Agamben Again: Reflections on Medicine as Religion

 

From the most recent of Giorgio Agamben's pandemic interventions, published on the website of Quodlibet we read: "Somewhere there is a sheet of paper on which the names of those who, in a world of lies, have testified to the truth that is written. This sheet exists, but it is illegible. Then there is another sheet, perfectly legible, which records these same names: it is in the hands of police officers and journalists".

The number of these short interventions now count in the dozens. Many - like this one, which is accompanied by quotes from Dante Alighieri and Bertolt Brecht - are of a gnomic, aphoristic type. For a philosopher known for his detailed examinations of the obscure corners of deep European history and thought, backed up with all the resources of citation and decades of specialist learning, these "real time" comments are akin to nakedness. One of the more extended pieces which has held my attention since it was published in May of 2020 is titled Medicine as Religion. In it Agamben claims that the pandemic has given rise to a new "cultic" practice elevating medicine and health more generally to the level of a religion, something we believe we believe. This most recent transformation is itself only the latest form that the long running veneration of science as the religion of Western modernity has taken.

This intervention was written months before the Covid vaccination program began, and even before the WHO changed its advice on masks. Over eighteen months later I frequently hear the more zealous supporters of vaccination and covid restrictions being compared to religious fanatics. And with my own eyes I've seen the frantic genuflections of people practicing the UK government's 'Hands, Face, Space' rituals (which someone wittily noted has displaced the Catholic "spectacles, testicles, wallet, watch" as the Faithfull's quotidian sacrament). There was, then, something prophetic about the general thrust of Agamben's analysis. But with many of these short pieces there is a tendency to generalise, and without broader exposition Agamben's noted inclination towards hyperbole ends up being the dominant factor.

"That science has become the religion of our time, that in which people believe they believe, has been obvious for some time now. In the modern West there have coexisted and, to a certain extent, still coexist three great systems of belief: Christianity, capitalism, and science. In the history of modernity, these three “religions” have often intersected, entering from time to time into conflict and later reconciling in a different way, until they progressively reached a sort of peaceful, articulated coexistence, if not a true and proper collaboration in the name of a common interest".

This schema is a rather drastic simplification of the methodology Agamben deployed in different ways and with different emphases throughout his rightly celebrated Homo Sacer series of books. There he frequently refuses the notion that historical forms and ideas can be neatly divided in this way. Commonly, he prefers to talk about "zones of indistinction" when it comes to concepts that appear to reside in the liminal space between otherwise familiar categories. This counts as much for the Homo Sacer herself - cast out between the divine and earthly realms - as it does for the "signatures" which in his examination of the writings of the early Church Fathers Agamben identifies in concepts such as Oikonomia, acclamation or hierarchy, the effect of which is to displace them into a constant oscillation between the secular and religious. As he states in his methodological text The Signature of All Things (2009), "a signature does not merely express a semiotic relation between a signans and a signatum; rather, it is what - persisting in this relation without coinciding with it - displaces and moves it into another domain, thus positioning it in a new network of pragmatic and hermeneutic relations".

Elsewhere, during an elaboration of Michel Foucault's use of the term dispositif (usually rendered as apparatus in English) written in 2006 he offers a definition of religion which again emphasises the dynamic and boundary dissolving nature of the sacred/profane divide: "...one can define religion as that which removes things, places, animals, or people from common use and transports them to a separate sphere. Not only is there no religion without separation, but every separation contains or conserves in itself a genuinely religious nucleus. The apparatus that activates and regulates separation is sacrifice. [...] , sacrifice always sanctions the passage of something from the profane to the sacred, from the human sphere to the divine. [...] From this perspective, capitalism and other modern forms of power seem to generalize and push to the extreme the processes of separation that define religion".

And finally, in a passage that would seem to have obvious relevance for understanding the past two years, we read in Capitalism as Religion (2017): "But it is in every sphere of experience that capitalism attests its religious character and, at the same time, its parasitical relation with Christianity. [...] If the Church seems to have closed its eschatological office, today it is above all the scientists, transformed into apocalyptic prophets , who announce the immanent end of life on earth. And in every sphere, in the economy as in politics, the capitalist religion declares a state of permanent crisis (crisis etymologically means "definitive judgement"), which is, as the same time, a state of exception that has become normal, whose only possible outcome presents itself, precisely as in the Apocalypse, as "a new earth". There are echoes here of anthropologist Carlo Caduff, whose work on pandemic preparedness and epidemiology anticipated so much about the confluence of expertise and government during the crisis, and who wrote in 2014: "Precaution has become a solid ground for dire prophecy and the thrill of terror, allowing experts and officials to commit a leap of faith and proceed as if the most frightening scenario was about to come true. In the political economy of disaster capitalism it is always better—ethically, politically, economically, and institutionally—to assume that the apocalypse is nigh".

