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Vital Circulations and Circuits: Reflections around vitality and the biopolitical regulation of its flows


Most of us probably feel well-schooled in the nature of respiratory viruses after a blistering global pandemic and frequent news items of the latest outbreak of another strain of COVID-19 or influenza. For many, a headache, a sneeze, or a new and persistent cough directs our attention within and across the circulations that simultaneously sustain and threaten our lives. To protect ourselves and others, the mundane act of breathing becomes an exercise in scrutinising the flow of air through and around us. At the same time, other things have to be circulated in the effort to suppress viruses: facial masks (and other ‘PPE’), ventilators, drugs, swabs and test kits, among others. Moving around, too, are saliva and blood samples, the genomic data, and then batch loads of vaccine.

COVID-19 countermeasures certainly tested corporeal coordination for suppressing unruly circulations. And yet, we have also come to take for granted the mandates of multiple more-or-less regulated flows that fold into our duty to ensure individual and collective survival.

Thinking with vital circulations and circuits

Stretching across the length of the COVID-19 pandemic and beyond, an interdisciplinary collective of scholars met regularly to explore points of consonance across all of our work,  tentatively named vital circulations. Reflecting upon the confluences of our own work in a time of extreme isolation, we became particularly interested in tracing the multifarious flows of vital and viral matter and the social striations engendered through the biopolitical governance of these flows. We further invited scholars and practitioners across disciplines (anthropology, epidemiology, engineering, global health, information studies, philosophy of science, sociology and STS) and sectors (architecture, art, healthcare regulation and IT) to share their work along these themes over a symposia series in 2022. This current piece has evolved from our final workshop in December 2022, during which we built on insights drawn from the symposia to tease out different modalities of vital flows, and their biopolitical ramifications surfacing through the COVID-19 pandemic.

For our discussion, we found it useful to distinguish ‘vital circulations’ from ‘vital circuits’. While ‘vital circulations’ encompass the messy circulations across bodies that all living beings depend upon for growth and reproduction, we may think of ‘vital circuits’ as regulated flows within confined time-space that optimise and channel the productivity of vital circulations.Building on the rich insightsoffered by the concepts of networks (Latour 2005) and assemblages (Deleuze and Guattari 1987), we take vital circulations and circuits as a departure point to sharpen our focus on the transformations of time and space, as well as the reconfiguration of vitality itself as a relational process.

Image credit: Nifty Fox Creative: Vital Circulations

Circulation as a metaphor and an analytic has been crucial in shaping critical thinking of aspects of life from biology to economy, from ecology to power (Gänger 2017; Lowry 1974). The very understanding of circulations in sustaining our bodies, which owes much to William Harvey’s 17th century discovery of the blood circulatory system, had contemporary influence in formulations of sovereign power. It is worth remembering that while drawing on modern techniques of observation and mathematics, Harvey turned to Aristotelian cosmology in explaining the circular motion of blood: just as the sun propels the circulations of air and water in atmospheric cycles, so does the heart for blood in the body, instantiating the microcosmic emulation of the macrocosmic circulations, perfecting and perpetuating life through each iteration (Harvey 1847[1628]:41; in Pagel 1967:82-86). Harvey’s thesis had immediate implications for political theorization of his time (Healy 2018). A most notable example is demonstrated in Thomas Hobbes’ figure of the Leviathan, the sovereign state that nourishes its members through the circulation of money, just as blood does for the body (Hobbes 1968[1651]:130; in Christensen 1989:707). As such, the modern conceptualization of circulations has been a political, moral and economic project at its core: it postulated how things and persons should be deployed, moved around and (dis)connected for vital processes.

