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Cultural Critique, Number 88, Fall 2014, pp. 203-213 (Review)

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DOI: 10.1353/cul.2014.0030

For additional information about this article

http://muse.jhu.edu/journals/cul/summary/v088/88.mitropoulos.html

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The Impersistence of Life

and Variations of Time:
Prognosis, Dialectics, Mutation
The Already Dead
by Eric Cazdyn
Duke University Press, 2012
Angela Mitropoulos

Eric Cazdyns The Already Dead ends on that most perilous but enigmatic of notes, a deep breath suspended in the time and place of letting
go while still holding on, bargaining between terrors and desires, tarrying with the fear of dying for long enough that, just maybe, it becomes
something else. For Cazdyn, that would involve a disposition no longer shaped by the state and, indeed, its hysterical desire for salvation and cure, without abandoning time to an interminable calculable
rhythm (204). This is the inconclusive insight of The Already Dead, an
aporia, if you will. What other kind of conclusion could there be? If this
is not necessarily the condition of all chronic or acute illnesses, I would
agree that this tempo may well describe a crisis that can alsopartic
ularly in the case of diseases whose treatments can be ongoing but
uncertain and ambivalent, such as cancerbecome a grueling tempo
without any apparent respite. According to Cazdyn, this is the deWning characteristic of a new chronic, a mode of time that cares little
for terminality or acuteness, but far more for an underlying present
that remains forever sick, without the danger of sudden death (8). He
deWnes this temporality, which he considers to be both progressive
and debilitating, as an existential mode that privileges management
over change and holds fast to rigid continuities while walking only with
the most tentative and straightforward of steps (17).
In Cazdyns book, the promise of a cure and the routine management of disease are juxtaposed and entangled. These are the organizing
Cultural Critique 88Fall 2014Copyright 2014 Regents of the University of Minnesota

204

Book Reviews

concepts of the text. Throughout The Already Dead, he sets management and cure apart and together; maps that distinction onto that of
reform and revolution; brings it into a conversation with theorists such
as Slavoj iek, Alain Badiou, Gyrgy Lukcs, Kojin Karatani, Frederic Jameson, Michael Hardt, and Antonio Negri; but, above all, retraces
the thematics of cure and management through psychoanalysis. There
being no cure, as yet, in Cazdyns account the Already Dead shufXe
among versions of disease management or fall into the cracks between
them. The walking dead, as it were. In his view, the antinomy of cure
and management feels a whole lot like having to be more or less sick
without ever being cured, much as one might feel reforms are quantitative degrees of better or worse with no prospect of revolution on the
horizon. But I am not so sure. It seems to me that the prevalent methodological options Cazdyn sets outnamely those of immanentist and
dialectical approachesare both interior to a Wnite history of medicine
and science, including the science of revolution, but in no way do
they exhaust that history. Simply put: quantitative understandings of
pathology remain perturbed by the individual case, just as any dialectical or antinomial schema will be fraught by that which is in excess of
any putative epistemic whole.
The contrast between reform and revolution, understood as a distinction between quantitative and qualitative temporal change was signiWcant to a dispute within ofWcial Marxism in the early twentieth
century. I think it could have done with some unpacking. Taken from
the title of a pamphlet by Rosa Luxemburg, the opposition of reform
and revolution has long informed the politics of the Third and Fourth
Internationals, of Leninists and Trotskyists respectively. Cazdyn notes
that Hardt and Negri are loath to accept the easy distinction (Cazdyn,
56). He might have added that this is because Hardt and Negri are the
least Leninist of the Marxists he admits to his theoretical frame and,
more so, because Negri in particular was inXuenced by poststructuralist
philosophies of science in France, such as those of Guattari, Deleuze,
and (less positively, but still) Althusser. In Cazdyns usage, the political concept of a cure aligns it with a voluntarist and evental deWnition
of revolutiona deWnition whose historical speciWcity, inasmuch as it
is not rendered as such, presents as a generalizable desire. In this Wrst
instance, it erases what Paul Mattick called the difference between
[the] jacobinical and the truly proletarian idea of the world revolution

