The Edinburgh Companion to Science Fiction and the Medical Humanities 1474485073, 9781474485074

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The Edinburgh Companion to Science Fiction and the Medical Humanities

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Edinburgh Companions to Literature and the Humanities These single-volume reference works present cutting-edge scholarship in areas of literary studies particularly those which reach out to other disciplines. They include volumes on key literary figures and their interaction with the arts, on major topics and on emerging forms of cross-disciplinary research. For a complete list of titles in the series, please go to https://edinburghuniversitypress.com/series/ecl

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The Edinburgh Companion to Science Fiction and the Medical Humanities

Edited by Gavin Miller, Anna McFarlane and Donna McCormack

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Edinburgh University Press is one of the leading university presses in the UK. We publish academic books and journals in our selected subject areas across the humanities and social sciences, combining cutting-edge scholarship with high editorial and production values to produce academic works of lasting importance. For more information visit our website: edinburghuniversitypress.com © editorial matter and organisation Gavin Miller, Anna McFarlane and Donna McCormack 2025 © the chapters their several authors 2025 Cover image: Vitruvian man of digital age © jiris via Shutterstock. Cover design: Euan Monaghan Published with the support of the University of Edinburgh Scholarly Publishing Initiatives Fund. Edinburgh University Press Ltd 13 Infirmary Street Edinburgh EH1 1LT Typeset in 10 / 12 Adobe Sabon by IDSUK (DataConnection) Ltd, and printed and bound in the UK using 100% renewable electricity by CPI Group (UK) Ltd A CIP record for this book is available from the British Library ISBN 978 1 4744 8507 4 (hardback) ISBN 978 1 4744 8508 1 (webready PDF) ISBN 978 1 4744 8509 8 (epub) The right of Gavin Miller, Anna McFarlane and Donna McCormack to be identified as the editor of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988, and the Copyright and Related Rights Regulations 2003 (SI No. 2498). This book is printed using paper from well-managed forests, recycling and other controlled sources

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Contents

List of Figures viii Acknowledgementsix Outline of the Collection Gavin Miller and Anna McFarlane

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Science Fiction Studies and the Medical Humanities: Interdisciplinary Futures Gavin Miller and Anna McFarlane

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Part I: Health and Pathology   1. Pregnancy as Analogy and Portrayals of Pregnancy in Science Fiction Anna McFarlane

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  2. Taking Stock of Future Shock: The Medicalised Rebirth of ‘Cultural Lag’ Gavin Miller

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  3. Objects, Embodiment, and Patterning Disability in William Gibson Stuart Murray

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  4. ‘At the front lines of the sleep apocalypse’: Sleeplessness, Biomedical Ambivalence, and Consumer Culture in Charles Huston’s Sleepless and H. G. Bells’s Sleep Over44 Manali Karmakar   5. Wellbeing and Worldbuilding Jo Lindsay Walton

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  6. Trauma Glyn Morgan

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Part II: Technologies   7. State-Mandated Health: The Tyranny of Chemical Meals Aline Ferreira

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vi contents   8. ‘Model for the Future’: Post-Disability and Non-Normative Female Embodiment106 Julia Gatermann   9. Psychotechnology Rob Mayo 10. Bodies, Right or Wrong: Medicine, Gender Identity, and Science Fiction’s Representation of Transgender Possibility Wendy Gay Pearson

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11. Science Fiction and Bioethics Ari Schick

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12. Cyberpunk: Techno-Biopolitics and Posthuman Multiplicity Ingvil Hellstrand

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Part III: Across Media 13. Metabolically Other: Race, Consumption, and ‘Superpower’ in Comics Patrick S. Allen

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14. Contemporary Theatre and Medical Science Fiction Ian Farnell

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15. Going with ‘the Crowd’: Representations of Unexplained Illness and Future Diagnostic Promises in Netflix’s Diagnosis213 Maaike Hommes 16. No Flesh Shall Be Spared: In-Game Bodies and Neoliberal Health Paweł Frelik

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17. (Dis)ability, Prosthesis, and Human Enhancement in Deus Ex: Human Revolution237 Lars Schmeink Part IV: Across Time 18. Medicine in Proto-Science Fiction Timothy S. Miller

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19. Overturning Hippocrates: Euthanasia and the Utopian Tradition Patrick Parrinder

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20. Unveiling a Parallel: Eugenics and Republican Motherhood in Nineteenth-Century Feminist Dystopia Jennifer M. Reeher

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21. Medicine and the Scientific Romance Emilie Taylor-Pirie

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22. War, Wounds, and Waldos: Science Fiction and Prosthetic Modernism Paul March-Russell

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contents

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Part V: Across Space 23. Overture to a Brave New World – Utopian Ends, Dystopian Means: Transhumanist Biopolitics in Paolo Mantegazza’s Italian Proto-Science Fiction Narrative The Year 3000331 Manfred Milz 24. Sucking Salt and Breathing Seawater in Caribbean SF Frances Hallam 25. Dissecting the Future in Chinese Science Fiction: Lu Xun, Transnational Surrogacy, Male Pregnancy, and Strange Children Mia Chen Ma

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377 Notes on Contributors Index382

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Figures

Figure 8.1 Figure 8.2 Figure 8.3 Figure 8.4

Aimee Mullins on the cover of Dazed & Confused (Sept. 1998) Modesta’s spike prosthesis in ‘Prototype’, © Channel 4, 2014 Weaponising the fetishistic prothesis, © Channel 4, 2014 Much needed rehumanisation: Modesta in an intimate and vulnerable shot, © Channel 4, 2014 Figure 17.1 The waiting room of a LIMB clinic, Deus Ex: Human Revolution, © Square Enix, 2011 Figure 17.2 Augmentation Screen, Deus Ex: Human Revolution, © Square Enix, 2011 Figure 17.3 Jensen’s fragmented body, Deus Ex: Human Revolution, © Square Enix, 2011

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Acknowledgements

W

e thank the Wellcome Trust, whose Seed Award on ‘Science Fiction and the Medical Humanities’ laid the groundwork for this edited collection, as did the 2016 special issue (vol. 42, 4) of BMJ Medical Humanities which emerged from that project. We thank also the British Academy for Postdoctoral Fellowship ‘Products of Conception: Pregnancy and Science Fiction, 1968–2015’, which has inspired and informed this project. Further thanks go to our ad hoc reviewers, whose specialist expertise has complemented our own. They are Amelia DeFalco, Matthew Barr, Marco Malvestio, and Hongling Liang. Our acknowledgements go also to the EUP editorial staff in Literary Studies who have guided this volume from contract to completion: Susannah Butler, Elizabeth Fraser, and Michelle Houston.

