Pills & Bullets
Hidayat reveals that Ratna is a professor of mycology, the study of fungi. Despite her fears, the soldiers escorting her care nothing for her political proclivities. They arrive at a hospital in all its modernist splendor; the top-of-the-line equipment and friendly staff. Down a secluded hallway, however, stand two armed sentries, wearing the proud berets of the paratroopers.
Beyond this security checkpoint, doctors are performing tests with all the accoutrements of modernist medicine: microscopes, Petrie dishes, and chemical slides. Here, we finally find out why Ibu Ratna was wrenched from her lunch by men in uniform: they need her expertise as a professor of mycology and as a medical doctor. Here again, we must take a significant historical diversion. Ibu Ratna’s profession is key to understanding the moral themes of The Last of Us, and the medical knowledge she is expert in is deeply entwined with colonialism.
Like other tropical dependencies, in Indonesia, there was a stark need for doctors and medicines to treat various diseases that Europeans had no immunity to. So-called, “Tropical Diseases:” malaria, cholera, Chagas disease, yellow fever, dengue, among many others. Fighting off bacteria, viruses, molds, fungi, parasites, and any other microscopic organism that could cause the “dis-ease” of the European colonialists became of paramount importance.[1] Such medical practice was a chief concern for military expeditions, historian Warwick Anderson notes that most of the American soldiers who died in the Filipino War perished due to disease.[2] Furthermore, because of this military necessity, Tropical Medicine became a key part of military discipline.[3] Anderson notes that “the bodies and habits of soldiers, as much as the territories they passed over, needed constant surveillance and care.”[4] Tropical Medicine, its study, education, and propagation, was not just important to European global colonialism, it was a central pillar that played a decisive role in the establishment of Western hegemony. Such was its importance and its certitude that Dr. Patrick Manson, the founder of the London School of Tropical Medicine, declared: “The successful colonization of tropical lands is entirely a matter of knowledge, and of the application of knowledge.”[5]
Yet, such medical practice was not just for the European colonialists, it was likewise extended to the colonial population itself. The historian Warwick Anderson has devoted much of his career and written pages upon pages upon the history of colonial tropical medicine and its application. His chief work, Colonial Pathologies is not only well-written but makes a very compelling case: medical practice in colonial holdings was not merely an attempt to cure local populations of ailments, but rather it was an expression of secular, modernist states imposing their claims to truth upon subject peoples, often at the point of a gun.[6]
A strong argument could be made that the processes that created medical knowledge were done so at the behest of colonialist ambition and likewise justified said colonialist ambition. In much the same way that Orientalist scholarship told 19th-century Europeans that non-Europeans were backward and ignorant, needing a stern, guiding hand; so too did tropical medicine reinforce notions of racial superiority and racial degeneracy.[7] Indeed, “the Orientals,” could not solve their medical problems themselves, they needed the guiding hand of European doctors to fix their hospitals and streets and cure their diseases. Rudyard Kipling, who is most remembered for The Jungle Book as well as his poem “The White Man’s Burden,” once wrote in a separate poem:
Now, this is the road that the White Men tread
When they go to clean a land…
The poem is capped with the lines:
Oh, well for the world when the White Men tread
Their highway side by side!
Edward Said sarcastically comments on this poem that, “‘Cleaning a land’ is best done by White Men in delicate concert with each other….”[8]
One American medical officer in the Philippines noted that it was “no small problem to sanitate eight million of semi-civilized and savage people.”[9] This attitude of racialized superiority was replicated throughout the colonial world. Dr. Patrick Manson once noted of his experience in Taiwan:
I prescribed and gave directions, and went away feeling, and probably expressing by manner, that we Europeans knew a great deal more about disease than the old Chinese doctor, who hitherto, with the assistance of the village idol, had been treating the patient.[10]
The Colonized, with their “Eastern Mysticism” were ignorant of the objective and scientific facts as derived from the Western (and supposedly superior) forms of medical science. Teaching the “Orientals” these ways became part of the “White Man’s Burden” as the West brought forth civilization out of chaos.[11] The self-assigned job of the Western European was “teaching [them] to take their place in our modern world.”[12]
Of course, however, in the process of developing such cures, colonial peoples themselves were often used as test subjects for human medical experiments. Dr. Manson, for instance, discovered that mosquitos transmitted malaria through experimentation on his gardener.[13] Furthermore, Dr. Manson publicly admitted to robbing Chinese graves to get tissue samples for his experiments.[14] Between 1898 and 1902, Dr. Almroth Wright conducted a series of typhoid vaccine tests on 4,000 Indian army volunteers.[15] Between 1930 and 1956, French colonial doctors conducted vaccine tests on 40,000 of the poorest Algerians.[16] Dr. Richard P. Strong, while stationed in the Philippines, conducted a series of vaccine trials at Bilibid Prison in 1905.[17] In this particular test, it was discovered later, that the vaccines were accidentally tainted with Bubonic Plague. Thirteen prisoners died horrible deaths as part of involuntary medical experimentation.[18] One could argue that colonialist tropical medicine was the highest form of Orientalism: deriving and producing knowledge from the standpoint of hegemonic power, at the expense of colonial peoples, ostensibly for their benefit.