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(5) that exempliWed the divergence between Lenin and Luxemburg. Yet
the Leninist assumption that revolution involved intentionwhich is
to say, the victory of a true consciousness over a false onecould never
give a plausible or critical account of its own history, including Lenins
embrace of Taylorism (otherwise known as scientiWc management)
in the factory, or the Bolsheviks adherence to the form of the nationstate and socialism in one country, any more than it has been able to
offer a critical analysis of the impact of quantitative theories of disease
on the temporal phenomenologies of medical and clinical practices.
Moreover, in Luxemburgs text the salient temporal concepts are not
the decisionist ones of revolution contra reform, as Lenin deWned it.
Despite the title of her essay, Reform or Revolution, the pertinent temporal concepts in the debate between Luxemburg and Edward Bernstein were those of evolution, crisis, and adaptation (Luxemburg). I
am not suggesting that either Luxemburgs, Bernsteins, or Matticks
arguments should or could be uncritically accepted. They are all open
to critical appraisal on a number of counts.
Instead, I would like to illustrate the extent to which the seemingly inevitable or necessary aporetics of The Already Dead (suspended
within the oscillation between pessimism and optimism, or reform and
revolution, management and cure, quantitative and qualitative epistemologies, and so on) has been made possible by the elision of an entire
history of critical debates around (not reform versus revolution, but
what I would characterize as the paradigm of) continuity and mutation
from the books philosophical and political canon. It is not that those
theories are nonexistent. They are present, after a fashion; not least in
Cazdyns book. Luxemburgs emblematic discussion of reform and revolution is a case in point. However when they appear, they do so as
either dialectical swing emptied of reference to its own complex and
Wnite history (including that of Luxemburg herself), or as the phenomenology of an unperturbed immanence. What results is a recursive, selfsame tempo without signiWcant discontinuities between, say, Luxemburg
and Lenin, or (germane to an analysis of both medicine and politics)
between the understanding of Marxism as a science of revolution in
the late nineteenth and early twentieth centuries and critical theories
of science (and medicine) since that time. While Luxemburg and Lenin
differed over the autonomy of the political (over the extent to which a
Marxist science could claim to be unaffected and therefore assume the

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status of the science, a true consciousness, of an intellectual vanguard),

the crucial shift in the philosophy and history of science in the twentieth century turned on the very same question. There have been numerous answers given to this question in various domains, from the work
of Thomas Kuhn to that of Donna Haraway in the areas of science and
technology studies. My intention, though, is not to offer STS as an
alternative but to clarify how concepts and analytical problems have
traversed seemingly disparate domains.
Considered in terms of the speciWc questions Cazdyn poses, the
most remarkable elision in the book is of the work of Gaston Bachelard and, following his, that of Georges Canguilhem. I am not proposing that Cazdyn must agree with either if he does not, and have few
clues as to why he did not engage directly with them. But it is impossible to read The Already Dead and not wonder why, having posed many
of the very same questions that Canguilhem did, Cazdyn opts for those
theoristsnamely, iek, Badiou, Hardt, and (to a lesser extent) Negri
who, notable among twentieth-century Marxists, have been least affected
by Bachelards arguments. BrieXy put: Canguilhem explicitly argued
against a view of life as a time of respite from death (263), whereas
Cazdyn insists that we are already dead, and he does so without
offering any reasons as to why Canguilhems arguments against this
proposition do not hold. Cazdyns delineation of historical shifts through
the use of the term globalization does little to explain or give a better account of the epistemological shifts in medicine that Canguilhem
charted because the problems of epistemology and authorial (or revolutionary) intentionality are intertwined.
Unlike those who regarded the sciences as unconditioned by history or politics, Bachelard insisted that the emergence of new experimental procedures and techniques ushered in new objects, modes of
inference and reference, and an accompanying temporal schematics of
event and duration. This does not suspend or resolve epistemological
questions, as I think do Badious and Lukcss Platonic contention
modiWed by Cazdynthat it is a matter of rearranging the parts of a
whole (Cazdyn, 60). Instead, I would suggest that Bachelards approach
contains a more general materialist proposition about the status of science, without which science (and for that matter politics) would have no
theory of its own historical and therefore mutable, discontinuous conditions. Absent this self-critical check, radical theoryand particularly