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Outline of the Collection Gavin Miller and Anna McFarlane

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y way of introduction, the collection opens with a consideration of the fields of medical humanities and science fiction studies and their intersections. Here Gavin Miller and Anna McFarlane explore the value in bringing these fields together through a consideration of their respective futures. The concept of the future is, of course, of clear interest to science fiction which often reflects on possible futures and their influence on the present – increasingly, as the speed of technological change and the possible end-of-the-future represented by the climate crisis shape our present moment. Miller and McFarlane compare this to the movement in medical humanities towards a ‘critical turn’ and use the opportunity to speculate on how the future might be conceived in medical humanities going forward. This introduction constitutes a disciplinary overview, suggesting a confrontation and a collaboration between medical humanities and science fiction studies that shape the collection as a whole. Part I of the collection, ‘Health and Pathology’, begins to consider the ways in which medical humanities can be used as a tool to analyse the binary distinction between the healthy and the pathological, between wellbeing and disease. These chapters unsettle the distinction by asking where the boundaries are in these binaries, and look at the ways in which science fiction and its imagined futures invite us to reconsider categories that may be taken for granted or normalised. To begin, Anna McFarlane investigates the representations of pregnancy in science fiction. Pregnancy is a commonly experienced condition, and one which feminist health campaigners have worked to establish as a potentially ‘normal’ and healthy state. However, it is also one which has been significantly medicalised over the course of the twentieth century. McFarlane investigates these boundaries as represented in science fiction, with particular focus on representations of ectogenesis (gestation outside of the womb) and the use of pregnancy and pregnancy loss as metaphors in the literature of the climate crisis. Gavin Miller investigates another boundary state, the case of ‘future shock’, as described by Alvin Toffler. Toffler uses future shock as a concept that seeks to pathologise reactions to the future, identifying the damaging shock that some might feel at breakneck technological and cultural change. In Miller’s reading, Toffler situates science fiction as an inoculation against future shock, a cognitive tool that can prepare readers for the future to come. Here, science fiction itself is a kind of technological cure. Stuart Murray takes a close look at objects in the science fiction novels of William Gibson, the godfather of cyberpunk. While cyberpunk is already well-known for bodily augmentation, Murray finds a consideration of the literature’s object-worlds as a fruitful means for considering Gibson’s work through the lens of disability studies – a lens that, Murray rightfully points out, has not often been brought to these texts despite their interest in embodiment and bodily difference. Manali Karmakar

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considers the concept of sleep in her chapter, another bodily process, like pregnancy, that is a normal part of life, but one that can be pathologised, particularly when considering cases of chronic insomnia. Karmakar considers the portrayal of insomnia in the context of neoliberal politics in two science fiction novels, Charles Huston’s Sleepless (2010) and H. G. Bells’s Sleep Over (2018). Karmakar uses this reading of sleep under neoliberalism to draw parallels with the role of rest and its representations in the wake of Covid-19. Jo Lindsay Walton focuses his attention on the concept of wellbeing as a site where science fiction explores the links between embodiment, surveillance, and democracy. ‘Wellbeing’ is used as a rubric for surveilling the body, even outside of healthcare settings when there need not be pathologisation of the body. This brings Walton to consider the creep of power from the political realm to the realm of the body itself, and how this is represented in science fiction texts, particularly the dystopia. Glyn Morgan’s chapter shows that science fiction has much to offer conversations about the role of trauma in literature through reading texts including Joe Haldeman’s The Forever War (1974) and Kurt Vonnegut’s Slaughterhouse-Five (1969). Morgan argues that the field of trauma studies has tended to foreground non-linear texts in the modernist tradition as exemplary of the representation of trauma, whereas science fiction can offer explorations of ‘inner space’ that lend themselves to conceiving of trauma in different ways, thereby widening the canon of what can be considered ‘trauma literature’. Part II focuses on the use of ‘Technologies’, particularly bringing attention to the intimate relationships between bodies and technologies imagined in science fiction. While science fiction is primarily characterised by its engagement with technologies, it imagines these as they appear in (and shape) social contexts. Aline Ferreira considers three dystopian novels – Keikaku Itoh’s Harmony (2010), Elizabeth Dougherty’s Blind Pig (2013), and Rachel Heng’s Suicide Club (2018) – which deal with the surveillance of food as a form of biopolitics. Ferreira uses these texts to argue that food can be a technology of control in authoritarian conditions. Julia Gatermann considers the portrayal of technology in the construction and subversion of the disabled body by analysing the music videos of Viktoria Modesta, a pop star who uses the prosthetic leg as a central technology for thinking through disability and superhumanity. Rob Mayo investigates the concept of ‘psychotechnology’, that is the use of technologies that directly interface with the brain in order to allow the exploration of ‘inner space’ (as opposed to the ‘outer space’ that was a major interest of mid-twentieth-century science fiction). Introducing the concept with reference to Daniel Keyes’s Flowers for Algernon (1966), Mayo explores the differing depictions of psychotechnology in Christopher Nolan’s Inception (2010) and Tarsem Singh’s The Cell (2000). Mayo’s investigation also addresses questions of medical ethics and the relationship between patient and medical authority, as the trope of ‘inner space’ presents a novel inversion of the conventional power balance. Wendy Gay Pearson considers the representations of the trans experience in science fiction to analyse the relationship between trans identities and medicalisation. Pearson particularly focuses on nonbinary and genderfluid identities as spaces that might disrupt the ‘wrong body’ narrative, and open space for wider discussion about the role that medicine can play in trans lives, exploring the changing relationship between the body and medical technologies. Ari Schick gives an overview of the influence science fiction has had on bioethics, and particularly speculative bioethics, as the field seeks to address the implications of possible future technologies. Schick argues that science fiction has always had a close relationship with bioethics

