The insertion kit used was the ARROW ® 16 G central venous catheterisation set (product no ES-04301; Arrow, Reading, Pennsylvania, USA).

The 18 G trocar needle attached to the supplied syringe was inserted into the speci- fied intercostal space in the mid-axillary line until it breached the parietal pleura and confirmed that free flowing pleural fluid could be obtained.

The Seldinger technique was applied with the flexible guide wire inserted 2 cm beyond the distance of the trocar needle.

The tract was subsequently dilated prior to the insertion of the catheter.

Care was taken that the dilator should not be inserted more than the expected distance from the chest wall to parietal pleura, in order to decrease the risk of lung injury.

The length of the catheter in the pleural space ranged from 5 to 15 cm, the final depth being dependent on the ease of aspiration of the pleural fluid.

The catheter was then connected to a urine drainage bag with a non-return valve (Polymedicure, Haryana, India) via a three-way stopcock (B Braun, San Goncalo, Brazil) and a modification from the end of an intra- venous drip set (B Braun, Penang, Malaysia).


A piece of transparent dressing (Tegaderm™; 3M, St Paul, Minnesota, USA) was applied over the junction of the urine bag tubing and the rubber bung of the intravenous drip set to prevent a disconnection.

The central venous catheter was stitched down to the skin and a similar transparent dressing applied over the insertion site.


A record of complications (pneumothorax, hemothorax, re- expansion pulmonary edema and equipment failure) was made.

A chest radiograph was performed routinely post catheter insertion for pneumothorax detection.

Subsequent radiographs made as part of the ICU management of the patient were also reviewed.

The catheter site was inspected daily for evidence of redness, swelling or discharge and the duration of the catheter's presence in situ was noted.

The daily and total volumes of pleural fluid drained were recorded.

Recurrence of the effusion after catheter removal and the need for a repeat thoracentesis was noted.


The means and standard deviations of the volumes of pleural fluid drained at 1, 6 and 24 hours post catheter insertion are presented.


Single puncture thoracentesis has been found to be a safe technique in mechanically ventilated patients [8] although there are still reservations about its use [9,10].

The procedure may need to be repeated frequently, however, and may thus cause some discomfort to the patient and an increased risk of complications associated with repeated puncture.

The bedside placement of large-bore chest tubes, 24-32 Fr gauge in diameter, is an alternative technique but its limita- tions are that the indwelling chest tubes are often associated with much patient discomfort and a relatively higher risk of mechanical complications.

This can be overcome using fine pig-tail catheters of 8.0-14.0 Fr [11].

This corresponds approximately to a diameter of 2.66 and 4.66 mm [12], respectively, and is usually placed under ultrasound guidance by radiologists.


The present technique describes the use of a similar flexible tube, but smaller in diameter (1.7 mm), which can be kept in situ to facilitate continuous drainage and thus avoid patient discomfort and potential complications from repeated thora- centesis.

Our patients reported minimal, if any, discomfort from the indwelling catheter and were able to cooperate with our physiotherapists and respiratory therapists to facilitate alveolar recruitment.


Ultrasound-guided techniques have been advocated for use in ICU patients [9,10].

Thoracentesis under ultrasound guid- ance is not complication free, however [13].

We ourselves seek the help of our radiological colleagues to insert pig-tail catheters in patients with difficult chest wall anatomy, with significant coagulation abnormalities or with possible locu- lated effusions.

In these instances, however, insertion is fre- quently delayed as arrangements have to be made with the radiologists and patients may need to be transported to the radiology department for the procedure.

Our complication rate is no worse than those rates reported by Lichtenstein


The first reported use of a central venous catheter to aspirate a pleural effusion might be attributed to Cooper who used it in a single patient to aspirate an effusion, after which it was removed [14].

We have been unable to trace any other pub- lished material on this technique except for the follow-up cor- respondence [15].

We therefore believe that the present paper is the first to document in detail the indwelling nature of this technique in a larger group of patients.

Grodzin and Balk have described a similar technique of leaving a 7 Fr indwelling pleural catheter (Turkel thoracentesis systems) for intermit- tent pleural drainage [5].

We are unable to determine the widespread availability or use of this system.


Our small study has also shown the feasibility and safety of using a urine drainage bag system instead of a water seal system in mechanically ventilated patients.

The bag is always placed below the level of the patient's chest.

We do not routinely flush the drainage system.

The catheter is removed if pleural drainage is less than 100 ml for two consecutive days and there is resolution of the effusion on the chest radiograph.


There are several potential advantages of this technique over repeated thoracentesis, use of pig-tail catheters and use of conventional large-bore chest drains.

This single lumen catheter is well tolerated with minimal patient discomfort and, in our small series, is not associated with catheter blockage, problems with the drainage system and with infection.

The technique thus avoids the need for repeated punctures, which are painful.


In our two hospitals, the advantage over the pig-tail catheters can be viewed from the point of logistics and cost.

Once the decision is taken to insert the single lumen catheter, this can be accomplished rapidly by the intensivist with the assistance of the bedside nurse.

For pig-tail catheter insertion, either the radiology team comes to the intensive care unit or the patient needs to be transported to the radiological suite.

We are also able to avoid the procedural charges of the radiol- ogy team.

The cost in our institution of the catheter and dis- posable preparation set is less than US$15.00.


In comparison with conventional large-bore chest drains, the catheter is asso- ciated with less discomfort during insertion and when it is in situ.

This facilitates nursing and physiotherapy care.

We are able to avoid the use of conventional chest drainage bottles which are expensive.

Demands on nursing care are minimal as the catheter entry site is small and not associated with pleural fluid leaks around it and because we have not needed to regu- larly flush the catheter while it is in situ.


In summary, the present article provides preliminary data on the use of a 16 G indwelling central venous catheter to drain large non-loculated pleural effusions in the ICU.

Although our case series is small, it appears that this technique is useful and safe in selected individuals.


• A number of techniques have been described to drain pleural effusions


• Each technique has its advantages and disadvantages


• In selected individuals, non-ultrasound guided placement of small bore catheters such as central lines provide effective and safe drainage of pleural effusions with minimal discomfort


I read with interest the paper by Singh and coworkers on the subject of pleural drainage [1].

In the respiratory field, this is a hot topic and guidelines were recently published [2].

Singh and coworkers used a 16-French gauge catheter, which is broadly in agreement with the British Thoracic Society guidelines (and this is what we sometimes use in our hospital).

However, the British Thoracic Society guidelines [2] do advocate a slightly smaller gauge.

The move is certainly away from large bore drains, and I would strongly support this.


Our unit has also achieved good success using 12-French gauge drains inserted using a Seldinger technique (Thal-Quick Chest Tubes, Cook Critical Care, Bloomington, IN, USA) in patients on a respiratory ward.

They seem to be patient-friendly with little initial morbidity.

However, it has been noted that blockage by fibrinous or clotted material does occur.

I am surprised that the authors did not encounter this problem, even with the larger drain.


I note the comments on the use of ultrasound guidance to access the pleural space.

A recent article [3] reported increased efficacy using ultrasound guidance in the hands of an interventional radiologist, performing the procedure in ‘real time’.

This seems a useful method but it is a luxury that is often not available.

The use of ultrasound to locate the most suitable position for access, using an ‘X marks the spot’ methodology, has in our experience often been unreliable.

I suspect that this is because the pleural access is not performed in ‘real time’.

I would be interested to know the authors’ thoughts on this and whether any of their catheters were inserted using ultrasound guidance.


I would urge caution on behalf of Singh and coworkers in interpreting some of the data.

This is a highly selected, small group of patients.

In this setting, the absence of infection or blockage is probably of limited value.

Our experience has revealed that there are definite, although low, rates of blockage and infection.

A larger, prospective, ‘real world’ study is needed.


We would like to thank Dr Kelly [1] for his interest in our recent article [2] on the use of central venous catheters for pleural drainage.

His comments add to those recently highlighted by MacDuff and Grant [3].

Potential medicolegal pitfalls with the use of the central venous catheters that we have described.

We believe, however, that cost issues should be taken into account when designing this study.

We would like to comment on the use of ultrasound (USS)-guided drainage of the pleural cavity.


The technique we have described is a cheaper and less traumatic alternative to the use of bigger bore chest tubes.

It is, however, not meant as an alternative for situations where USS guidance is needed, such as in difficult patient anatomy or in the drainage of loculated effusions.

As Kelly has pointed out correctly, it is a luxury and in our context also expensive, and it involves logistical arrangements that delay the performance of the procedure.

We have also encountered situations of failure despite the ‘X marks the spot’ methodology.

To avoid this, in situations where we seek the aid of the radiologist, we either perform the insertion with the radiologist present or get them to insert their fine bore catheters at the first attempt.

This avoids the double cost and logistical arrangements needed should we fail.


In our experience there have been occasions where chest radiograph diagnosis of significant pleural effusions was not confirmed by USS, and we invite caution in performing this procedure without USS information.

As we have highlighted in our paper and in our recent reply [4], our reported group is small and selective.

We recognize that we cannot accurately predict the rate of infection as well as catheter blockage with our sample size, although thus far we have not encountered these problems.

We agree that a ‘real world’ study is needed to answer a number of issues.

MacDuff and Grant have highlighted.


Diabetes mellitus is a bihormonal disorder, in which both insulin deficiency and absolute or relative glucagon excess contribute to the metabolic disturbances (1, 2).

Insulin re- sistance and beta-cell dysfunction are core defects in type 2 diabetes mellitus (T2D) (3).

Increased glucagon secre- tion and hyperglucagonemia also contribute to hypergly- cemia in T2D patients (2, 4, 5).

In the fasting state, plasma glucagon levels in T2D are elevated (1, 6) and fail to sup- press normally after a meal or glucose challenge (7-10).

Enhanced glucagon response to arginine also has been dem- onstrated (11).

In nonhuman primate models, worsening glycemia is associated not only with decreased beta-cell volume but also relative increase in alpha-cell volume and hyperglucagonemia (12-14).


In individuals with prediabetes, an increased glucagon response to arginine challenge has been shown to predict the development of T2D (15).

