The MRSA Epidemic and/as Fluid Biopolitics

Towels and Turf: Producing Pathogenic Bacterial Space

Staphylococcus aureus infections attack the skin and other soft tissues of the body. Such infections typically manifest in skin lesions, such as rashes, boils, abscesses or carbuncles, many of which are often pus-filled, highly inflamed and painful. Untreated or difficult-to-treat infections can cause tissue necrosis in an infection resembling what is commonly called ‘flesh-eating’ disease. Lesions may result in the death of skin, fat, muscle and even bone, causing gaping wounds that may only be treated with amputation. Some infections become systemic, infecting the blood and internal organs, causing sepsis and, in some cases, resulting in death (CDC, 2010b).

The first methicillin-resistant Staphylococcus aureus (MRSA) case was reported in the United Kingdom shortly after the antibiotic methicillin, a narrow-spectrum antibiotic that was intended to cure strains of S. aureus that had become resistant to all other forms of penicillins and cephalosporins that had been previously effective, was introduced in 1959. For most of the latter part of the 20th century, medical scientists classified MRSA as a nosocomial pathogen – meaning that it was almost exclusively contracted in healthcare facilities (Barrett et al., 1968; Jevons, 1961). However, from 1980 onward biomedical scientists began to see more incidents of MRSA contraction occurring outside of hospital and healthcare environments. ⁴ Following a series of outbreaks in North Dakota and Minnesota from 1997 to 1999, the U.S. Centers for Disease Control and Prevention (CDC) created two classifications for MRSA cases: the more common ‘healthcare-associated MRSA’ (HA-MRSA) and a new ‘community-acquired MRSA’ (CA-MRSA) (CDC, 1999). By 2003, the CDC had noted an ‘outbreak’ in CA-MRSA cases ranging from high school and college athletes in Colorado, Indiana, Pennsylvania, and California to adolescent schoolchildren in New England (CDC, 2003a, 2003b).

Currently, CA-MRSA and HA-MRSA are differentiated according to genetics and not the location of the patient at the onset of the infection, although the majority of all MRSA infections originate outside of the healthcare setting and can present either genetic strain of the bacterium (Evans, 2008). There is ongoing evidence to suggest, however, that there is a close relationship between outbreaks of MRSA within the healthcare setting and outbreaks within the community, and that control of the one requires control of the other (Beam and Buckley, 2006; Huang et al., 2006; Salgado et al., 2003).

Today, both healthcare- and community-acquired MRSA infections are commonly treated with the antibiotic vancomycin, but there is new evidence to suggest that this and other combinations of antibiotic treatments quickly become ineffectual for the rapidly evolving bacterium (McGowan and Tenover, 1997; Schentag et al., 1998). McGowan and Tenover’s (1997) report on the emergence of antibiotic-resistant strains of bacteria as the result of existing regimes of antibiotic prophylaxis and treatments identifies the rise of MRSA and other difficult-to-treat infections with current healthcare practices aimed at controlling other sorts of disease transmission. ⁵ Schentag et al. (1998) note this important distinction between epidemic and endemic bacterial diseases; in an effort to control population-level epidemics involving widespread and rapid transmission between individuals, current epidemiological practice has enabled endemic populations of bacteria to thrive within the human population, emerging opportunistically during hospitalization, incarceration and, increasingly, in zones of human contact that involve the transmission of bodily fluids and skin-to-skin contact. Endemic pathogenic bacterial populations exist naturally within a human population and become infectious or virulent due to some set of conditions inherent to the population itself; this stands in opposition to foreign pathogens (epidemics) that are introduced from an external source and do not normally live within the population. ⁶

This kind of paradox, whereby medical treatments or practices give rise to further medical issues, is commonly encountered in the healthcare system, as new diseases, symptoms and side effects commonly arise as the result of interventions aimed at some other set of health problems. ⁷ Endemic pathogens are carried by individuals who do not usually exhibit symptoms of infection. In the case of MRSA specifically, the spread of the disease from healthcare settings into the community, and the emergence of new strains of the bacterium, represents a complex relationship between current clinical healthcare practices and health imperatives that drive particular community spaces and the flows of bodies into and out of them; that many community MRSA infections are contracted in gyms, locker rooms, and sports fields is a sign of the paradoxical nature of the drive to achieve ‘healthy’ bodies in ways that put them at risk and construct tension between community life and the desire to isolate one’s body from the bodies of others.

