“Hounded by the Terrible Threat”: Illness at the Edges of Citizenship in Carlos Bulosan’s America Is in the Heart James M. Fitz Gerald MFS Modern Fiction Studies, Volume 65, Number 4, Winter 2019, pp. 599-617 (Article) Published by Johns Hopkins University Press For additional information about this article https://muse.jhu.edu/article/743752 Access provided at 20 Dec 2019 13:35 GMT from Binghamton University James M. Fitz Gerald f 599 “Hounded by the Terrible Threat”: Illness at the Edges of Citizenship in Carlos Bulosan’s America Is in the Heart James M. Fitz Gerald And I became aware of the presence of other things that had seemed inconsequential before: why Macario—why all of us were constantly hounded by the terrible threat of unemployment and disease. —Carlos Bulosan, America Is in the Heart Carlos Bulosan’s semiautobiographical America Is in the Heart follows Allos, its young protagonist, from his upbringing in US-occupied Philippines to his years working as a migrant laborer and poet-activist along America’s West Coast.1 Early in the novel, Allos details his family’s struggle to make payments on their farm, as land ownership under US tutelage shifts away from the Church and into the hands of usually absent corporate elites, making a usurious relationship sanctioned during Spanish rule worse. It is during this time that, after returning home with his mother from the yellow-bean fields of San Manuel, Allos finds his sister, Irene, sick in bed: “quiet and MFS Modern Fiction Studies, Volume 65, number 4, Winter 2019. Copyright © 2019 for the Purdue Research Foundation by Johns Hopkins University Press. All rights to reproduction in any form reserved. 600 Illness at the Edges of Citizenship in Carlos Bulosan’s America Is in the Heart uncomplaining” (41), Allos recounts, Irene lay “on her grass mat, following my mother with her eyes.” As the night wears on, Irene’s condition worsens: Toward midnight Irene began to cry. My mother took the oil lamp and prepared some herbs, while my brother Macario and I stood near, trying to assist her. . . . Suddenly she screamed with pain, rolling over on her stomach and beating the floor with her fists. My mother pressed Irene’s stomach with a little bag of hot ashes. Irene screamed again [and] blood began to pour from her nose, choking her. My mother ran frantically for cloths, but the blood kept coming. Afterward it started pouring from her mouth and ears. There was nothing we could do for her. In a few minutes she died like an animal that has been strangled with a rope. My mother looked at us helplessly. Here, the novel paints a grim portrait of health and welfare, particularly for poor children, in the early twentieth-century Philippines. It provides a painfully detailed account of Irene’s death while, at the same time, gesturing toward therapies practiced within and beyond a Philippines peasant class. Allos’s mother prepares “some herbs” while he and his brother try to provide assistance; the “little bag of hot ashes” pressed against Irene’s stomach rehearses the role medicine bags play across myriad cultures and healing practices.2 In addition to these palliative measures, the novel brings into clear focus the limited recourses made available to Allos and his family: the mother scrambles “frantically” for cloths to stop the bleeding; she stares “helplessly” at her surviving children; and Allos, forlorn, concedes that “there was nothing we could do for her.” Not only does the scene reenact a traumatic childhood experience, it also reflects more subtly on alternative remedies and coping strategies employed to offset the forms of health service exclusion that many in the USoccupied Philippines regularly experienced. The novel’s early invocations of ill-health and loss speak directly to this essay’s principle concerns, namely by signaling some of the social contingencies that underwrote health practices during US control over the archipelago (1898–1946). Scholars have often turned toward Bulosan’s deeply autobiographical America Is in the Heart as a prodigious testimony to the excesses of American empire. Lisa Lowe identifies it as “one of the core works of Asian American literature” (45). In fields of American studies and ethnic studies, critics have routinely drawn on the novel’s incisive configurations of Filipino emancipation to tie it to movements of social justice across the twentieth and twenty-first centuries. Michael Denning, for example, identifies America Is in the Heart with Popular Front cultural produc- James M. Fitz Gerald 601 tion of the 1930s and 1940s, while others, like Jeffrey A. Cabusao, have linked it to present-day efforts against racialized economic inequality.3 However, scholars have rarely discussed how America Is in the Heart incorporates health interventions and injustices in its aesthetic-political and unmistakably transnational vision. Exceptions might include E. San Juan Jr.’s categorization of convalescence in the novel as “not a gratuitous interruption but a functional device” (The Philippine Temptation 143) for character and plot development; and, in a resonant key, Oscar V. Campomanes and Todd Gernes’s insistence that medicalized “confinement” (169) inaugurates for Bulosan “period[s] of apprenticeship.” While constructive, these interpretations have not addressed America Is in the Heart’s intimate encounters between personal and social histories of health management, and, as a result, they have left unelaborated the novel’s postcolonial pathography of illness, care, and resistance. This essay both builds on and moves beyond these examples to reexamine America Is in the Heart through deeply imbricated histories of US health and empire. I suggest that, when read alongside fields of medical literature, history, and ethics, the novel comes into view as an uncompromising counternarrative to US-led medical progress in the Pacific. As it chronicles routine, often traumatic engagements between individuals, communities, illnesses, and institutions, the novel brings into sharp relief how the mixed predicates of race and class have long served to intensify forms of health inequality, especially for those at the margins of national belonging. This essay first aims to contextualize these uneven social gradients through the well-entrenched racial ideologies, catastrophic postwar conditions, and rising class discontinuities that fueled turn-of-the-century medicalization in the Philippines. This historical framework makes visible how the imperatives of US health intervention, cloaked in the abstractions of benevolent assimilation, entailed the racialized rescripting of Filipinos as pathogenic threats to whiteness, both in and beyond the tropics.4 I argue that America Is in the Heart inverts this language of contagion by opening onto subject-positions traditionally passed over in the medical-historical record. Amplifying perspectives from ill children, migrant laborers, and displaced refugees, the novel pieces together an unofficial archive of health inequality that documents intergenerational poverty and illness. It maps out more solidary models of convalescence that flex into forms of transnational fellowship to reveal an affective, decidedly patient-centered politics in radical contradistinction to the racialized clinical categories of early twentieth-century imperial health. 