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radical theories of biomedicine and associated institutional practices

might well entertain a voluntarist desire for a cure or an evental instance
of revolution or, often at the same time, fall into nostalgia for a time
that never existed. But the dialectical play of optimism and pessimism,
or management and cure, thereby appear as ahistorical conditions by
way of the methodological recursion of aporia that are, as it happens,
intrinsic to a speciWc and Wnite circumstance. To be sure, the predicament Cazdyn describesof an underlying present that remains forever sick, without the danger of sudden deathis discernible as the
experience of a medical regime that has, in some cases, lengthened the
survival rates of cancer patients such that the number of people who
are now said to live with cancer has vastly increased in just the last
two decades. This has had numerous implications, not all of which
could be regarded in the mostly pessimistic terms Cazdyn assigns to
the new chronic. The emergence of a radical politics around oncology is one of the results, including the emergence of, say, critiques of
corporate pinkwashing or activism around health care. But the periodization of signiWcant shifts in either medicine or politics is not accomplished by pointing to globalization, not least because there is no
evidence that capitalism has ever been something other than both global
and national throughout its entire history. The term globalization is
a social democratic periodization that leaves the disposition toward
the apparently protectionist nation-statesomething Cazdyn says he
would like to extricate us fromlargely intact. The general point is this:
epistemological questions involve not only a consideration of what is
known and how, but (as Foucault argued following Canguilhem) of the
powers that install particular regimes of the visible and the sayable.
The more speciWc point, however, is that Canguilhems approach
already situated both evental and continuous time (qualitative and
quantitative differences) within the context of medicine and in the
emerging sciences of the previous two centuries. Following Canguilhem, in Les temps du cancer Marie Mnoret (1999) argued that time,
otherwise synonymous with evolution and therefore mutation, is perceived by patients as both distended (as with waiting for test results)
or reduced with regard to the future. In other words, the phenomenology of the disease involves the tempo of testing, labor processes within
hospitals and laboratories, and so onsome of which Cazdyn discusses in Wne detail, but without engaging previous research on either

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Book Reviews

philosophies of medicine or the procedures of the clinic. The effect is

that the pertinence of those details to theorizing either the politics of
oncology or revolutionary theory are lost in the adherence to a psychoanalytical framework that has no concept of mutationother than
that which Lacan suggested makes the talking-cure possible and impossible, or simply interminable. I should note here that Lacans distance
from Freudparticularly his brief remark on the mutation in the economy of desire in the analyst-to-be (Lacan and Miller, 22021)can be
indexed by his proximity to Bachelard (just as Bachelards distance
from conventional philosophies of science is marked by his work on
the psychoanalytics of Wre). Yet if Lacan borrowed a theory of mutation from Bachelard in order to introduce an element of constitutive
discontinuity in the practice of analysis (as the construction of a desire
proper to the analyst), this renders the symptom as a sinthome and,
I would hazard, in so doing makes possible the continued enjoyment
of a symptom that Lacan implies is thereby auto-immunized from further analysis. If mutations appear at all in psychoanalysis, they do so
as slips, perversions, jokes, accidents on purpose, or, in ieks case, a
swift and plainly self-gratifying lesson in the (dehistoricized) dialectics
of Oedipal recurrence. They are not, as they are outside the (Lacanian
and) Platonic understanding of ideal forms, instants of the discontinuous motion that is integral to all movement, including, I would argue,
the movement that is a crucial part of life and revolutionary politics.
Of course, The Already Dead opens with an exemplary psychoanalytic
joke and concludes with a barely discernible slip. That said, I think
that much of the discussion in the book is all the better when it exceeds
its psychoanalytic framework and the nostalgia marked by terms such
as globalization.
Most notably, The Already Dead is as much about time as it is about
space. When it comes to questions about treatment, the geography and
place of health-care arrangements is as signiWcant as is time and can
determine prognosis. And so, the book is also a reXection on what hap
pens to an impatient sense of time at the boundary between states,
that non-place where many are stuckindeWnitely detained, or worse;
where border policing involves checks on health, marital status, and
more intrusive surveillance besides; an intolerable pause or abatement
of the irreversible and Wnite time that is a life. Try crossing national
boundaries with something like cancer, as Cazdyn has done, and it

