirs" in Paul Monette's autobiographical accounts on HIV/AIDS and the mourning of his partner Roger Horowitz as well as John Bayley's writings on his wife, Iris Murdoch's, journey with Alzheimer's disease. These narratives offer a critical engagement with language(s) and embodiment.

Treatments, Chapter 2: Diablog, Part 3

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In the second chapter of Treatments, called Politicizing Patienthood: Ideas, Experience, and Affect, Diedrich is most concerned with reading three separate accounts of breast cancer with and against each other in order to evaluate their prospects as effective and/or affective histories and "arts of being ill." She also wants to situate the illness event of breast cancer and the activism that sprung up around it in the 1990's in connection to the women's health movement of the 1970's and the AIDS activism of the 1980's. She credits these movement for bringing about a "politicization of patienthood" which she argues, "brings into being various techniques for doing illness in new ways, and that along with these new forms of doing illness come new forms of writing illness. What Diedrich is most directly referring to, I believe, is the re-positioning of the patient as active and decisive in their own treatment and diagnosis in a way that treated their illness as not only an illness event, but a political event and a call to political efficacy. This re-positioning challenges notions about the "personality" of the cancer patient, and opposing in particular neoliberal discourses which place responsibility for contraction and recovery from illness squarely on the shoulders of individual patients, which Diedrich discusses at the end of the chapter.

Diedrich moves to a discussion of Susan Sontag's work Illness as Metaphor, and writes, "Although at first glance Sontag's work does not appear to be a personal response to her own experience of illness, I argue that it might be read as, paradoxically, a depersonalized personal narrative of illness. In fact, Sontag depersonalizes, and also de-heroicizes, her response to illness in order to, in her view, offer a strategy to others that she believes is most effective in the face of illness," (26).

Sontag, according to Diedrich, wishes to drive out the notion of an inherent moral meaning in illness, to "unify and purify" the language surrounding and experience of illness. She does this in an attempt to free ill persons from the debilitating and mystifying metaphors and stereotypes that surround cancer, such as that there is such a thing as having a "cancer personality." Thus, Sontag's rendering of illness in Illness as Metaphor is purely an effective history, one that is opposed to an affective history. Of course, Diedrich cites several paradoxical readings of Illness as Metaphor in which Sontag's work is read as a thinly disguised, deeply personal work. In a later book entitled AIDS and Its Metaphors, Sontag revisits her earlier work, this time asking the question of what is useful for people experiencing illness - effective or affective histories? Sontag is invested in the use of ideas in and of themselves to combat the darkest fears of those experiencing illness.

Diedrich then moves to a discussion of Audre Lorde's two works, Zami: A New Spelling of My Name, and The Cancer Journals. She maintains that for Lorde, her experience with breast cancer had everything to do with her experience being a poor, black woman in the US. Through making the affective and personal visible through her illness narrative, Lorde is attempting to utilize that experience to produce an effective history, so that other women with her and after her might take something away that enables them to form new, productive political subjectivities. Diedrich writes, "For autobiography scholar Thomas Couser, Lorde's work is particularly powerful because it "shifts back and forth between the proximate and the distant, between the emotional and the intellectual, as Lorde struggles to bring all her resources to bear on a new and frightening challenge" (1997, 50-51)," (36-37). Lorde's illness narrative is thus both and effective and affective history. Lorde sees the transformation of illness and writing about illness and personal experience as an ethical engagement in which one seeks truth and meaning within language, poetic representation, and that opens up space for questioning. She uses her illness and visualization of that illness to incite political militancy and to connect mastectomized women in political movement. "According to Lorde, health is first and foremost a political issue; it is not an effect of or a means to personal happiness," (43).

