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From Modern to Postmodern Medicine: the Case of Organ Transplants

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From Modern to Postmodern Medicine: the Case of Organ Transplants FROM MODERN TO POSTMODERN MEDICINE: THE CASE OF ORGAN TRANSPLANTS A THESIS SUBMITTED TO THE GRADUATE SCHOOL OF SOCIAL SCIENCES OF MIDDLE EAST TECHNICAL UNIVERSITY BY NİHAN BOZOK IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN THE DEPARTMENT OF SOCIOLOGY FEBRUARY 2015 Approval of the Graduate School of Social Sciences Prof. Dr. Meliha Altunışık Director I certify that this thesis satisfies all the requirements as a thesis for the degree of Doctor of Philosophy. Prof. Dr. Ayşe Saktanber Head of Department This is to certify that we have read this thesis and that in our opinion it is fully adequate, in scope and quality, as a thesis for the degree of Doctor of Philosophy. Assoc. Prof. Dr. Erdoğan Yıldırım Supervisor Examining Committee Members Prof. Dr. Ş. Halil Turan (METU, PHIL) Assoc. Prof. Dr. Mustafa Şen (METU, SOC) Assoc. Prof. Dr. Erdoğan Yıldırım (METU, SOC) Assoc. Prof. Dr. Nedim Karakayalı (Bilkent U, POL. SCI) Asst. Prof. Dr. Çağatay Topal (METU, SOC) PLAGIARISM I hereby declare that all information in this document has been obtained and presented in accordance with academic rules and ethical conduct. I also declare that, as required by these rules and conduct, I have fully cited and referenced all material and results that are not original to this work. Name, Last name: Nihan Bozok Signature : iii ABSTRACT FROM MODERN TO POSTMODERN MEDICINE: THE CASE OF ORGAN TRANSPLANTS Bozok, Nihan Ph.D., Department of Sociology Supervisor: Assoc. Prof. Dr. Erdoğan Yıldırım February, 2015, 240 pages This thesis investigates the constituent tendencies of postmodern medicine, concentrating upon the organ transplantation therapy. Adopting a genealogical perspective, as a methodological tool, for reading the current history of medicine, it develops its theoretical framework through Michel Foucault’s discussions on biopolitics and Nikolas Rose’s discussions on molecular biopolitics. This study is based on the assumption that medical knowledges of body, vitality and death are historically fluid and context bounded. Therefore, the medical configuration of recent times operate under the conditions of postmodernity. This thesis explores the medicine peculiar to postmodern times, and presents the unique characteristics of current medicine through by focusing on organ transplantation as a postmodern medical case. As a result, it is argued in this thesis that, there are four prominent ruptures in the field of medicine in the postmodern times. Firstly, postmodern medicine does not iv imagine the body as something biologically given, contrarily it sees the body as something remouldable. Secondly, postmodern medicine transforms death into an event that is able to be experienced by individuals piece by piece. Thirdly, through operating in the conditions of current global capitalism, postmodern medicine transforms vitality parts into commodities. Fourthly, postmodern medicine gives new lives to the organs circulating without bodies. Keywords: Sociology of Health and Illness, Sociology of Body, Biopolitics, Postmodernity, Organ Transplants v ÖZ MODERN TIPTAN POSTMODERN TIBBA: ORGAN NAKİLLERİ ÖRNEĞİ Bozok, Nihan Ph.D., Sosyoloji Bölümü Danışman: Doç. Dr. Erdoğan Yıldırım Şubat, 2015, 240 sayfa Bu tez, organ nakli tedavisine odaklanarak, postmodern tıbbın kurucu eğilimlerini araştırıyor. Tıbbın günümüz tarihini okumak için, jeneolojik yaklaşımı metodolojik bir araç olarak benimsiyor. Teorik çerçevesini Michel Foucault’nun biyopolitika tartışmaları ve Nikolas Rose’un moleküler biyopolitika tartışmaları aracılığıyla geliştiriyor. Bu çalışmanın yaslandığı varsayım bedenin, canlılığın ve ölümün tıbbi bilgilerinin tarihsel olarak akışkan ve bağlamsal olduğudur. Bu yüzden, son zamanlara özgü tıbbi biçimleniş postmodern koşulların etkisi altındadır. Bu tez, postmodern tıbba ait bir vaka olarak organ nakli tedavisine odaklanarak, postmodern zamanlara özgü tıbbı inceliyor ve bugünün tıbbının biricik özelliklerini ortaya koyuyor. Sonuçta, bu çalışmada, postmodern zamanlarda tıp alanında dört önemli kopuşun gerçekleştiği tartışılıyor. İlkin, postmodern tıp bedeni biyolojik anlamda verili bir şey olarak tahayyül etmez, aksine, bedeni yeniden kalıba dökülebilir bir şey vi olarak görür. İkinci olarak, postmodern tıp ölümü parça parça deneyimlenebilen bir olaya dönüştürür. Üçüncü olarak, postmodern tıp hâlihazırdaki küresel kapitalizm koşulları içinde işleyerek, canlılık parçalarını metalara dönüştürür. Dördüncü olarak, postmodern tıp bedensiz dolaşan organlara yeni yaşamlar verir. Anahtar Kelimeler: Sağlık ve Hastalık Sosyolojisi, Beden Sosyolojisi, Biyopolitika, Postmodernite, Organ Nakilleri vii DEDICATION to Mehmet… viii ACKNOWLEDGEMENTS