New Organs Within Us: Transplants and the Moral Economy
by Aslihan Sanal
Duke University Press, 2011. 244 pp.
Sensitively written and deeply insightful, Aslihan Sanal’s ethnography of kidney transplantation in Turkey in the 1990s and 2000s is an intimate stitching of life histories, national and institutional narratives, and shifting meanings of life, death, and the body. Sanal takes the book’s beautifully multivalent title from a Goethe quotation about the psychic imbrication of external and inner worlds, foreshadowing her deep engagement with the psychological and her attention to realms of uncanny, unsettling experience. These “new organs within us” stand at once for bodily organs that are donated and transplanted, the creation of organ transplantation as an ethical and viable medical technology, and the psychic and bodily transformations of her informants in their personal and social lives. Sanal terms this complex topography a biopolis, a “universe” of technologies made local and personal (11). New Organs Within Us makes a unique contribution to a rich literature on how organ transplantation is made commensurable with cultural and religious cosmologies through the book’s unique attention to the ways these processes of commensuration leave residues of uncertainty and excess in individual and shared psychic worlds.
The book is divided into two parts titled “The Desirable” and “The Impossible.” Topically, Part One approaches the life histories of six Turkish transplant patients as well as an institutional history of transplant technologies and biomedical ethics in Turkey told by medical professionals. Part Two follows what Sanal calls “a geneaology of life-less objects all stemming from efforts to utilize the human body for medical ends: the suicide, the insane, the cadaver, and the sacrifice” (109). Together, these careful explorations address the book’s most explicit question: How did the transplant of cadaveric organs, once considered impossible in light of Muslim notions of a body on loan from God (emanet), become something to be desired? The concept of the biopolis allows her to speak at once of the ethical and epistemological landscapes forged through technology as well as the personal and social psychic spaces that make these shifts possible. Object relations theory from psychology and a subtle reworking of van Gennep’s rites of passage allow her to present organ transplantation as a ritual at multiple social scales: A young woman whose organs are harvested after she commits suicide becomes a posthumous hero for her sacrifice to the social body. Years later, seeking eternal solitude, another woman’s suicide note asks that her organs be left unharvested, to be allowed to “rot” along with her buried corpse.
Just as important to the unfolding of the “impossible” and the “desirable” is the uneasy relationship between the “known” and the “unknown”. Sanal uses these words in italics to track throughout the book the persistence of a deep entanglement between transplant organs and shadowy spaces “full of invisible beings and forces – ghosts, jinn, terror, oppression” (94). The unknown endures even as living and cadaveric organ transplants become logistical and ethical possibilities. As emerging technologies do boundary work on the realms of the known and the unknown, patients often find themselves deeply destabilized by their engagement with the biotechnological biopolis; a man cannot explain why he became violent towards the wife who donated him her kidney, a young woman question her religious beliefs and biological relationship with her family. Even surgeons and anatomists whose entire careers focused on making transplantation a locally acceptable and viable practice are not immune from experiencing the uncanny shadows of the unknown. A particularly innovative and compelling way Sanal represents this only partly exposed world of the unknown is by populating her biopolis with narratives and other discursive forms such as Islamic law, linguistic idiom, and writing and performance forms such as poetry and theatre. Most memorable is her discussion of artist Nazif Topcuoglu, whose work incorporates animal blood, organs, and bodies into social commentary. Here, Sanal subtly brings together the threads woven throughout the text by finding them in Topcuoglu’s artwork: the arresting uncanniness of the cadaver, the double entendre of sacrifice for God and the social body, and the rich social life of organs.
Narratives of the Turkish nation and its medical institutions are also woven through this story of transitions to possibility. It is here that her literary style is most in tension with the complexities of these histories; a historian or anthropologist of Turkey may desire a more fine-grained accounting of the events and trajectories that emerge through the text. At times it seems that the biopolis may be doing work for the unnamed concept of culture. Yet it seems to me that Sanal presents these national and institutional histories as something more like a life history than as empirical claims for certain kinds of Ottoman and Turkish pasts. Instead, she seems to present these histories as they may emerge in the field, that is, as parts of the dominant narratives comprising the topography she wishes to sketch. In this way, her literary style leaves open the possibility of complexity even as it may at times seem to obscure it.
In Sanal’s biopolis, bodies – living or dead, or somewhere in between – always exceed the scientific and religious spaces that work to contain them. Each current of life is handled with care, presented to the reader as deeply contextual as it is followed through transforming social and technological landscapes. New Organs Within Us therefore lays a powerful foundation for future contributions at the intersection of psychological anthropology, the anthropology of religion and ethics, and the anthropology of medicine and technology. The text almost threatens to burst at the careful seams that bring together these entanglements, yet the book thrives in this very tension. This bulging at the stitches helps convey complex imbrications of life, death, body and medicine while allowing for the uncertainty that runs throughout. True to her dedication to explore the excess in these processes of cutting and transforming, to attend to the ways in which technologies are incorporated through processes of social and personal internalization, this book cannot be simply dissected. It must also be felt.
Elizabeth DeLuca is a PhD student in Anthropology at the University of California, Irvine. Her research explores the emergence of elderly care in Turkey and municipal initiatives to provide basic medical monitoring in elderly homes.