602 Illness at the Edges of Citizenship in Carlos Bulosan’s America Is in the Heart Complicit Forms of Empire Scholars in the medical humanities have long chronicled how, in the first decades of the twentieth century, reforms in disease prevention, sanitation, and hygiene helped the US legitimize its dominance over the Philippines. Recent scholarship has demonstrated how colonial administrators turned to military doctors and public health officials to sustain labor productivity and maintain civic order among nearly seven million people. To this point, Reynaldo C. Ileto has identified that “the image of the conquering solider” (109) in the US-occupied Philippines soon became “transformed into that of the crusading sanitary inspector.” As Ileto writes, US medicine’s “humanitarian objectives” came to mask “other dimensions of colonial health and welfare measures: the ‘disciplining’ of the populace, the supervision and regulation of more and more aspects of life, and the suppression or elimination of what the state perceived as forms of resistance, disorder, and irrationality” (110). In the aftermath of the Spanish-American War in1898 and the subsequent Philippine-American War between 1899 and 1902, these “other dimensions of colonial health and welfare” (110) greatly intensified. The US’s violent suppression of anti-imperialist insurrectos had, in those first years of conquest, decimated civilian populations and demolished the archipelago’s medical infrastructure. Mortality rates among the poorest Filipinos soared as displacement and destitution catalyzed previously containable diseases into uncontrollable outbreaks. Cholera, for example, killed as many as 100,000 Filipinos between 1898 and 1903, and another 700,000 died during concomitant epidemics of typhoid, tuberculosis, and smallpox.5 Infant mortality skyrocketed due to a rise in beriberi (a form of vitamin deficiency) after agricultural reforms replaced subsistence crops with cash crops like sugar, hemp, and tobacco. As Anderson writes, “The Philippine-American War would directly and indirectly cause widespread sickness, injury, and suffering as well as destroy much of the recently constructed apparatus of education and public health in the archipelago. . . . The Filipino sick and wounded overwhelmed local hospitals, vaccination ceased altogether, and colleges and universities either closed or struggled to graduate students” (Colonial Pathologies 21–22). These sweeping crises in public health licensed US officials to command unprecedented influence over the everyday lives of Filipinos. Under the leadership of Dr. Victor G. Heiser, Director of Health from 1905 to 1915, American medicos in the Philippines redoubled efforts in food inspection, health education, and latrine construction James M. Fitz Gerald 603 while expanding biomedical measures of forced vaccination and physical examinations. Public health became tied to political, economic, and cultural advancement, and outmoded (more environmental) ideas about contagion were blended with newer microbial theories to validate invasive forms of race management across the archipelago. Heiser writes in his memoir, “As long as the Oriental was allowed to remain disease-ridden, he was a constant threat to the Occidental” (37). He later recounts that “we had to guard against the entrance of dangerous communicable disease by strict measures, even when [these measures] conflicted with convenience or personal necessity. . . . What the people ate, what they drank, where they went, and how they traveled had to be safeguarded” (151). Health securitization, it would seem, reached into the recesses of daily life with little regard for struggles over Filipino self-determination, sacrificing all “convenience of personal necessity” at the altar of sanitary immunity. During the first decades of occupation, US health officers recuperated these methods of disease prevention into benevolent assimilation’s salient narrative of racial development. They constructed an idea of Filipinos as unsanitary subjects ill prepared for the responsibilities of self-rule while, at the same time, softening rigid colonial and racial hierarchies with the more palatable rhetoric of humanitarian aid.6 Most importantly, their paternalistic rubrics for health intervention pathologized the Filipino body as a frail but no less menacing threat to whiteness: “The natives do not keep their hands clean” (148), lamented military surgeon Joseph A. Guthrie in 1903, adding that “at all events, they are not microscopically clean.” Dean C. Worcester, Philippines Secretary of the Interior, echoed Guthrie’s concerns when he recounted how “lazy, vicious” (354) natives endangered Euro-American health with their “almost unbelievable ignorance and superstition.” Only the gospel of “sanitary living” (665), Worcester concluded, could “make Asiatics clean up.” Heiser expressed similar worries when he reflected on his time as Director of Health: “I had not overlooked the fact that disease never stays at home in its natural breeding places of filth, but is ever and again breaking into the precincts of its more cleanly [white] neighbors” (37). US public health aimed not only to free Filipinos from outbreaks of tropical illnesses but also to protect whites from natives’ unhygienic atavism. According to this logic, Filipinos may have been helplessly ignorant, but as pathogenic vectors they jeopardized white stability and strength. US health officers mobilized state abstractions of progress and civilization to demand, as Anderson succinctly puts it, that “the un- 604 