The importance of these remarks for the battle of objects and subjects should be clear.

Today's neo- rationalist philosophies think themselves rigorous because of their adherence to a very specific proof, one that they hold marks a permanent cut between obsolete and living philosophy.

I speak of the circle of thought, or Meillassoux's correlational circle: the notion that to speak of what lies beyond thought is itself already a thought.

Virtually every philosophical claim made in the pages of Subject Lessons stems directly from the acceptance of this circle: the replacement of the real object with the objet a, the transformation of reality into the traumatic Real, the replacement of a rift between phenomena and noumena with a "cut" internal to the subject, the surrender of independent material atoms in favor of a counterintuitive "materialism" defined as a "blind spot" of the subject, and the notion that to speak of a world-in-itself is to fantasize the existence of an observer looking at it from outside.

What is interesting about this particular "proof" is that it demands assent despite very weak adequacy.

After all, one wakes up in the morning thinking that there are trillions of entities in the cosmos, and that they are busily influencing one another even when no human subject is watching them.

Against this everyday assumption, the "irrefutable proof" of the Ljubljana version of the circle of thought tells us that no such interactions really occur, that the subject must always be on the scene to monitor them, and that objects of desire have no capacity to satisfy in their own right.

Of course, this is exactly what proofs are capable of doing: making us sacrifice our previous sense of adequacy in favor of a surprising limitation that can be demonstrated beyond all doubt.

For example, it is counterintuitive to think that at any given moment there must be two antipodal points on the equator with exactly the same temperature, yet this is decisively proven as a consequence of the so- called Borsuk-Ulam theorem.⁵⁷ Philosophy too has aspired to enter the ranks of the disciplines that work via proof, especially in the modern period.

Perhaps the best example is that, from Kant onward (with the remarkable exception of Whitehead) we have taught ourselves that the thought-world relation is the root of all others.

Not a page of Subject Lessons makes sense without this particular "wager." But is the wager a good one? Is it really the case that I cannot speak of the relation between fire and cotton, but only of the conditions of possibility for how this relation appears to me? This is not the place to argue the point once more. I merely wished to show how dependent Ljubljana's arguments - both the Hegelian and the Lacanian sort - are on the circle of thought.


Another remark about Subject Lessons is in order.

At the beginning of this article, I mentioned that the collection is stronger in its combined defense of German Idealism, Marxism, and psychoanalysis than in its critical remarks on "New Materialism" broadly conceived.


The reason may be as follows.

I cannot recall a single passage in the book, by any of its authors, that shows evidence of having learned anything new from the "New Materialist" figures.

They are treated as belonging to a purely retrograde tendency; the Ljubljana School that stands at the end of this anthology is identical to the one we knew coming in.


That makes the encounter proposed by the book a disappointing one.

Some of this is only to be expected.

Žižek in particular is better known and more influential than any New Materialist figure, including Karen Barad (whose relative absence from the book is surprising) and Bennett.⁵⁸ Thus a certain degree of "King of the Hill" attitude was to be expected, with the editors' Introduction going out of its way to remind us that Žižek was already fighting cultural materialism for a quarter of a century before the New Materialists came along (5).


Yet there is something unsatisfying about hearing the same arguments, the same claims that Hegel is being misrepresented by his critics, the same complaints that the subject of psychoanalysis is not being taken into account.

In that respect, the collection is a missed opportunity.


That is why I am far more likely to recommend the positive chapters on Ljubljana School doctrine - such as Dolar's, one of the gems of the anthology - than any of the critical treatments of the new philosophies.


The author is the editor in chief of the journal and editor of this topical issue.

The evaluation process was handled by another editor and the peer reviews were double blind.

The manuscript was anonymized (references to the author were written in the third person) for the purposes of review.


This article mounts a defense of my and Slavoj Žižek’s co-edited anthology, Subject Lessons: Hegel, Lacan, and the Future of Materialism, against the two main criticisms of it made throughout Graham Harman’s article “The Battle of Objects and Subjects”: (1) that we and our fellow contributors are guilty of gross overgeneralization when we classify thinkers from various schools of thought – among them New Materialism, object-oriented ontology, speculative realism, and actor–network theory – under the broad rubric of the “new materialisms”; and (2) that despite our pretensions to the mantle of materialism, our Lacano-Hegelian position is actually a full-blown idealism.


In responding to and attempting to refute these criticisms, I make the case that our Lacano-Hegelian model of dialectical materialism is an “extimate materialism.” I would like, here at the outset, to express my gratitude to Graham Harman for cordially inviting me to respond to his recent article, “The Battle of Objects and Subjects: Concerning Sbriglia and Žižek’s Subject Lessons Anthology,” in which he not only defends his object-oriented ontology (OOO) from the critiques leveled against it throughout my and Žižek’s anthology, but also critiques the Lacano-Hegelian model of dialectical materialism championed by the anthology’s contributors.


Seeing that Harman has limited his response to those chapters of the collection that most concern OOO, in what follows I have tried my best to limit my response to Harman himself, though I will occasionally have cause to address critiques from compatriots of his such as Levi Bryant, Manuel DeLanda, and Quentin Meillassoux [1].

Likewise, though I may now and then refer to Harman’s comments on chapters by other contributors to the volume such as Nathan Gorelick, Adrian Johnston, Todd McGowan, and Molly Anne Rothenberg, my focus will remain primarily on Harman’s response to my and Žižek’s introductory chapter, which, as we shall see, is of a piece with other of the critiques he has leveled against Žižek and the Lacano-Hegelian position more generally in recent years.


I should make it clear at the outset of this reply that those coming to it expecting to find a polemic will be sorely disappointed.

Both the current piece and that to which it responds constitute merely the most recent installment in an ongoing friendly debate between Harman and various members of the Lacano-Hegelian camp whose work is featured in Subject Lessons [2].

I should also make it clear that I am not interested in using this reply to wage a further critique of OOO, as I am happy to let what Žižek and I wrote in regard to it in the introduction to our collection stand on its own.


What I am interested in doing is looking closely at and responding to Harman’s main critiques of our collection – not in the hope of ultimately converting him to our cause or convincing him of the correctness of our position (like Žižek, I have “no illusions” in this regard), but in the hope that doing so will help to provide greater clarity, not only about some of the seemingly contradictory claims undergirding our Lacano-Hegelian model of dialectical materialism – especially regarding the nature of the Lacanian “objet petit a,” the matter that matters most to this materialism – but also about where the true fault line between this “extimate materialism,” as I will be terming it, and Harman’s “immaterialism” lies [3].


Though it contains more granular critiques than these – especially when addressing those chapters of the book that engage OOO at the greatest length (Johnston’s, McGowan’s, and Rothenberg’s) – the two most overarching critiques throughout Harman’s response to Subject Lessons are the following: (1) we and our fellow contributors are guilty of gross overgeneralization when we classify thinkers from various schools of thought – among them New Materialism, OOO, speculative realism, and actor–network theory (ANT) – under the broad rubric of the “new materialisms”; and (2) despite our pretensions to the mantle of materialism, our Lacano-Hegelian position is actually a full-blown idealism.


I will address these critiques in order, beginning with the first; however, I will devote a good deal more space to the second, as there is far more at stake philosophically in this critique than in the first, which is more methodological in nature.


As outlined above, one of Harman’s more overarching complaints throughout his response to Subject Lessons is that we – specifically Žižek and I, but also some others in the collection, such as McGowan, Gorelick, and Alenka Zupančič – are “generally too indiscriminate in mixing various figures under the ‘New Materialist’ label, often suppressing crucial differences” [4]. I am tempted to both agree and disagree with Harman here.


As far as agreement goes, Harman is correct to note that such a “bulk treatment” of figures like himself and Levi Bryant (both of whom are object-oriented ontologists), Jane Bennett (a New Materialist), Quentin Meillassoux (a speculative materialist), and Bruno Latour (an actor–network theorist) cannot but help to “suppress” some of the more “crucial differences” among them [5].

To take Harman himself as an example, it is entirely understandable that he wouldn’t want to be lumped in with the New Materialists, if for no other reason than that his OOO, as he has argued on a number of occasions, is an “immaterialism.”


Indeed, in his book Immaterialism Harman explicitly distinguishes between the immaterialism of his OOO and the materialism of New Materialism by way of contrasting lists of “axioms” of both schools [6].

Thus, to give a few examples, whereas New Materialism holds that “[e]verything is contingent,” that “[t]hought and the world never exist separately, and therefore ‘intra-act’ rather than interact,” and that “[t]he world is purely immanent, and it’s a good thing, because any transcendence would be oppressive,” OOO holds that “[n]ot everything is contingent,” that “[t]hought and its object are no more and no less than any other two objects, and therefore they interact rather than ‘intra-act,’” and that “[t]he world is not just immanent, and it’s a good thing, because pure immanence would be oppressive” [7].