There exists considerable biomedical literature on the prevalence of MRSA in sports and fitness contexts and its transmission through skin-to-skin contact and ‘poor hygiene’ practices among athletes. Contact sports are the current source of most sports-related MRSA outbreaks (Benjamin et al., 2007), with one prominent example occurring on a college football team and involving eleven athletes suffering from boils. A study of the team found that 8% of 99 players carried MRSA in their nasal passages, and that carriers of the bacteria were often found to share towels and soap (Nguyen et al., 2005). Of the infected players, sharing soap and having pre-existing skin abrasions were found to be the most likely cause of transmission, with linebacker being the most likely position affected. Other cases have included seven players on a Wisconsin high school football team (one hospitalization), seven University of Southern California football players (four hospitalizations) and five members of a fencing association in Colorado, among others (Yee, 2009). Such cases have invariably been linked to the sharing and/or improper or infrequent cleaning of equipment, towels and soap, prompting concerns about the safety of physical activity that occurs in confined spaces and among teams of players who are required to come into close physical contact with one another. The fact that most of these athletes are young and healthy, with little prior exposure to clinical settings, has also challenged conceptions of MRSA as disease that afflicts immuno-compromised, post-operative or injured individuals (Nguyen et al., 2005).

For our purposes here, this new CA-MRSA classification that arose as MRSA cases became more common within the community introduced not just a new medical typology but also an important new spatiality to the mounting ‘MRSA epidemic/endemic’. Whereas prior to 1999 the scientific community associated the spread of methicillin-resistant Staphylococcus aureus with hospital and infirmary spaces, this new typology expanded MRSA’s pathogenic landscape, pointing to new spaces where flesh could be made susceptible to bacterial exposure. No longer was the hospital patient’s body – assumed to be already vulnerable and exposed – the only body at risk of encountering MRSA bacteria. Now those more vivacious and vital bodies – high-performing athletic bodies and playful bodies – were being put at risk by entering into the very spaces that gave them that vitality.

And biomedical experts made sure the moving public knew as much. As has tended to be the case with other recent ‘pandemics’ (i.e. the ‘bird flu pandemic’) or ‘epidemics’ (i.e. ‘the obesity epidemic’), a large-scale public awareness campaign soon followed. This alarmist public pedagogy featured such ‘awareness’ endeavors as World MRSA Day (www.worldmrsaday.org), which named October as World MRSA Awareness Month and organized a Global MRSA Summit with the goal of inciting the World Health Organization (WHO), Department of Human Health Services (DHHS) and the CDC to set up a world-wide surveillance and reporting of MRSA infections network. While these efforts were aimed primarily toward making hospitals and other healthcare facilities safer places to receive medical care, other efforts were directed towards the community, with athletic organizations and schools being the primary targets. The National Collegiate Athletic Association’s (NCAA) medical committee issued an official warning about skin infections such as MRSA and offered resources and information on how to prevent such infections in 2009, while the National Federation of State High School Associations issued a warning about drug-resistant skin infections in the same year (Yee, 2009).

This secondary focus on sporting spaces/equipment and the hygiene practices of athletes themselves led to increased concern about the cleanliness of active bodies and the spaces and objects with which they come into contact. A 2007 New York Times article warned: ‘[E]xtra vigilance should be used in health clubs and gyms – staph grows rapidly in warm, moist environments’ (Parker-Pope, 2007). An MRSA awareness website has this to say about locker rooms and gyms:

MRSA is spread by skin-to-skin contact, or through personal items that have been contaminated with the bacteria such as towels or athletic equipment. MRSA is spread more easily in close quarters, like gyms and locker rooms. It is not uncommon for MRSA infections to spread among athletic team members or people who regularly visit the gym. Athletes who play close-contact sports, such as wrestling and football, are also at an increased risk of contracting and spreading MRSA. In fact, MRSA infection rates are higher among football players than among other athletes. A total of 517 out of every 100,000 football players contracted MRSA from 2003 to 2005 as opposed to the overall national rate of 32 per 100,000 people. (www.stopmrsanow.org, 2012)

While much of the media attention around MRSA focused on hospitals (see Berens and Armstrong, 2008 for a particularly damning account of hospital practices), the increase in cases of MRSA reported in schools and sports teams has led to new practices of cleaning and wound reporting in such facilities in an effort to stop the spread of MRSA to people who seemed to be ‘the picture of health’ (ABC News, 2005). Our very concept of what it means to be a healthy, active individual, or to live the lifestyle of one who values and maintains his or her body by entering into particular spaces and engaging in particular sporting activities, was threatened by a disease that could kill even ‘big, strong football players’ (ABC News, 2005).