Illness at the Edges of Citizenship in Carlos Bulosan’s America Is in the Heart derdeveloped person follow a single track toward a unique modernity” (Colonial Pathologies 183). They condensed the complexities of transpacific health intervention into more stable narratives of racial development to encourage public health’s place in a US-colonial and -neocolonial order. By the 1920s and 1930s, these interventionist patterns began to abrogate national borders and gain traction far beyond the Philippines. Anderson explains that “in general, the medical experience of empire served to amplify or channel existing features of domestic public health work” (230). Racial stigmas fabricated in the Philippines had been “exported back to the United States [where] Filipinos, in particular, arrived already medicalized and racialized” (232). In the US, health officials wove medical-imperial attitudes about health and hygiene into the fabric of Filipino exclusion. For instance, Emily K. Abel discusses “the association of immigrants with dread diseases . . . in Los Angeles in the early 20th century” (“Only the Best” 938) to show how health officials “added grist to the Nativist mill” by speaking “with the voice of scientific authority.” Abel quotes the director of California’s Bureau of Tuberculosis, Edythe Tate Thompson, who wrote in her 1933 monthly reports that “these people seem to have more complications than other races. . . . They require much more nursing than a white patient” (qtd. in “Only the Best” 937). The California State Board of Health’s 1932 report confirmed Thompson’s suspicions: “Filipinos constitute one of our worst problems at the present time” (132). They warn that “many of them are food handlers, either working in fields with fresh fruits or vegetables or working in kitchens and restaurants.” In this way, influential health officials buttressed anti-Filipino sentiments with medical-scientific authority to inhibit Filipinos’ access to full civic inclusion, marking unequivocal the limits of benevolent assimilation’s integrative ideals. Bulosan completely redraws these limits in America Is in the Heart, as the novel exposes the nativism that underwrites early twentieth-century health management, while promoting a more nuanced, collectively driven paradigm of convalescence and care. America Is in the Heart and the “Vision of a Better Life” The novel’s suggestive characterization of Luciano, Allos’s oldest brother, helps to bring the physical and psychic toll of benevolent assimilation into clearer view. Like most of his four siblings, Luciano struggles to break free from the exploitative agricultural labor that has left his family penniless and landless. As a teenager, he and Allos catch and sell local birds to tourists; he builds a small shop to sell James M. Fitz Gerald 605 bananas and mangoes; and he “was always ready with the tools” (55) to repair broken-down cars. These ventures largely go nowhere, but, “determined to use every opportunity he had in that limited place” (56), Luciano eventually leverages his competence with a typewriter into a position at the presedencia, or town hall. What begins as a job develops quickly into a vocation as Luciano cultivates a fierce political consciousness and takes aim at the normalized corruption that has plagued their hometown of Binalonan. He tells his younger brother that he is “a different person,” adding, “Watch me turn this town into something else.” Equal parts ambitious and idealistic, Luciano quickly climbs through the ranks of local government to become mayor of Binalonan while still in his twenties. As Allos recalls: “he was a man of great convictions, [and] . . . he had great potentialities.” At first blush, Luciano appears to validate benevolent assimilation’s promises of social mobility: his rise through the rungs of Binalonan politics ties his individual determination to the liberal-pluralistic ideals of integration that guided US policy in the Philippines. As I suggested earlier in this essay, at the turn of the twentieth century the US extended to Filipinos the promise of social and economic uplift. This promise suggested that, with the added condition that they comply with their solicitous guardians, Filipinos could eventually transcend strict systems of social stratification and gain access to more inclusive forms of civic and national affiliation. This “imperialism as a form of good housekeeping” (641), Vicente L. Rafael writes, intended to foster a “‘special relation’ between colonizer and colonized more like the bond between parent and child than that between master and slave” (642). Therefore, it stressed that all Filipinos—even those from the peasantry, like Luciano—were entitled to the benefits of capitalist modernity as long as they acquiesced to the benevolent paternalism of US military, political, and civic control. Of course, this portrait of Luciano remains incomplete, as it vies with America Is in the Heart’s attestation to the hierarchical social relations that underlie and unsettle the inclusive claims of US tutelage. On the one hand, Luciano’s municipal position as mayor of Binalonan merges promises of assimilation and social mobility to traffic in the language of positive liberty, such as the freedom to access forms of political representation. On the other hand, the novel insists that neither Luciano nor Allos have freedom from the debilitating restraints of poverty and illness. Indeed, even as a young man, Luciano begins to exhibit violent symptoms of tuberculosis: he “cough[s] at night” (54); he grows thinner; and “a sad shine in his eyes” alludes to the frequent, low-grade fever associated with consumption. His 606 Illness at the Edges of Citizenship in Carlos Bulosan’s America Is in the Heart modest salary of twenty-four pesos just barely covers his medical expenses. After suffering with tuberculosis for years, Luciano eventually succumbs to the disease: “Years afterward I remembered Luciano’s hope,” writes Allos, himself plagued by ill-health. He continues, “I was in a hospital when the letter came telling me that he had died. . . . I crept out of the bed and cried in the bathroom, holding my chest for fear the blood would burst out of my own perforated lungs” (56). This scene explores subtle expressions of intersubjectivity to recoordinate the relationship between Allos, who is confined by illness, and the world around him. Suffering from the same pulmonary infection that kills his