Here in the early modern preoccupation with circulations, we already see the impulse to encapsulate circulations as enclosed systems of ‘circuits,’ a term that also appears in Harvey’s 1628 treatise. As we think of a circuit, we may recall its etymology in Latin circuitus ‘a going around,’ which acquired a spatial connotation in tandem with the rationalization of the English judicial circuit system in the sixteenth century (Onions et al. 1966:176; Cockburn 1972:1-11). Thus, delineating the trajectory of a travelling judge led to an understanding of marked territories without overlap. These regionally divided circuits continue to form the administrative units of barristers and judges in England and Wales today. In thinking with ‘circuits,’ we are reminded of how jurisdictions were spatialized in the circumscribed movements of adjudicating forces. The semantic expansion of ‘circuits’ beyond the juridical domain to electricity and economy map onto the period that Foucault saw the rise of modern government distinguished from sovereignty as stipulated by Hobbes. Criticizing the centrality of the heart of the Hobbesian sovereign state, Foucault noted that (bio)power ought to be ‘analysed as something that circulates, or rather as something that functions only when it is part of a chain. It is never localised here or there, it is never in the hands of some, and it is never appropriated’ (Foucault 2003:29). What Foucault calls ‘a chain,’ we might rephrase as circuits to denote the power-effects generated through regulated circulations of people, goods, discourses and techniques, a point articulated further in his extensive discussion on apparatuses of security (Foucault 1978:29-54).

A critical examination of the modern biological and political grip on the body and on life then may take a two-pronged approach: firstly, to recover what has been relegated to the background of the circulations. It would require taking a deliberately ecological view to foreground interdependencies and porosity of bodies, encompassing the more-than-human life forms in the shared capacity to affect and be affected. It is to see vital circulations of blood as co-dependent on circulations of air, of microbiomes that circulate within and across bodies, while acknowledging the deeply striated and unequal flows. Secondly, at the same time, maintaining an analytical distinction between circulations and circuits would allow us to attend to how the value of the former is harnessed and maximized by the latter through spatio-temporal techniques of governance. In distinguishing the two, Michel de Certeau’s conceptions of ‘strategies’ and ‘tactics’ may serve useful. If ‘circulations’ can be conceptualized as flows and movements created through ‘tactics,’ the agency of various things and persons in seizing opportunities without having the vantage point of the birds-eye’s view of the totality, ‘circuits’ make explicit a circumscribed place of ‘strategies’ where ‘[p]olitical, economic and scientific rationality’ operate (de Certeau 1984:xix). In thinking vital circuits as critical conduits of biopower, we come to delineate the specific material conditions and spatio-temporal injunctions, as well as their moral and technical demands on actors in circulation.

With the remainder of this piece, we offer three treatments of vital circulations and circuits which arose as particularly generative points of discussion in our workshop. They are intended to demonstrate the conceptual pliability of the ideas. They also act as an invitation to readers to join us in thinking through the potentials of circuitry and circulation as heuristics for understanding contemporary vitality and its regulation.

Case 1. Healthcare Circuits

Circuits have been instantiated in the healthcare system mainly through the language and form of lines: public policy and commentators use the language of guidelines (e.g. NICE), pathways (Neuberger et al. 2013) or mazes to regulate healthcare’s interactions with users. Pathways, corridors, and waiting lists, for instance, are embedded in healthcare systems and their regulatory environments. Lined out in maps or flow charts, healthcare is often visualized as concerted linear movements with a directionality and triaged entry and exit points for different actors. These imageries further inform progressive narratives of cure and remission more broadly. 

Further, in social sciences, visual descriptions of the connections between various parts of health systems use patterns of lines and dotted lines to allude to different degrees of intensity in long-term relationships between professionals and patients (see for instance Harding 2017: 110, and see Fox’s visual rendition of the three circuits of hygiene (1997)). Researchers have described the exertion of ‘navigating’ the ‘health and social care regulatory map’ (Harding 2017:110-1), and, in the context of access routes to abortion, have mobilised ‘the trail’ (Rossiter 2009; Fletcher 2016) and the ‘corridor’ (Duffy et al. 2018; Duffy 2020) as conceptual tools.

The metaphor, of course, has salience beyond the academy too. We see in contemporary artwork evocative examples of how circuitry can be a rich starting point for thinking through healthcare experience (Whatley 2006).