Given that Harman has gone out of his way to draw such distinctions as these, one can understand why he would bristle at seeing his OOO being grouped alongside New Materialism. And yet, as we will see, not only is this not an entirely accurate characterization of my and Žižek’s classification of these various schools of thought, but there is also considerable disagreement – even confusion – among these schools’ own members as to whether their philosophy is a materialism, a realism, or both.


In his response to Subject Lessons, Harman reiterates his anti-materialist stance by citing articles of his boasting such titles as “I Am Also of the Opinion That Materialism Must Be Destroyed,” “Realism Without Materialism,” and “Materialism Is Not the Solution” [8].

Surely, the title of the second of these three articles, “Realism Without Materialism,” would justify us in classifying Harman’s OOO as a “new realism” – especially given that, as I will address below, he explicitly rejects classic, “naïve” realism.


This brings me to the first of my objections to Harman’s criticism of our bulk treatment of these different schools: in our introduction, Žižek and I very explicitly – and very consistently – refer to them not merely as the “new materialisms” (which is itself somewhat more capacious a term than the proper noun “New Materialism”), but as the “new materialisms and realisms” [9].

Curiously, Harman doesn’t acknowledge this in his response (though he does quote our claim that, “from the Lacano-Hegelian perspective, what new materialists and realists understand as ‘subject’ simply fails to meet the criteria of the subject”) [10].


Instead, he takes Gorelick’s grouping of these different schools under the rubric of “new materialism” in his chapter “Why Sex Is Special: Psychoanalysis against New Materialism” as though it were indicative of the volume as a whole. But let us for a moment assume that this was indeed true of the book more generally.

Given the amount of disagreement that exists among the members of these various schools – even those belonging to the same school – not only as to whether their philosophies are materialist or realist, but even as to what “materialism” and “realism” mean, one could hardly blame other of the book’s contributors for following Gorelick’s example in resisting “the nominalist temptation to arbitrate such nuances,” especially seeing that such arbitration is “already a common preoccupation among these thinkers themselves” [11].


To indulge in a bit of this arbitration myself, we might note that though often considered the ur-text of speculative realism, Quentin Meillassoux’s After Finitude is, in Meillassoux’s own estimation, a work of “speculative materialism” [12].

As he asserts in his essay “Time Without Becoming,” “I prefer to describe my philosophy as a speculative materialism, rather than as a realism: because I remember the sentence of Foucault, who once said: ‘I am materialist, because I don’t believe in reality’” [13].


A similar tension exists within OOO.

Whereas Harman’s position, as we have seen, is staunchly anti-materialist, that of his fellow object-oriented ontologist Levi Bryant is staunchly materialist.

To exemplify this point, one need look no further than the very first sentence of Bryant’s Onto-Cartography, in which he proclaims, “This book attempts a defense and renewal of materialism” – both of which, he adds, are needed “in the face of critics and defenders alike” [14].


To take up this last point regarding defenders of materialism: in a passage that Harman often approvingly cites – including in his response to Subject Lessons – Bryant singles out Žižek’s work in particular as evidence that the word “materialism” has become an “empty” signifier, a mere “terme d’art which has little to do with anything material” [15].

I will quote and discuss this passage from Bryant at much greater length below.

For now, suffice it to note that his aim of “defending and renewing” materialism speaks to a fundamental disagreement among the two most prominent practitioners of OOO as to whether it is (or should be) a materialist or an immaterialist philosophy [16].


Complicating matters even further are disagreements and contradictions among these thinkers as to their very definitions of “materialism” and “realism.” As suggested earlier, by “realism” Harman means not a commonsense philosophy that insists upon the existence of material objects outside of human perception – a position whose naiveté is perhaps most famously (and colorfully) encapsulated by Samuel Johnson’s response to Berkeley’s idealism by kicking a large stone and proclaiming, “I refute it thus” – but rather a philosophy that “reject[s] the central teaching of Kant’s Copernican Revolution, which turns philosophy into a meditation on human finitude and forbids it from discussing reality in itself” [17].


While such a definition of realism could in certain respects double as a characterization of Meillassoux’s anti-correlationism, Meillassoux, as we have seen, rejects the label of realism, a move that would get him into trouble not only with Harman but with another figure in this orbit, Manuel DeLanda [18].

Responsible for having popularized the notion of “flat ontology” to which virtually all of the new materialists and realists that we discuss in our collection subscribe, DeLanda is, in Harman’s estimation, “both ardently realist and ardently materialist” [19].


As DeLanda himself asserts in his extended dialogue with Harman, The Rise of Realism – this after having confessed to “using the terms ‘realism’ and ‘materialism’ as if they were interchangeable when they are not” – “All (coherent) materialists must be realists, but not all realists must be materialists” [20].

From here, however, DeLanda, though critical of Žižek’s materialism (a critique which, like Bryant’s, I will address in greater detail below), proceeds to provide a definition of materialism which, were one to simply remove the term “realism” from it, would be entirely applicable to my and Žižek’s Lacano-Hegelian position: “a form of realism that rejects any entity that transcends the material world” [21].


Going by this definition, if ours is “a bad form of materialism,” then so too is DeLanda’s [22].

To reiterate, then: my response to Harman’s criticism of our “bulk treatment” of these various thinkers and schools is a simultaneous plea of “Guilty!” and “Not guilty!” While I can certainly appreciate his wanting us to have paid more attention to the differences both between and within OOO, New Materialism, speculative materialism, and ANT, I would nonetheless continue to insist that such differences do nothing to detract from the fact that all four of these schools share an overarching commitment to establishing a flat, horizontal ontology – a horizontology, if you will – the upshot of which is the decentering and demotion of the subject [23].


For this reason alone – especially seeing that, as its title suggests, Subject Lessons is a book dedicated to defending the subject against such decenterings and demotions – I stand by our grouping of these various schools under the rubric of “new materialisms and realisms.

” Harman’s second major accusation – that despite our pretensions to the mantle of materialism, our Lacano-Hegelian position is actually a fully blown idealism – is not merely of greater interest to me, but, as I have already suggested, of greater philosophical concern as well.


Before directly addressing the charge of idealism, however, I would like to first consider Harman’s critique of our materialism, since it is the latter that paves the way for the former.

Though an avowed anti-materialist (as we have established), Harman has on numerous occasions criticized the Lacano-Hegelian position (Žižek’s articulation of it especially) for its failure to be truly materialist.


As he has done elsewhere, Harman frames his critique of the position laid out in Subject Lessons by way of the following, aforementioned passage from Levi Bryant’s Onto-Cartography, in which Bryant cites Žižek’s work as a prime example of the putative “emptiness” of contemporary materialism: The term materialism became so empty that Žižek could write, “[m]aterialism means that the reality I see is never ‘whole’ – not because a large part of it eludes me, but because it contains a stain, a blind spot, which indicates my inclusion in it.” This is a peculiar proposition indeed. What need does matter have to be witnessed by anyone? What does a blind spot have to do with matter? Why is there no talk here of “stuff,” “physicality,” or material agencies? It would seem that among the defenders, materialism has become a terme d’art which has little to do with anything material.

Materialism has come to mean simply that something is historical, socially constructed, involves cultural practices, and is contingent.

It has nothing to do with processes that take place in the heart of stars, suffering from cancer, or transforming fossil fuels into greenhouse gases.

We wonder where the materialism in materialism is [24].


We will have cause to address Bryant’s critique of Žižek in its own right later.

For now, suffice it to note that Harman uses this passage as a means of teeing up his point that it is “by no means clear” where the materialism is in our claim that “from the dialectical materialist standpoint, the true formula of materialism is that material reality is non-all” [25].


As Harman explains in his Object-Oriented Ontology, “Traditional materialism was the idea that nothing exists other than tiny physical particles speeding through a void.

Everything else that seemed to exist was to be reduced to such particles, and everything immaterial was to be mocked ruthlessly on this basis” [26].

This is the sort of materialism with which Bryant explicitly aligns his “unabashedly naïve” materialism – a materialism which attends to the “‘stuff’ and ‘things’” that compose the physical world, from “trees, rocks, planets, stars, wombats, and automobiles” to “various forms of energy, strings, fundamental particles, and so on” [27].


To be clear, I am entirely sympathetic to the “meta-politic[al] and meta-ethic[al]” aims of Bryant’s “onto-cartographic” materialism.

After all, how could any self-respecting leftist not be interested in “expand[ing] our possibilities for intervening in the world to produce change so as to better understand how power functions and devise strategies so as to overcome various forms of oppression” [28]?