brother, Allos holds his chest in a performative effort to stymie the disease’s development in his own lungs. This compulsory, if not fraternal, gesture sets Allos’s memory in impressionistic motion. He recalls after Luciano’s death that “it was midnight and the hospital was in total darkness. Far away . . . in the workers’ republic of Spain, a civil war was going on that a democracy might live” (56). Without transition, he ties this historical event to the Filipinos’ own crusades against dispossession and debility: “I remembered all my years in the Philippines, my father fighting for his inherited land, my mother selling boggoong [fish sauce] to the impoverished peasants. I remembered all my brothers and their bitter fight for a place in the sun, their tragic fear that they might not live long enough to contribute something vital to the world.” Allos at first laments “all the years that had come and gone” (57), but he quickly comes to rally around these transnational social struggles: “my remembrance gave me a strange courage and the vision of a better life.” Allos retrieves leftist-revolutionary possibility from otherwise disparate historical junctures—war-torn Spain and the colonial Philippines—not only to repudiate political apathy and nihilism but to imagine “a better life.” Rather than accept things as they are, then, Allos ideates a yet-unrealized future against which he can measure the immiserating present. These movements in (the self in relation to itself) and movements out (the self in relation to others) carry suggestive implications for Allos as he journeys across the Pacific and struggles to negotiate categories of illness, disability, and belonging at the limits of national inclusion.7 Affliction, Immigration, Community Allos’s childhood in the Philippines indexes one misfortune after another, leaving him decentered and disconsolate from an early age: his parents lose their small plot of land to moneylenders, Luciano’s James M. Fitz Gerald 607 condition worsens day by day, and his access to formal education is short-lived. These circumstances heighten Allos’s desire to run “away—anywhere. I wanted to cast off the sudden gloom that shadowed our family, and I thought the only way to do that was to escape from it” (63). While still a teenager, he decides to flee colonial oppression for the US mainland.8 He treks to the Pangasinan coast to join the ranks of thousands of young Filipinos like him: “We carried our bundles and suitcases and waited in a wide room. After a while a doctor came and tapped on our chests; then we were taken to our boat” (93). Crammed into steerage, Allos describes his quarters as a prisoner might a cell: “I found the dark hole of the steerage and lay on my bunk for days without food, seasick and lonely. . . . The small opening at the top of the iron ladder was shut tight and we did not see the sun again until we had passed Hawaii” (97). Before long, the ship’s poor ventilation and overcrowded quarters leave its lower decks vulnerable to communicable disease. Within days of leaving the Philippines, meningitis spreads throughout the boat and concentrates among the steerage passengers.9 Allos also comes down with a fever. As fear of contamination intensifies, steerage transforms into a makeshift quarantine station: a “young doctor and an assistant” stop by “now and then to check the number of deaths and to examine those about to die” (98). Stewards stop delivering food to passengers and opt instead to slide plates under a door. Isolation, paired with early summer’s sweltering heat, overwhelm Allos: “One night, when I could no longer stand the heat in the closed room, I screamed aloud and woke up most of the steerage passengers.” Allos’s account of outbreak here anticipates the “terrible threat[s]” of poverty and illness that come to structure his migrant world.10 By novel’s end, he (like Bulosan himself) endures long stretches of institutionalization, precipitated by bronchopneumonia, a collapsed lung, bone cancer—the list goes on. But Allos’s Pacific crossing also anticipates, in widely imaginative ways, a dialectical tension held throughout the novel between debility-driven confinement and collective historical agency. This passage recalls the solidarity that emerges out of Allos’s hospitalization in California after news of Luciano’s death elicits fractured impressions of social struggle, from civil war in Spain to feudal oppression in the Philippines. These transnational forms of community, I argue, are prefigured by the quarantined subjects in steerage, who transform imposed isolation into a shared network of pathologized alterity: 608 Illness at the Edges of Citizenship in Carlos Bulosan’s America Is in the Heart [S]omewhere in the room a peasant boy was playing a guitar and another was strumming a mandolin. I lay on my bunk listening and wishing I could join them. In the far corner of the dining room, crouched around the dining table, five young students were discussing the coming presidential election in the United States. Not far from them was a dying boy from Pangasinan. . . . The boy who had been playing the guitar came to my bed with cold water and rubbed my forehead and back with it. I was relieved of my discomfort a little and told him so. “My name is Marcelo,” he said. “I came from San Manuel, Pangasinan.” “San Manuel?” I said. “I used to work there—in the mongo fields. I am glad to meet you.” (97–98) Such a scene illustrates how extemporaneous soundscapes and youth-driven political exchange regroup the isolated, contaminated subjects in steerage into more collective forms of social belonging. By drawing on their precarious past and equally precarious present to fashion emergent and regionalized systems of support, this community of colonial-economic refugees resists the subtle segmentations of a maritime, medico-carceral order: “It was enough that Marcelo had come from a familiar town. It was a bond that bound us together in our journey” (98). Allos’s passage across the Asian Pacific—modeled after a broad migratory pattern known as the manong, or older brother generation—elaborates on the forms of racial pathologization that followed Filipinos to the US during the 1920s and 1930s. San Juan writes that manongs “were colonized ‘subalterns’ . . . transported from the hinterland to the metropolis, their physiognomies studied and their customs classified by the appropriate ideological mechanisms” (The Philippine Temptation 