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discourses, and can act as a useful space for the practice of bioethics that should not be disavowed. Ingvil Hellstrand focuses on cyberpunk, which, she argues, is a mode, a type of science fiction that has grown from a subgenre to a wider cultural language that can be put to use in exploring contemporary society’s saturation with ‘the future’ and its visual markers. Hellstrand explores Altered Carbon (both Richard Morgan’s series of novels and their televisual adaptation, 2018–20) and the Canadian television series Orphan Black (2013–17) via a posthuman feminist lens to argue that cyberpunk allows viewers to engage with a ‘techno-biopolitics’, exploring the relationships between embodiment and political structures. In Part III, we consider the intersections of science fiction and the medical humanities ‘Across Media’, considering how the mechanics of various science fiction media afford different possibilities for the representation of medicine and medical futures. This section brings attention to a range of media: comics, theatre, television, and video games. Patrick Allen discusses the comics series Chew (2009–16), in which a Chinese-American US agent uses the power of cibopathy – a telepathic connection with anything he eats – to investigate cases. Allen reads this comic as an exploration of anti-Asian racism in the USA and the racialisation of bodies in medicine, including the case of Henrietta Lacks. Ian Farnell considers the role of medicine in science fiction theatre, particularly three productions – Manjula Padmanabhan’s Harvest (1997), Caryl Churchill’s A Number (2002), and RashDash/Unlimited Theatre’s Future Bodies (2018). Farnell foregrounds the presence of the body in theatrical spaces, and argues that this focus on the body can make it a particularly relevant space for thinking through relationships between bodies, space, medicine, and the future. Maaike Hommes analyses the Netflix documentary series Diagnosis (2019). While this is, on the face of it, a realist series, Hommes argues that the series situates the use of international streaming, and its reach to global audiences, as a futuristic tool for diagnosing rare illnesses. In doing so, Hommes brings close attention to the construction of the series and the relationship it imagines between the patient, the medical establishment, and the global crowd-sourcing community. Paweł Frelik’s chapter on video games focuses on four foundational, structuring conceits in video games: power-ups (often depicted as first-aid kits), avatar customisation, saves, and head-up displays (HUDs). Frelik finds that, through reading video games via the lens of the medical humanities, these structuring tropes of video games show a common interest in the maintenance of able-bodied masculinity through their interests in maintaining health (here, read ‘strength’), modifying the body, and cheating mortality. Frelik reads these attitudes to mortality as indicative of the flows of capital characteristic of the globalised culture of the gaming industry. While Frelik finds video games in general to venerate the neoliberal, masculine able-body, Lars Schmeink finds some more complex representation in the video game series Deus Ex. By reading the game through the lens of disability studies, Schmeink reveals its complex commentary on issues of non-normative embodiment. The game oscillates between the transhumanist position of self-optimisation and revealing the limits of new transformative technologies. It also critically comments on the social and political framework in which prosthetic, technological augmentations exist. Part IV looks at medical humanities ‘Aross Time’, looking at a variety of literary periods and the engagements that they offer. T. S. Miller discusses the role of medicine in medieval proto-science fiction, drawing examples from Geoffrey Chaucer’s ‘The Squire’s Tale’ amongst others. Miller argues that considering proto-science fiction

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from this period shows how the different discourses of proto-medicine (e.g. alchemical discourse) are mobilised in discussions of health and illness, and invites us to contemplate the speculative nature of medicine at this time. Patrick Parrinder uses the concept of euthanasia as a way to analyse the relationship between utopia and dystopia. Parrinder argues that euthanasia, the idea of a good or easy death, easily slips into the discourse of eugenics – for example, in a text like Aldous Huxley’s Brave New World (1932) – and asks how we can make sense of the utopian/dystopian dialectic through thinking about medicine and the Hippocratic oath. Jennifer M. Reeher takes a feminist perspective on utopia by analysing an American text, Alice Ilgenfritz Jones and Ella Merchant’s Unveiling a Parallel: A Romance (1893). Reeher sees numerous contemporary discourses at play in this utopian text, including engagements with women-led movements for prohibition and the nationalistic framing of maternity as a service to the state. Emilie Taylor-Pirie’s chapter analyses the genre of the ‘scientific romance’, as it was in the nineteenth century, as another form of proto-science fiction. The influences on this genre, and in turn its influence on later cultural forms, can shed light on the relationship between science (particularly medicine) and literary culture. Paul March-Russell brings his attention to the Modernist period, using Tim Armstrong’s concept of ‘prosthetic modernism’ as a starting point to think about the real-life uses of prosthetics and the growth of the prosthetics industry in this period. In doing this, March-Russell uses the lens of disability studies and critiques the tendency to consider the prosthesis as a heuristic tool, distanced from its real-world uses. Finally, Part V, ‘Across Space’, considers various geographical spaces, highlighting that medicine and its associated power structures are context-dependent, and meanings can shift depending on the communities involved. Manfred Milz sees the nineteenthcentury Italian science fiction novel The Year 3000 (1897) by Paolo Mantegazza as crucially influenced by Mantegazza’s experience of medicine as a physiologist, neurologist, and psychologist. Milz’s reading of The Year 3000 speaks to Parrinder’s exploration of the relationship between utopia and dystopia, as Mantegazza’s novel situates itself in the utopian mode while laying the foundation for dystopian texts like Huxley’s Brave New World. Frances Hallam considers the practice of salt-eating in Caribbean literature, focusing on Nalo Hopkinson’s The Salt Roads (2003) and Alexis Pauline Gumbs’ M Archive: After the End of the World (2018). Hallam finds salt-eating a culturally rich practice that challenges normative medical practices, and therefore invites a consideration of the socio-political valences of medicine. Mia Chen Ma looks at the future of reproduction, as envisioned in works of Chinese science fiction authors Chen Qiufan and Han Song. Ma’s reading of the issues of surrogacy and foetal/childhood disability point towards the need for a consideration of how health issues travel across borders in a globalised society.

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Science Fiction Studies and the Medical Humanities: Interdisciplinary Futures Gavin Miller and Anna McFarlane

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he overlap between speculative culture and medicine has intensified in recent decades. New technologies have emerged that were once only speculative, such as organ transplantation, in vitro fertilisation, and genetic screening. This track record of technological progress underwrites capitalist speculation in which the imagined future, as much as any individual or corporation, promises advances such as human gestation ex utero, the use of animal organs in human transplantation, and technologies for the genetic enhancement of future generations. In this context, science fiction seems uniquely placed as a cultural mode that can respond to and interrogate the investment of contemporary biomedicine in speculation. In this introduction we firstly show the value of collaborative investigation between science fiction studies and the medical humanities, emphasising the close connection between biotechnology and modern technologies of the self. We then explore how science fiction studies and the medical humanities illuminate each other as programmes of academic research. How does it help to think of medical humanities using science fiction studies as a provocation? Our answer explores the model(s) of the future imagined by medical humanities and which are used to mobilise resources, pre-eminently capital. We then ask the reciprocal question: how might the medical humanities interrogate the presuppositions of science fiction studies? In answering this question, we critically examine the way in which science fiction studies has understood itself as cultural therapeutics – as a treatment for a society pathologically oriented towards an out-of-control future shaped by capitalist technoscience.