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quickly becomes apparent that along with the increasingly global reach
of pharmaceutical companies, laboratories, and online networks of more
or less self-organized patients, lives are wrought by the vast and incremental differences between states when it comes to access to health
care, drugs, information, treatment regimes, welfare, insurance, labor
markets, and, not least, the criterion of medical admissibility in migration and citizenship laws. Cazdyn Wnds himself denied permanent residency, as so many have been and continue to be, on medical grounds.
I was being treated like a felon, one whose crime was getting cancer
at the wrong time (101). And, it might be noted, in the wrong place.
Cazdyn also takes us through some of the genealogical conditions of
citizenship. Writing of the selection of citizens and visa applicants on
the grounds of medical admissibility, he writes that the normative
family has attained a legitimacy from the nation at the very moment
when other kinship practices and social relationships are emerging
(stoked by globalization processes) and challenging the traditional familys dominance (136). I am as unclear as to the reasons for Cazdyns
association between globalization and nontraditional forms of kinship as I am about the homology between cancer and capitalism that,
following Karatani, Cazdyn insists upon. I would agree that there is,
contrariwise, a good deal of evidence for the increasingly heteronormative character of state policies around the world, including those
that pertain to migration between states. Yet I would argue that the
homology between cancer and capitalism makes it impossible to think
the politics of mutation beyond the symbolic but inapplicable terms of
lack and plenitude, or beyond the positivist ranges of abnormal and
normal.
In a sense, The Already Dead is deeply ambivalent about how to characterize and periodize the terms of norm and crisis, even as it begins
with an exemplary psychoanalytic joke about the norm as the emergency (Cazdyn, 1). This could have raised the questionif crisis has
become normwhat, if any, sense is there in continuing to talk about
the abnormal? Indeed, Canguilhems The Normal and the Pathological
presented this very problem in the context of a discussion about the
eclipse of qualitative theories of disease (and therefore cure) by quantitative measures. According to Canguilhem, where pathology had once
been viewed as an ontologically distinct state from that of health, from
the 1800s illness became increasingly deWned as a measurable deviation

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from a norm. Disease and health were no longer seen as antithetical

qualities but, instead, approached through the lens of deviation, frequencies, averages, and anomalies. Freudian psychoanalysis did not
emerge outside this transformation, but within itand in so doing
tended toward the pathologization and medicalization of the ostensibly abnormal. That is, Freud adapted the language of management and
cure to his analysis of the psyche, just as Comtean sociology had dreamed
of studying society with (I would add, a false view of) the epistemological neutrality and precision of sciences such as biology and medicine, and thereby made it possible to draw a highly normative analogy
between biological diseases and putative social problems. I am not suggesting that the requisite leap is an epistemological one. Forms of knowledge such as oncology or biomedicine are, as with any established
disciplines, disinclined to deconstruct an object of knowledge that is
integral to the disciplinary practices and divisions of labor of a Weld
they are involved in managing and, in some cases but increasingly,
treating as a species of commercial value.
The leap, as it were, comes not from epistemology or thinking, but
from the material differences among bodies and the tendency of forms
of life toward complexity and variation. This is not a story about scientiWc heroism or action. Indeed, the shifting epistemologies of disease
do not exhaust the disease, and this is particularly so in the case of cancer because it is remarkably difWcult to distinguish between normal
and abnormal cells. The deWnition of cancernot a speciWc and diagnosed cancer, which would assume a singular body and clinical context, but canceris neither formal nor substantive, and to that extent
barely a deWnition at all. It eludes epistemic and normative certainty.
Characterized as a disease caused by the unregulated division of abnormal cell tissue, the distinction between normal and pathological cell
division is not so easily discerned in either epistemologies of cancer or
the treatments associated with it. Because this distinction has proved
troublesome to pin down, in practice the emphasis has fallen to treatments that are far less regulatory of excessive cell division (as the routine deWnition of cancer might imply they should be) than they are
indifferently cytoxic. Conventional chemotherapies, extrapolated from
the effects of mustard gas campaigns in the trench warfare of World
War I, do not distinguish between normal and pathological cells. They

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inhibit rhythms of cellular regeneration in the entire body, from hair,