I am grateful for a number of people for their contribution throughout the preparation of this study. First of all, I have to state my indebtedness and gratitude for my supervisors Assoc. Prof. Dr. Erdoğan Yıldırım and Dr. Adnan Akçay. I am also thankful for the members of my thesis examination committee: Prof. Dr. Ş. Halil Turan, Assoc. Prof. Dr. Mustafa Şen, Assoc. Prof. Dr. Nedim Karakayalı, Asst. Prof. Dr. Çağatay Topal. I am particularly thankful to Dr. Mehmet Bozok for being my beloved, my friend, my comrade, and my valuable colleague. I also wish to present my thankfulness for my family and friends, without their endless support, encouragement and patience this thesis could hardly be possible. ix TABLE OF CONTENTS PLAGIARISM .......................................................................................................... iii ABSTRACT ............................................................................................................. iv ÖZ ............................................................................................................................. vi DEDICATION ....................................................................................................... viii ACKNOWLEDGEMENTS ..................................................................................... ix TABLE OF CONTENTS .......................................................................................... x CHAPTER I INTRODUCTION .................................................................................................. 1 II THE SLIPPERY KNOWLEDGE OF MEDICINE ...............................................12 2.1 Unstable, Time and Context Dependent Knowledges of Health and Illness . 15 2.1.1 Accumulation Patterns of Medical Knowledge ....................................... 16 2.1.2 “Changeable Social” versus “Fixed Biology” ......................................... 22 2.2 Methodological Concerns: “How Should the History of Contemporary Medical Subject Be Made?” .................................................................................. 24 2.2.1 “The History of the Present” and the “Cartography of the Present”: Genealogy as a Methodology ............................................................................. 25 2.2.2 Power: A Genealogical Axis ..................................................................... 28 2.2.3 Knowledge: A Genealogical Axis ............................................................. 36 2.2.4 Body: A Genealogical Axis ...................................................................... 41 III FROM MODERN MEDICINE TO POSTMODERN MEDICINE ..................... 50 3.1 Modernity and Its Imagination of Medical Subject ......................................... 52 3.2 Postmodern Turn and Its Reflections on Medicine ......................................... 66 3.3 Constituent Tendencies of Medicine in Postmodern Times: First Steps towards a Sociological Analysis of Organ Transplants as a Postmodern Medical Case ........................................................................................................................ 87 IV POSTMODERN MEDICINE, ORGAN TRANSPLANTS, AND THE BODY ..................................................................................................... 95 x 4.1. Molecular Body as a Network: New Spatialization ..................................... 98 4.2 A Comparison between Molar Body and Molecular Body ......................... 104 4.3 Plasticity and Softness of the Body ............................................................. 112 4.4 Organs Jettisoned Out of the Body: From “Abject” Elements to Biovaluable Things ................................................................................................................ 116 4.5 Concluding Remarks: The Piecemeal Body ................................................ 122 V POSTMODERN MEDICINE, ORGAN TRANSPLANTS, AND THE DEATH ............................................................................................... 125 5.1 Reconfiguration of the Death: Delayed and Partial Deaths ......................... 128 5.2 Death in the Modern Context of Medicine .................................................. 132 5.3 Partial Deaths in the Postmodern Context of Medicine: The Notion of Brain Death .................................................................................................................. 135 5.4 Creating Partial Deaths in the Living Body: Immunosuppressants ............. 144 5.5 Concluding Remarks: Blurred Deaths ......................................................... 148 VI POSTMODERN MEDICINE, ORGAN TRANSPLANTS, AND COMMODIFICATION ............................................................................... 150 6.1 Exchanging Organs: Organs as Commodities without Bodies .................... 152 6.2 What Kind of Commodity
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