However, to claim, as Bryant and Harman do, that Lacano-Hegelian dialectical materialism is not really materialist because it doesn’t subscribe to the same tradition of naïve materialism as Bryant’s onto-cartography strikes me as not only rather peculiar (would Žižek and I be justified in claiming that Harman’s object-oriented ontology isn’t truly realist because it doesn’t subscribe to the naïve realism of Samuel Johnson or Scottish common sense philosophers like Thomas Reid and James Beattie?), but also simply incorrect.


Though it doesn’t come up in his response to Subject Lessons, a common accusation of Harman’s is that Žižek clings to the moniker “materialism” primarily as a means of demonstrating his leftist bona fides.

For instance, in his aforementioned dialogue with DeLanda, Harman, having claimed that Žižek isn’t “the least bit materialist,” goes on to suggest that the reason he continues to call himself such is that he “want[s] to link [himself] to the Left/Enlightenment political prestige of the term” [29].

Nodding in agreement, DeLanda not only dismisses the “old Left” as an “exhausted,” “embarrassing,” and “increasingly irrelevant tradition,” but, more importantly, accuses Žižek of having contributed to “the debasement of the term ‘materialism’” by using it “as short for either ‘dialectical materialism’ or ‘historical materialism,’” “as if Marxists had a monopoly on materialist ideas” [30].


Leaving aside DeLanda’s labeling of Žižek’s dialectical materialism as Marxian when, for over 30 years now, he has repeatedly gone out of his way to stress that it is Hegelian contra Marxian [31], the implication that Žižek is continuing to wave the banner of materialism primarily for the political prestige it carries on the Left overlooks the many links between his dialectical materialism and the very “traditional materialism” to which Harman (like Bryant) accuses it of bearing no relation [32].


Let us return to Harman’s query regarding where, exactly, the materialism lies in our claim that “from the dialectical materialist standpoint, the true formula of materialism is that material reality is non-all.” As Žižek and I explain in our introduction to Subject Lessons, the formula “material reality is non-all” is Lacanese for asserting that material reality is “ontologically incomplete,” “inconsistent,” “thwarted,” contradictory [33].

Though Harman claims that the link between “such language of the ‘non-all’” and materialism “is by no means clear,” it becomes quite clear if one looks more closely at the tradition of dialectical materialism whose torch he accuses us of carrying merely as a means of brandishing our leftist credentials [34].


In addition to Mladen Dolar’s and Andrew Cole’s chapters in Subject Lessons, I would refer readers to the recently-published second volume of Adrian Johnston’s Prolegomena to Any Future Materialism – A Weak Nature Alone – which covers much of this ground in painstaking detail and depth.

For our present purposes, suffice it to stress that our understanding of materialism as “non-all” can be traced back not only to “modern” dialectical materialists, from Hegel, Marx, and Engels in the nineteenth century to Lenin, Mao, and Lacan in the twentieth, but also to ancient materialists like Heraclitus, Democritus, Epicurus, and Lucretius [35].


Let us not forget that Hegel, Engels, Lenin, and Mao all esteemed Heraclitus the father not only of the dialectic, but of dialectical materialism [36].

Let us also not forget that Marx wrote his doctoral thesis on “The Difference Between the Democritean and Epicurean Philosophies of Nature,” a text in which, as Dolar notes, Marx “pinned the fate of materialism” on the great Epicurean archetype of contingency, “clinamen,” the swerve of atoms from their linear path [37].


Nor, finally, let us forget that not only did Lacan link the death drive, the “‘negative’ libido” that opens up “the dimension of a vital dehiscence constitutive of man,” to “the Heraclitean notion of Discord – which the Ephesian held to be prior to harmony,” but that he also cited both the Epicurean clinamen and the Democritean “den” (the “less than nothing”) as precursors of the psychoanalytic object par excellence (that object which Lacan claimed was his only invention), the objet petit a, the object-cause of desire [38].

Examples such as these would suggest that our continued use of the term “materialism” is far from a mere exercise in political branding.


My having (finally) mentioned Lacan’s objet petit a brings us, at long last, to Harman’s claim that throughout Subject Lessons “‘materialism’ is used as an alibi to advance a thoroughly idealist position while claiming to be immune to the usual defects of idealism” [39].

What makes such a position ineluctably idealist, according to Harman, is that the objet a, the miserable little piece of the Real, the traumatic kernel that resists symbolization (and thus integration into the Symbolic), “does not come from the outside in any rigorous sense of the term,” but is merely (and this is a wonderful turn of phrase) “a flaw in the jewel of consciousness” [40].


As the ensign of a Real that “has little reality about it” insofar as it “stands not for some sort of real world outside the mind, but for an immanent trauma in consciousness itself,” the objet a, whatever Lacan’s claim that his “discourse” is a dialectical materialist one, renders his teaching, perforce, an “extreme idealis[m]” [41].

For Harman, this holds true even when Lacanians like Žižek and I attempt to “finesse [ourselves] out of this jam” by calling attention not only to the reciprocity between the subject and objet a, but also to the way in which the objet a interpellates – or, more precisely, hystericizes – the subject.


Take, for instance, Harman’s recent discussion of Rosalind Krauss’s invocation of the famous “floating sardine can” anecdote from Lacan’s eleventh seminar, The Four Fundamental Concepts of Psychoanalysis, in which Lacan explains his theory of the “gaze” (regard) as the look which an object casts at the subject rather than the typical vice versa of the subject looking at an object [42].

In Harman’s view, while this inversion may very well “suggest a novel equality between subject and object,” ultimately no reciprocity of this kind is ever enough to escape idealism, since human and world are still the only two terms allowed in the picture; above all, there is no talk of objects looking at each other, meaning that a human subject must always be somewhere on the scene.

Thus, we are still inside the Kantian formalism that was supposedly just overcome […].

[ T]he inversion of the human being from an active conscious agent into a passive receiver of something from elsewhere does nothing to escape idealism, as long as humans and non-humans remain the only two pieces of the puzzle [43].


For Harman, then, “placing ‘the gaze’ in the world itself rather than in a mind” and “proclaiming that the world looks at me just as I look at it” is neither a “genuine philosophical innovation” nor a genuine escape from correlationism [44].

So long as we remain within the “onto-taxonomical” subject–object dyad, it matters not if we attribute equal or greater agency to the object: failing to address “object–object relations” means that our so-called materialism will always already be “spoil[ed]” by the same “central idealist defect” [45].


Harman is not alone in holding such a view of our Lacanianism – a point of which he is well aware.

In an interview conducted by Harman, Meillassoux likewise accuses Žižek’s materialism of being a “disingenuous idealism” insofar as it is (in his estimation) merely a “misfired” or “sickened” correlationism.

Though lengthy, Meillassoux’s remarks are worth quoting in full: [The position] of Žižek [...] consist[s] at bottom in making of materialism a “misfired correlationism.” Ever since Derrida in particular, materialism seems to have taken the form of a “sickened correlationism”; it refuses both the return to a naïve pre-critical stage of thought and any investigation of what prevents the “circle of the subject” from harmoniously closing in on itself. Whether it be the Freudian unconscious, Marxist ideology, Derridean dissemination, the undecidability of the event, the Lacanian Real considered as the impossible, etc., these are all supposed to detect the trace of an impossible coincidence of the subject with itself, and thus of an extra-correlational residue in which one could localize a “materialist moment” of thought. But in fact, such misfires are only further correlations among others: it is always for a subject that there is an undecidable event or a failure of signification.

Unless we fall back on naïve realism, we cannot treat these misfires as “effects” of a cause that could definitely be established as external to the subject or even to consciousness.

In any case, a correlationist would have no difficulty in retorting that this genre of materialism is either a disingenuous idealism or a dogmatic realism of the “old style.” When a chair is wobbly, the “wobbly” exists only in relation to the chair, not independently of it.

When one clogs up the Subject, one does not go outside it: instead, one merely constructs a transcendental or speculative Wobbly Subject – a subject that is assured a priori, and according to a properly absolute Knowing, for which things always turn out badly in its world of representations [46].


Though not a realist (as we have seen), Meillassoux here makes all the same arguments as Harman.

Shifting the locus of subjectivity from consciousness to the unconscious does nothing to break us out of the correlationist circle (the “Kantian formalism,” as Harman puts it), for however “wobbly” such a subject of the unconscious may be, it remains a transcendental subject all the same, a subject for whom knowledge, precisely insofar as it is “assured a priori” (i.e., rationally constituted), is absolute [47].


Such being the case, the objet a whose materialization is an “effect” of this wobbliness, this “impossible coincidence of the subject with itself,” though it may very well be a little piece of the Real, is ultimately not a real outside, not a genuine “extra-correlational residue” that would usher us into what Meillassoux, in his After Finitude, refers to as “the great outdoors,” “the absolute outside of pre-critical thinkers” [48].