Each of these quotes from Agamben implies a method operating on the level of ontology. A seemingly commonplace distinction is shown to have a more fundamental basis, rooted either in a signification which exceeds its referent, or in a deeper, more primordial structure, within which the distinction forms two modes or the excluded category is captured. Rarely if ever does Agamben talk about the psychology or epistemology of religious belief, but much of his short essay in May 2020 seems aimed at that level, certainly where he talks about cultic practice; which is to say, the everyday, pragmatic or liturgical side of religion. 

 Giorgio Agamben's contributed virtually for the launch of the Commissione Dubbio e Precauzione (DU.PRE), Dec 8, 2021

“What is new is that between science and the other two religions there has ignited, without our noticing it, a subterranean and implacable conflict, the successful results of which for science are daily before our eyes and determine in an unheard-of way all aspects of our existence. This conflict does not concern, as happened in the past, theory or general principles, but, so to speak, cultic practice. Indeed, science too, like every religion, knows diverse forms and levels through which it organizes and orders its structure: to the elaboration of a subtle and rigorous dogmatic there corresponds in practice an extremely broad and widespread cultic sphere which coincides with what we call technology”.

The simplified historiological schema I highlighted above bears some resemblance to Carl Schmitt's analysis in The Age of Neutralizations and Depoliticizations (1929), where he claims European statecraft has always attempted to govern from out of a neutralised central domain, which in the past included religion and economy. The 20th century, he went on to argue, appeared not just as the age of technology but of the religious belief in technology; "The question of the significance of overwhelming technicity should for now be left open, because the belief in technology is in fact only the result of a certain tendency in the shifting of the central domain - as a belief, it is only the result of this shifting".

Now, according to Schmitt we have been living in an age marked by the religious belief in technology for some time. His analysis was rooted in the experience of Germany's rapid industrialisation during the latter half of the 19th century. This context means his religion of technology and its miraculous powers is comparable to what otherwise we might call the religion of progress, much exemplified by Anglo-Saxon industrialists and pretty much the unofficial ideology of the British Empire. Indeed Schmitt had a notorious animosity towards English (and later American) technical domination, seeing it as the wellspring of global disenchantment and spiritual impoverishment, not to mention Germany's status as also-rans in the colonial scramble. Agamben, no doubt drawing on these thoughts, is nevertheless talking about much more recent events, and moreover he is specifically imputing a religious character to medicine during the pandemic.  

A straight-forward response here might be to ask whether medicine and cultic practice were not always aligned from the start? All cultures of the earth have known some form of witch doctors, healing rituals and rites in which the pragmatic/cultic part is paramount, forming as it were a bridge or mediating zone between the state of the individual and their community, or even the cosmos. Modern medicine, having benefitted from the results of diverse scientific fields has largely dispelled its superstitious and cosmological supports, at least where causes are concerned. Nevertheless it is certainly true that vestiges of the older holism persist where the medico-technical intervention coincides with broader social factors, among them being: the nature and meaning of recovery, the social status of the illness, and the network of complexities situating the "patient' within the heath culture of the society at large.

And is not the continuing significance of cultic practice within health most strongly confirmed in the case of the placebo?; a "treatment" which carries an effect without the presence of an active agent? The term originates in the Vulgate, psalms 114:9 Placebo Domino in regione vivorum. (I will please the Lord in the land of the living.) This psalm was commonly used in the  Office of the Dead where we also find the well-known Timor mortis conturbat me (I am scared to death of dying), which has become something of an silent guiding maxim for many during the pandemic. Over time placebo became a shorthand for any deceptive act to please, apparently owing to the common practice of mourners with no connection to the deceased participating in the ritual for the purpose of getting a share of the funeral meal. 

Agamben certainly has a point about the pandemic leading to an explosion of strange public rituals, be they obsessive hand-washing - which compares to the Islamic Wudhu, performed before entering a mosque - to the diverse practices around masks which have been such a flashpoint in Europe and America. This might be more easily explained if modern European societies were places where rituals and superstitions were still thriving, rather than having been melted into air by the white heat of consumerism. As Max Weber famously analysed, Capitalism and the Protestant faith share a common ethos, one expression of which are multiform processes of rationalisation. Consequently, both are lacking in ritual, in lingering, in acts which signify the marking of (non-clock) time.