In nondiabetic (16-18) and T2D (16-20) subjects, impaired suppression of glucagon secre- tion after glucose ingestion is associated with postprandial hyperglycemia, and hyperglucagonemia has been shown to correlate with insulin resistance (16, 18, 21-23).

However, in these studies, subjects with impaired glucose tolerance (IGT) and T2D had a higher body mass index (BMI), and obesity is an insulin-resistant state (24, 25).

Dysregulation of glucagon secretion has been shown in obese individuals with and without T2D as compared with lean individuals (26, 27).

However, it is not clear whether the altered glu- cagon secretion in these subjects was secondary to obesity, abnormal glucose tolerance, or the underlying defects in insulin sensitivity and insulin secretion.

To further examine the regulation of glucagon secretion by insulin and glucose in obese subjects, we assessed insulin-mediated suppres- sion of plasma glucagon levels and its relationship with insulin resistance and beta-cell function in obese Hispanic Americans with variable levels of glucose tolerance.


The participants included 275 obese subjects of Hispanic American descent who participated in the Veterans Administration Genetic Epidemiology Study (VAGES) study (28).

Obesity was defined as a BMI ≥30 kg/m 2 .

All subjects received a 75-gram 2-hour oral glucose tolerance test (OGTT).

Based on American Diabetes Association cri- teria, individuals were classified as having normal glucose tolerance (NGT) (n = 69, BMI = 32.7 ± 0.6, M/F = 23/46); prediabetes, with fasting plasma glucose (FPG) of 100 to 125 mg/dL and a 2-hour plasma glucose of ≥140 to 199 mg/dL (n = 115, BMI = 33.8 ± 0.5, M/F = 37/78); or T2D (n = 91, BMI = 33.9 ± 0.5, M/F = 38/53).


All subjects had normal liver, cardiopulmonary, and kidney function as determined by medical history, physical examination, screening blood tests, electrocardiogram, and urinalysis.

NGT and prediabetes subjects were not taking any medi- cation known to affect glucose tolerance.

T2D subjects were either on diet or metformin, which was held on the day of study.

No subject participated in any regular phys- ical activity program.

Body weight was stable (±2 kg) for at least 3 months before study in all participants.


The study protocol was approved by the Institutional Review Board of University of Texas Health Science Center at San Antonio, and informed written consent was obtained from each subject before participation.


All OGTT studies were performed at the Bartter Clinical Research Unit (BCRU) in the Audie L. Murphy Memorial VA Hospital at 7:30 to 8:00 am after a 10- to 12-hour overnight fast.

Before the start of the OGTT, a small poly- ethylene catheter was placed into an antecubital vein for blood withdrawal.

At time 0, subjects ingested a 75-g glu- cose solution.

Blood samples were collected at −30, −15, 0, 30, 60, 90, and 120 minutes for measurement of plasma glucose, insulin, C-peptide, and glucagon concentrations.

On the day of the OGTT, waist and hip circumference was measured with a Gulick tape measure.


After a 10- to 12-hour overnight fast, a subset of parti- cipants (26 NGT, 37 prediabetes, 27 T2D) received a 120-minute euglycemic insulin clamp (40 mU/m 2 •min) (29).

Before the start of the euglycemic insulin clamp, a catheter was placed into an antecubital vein for the infu- sion of all test substances.

A second catheter was placed retrogradely into a vein on the dorsum of the hand which was placed in a heated box (60 °C) for arterialized blood withdrawal.

During insulin administration, plasma glu- cose was measured every 5 minutes and a variable glucose infusion was adjusted to maintain each subjects' plasma Downloaded from https://academic.oup.com/jcem/article/106/5/1398/6125730 by Stanford University user on 07 October 2025 1400 The Journal of Clinical Endocrinology & Metabolism, 2021, Vol. 106, No. glucose at his/her fasting level.

In T2D subjects, the plasma glucose concentration was allowed to decline to 100 mg/ dL, at which level it was maintained.

The coefficient of vari- ation of plasma glucose was less than 5%.


Plasma glucose was measured by glucose oxidase reaction (Glucose Analyzer from Beckman, Fullerton, CA).

Plasma insulin and C-peptide concentrations were measured by radioimmunoassay (Linco Research, St. Louis, MO).

Plasma glucagon concentration was measured by radio- immunoassay (Millipore Sigma, Burlington, MA).

The intra-assay coefficient of variation for glucagon was 4.9%.


Insulin-mediated suppression of glucagon secretion was determined by plasma glucagon/insulin ratio.

Glucagon suppression at 60 minutes during the OGTT was calcu- lated as follows: [1-(glucagon 60 min /glucagon 0 min )] × 100%.

The Matsuda index (30) was used to assess whole-body insulin sensitivity, using the plasma glucose and C-peptide (CP) concentrations measured during the 2-hour OGTT.

The mean rate of insulin-stimulated glucose metabolism (M value) during the euglycemic hyperinsulinemic clamp was calculated to provide an independent measure of in- sulin sensitivity.

Beta-cell function was calculated using the formula ΔCP/ΔG ÷ IR, where ΔCP/ΔG is the ratio of the incremental area under the curve (AUC) for plasma C-peptide to the incremental AUC for plasma glucose (ΔAUC-CP/ΔAUC-G) during the 2-hour OGTT, and IR is insulin resistance measured by the inverse of the Matsuda index (31, 32).

Subjects were stratified into 4 groups based on their insulin sensitivity (Matsuda index and M value), and beta-cell function (insulin secretion/insulin resist- ance or disposition index).

Subjects in Quartile 1 (lowest Matsuda insulin sensitivity index or M value) were the most insulin-resistant and subjects in Quartile 4 were the most insulin-sensitive.


Statistical comparisons were performed using Graph Pad Prism 9 (Graph Pad Software, San Diego, CA, USA) and NCSS (Version 12, Chicago IL).

Study participants were categorized into equal quartiles of Matsuda index of insulin sensitivity and insulin secretion (ΔCpep 0-120 / ΔGlu 0-120 ).

Plasma glucagon levels and suppression of glucagon during OGTT were related to glucose tolerance status and to quartiles of insulin sensitivity and insulin secretion using Spearman's correlation.

Comparison between the quartiles of insulin sensitivity and beta-cell function was performed using 2-way ANOVA with Bonferroni post hoc testing when appropriate.

Group comparisons (baseline vs OGTT and baseline vs euglycemic insulin clamp) were performed by Student t test.

Data represent the mean ± standard error of the mean.

The relationship between plasma glucagon/ insulin ratio versus insulin sensitivity and versus insulin se- cretion were determined by Spearman's correlation.


The clinical and metabolic characteristics of study participants are shown in Table 1.

Of the 115 subjects with prediabetes, 30 had impaired fasting glucose (IFG), 42 had impaired glu- cose tolerance (IGT) and 43 had combined IFG/IGT.

Subjects with NGT were slightly younger than prediabetic and T2D subjects.

There was no difference in BMI, waist and hip cir- cumference, or male/female ratio between the 3 groups.

The FPG and 2-hour OGTT glucose concentration increased from NGT to prediabetes to T2D (Fig. 1A).


There was no difference in fasting plasma glucagon con- centration between NGT, prediabetes, and T2D subjects.

However, the fasting plasma glucagon in T2D subjects tended to be higher compared with both NGT and prediabetes (Fig. 1B).


The mean plasma glucagon concen- tration during the OGTT at 60 minutes and 120 minutes were similar in NGT and prediabetes groups and slightly, although significantly (P < 0.05), increased in T2D (Fig. 1B).

The fasting plasma insulin and C-peptide concentra- tions rose progressively from NGT to prediabetes to T2D (Fig. 1C and 1D).


The mean plasma insulin and C-peptide concentrations during the OGTT at 60 minutes and 120 minutes were significantly increased in prediabetes versus NGT (P < 0.001) and reduced in T2D versus both NGT and prediabetes groups (P < 0.001) (Fig. 1C and 1D).

The fasting plasma glucagon/insulin ratio declined progres- sively from NGT to prediabetes to T2D (P < 0.001) (Fig. 2A).


When subtypes of prediabetes, (ie, IFG, IGT, and IFG/ IGT) are compared, there was a progressive decline in the fasting glucagon/insulin ratio from IFG to IGT to combined IFG/IGT (Fig. 2B).

At 60 minutes (Fig. 2C) and 120 min- utes (Fig. 2D) during OGTT, the plasma glucagon/insulin ratio was similar in prediabetes and NGT groups but mark- edly increased in T2D versus both NGT and prediabetes (P < 0.001).


When subtypes of prediabetes, (IFG, IGT, and IFG/IGT) were compared, there was a progressive decline in the glucagon/insulin ratio fasting glucagon/insulin ratio at 120 minutes from IFG to IGT to combined IFG/IGT (Fig. 2E).

Suppression of plasma glucagon at 60 minutes during OGTT compared with fasting glucagon was similar in NGT (10.4%) and prediabetes (9.1%) groups, but sig- nificantly impaired in T2D individuals (3.3%) (P < 0.05).


During the OGTT, the number of subjects in whom the 2-hour plasma glucagon concentration was lower than the fasting plasma glucagon was 53/69 (77%) in NGT, 88/115 (77%) in prediabetes, and 64/91 (71%) in T2D (P = NS).

There were no significant differences in age, BMI, FPG, 2-hour glucose, Matsuda insulin sensitivity index, and in- sulin secretion/insulin sensitivity (disposition) index between subjects with suppressed (2-hour plasma glucagon below fasting plasma glucagon) versus nonsuppressed (2-hour plasma glucagon above fasting plasma glucagon) in the entire group, as well as between NGT, prediabetic, and T2D groups.


Insulin sensitivity, measured with both the Matsuda index of insulin sensitivity and the rate of insulin-mediated glucose metabolism (M values) during the euglycemic hyperinsulinemic clamp, decreased progressively from NGT to prediabetes to T2D (Fig. 3A and 3B).

Subjects were stratified into 4 groups based on their insulin sensitivity; subjects in Quartile 1 were the most insulin-resistant, while those in Quartile 4 were the most insulin-sensitive (Table 2).

As expected, the greatest number of NGT subjects were in Quartile 4 (most insulin-sensitive) of Matsuda insulin sensitivity index or the M value, and the largest number of individuals with T2D were in Quartile 1 (most insulin- resistant).