Žižek has responded to this critique of Meillassoux’s on two occasions, both of which can also be taken as rejoinders to Harman avant la lettre [49].


I will here focus on the more extended of these two responses, which occurs in his book Less Than Nothing [50].

Having identified the thrust of Meillassoux’s (and, as we have seen, Harman’s) argument to be the accusation that “beneath the rhetorical materialist surface, there lies good old-fashioned idealism,” Žižek begins his reply as follows: On the face of it, the argument is convincing: do I not claim that, beneath the transcendental correlation between (the conscious) subject and reality, there is the correlative between the subject (of the unconscious) and its Real/impossible objectal counterpoint, S-a?

Strange as this correlation is, it still makes sense only if a subject is already there, that is, it does not enable us to think reality without a subject. But, again, is this truly the case?

The point Meillassoux misses is that this impossible/Real object is the very mode of inscription of the subject into trans-subjective reality; as such, it is not transcendental, but (what Derrida would have called) arche-transcendental, an attempt to circumscribe the “subject in becoming,” the trans-subjective process of the emergence of the subject [51].


To translate from Derridean to Lacanese, the subject of the unconscious is not a priori but objet a priori, by which pun I mean that it is not the subject that grounds the objet a, but the objet a that “grounds” the subject, that “gives body to,” that “positivizes,” the void that is the subject.

The objet a is the subject’s “only substance,” the “only positive support” of its being [52].

As such, it is not a question of what this impossible/Real object is “for a subject,” as Meillassoux (and Harman) want to frame things, but rather a question of what, for this object, is the subject.

This hysterical question, “What for an object am I (in the eyes of the Other, for the Other’s desire)?,” is the inaugural gesture of subjectivity [53].


Hence the Lacanian maxim, “the desire of the subject is the desire of the Other.” Indeed, one can only speak of a “subject” (in the strong, psychoanalytic sense of the term) insofar as a “radical perplexity persists as to the Other’s desire, as to what the Other sees (and finds worthy of desire) in me” [54].

The objet a is thus not an answer to the question of the subject’s desire; on the contrary, the subject is the “answer” to the question provoked by the enigma of the Other’s desire, the question that Lacan famously identified as the “Chè vuoi?”: “ What does the Other want from me?” “ What am I for the Other?” “ Why am I what the Other says I am?” [ 55]


(Of course, we should also stress here that the Other is likewise desiring/lacking – hence another maxim of Lacan’s, “the big Other does not exist” – which is why, contra Harman’s accusation, Lacanian psychoanalysis does, in fact, attend to “object–object” relations: the relation between the “small other,” objet petit a, and the “big Other,” l’Autre.

As Žižek long ago explained, “the most radical dimension of Lacanian theory” lies not in the “commonplace” that the Lacanian subject is divided/barred, but in “realizing that the big Other, the symbolic order itself, is also barré, crossed-out, by a fundamental impossibility, structured around an impossible/traumatic kernel, around a central lack,” that the “structural network of relations” that comprises the symbolic order “can establish itself only in so far as it is embodied in a totally contingent material element, a little-bit-of-Real,” the objet a [56].

This, Žižek concludes, is the key to what Lacan called “traversing the fantasy,” the realization not that the subject is forever separated from the object, but that “the object is separated from the Other itself, that the Other itself ‘hasn’t got it,’ hasn’t got the final answer – that is to say, is in itself blocked, desiring; that there is also a desire of the Other” [57].

Traversing the fantasy thus cannot help but concern object–object relations insofar as it entails recognizing “how the ever-lacking object-cause of desire is in itself nothing but an objectivation, an embodiment of a certain lack; [...] how its fascinating presence is here just to mask the emptiness of the place it occupies, the emptiness which is exactly the lack in the Other – which makes the big Other [...] perforated, inconsistent” [58].)


Having explained the “arche-transcendental” status of the objet a, Žižek, following “both Lacan and Hegel,” proceeds to reframe the correlationist problematic, arguing that its answer lies not in grasping for an “objective reality which is independent of (its correlation to) subjectivity,” but in grasping that “subjectivity is already inscribed into reality” in the form of the objet a. Žižek here anticipates our claim in the introduction to Subject Lessons that the In-itself is reached “not by tearing away subjective appearances and trying to isolate ‘objective reality’ as it is ‘out there,’ independently of the subject” – a move which only further mires us in the transcendental circle – but by attending to how the In-itself “inscribes itself precisely into the subjective excess, the subjective gap or inconsistency, that opens up a hole in reality” – the objet a – rendering it “inconsistent, thwarted, non-all” [59].


As Žižek further elaborates: we cannot gain full neutral access to reality because we are part of it.

The epistemological distortion of our access to reality is the result of our inclusion in it, not our distance from it.

The objet a is the splinter in the eye which distorts our clear perception of reality, and the agent of this distortion is desire (recall that the objet a is the object-cause of desire).

This brings us to the unique “short-circuit between epistemology and ontology”: the very epistemological failure (to reach reality) is an indication and effect of our being part of reality, our inclusion within it [60].


Žižek’s characterization of the objet a as “the splinter in the eye” recalls the very example that Harman, in his critique of Krauss, rejects as an authentic escape from the correlationist circle: Lacan’s floating sardine can as an instantiation of the objet a. As Lacan puts matters in this same episode, the objet a (in its manifestation as gaze) is the point of “opacity,” the “stain,” or “spot,” in the visual field “which is in no way mastered by me,” but which, on the contrary, “grasps me, solicits me at every moment, and makes of the landscape something other than a landscape” – a stain which Lacan comes to identify with the subject itself [61].


Sure enough, Žižek explicitly invokes this episode in his reply to Meillassoux, quoting what is arguably its most famous line as a means of encapsulating his point that the only way to access reality is through the subject’s inscription into that reality in the form of the objet a, the excess that distorts it: “not only is the picture in my eye, but I am also in the picture” [62].

With this fundamental Lacanian lesson in mind, Žižek concludes that “what Meillassoux calls ‘sickened’ or ‘failed’ correlationism, far from being a half-hearted break-out from the correlationist constraint, is the key component of any true escape” [63].


Indeed, from the Lacano-Hegelian perspective, the tragic irony of Meillassoux’s position is that it is his very “anti-transcendentalism” that keeps his speculative materialism “trapped within the confines of the Kantian-transcendental opposition between reality the way it appears to us and the transcendent beyond of reality-in-itself, independent of us” [64].

Hence Žižek’s insistence that the way out of this bind is not “to think the Real outside of transcendental correlation, independently of the subject,” but rather “to think the Real inside the subject, the hard core of the Real in the very heart of the subject, its ex-timate center” [65].


Based on what we have seen, Harman’s answer to such a claim would likely be that the objet a, however fond Lacanians are of dubbing it “a little piece of the Real,” is not a real outside, for though “a perfectly fascinating psychoanalytic concept,” the Lacanian Real is “merely a poor man’s realism in philosophy” [66].

Moreover, does not Žižek himself suggest as much when he says that we must “think the Real inside the subject,” in its “very heart”? Does this not confirm Harman’s suspicion that, at bottom, the Real is “just an immanent traumatic kernel in the subject,” “an immanent trauma in consciousness itself?” [ 67]


The key to properly responding to this question lies in Žižek’s invocation of the Lacanian concept of “extimacy.” In his seventh seminar, The Ethics of Psychoanalysis, Lacan coined the neologism “extimacy” (extimité) to characterize the relationship of the objet a to the subject as one of “intimate exteriority” [68].

As Jamil Khader nicely summarizes it, Lacan deployed the term extimacy as a means of designating “a paradoxical mode of subjectivity in which binary oppositions such as inside and outside, intimate and external or foreign, are spliced and conjoined to engender a radical zone of indistinction that can be referred to as interior-exteriority” [69].


Though it has gone on to become one of the more central concepts in Lacanian theory, Lacan himself didn’t use the term extimacy all that often; it would be left to collaborators and commentators like Jacques-Alain Miller and Žižek to pick it up and champion it [70].

Lacan did, however, frequently speak of the subject’s “ex-sistence,” a paradigmatic example of which occurs at the outset of his “Seminar on ‘The Purloined Letter,’” when he speaks of “the ex-sistence (that is, of the eccentric place) in which we must necessarily locate the subject of the unconscious, if we are to take Freud’s discovery seriously” [71].