132). Categorized by what San Juan calls an “irreconcilable alterity” (132–33)—designated as neither protected wards nor citizens, but instead as non-citizen nationals—Filipinos bore the brunt of racial and economic exclusion across America’s West Coast. In particular, health officials and state legislators drew on forms of yellow peril hysteria to construe Filipinos as threats to white health and jobs. Immigrant acts passed in response to mass migration stressed the potentially diseased constitution of the “alien seaman” (154) landing on US shores: “it shall be unlawful for any [person or vessel],” declares the Immigration Act of 1924, “to bring to the United States either from a foreign country or any insular possession of the United States any alien afflicted with idiocy, insanity, imbecility, feeble-mindedness, epilepsy, constitutional psychopathic James M. Fitz Gerald 609 inferiority, chronic alcoholism, tuberculosis in any form, or a loathsome or dangerous contagious disease” (An Act to Limit 166). Mirroring legislation passed in the Chinese Exclusion Act of 1882, the Johnson-Reed Act—executed to “preserve the ideal of US homogeneity” (“Immigration Act of 1924”), according to the US Office of the Historian—targeted foreigners as invasive vehicles for virulent pathogens. By redoubling administrative enforcement of economic penalties and medical surveillance, the act built on and amended the health regulations of prior exclusion bills in significant ways. In fact, the Johnson-Reed Act channeled the same language as the Immigration Act of 1917 (otherwise known as the Asiatic Barred Zone Act) to sanction vessels carrying the diseased or disabled. According to the Act of 1917, if “the existence of such disease or disability might have been detected by means of a competent medical examination, such person or transportation company, or the master, agent, owner, or consignee of any such vessel shall pay to the collector of customs . . . the sum of $25” (An Act to Regulate 880–81). We can consider the doctor who “tapped” on Allos’s chest as one of those persons who would owe such a fee. The only difference between this and the Johnson-Reed Act of 1924 is that Congress demanded $1,000 (rather than $25) for the same infraction. Dramatic escalations like this emblematize how Asiatic exclusion in the US—“fully matured by the 1920s” (99), in Mai Ngai’s words—increasingly drew on normatively constructed categories of physical and cognitive ability to cast subjects (like Allos) from national membership. In this way, the Johnson-Reed Act legitimized convictions consolidated more than a decade earlier in the Philippines by tying civic belonging to a more racialized ecology of health. It promoted and maintained ascriptions of biological inferiority to non-US citizens, especially those from what the 1924 Immigration Act called “insular possession[s]” (166), to pave the way for future legislation that took aim more directly at Filipinos’ unsettled legal status. The Tydings-McDuffie Act of 1934, for example, drew heavily on the Johnson-Reed Act (and the Asiatic Barred Zone Act) to justify its reclassification of Filipinos as aliens rather than as nationals. The following year, US representatives tied the Tydings-McDuffie Act to the Repatriation Act to encourage further expulsion of Filipinos from America’s shores.11 In a letter to a friend in 1941, Bulosan characterizes the indeterminacy fueled by statutes like these in no uncertain terms: “I feel like a criminal running away from a crime I did not commit, and the crime is that I am a Filipino in America” (“On Becoming Filipino” 9). 610 Illness at the Edges of Citizenship in Carlos Bulosan’s America Is in the Heart Emergence from the Clinic In America Is in the Heart, the invasive forms of legislative regulation and health administration that I have discussed structure Allos’s struggles across America’s West Coast. Poverty-driven illness haunts him for much of his adult life and culminates in a two-year stay in the tubercular ward at a Los Angeles hospital: “I was sick; the years of hunger had found me at last” (225). In ways redolent of those already described, Allos refashions incapacitation into collective struggle: “At first I did not realize the extent of the disease. . . . But during the first days of anxiety, lying in bed alone and thinking of my interrupted work, I had only one desire: to get well as soon as possible and go back to the labor movement. It was an exhilarating feeling—this belonging to something vitally alive in America” (226). By drawing on the urgencies of politico-economic transformation, Allos dismantles the morbidity of cascading illness and signifies a form of resistance to the socially paralyzing dimensions of debility-driven internment. Allos articulates these patterns of collective struggle out of a distinctly clinical architecture that, while at first atomizing in its spatial order, ultimately preconditions reflection, examination, and critique. To gesture toward Michel Foucault, we might think of how clinical space reorganizes the elastic body into a more static and knowable “patient” (8)—from “a sick person [into] the endlessly reproducible pathological fact” (97)—in order to train the medical professional’s specialized, regulatory “gaze,” or le regard (8). At various institutional and cultural locations (the hospital, the treatment room, the bedside), individuals disappear into dehumanizing catalogues of symptoms and conditions under the discerning eye of medical authority. Foucault writes, “In the clinic the patient is the accident of his disease, the transitory object that it happens to have seized upon” (59). Allos, I argue, puts pressure on this transitory patientsubjectivity to reregister medicalized isolation alongside resurrected histories of dispossession and deterritorialization: “I became intensely aware of the room: the four gray walls that seemed to fall upon me, the antiquated furniture, ugly and dark, and the utter dullness of everything around me. And I became aware of the presence of other things that had seemed inconsequential before: why Macario—why all of us were constantly hounded by the terrible threat of unemployment and disease” (226). Forged out of intense awareness, Allos’s critical development imbues legacies of health inequality with levels of signification that subvert medico-carceral “dullness” by lending legible presence to a past that “seemed inconsequential