We should perhaps concede that there was a space open for a new cultic practice to be introduced for the disaffected classes (most of all the professional middle classes) to fall into. But it is also true that the Covid cult furnishes rituals of a unusual kind. Lingering is by no means encouraged, particularly in proximity with others. And a deadening suspicion falls upon anything that denotes a commitment to the intensity of a life well lived. In his book The Disappearance of Rituals Byung-Chul Han reflected on this fear when discussing George Bataille's distinction between strong and weak play. For us moderns, he claims; "Only weak play is tolerated and it forms a functional element within production. The sacred seriousness of play has entirely given way to the profane seriousness of work and production. Life subordinated to the dictates of health, optimization and performance comes to resemble mere survival. It lacks splendour, sovereignty, intensity. The Roman satirist Juvenal expressed this well when he spoke of 'losing the reasons to live for the sake of staying alive'".

Is there not something of the Timor mortis conturbat me in this line from Juvenal? Timorousness is certainly as near to us as any of the more virtuous responses to the crisis. In stark opposition to the splendour and intensity of ancient rituals, the pandemic offers only empty rituals, rituals of stasis which tie the practitioner to the present as a state of fear and constant threat. As such, the characteristic utility of religious and cultic practices for making life more bearable is absent. Instead, every vigorous scrub with the alcohol gel or hasty fumble for the mask on reaching the threshold of a shop is a reminder of the unknowable evil which now hangs over the everyday.

“The enemy, the virus, is always present and must be fought unceasingly and without any possible truce. The Christian religion also knew similar totalitarian tendencies, but they concerned only some individuals—in particular, monks—who chose to put their entire existence under the emblem “pray unceasingly.” Medicine as religion takes up this Pauline precept and, at the same time, reverses it: where monks gathered together in convents to pray constantly, now the cult must be practiced even more assiduously, but while remaining separated and at a distance”.

Again the spectre of Schmitt hangs over this passage, as the evocation of absolute enmity makes clear. Perhaps this is unavoidable, as it is true that from the beginning much of the political messaging around the pandemic has been couched in terms of war and military struggle against a foreign invader. There are, however, dangerous consequences to propagandising in this way. In an atmosphere of fear and uncertainty the cult becomes a means of organising this generalised enmity, opening the way for politically managed ostracism and othering. Nowhere is this more apparent than in the increasingly punitive actions being directed against the unvaccinated. A historical example is instructive here. In the 14th century, partly in response to the Black Death, a popular phenomenon which came to be known as The Flagellant Movement appeared in Northern and Central Europe. Processions of ordinary people would perform public acts of penitence, most notably by whipping themselves in the hope of cleansing their sins or earning mercy from whatever ill was afflicting their community. During the plague in Europe these zealous groups would lead the persecutions against marginalised communities, accusing them of lacking piety and being the cause of the disease. Jews were especially targeted. Pope Clement VI officially condemned them in a bull of October 20, 1349.

14th Century depiction of a a procession of Flagellants

One does not have to stretch the imagination far to see a parallel in the way politicians and the media have whipped up resentment against apparent rule breakers and unvaccinated persons. Even to question the efficacy of lockdowns and other modern penitential methods is to invite scorn for a lack of piety. As for modern flagellants; double maskers, ostentatious social distancers and vaccine eulogists, all tend to be quick to demand harsh action against those who resist the cult, even if only in thought. Other Medieval methods of disease prevention which have seen a revival include amulets and charms (masks and health passports) and despite the theory of miasmas having long been superseded we nevertheless have seen the practice of fumigating “bad air” make a return, notably in classrooms full of freezing children.

The historian Norman F. Cantor associates modern explanations for plague with a rational synchronic method (we might also say non-teleological), whereas the Medievals viewed the plague diachronically and told stories. It is perhaps too optimistic to conclude this latter mode of explanation has been consigned to the past. We are now overly familiar with stories from both the conspiratorial side and the so-called followers of science as to the ultimate meaning of the pandemic (sins of the Chinese fishmongers anyone?).  If the modern scientific synchronic explanation were sufficient, why do we need a story about the evil of the unvaccinated to explain the failure of our containment strategies?; just as during medieval times Europeans scapegoated Jews, women accused of witchcraft, and those lacking in piety for the disease? The millenarianism which accompanied the reaction to the Black Death is mirrored in explanations for Covid rooted in ecological exploitation and climate collapse. The virus entered a world (well, the West really) already gripped by eschatological fervour.

We have long become accustomed to the cult of health and "body fascism" through the media's veneration of youth and the now commonplace desire amongst citizens of the most developed economies to use medical technology as a way of modifying the corporeal form they were given, in pursuit of some ideal, often just the latest trend pushed by digital influencers. Diet fads, mass gym membership, body shaming, cosmetic surgery,  supplement addiction, performance enhancing drugs; all of these are tributaries running into the torrent of health terror which we are now swimming in. For transhumanists and post-modern gnostics the pandemic is just one more sign that it's time we jettisoned Brother Donkey.  