Interestingly enough, as Bruce Fink explains in his translator’s notes on the “Seminar,” the term “ex-sistence” was first introduced into French by way of translations of Heidegger – arguably the most important thinker for Harman’s OOO – to represent both the Greek “ekstasis” and the German “Ekstase,” the root meaning of which in Greek is “standing outside of or standing apart from something,” and which was generally used to connote “the ‘removal’ or ‘displacement’ of something,” although “it also came to be applied to states of mind which we would now call ‘ecstatic.’” As Fink further explains, Lacan, drawing on Heidegger’s play on both the term’s root meaning as “standing outside” or “stepping outside oneself” and “its close connection in Greek with the root of the word for ‘existence,’” regularly uses the term “ex-sistence” to “talk about ‘an existence which stands apart from,’ which insists as it were from the outside, to talk about something not included on the inside, something which, rather than being intimate, is ‘extimate’” [72].


One of the few other instances in which Lacan explicitly uses the term “extimacy” is in his sixteenth seminar, D’un Autre à l’autre, where he again deploys it to designate a “conjoining of the intimate with the radically exterior” [73].

In this instance, however, he links it to a series of “unorientable” objects, foremost among them the Möbius strip [74].

As demonstrated by the illustration from Lacan’s essay “Of Structure as an Inmixing of an Otherness Prerequisite to Any Subject Whatever” (Figure 1), the Möbius strip is an object which appears to be two-sided but which, when we trace around its directrix, we come to find is actually only one-sided.


Lacan had already introduced the figure of the Möbius strip in his tenth seminar, Anxiety, wherein he illustrates its one-sidedness by describing an ant walking along its surface – an illustration of which by M.C. Escher would end up gracing the covers of both the French and English publications of the seminar (Figure 2).

As Lacan explains, “An ant walking along one of the apparent faces [of the strip] will pass over to the other face without needing to go over the edge” because, in actuality, a Möbius strip is “a surface that has just one face” [75].


Properly speaking, there is no “edge” to a Möbius strip; there is merely a torsion or “twist” that makes what would otherwise be a two-faced object a single-faced one [76].

One can thus never say whether an ant crawling along a Möbius strip is at any point on its “outside” or “inside” because a Möbius strip effectively has no outside or inside: the ant is at one and the same time both “inside” and “outside” the strip, which in turn means that it is really neither.

In short, the ant’s relation to the strip is an extimate one, a relationship of intimate exteriority, and it is this very same extimate relation, Lacan concludes, that “is involved when [objet] a enters the world of the real” [77].


There is considerable irony in the fact that although Harman devotes a sizeable portion of his response to Subject Lessons to engaging the chapter of it that most concerns the concept of extimacy, Molly Anne Rothenberg’s “Twisting ‘Flat Ontology’: Harman’s ‘Allure’ and Lacan’s Extimate Cause,” he doesn’t once engage the concept of extimacy [78].

To be fair, he comes close to doing so when, anticipating our response to the charge of idealism, he indulges in the following ventriloquization: “‘For us it is not like Berkeley where everything is just an image, you see: there is a bone in the throat, a trauma in the subject, an Anstoß that is sort of outside the mind even while not being really outside the mind’” – a position, he concludes, that amounts to wanting to have one’s cake and eat it too [79].


But as it turns out, it is Harman who “wants to have it both ways,” so to speak, for his insistence on positioning the unconscious inside the subject when the “position of the unconscious” (to invoke the title of one of Lacan’s most foundational écrits) is ultimately extimate, “ex-centric,” ends up reifying a non-existent boundary between inside and outside that cannot but leave us trapped within the correlationist circle [80].

In short, it is not Lacan himself that is guilty of idealism, but rather Harman’s (mis)reading of him as a thinker for whom the unconscious is merely “a flaw in the jewel of consciousness.”


To further elaborate on this point, it is not entirely accurate to claim, as Harman (quoting Krauss) does, that Lacan “pictures the unconscious [...] as inside consciousness, undermining it from within” [81].

To quote what Lacan himself says of the position of the unconscious (this from Seminar XI, the very same seminar in which he introduces his theory of the gaze as objet a): “I say somewhere that the unconscious is the discourse of the Other.

Now, the discourse of the Other that is to be realized, that of the unconscious, [...] is outside” [82].


Nodding to this very passage, Jacques-Alain Miller argues that Lacan’s point can be “expressed with a single word: ‘extimacy,’” for extimacy is precisely “what Lacan is commenting on when he speaks of the unconscious as discourse of the Other, of this Other who, more intimate than my intimacy, stirs me.” As Miller concludes, “If we use the term ‘extimacy’ in this way, we can consequently make it be equivalent to the unconscious itself” [83].


Lacan insists that the unconscious is outside because its intimacy with respect to the subject is so in excess of the intimate that it can only be described as extimate, something that ex-sists, that is ex-centric. And that this excess inscribes itself in reality in the form of the objet a – the little piece of the Real whose “phenomenalization,” as Hegel might put it, effectuates a rend in this very reality, rendering it non-all – is the very “thing” that makes dialectical materialism a materialism [84].


It is also what makes it a non-idealism, for the co-relation between subject and objet a is, as those in the Ljubljana camp like to put it, a “relation of non-relation.” When it comes to the relation between subject and objet a, we are dealing not with two discrete entities participating in an “intersubjective” exchange of gazes that results in a “mutual recognition” between the two – which, incidentally, is the same misunderstanding of the dialectic perpetuated by those who read Hegel as a philosopher of “mutual recognition.

” For Lacan (as for Hegel), the (non-)relation between subject and objet a is one not of recognition but misrecognition (méconnaissance).


As Žižek and I explain in our introduction to Subject Lessons, subject and objet a “can never encounter each other in a direct opposition or mirroring, but are instead like the two sides of the same spot on a Möbius strip” [85].

This is the function of the lozenge/poinçon (◊) in Lacan’s formulaic rendering of the relationship between the (barred) subject and the objet a as “$◊a.” As Fink explains, the lozenge stands just as much for the “disjunction” between subject and objet a as their “conjunction” [86].


To thus invoke another line of Lacan’s that Harman is critical of in his response to Subject Lessons, “the reciprocity between the subject and object a is total” because subject and objet a are not two discrete, interrelating objects, but are, rather, “impossibly” one and the same object [87].

Hence our insistence that “what new materialists and realists understand as ‘subject’ simply fails to meet the criteria of the subject” [88].


To put a finer point on this claim, let us consider Lacan’s theory of the gaze as anamorphosis – which, like the floating sardine can anecdote, is found in Seminar XI.

The typical understanding of anamorphosis is that of a “subject” whose desire causes it to “look awry” at an object, thereby distorting and, subsequently, elevating/sublimating it to the position of objet a. But “anamorphosis” for Lacan names less the process whereby the subject creates/confronts the sublime object and more the phenomenon whereby the “human being” confronts that which is in excess of itself, that “vital dehiscence” which is at one and the same time “constitutive of man” (to recall an aforementioned line of Lacan’s) and which “renders man as such ‘nature sick unto death’” (to invoke a line from our introduction to Subject Lessons): the phenomenon of subjectivity.


This is the real lesson of Lacan’s discussion of the famous Hans Holbein painting, The Ambassadors (Figure 3), his primary example of anamorphosis.

It is not the case that “subject” refers to the person viewing the painting, while objet a refers to the anamorphic skull lying at the bottom center of the canvas.

Rather, the anamorphic skull, as objet a, is itself the subject: they are one and the same [89].

Thus, when Lacan says “not only is the picture in my eye, but I am also in the picture,” his point is not simply, as Harman interprets it, that “the world looks at me just as I look at it,” as though he is merely talking about a reciprocal, dyadic relation between subject (as viewer) and objet a. To grasp the true import behind Lacan’s claim, we must distinguish between the phenomenal “my”/“me,” the person viewing the picture, and the (objet) a priori “I,” the “stain,” the “blind spot,” the “bone in the throat,” that embodies, that phenomenalizes, the alienated, extimate core of subjectivity [90].


And this returns us to Bryant’s critique of Žižek’s claim that “[m]aterialism means that the reality I see is never ‘whole’ – not because a large part of it eludes me, but because it contains a stain, a blind spot, which indicates my inclusion in it,” a stain/blind spot that renders material reality “non-all.” I cannot but agree with Bryant that this is indeed a “peculiar proposition.” It is the proposition, in fact, of a “weird,” extimate materialism – “weird” insofar as, like Harman’s “weird realism,” it is primarily concerned with reality’s “incommensurability with any attempt to represent or measure it” [91].


Indeed, could not Harman’s definition of “weird realism” double as a very definition of the Lacanian Real as the remainder or leftover resultant from the incommensurability of reality and every attempt to represent it, to fully integrate it into the symbolic order? And yet, a crucial difference nonetheless persists between the two positions.