The mean plasma glucagon concentration in the fasting state and during the OGTT (0-120 minutes) in relation to quartile of insulin sensitivity is displayed in Fig. 4.

Both fasting and 2-hour plasma glucagon concentra- tions increased progressively with decreasing insulin sensi- tivity, measured both with the Matsuda index or M value during the euglycemic insulin clamp (Fig. 4A and 4B).

The plasma glucagon/insulin ratio progressively declined with worsening insulin resistance (Figs. 5A-5D).


Beta-cell function, measured with insulin secretion/in- sulin resistance (disposition) index, gradually decreased from NGT to prediabetes to T2D (Fig. 3C).

The rela- tionship between plasma glucagon concentration and insulin secretion/insulin resistance (disposition) index is displayed in Fig. 4.

As expected, the highest quar- tile of disposition index (Quartile 4, Table 2) contained the highest percentage of individuals with NGT, while the lowest quartile of disposition index contained the highest percentage of individuals with T2D (Quartile 1, Table 2).

Both fasting and 2-hour plasma glucagon levels increased progressively with worsening beta-cell function (Fig. 4C and 4D) and the glucagon/insulin ratio decreased progressively with declining beta-cell function (Fig. 5E and 5F).


Fig. 6A) and beta-cell function (disposition index, r = 0.35; P < 0.001) (Fig. 6B).

During OGTT, the glucagon/insulin ratio at 60 minutes (Fig. 6C) and 120 min- utes (Fig. 6D) was inversely correlated with beta-cell func- tion (disposition index, r = −0.47; P < 0.001 and r = −0.32; P < 0.001, respectively).

Glucagon suppression during the OGTT (r = −0.53; P < 0.001) was inversely correlated with the glycated hemoglobin (HbA1c) in nondiabetic subjects, but not in prediabetic or T2D subjects.


To identify factors contributing to the impaired suppres- sion of glucagon and fasting hyperglycemia, we performed a multiple regression analysis using glucagon/insulin ratio as a dependent variable and Matsuda insulin sensitivity index, fasting glucose, and insulin secretion (ΔI I0-120 /ΔG 0-120 ) as independent variables.

Together, Matsuda insulin sensi- tivity index, fasting glucose, and the insulinogenic index explained 61% (r 2 = 0.605; P < 0.001) of the variation in fasting glucagon/insulin ratio.

Similarly, when the FPG con- centration was the dependent variable, and fasting glucagon to insulin ratio, glucagon suppression at 120 minutes, and glucagon to insulin ratio at 60 minutes were independent variables, together they explained 51% of variation in fasting glucose level (r 2 = 0.506; P < 0.005).


The present results demonstrate that, in a large cohort of obese Hispanic American subjects with a wide range of glu- cose tolerance, both the fasting and OGTT plasma glucagon concentrations and the glucagon/insulin ratio progressively worsened with increasing insulin resistance and declining beta-cell function.

Impaired suppression of glucagon by in- sulin during the euglycemic hyperinsulinemic clamp also progressively declined with worsening glucose tolerance.


In the present study we focused on obese subjects be- cause: (i) obese subjects are at high risk of developing dia- betes; (ii) a recent study (33) suggested that obese subjects have a lower fasting plasma glucagon concentration that results from elevated fasting insulin levels secondary to insulin resistance; and (iii) although several studies (15- 17) have reported increased plasma glucagon levels in prediabetes versus NGT subjects, there were significant dif- ferences in BMI between the 2 groups (16, 18, 27).

Despite similar BMIs between the NGT, prediabetes, and T2D groups, the results clearly show that fasting and 2-hour plasma glucagon levels increase with worsening glucose tolerance as well as with worsening insulin resistance and declining beta-cell function.

The plasma glucagon concentration during the OGTT failed to suppress (ie, return to the fasting level during the OGTT) in 21% to 28% of the participants.

Importantly, there were no significant differences in the prevalence of nonsuppressed plasma glucagon levels between NGT, prediabetic, and T2D individuals.

However, when stratified by quartiles of insulin sensitivity, there was a marked dif- ference in mean plasma glucagon concentration during the OGTT between subjects in the lowest and highest quar- tiles of insulin sensitivity (Fig. 4A and 4B).

This suggests that the impaired glucagon suppression is more strongly related with insulin resistance than with plasma glucose levels.

Our results are consistent with those reported by Faerch et al in Danish subjects (16).


Both glucose and insulin are important regulators of the plasma glucagon concentration.

Insulin inhibits glucagon secretion both by paracrine mechanisms and elevated plasma levels (34, 35), while glucose inhibits glucagon by increasing cyclic adenosine monophosphate (cAMP) levels in the alpha-cell (36).

The current study design does not allow us to determine whether there is resistance to the suppressive effect of glucose or insulin or both.

In the current study, plasma glucagon levels are clearly more affected by insulin sensitivity and beta- cell function than by the plasma glucose level per se.

The changes in plasma glucagon levels were more pro- nounced when measured by change in quartiles of in- sulin sensitivity than changes in plasma glucose.

Elevated fasting glucagon levels have been associated with insulin resistance, measured by the euglycemic hyperinsulinemic clamp, in nondiabetic subjects, suggesting insulin resist- ance at the level of pancreatic alpha-cells (37).

In the present study, we show that a similar relationship also exists in individuals with prediabetes and T2D.

Among the subtypes of prediabetes, our data suggests that there is a progressive worsening in suppression of glucagon when moving from isolated IFG to combined IFG/IGT, which could be explained by worsening insulin sensi- tivity and insulin secretion in isolated IFG versus com- bined IFG/IGT.


Impaired plasma glucagon suppression in response to meals and hypersecretion in response to arginine have pre- viously been shown (11, 38).

The present study demon- strates that elevated plasma glucagon levels are present in the fasting state as well as at the 60-minute and 120-minute time points during an oral glucose load.

Our results differ from those of Faerch et al, who showed that impaired glu- cagon suppression in T2D patients during an OGTT was most marked at 30 minutes, while a normal decrease was observed at 120 minutes (16).

Our results demonstrate that both early and late glucagon suppression are impaired in T2D subjects during the OGTT and contribute to hyper- glycemia.

This difference could be related to the different ethnic populations that were studied (Mexican Americans versus Caucasians) or the greater severity of insulin resist- ance in our subjects.

Of note, glucagon response to a mixed meal is different from the glucagon response to OGTT.

While glucose load leads to suppression of glucagon, fol- lowing a mixed meal there is an initial increase in glucagon followed by suppression (39, 40).

It is possible that the glu- cagon response to mixed meal in relation to insulin sensi- tivity could differ from that seen with OGTT.


How insulin sensitivity modulates plasma glucagon levels is not clear.

It is possible that insulin resistance is present at the level of the pancreatic alpha-cells, which contain insulin receptors and the insulin signal transduction system (34, 41).

Deletion of pancre- atic alpha-cell insulin receptors in mice (αIRKO mice) causes impaired glucose tolerance, hyperglycemia, and hyperglucagonemia, demonstrating the important role of the insulin receptor in the regulation of glucagon se- cretion (34).

Our results are consistent with the concept that insulin resistance at the level of pancreatic alpha- cell, as well as impaired insulin secretion, contribute to impaired glucagon suppression in T2D.

Consistent with this scenario, insulin has been shown to modulate glucagon secretion by reducing the sensitivity of Katp channels in pancreatic alpha-cells, resulting in decreased phosphatidylinositol 3-kinase (PI3K) and Akt activity (42).

An increase in plasma free fatty acid concentrations has been shown to decrease glucagon secretion in hu- mans (42).

In contrast, a recent study showed that ex- posure of human cultured islets to increased fatty acid levels enhanced glucagon secretion (43).

Plasma free fatty acid levels were not measured in the present study.


In rats, chronic (7 days) exposure to elevated plasma glu- cose levels was shown to augment glucagon secretion, and this was attributed to glucotoxicity (44).

Consistent with these results in rodents, we have shown that mild physiologic hyperglycemia (+50 mg/dL) in healthy NGT individuals for 72 hours markedly impairs suppression of glucagon during euglycemic hyperinsulinemic clamp (45).

As expected, a novel human monoclonal antibody and competitive antagonist of the glucagon receptor im- proved glycemic control, reduced hepatic glucose pro- duction, and improved skeletal muscle insulin sensitivity in rodent models of obesity and insulin resistance (46).

A glucotoxic effect on pancreatic alpha-cell secretion of glucagon also has been demonstrated in vitro (33), and correction of the hyperglycemia with phlorizin restored the ability of glucose to suppress glucagon secretion (47).


In summary, the present results demonstrate that sup- pression of glucagon secretion is impaired with increasing severity of glucose intolerance and is closely associated with insulin resistance and to a lesser extent with beta-cell dysfunction in obese Hispanic Americans.


We read the article titled “Impaired Suppression of Glucagon in Obese Subjects Parallels Decline in Insulin Sensitivity and Beta-cell Function” by Chen and colleagues [1] with great interest.

The study has evaluated the relationship of glucagon suppression with insulin resistance and beta-cell function assessed by oral glucose tolerance test (OGTT) and euglycemic hyperinsulinemic clamp studies in obese normal glucose tolerance (NGT), prediabetes, and type 2 diabetes (T2DM) Hispanic population.

It demonstrated a progressive increase in both fasting and 2-hour plasma glucagon levels during OGTT, which had a positive correlation with the severity of insulin resistance (IR).

Moreover, the study also showed the decrease in fasting glucagon/insulin ratio to be associated with increasing insulin resistance and declining beta-cell function.

This interesting finding supports that impaired alpha-cell function is more closely related to the development of IR and beta-cell function rather than solely depending on the glycemic levels alone.


This prompted us to reanalyze the data of our recently published study [2] involving Asian-Indians with impaired glucose tolerance (IGT), impaired fasting glucose (IFG) and NGT.

At baseline, the mean age of the population (n = 60) was 36.8 ± 7.6 years and mean body mass index was 25.7 ± 2.8 kg/m2.

Among the included participants, 80% were females (n = 48) and 20% (n = 12) were males.