Through these public ‘[bio-]pedagogies’ (see Evans et al., 2008; Sicilia-Camacho and Fernández-Balboa, 2006), we learned that to locate the body within spaces of movement, to move in and among other bodies in motion – and to do so with the fluid-producing vigor that makes the body strong and healthy – was to put the body at risk. Such was and continues to be the dominant public pedagogy of the ‘CA-MRSA Epidemic’. Such a public pedagogy presents a paradox of immunity that we will revisit later in this piece.

On Solidity and Fluidity

For now, let us turn to a discussion on how we might conceive of these concurrent flows of bodily fluid and public bio-pedagogy about its immanent risk. We start at the intersection of two colliding vectors; one that we tend to think of as being necessarily fixed, and the other as necessarily unfixed: bio-space and biomedicalized flow. Drawing upon physics parlance, we begin by suggesting that the biomedicalized body has viscoelastic qualities: it is deformed (and reformed) in relation to the stresses of spatial solidity and at the same time flows across spatial gradients, leaving behind traces of the material, biosocial, and political bonds that make it. We might then be well served to consider the moving body – in the framings of the CA-MRSA epidemic just as in everyday life – as a vessel flowing about these solidities and fixities. The body is at once fluid and fluids. It is an assemblage of blood and bones, muscles and neurons, and it holds the capacity to, by way of its very physiological potential, alter the spaces it moves through and brings to life.

As we know, the flesh under which all this is packaged does not enclose the body’s potential for influx, discharge or infection. The body permeates and is permeable; the body is living and transmutable. To make this point more clear, we turn to the body’s fluidities. In so doing, we seek to make three related illustrations, each of which will work to inform the broader argument at hand: (1) the body is fluid (in relation to its capacity for movement in and about a solid environment); (2) the body produces and exchanges fluids (blood, sweat, water, etc.); and (3) bodily fluids are always flowing through the spatial environment.

First, as we have already noted, the body is both fluid in terms of its capacity for movement in and between physical objects and environments, as well as being materially composed of fluid substances and tissues that slide past one another (and enter the bodies of others), producing movements, consciousnesses and political potentialities. Bodies flow en masse, along particular, migratory trajectories, into and out of buildings at particular times of day, circulating through and between institutions, public and private spaces in daily, sometimes regimented and other times unchoreographed, cycles of movement. If bodies were static there would be no culture, no meaning, no change. Just as the fluids within the body must be in perpetual exchange with one another, so must bodies themselves cycle into and out of contact with one another, the process of which enables the whole to operate on some meaningful level. And just like bodily fluids, fluid bodies move according to patterned repetitions, though these (unstable) patterns arise from the momentary solidifications of meaning that enable social life and consciousness to be organized around some kind of logic.

Second, the actual fluids that the body produces, leaks, excretes and secretes are, despite, perhaps, our best efforts to the contrary, in constant circulation. As we move we leave traces of our bodies behind, fixed to the solid surfaces that enable our movements in the first place and waiting to be picked up by others who move across the same spaces and encounter the same objects. Our porous bodies avail themselves of these fluid compounds whether we like it or not, and our fear of the physical opening up of one body to another is inherently tied to our concept of disease and the potential for death (Shilling, 2003), which is manifest in the current regime of biomedical and biosocial literature in terms of the bacteria, protozoa and viruses that make us ill and/or kill us. The illusion that our bodies are solid, discrete containers of ourselves is thrown into question by the existence of diseases such as CA-MRSA and the knowledge that the bodies of others transmit such illnesses to ours. The boundaries between individual bodies are somewhat blurred by this knowledge; that a potentially life-threatening infection can be picked up through the skin by an act as benign as using a towel is disconcerting. We come to realize that bodily fluids are more pervasive and co-mingling than ever before, and we become subject to new biomedical discourses of prevention, safety and health in an effort to re-establish bodily boundaries.

Third, the spatial environment itself is not static but in motion, subject to being made and remade through its interaction with the bodies that move through it, and the articulations those bodies then make between spaces, times and the bodies of others. In this way, solidity, or the appearance of solidity, is an attribute given to other things in the constitution of fluid things. Where we have described bodies as fluid entities moving through a solid environment, to conceive of the fluidity of space requires, conversely, that we conceive of bodies as solid as they come into momentarily fixed relationships with space. Solidity is not an actual quality, then, but a temporary state, a nexus around which particular meanings come into being; it is a concept that allows us to make sense of our bodies in particular, biologized ways.