Ultimately, like many scientific pursuits, tropical medicine received the bulk of its funding and initiative from the State insofar as it demonstrated its helpfulness to the colonial project. Historians Paolo Palladino and Michael Worboys observe that, “in the British Empire influence…went to those scientists and sciences whose activities served or promised to serve the direct economic and political goals of imperialism.”[19]
But such a commentary about medicine is not limited to the colonial sphere, one could argue that medicine makes up the very foundation of the secular modernist state’s power. Michel Foucault, in his delightfully irreverent manner, spent most of his career exploring the history of institutions of modern society that we take for granted and indeed believe to be normal. Not only does Foucault explore these institutions themselves, but likewise the ideologies that create and are propagated by them. The Birth of the Clinic is Foucault’s exploration of how the modernist hospital was constructed, governed, and how it created an ideology of normalcy that became its own raison d’etre.[20]
Foucault focuses heavily on what he terms “The Gaze,” the ways in which doctors view their patients and their various ailments. More than that, though, “The Gaze” represents the conceit of scientists’ claims to know things for certain. “The Gaze” is a claim to truth, particularly medical truth by way of scientific truth.[21] The doctor, the scientist, observes and categorizes and sorts and prescribes. The Doctor knows best. The Doctor knows what can happen and what should happen. In this way, The Doctor is an authority on what is healthy and what is unhealthy, what is “normal” and what is “abnormal.” In “rationally” and “scientifically” deciding what is “normal,” Foucault argues that The Doctor, through their authority, helps to enforce that “normality.”[22] Even when that sense of “normal” is ideologically motivated or culturally contingent, because The Doctor has the weight of “science” behind them, it is no longer just an opinion, but a fact. A Truth.
Connected to this scientific claim to truth, there is an impetus to standardization, practices and processes that everyone ought to follow. This impetus is reinforced and enforced by medicine’s marriage to the State and usually takes the form of licensure.[23] In this way, The Doctor gets to decide, “scientifically,” what is “normal,” and the State has the power to decide who gets to be a Doctor. Thereby, The State gets to decide what is “normal” and what is “true.” How is it that Anthony Fauci can tell millions of Americans to stay in their homes? Well, he’s a Doctor, but not just any Doctor: he’s the Government’s Doctor.
Thus, we come to the crux: medicine and science as the basis for the modernist, secular State. The wedding of knowledge and truth production to the authoritarian apparatus of violence. The two together begin as a Polizeiwissenschaft[24] which invariably develops into the Polizeistaat: the Police State. Foucault argues that such States “subscribed to the principle: One is not paying enough attention, too many things escape one’s control, too many areas lack regulation and supervision, there’s not enough order and administration.” Thus, as part of this fear of losing control and the perceived need to preserve the public good, medicine and public health naturally falls into the purview of the State.[25] Lee, the drug-addicted FEDRA guard in The Last of Us, describes this kind of State even more succinctly: “Pills and bullets, bullets and pills.”[26]
Here then stands Ibu Ratna, professor of mycology, invited by the military to look at a tissue sample through a microscope. The State, recognizing an emergency, in its concern for public order, is calling upon the expertise of The Doctor. How do we know that she is an expert? Because the State has called her thus. But, when Ratna looks upon the sample, she beholds something that her years of study had never prepared her for and had told her was impossible: a living Cordyceps in a human body.
The following scene is gruesome in nearly every detail. Ibu Ratna is asked to turn her Gaze upon the corpse from which the tissue sample was obtained, all the while General Hidayat observes from the attending booth. The nudity of the body not only conveys the vulnerability of the human form, now devoid of life’s spark, but also emphasizes the cold sterility of the medical table and the dispassion of the scientific doctor. Further, the nudity of the corpse emphasizes social and cultural tension, particularly considering the socially conservative nature of Indonesia’s Muslim-majority culture.[27] Such a tension exists in large measure as pre-Modern beliefs butt up against Modernist conceits. But more on that later.
Ratna’s task is straightforward, to utilize her expertise of fungal infections to make an assessment, to utilize her Gaze to determine what is “normal.” The absence of normality is emphasized as she cuts the corpse’s leg with a scalpel; instead of the expected red blood, there is nothing but pale fibers. Further, to accentuate the abnormality, General Hidayat confirms that the infection was caused by a bite from a human being. Next, as part of her clinical process, she inserts a tool into the corpse’s mouth in an action that seems to be a deliberate homage to Silence of the Lambs. After some effort, Ratna yanks the tool out with a fibrous mass clinging to it. To her horror, and the horror of the audience, these inert tendrils extend themselves toward her: seeking her, wanting her, needing her. In a fraction of a second, Ratna’s clinical Gaze, her scientific coldness, breaks. In terror and disgust, she drops the tool to the floor and flees from the room as more tendrils slither out of the corpse’s mouth.