Science Fiction, Medicine, and New Ontologies of the Self This collection builds on an earlier Wellcome Trust-funded project, ‘Science Fiction and the Medical Humanities’ (2015–16). As part of it, we edited a special issue of BMJ Medical Humanities. In the editors’ introduction, we proposed that the medical humanities move beyond viewing science fiction as entertainment-education that can promote (or degrade) science literacy. Instead, we argued, the medical humanities should recognise and explore science fiction’s ‘critical dialogue with the hegemonic technoscientific imaginary’ (Miller & McFarlane 2016: 215). This meant in part the exploration of speculative bioethical scenarios that inhabit ‘the future’ as imagined in the here and now. A text such as Marge Piercy’s Woman on the Edge of Time (1976) imagines, for instance, an anarchist utopia in which new technologies allow not only

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gestation ex utero, but also breastfeeding by men. But this critical dialogue also meant bypassing scientific plausibility in order to analyse seriously science fiction’s capacity to interrogate taken-for-granted ideologies in the present. One has also to allow for texts such as Richard Matheson’s The Shrinking Man (1956), where a highly implausible extrapolation (a radiation-induced shrinking effect) underpins meditations on issues such as atomic anxiety, and patriarchal power and desire. Our special issue was among various roughly contemporary enterprises that sought to move medical humanities beyond a focus on canonical literary texts and other artefacts high in cultural capital. These complementary initiatives include Sara Wasson’s work in medical humanities and gothic studies (2015), Ria Cheyne’s exploration of disability in contemporary genre fiction (2019), Agnes Arnold-Foster’s historiographical and cultural recuperation of mass-market doctor–nurse romance fiction (2021), and the critical attention given to the genre – or market category – of Young Adult (YA) fiction, with discrete studies tackling anorexia nervosa (Jones 2021), end-of-life narrative (Kirkman et al. 2019), and mental health (Wickham 2018). These initiatives complement and interrogate a paradigm in which authors such as Flaubert, Dickinson, Proust, and Musil have been touchstones for the medical humanist – as exemplified by the physician Iain Bamforth’s anthology The Body in the Library (2003). Like gothic, romance, and YA fiction, science fiction originates in commercial genre fiction. It draws on the so-called science fiction ‘mega-text’, a reservoir of established devices, plots, and settings that offer familiar reference points to its readers (Broderick 1995). The megatext, like other genre conventions, might seem to hinder literary representation of illness, health, and disability. Any narrative fiction is, however, in dialogue with convention. Arnold-Foster shows how highly conventionalised Mills & Boon ‘Doctor–Nurse’ novels were invariably written by ‘trained healthcare professionals’ who could offer a ‘complex interplay’ of fictional representations of clinical labour with their personal experience (2021: 158). Equally, illness narrative is itself saturated with convention. The critical literature on the genre has produced a sprawling and partly contradictory range of narrative taxonomies invoking types such as restitution, chaos, and quest (Frank 2013), as well as healthy-mindedness, rebirth, battle, and journey (Hawkins 1999). Science fiction presents, however, a peculiar case because, as a variety of the fantastic, it deals, by definition, in non-mimetic fictional worlds. By eschewing realism to some greater or lesser extent, science fiction seems to frustrate the aspiration to tell authentic stories of illness experience located in realistic social, cultural, and material contexts (the modern hospital, for instance). Science fiction seems then to contrast with the boom in illness narratives – or ‘pathographies’ – that occurred toward the end of the twentieth century amid a context that included technologised and specialised medical care, patient and disability activism (including feminist currents), and the HIV-AIDS epidemic (Jurecic 2012: 4–10). The flourishing of pathography was both cause and index of the patient ‘voice’ as a social force, proceeding from an assumption that individual narrative instances speak for, and to, a larger hinterland of experience that had been neglected by institutionalised scientific and technological medicine. Anne Hunsaker Hawkins summarises a widely held view that ‘[p]athography [. . .] returns the voice of the patient to the world of medicine, a world where that voice is too rarely heard, and it does so in such a way as to assert the phenomenological, the subjective, and the experiential side of illness’ (1999: 12). The problems posed by the

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illness narrative genre consequently lend themselves to a predominantly expressivist aesthetic aimed at recuperation of lived experience, a style in which stories and poetics of subjective experience inhabit a broadly mimetic representation of ‘the world of medicine’. But there are important elements of contemporary medicine that elude dominant forms of pathography. Sara Wasson’s pioneering work has shown how gothic and horror studies offer a fruitful model for understanding the ‘oppressive illness, pain and despair’ of what might be otherwise deprecated as ‘chaos anti-narrative’ (2015: 5). Science fiction too has its special generic affordances, as indicated by Kathryn Allan’s pioneering work on science fiction and disability. Allan observes that ‘the idea of curing the body of its infirmities is a powerful trope repeated throughout the entire history of the SF genre’ (2013: 9). One might think here, for instance, of eugenicist visions such as that unironically propounded by H. G. Wells’s A Modern Utopia (1905), in which ‘Utopia will kill all deformed and monstrous and evilly diseased births’ (2005: 100), while forbidding reproduction to ‘idiots and lunatics’, among others (2005: 99). But the trope of cure is far from merely affirmative, despite its potential to fictionally ‘cure or normalize what is deemed “wrong” with the body’ (Allan 2013: 10). Science fiction can expose and interrogate the way in which ‘[t]he ideology of the perfect body – and our ability to make imperfect bodies perfect through medical intervention – is woven throughout our various social discourses, and the onus to be a perfect body rests on both the abled and disabled alike’ (Allan 2013: 9). Speculative technology may ‘cure’ impairment, normalising the supposedly deviant body. But it may also expose the apparently normal body as itself deficient or deviant with respect to possible enhancement. Disability studies has found a productive dialogue with science fiction studies in terms suggested by the social and cultural model of disability. Medical humanities, however, has not engaged so readily with science fiction studies. This is partly because medical humanities has greater investment in foundational work in illness narrative, which presents something of a discursive obstacle to the insights and approaches of science fiction studies. Anne Whitehead and Angela Woods propose that the ‘primal scene’ of the medical humanities has formerly been ‘the clinical encounter between the doctor and the patient: more specifically, the scene that unfolds the diagnosis of cancer’ (2016: 2). From this implicit prototype flows a concern with ethics, education, experience, and empathy that is questioned by a later ‘critical’ medical humanities (Whitehead & Woods 2016: 3­–5). Certainly, these four features tend to present some difficulty for a productive engagement with science fiction studies (not just education and experience, as already indicated, but also empathy, given the Brechtian dimensions of foundational science fiction theory (Spiegel 2008)). However, there is a further obstacle: namely, the centrality and persistence of a post-colonial metaphor that has helped to inform the medical humanities since Arthur Frank’s influential work on illness narratives in the 1990s. Frank’s The Wounded Storyteller presents a master narrative of recuperation in which persons are restored from the imposition of medical authority upon their lives, be this in nosology and aetiology, biomedical therapeutics, or the wider alienating apparatus of modern healthcare. Frank offers a metaphor in which the patient’s encounter with modern medicine resembles that of a colonised society with its coloniser: ‘Just as political and economical colonialism took over geographic areas’, Frank proposes, so ‘modernist medicine claimed the body of its patient as its territory’ (2013: 10). The metaphor is