There was no difference in either fasting glucagon (measured by ELISA; R & D Systems, catalog #DGCG0, AB_2893019) or total area under the curve (AUC) glucagon across body mass index or age quartile.

Sex had also no effect on the plasma glucagon level.


We did not find any difference in the fasting insulin and glucagon levels among the IGT, IFG, and NGT groups.

However, we found significantly increased fasting glucagon/insulin ratio in the NGT group compared with both the IGT and IFG groups.

This finding is similar to the study by Xi et al [1]. But, in our study, this ratio did not differ between the IFG and IGT groups, whereas Xi et al noted a progressively decreasing trend in the fasting glucagon/insulin ratio from IFG to IGT to combined IFG/IGT.


Notably, we also found that fasting glucagon/insulin ratio decreased progressively with increasing insulin resistance, as measured by Matsuda Index derived from a 2-hour mixed meal tolerance test (MMTT).

The difference in the fasting glucagon/insulin ratio across 4 quartiles of IR was also statistically significant (P < 0.001).


Moreover, across the quartiles of increasing IR, fasting insulin secretion increased significantly as expected, but fasting glucagon levels were almost similar, suggesting that even in the face of increased insulin, fasting glucagon was not suppressed.

This finding is comparable to that of the study being discussed.

We also found a positive correlation between the fasting glucagon/insulin ratio with the Matsuda Index (Spearman’s rho: 0.704; P < 0.0001).

However, the relationship between the beta-cell function as measured by insulin secretion and sensitivity index-2 from the 2-hour MMTT [3] and fasting glucagon/insulin was weak (Spearman’s rho: 0.31; P = 0.014).

On the other hand, we found a trend of decreasing fasting glucagon/insulin ratio with declining insulin secretion and sensitivity index-2 values.

However, this relationship did not reach statistical significance, possibly reflecting small sample size of our study.


On the contrary, meal-stimulated glucagon did not have any relationship with either IR or beta-cell function in our study.

There was also no correlation found between total AUC glucagon with Homeostatic Model Assessment-IR and beta.

This may reflect the difference in methodology because we used MMTT instead of OGTT and clamp study.

Furthermore, our study did not have a T2DM group.

Paradoxically, we found a lesser glucagon secretion during MMTT in the prediabetes individuals compared with the NGT population at 60 and 120 minutes.

Hence, there was a negative correlation found between total AUC glucagon and total AUC glucose.


The finding from our study consolidates the idea of impaired glucagon suppression (at least fasting) as a correlate of IR across ethnicities, including Asian-Indians.

Moreover, this finding paves the way for further studies to assess the relationship of impaired glucagon suppression with both IR and beta-cell function using the gold standard clamp studies in different ethnicities across the world, including Asian-Indians in whom the prevalence of prediabetes and diabetes is rising alarmingly.

Nonetheless, it would be interesting to observe the effect of improved IR through weight loss (including dietary modifications and exercises) on the impaired glucagon suppression in insulin-resistant obese individuals.


Roy et al [1] analyzed plasma glucagon levels in relation to insulin sensitivity in Asian Indians with normal glucose tolerance (NGT), impaired fasting glucose (IFG), and impaired glucose tolerance (IGT) and found that their observations are mostly consistent with the results seen in Mexican Americans, particularly in the fasting state [2].

Since underlying metabolic abnormalities in pathogenesis of type 2 diabetes mellitus (T2DM) in different populations should be similar, one should not expect to see major differences in results across different ethnicities.

The authors demonstrate a progressive decline in fasting glucagon/insulin ratio from NGT to IGT and with worsening insulin sensitivity, based on quartiles of insulin sensitivity.

They did not observe any difference in glucagon/insulin ratio between IFG and IGT individuals.


Of note, although we showed a trend in declining glucagon/insulin ratio between IFG and IGT groups, the difference was not statistically significant.

The other possibility could be that the number of participants in each category appears too small in their study.

Insulin sensitivity was measured by the Matsuda insulin sensitivity index (MI) during a mixed meal test.

Though their observations may be similar, it is not equivalent to MI obtained from an oral glucose tolerance test (OGTT) [3].


The other differences between their observations and our results could be explained by the following.

Our study enrolled exclusively obese individuals with a body mass index (BMI) greater than 27, and there was no difference in BMI between the groups (NGT vs IFG/IGT vs T2DM).

It is not clear if there was a difference in BMI in their study population.

Although plasma glucagon did not differ in relation to BMI, plasma insulin levels are usually higher in obese individuals, which will therefore affect the glucagon/insulin ratio.

Roy et al [1] also note that meal-stimulated glucagon responses did not correlate with either insulin sensitivity or insulin secretion.

It is well known that glucagon response following OGTT and a mixed meal are different [4].

Following an oral glucose load in NGT and IGT patients, there is a progressive decline in glucagon levels whereas following a mixed meal there is usually a transient rise in plasma glucagon followed by a decline, thus the glucagon area under the curve following OGTT and mixed meal cannot be compared.


Overall, there is congruence between plasma glucagon levels and insulin sensitivity in Asian Indians and Mexican Americans, and we agree that future studies with euglycemic insulin clamps at least in a subset of patients will better characterize this relationship.

Evaluation of this relationship after interventions such as weight loss will provide further insights into the role of glucagon in pathogenesis of T2DM.


In keeping with editorial convention, Sbriglia and Žižek spend a number of pages summarizing the chapters of their various authors.⁹ Before doing so, they lay out their own general position from pages 2 through 16, beginning gently and progressing gradually toward the technical heart of their argument.

The editors note that from the 1980s until recently, "materialism" in the humanities and social sciences referred to a cultural rather than physical materialism, as embodied especially in the works of Louis Althusser and Michel Foucault: "cultural materialism holds that subjects are by-products of their respective cultural milieus - epiphenomena of socio-symbolic networks and matrices, ideological state apparatuses, and disciplinary techniques and epistemes" (3).

They capably observe that at least two different strands of opposition to cultural materialism have emerged, as embodied in two prominent anthologies now roughly a decade old.

Diana Coole and Samantha Frost introduce their New Materialisms collection by rejecting "substantialist Cartesian or mechanist Newtonian accounts of matter […] [as] simply passive or inert. "¹⁰ A year later, in The Speculative Turn, Bryant, Nick Srnicek, and I emphasized the need for a realist turn against cultural materialism's obsession with "texts, discourse, social practices, and human finitude. "¹¹ Nonetheless, Sbriglia and Žižek assert, "whatever their differences from cultural materialism, the materialisms and realisms that Bennett and Bryant advocate alongside Coole, Frost, and Harman […] not only share in but also advance the cultural materialist project of placing the subject under In one sense, this assertion of genuine novelty against the hidden traditionalism of one's opponents is simply the sort of thing that philosophers do.

Everyone places a more or less educated bet on where the crux of contemporary philosophy is located; this having been done, all those who fail to follow our own preferred bet are proclaimed to be victims of the same traditional presupposition that we ourselves have overcome.

In precisely this way, Heidegger depicts the entire previous history of philosophy as a long forgetting of Being countered only by Heidegger himself, and Kant's Copernican Revolution treats his illustrious chain of predecessors as equally "dogmatic" through their assumption that the thing-in-itself is accessible to rational proof.

There is always a dose of exaggeration in such tactics, but also - in successful cases - the glimmer of a new insight that leaves philosophy different from what it was before.

The "wager" of the Ljubljana School - to use a term so dear to their fellow traveler Badiou - is that the path forward for philosophy leads not through a rejection of the subject, but instead through a "doubling down" (9) on Hegel's claim that substance is subject.

Additionally, there is a further wager that we must also replace the lucid modern "Cartesian subject" with a "barred" Lacanian subject traumatized by its disgusting encounter with the real: a model said to be already at work in both Hegel and his one-time friend F. W. J. Schelling.

Ljubljana's commitment to this twofold vision is famously durable, intense, and prolific.


Must we now follow the lead of the Ljubljana School and push forward with subject-oriented philosophy grounded in psychoanalysis, or should we instead view this current as a once-refreshing challenge to continental orthodoxy that is now showing its age in the face of one or more newly emerging trends? These are the stakes of the half-declared war of Subject Lessons.

As a helpful analogy, let's imagine that the pre-Socratic thinker Thales of Miletus, famous for his doctrine that water is the first principle of everything, had lived to see Kant's Copernican Revolution replace the Wolffian rendering of Leibnizian philosophy that preceded it in Germany.

We might well picture Thales speaking as follows, in the manner of Sbriglia and Žižek: "Whatever Kant's differences from Leibniz, the transcendental philosophy he advocates not only shares in but also advances Leibniz's project of placing water under erasure." Since water is no longer taken seriously as one of the building blocks of philosophy, we would probably just laugh at Thales and move on.


Yet the claim would be far from laughable for any odd soul who might still think that water is the root of all existence.

There is a crucial difference from the present case, of course, since water is philosophically irrelevant to both Kant and Leibniz, while the subject is anything but irrelevant to the "New Materialists": for all of them, the supremacy of the human subject is the chief obstacle to any philosophy that foregrounds the object.

Yet the point remains: to claim that cultural materialism and the "New Materialisms" are united in "erasing the subject" is only relevant to those who assume in advance that the subject is the necessary core of a genuine contemporary philosophy.

It makes no difference whether we accept the "Cartesian subject," replace it in cultural materialist fashion with "ideological interpellation and discursive formation," (3) or embrace an edgier, Ljubljanized subject characterized by a "tarrying with the negative," plunged into "the night of the world," betrayed by the "cunning of reason," standing at the mercy of the unconscious, or haunted by a death drive (3).

The problem is that in all three of these cases, we have human thought on one side and everything else on the other, no matter how turbulent our model of the subject may be.


What neither Foucault, nor Althusser, nor Kant, nor Hegel, nor Schelling, nor Husserl, nor Heidegger, nor Žižek himself is able to think is the interaction of two non-human entities when not under some sort of human surveillance: this is simply ruled out of court as a form of pre-Kantian dogmatism.

It will be said, according to the old post-Kantian trope, that even to think this interaction is already to put it under surveillance, so that the very idea is nonsensical.