In these juxtapositions of solidity and fluidity we find an interesting way of thinking through the body’s ‘fluid boundaries’ (Irigaray, 1985). Here we are using Irigaray’s concept in its double meaning, both in looking at (1) how leaky (feminine) bodies tend to be framed within biomedical discourse as in need of containment and (2) that the body itself is necessarily bounded to (biotechnological, biosocial, biospatial) solidities and solidarities. Indeed, what is at stake in traditional healthcare practices and discourses is that ‘the material boundaries of the body should be secure and that otherness [be] excluded’ (Shildrick, 1997: 11). Conceived as such, the body is at once a closed and open vessel; a container and that which is to be contained; solid and fluid; a giant semilunar valve that begrudgingly permits fluids to be forced through its dermatological coverings, but wishes to prevent backflow or the intrusion of pathogenic substances into and out of the body.

In/Operative Bodies

Biopolitics is primarily that which is not sovereignty. (Esposito, 2008: 33)

Up to now we have suggested that the body is a set of contingencies and inexhaustible articulations; a flesh-bound synthesis of physics, anatomy, geometry and ideology at once (1) moving fluidly about space, (2) becoming an open vessel of fluid transmission and exchange and (3) always about to encounter solid and imagined spaces already contaminated by the residues and seepages of the fluid exchange. This logical progression raises a number of questions as we turn back to the CA-MRSA Epidemic, particularly with relation to prescriptions aimed at ‘prevention’, ‘isolation’ and ‘immunity’. How are we to conceive porousness in light of contemporary biopolitical doxa? What are the inherent contradictions of a body at once positioned as fluid and about solidity? How can the body be isolated from those communal and othered bodies which produce the very (p)references for such isolation?

To entertain these questions, we believe it would be useful to delve deeper into the metaphysical incongruities underpinning prevailing ‘CA-MRSA Epidemic’ discourse – namely those of proximity, prevention and preservation. Biopoliticians now vigilantly remind us that to preserve vital life, we must avoid others’ secreting bodies (as well as bodies that hold the potential to secrete) and the spaces in which they ooze. To recast Foucault’s contemplations in The Birth of the Clinic, it is in the perception of dermatological abscess that the individual finds her/his own healthy flesh (1975: 171). These discursive framings implore avoidance of active body spaces and the bacterial deposits residing in those spaces; inoculation through isolation, if you will.

Ironically, the CDCs also remind CA-MRSA sufferers of the ‘Five Things to Remember about Living with MRSA’:

Wash your hands often.

In other words: get outside, seek help, be active in active spaces, be responsible with your skin as it will certainly come in contact with others’ assumedly (un)healthy flesh. Another CDC article aimed specifically at athletic facilities divides its advice on how to prevent MRSA spread into three categories: improve athlete hygiene; clean and disinfect athlete facilities; exclude athletes with MRSA from participation (CDC, 2010a). These three subsections cover the topic of prevention (through practices of personal and facility hygiene), location (through the isolation of the infected athlete’s body, hygiene practices that maintain boundaries between athletes and between athletes and particular objects), and preservation (through recommendations for the treatment of wounds, the assumption that healthy skin and bodies are wound- and bacteria-free). Paradoxically, the bodies of athletes are encouraged to continue their lively, communal activities, but in ways that isolate and individualize them as much as possible. While sports participation still falls under the purview of discourses of health and activity, the individual (usually team-playing) athlete comes to be perceived as a threat to the community, and the community as a threat to him or her. The relationship between the individual and the community, then, is complicated as each resists, but requires, the other.

These narratives project an impossible (meta)physics of being separated from an always-bacterial human ecology while being mindful of the substrate’s ecological permeability. However, such impossibility is not beyond the popular biopolitics of our times; times, as Agamben wrote in The Coming Community, when ‘the absurdity of the individual existence, inherited from the subbase of nihilism, has become in the meantime so senseless that it has lost all pathos and been transformed, brought out into the open, into an everyday exhibition’ (1993: 64). The biomedical and scientific communities have promulgated and given life to a certain ‘biolegitimacy’ of individualizable ‘biosociality’ (Lemke, 2011: 7); an ethopolitics of a healthy and autarkic self – isolated from the very biosocial world that vitality is given to and takes reference from. For us, at least two epistemological narratives help countenance the popular biopolitics of the CA-MRSA Epidemic: (1) immunity and contagion and (2) constructions of the immunological Self.