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appealing in its epistemic and moral clarity. The patient’s experience – and the popular and folk cultures that shape it – have an indigenous purity or innocence upon which modern technological medicine is imposed. Frank appeals to the example, borrowed from Pierre Bourdieu, of a North African woman describing her society’s encounter with modern medicine: ‘The specialized medical terms that the woman claims her people have only recently learned overwhelm her experience because they come from elsewhere’ (2013: 5). The example is supposedly informative for patients under modern medicine even in the Global North: ‘popular experience is overtaken by technical expertise’ as patients enter a medical administrative apparatus in which professionals ‘reinterpret their pains as symptoms, using a specialized language that is unfamiliar and overwhelming’ (Frank 2013: 5). Given the obvious technological advantages of modern medicine, this metaphorical ‘colonization of experience was judged worth the cure, or the attempted cure’ – at least for a while (Frank 2013: 11). But as the limits of modern medicine have become clear, particularly for those with chronic illness, so ‘[t]he post-colonial ill person, living with illness for the long term, wants her own suffering recognized in its individual particularity; “reclaiming” is the relevant postmodern phrase’ (Frank 2013: 11). The patient, as imagined by Frank, is someone upon whom biomedicine is imposed, overwriting their spontaneous experience and self-understanding, which remains nonetheless legible and recoverable, albeit with expert help. The challenge is therefore to reclaim and renew an indigenous illness culture and experience threatened with extinction. This post-colonial metaphor is surprisingly persistent within medical humanities, despite what may be viewed as its propensity to trivialise the violence of colonial history. Gail Hornstein imagines an anti-colonial struggle of liberation in which a scattered diaspora of the mad expels its psychiatric colonisers, re-awakens from national hibernation, and reclaims its homeland – the inner, experiential world of madness (Miller 2018). The post-colonial metaphor persists also in narratives of biomedicine’s imperial monoculture being supplanted – or at least supplemented – by renewed and recovered cultural diversity. Summarising a major Wellcome-funded project on voice hearing, Jane Macnaughton explains how work with ‘experts by experience’ frees ‘the individual and collective experience [of voice hearing] from the confines of conventional medical dominance’, allowing the ‘creation of a new culture’ that can co-exist with that of clinical medicine while respecting ‘powerful individual stories of empowerment and recovery’ (2023: 549). Despite the post-colonial metaphor’s persistence, the boundaries between the everyday lifeworld, patient activism, and the expert culture of healthcare seem increasingly porous, particularly in the internet era. This is regardless of the canard, derived from medical anthropology, that ‘[c]ontemporary medical practice has become increasingly discordant with lay expectations’ (Kleinman et al. 1978: 251). In the internet era, the encounter between patient and physician is in fact often a love triangle of ‘patient– Web–physician’ (Wald et al. 2007: 222). Moreover, in modern industrialised societies of mass literacy, prolonged formal and informal education have been commonplace for decades, long before mass availability of the internet. Consider the feminist health classic, Our Bodies, Ourselves, which both educated women on their biology and challenged patriarchal medicine. As Kathy Davis explains, ‘The first commercial edition of OBOS appeared in 1973 and was revised and updated in 1976 and 1979. It was an immediate success, selling nearly 2.5 million copies by 1976’ (2007: 24). By

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2006, she explains, there were ‘twenty foreign-language editions of OBOS, as well as seven books in other languages that were “inspired” by it’ (Davis 2007: 51). Naturally, there is always more to be done, and someone somewhere who has not encountered this text – such as the ‘three hundred young Tibetan nuns’ who benefited in 2000 from a course based on Our Bodies, Ourselves (Davis 2007: 50). Nonetheless, the enormous transnational success of this text in both the commercial marketplace and in development contexts indicates the porosity of the boundary between everyday experience, politicised patient activism, and biomedicine. Despite its difficulties, the post-colonial metaphor remains appealing to some strands of medical humanities. Part of its plausibility derives from its assumption of the meeting between (pre-modern) patient and (modernising) medical expert as an abrupt, unwelcome, and asymmetric encounter with medical discourses, practices, and technologies – as an invasion of the patient by a foreign entity, medicine. The model is clearly problematic in its hackneyed opposition between natural (primitive) and medicalised (civilised). It inhabits for instance the rhetoric and practice of professionalised ‘natural’ childbirth, in which ‘the lived experience of midwifery’ stands for ‘a return to what childbirth “really is”’, in opposition to a supposedly medicalised and patriarchal obstetrics (Annandale & Clark 1996: 30). But, as Sunna Símonardóttir and Annadís Greta Rúdólfsdóttir explain, with reference to epidural analgesia, ‘the “medicalized” and the “natural” models for giving birth’ should be thought of ‘not as the traditional binary opposites of science and nature [. . .], but rather as a set of competing discourses that are both constructed as scientific truths and incorporated, to varying degrees, by health-care systems worldwide’ (2020: 226). Such deconstruction of oppositions between medicalised and natural, between modern and pre-modern, extends to the social transformation effected in the Global North by biomedicalisation. According to Adele E. Clarke and her co-authors, ‘biomedicalisation’ denotes ‘the transformations of both the human and nonhuman made possible by such technoscientific innovations as molecular biology, biotechnologies, genomization, transplant medicine, and new medical technologies’ (2003: 162). Biomedicalisation, the beginning of which Clarke dates to around 1985 (2003: 164), offers the prospect of plastic, customisable bodies, as well as new personal and social identities that proceed from technoscientific knowledge and techniques. It extends beyond clinical innovations in the treatment of pathology to the ‘extension of medical jurisdiction over health itself’ and a concomitant ‘commodification’ of health (Clarke et al. 2003: 162). It is constituted by a variety of overlapping historical developments (Clarke et al. 2003: 166–83). Medical research has become the domain of technoscientific corporations whose products – from pharmaceuticals to genetic markers – are commodified through mechanisms such as patents. Individuals are increasingly required to survey, regulate, and promote their health as a matter of ‘ongoing moral self-transformation’. Rapid progress in information technology, molecular biology, genomics, and other areas further embeds technoscience in contemporary healthcare, at least for the welloff and privileged members of industrial capitalist societies. The sources of biomedical knowledge become far more diverse and far more accessible – to the advantage of the service user, who is thereby empowered – but also to the advantage of biomedical corporations, for instance by direct marketing of pharmaceuticals to potential consumers. Ulrich Beck and Elisabeth Beck-Gernsheim explore the encounter between biomedicalisation and what they describe as ‘the central character of our time’, namely