In her evaluation of Eve Sedgewick's work Performativity and Performance, Diedrich again asserts that Sedgewick's illness narrative constitutes both an effective and affective history. Here she describes how Sedgwick imagines the terms queer, ill, and performative in radical ways. She understands queer, it seems, as a doing, a movement across, "transitional, and strange," and she wants to explore performativity as a "means of "understanding the obliquities among meaning, being, and doing; not only around the examples of drag performance and (its derivative?) gendered self-representation, but equally for such complex speech acts as coming out, for work around AIDS and other grave identity-implicating illnesses, and for the self-labeled, transversely but urgently representational placarded body of demonstrations" (2)," (45). Diedrich goes on:

"For Sedgwick, exploring the connections (and disconnections) between modes of being ill, the meanings attached to illness, and the politics surrounding illness (that is, between forms of meaning, being, and doing that surround the experience and event of illness), requires that she hurl her energies outward into new forms of representation and embodiment, rather than, as Sontag proposes, inward into a "pure, untranslatable, sensuous immediacy" (1966, 9)," (45). In particular, Sedgwick find shame, a bad feeling attached, "not to what one does, but to what ones is," a "near-exhaustible source of transformational energy'. . . "Shame is productive not only of normalizing identifications, but also of transgressive disidentifications," (46).

In contrast to Sontag, then, Lorde and Sedgwick find that through "mucking about" in the affects of illness one finds new, effective forms of being ill that have the potential to provide space for questioning, transformation, and the politicization of patienthood and illness. Diedrich concludes, "Yes, ideas are useful in the face of life-threatening disease, but so are stories, dreams, and hypotheses about the panic, terror, shame, and the institutional violence that we endure and resist. To queer the experience of patienthood is to "include, include" no to "purify, purify," (48).


QUESTIONS AND COMMENTS. . .

-Is there necessarily an opposition between feelings and ideas as seems to be implied in several passages in this chapter? Do not feelings come from ideas?

-Is it possible to locate ethical/moral meaning in the experience of illness itself? Or is it always in the affective aspects/the doing of experience?

-The narrative/concept/act of transformation plays a central role in this chapter in the kinds of e/affective histories that Lorde and Sedgwick are trying to make. What are we to make of the ethics of transformation? Of practices of the self? What does this say about the self?

Treatments, Chapter 1: Diablog, Part 2

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In the first chapter of her book, Diedrich examines two case studies of illness narratives of tuberculosis in the early twentieth century US: those of Betty MacDonald in her book The Plague and I, a white woman who received treatment for her illness at a top-notch institution called the Firland Sanatorium (the Pines Clinic and Sanatorium in the book), and Madonna Swan, a Lakota woman who narrated her experience of being kept in the Souix Sanatorium near Rapid City to St. Pierre, a pastor in her community. She illustrates the ways in which these two narratives are examples of ". . . the anatomo-clinical method and the two modes of biopower: the disciplining of bodies and the regularization of populations," (1). She also presents these two illness narratives as examples in which the hegemonic structure and categories of the medical industrial complex and US genocide/eugenics are both upheld and challenged through the stories of both women.

Diedrich first launches into an explanation of her approach to the two case studies, using the theories of biopower and subjugated knowledges as posited by Foucault. She is interested in exploring the subversive/productive potential of these two illness narratives as subjugated knowledges (as apposed to hegemonic ones) that position "the patient" in other ways besides the passive body upon which medical practice and theory is inscribed (though this indeed still occurs). She writes:

"For Foucault, the investigation into subjugated knowledges in the past opens up a space for thinking, being, and doing otherwise in the present and future. . . Subjugated knowledges always threaten to disrupt the power/knowledge nexus; they are something of a Freudian "return of the repressed" in terms of socio-cultural rather than individual histories," (2).

She refers this to the "overturning moment" in postmodernity as expressed by historian Michel de Certeau, in which the general, or popular knowledge of the "ordinary" man situates itself within and outside institutional, specialized, and authoritative knowledges. She also writes that Arthur W. Frank says, in his book The Wounded Storyteller, that the "proliferation of illness narratives from the patient's perspective is a necessary counternarrative to the narratives of doctors and other medical professionals. . . he [Frank] identifies the figure of the "wounded storyteller" as having emerged in postmodern times, because in postmodernity, "the capacity for telling one's own story is reclaimed" (7)," (2). Continuing with Frank, Diedrich writes how he explains that the modern experience of the patient is much different from the postmodern experience of the patient. The modern patient, Frank tells us, assumed the "sick role" characterized by absolute passivity and surrender to medical practices and technologies. The modern focus on acute illness meant that patients generally recovered or died. The postmodern patient, in contrast, is characterized by chronic illness, someone who negotiates the space between health and illness. Frank calls this a "remission society." Here Diedrich writes, "In a "remission society" the boundaries between health and illness are permanently disrupted, thereby challenging the dichotomous formulation of health as the norm and illness as that which deviates from the norm," (3). She writes that Frank argues that contrary to the postmodern proliferation of the illness narrative signaling an evacuation of ethics and a move towards a relativization of the experience of illness, it rather signals a "radical democratization of medicine."