For whereas Harman insists that the way to access this weird, excessive reality is to flatten the ontological plane and attend to object–object relations, following Hegel and Lacan this excess can only be accessed by attending to the “weird,” extimate object that, in giving body to the subject’s “out-of-jointness,” curves or biases the ontological plane, “disorienting” reality, rendering it much like a Möbius strip – or an anamorphic skull [92].


Hence Alenka Zupančič’s claim that “[i]f there is an ontology that follows from psychoanalytic (Lacanian) theory, this can only be an ontology as ‘disoriented’ by what he calls the object a” – in short, an “object-disoriented ontology” [93].

Such an object-disoriented ontology – or, as Joan Copjec has dubbed it, an “object a ontology” – would, as Lacan himself knew, more accurately be characterized as a “para-ontology” insofar as the objet a, the inscription of the subject into reality, is “not of the order of being” but is, rather, being’s “inherent impasse,” the cut or crack that “curves and determines” being’s “appear[ance]” by “haunt[ing it] from within, in-form[ing] it” [94], leaving it “beside itself,” “ex-static.” To strike a Derridean note, we might say that the subject is “hauntological,” a “ghost in the machine” of being.

To strike – and end on – a more Ljubljanian note, we might say that the subject is the “short circuit” in being.

This, above all else, is why we so “dogmatically” insist upon the subject’s necessity to any future materialism whatsoever.


For the third consecutive year, there were a sufficient number of submissions for Open Philosophy to assemble a special issue on the theme of “Object-Oriented Ontology and its Critics.” My editorials for the first and second such issues, in 2019 and 2020, can be consulted by anyone interested in seeing what themes were covered there [1].

Among the six articles newly published in the present issue, two (by Tim Flohr Sørensen and Russell Sbriglia) are responses to previous articles of mine in past volumes of Open Philosophy, one gives my response to Catherine Malabou’s recent political critique of Speculative Realism, another (by Jordi Vivaldi) gives an object-oriented response to our occasional critic Rosi Braidotti, and two (by Gonzalo Vaillo and Niki Young) propose technical developments in Object-Oriented Ontology itself. I will cover the articles briefly in that order.


The prolific archaeologist Tim Flohr Sørensen makes a welcome first visit to Open Philosophy in his piece “That Raw and Ancient Cold: On Graham Harman’s Recasting of Archaeology” [2].

It is the latest installment in an exchange triggered in 2018 by his fellow archaeologists Þóra Pétursdóttir and Bjørnar Olsen in “Theory Adrift: The Matter of Archaeological Theorizing,” which found fault with what the authors regarded as the excessively textual and insufficiently material approach to the Dutch East India Company in my 2016 book Immaterialism [3].

My response, in a 2019 article in the pages of this journal entitled “The Coldness of Forgetting,” was to contest the claim of Pétursdóttir and Olsen that the specific feature of archaeology is its focus on material remains rather than texts.

It would be better, I proposed, to view archaeology as focused especially on situations of low information, with history being the proper field to process situations in which relevant information is either ample or downright excessive.

I linked this idea to Marshall McLuhan’s famous though sometimes embattled distinction between “hot” and “cold” media, with the former possessing a high density of information and the latter possessing fainter traces of data, and therefore in need of more participation by the viewer [4].

In response, Sørensen contests my claim that archaeology is a low-data field, pointing to what amounts in fact to an information overload in the profession [5].

To miss this, he holds, is to conflate archaeology as a “trope” with what it really is as an “ecology of practices,” a phrase beloved among New Materialists [6].

Sørensen’s article marks another important engagement by an archaeologist with philosophy, and will be read with interest by the audience of this journal.

Rather than respond to Sørensen in the pages of Open Philosophy, I have done so in a portion of a book chapter entitled “The Shipwreck of Theseus,” which can be found in a collection edited by Peter Campbell and Sara Rich, Contemporary Philosophy for Maritime Archaeology [7].


The second response piece in this year’s issue is “Notes Toward an Extimate Materialism” by Russell Sbriglia of Seton Hall University, an emerging figure in the Ljubljana School which by now is quite famous for its fusion of Hegelian philosophy and Lacanian psychoanalysis [8].

In 2020, Sbriglia and Slavoj Žižek were co-editors of a much anticipated volume entitled Subject Lessons, which featured numerous articles by Ljubljana School members old and young, defending the intellectual contributions of Hegel and Lacan while criticizing recent schools that depart from the priority of the subject, such as New Materialism and Object-Oriented Ontology [9].

I read this book with great interest immediately following publication, and quickly penned a response: “The Battle of Objects and Subjects,” which appeared in this journal a few months later [10].


Sbriglia’s strategy in “Notes Toward an Extimate Materialism” is twofold.

First, he responds to my complaint that the authors in Subject Lessons are too quick to conflate New Materialism with Object-Oriented Ontology.

While conceding that there are numerous differences between these two schools, Sbriglia counters that such distinctions are of less importance than the shared move in both groups toward a “flat ontology,” which he takes to be the real bone of contention between New Materialism and Object-Oriented Ontology on one side and the Ljubljana School on the other.

Second, Sbriglia rejects my claim that Ljubljana calls itself “materialist” solely in order to wrap itself in the mantle of Enlightenment prestige.

Instead, the Ljubljana species of materialism is characterized by its rejection of any totality or whole.

For those who doubt that this is what materialism has ever meant, Sbriglia points to Adrian Johnston’s historical argument published recently in Prolegomena to Any Future Materialism, Volume 2, A Weak Nature Alone [11].


This pair of articles eventually led to a fruitful online discussion between me and Sbriglia on October 29, 2021 (just one week before this writing) at the Psychoanalytic Practices Seminar of the Mahindra Humanities Center at Harvard University.

Video of the debate should be available online shortly.


My own article in this year’s issue is “Malabou’s Political Critique of Speculative Realism.” In a recent article in French, “Le vide politique du réalisme contemporain” (“The Political Void of Contemporary Realism”), the prominent philosopher Catherine Malabou critiques the Speculative Realism movement (founded in 2007 by Ray Brassier, Iain Hamilton Grant, Quentin Meillassoux, and me) for turning too much force over to reality itself and leaving too little for the human subject [12].

In a political context, Malabou holds, this suppresses the radical creative impulses she sees at work in the emerging politics of recent years.

She argues the point by focusing on two pieces by Brassier (his doctoral dissertation at the University of Warwick, and his well-known article “Concepts and Objects”) and two by me (“The Future of Continental Realism” and the book chapter “The Four Most Typical Objections to OOO”) [13].

Whereas Speculative Realism strongly emphasizes a real that exists independently of human thought, Malabou charts an opposite course, invoking Louis Althusser’s idea of a materialism that would not be determined by anything pre-existing: one in which matter would only be summoned into its existence by its relations, and be marked by an entirely unpredictable contingency freed from the bonds to autonomous matter found in the rather different model of contingency in Meillassoux [14].

In response, I point to some problems that emerge when non-human reality is left out of consideration in politics and society, citing as evidence the joint work of Shirley Strum and Bruno Latour [15].


Readers of this journal are already familiar with Jordi Vivaldi, who in 2020 published a thoroughly fresh article called “The Twofold Limit of Objects,” which applied concepts from the Spanish philosopher Eugenio Trías to interpret Timothy Morton’s concept of “rift” [16].

Now, in a detailed piece entitled “Xenological Subjectivity,” Vivaldi considers the work of Rosi Braidotti, charismatic intellectual leader of one of the major sub-schools of New Materialism, and a prolific author of influential philosophical works [17].

As Vivaldi tells us, he thinks Braidotti succeeds in accounting for the self as a “transversal multiplicity” and the world as “non-hierarchized by nature-culture distinctions” [18].

Like many other Deleuzeans, however, Braidotti invests too heavily in a neo-Spinozistic monism, and thereby “blurs the notions of finitude, agency, and change, obscuring the possibility of critical dissent while decreasing the overall theory’s consistency” [19].

Vivaldi’s proposal is that Braidotti can avoid these difficulties by opening up to the object-oriented notion of “withdrawal,” reflecting the influence on OOO of Martin Heidegger [20].


Gonzalo Vaillo’s “Superficiality and Representation” marks his debut in Open Philosophy, though he is already well-known in object-oriented circles [21].

As Vaillo aptly remarks, there are two basic positions when it comes to the relation between appearance and reality, which he calls “reality as appearance” and “reality beyond appearance” [22].

While OOO clearly belongs to the second of these families, Vaillo also notes that it distinguishes between ontologies of continuity and ontologies of discreteness: Deleuze is mentioned as a good example of the first, and Kant and OOO as models of the second.

On the basis of these distinctions, Vaillo makes several intriguing claims.