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‘[t]he choosing, deciding, shaping human being who aspires to be the author of his or her own life’ (2002: 45–6). Personal health in postmodern society is no longer a spontaneous condition that may be interrupted by illness: ‘Whereas health used to be something given to us that only required repairs in an emergency, it now has to be constantly produced’ (Beck & Beck-Gernsheim 2002: 155). This attitude is due partly to economic individualism, for ‘[t]o keep one’s head above water in a competitive labour market, it is necessary to be fit, healthy and capable’ (Beck & Beck-Gernsheim 2002: 155). It results also from the collapse of soteriological expectations among much of the population: ‘The more personal and unique life is, the more it is irreplaceable’ (Beck & Beck-Gernsheim 2002: 167), so ‘[w]hen belief in an afterlife is lost, health acquires a new meaning and a higher value; it becomes a secular expectation of salvation’ (Beck & Beck-Gernsheim 2002: 156). Accompanying this change in the meaning of health is a technologically mediated expansion of the individualised way of life, which now encompasses the body itself as a plastic resource that can be moulded to better suit the individual: Biology [. . .] is no longer destiny but starting point. Expectations of indefinite change and improvement are now the order of the day. Nature is not completely passé, as it still supplies the necessary raw materials, but technology will fashion it into a work of art. (Beck & Beck-Gernsheim 2002: 158). The authors have in mind technologies for genetic manipulation, but the point extends of course to putative enhancements of the individual as phenotype. The medical humanities need cultural resources adequate to a contemporary age in which the colonial metaphor of contact between medicine and patient is increasingly irrelevant. Biomedicalisation has coupled with a newer form of politics in the Global North in which technologies of self-governance are increasingly prominent. Daniel Keyes’s widely adapted and translated (Miller 2022: 167) science fiction novel Flowers for Algernon (1966) offers an ur-text for the alliance between biomedical possibility and self-governance. The protagonist and narrator, Charlie Gordon, is a cognitively impaired, lower-class New Yorker who receives an experimental neurosurgical treatment for cognitive enhancement. The procedure, at least for a while, is highly successful, and Charlie is propelled rapidly on an upward trajectory towards superhuman genius. Throughout the experiment, he keeps a diary which tracks a process of quasipsychoanalytic self-reflection by which he comes to reconstruct and to be liberated from a traumatic life-history of abandonment and humiliation. Charlie is a template for a new form of human life, at once superior in intelligence but also with newfound powers of spontaneity, self-insight, and creativity. We might imagine Charlie as investing in his human capital: he expresses in magnified form the apparent potential of rising levels of education in post-war society, which were rapidly breaking down older class structures. While intelligence enhancement is the manifest innovation (or novum, to use Darko Suvin’s field-defining terminology (2016: ch. 4)), the narrative is equally dominated by the technology of a self-administered narrative psychotherapy that overcomes Charlie’s deeply ingrained emotions of shame and anxiety – building self-esteem as well as brains. Science fiction such as Flowers for Algernon condenses complex social assemblages into discrete technologies and gadgets, bringing together social realms of education

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and the clinic with a wider culture of self-governance. As Nikolas Rose and Peter Miller argue, political power must be conceived more broadly than that of the state apparatus over the individual through, for instance, mechanisms of literal and ideological coercion. Instead, Political power is exercised today through a profusion of shifting alliances between diverse authorities in projects to govern a multitude of facets of economic activity, social life and individual conduct. Power is not so much a matter of imposing constraints upon citizens as of ‘making up’ citizens capable of bearing a kind of regulated freedom. (1992: 174). Diverse ‘technologies of government’ connect individuals and groups to ‘the aspirations of authorities’ (Rose & Miller 1992: 183). Such technologies are not necessarily or typically gadgets; they may instead be ‘humble and mundane mechanisms’ such as ‘techniques of notation, computation and calculation’ complemented by ‘the inauguration of professional specialisms and vocabularies’ (Rose & Miller 1992: 183). By inscription and calculation – by writing things down, and by operating upon these writings – experts can ‘lay a claim to legitimacy for their plans and strategies because they are, in a real sense, in the know about that which they seek to govern’ (Rose & Miller 1992: 186). The operation of expertise does not represent coercion of the individual by the state. Rather, expertise offers to enhance freedom and autonomy ‘by turning blind habit into calculated freedom to choose’ (Rose & Miller 1992: 187). Expertise translates ‘daily worries and decisions over investment, child rearing, factory organization or diet into a language claiming the power of truth’, and thereby facilitates ‘techniques’ by which one may ‘manage better, earn more, bring up healthier or happier children and much more besides’ (Rose & Miller 1992: 188). Nikolas Rose argues that biomedicalisation has created a new form of such politics – a ‘politics of life’ itself (2007) – concerned with technologies that allow manipulation of life processes that were previously inaccessible to intervention. But rather than simply aiming to restore normative health, biomedicine can now engage in projects of ‘susceptibility’ and ‘optimization’. The former term ‘indexes the multitude of biomedical projects that try to identify and treat persons currently without symptoms, in the name of preventing diseases or pathologies that might manifest themselves in the future’ (Rose 2007: 82). Through such projects, biomedical actors construct ‘a state of potential disease, or protodisease’ (Rose 2007: 85), through which ‘the responsible asymptomatic individual is enrolled for a life sentence in the world of medicine – of tests, of drugs, of self-examination and self-definition as a “prepatient” suffering from a protosickness’ (Rose 2007: 94). New technologies of ‘optimisation’ allow, or promise, the ‘conscious and calculated management, maintenance, modification, and manipulation of our somatic existence through the course of our lives’ (Rose 2007: 105). These technologies challenge the role of medicine, which was previously ‘to restore a lost normativity’ (Rose 2007: 81). Through the promise of such technologies, and their rather more ambiguous antecedents in the here and now, we seem to be on ‘the cusp of a new age, in which we are no longer content with the restoration of sickened bodies and souls to their organic, vital norms’ (Rose 2007: 97–8). No longer does medicine aspire merely to restitutio ad integrum, to the restoration of a normative wholeness; it also aims at transformatio ad optimum, the shaping of a more perfect human being (Wiesing 2009).