Diedrich moves to an explanation of the mechanisms of the anatomo-clinical method and its relation to biopower through a discussion of the terms Foucault opens his book The Birth of the Clinic with: space, language, and death. Foucault's description of space is both an internal and external space: the space of the body as internal, and that of the clinic which is external. These spaces form the venue for the unequal meeting of doctor and patient, in which the "pathological fact" is located in the patient by the doctor, thus individualizing the patient as a body only, rather than as a subject of the experience of their illness. Foucault's second term, language, is explained through the way the doctor moves from examination to interrogation, and "makes the body speak," as it were, its pathology. Here, though the patient may speak of their illness, it is not their voice that matters, for nothing but the doctor and, supposedly, the body, speaks in the true, initiates-only language of modern medicine. Thus, the doctor resembles a "speaking eye" that interprets the objects of the patient's body and words into a pathological fact. Foucault's third term, death, becomes clear from the point that what matters is not the words of the patient but the doctor's interpretation of the patient's abstracted body. However, the uncertainty of the pathological fact present in a living patient can only truly dissipate upon the patient's death, at which point the corpse could be made to tell all of the body's internal workings. Foucault marks these medical developments within a larger philosophical development, in which the individual could now "be both subject and object of his own knowledge" (197)," (6).

Diedrich then moves to the next subheading in the chapter: Tuberculosis as Experience and Event. Here she summons the work of Anne Hunsaker Hawkins, who coins the term "pathography" to describe illness narratives. Hawkins defines the term "pathography" as, "our modern detective story," where we are transported out of the everyday, familiar world of health into the unknown, uncharted world of illness (1)," (6). She says that Hawkins draws a parallel between illness narratives and older narratives of religious conversion, ". . . what she identifies as the "myth of rebirth;" that is, that the experiences of religious conversion and of illness afford "a process of transformation so profound as to constitute a kind of death of the 'old self' and rebirth to a new and very different self" (33)," (7). Diedrich wants to illustrate how tuberculosis is both an experience of those afflicted with it and in what ways it is an illness event that differs dramatically based on the context in which it takes place. She also situates the telling of both women's stories as two separate events. Whereas MacDonald's story was published shortly after her discharge from the sanatorium, Swan's story was published much later, and she did not write it, but told it to St. Pierre, who therefore had a definitive and ultimate role in how the story was told. "Tuberculosis as experience and event comes into being through the various spaces, objects, and people associated with its diagnosis and treatments," (11).

Diedrich draws out the parallels between Foucault's anatomo-clinical method and the experience of MacDonald at The Pines. While The Pines itself is quietly sequestered from the general population, the clinic in which MacDonald is first diagnosed with TB is part of the same complex of buildings that houses a jail, police station, emergency hospital, and venereal clinic, ". . . the link between criminality and disease is designed into the architecture of the building itself," (10-11), showing the spacialization of criminality and disease in this illness event. At the Pines itself the doctors are illusive at best, engaging in little if any direct dialogue with MacDonald about her treatment and progress. Indeed her discharge from the sanatorium was unexpected - her doctors did not update her on her progress. The privileged position of being a patient at The Pines required adherence to a strict "new regime of living" that required absolute, rest, absolute inert docility of the patient, which MacDonald notes extended well beyond the time one actually spent at the sanatorium. This "technology of the self" required first and foremost a disciplining of the mind before that of the body. Diedrich writes, "The ability to monitor oneself effectively indicates one's desire fore health and, and one's desire for health indicates one's fitness for citizenship in a normalizing society," (13). Here we see not only the external space of the clinic in connection with deviance, but also the internal space of body, disciplined into an almost death-like posture, enabling the professionalized eye of the doctor to speak of the immobilized body, and thus also to make the body speak through compliance to a "regime of living." Diedrich also cites MacDonald's acknowledgement of the inevitable failure of TB patients to completely adhere to the tuberculosis routine as a possible proto-ethics of failure. MacDonald's experience is certainly illustrative of the disciplining of bodies described in Foucault's biopower.