before.” Allos’s clinical environment inhibits self-actualization while, at the James M. Fitz Gerald 611 same time, enabling new, more radical knowledges to emerge. From his bed, Allos develops his poetic voice, corresponds with union delegates, and, all the while, absorbs materialist histories like R. Palme Dutt’s World Politics, Robert Briffault’s Rational Evolution, and Frederic Engels’s The Origin of the Family, Private Property, and the State. As he puts it, “Every day the words poured out of my pen. I began to cultivate a taste for words” (235). Allos’s compulsion toward cultural and political expression, his cultivated “taste for words,” brings into sharp relief what Bulosan called the writer-activist’s “sole responsibility” (“Biographical Sketch”). The author diarized from his own hospital bed not long after he published America Is in the Heart: “the question is, what impelled me to write? The answer is, my grand dream of equality among men and freedom for all. To give a literate voice to the voiceless one hundred thousand Filipino people in the Philippines and abroad in terms relevant to contemporary history. Yes, I have taken unto myself this sole responsibility.” His yearlong stay at Seattle’s Firland Sanitarium in 1952, prompted by complications from tuberculosis, sets the stage here for a set of affiliated identities that can push through the restrictive deadlock of clinical confinement. When Bulosan channels individual infirmity into forms of intersubjective memory, he contemplates the complexities of “contemporary history” from the stratified position of patienthood. He flips the script for convalescence and, along the way, heralds his role as writer for the masses, “giv[ing] a literate voice” to those “voiceless one hundred thousand” cast at the threshold of citizenship. This transnational perspective puts on full display what readers confront more dramatically throughout America Is in the Heart: namely, chronic illness and isolation dissolve into the writer’s “grand dream of equality among men and freedom for all” to catalyze, rather than suppress, democratic visions of community and belonging. Bulosan described this aesthetic-political production, this deeply creative capacity, as intimately bound up with climates of physical pain. In an unaddressed letter from around 1954, he writes, “I have written a few things since my release from the sanatorium. But they are negligible. I did my best writing when I was confined in bed” (Unaddressed letter). When understood through America Is in the Heart, these relations between space and knowledge point toward an emergent, decidedly dialectical worldview nourished from within the regimented regions of the hospital. As Allos explains, “this force annihilated all personal motives, and again I began to feel stirrings inside me, coming out in torrents of poetry” (236). He writes later, after a surgery, “I wanted 612 Illness at the Edges of Citizenship in Carlos Bulosan’s America Is in the Heart to educate myself as fast as possible and the fury of my desire was so tumultuous, I could not rest” (242). In identifying Allos’s critical consciousness as emergent, I echo Raymond Williams’s analysis of dominant, residual, and emergent cultural systems. For Williams, dominant social orders retain residual elements long after the conditions that produced those elements have disappeared. Emergent forms, on the other hand, express yet-undefined meanings, values, and practices markedly alternative (even oppositional) to dominant culture. They maintain a disruptive distance at the margins of social and political recognition. Williams stresses “the process of incorporation” (126) that tends to compress elements of dissent into mere “facsimiles of the genuinely emergent cultural practice.” Williams’s ideas provide a useful vocabulary to describe how an emergent subject-position like Allos’s issues from within a dominant power structure: “Since we are always considering relations within a cultural process, definitions of the emergent . . . can be made only in relation to a full sense of the dominant” (123). Within this paradigm, Allos’s emergent intellectual emancipation dismantles a dominant landscape of medical authority by accessing collective political imaginaries from writers, artists, and activists. It draws on a dynamic literary cast—from Maxim Gorki to Federico Garcia Lorca, Walt Whitman to William Saroyan—to transubstantiate medicalized precarity into fuel for historical-materialist inquiry. Allos says, “From day to day I read, and reading widened my mental horizon, creating a spiritual kinship with other men who had pondered over the miseries of their countries” (246). Under the weight of this “spiritual kinship,” the regulatory, individuated regions of the clinic crumble: “Then it came to me that the place did not matter, these sensitive writers reacted to the social dynamics of their time. I, too, reacted to my time. I promised myself that I would read ten thousand books when I got well. I plunged into books, boring through the earth’s core, leveling all seas and oceans, swimming in the constellation” (246). Forged out of the commitments and “constellations” that tie together transnational struggles for social justice, Allos’s aesthetic education does not simply advance literacy as a salvational form of political agency, but rather literacy and teaching establish forms of fellowship built on shared ideals “defined,” as Joseph Keith puts it, “less by [Allos’s] ability to reassemble the story of his personal development than by his ability, ultimately, to depersonalize himself and his story” (48). Allos’s model for self-formation and emergence, therefore, enable his boundless identification with larger communities and commitments of affiliation—his “move,” Keith writes, “from an individual to a collective experience.” James M. Fitz Gerald 613 Nowhere does this conversion from the personal to the interpersonal become more evident than at the novel’s conclusion. The conclusion has received much attention for its ostensibly affirmational, even optimistic perspective on the nation. Finally released from the hospital and reconciled with Amado, his estranged brother, Allos hops on a bus “to catch the last crew of cannery workers in Portland” (326). He glances out at the Filipino pea-pickers, “who stopped working when the bus came into view.” He closes by describing that he hears bells ringing from the hills—like the bells that had