This attitude is precisely what OOO rejects as "onto- taxonomy," referring to the assumption that there are two and only two basic kinds of things in the cosmos: (1) humans, and (2) everything else.¹² This is what makes it so pointless when Sbriglia and Žižek complain that "from the Hegelo-Lacanian perspective, what new materialists and realists understand as  12 See Harman, "The Only Exit from Modern Philosophy."


Sbriglia and Žižek's Subject Lessons  317 'subject' simply fails to meet the criteria of the subject" (14-15).

For by the same token we could say that from Thales' perspective, what Leibniz and Kant understand as "water" is merely a minor chemical substance, and therefore simply fails to meet the criteria of water as the arche of everything.

Perhaps more to the point, from a OOO perspective what Hegelo-Lacanians call objet petit a simply fails to meet the criteria of the object, since it reduces the object to a correlate of the subject's desire.

This sort of dispute needs to be conducted at a more basic level than merely accusing one's opponents of an inability to account for one's own pet entities.

The need for such entities to exist must first be established, and this certainly holds for the "subject" of modern philosophy, whose theoretical downside is at least as obvious as its benefits.

Otherwise, we might just as well invite Reichians to dismiss Lacan on the basis that he cannot account for the existence of "orgone."


Sounding the alarm about the disappearance of the subject is just one of several ways that Subject Lessons preaches to the converted.

Another can be found in Sbriglia and Žižek's mockery of the quest for a "re-enchantment" of the world by way of a "posthumanist reversion to a pre-modern ontology" (9).

The word "pre-modern" seems to have been deliberately chosen to evoke not just a specific period of philosophy, but a purported allegiance by "New Materialists" to an irrational, unenlightened, unscientific, and mythical past.

I do not exaggerate.

Just one page later, the editors compare flat ontology - the fairly basic notion that all entities must be treated by philosophy on an equal footing - to "a Tolkienesque world of magical forces in which the subject is merely one among countless vital objects," (10) before repeating the slap in a footnote: "little wonder, then, that the pluriverse envisioned by neovitalists resembles the Middle-Earth of Tolkien's Lord of the Rings, the defining work of fantasy literature" (27n57).


Since no argument in particular is made for the purported resemblance between the "New Materialists" and the workings of Middle Earth, this would appear to be an instance of reverse projection: rather than the "New Materialists" being obsessed with enchantment, Ljubljana seems obsessed with the disenchantment of the world, as if this were the very key to enlightenment.

Žižek's first critique of OOO, published in 2016, already sounded this note: "the main target of OOO is thus not transcendental philosophy with its subject/ object dualism, but modern science with its vision of 'gray' reality reduced to mathematical formalization: OOO tries to supplement modern science with a premodern ontology which describes the 'inner life' of things"¹³ (177).

Not at all.

The OOO critique of modern science is not for its "grayness," but for its literalism in reducing objects to bundles of qualities: a pivotal argument mentioned nowhere in Subject Lessons.

In any case, the "Tolkien" jabs will no doubt earn much laughter from Žižek's loyal readership, but they fail to advance the discussion a single step.

They are little more than morale-boosting jests among friends in a beer hall.


It is fortunate that Sbriglia and Žižek do eventually show their hand as honestly as one could wish.

Their highest-ranking card is the same one thrown down by so many others in post-Kantian philosophy: the sheer impossibility of old-fashioned realism in the face of the closed circle of transcendental thought. As they put it, any "naïve notion of fully constituted material reality as the sole true reality outside our minds, of materiality as 'all,' relies on the overlooked exception of material reality's transcendental constitution […]" (9).

After all, how can anyone claim to speak of a reality apart from the subject when that same person is already a subject?

Here they find fault with an unusual trio of thinkers: "Lenin, but also […] Bennett and Bryant, all […] fail to account for the very position of the enunciation of the subject whose mind 'reflects' matter" (9). And later: "From where does the subject […] who deploys these object-oriented ontologies, these thing-power materialisms, speak? From what standpoint? Such theories obviously cannot be uttered from the position of merely one object among others" (15).

The editors inform us that, as German Idealism knew all along, "the more we try to isolate reality as it is 'in itself,' independently of the way we relate to it, the more this In-itself falls back into the domain of the transcendentally constituted, always already caught in the transcendental circle" (9).

This leads Sbriglia and Žižek to make a heroic call "to fearlessly think through the consequences of rejecting 'objective reality' […]" (10).

The reader will be  13 Žižek, "Afterword: Objects, Objects Everywhere," 17. 318  Graham Harman forgiven for saying that this sounds like a Berkeleyan solipsism, though we will soon be reminded of why the editors think it is not.


Before moving on, we should say something about the Ljubljana School's unusual relation to Meillassoux, whom they tend to see as an opponent who gets things basically wrong, despite the fact that there is a tremendous degree of agreement between them.

An early taste of this aversion can be had from Žižek's remark in Less Than Nothing that "the problem is not to think the Real outside of transcendental correlation, independently of the subject [as Meillassoux attempts]; the problem is to think the Real inside the subject, the hard core of the Real in the very heart of the subject, its ex-timate center. "¹⁴ Zupančič says much the same a few years later in her well-received book What IS Sex?: "[ Meillassoux's Great Outdoors] is a fantasy that conceals the Real that is already right here. "¹⁵ Johnston's article "Hume's Revenge" is even harder on Meillassoux, although mostly in connection with the latter's speculations on a virtual God.¹⁶ But while it is true that Meillassoux ultimately seeks a reality both prior and posterior to human consciousness - and to this extent is closer to traditional realism than anyone in the Ljubljana orbit - it is generally ignored that he accepts the same closed circle of thought on which Sbriglia and Žižek depend.

That is to say, Meillassoux accepts the limit that correlationism places on speculation about reality itself, as seen in his widely overlooked remarks at the 2007 Goldsmiths SR workshop:


I insist on this point - the exceptional strength of this [correlationist] argumentation, apparently and desperately implacable.

Correlationism rests on an argument as simple as it is powerful, and which can be formulated in the following way: No X without givenness of X, and no theory about X without a positing of X. If you speak about something, you speak about something that is given to you, and posited by you.¹⁷


So impressed is Meillassoux by the correlational circle ("you can't think something outside thought without turning it into a thought") that far from "refuting" it by way of the arche-fossil, he has to invent a rather complicated argument for how to get out of the circle, albeit one I have argued is faulty.¹⁸


Obviously, the insistence that we are unable to escape the closed circle of thought immediately raises the specter of an extreme form of idealism, which is why I alluded to Berkeley above.¹⁹ Ljubljana foresees such objections and already has prepared responses, such as Žižek's appeal to "the hard core of the Real in the very heart of the subject" and Zupančič's "Real that is already right here." Against "the autonomous bourgeois monad or ego or individual," what is defended is "the idea, as Freud earlier articulated it, that 'the ego is not master in its own house,' which means that subjectivity/subjectivation concerns not the ego but the unconscious" (8).

This explains the group's attraction to Schelling, with his gap between Existence and Ground of Existence rumbling within - if not beneath - the given, like a Lacanian cut or fracture in the subject itself (9).

My response is that neither Schelling nor Maurice Merleau-Ponty - another figure who claims to be on the scent of a purely immanent Real - escapes the onto-taxonomical assumption that the two basic poles of reality are (a) the human, and (b) everything else.²⁰ Moreover, we find no discussion of relations between two non-human objects, which make up the vast majority of interactions in the cosmos.

There is a related problem with Sbriglia and Žižek's claim that "prior to fully existent reality, there is […] a chaotic 'non-all' proto-reality, a pre-ontological virtual fluctuation of a not yet fully constituted Real.

In short, from the dialectical materialist standpoint, the true formula of materialism is that material reality is non-all" (9).

While such language of the "non-all" is comfortably reminiscent of Badiou's recourse to the transfinite mathematics of Georg Cantor, its link with materialism is by no means clear.²¹ As Bryant notes about a similar passage: That brings us to the topic of Lacan's objet petit a, or simply objet a, referring to the uttainable object of desire.

The polar opposite of any autonomous thing-in-itself, objet a is "an entity that has no substantial consistency, which is in itself […] 'nothing but confusion,' 'naught but shadows/Of what is not'," (12) as Bushy puts it in Shakespeare's Richard II.

Stated differently, "the [objet a] is a weird, alien object which is nothing but the inscription of the subject itself into the field of objects in the guise of a stain that acquires form only when part of this field is anamorphically distorted by the subject's desire" (12).

This weird, alien object is not just another species to be added to the objects already found in the OOO bestiary, but is meant to replace real objects altogether: "we pass from the secret core of an object inaccessible to other objects (the 'withdrawal' thesis of Harman and Bryant's object-oriented ontology) to inaccessibility as such" (12).

Objet a "is not simply the excess of the In-itself, what Harman characterizes as the 'withdrawn,' volcanic core of objects […]" (10).

Instead, it represents the hard core of a Real that is not hidden, but already right here in front of us.

Moreover, objet a itself turns out to be the "objective correlative" of the subject:


As defined by Lacan, the objet petit a is a strange object which is not only lacking, never fully here, always eluding the subject, but which is in itself nothing but the embodiment, the materialization of a lack.

That is to say, since the subject is the self-appearing of nothing, its "objective correlative" can only be a strange object whose nature is to be the embodiment of nothing, an "impossible" object, an object the entire being of which is an embodiment of its own impossibility, an object whose status is that of an anamorphosis, a distorted projection.

( 11)


As we have seen, no withdrawn real objects are permitted by the Ljubljana School.

This is due initially to its allegiance to the closed circle of thought as deployed by German Idealism against the Kantian Ding an sich. But it is further cemented by its ontologization of psychoanalysis as a theory not just about the psyche, but - since only a psyche can pursue philosophy - about reality as a whole.

For this reason we only have the subject, which is "nothing but its own inaccessibility, its own failure to be substance"  22 Bryant, Onto-Cartography, 2.

The citation from Žižek comes from The Parallax View, 17. 23 For another argument that materialism is actually a secret form of idealism see Latour, "Can We Get Our Materialism Back, Please?" 320  Graham Harman (12; emph. removed) along with its "objective correlative" the objet a.


It is not entirely clear, however, why the failure of the subject would lead it to generate an objective correlative in the first place.