[IMAGE 2. ‘12 Beds’ (2006)]

Image credit: Screen capture from RosaSenCis Film Productions: ‘Twelve Beds‘. Sarah Whatley and her collaborators exploring spatial connections between a hospital site and its nurses, cleaners, doctors and patients. Shot in the Coventry and Warwickshire hospital during the last days before its closure, the work alludes to the experience of entering and exiting the bounded space of the hospital, the need for ‘running the circuits’ of experts to access care, and the coming to terms with it being closed down to be relocated in another part of the city.

Meanwhile, from the patients’ perspective, healthcare circuits are experienced most acutely as mandates of specific temporalities of accessing care. Long waiting times are amply documented as a common condition of poorly funded public institutions (Auyero 2012; Barrera and Arcidiacono 2020; Bridges 2011; Sarat 1990). The fact that circuits of healthcare are made of various ‘stations’ that patients must ‘run through’ further modulates this temporality of healthcare, since the waiting is rehearsed multiple times. Anthropologist Khiara Bridges (2011) notes that within obstetrics and prenatal care in state hospital apparatus in the US, the multiplication of intervenors and serial appointments with a coterie of various professionals (2011:50) forms a circuit of sorts, slowing care down. This circuit provides an ‘opportunity for state supervision, management and regulation of poor women’ (Bridges 2011:43). Her account thus tells us as much about the reconfiguration of the state as a circuit as it does about poor pregnant women in the US. These blockages and bottlenecks in healthcare may be considered as ‘chokepoints’ (Carse et al. 2018) that are very much integral to the vital circuits as points of surveillance and discipline rather than as mere disruptions.

However, we also see different kinds of healthcare circuits emerging beyond the long winding movements towards treatments and recovery. For instance, there are real-time networks of people and objects linked together, as seen in The Circuit, the UK’s national defibrillator network. A live searchable map comprising all the UK’s registered defibrillators, The Circuit invites all defibrillator guardians to register their device to include them on its circuit. It enrols individual participation to meet its aim to facilitate an ideal immediate access to defibrillators across national territory in context of life-threatening corporeal circulation breakdowns. These new configurations of healthcare lead us to ask whether the temporality of its circuitries can move beyond the mandates of a linear unidirectional trajectory from illness to cure. Can ‘the circuit’ be reimagined as a shared language and illustrative form to propose more somatic approaches attuned to individuals’ (chronic) conditions and embodied experience of healthcare pathways?

Case 2. Immunitary Circuits

While healthcare circuits aim to channel patients through the circuitry of diagnosis and treatment, they also operate within the context of a wider circulation of endangering or pathogenic vitality. An immunitary framework (Brown 2019), here, enables us to foreground the embodied defences, boundaries and barriers that both make possible and also inhibit such flows of vitality. This is underpinned by an immunitary biopolitics concerned with restricting bodily flows, instituting exemption from exposure, and protection from circulation. This version of the biopolitical can be said to be an expression of a contemporary ‘immunitary paradigm’ (Esposito 2011) where vitality is both protected but also put at risk of overprotection from movement and circulation.

An immunitary biopolitical perspective expresses the tensions between communitas (living in community) and immunitas (the immunisation of the population and its subjects from threats to health and vitality). This maps onto the distinction we outlined earlier between vital circulations and circuits, communitary circulation and the immunitary circuitry that seeks to regulate it. Circuits of immunity (for example, distancing, restrictions on movement, travel, limiting building occupancy, etc) can be necessary for the protection of life but can also undermine the communitary circulations they are intended to protect. COVID-19 could be said to have surfaced and reinforced an already fully fledged immunitarian attitude, dispositif or imaginary (Davis et al. 2016). The spaces between circulations and circuits are deeply contentious and ambivalent, with immunitary measures recoiling to generate their own risks and dangers. Post-pandemic public enquiries around the world are all concerned with investigating the quarrelsome tensions between circulation and circuits: too little or too much? too late or too early?