tolled in the church tower when I had left Binalonan. I glanced out of the window again to look at the broad land I had dreamed so much about, only to discover with astonishment that the American earth was like a huge heart unfolding warmly to receive me. . . . It was something that grew out of the sacrifices and loneliness of my friends, of my brothers in America and my family in the Philippines—something that grew out of our desire to know America, and to become a part of her great tradition, and to contribute something toward her final fulfillment. I knew that no man could destroy my faith in America that had sprung from all our hopes and aspirations, ever. (326–27) Scholars have been predictably torn over this final declaration of “faith in America.” Elaine Kim, for example, attributes the hopeful conclusion to publishers’ deadlines and popular expectations, whereas Jeffrey Santa Ana, on a more affective note, understands the final “lyrical rendering of American kindness” (123) as a realignment between Allos’s “socialist vision [and his] tenacious attachment to the American Dream.” Allan Punzalan Isaac has argued, too, that the ending’s “typographic and stylistic disconnect” results from “the different locutionary positions the narrative voices take” (123). Isaac aptly states that “to make possible the logical leaps in this paragraph, several ‘Americas’ are invoked—as place, as ideal, as faith, and as project.” He explains that “the conflation makes possible the shift from an America as physical place (topos) to one that is a figure (tropos) for locating unfulfilled desire” (124). After the novel puts on “display for the reader the process of disintegration of the brown male body” vis-à-vis Allos’s unstable health, Isaac concludes, it offers an alternative, “disembodied voice that makes claims upon a fantastical ‘America.’” I would add to this discussion that the conclusion’s shift in emphasis from physical place to figurative ideal cannot come into full view without an adequate account of the counter-convalescent imagination that makes such a “disembodied voice” possible in the first place. When the novel’s de-individualized rubric for artistic 614 Illness at the Edges of Citizenship in Carlos Bulosan’s America Is in the Heart production and political participation transforms medicalized geographies (the hospital, the tubercular ward, the bedside) into sources of collective critical rupture, it generates new spaces out of which more inclusive and shared visions of America can emerge. Therefore, Allos’s final, kaleidoscopic vision on the bus springs from a dialogic project first cultivated within the dark recesses of a medical-disciplinary order, culminating the novel’s transnational map of health injustice and fleshing out the errant heart within which, for Allos, so many different Americas reside. The novel’s end builds on an unauthorized model of convalescence, a framework for healing on one’s own terms, to assemble from irreconcilable alterity stretchable nets of kinship that cross cultural and national borders. As I have argued throughout this essay, America Is in the Heart channels this liminal social location, this “underview” (xx), as Carey McWilliams writes in the novel’s preface, “from the bottom looking up,” into forms of collective struggle to open up radical political coordinates with which alienated subjects—the bedridden patient, the migrant laborer—can redraw the limits and virtues of the nation. In this way, Bulosan’s work brings to surface the capacity to heal in the face of abject exclusion and unbelonging, gesturing in the process toward therapeutic strategies culled together from new forms of knowledge, agency, and community. Notes 1. Throughout Bulosan’s novel, the narrator is interchangeably called both Allos and Carlos. I refer to him simply as Allos, so as not to confuse him with his historical counterpart. San Juan and Abel have both considered the biographical overlaps between America Is in the Heart and Bulosan’s life in far more detail. See, for example, San Juan’s introduction to Bulosan’s archive material in On Becoming Filipino and Abel’s descriptions of America Is in the Heart as “30% autobiography, 40% case history of Pinoy life in America, and 30% fiction” (Tuberculosis 104). 2. A slippery term, medicine bags take on vastly different shapes and meanings depending on culture, time, and place: while often imbued with intense spiritual meaning, their practical function has many applications. In some cases, they store other medicines, and in others they act as heating pads (as America Is in the Heart’s “little bag of hot ashes” suggests). On the development of medicine bags across different indigenous groups, see Struthers, Eschiti, and Patchell. 3. I am thinking here especially of Denning’s The Cultural Front and Cabusao’s introduction to Writer in Exile / Writer in Revolt, both of which James M. Fitz Gerald 615 place Bulosan’s writing in the context of early twentieth-century labor movements on the West Coast. For another rich and relevant study of America Is in the Heart, see Kim, who also locates Bulosan in Depressionera proletariat literature movements but does so against the backdrop of Asian and Asian-American migration in the late nineteenth century. 4. While benevolent assimilation and its origins have been well-rehearsed, Rafael conducts an especially cogent summary. Note that this policy, fueled by progressivist pretenses of social uplift, also obscured the violence of conquest precipitated by the Philippine-American War. For the text of McKinley’s proclamation, see the Adjutant General of the Army’s Correspondence Relating to the War with Spain, 859. 5. For a further discussion of cholera’s effects on Filipinos at this time, see Anderson 14. 6. Take, for example, just a few chapter titles from Heiser’s memoir: “Washing up the Orient”; “Eat, Drink, and Be Merry”; “Dividends from Philanthropy.” The medical humanities, among other fields, has long traced (and complicated) what Catherine C. Choy calls this “popular conceptualization” of “Western medicine as a universal humanitarian effort” (1). 