He first considers the direct realisms of Thomas Reid and James J. Gibson, the “bundle” theory of David Hume, and the refutation of the latter by Edmund Husserl’s introduction of the intentional object (Franz Brentano’s earlier intentional object is too close to the Humean bundle to match Husserl’s significant breakthrough) [23].

At least in the cases of Reid, Gibson, and Hume, it turns out that communication between different observers of the world will be difficult, given that they are excessively locked into private viewpoints without possibility of unification.

In an especially clever twist, Vaillo even interprets Husserl’s Polish rival Kasimir Twardowski as a “superficialist” despite his distinction between deep objects and superficial qualities, since his notion of depth is merely projected retroactively as the result of some specific perception [24].


Turning next to theories of reality beyond appearance, Vaillo shows more sympathy for OOO’s discrete ontology than for the continuisms of Deleuze and Henri Bergson, though he also identifies multiple problems facing both my version of OOO and Levi Bryant’s (“onticology”), including their inability to do justice to what Morton calls “hyperobjects” [25].

Vaillo expresses the additional concern that my claim that “knowledge” and “truth” have nothing to do with each other runs the risk of an epistemological idealism that grants too much weight to the position of the observer and too little to the object of knowledge [26].

Vaillo’s original solution consists, in part, in denying the view of Kant and Clement Greenberg that aesthetics is an end in itself [27].

Instead, the experience of allure generates a number of side-effects that also contribute to our knowledge of objects, rather than knowledge being walled off from aesthetics as a dangerous threat to its autonomy.

After many readings, I am not yet sure that I have exhausted the complexity of Vaillo’s theory.


The final article in this year’s OOO issue, “Object, Reduction, and Emergence” is written by Niki Young, another Open Philosophy veteran [28].

Our issue of last year features Young’s already influential “On Correlationism and the Philosophy of (Human) Access,” with its insistence on drawing a distinction between Meillassoux’s famous term “correlationism” and my own closely related “philosophy of access” [29].

In the same general timeframe, though elsewhere, he published “Only Two Peas in a Pod,” a powerful piece on the increasingly important OOO topic of “onto-taxonomy” [30].


The premise of “Object, Reduction, and Emergence” is that OOO so far has relied heavily on the concept of emergence without providing any centralized discussion of the topic: a lacuna that Young aims to fill.

This claim rings true, to the extent that most OOO discussions of emergence so far have simply adopted Manuel DeLanda’s discussion of it as their starting point [31].

Even Morton’s interesting discussion of emergence in Realist Magic treats it as a “sensual” phenomenon, rather than as the emergence of a “real” object as my own position would seem to require [32].

While there is a negative sense of emergence throughout OOO in the context of the unreachable withdrawal of objects, Young identifies a positive sense of the term in my 2010 article “Time, Space, Essence, and Eidos,” and from here he pushes further, showing along the way how the OOO conception of emergence must depart from David Chalmers’ distinction between “strong” and “weak” versions of the concept [33].

After reminding the reader that my 2005 book Guerrilla Metaphysics argued that causation is always vicarious, asymmetrical, and buffered, Young goes on to expand this trio of terms to six: adding that it must also be binary, alluring, and aesthetic [34].


The rapid influence of Young’s article can be seen in the fact that it is already cited in Vivaldi’s “Xenological Subjectivity,” discussed earlier.


It perhaps goes without saying that I have learned a great deal about Object-Oriented Ontology from each of these articles; otherwise, they could never have survived the review process for this issue.


In the UK, more than 50% of medical students and 45% of practising doctors are female [1].

In the specialty of anaesthesia, 32% of UK consultants are female.

The proportion of female consultants has risen consistently between 2007 and 2015 [2].


However, compared with males, females are under-represented as authors of articles published in high-impact journals.

In one study [3] researchers examined articles published between 2005 and 2017 in 15 major science and neuroscience journals, including Nature, Science, Proceedings of the National Academy of Sciences (PNAS), Nature Neuroscience and Neuropsychology Review.

Females accounted for approximately 25% of first authors in Nature and Science and just over 35% of first authors in Proceedings of the National Academy of Sciences.

In only one journal, Neuropsychology Review, did female first authors outnumber males (by 53-47%).

This study also highlighted an inverse relationship between the prevalence of female authors and a journal's impact factor: the higher the impact, the lower the proportion of female first authors.


It is widely recognised that there is a 'glass ceiling' within academic medicine that may contribute to these findings.

Only 29% of UK professors in medicine are female.

Anaesthesia has one 1432 © 2019 Association of Anaesthetists Anaesthesia 2019, 74, 1432-1438 doi:10.1111/anae.14797 of the lowest proportions of female professors (8%) than any other medical discipline [4].


However, with an increasing proportion of the anaesthetic consultant workforce being female, more clinically-based publications, such as case reports, may not be as affected by sex bias.

We decided to perform a retrospective analysis of the proportion of female first authors of case reports submitted to Anaesthesia Cases including rejected, as well as accepted, submissions.


We examined all submissions to Anaesthesia Cases since its inception in January 2013, to August 2018.

For both rejected and accepted case reports, we noted the sex of the first author.

If we could not immediately identify the sex of the author we used Google TM , Google images TM , Facebook TM , LinkedIn TM and ResearchGate TM in order to determine the sex of an author.

If this was not possible, we emailed the first author for further information.


We defined authors by their sex (male or female), that is, biological characteristics rather than gender (masculine or feminine), which reflects psychological, behavioural and sociological characteristics.

For clarity, the term 'sex' will be used throughout the article to differentiate between male and female authors.

We did not enquire whether an author considered themselves as having a specific preference such as gender dysphoria (incongruity between a person's sense of themselves and the sexual characteristics they were born with), a trans woman (a woman who was assigned male at birth), a trans man (a man who was assigned female at birth) or non-binary transgender (someone who does not exclusively identify as man or woman, masculine or feminine, male or female).


Data were explored using descriptive statistics.

A chi-square test was performed using SPSS version 25 (IBM â , Armonk, NY, USA) software to compare proportions of female first authors in accepted and rejected articles, and OR were manually calculated.


There were 802 submissions to Anaesthesia Cases over the 4.5-year period.

Sixteen submissions were excluded; nine were duplicates and seven were administration test submissions (Fig. 1).

Out of the remaining 786 submissions, 279 were accepted and 507 rejected, an acceptance rate of 35.5%.

Twenty (2.5%) authors' sex could not be identified and were excluded from overall analysis.


The overall proportion of female first authors was 37.1%.

The proportion of female first authors of accepted case reports was 42.1% and females were first authors of rejected case reports in 34.4%.

There was a significant association between the sex of first author and whether a submission was accepted (χ 2 (1) 4.095, 1 df and p = 0.043).

The odds of acceptance were 1.39 times higher if the first author was female rather than if the first author was male.


The number of female first authors increased over time as shown in Fig. 2.

There was an increase in the proportion of submissions by female first authors during the period studied, rising from 35% in 2013 to 40% in 2017 (Fig. 3).


Anaesthesia Cases was launched in January 2013 as an online library of case reports in anaesthesia, pain management and intensive care medicine.

These are case reports that previously would have been considered for publication in Anaesthesia.

Journals have reduced the number of case reports they publish, or even excluded them altogether.

Anaesthesia Cases was created as an online library for the continued publication of informative, educational and important case reports.

Since its launch, submission and publication in Anaesthesia Cases has been free for authors.

All submissions are assessed for suitability by two editors.

Anaesthesia Cases became so popular that it was relaunched in May 2019 as Anaesthesia Reports, a fully independent journal publishing cases in clinical practice.


To our knowledge, this is the first review of an anaesthetic publication that considers the influence of the first author's sex on the outcomes of all submissions (both accepted and rejected articles).

In our study, the overall proportion of female first authors for any submission was 37%.

This reflects the proportion of female anaesthetists currently working throughout the UK (32% consultants and 39% staff and associate specialist doctors are female) [2].

Comparing the proportion of female first authors between anaesthesia-specific journal publications, females represented a higher proportion of published first authors (42%) in Anaesthesia Cases than female first authors of original research papers in the British Journal of Anaesthesia for the year 2011 (30%) [5], or selected original articles published in the journals Anesthesiology and Anesthesia and Analgesia over a 15-year period (both 26%) [6].

Thus, in terms of sex bias, Anaesthesia Cases compares favourably with these other anaesthetic journals (Fig. 4).


There are a number of possible reasons for these findings.

It could be that females are more likely to be first authors of case reports rather than other types of articles, such as reviews or original research.

However, data to support this assumption are lacking within the speciality of anaesthesia.

Other anaesthetic publications that explored the sex of first authors did not analyse whether different types of articles were more commonly authored by females.