And at the same time, we have witnessed the proliferation of intentional practices oriented to reshaping immunity through benign or beneficial multispecies exposure (Lorimer 2016). This can include the fostering of parasitic intimacies with which to diversify the gut microbiome or probiotic exposure intended to therapeutically enhance mental health, cure autoimmune disease or optimise general wellbeing. Being invested in new parasitically symbiotic relationships reflects a turn against the sterile hygienism of the hermetically sealed body and is instead shaped by more ecologically inter-related conceptions of ‘co-immunity,’ ‘co-evolution,’ and ‘living with’ rather than against. Here, vitality can be seen as a question of ‘being well together’ (Kirk et al 2019), of fostering collaborative and companionable circulations, partnerships and the partial suspension of the immunitary circuitry that restrict exchange and interaction across species. The flexibly adaptive immunitary biopolitics of the contemporary period might be said to express a popular posthumanist, even multispecies, imaginary in sharp contrast to the more binary immunitary paradigm that preceded it (Martin 1994).

Immunity’s vitality is also shaped by the built environments in which humans, animals and the microbial circulate, from the way buildings shape pathways, flows and movement (Brown et al. 2021; Buse et al. 2020) to the ways bodies and the microbial together journey through transport systems (Roe et al. 2021). Architectural immunitary circuits emphasise the inter-relationship between the ‘building of the body’ and the ‘body of the building’. Some architectures are highly boundaried while others are more open, porous and permeable. It has become important to consider the relatively ignored inter-connectedness of architectural design and microbial ecology and to reframe buildings as ‘multi-species ecosystems’ (Kembel et al. 2014). There is growing interdisciplinary interest in such ‘re-wilding’ approaches to pathogenic infrastructures (Lorimer 2020), challenging modernist attachments to sterility. Instead, biotic living becomes the question of focussing on microbial enrichment/diversification rather than eradication. ‘Biodesign’ can be seen to ‘flip’ the ‘antibiotic turn’ of the twentieth century (Beckett 2021). Enhancing vitality becomes a question of harnessing the missing or eviscerated microbial ecologies that have resulted in pathologies of absence (Beckett 2021:6). A new immunitary paradigm, then, would require rethinking the relationship between immunitary circuits and communitarian circulations.

Case 3. Bioeconomic Circuits

If attention to biotic vitality in immunitary circuits brings us to consider interdependencies between the human and the non-human, reflections on expanding bioeconomic circuits similarly calls for relational thinking to examine how different bodies are made interdependent upon each other through exchanging and pooling tissues. For tissues that are used for treatment (transfusion or transplant), we may consider the overarching bioeconomic circuits consisting of two entry points for different bodies: one for donors and the other for recipients.

On the one hand, for donors and their tissues, regulations and standards of screening and selection tend to be laid out in documents that guide whose tissues can enter the circuit. The social, ethical and regulatory complications arising from these guidelines have been explored in a rich body of scholarship. For example, concerning blood donation, particularly insightful discussions have been generated around how the screening of blood donors or labelling and discarding of blood associated with ‘risky bodies’ may reinforce social striations around race/ethnicity (Avera 2023; Lederer 2008; Seeman 1999), sexuality (Strong 2009) and gender (Kent & Farrell 2015). Meanwhile, the expanding category of eligible organ donors with biotechnological innovations and accompanying legal changes have prompted fine-grained studies into the ethical debates around death (Cooper and Kierans 2016; Cooper 2018; Lock 2001; Potter 2018). For tissue recipients, on the other hand, their entry into the circuits is contingent upon other (healthcare) circuits of multidisciplinary assessment: which treatments and what tissues are available? how will treatments be paid for? how urgent is the patient’s need?

While we may be tempted to formulate our critique around the valuation of the bodies, tissues and needs of either donors or recipients, when we broaden our view to the bioeconomic circuits that constantly draw different bodies of donors and recipients together, a very particular temporal mandate comes into focus: the demand, at one point of the circuit (the recipient, their family, their hospital, their doctors), often outpaces supply (which is used to describe the material moving through the circuit). In short, materially finite bioeconomic circuits cannot be overburdened with unnecessary or undesirable tissues, and in this context, they are under ‘chronic shortages’.

