Strange Harvest. Lesley A. Sharp
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anticipation of a lifelong bipedal stride. It can propel itself on a bicycle or in a wheelchair, or run at breakneck speed. Beneath the skin one encounters a dizzying array of systems that together enable the body to survive as well as perform astonishing tasks. As the artful renderings of anatomist Andreas Vesalius (1973) illustrate so vividly, the body's inner workings include the web of the nervous system, an interlocking musculature complex, an extensive vascular network, an elegant skeletal framework, and a sophisticated amalgamation of internal organs that can draw oxygen from the atmosphere, pump and maintain blood at a stable volume and temperature, and filter and expel inhaled, ingested, and absorbed toxins.
The brain is frequently described as the nexus of control for this body complex. This single organ drives the inner workings in exquisitely complex ways, enabling us to move, breathe, and sense the world around us. Whereas the brain, as the control center, governs bodily functions, the mind is its abstract counterpart, serving as the seat of learning, the emotional center, and the locus of the self. The mind, understood as such, enables us to create, preserve, and recall memories, and to form words into speech, manual signs, and written text; it also generates dreams. We are thus simultaneously organic creatures, cognitive beings, social persons, and private selves, categories of existence that are all inextricably linked to this mind-brain complex. The mind-brain is always at work, regardless of whether we occupy conscious or slumbering states. This sophisticated complex defines us as alive, as functioning, and, ultimately, as human beings (Damasio 1994; 1999: 3-31, 317-55; Sacks 1973, 1985).1
This exercise in describing ourselves in reference to the mind-brain may seem truly odd; my attempt to do so certainly strikes me as such. For one, it is shaped by an extreme form of biological reductionism; for another, it is an exclusively secular vision, allowing no room for musings on the soul, for instance. My intention is to underscore the ease with which we comprehend this view of our bodies. (Whether we embrace it is another matter, of course.) American culture is permeated by scientific reasoning, represented quite obviously by the pervasiveness of biomedicine as a dominant system of thought. Indeed, we frequently allow ourselves to be described in terms derived from biology, physiology, and anatomy, permitting internists, pulmonologists, cardiologists, and neurologists to probe and ponder us when all is not right with our health.
As philosopher Drew Leder reminds us, it is precisely at those moments when the body breaks down that we become painfully aware of its existence (Leder 1990; Sacks 1998), and biomedicine provides a framework for comprehending bodily disorder. At moments of sickness we typically ask, “What is wrong with me?” (cf. Zola 1978), and the answers are supplied most frequently by physicians, nurses, or other specialists who explain, “You have a lung infection,” “You've broken your leg in two places,” or “You've sustained a concussion.” Thus, within medical parlance we are frequently reduced to our functioning body parts. More important, we might accept this model of the body unquestionably and embrace such diagnoses and their associated treatments with gratitude.
Medical anthropologists have long argued that a pervasive weakness within biomedicine is the insistent separation of the body and mind in clinical discourse and treatment. Biomedicine privileges knowledge concerned with the body's biomechanics, often to the exclusion of both the inner workings of the self, or emotions, and the individual's place within larger social or ecological milieus. For instance, surgery occupies a more prestigious position in the biomedical hierarchy than does psychiatry, and psychosomatic disorders may quickly be dismissed as patients' fantasies rather than being read as embodied, covert forms of protest and misery (Kleinman, Das, and Lock 1997; Sawday 1995; Scheper-Hughes 1992; A. Young 1997). Today even psychotherapy is rapidly being displaced by approaches that favor drug therapies designed to tackle problems in brain chemistry (Luhrmann 2000). In contrast, within medical anthropology one encounters an established tradition of arguing for greater mind-body harmony in medicine, with proponents frequently drawing on cross-cultural data to illustrate how other healing traditions reflect more holistic approaches to human suffering (Murphy 1987; Scheper-Hughes and Lock 1987).
Nevertheless, a dominant cultural logic insists on the primacy of the mind-brain as a defining principle of our humanity. We are certain, after all, that we most definitely are not chimps, or dolphins, or lizards. This sense of difference not only springs from our morphological uniqueness but is driven, too, by a widely accepted premise within American culture that our brains are radically more sophisticated than those of all other creatures in the animal kingdom. The success of anthropology as a social science is certainly driven by such principles. Our uniqueness as a species is marked by our ability to generate complex social systems, sophisticated forms of symbolic communication, and creative technological innovations that enable us to transform hostile environments into habitable ones. In addition, arguments about our special abilities are phrased in evolutionary terms, and they rest heavily on assumptions concerning the primacy of the human mind. As Rene Descartes so famously asserted, cogito, ergo sum (“I think, therefore I am”; Descartes 1999 [1637]). Within a host of other specialized fields—such as sociolinguistics, cognitive psychology, neuroscience, and artificial intelligence—it is possible to argue that the mind-brain complex defines how unique we truly are.
Against such premises, organ transfer emerges as an intriguing realm of medical practice because it insists on these forms of mind-body bracketing, yet specialists in the field still struggle to maintain a stable boundary between the two. Consider these sorts of contradictory circumstances. On the one hand, the identities of organ recipients are often reduced to their transplanted parts, so that at transplant events recipients are relegated to such categories as “the hearts,” “the lungs,” or “the kidneys.”2 Organ donors, too, are rapidly reduced to the status of bodies or body parts because both procurement professionals and transplant surgeons may conceive of them primarily as repositories of reusable organs. On the other hand, cadaveric organ donation in the United States is possible because we legally sanction brain death as true death. The label of death is applied even though the artificially ventilated donor-patient remains warm to the touch, appears to breathe, and has a heart that continues to beat within its own chest. Even more bewildering is the fact that brain dead organ donors are routinely anesthetized at the onset of procurement surgery.
When we accept brain death criteria, as defined within a clinical framework, it is because we recognize that what matters is whether the mind, not the body, has ceased to function. In other words, we care greatly whether the essence of the individual person is no longer there, and thus the body's significance in defining the self slips away. A comatose patient, while assisted by “life support,” might thus be described as a broken mind-brain inhabiting a dormant body. In contrast, a brain dead individual (and, thus, an organ donor) is a mindless and dead—yet artificially maintained and thus temporarily functioning—body. The conundrum posed by brain death criteria problematizes certain assumptions about our selfhood, our humanity, and our social worth as (non)sentient human beings. It also uncovers subtle forms of medical unease over what we are certain of, versus what we can never truly know, about human death. Particularly troubling for all concerned parties are questions about the timing and detection of death, questions that quickly degenerate into existential quandaries. This is most clearly marked by the tension created between brain death and cardiac death as markers of true or absolute death. Are organ donors dead once they cease to be sentient beings, or does everyone secretly believe that true death occurs only when the body itself expires?
Such questions arise because of a flawed logic that insists on death as an either-or category of (non)existence. As we shall see, a range of involved parties understands death in more creative and flexible ways, although opinions remain muted, because to voice them publicly and openly is regarded as a dangerously transgressive act. Alternative visions defy a dominant ideological premise of organ transfer, where death occurs at a precise moment in time, coinciding with the legal declaration of the cessation of brain function at, say, Tuesday, March 9, at 5:06 p.m. If one embraces organ transfer as a social good, then one should accept, unquestionably, that brain death is a marker of true or absolute death. Nevertheless, subsequent cardiac death, or the death of the body, creeps in as contradictory evidence for nearly all concerned parties.
In response to these troublesome contradictions, Margaret Lock (2002), in her comprehensive study of brain death in North America and Japan, has described organ donors as a category of the “twice