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Rose notes that, in the face of technologies of susceptibility and enhancement, traditional medical ethics seems ‘insufficient at the level of political technologies of regulation of legal and political subjects’ (2007: 97). We might say the same of the medical humanities. The speculative character of biomedicalisation further problematises Frank’s ideal type of a serious breakdown in health (of ‘shipwreck’ (2013: 53–6)) and a consequent reclamation by the ill person of their experience from medical colonisation. The protopatient is not yet ill, and may never be. Their narratives have not broken down, and nor do they have necessarily a problematic experiential world to convey. Similarly, the client seeking optimisation through a so-called ‘lifestyle’ therapy may be in perfect health. Existing lifestyle therapies – from oral contraception (Watkins 2012) to cosmetic surgery – may require a clinical encounter to be accessed, but, by definition, they are technologies that ‘are intended or come to be used for conditions that currently lie at the socially constructed boundary between lifestyle wishes and health needs’ (Gilbert et al. 2000: 1341). Biomedicine calls for a creative culture that can respond to its speculative redefinition of human life, where health is more than the absence of illness, and where technological medicine is intimate, both physically (in terms of augmentation) and intertwined with identity and self-understanding. To take an example from this volume (see Chapter 10), Wendy Gay Pearson analyses the way in which science fiction has interrogated the ‘wrong body’ narrative that has dominated medical care for transgender persons. This narrative presumes that transgender medical care aims to restore a lost original order conceived as a normative congruity between gender identity and bodily morphology – to which the transgender person is supposedly an exception. Science fiction asks troubling questions about this supposed original condition, its prevalence, and its desirability. Pearson wonders, ‘will sex changing remain understood as something specific to transgender people or might it become a widespread, if perhaps not universal option?’ Science fiction speaks to the changed emphasis in the medical imaginary under biomedicine, from restoring normativity to managing risk and enhancing abilities. The subgenre of cyberpunk, which, like biomedicalisation, emerged in the 1980s, imagines a relationship between human and machine in which technology is intimate, under the skin. In his 1986 preface to the foundational Mirrorshades: A Cyberpunk Anthology, Bruce Sterling contends that, for cyberpunk, ‘technology is visceral. [. . .] it is pervasive, utterly intimate. Not outside us, but next to us. Under our skin; often, inside our minds’ (1988: xi). Sterling’s preface was as much a manifesto for the future of science fiction as it was an identification of common tropes in the writing of contemporary authors like William Gibson and Pat Cadigan who came to be seen as key writers of the cyberpunk movement. Rather than human dominance over the (possibly extraterrestrial) environment through technology-as-tool, Sterling identifies technology as something inseparable from the figure of the human, because the technology is already under the skin, both literally and metaphorically. Sterling aligns with theorists like Donna J. Haraway, whose ‘Cyborg Manifesto’ (Haraway 1991: ch. 8) famously borrowed the rhetoric of science fiction to identify the science fictional nature of life in the 1980s – Haraway’s essay draws upon science fiction writers Octavia Butler and Marge Piercy among others. Both Sterling and Haraway imagine the binary of human versus machine as a distinction that no longer fully makes sense. As Anna McFarlane has argued elsewhere, reading medical humanities through science fiction can involve a departure from the humanist subject implicit in much medical humanities discourse by considering what a posthumanist medicine might look like:

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Rather than treating the individuated human-as-patient, a posthumanist conception of healthcare is more likely to view the patient as an integrated member of a wider community, one who is subject to interaction with human and nonhuman others and will experience illness and health in a social context. (2022: 932) Science fiction has much to offer a field of medical humanities that considers perspectives beyond the strictly humanist. Considering medicine and healthcare beyond the interaction of two human individuals (the doctor and the patient) opens up the field to consider the complex systemic situations in which healthcare occurs. The move from the human drama of the post-colonial metaphor to a systemic consideration of healthcare encounters invites a posthuman medical humanities. As Stuart Murray indicates, medical humanities now increasingly challenges ‘a functional and pragmatic approach to the body and health, often focused around the authority of the single practitioner [. . .] and the bounded unit of the single patient’ (2023: 109). Science fiction is particularly suited to these systemic considerations, which are often explored in dystopian narratives. In her contribution to this volume (see Chapter 7), Aline Ferreira explores, for instance, science fictional depictions of food and nutrition in dystopian fiction, where quantification and surveillance of citizens’ health and other behaviours extrapolates from tendencies within our own worlds. Jo Lindsay Walton, meanwhile, examines in his chapter (see Chapter 5) ‘the deep suspicion of quantified publics’ in science fiction, and the generic difficulty in accommodating more optimistic imaginaries for data purporting to measure wellbeing. These chapters build upon a research context that includes also Luna Dolezal’s contribution to our 2016 special issue of BMJ Medical Humanities, where she discusses speculative fiction as a site of satire that pushes current trends – for step-counters, sleep trackers, and other forms of personal monitoring – to extremes, and where narratives are shaped by the agency of ‘commercial technologies, which reduce human life and the physical body to information sets, or data assemblages, governed by market and workplace agendas’ (2016: 220). Here, science fiction clearly offers something specific and beneficial to the posthuman direction of the medical humanities and its response to biotechnology. Engagement with science fiction also builds on the demands placed on literature in the context of critical medical humanities projects. Angela Woods and James Rákóczi conducted multiple interviews with literary scholars involved in interdisciplinary medical humanities projects in the United Kingdom. They found that interdisciplinarity tends to move the literary text beyond the instrumental versus non-instrumental debates that had previously characterised its use in medical humanities contexts: Texts, we were told, were and were not like data drawn from interviews or testimony from lived experience; they acted similarly to historical archives and case studies from the past, but not in straightforward ways. They could function as empirical data akin to those derived from the psychological study or medical case history, but also act as sites of speculative intuition like that of the philosophical thought experiment. (2024: 363) Literary texts here are not treated simply as representative of lived experience. The texts are like evidence from the past, but also gesture towards a future, providing a different kind of data which is speculative, intuitive, and akin to a thought experiment.

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Given such observations, we might ask how the medical humanities can apply methods from science fiction studies to texts from other literary genres and modes, such as realist autopathography. By engaging with science fiction and science fiction studies, the medical humanities can more fully explore the speculative discourses that permeate our literary cultures.