Is it helpful, then, to posit that circuits can have an insatiable appetite? Where there is an appetite, there is a moral economy and politics. Then, what is the circuit’s currency, considering its etymology: currere (to run or flow)? We might, for example, ask what the circuit hungers after, or more accurately whom – as is generally the case with bioeconomic circuits, where the matter has to be alienated from a human body. Here, we see racially minoritised people called upon around discourses of the ‘unmet’ need within their ‘own’ communities (Williams 2015, 2021) and expectant mothers invited to consider the life-saving power of the by-product or ‘waste’ of their delivery (Brown 2013). In other words, bioeconomic circuits thrive on the cultivation of affects that keep potential donors and recipients connected and make certain bodies more operable and bioavailable than others (Cohen 2007).

Temporal mandates abound: of regularity (consider the need for regular blood donors), of being permanently on-reserve and on-call (as in, say, a stem cell registry waiting to be searched), or of urgency (posthumous organ donation requires the harvest and movement of organs within a matter of hours). These mandates trump any moral code. They enable an abundance of competing meanings and relational logics: blood ‘has no colour’ whilst being simultaneously ‘black’ (Avera 2023, Williams 2021); donating organs of the deceased is both an extension of, and end to, the donor’s personhood (Lock 2001); donors and recipients are kin whilst simultaneously anonymous strangers whose distance must be policed (Sharp 2006). Whilst healthcare is increasingly defined in terms of individual responsibilities, autonomy and ‘the logic of choice’ (Mol 2008), bioeconomic circuits weave different bodies together, evoking heterogeneous logics of care around idioms of kin, community, nation and humanity.

Colliding and Overlapping Circuits

Having considered the mandates of different vital circuits, we can further examine the careful coordination required in juggling between colliding circuits in healthcare settings. An example of healthcare circuits being intercepted by bioeconomic circuits can be found in Jessie Cooper’s work (n.d. and 2023) on organ donation after circulatory (cardiac) death (DCD) in the UK. After being re-introduced in 2008, the DCD programme has helped to tackle organ shortage by allowing organ donation from patients who die following the planned withdrawal of life-sustaining treatments. With the DCD donors making up 40% of deceased organ donors in the UK today, the practice seems to have become a routine in end-of-life care settings. Yet, as Cooper’s ethnographic work shows, the burden of managing the conflicting demands of caring for dying patients within end-of-life care protocols and preparing bodies for organ extraction fall upon health professionals, who painstakingly endeavour to reassert spatiotemporal, bureaucratic and moral boundaries between the two circuits, effectively decoupling them from each other.

Meanwhile, we can see how circuits can merge and connect in more planned and deliberate yet surprising ways in Rachel Douglas-Jones’ work (2017) on cadaver donation for anatomical studies in Taiwan. In contrast to the principle of anonymity observed in cadavers donated for medical training elsewhere, the Taiwanese Tzu Chi Buddhist Silent Mentor programme promotes the identities of cadaver donors to be honoured with their names, images and biographies figuring prominently in the anatomy lessons, associated ceremonies and the hospital corridors. In other words, the moral dilemma of having to justify the instrumentalist dissection and discarding of bodies (bioeconomic circuits) while training for a profession that is dedicated to caring for living humans (healthcare circuits) was resolved by honouring cadaver donors as ‘silent mentors’ who guide the medical professionals through their career.

Further research in this area has focussed on the contested use of non-human animals in xenotransplantation in which competing circuits enter into friction and contradiction with one another (Brown 2019; Brown et al 2006). This extends to long-standing debates on the relative merits of using non-human primates as a source species who may be immunologically similar to humans, but morally prohibitive exactly because of their biopolitical ‘closeness’. The use of pigs may potentially be morally or culturally less contentious but require more ambitious immunitary biotechnological innovation. Creating new immunitary circuits between human organ recipients and porcine source animals leads to equally novel transspecies disease risks necessitating complex biosecurity arrangements. Here, the immunitary protection of the communitas is premised on fixing xenograft bodies in healthcare surveillant circuits, recording any instance of their more inevitable tendency towards fluidity and circulation.