skin, and saliva, to tissue and blood cells. Likewise, radiotherapies burn
subcutaneous tissue, irrespective of whether that tissue is healthy or
not. The art of these techniques lies in the Wne measure and direction
of a series of doses, recommendations based on statistical projections
and classiWcations; and each cancer treatment is simultaneously treatment, experiment, a point in data collection and analysis that, in turn,
informs subsequent doses. Surgical interventions, for their part, are
always preoccupied with locating the margin between healthy and
diseased tissuea difWcult thing to do with precision.
Put another way, there is no qualitative distinction between normal
and pathological cell division outside the context of a speciWc body
and, for that matter, outside a diagnosis in an initial clinical encounter.
Cazdyns analogy between the disease and capitalism does not, I think,
hold. Cancer does not retain an ontological consistency as pathology,
as pathos, outside the context of an individual organism. Around its
diagnosis, however, increasingly multidimensional arrangements of
health care and biometrics have emerged, or as Peter Keating and
Alberto Cambrosio (2003) have put it, platforms of biomedicine. As a
meshing of medicine and biology, biomedicine reduces a pathological singularity to a biological continuum (61). Yet one of their illustrations of the epistemological gap that, despite this reduction, continues
to exist between these two termsand which has driven an increasing complexity in both etiologies of cancer and biomedical platforms
is the pap smear test. Invented by George Papanicolaou in the 1920s,
the pap smear test is not diagnostic tool for cervical cancer, but a classiWcatory schema. Indeed, its use was resisted in the history of medicine to the extent that it did not involve making a distinction between
pathological and normal cell tissue. Keating and Cambrosio emphasize the changing and conXictual labor processes in the history of biomedicineas they elaborate it: in the laboratory, clinic, and hospital, and
as the obstinate expression of the expert judgement of a pathologist,
which remained singularly resistant to automation (58) within that
milieu. Their study of emerging biomedical platforms concludes by
arguing that for their regulation so as to provide a common measure
(258), which points to a proximity between the way in which their questions are posed and (one would hazard) institutional conXicts around

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performance indices; but it nevertheless also illuminates the extent to

which the conXicts over labor and management processes presume an
unreliable conXation between classiWcatory systems and life.
BrieXy put: from an evolutionary perspective, mutations are a biological fact and integral to its concepts of timewhich is to say, there is
no concept or vocabulary of pathos. From a social perspective by contrast, pathologies can only be expressed as norms derived from the
curve around averages. So while vitalist concepts of society are inclined
to present norms in positivist, if not always positive terms (as in psychoanalysis), there are far fewer illusions about the ease with which it is
possible to distinguish between norms and pathologies in cancer diagnoses and treatment. Hence, there has been a tendency since the late
1960s toward multidimensional cancer treatment and care, national cancer centers, or biomedical platforms. In the individual case, the reliance
on the statistical law of large numbers can be determinative (not least
insofar as it shapes health-care systems; conditions access, treatment
protocols, and standards; and shifts and creates outcomes), but it cannot
tell you what will happen in that case. Risk is distributed, as is uncertainty. Mutations pose an epistemological problem that has informed the
developments from humoral to cellular to biochemical to informational
theories of pathogenesis but, at the same time, knowledge, particularly
that derived from extrapolations of frequentist norms, simply cannot
explain those anomalies that biological scientists call mutations. In other
words, even within the cramped conditions of disease management, I
do not see how the living are reduced to being the dead with respite,
to borrow a phrase from Canguilhem (263). That is, science, technology,
biomedicine, or radical, reformist, and revolutionary theories willin
ontolological and existential termsalways play catch-up to the excessive and wayward variations of bodies and of life. Reading The Already
Dead, I felt at times as if the living have become dead so as to become
an object of knowledge, albeit one suspended between the symptomatic limits of immanence and dialectics. But all concepts of revolution
and life require a combined sense of both Wnitude and variation.
Angela Mitropoulos is the author of Contract and Contagion: From Biopolitics to Oikonomia (2012). She is a research fellow at the University of
Sydney and in the Mapping Supply Chains & Infrastructure Networks
project.

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Works Cited
Canguilhem, Georges. 1989. The Normal and the Pathological. New York: Zone Books.
Cazdyn, Eric. 2012. The Already Dead: The New Time of Politics, Culture and Illness.
Durham: Duke University Press.
Keating, Peter, and Alberto Cambrosio. 2003. Biomedical Platforms: Realigning the
Normal and the Pathological in Late-Twentieth-Century Medicine. Cambridge, Mass.:
MIT Press.
Lacan, Jacques, and Jacques-Alain Miller. 1991. The Seminar, Book VIII: Transference
(In Its Subjective Disparity). Paris: Seuil. (Orig. pub. 196061.)
Lukcs, Gyrgy. 1971. History and Class Consciousness. Cambridge, Mass.: MIT Press.
Luxemburg, Rosa. 1989. Reform or Revolution. London: Bookmarks. (Orig. pub. 1900.)
Mattick, Paul. 1978. Anti-Bolshevik Communism. White Plains, N.Y.: M. E. Sharpe.
(Orig. pub. 1947.)
Mnoret, Marie. 1999. Les Temps Du Cancer. Paris: CNRS.

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