In one fluid motion, it was not just Ibu Ratna who lost her composure, but the edifice of modern science lost its calculated Gaze as well. The Professor of Mycology, in this context the symbol of Science, had Known for a fact that a cordyceps could not exist within the human body, she had said so with a stern, almost condescending authority. And when confronted with this new fact, this new scenario that challenged the very tenets of her education and expertise; gone is the condescension to be replaced with terror. Normality has broken down at the same moment that Modernist certainty has failed.
[1] Warwick Anderson, “The Trespass Speaks: White Masculinity and Colonial Breakdown,” The American Historical Review, Vol. 102. No. 5. (Dec., 1997), p. 1345, Accessed March 9, 2022.
[2] Warwick Anderson, Colonial Pathologies: American Tropical Medicine, Race, and Hygiene in the Philippines, (Durham & London: Duke University Press, 2006), pp. 14, 23, 38.
[3] Warwick Anderson, “Immunization and Hygiene in the Colonial Philippines.” Journal of the History of Medicine and Allied Sciences, Vol. 62, No. 1, (Jan. 2007), p. 11. Accessed Feb. 4, 2022.
[4] Anderson, Colonial Pathologies. p. 26.
[5] Patrick Manson, et. al. “Acclimatization of Europeans in Tropical Lands: Discussion,” The
Geographical Journal, Vol. 12, No. 6. (Dec., 1898), p. 601, Accessed March 9, 2022.
[6] Anderson, “Immunization and Hygiene in the Colonial Philippines,” pp. 3, 4, 8, 9.
[7] See Patrick Manson, et. al. “Acclimatization of Europeans in Tropical Lands: Discussion.”
[8] Edward W. Said, Orientalism, (New York: Vintage Books, 1979), p. 226.
[9] Anderson. “Immunization and Hygiene in the Colonial Philippines.” p. 9.
[10] Manson. “The Necessity For Special Education in Tropical Medicine.” p. 987.
[11] Somawantha Hewa & Soma Hewa, “Dissent And Desire: Colonial Discourse And Medicine In
Nineteenth Century Sri Lanka,” Journal of the Royal Asiatic Society of Sri Lanka, Vol. 42. (1997), pp. 38, 40.
[12] R. S. F. Hennessey, “Some Social Effects of Tropical Medicine within the Commonwealth,” Journal of the Royal Society of Arts, Vol. 104, No. 4973, (March 16th, 1956), p. 334.
[13] LG Goh & KH Phua, “‘By Whose Efforts the Tropics Have Been Made Safe:’ The Work of Sir Patrick Manson,” Asia Pacific Journal of Public Health, Vol. 1, No. 2. (1987). p. 86, Accessed March 9, 2022.
[14] Patrick Manson, “The Necessity For Special Education in Tropical Medicine,” The British
Medical Journal, Vol. 2, No. 1919, (Oct. 9, 1897), p. 987, Accessed March 9, 2022.
[15] Anderson. “Immunization and Hygiene in the Colonial Philippines.” p. 13.
[16] Clifford Rosenberg, “The International Politics of Vaccine Testing in Interwar Algiers,” The American Historical Review, Vol. 117, No. 3. (June 2012), p. 673, Accessed Feb. 4, 2022.
[17] See Campbell, Kristine A. “Knots in the Fabric: Richard Pearson Strong and the Bilibid Prison Vaccine Trials, 1905-1906.” Bulletin of the History of Medicine. Vol. 68, No. 4. (Winter 1994). pp. 603-638. Accessed March 22, 2022.
[18] Anderson. “Immunization and Hygiene in the Colonial Philippines.” p. 16.
[19] Paolo Palladino & Michael Worboys, “Science and Imperialism,” Isis, Vol. 84, No. 1, (Mar.,
1993), p. 101.
[20] Michel Foucault, The Birth of the Clinic: An Archaeology of Medical Perception, Trans. A. M. Sheridan Smith, (New York: Vintage Books, 1973), pp. 35, 39, 88, 107.
[21] Foucault, The Birth of the Clinic, pp. 4, 64, 88, 107, 124, 146, 159, 171, 192, 196.
[22] Foucault, The Birth of the Clinic, pp. 35, 39, 88, 107.
[23] Foucault, The Birth of the Clinic, pp. 38, 39, 62, 64, 85, 196.
[24] Michel Foucault, “The Birth of Biopolitics,” in The Essential Foucault, eds. Paul Rabinow & Nikolas Rose, (New York & London: The New Press, 2003), p. 203.
[25] Foucault, “The Birth of Biopolitics,” p. 203.
[26] Craig Mazin & Neil Druckmann, writers. The Last of Us. Season 1, Episode 1, “When You’re
Lost in the Darkness.” Directed by Craig Mazin. Aired Jan. 15, 2023. HBO, 2023, Streaming.
[27] “Muslim Population of Indonesia,” Nov. 4, 2010, Pew Research Center, Accessed Dec. 28, 2023. https://www.pewresearch.org/religion/2010/11/04/muslim-population-of-indonesia/