In addressing the twin hurdles of rejection and transspecies disease recent clinical studies have shifted to the use of ICU ‘brain dead’ decedents kept alive in xenograft trials (Porrett et al. 2022). Here, the bodies of the recently deceased, yet still physiologically alive, are made to perform a service of ‘necrolabour’ as the recipients of pig organs, rather than their more usual use as organ ‘donors’ or the bearers of gifts. The novelty here is the unique precedence of using ICU decedents as a ‘viable preclinical human model’ and the attribution of ‘preclinical’ to human rather than animal necrolabour. The future of such new ambitious biotechnological interventions will depend on how the frictions within and across circuits of healthcare, immunity and bioeconomy are resolved or absorbed.

Conclusion

Vital circulations and circuits help us think through the im/mobilisation and de/regulation of movements of matter and affect that sustain and enable life. The three examples drawn out in the cases of healthcare, immunity and bioeconomy reveal important contours of social striations engendered through regulated vital flows. Our discussion led us to consider, among other things: the temporal demands of healthcare circuits that produce short-term acceleration towards nodal points on the one hand and punctuated or drawn-out ‘waiting’ on the other; the enhancing of biotic vitality in the intricate balancing between communitary circulations (humans, animals, microbiomes, etc.) and immunitary circuits (regimes of sterilization, quarantine, distancing, etc.); and the ‘chronic shortages’ that characterise bioeconomic circuits to mobilize various modalities of relationality (kin, community, nation, humanity and various ‘Others’). As the impetus to generate surplus vitality is shot through these circuits, we might expect rising frictions within and between them. Those places where circuits emerge, break, overlap and collide draw in the most critical observers and actors, opening up new moral, political and affective possibilities.

Below we lay out some possible questions that attention to vital circulations and circuits can help to tackle:

Image credit: Nifty Fox Creative: Key Dimensions

Spatiality and Temporality

  • What happens when vital circulations are channelled into circuits? What kinds of spaces are created and what temporalities are necessitated to inhabit these spaces?
  • How are bodies halted and harmed by the time pressures and geographies of access of specific vital circuits? Can some health conditions and dynamic movements of individuals disrupt the linear and unidirectional temporal demands of vital circuits?
  • Can ‘the circuit’ be reimagined to propose more somatic and holistic approaches incorporating individuals’ embodied experience, as well as the interdependencies and mutualities among disparate bodies and forms of life?

Vitality

  • How is vitality being resituated as a question that extends beyond the individualistic and anthropocentric to accommodate forms of circulation that implicate the non-human, animal health, the biotic, but also the built environmental aspects of architecture, urban planning, space, transportation and global/regional flows/movement?

Actors and Agency

  • Who are the actors involved in creating and maintaining vital circuits and with what kinds of intentions? Who/what may be mobilized into circuits willingly, or not? Who/what are being circulated in the circuits?
  • What possibilities of ontological, political and social changes are opened up (or foreclosed) through creating, maintaining or disrupting vital circuits?
  • What kinds of frictions incur among and within different circuits? How are they resolved, or not? Upon whom falls the moral and practical burden and responsibilities to resolve these frictions?

Metrification and Valuation

  • How are things/bodies/persons measured, classified and triaged to be enclosed in circuits? How do blood, genes, tissue, organs and viruses/microbes as vital matter define the self/other/environment through notions of exchange and contamination?
  • How do vital circuits reinstate inequalities and differences? Whose bodies are made more available or vulnerable than others?
  • How is the body or biogenic matter being redefined as a boundary making object that must be regulated?

Acknowledgements

This report emerges from the conversations built up through the White Rose Vital Circulations Network’s symposia series and workshops (2021-22). This piece has been written for Somatosphere after the conclusion of our project activities in a collaborative writing process. We deeply appreciate the thoughtful feedback from Carlo Caduff and the Somatosphere editorial team to help improve this piece. Special thanks go to all the invited panellists and participants of the Network’s events for stimulating discussions and insights that led to the conception of this report. More detailed reports on these events can be found at the project website. The network has been supported by the White Rose Consortium and all illustrations are created by the Nifty Fox Creative. Since September 2023, the Network has merged into the broader regional STSMN Network.

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