The Immunitas Paradigm

In his recent works, Roberto Esposito (2008, 2009, 2011) has set out to conceptualize the ‘immunity paradigm’ as a way of understanding how the apparently unrelated phenomena that are coming to saturate contemporary biomedical discourses – the ‘fight’ against epidemics, illegal immigration battles, attempts to neutralize the latest computer virus – come under the sway of biopolitical doxa. It is here that we find the biopedagogical production of a protective negation of life. In other words, within epidemical constructs such as CA-MRSA, the individual is called to act in ways that immunize the body from the risk of, and risks associated with, corporeal contact: to protect life by isolating oneself from life (Campbell, 2008a). Where the term ‘immunity’ for the biomedical sphere refers to a condition of natural or induced refractoriness on the part of a living organism when faced with a given disease (Esposito, 2011), immunity’s cultural locutions ‘allude to a temporary or definitive exemption on the part of subject with regard to concrete obligations or responsibilities that under normal circumstances would bind one to others’ (Esposito, 2008: 45).

Such a biopolitics of immunity, we might then argue, starts with the promise of exception and ends with the rejection of sovereignty. As Foucault once wrote, the exigent strategies of sustaining life become powerful:

when it becomes technologically and politically possible for man [sic] not only to manage life but to make it proliferate, to create living matter, to build the monster, and ultimately, to build viruses that cannot be controlled and that are universally destructive. (2003: 241)

‘This formidable extension of biopower’, he continues, ‘will put it beyond all human sovereignty’ (Foucault, 2003: 241). Or put differently, a ‘biology and politics that originates in immunity’ (Campbell, 2008b: ix) is always in dialogue with that which is to be staved off, those impediments standing in the way of a perfect life. The freedom to pursue a pure and vital life is an articulated disarticulation, a life bound to, in its attempt to avoid, the proximities of deathly carriage present in, and presented by, others. In this way ‘freedom is necessarily shared (partagé), and the experience of the other’s mortality constitutes something like a condition of this sharing’ (Fynsk, 1991: xv). As such, an immunological body demands the rejection of its opposite – the communal. As Campbell suggests, it is conventional to assume that the individual ‘who has been freed from communal obligations or who enjoys an originary autonomy or successive freeing from a previously contracted debt enjoys the condition of immunitas’ (2008b: xi). Campbell continues, explaining that within the biopolitical sphere ‘the condition of immunity signifies both not to be and not to have in common…protecting itself from a presupposed excess of communal gift giving’ (2008b: xi).

Here is where a number of logical precepts of the current biopolitical enterprise come unraveled. Immunity must first be conceptualized as an ‘exemption from the obligation of the munus’ (Esposito, 2008: 5). Esposito (2009) explicates this point by noting three separate yet related meanings of the term communitas, each etymologically bound to its Latin origins around the term munus – at once a privilege of belonging and an exchange of gifts (see Campbell, 2008b for an extended etymological reading of Esposito’s use of communitas). This results in a corporeal juxtaposition in which immunity constitutes or reconstitutes community precisely by negating it (Esposito, 2011):

Immunitas is not just a dispensation from an office or an exemption from a tribute, it is something that interrupts the social circuit of reciprocal gift-giving, which is what the earliest and most binding members of the community are bound by the obligation to give back the munus that defines them as such, whoever is immune, by releasing him- or herself from the obligation, places himself or herself outside of the community. (Esposito, 2008: 6)

It is this indeterminacy that provides the location for Esposito’s heuristic on the indebtedness of the corporeal self to the collective body. It is what belongs to all or most and is therefore ‘public in juxtaposition to “private,” or “general” (but also “collective”) in contrast to particular’ (Esposito, 2011). It is a space in which borders meet and are (re)drawn.

This comes to light in a second notion that Esposito (2011) develops, drawn from the biomedical expansion that became the foundation for vaccination science – the introduction of a weakened form of infection to protect against future risk from the same type of contagion. Based on this premise, Esposito suggests that the immunitary paradigm presents itself as a ‘reaction’: ‘rather than a force, it is a repercussion, a counterforce, which hinders another force from coming into being’ (2011: 7). Furthermore, the immunity mechanism works by using that from which it is meant to protect us, thus reproducing exactly what it opposes. In this we see one of the central themes of Esposito’s work: the relationship between the protection and negation of life. And while he tends to be preoccupied with the microbiologic aspects of immunology, a similar line of thinking could be applied to the spatial relationships of immunity: a relationship of exclusionary inclusion.