Objet a is a perfectly fascinating psychoanalytic concept, and no doubt goes a long way toward explaining the vicissitudes of human desire and the clinical phenomenon of transference.

But psychoanalysis alone cannot establish that we must dispose of any object that is not merely the "objective correlative" of a subject.

That only makes sense if we agree with Ljubljana - and their unrecognized ally Meillassoux - that the correlational circle is a strong argument, a topic to which I will return at the end of this article.


Before moving on, we should raise the issue of relationism in philosophy, mentioned briefly above in connection with Whitehead.

A relational ontology is one in which there are no autonomous or independent elements, but only a network in which each term gains its reality differentially from the others.

Along with Whitehead's "philosophy of organism," Bruno Latour's Actor-Network Theory is another such case, and most people read the linguistics of Ferdinand de Saussure in this way.²⁴ OOO is adamantly opposed to such extreme relational theories, on the grounds that if entities are fully deployed in their current relations, there is nothing in them that could disengage from those relations and enter into others.

Change is impossible if objects are "overmined" into their current effects on other things.²⁵ Here, Sbriglia and Žižek take the opposite tack once again.

Whereas Bryant insists - as do I - on the nonrelational core of every object, the editors cite Lacan in making the opposite assertion.

In their words: "for Lacan, the subject is precisely a non-substantial entity, an object that is entirely - indeed, is perforce - reducible to its relations to other entities" (14).

They conclude as follows: "a truly radical materialism can only be a dialectical materialism […] according to which the subject is a purely relational entity - indeed, is nothing but this very relationality" (14).

As might be expected, this entails that objet a - as the mere "objective correlative" of the subject - also has a purely relational structure.

On this point Žižek cites Lacan from Seminar XX as saying that "[t]he reciprocity between the subject and object a is total"²⁶ (14).

But this leaves at least two questions hanging in midair.


First, if the reciprocity between subject and objet a is "total," we have to wonder where the rest of sense experience comes from: namely, the massive banal portion that is not cathected in the form of unfulfillable objects of desire.

If this giant commonplace sensory mass exists in total reciprocity with the subject as well, then we have a form of Berkeleyan idealism without God; if it does not, then we have no idea where it might come from.

Second, the notion of the subject as pure relational reciprocity makes an uneasy fit with Žižek's further description of the subject as "an excremental little piece of the Real, a recalcitrant, unsymbolizable remainder of every signifying process" (14).

For it is unclear why any system of pure relational reciprocity would even be able to have such a "recalcitrant, unsymbolizable remainder." Any such remainder should apparently stem from outside the relational system. And given that Lacan's Real is not an autonomous thing-in-itself, but simply a wound to the subject, this Real cannot provide anything more than an immanent remainder: in other words, it is no remainder at all.


McGowan's chapter has an amusing point of departure that he turns to real philosophical effect. " According to Fichte," he reminds us, "philosophy is inevitably caught up in a perpetual struggle between idealism and what he calls dogmatism (but which we would call materialism.) Though Fichte hopes to sway the reader in the direction of his version of Kantian idealism, he freely admits that neither side can persuade the other" (68).

This points to a possible element of choice at the basis of any philosophy: a theme so prominent in Heidegger and the existentialists, and more recently in Badiou's notion of fidelity to Sbriglia and Žižek's Subject Lessons  321 the event.

The status of this topic is far from settled.

But McGowan prefers to emphasize the humorous polemical consequences of the situation: "Since both idealists and materialists operate with an unquestioned fundamental principle […] in order to convince his reader about the superiority of idealism relative to materialism, Fichte has no alternative but to resort to name-calling" (68).


As even the casual reader of Fichte knows, his name-calling skills are extraordinary.

McGowan offers the following sample: "What sort of philosophy one chooses depends, therefore, on what sort of man one is […] A person indolent by nature or dulled and distorted by mental servitude, learned luxury, and vanity will never raise himself to the level of idealism. "²⁷ Quickly showing his own sense of fair play, McGowan notes that there is another side to the story, as represented most famously by Marx: "Subsequent thinkers haven't found Fichte's attempt at moral blackmail all that convincing.

In fact, after Marx inaugurates his materialist revolution that upends German Idealism, the moral valence of the decision undergoes a thoroughgoing transformation" (68).


Even so, Marx turns out to be just a mirror image of Fichte: "At no point does Marx attempt to refute the idealist position through an argument.

Instead, he meets idealism with assertion and ridicule" (69).

As we read in one of Marx's gentler statements on the matter: "It is not the consciousness of men that determines their existence, but their social existence that determines their consciousness. "²⁸ When it comes to more contemporary thinkers, McGowan goes so far as to claim that Badiou remains on the Fichtean side of the fence, and - perhaps less controversially - that Heidegger too remains stranded in idealism (79n5).


For McGowan himself there is no deadlock at all, since the opposition between idealism and materialism is already successfully overcome by Hegel: "at the moment when Hegel becomes Hegel, he comes to see the inseparability of idealism and materialism" (70).

The familiar term McGowan uses for the Hegelian solution is "objective idealism," though we can leave this term for our discussion of Johnston below.

More pressing here is the particular set of themes in Hegel that McGowan wishes to emphasize.

Although none of them is especially shocking for the reader of Hegel, they do lay the groundwork for McGowan's critique of OOO:


1. The Kantian thing-in-itself is nonsense.


2. Contradiction is not found in our inability to think about reality (as Kant holds) but in reality itself.


3. This central status of contradiction entails a relational model of philosophy.


It should already be clear that McGowan is as anti-object-oriented as he could possibly be.

After all, OOO stresses precisely the opposite of the three principles just listed: (1) Kant's thing-in-itself is real, (2) there is no contradiction in reality itself, and (3) relational models of philosophy automatically collapse through their own inherent weakness.


Like a number of authors in Subject Lessons, McGowan indulges in psychoanalysis of the philosophical positions with which he happens to disagree.

For instance, Kant's views on the impossibility of moral perfection are diagnosed as a form of "hysteria," although one might have expected a verdict of obsessional neurosis instead (71).

In McGowan's view, "Kant needs someone - the world - to play the bad guy, which is how hysteria operates" (71).

The same critique extends to the very notion of the thing-in- itself, which cannot be accessed any more directly than pure duty can in the ethical field.


But McGowan's diagnosis of Kant is of less interest than the positive, Hegelian alternative he offers: "Our knowledge cannot remain at a remove from what it knows.

It cannot treat what it encounters as phenomena distinct from things-in-themselves" (71).

Rather than making use of the "circle of thought" objection to the Ding an sich discussed in the previous section, McGowan makes dubious use of one of Hegel's funniest but least convincing passages.

The version McGowan selects is the one from the Philosophy of Nature: "Of a metaphysics prevalent today which maintains that we cannot know things because they are absolutely shut to us, it might be said that not even the animals are so stupid as these metaphysicians; for they go after things, seize and consume them. "²⁹ (A similar passage, of course, can be found in the Phenomenology of Spirit.³⁰) The problem with this  27 Fichte, The Science of Knowledge, 16.

rebuke to the thing-in-itself is that it confuses inaccessibility with indestructibility.

I am not aware of Kant ever arguing that the in-itself must be eternal in the manner of Platonic forms, and even if he did, we would not be bound to accept such a conception of the an sich.


Admittedly, McGowan's main argument is slightly different, and hinges on the inherent anti-idealist properties of action: "Acting lifts us out of our hermetically sealed idealism" (70). But while action is an intriguing path to follow against the thing-in-itself, McGowan overplays his hand: "When we act, we cut into the world of objects and reveal that it is not epistemologically off-limits in the way that Kant and Fichte would have it" (71-72).

There are several problems with this, the first being the failure to consider that Fichte himself spent a good deal of time thinking about action, and simply reached different conclusions on the matter from Hegel.

The second problem is that the ability to act says nothing about whether the things are accessible "epistemologically," which concerns knowledge rather than action.

But the main problem here is the same as with Hegel's claim about animals and eating.

Namely, our ability to act on things - which no one denies - does not mean we are able to act on them directly.

We will consider this topic more closely below, when considering Rothenberg's chapter.


But the real heart of McGowan's chapter is the notion of contradiction as existing in the world itself rather than merely in the impasses of human thinking.

Whereas Kant treats his famous antinomies as red flags warning of the limits of human cognition, Hegel treats them positively: "According to Hegel, [the antinomies do not] mark reason's failure but its success.

The moment at which reason runs into contradiction indicates a contradiction in being itself that reason grasps through its own contradictions" (72).

He notes that this sharply distinguishes Hegel from Karl Popper, whose falsificationist model of science treats any contradiction as spelling the catastrophic end of a theory.³¹ Spirit, in its "fundamental masochism" (74), can endure contradiction in a way that lifeless materials cannot.

McGowan's crowning defense of contradiction had appeared earlier on the same page:


Contradiction manifests itself in the becoming of every entity that exists.

There is no entity that simply is what it is.

Instead, every entity is both itself and what it is not.

This is the fundamental contradiction that defines the entity as such.


If any entity were only itself and had no reference to what it was not, it could not exist in contrast with other entities. ( 74) This insistence on the truth of contradiction is reminiscent of the analytic philosopher Graham Priest, whose "dialetheism" asserts the existence of true contradictions, and the consequent downfall of any strict principle of identity.³² While this runs counter to my own and Meillassoux's differing defenses of identity, no less a OOO figure than Timothy Morton relies extensively on Priest's position, which is perhaps made easier by Morton's pre-OOO roots in the philosophy of Jacques Derrida - another prominent skeptic of identity.³³ At any rate, McGowan's focus on contradiction leads him straight to a relational ontology, on the basis that "[c]ontradiction is revealed through interaction" (74).

And with this conclusion, his third anti-OOO principle is established.


To solidify his case, McGowan notes OOO's roots in Heidegger and its relative lack of reliance on Hegelian principles.

Unfortunately, he misinterprets several key points in the OOO interpretation of Heidegger, in ways that sometimes make his argument difficult to follow.

While McGowan is certainly right that Heidegger - like Edmund Husserl - treats the question of the existence of the external world as a false problem from the outset, he is wrong to imply that OOO greets this as a liberation from stale epistemological problems.