Does this amount to evidence of medicine being treated as a religion? One of the commonplaces attributed to religious belief is that it gives you a story about how the world is, allows you to face living in a universe governed by irreducible uncertainty. Agamben himself once offered a provisional definition of religion as a form of social ordering centred around the sacred. There is also a fundamental epistemological side to this. Adhering to a rule, even an entirely arbitrary one, can function like a founding gesture, akin to drawing a line in the sand, and can have the effect of dispelling uncertainty for the one who obeys. Here we might reflect on the role played by the increasingly discredited epidemiological modelling used repeatedly to justify government restrictions. As Carlo Caduff noted in his work on "pandemic prophesy", apocalyptic scenarios cover over the uncertainty inherent in the crisis, instead presenting a situation governed by the pure necessity to act. This has the effect of securing legitimacy for the governing power to act maximally without the need to justify itself as to alternative courses. The fear this produces in the population similarly converts contingency into necessity, rendering them governable.  

If medicine has taken on the character of a religion then this represents a corruption of medicine which can only be detrimental to the public good. Witness the wholesale abandonment of comprehensive public health during the pandemic and the enthusiastic support for lockdowns and other measures which raise fighting the virus to the zenith, while ignoring everything else worthwhile in life. An excellent article in the BMJ in 2020 made just this case. This week I've read that several hundred thousand cancer screening appointments were missed in the UK during the lockdowns, likely resulting in many missed diagnoses and a reduction in health outcomes for cancer sufferers.  

“Like capitalism and unlike Christianity, the medical religion does not offer the prospect of salvation and redemption. On the contrary, the recovery which it seeks can only be provisional, since the evil God, the virus, cannot be eliminated once and for all, but mutates continually and assumes ever new, presumably more dangerous, forms. Epidemic, as the etymology of the term suggests (demos is in Greek the people as a political body and polemos epidemios is in Homer the name for civil war) is above all a political concept, which is preparing to become the new terrain of world politics—or non-politics”.

Could the present cultic status of medicine and health practices be a temporary phenomenon rather than the gestalt switch which Agamben claims here? This is not the first time he has written on modern medical technology. He devoted a quite chilling chapter of Homo Sacer: Sovereign Power and Bare Life to the consequences of life support machines on our understanding of death, notably shifting it from the cessation of the pulmonary function onto so-called brain death.

There is no more ghoulish example of the end-point of sacralising bare biological life under the reign of technology than the body of a brain-dead individual kept nominally “alive” indefinitely by life-support machines while relatives - for religious reasons - will not allow the earthly remains to pass away. Agamben makes the point that this technologically suspended death realises in practice the abstraction wrought by modernity between the biological existence of human beings, and their social, emotional and cultural existence. Modern science and medicine direct their interventions upon the former, with the latter either being ignored completely or considered an epiphenomenon of biological systems, and thus themselves calculable and potentially malleable by medico-scientific means. The pandemic has seen this abstraction applied vigorously as societies across the globe have been reduced to the level of base productive systems; an ant hill or battery farm, which must be managed so to preserve biological productive capacity at the expense of all else. 

Perhaps then we might better understand the sudden appearance of this "cult of medicine" as having its conditions of possibility in other pre-existing discourses? Rather than medicine having found a new cultic vocation by taking on the characteristics of a religion, could we not also attribute the near hysterical permanent "celebration" of the cult to the fact that biomedical sciences have been radicalised through historical contamination with the Security State? Here too there is the Gnostic-Manichean duality of an unceasing battle against implacable evil, which - in accordance with the logic of worst cases - we can never be certain to have won. For how long now have we suffered the cultic rituals of security as we go about our daily business? And how totally has the equally pernicious cult of "risk management" polluted every area of human life, leaving anything that escapes the calculation of risks as either suspect or irrelevant. 

 It is not insignificant that pandemic preparedness was an outgrowth of Cold War disaster planning. One way of understanding the management of the pandemic (at least in its early stages) is as an application of so-called "vital systems security", where the maintenance of certain national systems (health services, supply chains, government functioning, etc), are prioritised as vital to the survival of the country under existential threat. This way of conceiving disaster planning developed primarily as a response to the threat of nuclear attack, confirming both Agamben and Caduff's observations regarding the overwhelming power of apocalyptic thinking within what are meant to be cool headed and rational scientific approaches. But such an apocalyptic and militarised framing is caustic to comprehensive public health. It's not really a public health strategy at all. It's a brutal strategy of survival where the religious logic of sacrifice and penitence are writ large. All the more so owing to their appearance as emanations of our best science.

Whether the cult will persist and be integrated into a more permanent regime of global health security is unclear. The flagellants disappeared, though practices of penitence at times of crisis did not. There are also some signs that the damage done by abandoning comprehensive public health is gaining public awareness. Agamben's essay, like many of his interventions since the start of the pandemic, is pregnant with pointers and portent, but lacking on the detail which usually characterises his work. This doesn't mean there isn't something there to think about.