For instance, by reading space into the following query:

If life – which in all its forms is the object of immunization – cannot be preserved except by placing something inside it that subtly contradicts it, we must infer that the preservation of life corresponds with a form of restriction that somehow separates it from itself. (Esposito, 2008: 8)

…we can see how the fleshed body itself, in its capacity to carry, transmit, and submit to the pathogenic invasions of invisible foreign entities can be positioned as the very outside presence which the corpus seeks to reject. Moreover, he suggests that this submission of life to an alien force is a process that necessarily inhibits the very development of life: ‘it can prolong life, but only by continuously giving it a taste of death’ (Esposito, 2008: 9). This is linked to the concept of the pharmakon, which ‘is a gentle power that draws death into contact with life and exposes life to the test of death’ (Derrida, quoted in Wolfe, 2013: 38). The presence of death, and its location in the bodies of others, is a kind of (dis)organizing force that requires both our attention and revulsion.

Since the self is not ‘designed’ to fit perfectly into any way of life, we must anticipate that every good way of life will both realize something in the self and encounter elements in the self resistant to its form. (Campbell, 2011: 154, quoting Connolly, 1992)

The more rigidly we define the borders of the self (and these borders are necessary to the maintenance of biomedical knowledge and the organization of politics and policy it demands), the more we avail ourselves of touching, or crossing, borders with thanatos (Campbell, 2011), or the prospect of death that, through its negation of our lives and our lively attempts to manage it, becomes increasingly powerful the more we try to avoid it. That the threat of death and contamination exists in the bodies of others reaffirms our sense of, and desire to maintain, the boundaries between our own lively bodies and their thanatotic ones.

The Immunological Self

In order to break the teleological bonds between the protection and negation of life, to reconcile the disjunctures of sovereignty and sovereign power, Esposito (2008, 2011) problematizes the very theme upon which the immunity paradigm was introduced: namely, the relation between ‘I’ and ‘other’ that permeates the discourse of modern struggles. The body – individual as collective node – need not be conceptualized simply in the form of boundaries, insides, outsides, threats and contagions which require the immune system to strengthen, maintain, guard, expel and kill. Instead, a body of literature is emerging which provides a contrasting view on the biological system. Nancy writes that:

community does not weave a superior, immortal, or transmortal life between subjects…but it is constitutively, to the extent that it is a matter of ‘construction’ here, calibrated on the death of those who we call, perhaps, wrongly, its ‘members’ (inasmuch as it is not a quest of organism). (1991: 14)

Esposito demonstrates instead that the calibration of which Nancy speaks does not just involve the future deaths of the community’s ‘members’, but also revolves around the mortal threat that the other members represent for each other. It is precisely this threat, and the calls for immunization from it, that explain why so many have in fact made the question of community ‘a question of organism’. Or, better, it is precisely the unreflected nature of community as organism that requires deconstruction. Only in this way will the biopolitical origins of community be made clear via community’s aporia in immunity (Esposito, 2008: 197). Nancy conceives the spatial dimensions of this undeniably communal corporeal-self this way:

community does not subflate the finitude it exposes. Community itself, in sum, is nothing but this exception. It is the community of finite beings, and as such it is itself a finite community. In other words, not a limited community as opposed to an infinite or absolute community, but a community of finitude, because finitude ‘is’ communitarian, and because finitude alone is communitarian. (1991: 27)

This would suggest a necessary production of the self-as-immunological individual: a programmatic and discursive construction of the excommunicated corpus. The biologization and technologization of (late) modern life has come to rely, Campbell (2011) argues, on the process of defending the self and its borders. But this process is ultimately in service of the population, of the community, and not of the individual him- or herself. If the individual is concerned to avoid death and contamination, and to take up a definition of him- or herself that takes the impermeability of borders for granted, it is because some population-level objective is being served; it is in this sense that the management of the population comes to depend upon the death of the individual, and we must always be aware of these deaths in order for them to give power to the organization of life.

Population in this way is both ‘secured’ and ‘explicitly linked to thanatos’ through the immunological conception of individuals as both threatening and avoidant of threat (Campbell, 2011: 122). The population of which individuals are members is abstracted from them as it comes to be seen as in need of protection from the threat of the individual’s, and its own, permeability. However, individuals themselves maintain a vested interest in the securing and proliferation of the ‘healthy’ population of which they wish to be a part, despite the fact that the individual and the population are constructed as mutually threatening entities. Drawing on Foucault, Campbell extends the concept of biopower to the realm of thanatology; populations are managed in order to become ‘secured and free (free precisely because secure)’ (2011: 125), and individuals and their bodies are subjected to control of their life processes through their simultaneous attraction to, need of, and fear of the population to which they belong.