Instead, OOO is openly horrified by this aspect of Husserl and Heidegger, which it regards as setting the table for a long tradition of mediocrity in continental meditations on reality- in-itself.

For example, I complained in discussion with Manuel DeLanda that "the usual procedure, following in the footsteps of Edmund Husserl and Martin Heidegger, is to treat realism as a pseudo-problem. "³⁴ As a rule, OOO would much rather pose the question of the objective existence of the world than deny the question's pertinence, as happens in nearly all strands of phenomenology.


McGowan  31 Popper, The Logic of Scientific Discovery.

That said, the weight of McGowan's argument about Heidegger comes to rest in his treatment of the distinction between "worldless" stones, "world-poor" animals, and "world-forming" humans in the widely read 1929/30 lecture course, which McGowan contrasts with Hegel's approach.³⁹ On the whole, McGowan's critique of Heidegger's threefold schema is persuasive.

As he rightly notes, the world-poverty of animals is never sufficiently illuminated by Heidegger, and the resulting distinction between stones and humans gives us little more than commonsensical banality: (75) the stone is worldless because it is aware of nothing, while humans are "world-forming" since they partake in language and are open to the world (76).

Here, McGowan announces, is where Heidegger will "[pay] a steep price" for his abandonment of subjectivity in favor of Dasein - though to repeat, OOO denies that the move from the subject to Dasein changes much at all.


As McGowan has it, what is the steep price that Heidegger pays but Hegel avoids? His first step toward an answer is puzzling, but not obviously wrong.

Here are McGowan's words on the matter:


For Kant, Heidegger's claim that the stone is worldless would already be going too far.

Though we might discuss the stone as a phenomenon, we cannot say anything about its status in-itself.

By identifying it with worldlessness, Heidegger steps beyond the limits that govern knowledge […].

In Kant's thought, our worldliness depends on not making claims about the worldlessness of stones.

( 76)


Is it really the case that Kant's conception of the thing-in-itself leaves him skeptical about our ability to make any statement at all about stones lacking inner life, while Heidegger's assertion that being-in-the- world eliminates the distance between Dasein and things makes him feel empowered to utter bald-faced statements about the status of non-human entities? I had not thought of it this way before, though I suspect McGowan is overstating both Kant's caution in making such statements and Heidegger's dogmatism in doing so.

In any case, the real problem is that McGowan goes on to ascribe this way of looking at things to OOO itself: "This is precisely why object-oriented ontologists find Heidegger's ontology more hospitable than Kant's.

Even though Heidegger sustains a radical difference between the relations are haunted by a noumenal surplus even when no humans are on the scene, this is the main point of Heidegger's superiority for us.


There is a final twist to McGowan's argument, and while it is pleasingly counterintuitive, it also repeats a problem we encountered in Sbriglia and Žižek.

Here is McGowan: "the moment that he avoids the distinction between subject and object, Heidegger loses the ability to recognize the nature of the difference between the subject and other entities [namely, a special relationship with contradiction]" (77).

Quite apart from OOO's refusal of the idea that Heidegger is a flat ontologist who smooths out the difference between Dasein and everything else, McGowan is simply repeating the Sbriglia/Žižek charge (already made by Žižek solo against Bryant in 2016) that what OOO thinks as subject does not meet the criteria for subjecthood.⁴⁰ Stated differently, McGowan is left with the tautology that since Heidegger no longer recognizes a fundamental difference between subject and object, he is unable to see what makes the subject so special.

I do not doubt that humans can do many things that other entities cannot, that in psychoanalytic terms we are distinguished even from other animals by repression and castration, that history plays an eminent role in human existence but not in the vegetable kingdom, and so forth. What has not been demonstrated is that the human subject is ontologically special, a claim that makes sense only for those who accept the Cartesian assumption that we have direct access to thought but indirect access to everything else.


Let's end this section with a final word about McGowan's reversal of Heidegger's worldless/world- forming schema, a reversal that I for one find interesting and imaginative.

Whereas Heidegger adopts the commonsensical stance that stones have no world but humans are very much immersed in one, McGowan sees Hegel as holding the contrary view: "Although Hegel doesn't theorize the stone as world-forming, he does see it as fully in the world in a way that the subject cannot be" (77).

That is to say, the stone is so fully delivered to the world as to be possibly shattered by causal forces with no hope of active self-preservation.

McGowan continues: "Hegel defines the organic as that which has the ability not to be simply a victim of its world.

Unlike the inorganic, the organic reacts to the destruction that the world heaps on it with self- restoration" (77).

This power of self-restoration is one that McGowan interprets not in the biological sense of immune response and regeneration, but in the ontological sense of contradiction. And this is where his article finally comes to rest, at the same unconvincing point toward which it has always been signaling:


We know that the stone is not self-identical, that it is not an independent substance, because it is capable of breaking. But the stone is not a subject, a being that makes its ability to break apart its founding principle.

Though it can suffer violence from the external world, the stone lacks the ability to perform any violence toward itself.

It is divided against itself, but not in a way that grants it any purchase upon contradiction.

( 78)


The second part of this passage is insufficiently clear about the difference between a thing being merely divided against itself, or divided against itself in a way that "grants it purchase upon contradiction," and thus it will be convincing only to those already in the Ljubljana camp.

The bigger problem comes at the beginning of the passage.

The claim that a thing cannot be self-identical if it is capable of breaking is not only introduced without argument, but is made in the face of the glaring counterexample of Aristotle: who was both the philosopher of self-identical substance par excellence and one of the great thinkers of motion and growth.


Johnston's chapter is framed explicitly as a response to his critics, myself included.

Since Johnston is a personal friend, and I fully expect to engage him in further debate in the future, this section will limit itself to one key point.

Namely, he is especially perturbed by what I do with a particular passage from Žižek's conversations with Glyn Daly.

The relevant words from Žižek are as follows:


The true formula of materialism is not that there is some noumenal reality beyond our distorting perception of it.

The only consistent materialist position is that the world does not exist - in the Kantian sense of the term, as a self-enclosed whole.

The notion of the world as a positive universe presupposes an external observer, an observer not caught in it.

The very position from which you can perceive the world as a self-enclosed whole is the position of an external observer.

It is thus paradoxically this radical perspectivism which allows us to formulate a truly materialist position, not that the world exists outside the mind, but that our mind does not exist outside the world.⁴¹


It would be an exaggeration to say that there is "a lot going on" in this passage, since the exact number of things going on is three. ( 1) Žižek denies "noumenal reality," (2) Žižek denies that the world is a self- enclosed whole, and (3) Žižek asserts that the world could only be a self-enclosed whole if there were an external observer to look at it, but no such observer can possibly exist.

The dispute between me and Johnston turns on points (1) and (2), while (3) is one of the key arguments that recurs throughout the chapters of Subject Lessons.

Let's consider the situation briefly.


In essence, Johnston charges me with deliberately distorting the Žižek passage above by ending after "the world does not exist" instead of giving the full context for this phrase.

In Johnston's words, "Harman latches onto the line 'the world does not exist' without acknowledging the crucial caveat immediately following it: 'in the Kantian sense of the term, as a self-enclosed whole.' What this caveat unambiguously indicates is that Žižek does anything but, as Harman falsely charges, deny the real world's existence tout court" (127).

Yet the reason I elided the part about the world as a "self-enclosed whole" is its distracting irrelevance to my argument.


When Žižek denies "some noumenal reality beyond our distorting perception of it," this is not an accusation aimed at the Kantian noumena specifically, but at the idea of a reality "beyond our distorting perception of it." In other words, for Žižek, reality is simply not something that exists apart from our encounter with it.

This view is entirely unsurprising given his admiration for Hegel and Lacan, who argue respectively that the thing-in-itself is just a negativity immanent to thought, and that the Real exists only through being encountered as an unsymbolizable trauma.


Nowhere in Hegel do two things-in-themselves interact beyond surveillance by the subject; nowhere in Lacan do two pieces of the Real enter into relation apart from the human subject, however "barred" that subject may be.

As a reliably Hegelo-Lacanian thinker despite his numerous innovations, Žižek is not just opposed to a reality beyond our distorting perception of it, but even to a reality that is not beyond our distorting perception of it.

What exists for him is simply the subject, the objet a correlated with it, and a Real that does not come from outside in any rigorous sense of the term.


The portion of the passage that Johnston accuses me of eliding is nothing more than a Houdini-like effort by Žižek to escape from idealist handcuffs he has dangerously placed on his own hands.

This effort includes two separate elements: (1) his denial that the world is a self-enclosed whole, and (2) his assertion that such a self-enclosed world would require an observer external to it.

The problem with (1) is that there are many different ways to deny that the world is a whole other than Žižek's method, which is to proclaim a subject whose anamorphic squints of desire prevent the world from having any inherent status apart from such squints.

For instance, his part-time ally Badiou also frequently asserts that "the whole is not," but this is based on his interpretation of set theory rather than any Lacanian considerations.

OOO equally denies that reality forms a whole, but for the very different reason that relations are raggedy enough that at any moment some things - called "dormant objects" - exist in disconnection from the rest.⁴²  41 Žižek and Daly, Conversations with Žižek, 97.

There is also Markus Gabriel, who wrote a best seller in Germany literally entitled Why the World Does Not Exist, but on the basis of reasons entirely different from Žižek's, Badiou's, and my own.⁴³ In short, the issue of whether the world is a whole is not the same as that of whether something exists independently of the subject. But point (2) is where we encounter the real soft spot in the argument.

The relevant portion of text is as follows (again, this is Žižek responding to Daly):


The notion of the world as a positive universe presupposes an external observer, an observer not caught in it.

The very position from which you can perceive the world as a self-enclosed whole is the position of an external observer.

It is thus paradoxically this radical perspectivism which allows us to formulate a truly materialist position, not that the world exists outside the mind, but that our mind does not exist outside the world.

Let's admire for a moment the sheer audacity of this passage.

Žižek is widely known as a gifted promoter and developer of the doctrines that the thing-in-itself is merely an immanent obstacle of thought itself (Hegel), that the object of desire is only the correlate of a posited lack (Lacan), and that the Real exists only in its traumatization of the subject (Lacan).

