At the Heart of Identity

Laura Donald discusses the heart and the Northern Network for Medical Humanities Research 3rd Congress, Sheffield, 23rd-24th January 2020

The recent Wellcome Trust-funded two-day congress in Sheffield packed in three keynotes and a massive sixteen panels, but I’m following my heart (pardon the pun) to discuss three presentations that particularly appealed to my personal and academic interests in all things cardiological and that got me thinking, once again, about how the physical reality of a person’s heart might interact with and shape their personal identity.

Professor Havi Carel closed day one with her fascinating keynote, ‘Organ transplantation: the shadow of illness in philosophy and literature’, a presentation which deftly wove together ethereal fiction, lived experience of transplantation  and the philosophy of decision-making to explore identity, otherness and the uncanny through the lens of three very different texts: Hans Christian Andersen’s story The Shadow, Jean-Luc Nancy’s essay The Intruder, and L.A. Paul’s book Transformative Experience.

Presenting The Shadow as a potential allegory for organ transplantation, Carel drew examples from Nancy’s first-hand experience of heart transplant to show the profound impact a new organ, perhaps especially a new heart, can have on a post-transplant individual’s sense of selfhood and identity.  The perceived intrusion of a new organ, never fully accepted by the host body and only tolerated thanks to immunosuppressants, necessitates the displacement of the original organ – the two hearts cannot coexist and a new identity, neither pre-transplant Nancy nor the pre-transplant donor, comes to exist, an identity at once both strange and familiar.

Nancy’s negative emotional and psychological reaction to the heart transplant he regretted choosing to undergo was, suggested Carel, a result of the constant battle between the new “intruder” organ and the body’s immune system, with Nancy describing his old heart as slipping from him while he tried and failed to incorporate the new heart into his pre-transplant identity. The difficulty of deciding whether to put himself forward as a candidate for transplantation, said Carel, was that while Nancy may have been able to predict with some accuracy how his pre-transplant self might respond to the challenges of e.g. chronic rejection, he could not reliably predict the response of post-transplant Nancy – an identity that by necessity could not exist prior to transplantation.

The difficulty of making a decision where choosing one option would result in a new experience that can’t possibly be assessed in advance (e.g. the creation of a new post-transplant identity) is precisely the paradox discussed in Paul’s Transformative Experience, Carel’s explanation of which made the uncanny seem almost logical.  What’s not to love about a presentation that makes sense of so much confusion…other than the worrying possibility that, according to the three texts discussed, there can be no good outcome to a new heart, or as one audience member put it, no room for the language of hospitality in this particular discussion of otherness?

With a stated foundation in the theory of trans-corporeality, Dr Emma Trott’s paper, ‘Heart surgery, the posthuman body and the materially entangled self’, began with an examination of the story of Hugh Montgomery’s heart.  The 17th-century nobleman Montgomery, as a result of a childhood fall and subsequent infection, lived with a large hole in his left side, which he covered with a metal plate. When the plate was removed, his beating heart could be observed and even (as happened when William Harvey introduced Montgomery to Charles I) touched.

What might have been considered an incredible advancement in scientific understanding is described, rather, as shaking the King’s faith, causing him to take to the Royal bed as he grappled with the possibility that Harvey’s demystifying examination of the human heart, the supposed seat of the soul, would necessitate a challenge to human exceptionalism.

Trott moved swiftly from human exceptionalism in the 17th century to posthumanism in the contemporary era, discussing xenotransplantation via  1997’s speculative children’s novel Pig-Heart Boy by Malorie Blackman – the story of 13-year-old Cameron and the pig’s heart he receives in a transplant.  The reactions of Cameron and his classmates to the pig’s heart (whether Cameron should feel bad about eating bacon, for example) demonstrate the continuing perceived link between the heart and identity, but also ask us to consider the following: what makes us human, what separates us from animals, and what are the boundaries of the hybridised posthuman body?

Dr Finola Finn further elaborated on the historical and spiritual view of the heart and its role in identity through her presentation, ‘The Heart and Experience in 17th-Century England’.

“A new heart also will I give you, and a new spirit will I put within you, and I will take away the stony heart out of your body, and I will give you an heart of flesh.”
Ezekiel 36.26 (Geneva)

Beginning with this Biblical quotation, Finn described the Reformation Protestant belief that spiritual experience was something felt within the body, brought about by God’s enacting actual physical changes, such as swelling, warming or breaking the heart, during a visitation.

For Reformed Protestants, it was important that believers must feel their faith in their hearts, but it was equally important that they communicate that feeling to others. The organ of the heart functioned as a standard unifying object, enabling individuals to communicate their salvation by describing its physical sensations. So vital was the organ to the 17th-century concept of spiritual identity that Edmund Gregory, writing at that time, contrasted the real experience of the heart to the imagined experience of the brain.

The illness of melancholy was also considered, in the 17th century, to impact on the heart’s physical state, causing the condition to be linked to spirituality in both positive and negative ways. While a label of “melancholic” could cause a Puritan’s religious belief to be disputed, over time the heart broken or made tender by melancholy became imbued with spiritual significance and was viewed as more receptive to God than the non-melancholic heart.

The audience questions at the end of the panel asked the two presenters to compare their discussion of the heart to that of Carel’s. Finn responded that, in contrast to Nancy’s experience, Reformed Protestants viewed receiving a new heart and separating from their old one as a positive outcome. Might physically altered contemporary hearts be viewed in a similarly positive way? Regardless, seeing the potential for the language of hospitality in changed or transplanted hearts was a heart-warming (sorry…) conclusion to a very interesting two days.


Laura Donald is a Wellcome Trust funded first-year PhD student in English Literature/Medical Humanities at the University of Glasgow, with co-supervision from the University of Edinburgh.  Laura is researching post-1980 written representations of chronic heart disease. You can find her tweeting @_Laura_Donald and blogging about books and hearts at Hearty Tales.


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