The ‘future’ of the Medical Humanities The preceding discussion has shown how our understanding of science fiction, and of the cultures of health, illness, and medicine, can be enriched by the meeting of science fiction studies with the medical humanities. But this encounter can offer something more: namely, mutual critical reflection on these two research fields. In this section, we look critically at medical humanities as a research programme within a contemporary culture of speculation. In this spirit, we ask: what is the ‘future’ of medical humanities? This query is not an exercise in prognostication, but rather a question about the model(s) of the future imagined by medical humanities and which mobilise resources, pre-eminently capital. Mads Borup et al. point to the ‘“strategic turn” in science and technology visible in the development of explicit research and innovation policies in many countries and in changes in research and education systems and their funding structures’ (2006: 286–7). In this context, researchers and their collaborators increasingly need to offer ‘imaginings, expectations and visions’ of the future (Borup et al. 2006: 285). Such ‘expectations’ are ‘fundamentally “generative”, they guide activities, provide structure and legitimation, attract interest and foster investment’ (Borup et al. 2006: 285–6). As Mike Michael explains, To enunciate a research question, to formulate a research programme, to outline a prospective technological system, to posit the coordination of industry, government and university sectors in the pursuit of ‘sound technoscience’ – all these entail statements made (or rather performed) in the present that draw (on) the past and the future. (2000: 22) The past is the place of some problem, absence, or wrong, against which the ‘future is represented as the “place” where solutions are realized, presences manifested, and wrongs righted’ (Michael 2000: 22). The future may be represented discursively (and materially embodied) in dimensions that vary meaningfully (Michael 2000: 24–33). The future can be farther or nearer in time, which may then motivate judgements of urgency and risk. The future can be imagined as one for individuals, such as particular patients who would benefit from a new therapy, or for collectives, including the entire human species under the threat of climate change. The future can be one of extrapolated instrumental rationality (economic advantage, for instance) or one in which the ‘good life’ is substantively examined, critiqued, and modified, perhaps according to some utopian ideal. The future can be a good one, that is to be welcomed and facilitated, or a bad one, usually but not necessarily to be averted. The future also arrives at a different pace – often a tempo of continual acceleration, but also with other possibilities that resist capitalist technoscience. The medical humanities have emerged within the context of the strategic turn in research investment. Though they are not technoscience, they are nonetheless open to

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similar interrogation. A systematic examination is beyond the scope of this introduction. But some convenience sampling is possible. The rhetoric of expectations appears within the influential statement of a turn to a ‘critical’ medical humanities of interdisciplinary entanglement distinguished from an earlier form – a problematic ‘past’ – more closely linked to the needs of clinical practice, and which emphasised ethics, education, experience, and empathy (Whitehead & Woods 2016: 3–5). This repudiation of a deficient ‘past’ – with its handy mnemonic formula of the four ‘Es’ – aligns with a pattern noted by Julie Thompson Klein wherein a critical interdisciplinarity emerges that ‘interrogates the dominant structure of knowledge and education with the aim of transforming it, raising questions of value and purpose silent in instrumental I[nter] D[isciplinarity]’ (2017: 28). Jane Macnaughton has sketched, for instance, a vision of the future of medical humanities as a ‘disruptive teenager’ that addresses the UK government’s emphasis on ‘impact’ when funding research; she explicitly repudiates an earlier model in which the medical humanities are ‘characterized by their instrumentality in serving the larger purposes of medical education and practice’ (2011: 930). The narrative of emergent criticality is, though, selective, which suggests that this is a rhetorically constructed past, rather than a rigorous historiographical narrative. By focusing on the medical humanities as institutionalised in medical education (particularly in the USA), Macnaughton sidesteps influential work on medical issues within the humanities that may not have been explicitly labelled ‘medical humanities’. Within literary studies alone, one might think here of Elaine Showalter’s The Female Malady (1987), Louis Sass’s Madness and Modernism (1992), or Priscilla Wald’s Contagious (2008). The narrative of a turn away from the instrumental past and toward a new critical future may indeed mark genuine change in interdisciplinary research traditions. But it may also indicate a resignification of the term ‘medical humanities’ that appropriates existing interdisciplinary work through the retroactive claiming of fields that had not sought to rally around this barrier. While scholarship might benefit from the spread of (critical) medical humanities models and academic networks, it may be in danger of asking diverse research fields to conform to a singular programme of study or set of beliefs. The emergence of medical humanities modules and degree programmes at undergraduate and postgraduate level may further consolidate professional folk history of the field, formalising an intellectual pipeline for thinking through what ‘medical humanities’ means. As well as repudiating the supposed instrumental past, the postulation of new futures for medical humanities means fresh opportunities for alignment with strategic national and global research priorities. A 2023 Royal Society of Canada policy briefing on The Humanities and Health Policy deploys the Covid-19 pandemic as an additional problematic past, stating frankly that ‘understanding a novel pathogen is essential but insufficient to protect us from disease’, for ‘[a]long with the science, it is imperative to understand cultures, values, languages, histories and other determinants of human behaviour’ (Jones et al. 2023: 4). What this problem requires is funding for crossdisciplinary ‘convergence research’ (Jones et al. 2023: 8) in collaboration with the humanities, and drawing upon enhanced archival resources (Jones et al. 2023: 11–15). In this way, ‘we can learn from past successes as well as mistakes to better prepare for a future where global pandemics may occur more frequently’ (Jones et al. 2023: 12). The imagined future is particularly clear, since the report’s authors draw upon David Morens and Anthony Fauci’s inauguration of a new ‘pandemic era’ in which ‘our

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human activities represent aggressive, damaging, and unbalanced interactions with nature’ that ‘will increasingly provoke new disease emergences’ (2020: 1089). To avoid ‘increasingly extreme backlashes from nature’, they contend, we might ‘begin to think in earnest and collectively about living in more thoughtful and creative harmony with nature’ (Morens & Fauci 2020: 1089). The medical humanities may not (we hope) endorse the image of a vengeful Mother Nature scourging humanity with zoonotic plagues. The imagined pandemic future is nonetheless a flexible resource, with much potential to attract investment. As Heather Schell reminds us, with reference to earlier anxieties about a possible Ebola pandemic, the viral future is protean in its meanings: the metaphor of the virus represents our possible fates – the disintegration of self or of nation; Armageddon; the triumph of multiculturalism and the global community; the ecosystem’s anger at and vengeance for our meddling; the loss of the unknown; or the escape of the unknown into our society, where everything familiar will be destroyed in its path. (1997: 131–2) Covid-19 functions as a problematic rec