In contrast to Foucault – who expresses biopower’s tendencies toward the body as normalizing and medicalizing – Haraway argues for the dismantling and multiplication of the body orchestrated by emergent technologies. Importantly, this view eliminates the separation between inside and outside with respect to bodies:

while up to a certain point human beings projected themselves into the world, and then also into the universe, now it is the world, in all its components – natural and artificial, material and electronic, chemical and telematics – which penetrates us. (quoted in Campbell, 2011: 147)

Campbell (2011) also moves beyond Foucault’s argument to discuss the possibility of an order of life that does not require the ongoing iteration of borders, and while he sees this possibility in the development of an aesthetics of play, we have, throughout this article, attempted to argue that the boundaries of the body and of the community are, despite our best efforts to secure them, already inherently porous and conducive to transmission. It is, in fact, our increasing awareness of this quality of existence that fuels the drive to close borders, to isolate them from contact with other borders, and perhaps even to fear what is contained within our own bodies.

Thus, because the immune system is the crucial point in which the body encounters what is other than itself it becomes the ‘nerve center’ through which the political governance of life runs. This perspective sees the embodied self, not as an immutable construct, but rather a dynamic entity open to continuous exchange: ‘a semipermeable self able to interact with others’ (Haraway, cited in Campbell, 2011: 165). Esposito takes this line of thinking a step further, suggesting that the polysemic corpus comes to represent the instability of the immune system. He draws upon the work of Tauber, who identifies the primary function of the (biological) immune system as defining the identity of the subject. As Campbell surmises, this immunological self is:

more than a simple logic of negation, it seems to refer to a contradiction by which identity is simultaneously affirmed and altered at the same time: it is established in the form of its own alteration. Like a pronoun that names it and the root from which the pronoun descends, the immunological self would thus be that which is more individual and that which is more shared. By overlaying these two divergent meanings into one figure, what we get is the unique profile of shared individuality or a sharing of immunity. It is perhaps in this chiasm that the enigma of immunity still lies preserved. (2011: 177)

The immunological self-building project – a body made in contrast to ‘the people’s body’ (Lemke, 2011: 11) – could thus be conceived as the materializing enfleshment of (bio)power. It is the articulation of flesh politics to the geometric and socio-political moorings about which that flesh flows. Molecule and signifier, individual and collective both unite under conditions of coupled separation: ‘there’s an infinite presupposition of a body-community, which bears a double implication’ (Nancy, 2008: 71).

Coda: The Biopolitics of Moving Mysophobia

In closing, we follow Julie Guthman and Melanie DuPuis (2006), Elizabeth Grosz (1995) and Arturo Escobar (1996) in seeking to locate the body and its movements within a ‘dialectic of dialectics’, thus providing a way to rethink the social constructed-ness of the biopoliticized moving body and its flow within and through always shifting (bio)political spaces. To return to the title of this article, we would conclude by suggesting that the CA-MRSA Epidemic tells us quite a lot about both fluidity and biopolitics, about how bodies and (bio)politics flow across enfleshed space. Following on from the argument developed in Merleau-Ponty’s (2002 [1945]) Phenomenology of Perception and Grosz’s (1994) elaboration on that work, we might assume that the body’s active flesh is capable of a double biopolitical sensation. It is at once the object of biopolitical governance, maintenance and control, and the subject of touch, of sensation, of movement. It is the producer of the very substance(s) from which the objectifying mechanisms are given life. It is both the object that is vulnerable to bacteria infection, and the carrier of that infection.

Of course, this is the case with many forms of disease. Yet there is something more to the CA-MRSA problem. There is a contradictory logic at work in the coming together of bodies, and what brings them together. The very spaces – the material contexts of contemporary hyper-corporeal dispositifs – are constructions of broader biopolitical systems; the gym or field are made, inhabited and made significant in large part because biopolitical forces bring us there. The congregations on the elliptical, or treadmill, or soccer pitch are in part enactors and subjects of biopolitical recourse. ⁸ The relationship of the individual subject to the community is constructed through such political processes and manifested in the bodies of people who are compelled to visit such sites of physical activity, but also compelled to pathologize an active body mysophobia, a distrust of the bodies of others and the surfaces with which they make contact. As biomedical discourses on bacteriology, epidemiology, and general health and fitness locate (and, in the case of CA-MRSA actually play a role in creating) new threats to the integrity of bodily boundaries, so too does it seem that the immunological self incurs the burden of increasingly complex and contradictory biopolitical forces that both drive them away from and encourage them to stay in contact with others, that identify their bodies as both the source and the negation of disease and fleshy decay.