On this basis, any neutral reader would say there is at least a strong prima facie case for concluding that Žižek is a full-blown idealist, so that one of the most urgent challenges for his position is to account for a reality independent of the mind in sufficiently robust terms.

Given these circumstances, what does he do? Incredibly, he tries to displace the "observer-dependent" burden of idealism onto its polar opposite: realism.

After all, the argument runs, those who think the world exists apart from the mind must accept an external observer looking at that world from outside it, in a sort of God's-eye view.

No matter that no realist actually thinks this, since the whole point of realism is that the world exists (and not necessarily as a "whole") whether anyone is looking or not; the mere fact that one says this does not make one an "observer" in the same sense that Berkeley's (human or divine) subject is such an observer.

In other words, Žižek is trying to argue that if I think of a world outside thought, then precisely through doing so I become an "external observer" thinking and talking about the world.

This is the same argument that Meillassoux calls the "correlationist circle."


Žižek's special audacity in this case comes from the fact that he claims not to accept an external observer, but only an internal one. And with the external observer's statement about an independent world now disqualified by her apparent self-contradiction, only the internal observer is left to testify about the world, which makes the latter the only qualified party to tell us that there is anything at all.

Somehow this flagrant idealism is permitted to go by the nickname "materialism," and Žižek conceals this gesture behind an especially clever play on words: as he puts it, materialism means "not that the world exists outside the mind, but that our mind does not exist outside the world." We might just as well say that phenomenology (the most unapologetic idealism of its century) means "not that no world exists outside the mind, but that no mind exists without a world," which is essentially Husserl's argument, after all.


Rothenberg's chapter contains the most detailed engagement with OOO anywhere in Subject Lessons, and for this I am grateful.

Her main concern is the concept of "allure," which she treats as a self-defeating concept whose aims are better addressed by Lacan's notion of "extimate cause. "⁴⁵ "According to Harman," Rothenberg reports, "our failure to know the object-in-itself has nothing to do with the epistemological limitations of the subject but is due to the fact that the object withdraws from itself. For Harman, the object-in-itself has neither qualities nor relations […]" (190).

She cites Žižek's criticism that this amounts to "a quasi-magical reversal of epistemological obstacle into ontological premise," such that my position Sbriglia and Žižek's Subject Lessons  327 entails transcendental subjectivity even while claiming to deny it.⁴⁶ Crossing from Hegelian into Lacanian territory, Rothenberg posits that the "self-withdrawn object" of OOO should really be understood as objet a, so that its supposed withdrawal is only an imaginary loss, "the fantasy of a substantialized object that is imagined to rectify the so-called loss accompanying subjectivization" (191).

However, she adds, OOO's attempted prohibition on accessing the in-itself is really just an impossibility, since no in-itself exists.


There are several things to be said in response.

First, it is inaccurate to say that for OOO our failure to know the in-itself is due to its self-withdrawal, since "withdrawal" alone (without adding the "self-" part) does the trick.

The notion of self-withdrawal occurs in OOO only with reference to the special case in which a specific kind of object (namely, a human being) looks at itself and fails to grasp it directly, just as it fails in the case of any other object.

This will not come as welcome news to the Ljubljana School, which accepts the Hegelo-Lacanian consensus that we do have direct access to the thought-world relation in a way that we do not for object-object relations, despite their great haste to disown the transparent Cartesian subject in favor of a turbulent subject that - in its traumatic madness - never quite coincides with itself.

Whatever the busy efforts of Ljubljana to create a "wobbly subject," as Meillassoux aptly puts it, the object-object interaction is entirely excluded from consideration.⁴⁷ Second, it is not the case that "for Harman, the object-in-itself has neither qualities nor relations." Here there is one serious mistake and one moderate one.

The moderate mistake is that the OOO real object (or "object-in-itself") does in fact often engage in relations, but only indirectly, through sensual mediators; real objects that are not currently in any relations at all are called "dormant objects," but they may be rather rare.

The serious mistake is the claim that real objects have no qualities.

Au contraire!

Real objects can have both sensual qualities and real qualities, though the former are found only in cases of allure.⁴⁸ As for Žižek's claim that referring to the withdrawal of objects is a "quasi-magical" imputation of a merely epistemological barrier into the object itself, this charge has frequently been made by critics, though none of them have bothered to demonstrate that the barrier is really just "epistemological." This claim is convincing only for those who assume that the circle of thought is valid, so that we must confine our initial remarks to a thought-world correlate, thereby ascribing everything to the "subject" pole and nothing to the "object."


We now turn to Rothenberg's discussion of the OOO idea of "allure," an intermediate experience in which we have a suggestive indirect access to objects.

The idea is crucial for the OOO account of aesthetics, where it is described as the heir of Socratic philosophia.

Rothenberg's first concern is to claim that OOO allure arises not only from the philosophy of Husserl, but from a flat-out misreading of his work.

For instance: "'allure' is Harman's (mis)appropriation of the Husserlian horizon of indeterminacy" (196), and "Harman's reading [of Husserl] constitutes a serious misprision" (198).

All right, then: what does a proper appropriation of Husserl look like for Rothenberg? At the very least, it apparently requires that we emphasize an object's horizon of indeterminacy.

In her own words: "No act of consciousness can completely grasp the object, if only because an [intentional] act occurs in the present and the object endures through time […] That is, the object, in Husserl's terms, necessarily transcends the intentional act that fixes its meaning (Sinn) for consciousness.

This indeterminate horizon draws consciousness to it" (196-197).

So far there is no problem; this is in fact what Husserl says. What is subtly wrong here, however, is the implication that allure is somehow related to Husserl's indeterminate horizons.

OOO's allure is a matter of real objects, and no such objects are permitted by Husserl to exist - given his outright rejection of objects that could not, in principle, be the terminus of some intentional act.

Rothenberg is free to argue the contrary, but then she would simply be siding with the mainstream Husserlians who claim that his "horizon" already contains everything that we find in Heidegger's Sein.

There is no time to argue the point here; I did so in my first book in connection with a similar argument made by Rudolf Bernet.⁴⁹ From a OOO standpoint, the idea of an object as having indeterminate horizons leading beyond its current By linking allure and vicarious causation with the long-discredited notion of an ether that fills cosmic space and allows for the transmission of electromagnetic waves, Rothenberg is trying to make these concepts look both superfluous and old-fashioned.

For this reason, it may be worth recalling why I introduce them at all, especially since my reasons are rooted in some of the most venerable currents in the history of philosophy.

The assumption that something can either be stated directly in clear propositional terms, or else it is nothing but negative-theological hand-waving, is a contemporary version of the sophist's trick known as Meno's Paradox: either we know something or we don't, have access to it or not, period.

Among other difficulties, this renders Socratic philosophia impossible, and turns all forms of human cognition into full-blown knowledge, despite ample evidence - from aesthetics and elsewhere - that direct access to reality is not the only kind.

Nor did we need to wait for Kant's thing-in- itself or Heideggerian withdrawal to encounter this point in the history of philosophy.

Although Aristotle was no theorist of indirect causation - this would only come later, with the early occasionalists of Islam - he already noticed that we cannot define a substance in words, since words employ universals but substances are always concrete.⁵³ Stated differently, there is an automatic gap between reality and anything we might say about it.


Now, any attempt to dismiss indirect causation as a pseudo-problem that OOO brings upon itself through a mere "dislike" of "immanent causation" (199) leads to an overmining situation, in which causation is "internal" and there is no surplus beneath the current set of relations in which a thing is involved.

Of course, Rothenberg has already rejected this claim, but then again, I have also refused her rejection of it.

The question of how things interact is a real one, and the term "vicarious causation" was coined in order to pin down this question for further study, rather than wish it away.

Nor is it merely posited as a "notional" or "mysterious" force, since a preliminary answer is given as to how it works.

While it is true that for OOO no two real objects can touch, and true as well that inserting another real object between them would simply multiply the problem, it is nonetheless evident that real objects can touch sensual ones: this is precisely what happens in human experience.

I am a real object, inexhaustible by any amount of introspection, and it is I myself who make contact with the sensual objects of experience: not just a sensual image of this "I." Thus, the first secret of vicarious causation is that I as a real object touch a sensual object directly through encountering it (say, a tree).

For its own part, the real tree touches the sensual tree by generating it; in this way, it is the medium through which I make second- hand contact with the other real object despite the impossibility of direct contact between us.

To assert that all contact is either direct or nonexistent is merely a way of evading the bona fide problem that OOO has noted with direct interaction.


Of the many wise remarks about philosophy made by Whitehead, the following is of especial importance: "It has been remarked that a system of philosophy is never refuted; it is only abandoned. "⁵⁴ He adds further that attempts at refutation have an in-built flaw: "logical contradictions […] are the most gratuitous of errors; and usually they are trivial.

Thus, after criticism, [philosophical] systems do not exhibit mere illogicalities.

They suffer from inadequacy and incoherence. "⁵⁵ Not logical flaws, but inadequacy and incoherence, are the real shortcomings of abandoned philosophies.

The need for  53 Aristotle, Metaphysics Z 7.

See also Harman, "A New Occasionalism?", and Harman, Aristotle With a Twist. coherence in a philosophy is real, though it should also not be rushed.

It is often fruitful to pursue contradictory intuitions for a time, and much can be lost through a forced or premature consistency: this is the grain of truth in Ralph Waldo Emerson's maxim that "a foolish consistency is the hobgoblin of little minds. "⁵⁶ It is best to think of consistency as a goal rather than a starting point of the philosopher.

The more pressing matter is always adequacy, meaning that nothing that exists should be excluded from a philosophy's scope; it is a bad sign if too much is explained away by a theory for the sake of easy self- consistency.

If philosophies are generally refuted rather than abandoned, what this means is that they are left behind not because of some purported mistake, but because they account for less of experience than their successors do.

Nonetheless, philosophers generally behave as if they were more afraid of being refuted than being abandoned.

They spend more time constructing ironclad proofs and "knockdown arguments" than asking themselves what portions of reality they are missing.

This is especially true in the modern period of philosophy, so eager to mimic the natural sciences and geometrical deduction whenever possible.