Madonna Swan's experience and illness even, in her initial diagnosis and the time she spent in the Souix San, in contrast to MacDonald's experience and illness event, was characterized by the widespread death of other Lakota in a place to which they were sent to die. MacDonald describes this as being parallel to Foucault's assertion that the nineteenth century saw a shift from the "right of sovereignty to "take life or let live" to a new state right to "make live and let die" (241)," (17), though I would contend that "take life" is probably still appropriate in this instance. She describes TB as being a disease "endemic," in the Foucaultian sense, to indigenous populations, as death which, rather than being an event, becomes part of the backdrop of everyday life - it gnaws and saps at the general community. The eugenic intent of this massing of TB positive indigenous people together in a virtual hospice is the regularization of populations of Foucault's biopower. While Swan does survive her stay at Souix Sans, it is only when she is accepted into a white sanatorium that she begins to recover.


COMMENTS AND QUESTIONS. . . .

-Diedrich wants to challenge the binary between health/illness. How does she accomplish this/fall short? What nuances of this binary does she draw out here?

-Diedrich cites the tuberculosis routine describes by MacDonald as an ethical technology of the self. What might she mean here? Can we connect this to Foucault's virtue ethics?

-How does ethics and ethical practices of self making encompass both life and death in these case studies?

Treatments, Introduction: Diablog Part 1

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Hey Reina and everyone! I hope you're all well, especially in light of this somewhat gloomy reading about deadly illnesses.

Anyways, I thought I'd open open our diablog discussion by covering the introduction through the first two chapters. I'll provide a summary of each in separate blog entries and after each I'll provide a little subsection with connections made in the readings between chapters and authors, and with questions and comments about each chapter that we might use to structure discussion on Tuesday. I thought perhaps we might best carry out our dialogue through comments under our blog entries.

INTRODUCTION

In the Introduction to her work Treatments: Language, Politics, and the Culture of Illness, Lisa Diedrich states:

"I explore the ways that illness narratives can be read as symptomatic texts of our time in at least two respects: as texts that literally describe symptoms (and struggle with finding a form to describe the affective and physical experience of symptoms), and as texts that describe illness as an event that goes beyond any particular individual's experience and account of it, reflecting wider cultural categories, including race, gender, class, and sexuality," (vii).

In the first sense of reading memoirs of illness as the struggle to describe the affective and physical aspects of illness, Diedrich wants to explore the prospects of "the gap" between "words and things," expressing the lack of words to make "accurate" or truthful representations of things. In particular, she wants to move toward an exploration of the prospects of the act of writing as a negotiation of such a gap, as an "art of self making" (borrowed from Foucault's "technology of the self" as an ethical act) that utilizes both language and sensory experience to produce both effective and affective change and experiential histories (as indicated in the second sense of reading memoirs of illness as events which go beyond one's personal experience). She asserts that the utilization of experience through the particular art of self making that is the memoir form is not always simply being an act of fishing for pity and attention. Rather, it is not only useful to the healing process of those with deadly illnesses, but in effecting political change that addresses the hegemonic subjectivities of patients and figures of authority in the medical industrial complex along the lines of hegemonic categories of sexuality, class, race, and gender, to name a few.

Diedrich goes on to describe the interdisciplinary nature of her engagement with memoirs of illness:

"In her book Ghostly Matters, Avery Gordon quotes Ronald Barthes on interdisciplinarity: "Interdisciplinary work, so much discussed these days, is not about confronting already constituted disciplines (none of which, in fact, is willing to let itself go). To do something interdisciplinary it's not enough to choose a subject, a theme and gather around it two or three sciences. Interdisciplinary consists in creating a new object that belongs to no one" (Gordon, 1997)," (vii-viii).