7. In framing these relations as movements out and movements in, I allude here to Diedrich’s discussion of the embodied self in illness narratives. She writes that “effective and affective theoretical modes” in illness narratives oscillate “from the outside in to the inside out” (xviii), with the “embodied self in relation to itself and to death” always connecting to “the embodied self in relation to others; to institutions, including, in particular, the institution of medicine; and to communities, national or otherwise” (xix). In addition, Bolaki similarly stresses the personal and interpersonal bonds that shape the lived experience of illness; see especially 10–11. 8. Bulosan often claimed to have left for the US at the age of 13. Much of this depends on the year of his birth, on which scholarship tends to waver. Bulosan could not decide between 1913 and 1914 (as his “Biographical Sketch” suggests), though others, like San Juan, have turned to baptismal papers to support 1911 as the more accurate guess. For more on this issue, see San Juan, On Becoming Filipino 9. 9. Meningitis, an infectious disease, results in inflammation of the brain and spinal membranes, symptomized by fever, headaches, and nausea. If left untreated, it can lead to seizures, paralysis, and, in severe cases, death. Many studies have examined how overexposure to heat and crowded quarters (both characteristics of steerage) exacerbate these symptoms and increase rates of infection. See, for example, Hayden et al. 10. By highlighting this passage as an account of outbreak, I allude here to Wald’s influential discussion of “outbreak narratives” (2): those 616 Illness at the Edges of Citizenship in Carlos Bulosan’s America Is in the Heart “contradictory but compelling stor[ies] of the perils of human interdependence and the triumph of human connection and cooperation, scientific authority and the evolutionary advantages of the microbe, ecological balance and impending disaster.” While this essay centers on Allos and his companions in steerage, Wald’s skillfully argued book on outbreak narratives lends more attention to the microbial actors in disease emergence, drawing on (and contributing to) fields of science studies and animal studies. 11. I am indebted here to Lowe’s genealogy of these acts. See especially chapter 1. Works Cited Abel, Emily K. “‘Only the Best Class of Immigration’: Public Health Policy Toward Mexicans and Filipinos in Los Angeles, 1910–1940.” American Journal of Public Health, vol. 94, no. 6, 2004, pp. 932–39. ———. Tuberculosis and the Politics of Exclusion: A History of Public Health and Migration to Los Angeles. Rutgers UP, 2007. Anderson, Warwick. Colonial Pathologies: American Tropical Medicine, Race, and Hygiene in the Philippines. Duke UP, 2006. Bolaki, Stella. Illness as Many Narratives: Arts, Medicine, and Culture. Edinburgh UP, 2016. Bulosan, Carlos. America Is in the Heart. 1946. U of Washington P, 2014. ———. “Biographical Sketch for 20th Century Authors.” 1952. Carlos Bulosan Papers, 1914–1976. U of Washington Special Collections, U of Washington, Seattle, box 4, folder 10. ———. Unaddressed letter. 1954. Carlos Bulosan Papers, 1914–1976, The U of Washington Special Collections, U of Washington, Seattle, box 4, folder 5. Cabusao, Jeffrey A., editor. Writer in Exile/Writer in Revolt: Critical Perspectives on Carlos Bulosan. UP of America, 2016. ———. Introduction. Cabusao, pp. xix-xxxiii. California State Board of Health. Thirty-Second Biennial Report of the Department of Public Health of California for the Fiscal Years from July 1, 1930 to June 30, 1932. California State Printing Office, 1932. Campomanes, Oscar V. and Todd Gernes. “Two Letters from America: Carlos Bulosan and the Act of Writing.” Cabusao, pp. 163–95. Choy, Catherine C. Empire of Care: Nursing and Migration in Filipino American History, Duke UP, 2003. Diedrich, Lisa. Treatments: Language, Culture, and the Politics of Illness, U of Minnesota P, 2007. Denning, Michael. The Cultural Front: The Laboring of American Culture in the Twentieth Century. Verso, 1997. Foucault, Michel. The Birth of the Clinic. 1973. Translated by Alan Sheridan Smith, Vintage, 1994. James M. Fitz Gerald 617 Guthrie, Joseph A. “Some Observations While in the Philippines.” JAMS, vol. 13, 1903, pp. 141–49. Hayden, Mary H., et al. “Knowledge, Attitude, and Practices Related to Meningitis in Northern Ghana.” The American Journal of Tropical Medicine, vol. 89, no. 2, 2013, pp. 265–70. Heiser, Victor G. An American Doctor’s Odyssey: Adventures in over Forty-Five Countries. Norton, 1936. Ileto, Reynaldo C. “Outlines of a Non-linear Emplotment.” The Politics of Culture in the Shadow of Capital, edited by Lisa Lowe and David Lloyd. Duke UP, 1997, pp. 98–131. Isaac, Allan Punzalan. American Tropics: Articulating Filipino America. U of Minnesota P, 2006. Keith, Joseph. Unbecoming Americans: Writing Race and Nation from the Shadows of Citizenship, 1945–1960. Rutgers UP, 2013. Kim, Elaine. Asian American Literature: An Introduction to the Writings and Their Social Context. Temple UP, 1984. Lowe, Lisa. Immigrant Acts: On Asian American Cultural Politics. Duke UP, 1996. McWilliams, Carey. Introduction. America Is in the Heart, by Carlos Bulosan, 1946, U of Washington P, 2014, pp. vii-xxiv. Ngai, Mai. Impossible Subjects: Illegal Aliens and the Making of Modern America. Princeton UP, 2004. Office of the Historian. “The Immigration Act of 1924 (The Johnson-Reed Act).” Office of the Historian, United States Department of State, 1 June 2017. Web. Rafael, Vicente L. “Colonial Domesticity: White Women and United States Rule in the Philippines.” American Literature, vol. 67, no. 4, 1995, pp. 639–66. San Juan, Jr., Epifanio. Introduction. On Becoming Filipino: Selected Writings of Carlos Bulosan, edited by Epifanio San Juan, Jr., Temple UP, 1995, pp. 1–44. ———. The Philippine Temptation: Dialectics of Philippines-U.S. Literary Relations. Temple UP, 1996. Santa Ana, Jeffrey. Racial Feelings: Asian America in a Capitalist Culture of Emotion. Temple UP, 2015. Struthers, Roxanne, Valerie S. Eschiti, and Beverly Patchell. “Traditional Indigenous Healing: Part I.” Complimentary Therapies in Nursing & Midwifery, vol. 10, no.3, 2004, pp. 141–49. United States, Adjutant General of the Army. Correspondence Relating to the War with Spain, vol. 2, Government Printing Office, 1902. United States, Congress, Senate. An Act to Regulate the Immigration of Aliens to, and the Residence of Aliens in, the United States. 64th Congress, 1st session, 1917. ———. An Act to Limit the Immigration of Aliens into the United States, and for Other Purposes. 68th Congress, 1st session, 1924. Williams, Raymond. Marxism and Literature. Oxford UP, 1977. Worcester, Dean C. The Philippines, Past and Present. Macmillan, 1930.