Thus we need to reconcile two seemingly oppositional tenets of the contemporary biopolitical project, whereby biopolitics is often framed as a systematics of subordination imposed upon the body (e.g. the medical expert(ise), the biomedical gaze, occupational managerialism), with the idea of being fluid conceived as diffusive and emanating from the body (in vast and interconnected ways). Here we have been concerned with how the body, when set in motion (by choice or by force), spreads with and across various dialectical and articulative formations. The body is a vessel of biological and spatial articulation: connecting sinews and organs, linking – through movement – flesh and bones with the spaces in which they exist. The active body articulates with the bodies of others; with geometric and imagined space; with systems of homeopathy, prescription, and medicalization (and the biopolitics that give those systems form); with structures of capital, race, gender, sexuality and ability.

We have thus sought to illuminate an irreconcilable tension: a fleshed corpus, with its fleshy boundaries, is, under the auspices of the contemporary biopolitical project, a corpus in need of ongoing protection, constraint, compression and insculption (Pronger, 2002). It needs to be ridded of its cellulite, toxins, bacteria and pollutants, and defended against the invasion of new foreign bodies. And yet, in many instances, that same fleshy boundary, to actualize its biopolitical obligation and hubris, must come in close proximity to (spaces of) the very pathogens it seeks to expel and repel. Whereas most scholars writing about biopolitics and biopolitical formations have tended to focus on ‘competition and cooperation, anxiety and aggression, relations of dominance, the construction of hierarchies, enmity toward foreigners, and nepotism’ (Lemke, 2011: 18) – often to the privilege of macro (structural) and meso (institutional) level orders of biopolitical embodiment – here we have sought to explicate the ways in which embodied projects of healthy biocitizenship (indeed the very pursuit of those ends enacted through discourses of health, disease and fitness) often produce new corporeal subjectivities at the level of the individual body and its necessary, but inherently dangerous, contact with others.

To avoid the threat of diseases that are invisibly transmitted between bodies via their fluids and porous membranes, certain spaces and the bodily practices therein come to be managed and regimented in particular ways; towels become contaminated and unhygienic, soap becomes a guarded personal item, and skin-to-skin contact with teammates or strangers becomes frightening and unclean. Certain spaces may come to be avoided altogether, or frequented only as briefly as possible. Mysophobia itself becomes an increasingly complex state as the places we go to be cured are simultaneously the places that harbor germs and the threat of incurable illness, and the places we go to improve our bodies are simultaneously the places where our bodily boundaries are subject to violation, contamination and eruption.

It is in this way that the distinction between epidemic and endemic becomes significant. For insofar as the discourse of epidemic, which has been used so frequently to describe MRSA and educate the public as to its prevention, conjures images of a foreign bacterial invader, it obscures the reality of the disease; S. aureus is an extremely common and normally benign bacterium that exists on most bodies. It is only through the intervention of biomedical knowledge into the effort to manage and control life that this relatively harmless microorganism became dangerous. Rather than throw into question standardized healthcare practices or biomedical research aimed at managing population-level health concerns, the biopolitical framings of the MRSA Epidemic actually serve to re-authorize and legitimate an increased level of medical intervention at the suggestion of an increasing number of biomedical research reports, as well as to deflect attention away from the flawed logic that gave rise to the problem in the first place.

To use the word endemic regularly and with explanatory intent, or to point fingers at the healthcare institutions that we invest with so much authority, would be to disrupt the entire foundation of medical(ized) knowledges that enable the operation of the biopolitical forces we have attempted to illuminate and refer to here. It is, in our view, no coincidence that the conflicting and contradictory forces that surround and confound the individuals’ experience of their bodies in relation to the bodies of others emerge, at least in part, alongside contradictions in the logic of medicine and health that often remain ineffectual at eradicating disease and preventing its transmission between bodies. That problems which result from medical intervention may only, within the current regime of biomedical discourse, be legitimately addressed with further attempts at intervention and management practices is testament to the paradoxical nature of embodied existence within such a modern community, as well as to the primacy of the body as the instrument and effect of our experiences within it.

So we follow Foucault (2001) in concluding that, ‘it is the biopolitical that is important before everything else; the biological, the somatic, the corporeal. The body is a biopolitical reality’ (quoted in Campbell, 2011: 222). ⁹ Ontologically, then, the body is always already thrust into the political (and vice versa). As we run, jump, throw, pull and push – as we inhabit and move about spaces of active bodily reproduction – our bodies are being set against both (1) the bodies and bodily movements of others and (2) the already activated biopolitical formations those movements are thrust into. ¹⁰ And, as we look to specific active body contexts to investigate the operation of these biopolitics – namely sporting fields (community-based, high-profile, professional), exercise gymnasia and other physical activity settings – what we find is a body flowing with contradictions.