I find this quote from Gordon (from Barthes) compelling, as it seems to reflect the nature of that with which Diedrich is struggling in her book and expressed in her first sens of reading memoirs of illness as the negotiation of the gaps inherent in the attempt to represent some "thing." The negotiation of the ill person between boundaries of health/illness, patienthood (victimhood)/warrior (agent), and across hegemonic social categories seems to be an experience that does not, shall I say, make one feel comfortable in one's own skin. Rather, it pushes one to the limits of what can endure, physically, intellectually, emotionally, and politically, and confronts one with the limits of their own mortality. Diedrich contends that the "art of being ill" that memoir is a part of is a radically transformative practice, both for those writing memoirs and those reading them. Thus, it seems an interdisciplinary approach is the only approach for an engagement with such transformative material, as Barth implies that interdisciplinary work is all about confronting head-on the limits of one's own knowledge and ways of knowing, not to bolster a comfortable sense of owner ship in one's own disciplinary field, but to develop common ground that negotiates distance and creates new languages.

Diedrich deplores the backlash wave of condemnation of memoirs of illness she cites as being all too common in contemporary criticism, and seems baffled by accounts of experience-based writings and performances as "unmediated self indulgence and self pity." Such works, she insists, are hardly unmediated, and to reduce them to self indulgence denies their effective and affective characters and doings. She disagrees with the idea that one cannot judge a piece of writing or performance art that deals explicitly with personal experience, as one would then be forced to judge a person or a person's illness. She cautions that:

". . . to judge a memoir is not to judge a life but to judge a representation, which is always partial and contingent, and determined as much by the reader and what she brings to the text as by the author," (xvii).

Diedrich goes on to explain what she means by memoirs of illness being "effective and affective histories." To do this, she quotes Foucault's (borrowed from Nietzsche) definition of an effective history:

"The problem and the stake [of writing about topics in which Foucault had personal experience] there was the possibility of a discourse which would be both true and strategically effective, the possibility of a historical truth which could have a political effect," (64)," (xvii).

While Diedrich wants to highlight the political and ethical efficacy of memoirs of illness after the fashion of Foucault, she also realizes that Foucault's ". . . work sometimes fails to provide a theoretical and methodological model for reading experiences of loss such as those articulated in illness narratives. . . It is necessary, therefore, to do affective as well as effective history in order to grasp the ways in which the breakdown of the body that occurs in illness provides a phenomenological reduction of of sorts that allows one to look anew upon that which one has formerly taken for granted, in terms of one's relationship to the world, to others, and to the self," (xviii). Thus, "By doing both effective and affective history I approach the figure of the ill person and the writings that emerge out of the experience of illness from, in the terminology of Elizabeth Grosz, both the "outside in," and the "inside out," (xviii). Diedrich uses this terminology to describe the movement in illness narratives between a movement in "(the embodied self in relation to itself and to death) and a movement out (the embodied self in relation to others. . .," (xix).

At the end of her introduction, Diedrich alludes to her proposal of "an ethics of failure" which she develops in the final chapter of the book. She asks, "What aesthetic, ethical, and political practices must we invent to communicate across this incommensurability [between the idioms of medicine, among other things]?" (xxiii). She describes this ethics of failure as the persistence in the face of unknowingness and literal failure, the seeking of new routes, methods, and connection when old ones have died or collapsed. In this gesture, Diedrich hopes to revalue both loss and failure, ". . . the idea that we are fallible, that we get things wrong, that we might not be able to do, [etc.]. . .," (xxiii).

QUESTIONS, COMMENTS FOR MOVING FORWARD. . .

-What might be the challenges of "judging" a memoir, and how is "judging" understood here?

-Diedrich alludes to the effective and affective history of the illness narrative as going beyond one's self and one's own experience of illness. Later she cites Audre Lourde's book The Cancer Journals where Lourde says that her political work around breast cancer and women's health comes both before and after herself. What happens to the self in this understanding of a/effective histories, and what happens to the way personal experience is understood?

-I'm interested in exploring the interdisciplinary nature of "technologies of the self," and the "art of doing illness," through memoir. Thoughts, anyone?

-Where do you suppose the "backlash" against personal, experience based work comes from? What about work done through personal experience produces discomfort? What can be made of the tensions between the neoliberal obsession with self-responsibility, the backlash against the form of memoir, and the politicization of patienthood?

-Can we queer or stir up Diedrich's explanation of the movements from the "inside out" and from the "outside in?"