© 2019 Association of Anaesthetists 1433 Laycock and Bailey | Author sex and Anaesthesia Cases Anaesthesia 2019, 74, 1432-1438 13652044, 2019, 11, Downloaded from https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.14797 by Mcgill University, Wiley Online Library on [19/05/2024].

See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License influence acceptance rates.

Since the inception of Anaesthesia Cases (now Anaesthesia Reports), females have represented between 50% and 67% of the editorial Board.


This is in contrast to 20% female editors of the British Journal of Anaesthesia in 2013 and 16% female Editorial Board membership of Anesthesiology and Anesthesia and Analgesia in 2018.

There was no active positive discrimination strategy for editorial review at Anaesthesia Cases to favour female first authors; however, as submissions are not anonymised, editors' subconscious bias could have contributed to these results.


It could be that the proportion of female doctors within a specialty influences the likelihood of females being first authors in specialty-specific publications.

In general, irrespective of the medical specialty, females appear to be under-represented in subject-specific publications as first authors compared with the proportion of the workforce they represent in that specialty.

Table 1 highlights the proportion of the UK workforce that are female for a selection of medical specialties, alongside the proportion of female authors for specialty-specific publications, evaluated at a similar time period.


Specialties within the table fall into three possible groups.

Firstly, those with a female dominant workforce, where greater than 50% of the workforce are female (dermatology and paediatrics).

Second, specialties that have a similar female-to-male proportion of the workforce to anaesthesia (psychiatry, general practice and ophthalmology) and third, specialties where less than 25% of the workforce are female (otorhinolaryngology and orthopaedic surgery).


For most specialties represented in Table 1, there appears to be around a 10% discrepancy in the proportion of female authors compared with the UK workforce proportion.

Exceptions to this include dermatology, where despite females representing nearly two thirds of the workforce, only 50% of authors were female [7, 8].

Conversely, otorhinolaryngology has a similar proportion of female first authors in speciality-specific publications [9] compared with their proportion within the UK workforce.

Although the available data fail to account for differences in female workforce proportions in different countries, they do suggest that under-representation of females as first authors in publishing is not confined to one specialty.


In the wider medical publishing world, it is clear that females are under-represented.

Bendels et al. [ 10] examined 54 journals listed in Nature Index between 2008 This proportion is similar to that found by Filardo et al. [ 11] who looked at six high-impact medical journals over a 20- year period.

The journals examined were the British Medical Journal (BMJ), the New England Journal of Medicine (NEJM), Lancet, Annals of Internal Medicine, Archives of Internal Medicine and Journal of the American Medical Association. They found that overall female first authorship increased from 27% in 1994 to 37% in 2014 and that first authors were more likely to be female in the BMJ and less likely to be female in NEJM.


Females also appear under-represented as authors in publications from allied medical professions, such as pharmacy and nursing.

In pharmacy, Dotson [12] found that although the incidence of female first authors increased from 30% in 1989 to 52% in 2009, this was still an under-representation.

It is also noticable in nursing, where 90% of the workforce are females yet only 70% of articles in three nursing journals had females as first authors [13].


The ability to publish requires time for research to be conducted and articles to be written, submitted and revised.

Doctors who publish, especially early in their careers, are required to fit this in around clinical and out of hours on call commitments, as few have dedicated research time.

A critical time for career development occurs between the ages of 21 and 35, and this coincides with the ages at which females are most likely to start a family.

Female doctors are more likely to work less than full time (LTFT), thus reducing the time available to spend within the working week on these projects.

A survey of over 10,000 medical graduates over a 10-year period in the UK by Lachish et al. demonstrated that, for doctors working in the NHS, approximately 42% of female doctors worked LTFT compared with 7% of male doctors [14].

Although there are a number of reasons for individuals to choose to work LTFT, including caring for ill or older relatives, this survey found child rearing responsibilities significantly influenced the probability that females worked LTFT but had no effect on the likelihood that male doctors worked LTFT.

This is in keeping with other evidence in this area and suggests that starting a family could in turn reduce the available time to publish.


Females are also less likely than males to enter academic medicine or have research allocation within their job plan, again reducing the time necessary to produce publications [4].

In general, females who do enter academic medicine, compared with males, seem to have more difficulty in securing grants from funders.

A meta-analysis of 21 studies considering whether an applicant's sex influenced decisions in grant peer review found that males had statistically significant greater odds, around 7%, of receiving grants than females [15].

There are also data to suggest that grants obtained by females are of lower value [16]; however, the interpretation of this is more nuanced, as it may represent females being less ambitious in their funding requests.

Notably a recent publication found there was no sex effect on the likelihood of being awarded a National Institute of Academic Anaesthesia research grant (p = 0.484) [17], although whether this is applicable to female anaesthetists applying to other funding bodies is not known.


This may also represent a loss of females from the academic workforce at each stage of career progression.

A report in 2013 by the Academy of Medical Sciences showed that although approximately half (52%) of junior clinical fellowships were awarded to females, this decreased to 37% of intermediate fellowships and 12% of senior fellowships [18].

Females are, therefore, under-represented in senior academic posts, with the proportion of females in academic grades decreasing with seniority.

The small proportion of female leaders in academic medicine may impact on sex bias in publishing; there is evidence to suggest that females in leadership roles who are last authors on manuscripts are more likely to have female co-authors and have more female authors contributing to their research [19].

Additionally, the traditional entry into publishing was first by publishing a case report and then building experience with more extensive pieces of writing whilst developing an academic career.

Although academic careers that follow formalised training schemes, such as those delivered by the UK National Institute for Health Research, may not depend as heavily on this stepwise approach to publishing, a positive experience at an early stage will surely encourage future engagement.


Success in publishing is aided by presenting at scientific conferences, yet females are very under- represented at major medical meetings.

A common picture is that of the all-male panels of speakers, or 'manel' (now officially adopted by the Oxford English Dictionary).

This reflects the fact that females are not invited as often as they should be.

There are positive signs of a change in sex


Publications by females would undoubtedly be helped by having more female journal editors, yet they are still very under-represented on editorial boards.

In 2008, only 12% of 16 biomedical journals had females as board members [21] and in 2011 only 16% of the editors-in-chief of 60 top ranked medical journals were female [22].

This sex disparity on journal editorial boards and unconscious bias likely contributes to less female authorship.

Females are also under-used in the peer review process.

In 2014 and 2015 less than a quarter of reviewers in Nature were female [23].

However, the journal highlighted that this is in part due to authors submitting manuscripts and only recommending approximately 12% female reviewers to evaluate their articles.

This relates to authors requesting senior academics to review their submissions and, as already highlighted, females are under-represented in senior academic roles.


Intentional inclusion and solicitation of females authors by medical journals is one way to rectify some of the imbalance.

Journals should also consider reducing the possibility of bias by adopting mandatory double-blinded reviews.

Other broader recommendations to reduce the risk of sex bias include: investigating inclusion; determining gaps; implementing strategies to address disparities; tracking results; and reporting outcomes to all stakeholders.


A limitation of our study is that, due to the structure of the database, we could only retrieve the name of the first author rather than all the authors' names.

Additionally we did not consider international differences in female proportions of the workforce and whether this affected the international authorship of the journal.

A strength of the study is that we extracted the first author name of every submission to Anaesthesia Cases over the last 5 years and could not identify the sex of the author in only 2.5% of all submissions.


In conclusion, we found that, compared with previous studies on female sex bias in publishing, there was a relatively high (42%) proportion of female first authors publishing in Anaesthesia Cases and this accurately reflects the proportion of female anaesthetists currently working.

Case reports from female first authors were more likely to be accepted than those from male first authors.

Authorship is an important reflection of career success.

It is the culmination of career development, mentorship, funding and support.

We suggest that sex inequity must be tackled at all levels, from application to medical school, through research funding, journals and Editorial Boards.


I congratulate Drs Laycock and Bailey on their recent publication [1] and observation that ‘female first authors were more likely to be accepted than male first authors’ for case reports published in Anaesthesia Cases.

Data from the Universities and College Admissions Service demonstrate that, in the UK, 59% of those accepted to medical school in 2017 were women, possibly reflecting the fact that traditionally women achieve better A-level grades than men.


However, I find the suggestion by the authors that ‘publications by women would undoubtedly be helped by having more female journal editors’ extremely worrying. I would like to think that, in an era of evidence-based medicine, a publication has been accepted for its scientific merit and not, as Laycock and Bailey seem to suggest, because an editor has unconsciously selected the publication on the basis of the author’s sex.


As a reviewer of many manuscripts I have been blinded to the name and sex of the author and my decision to accept or reject a submission has been based upon the scientific quality of the article.

As an author, I would like to think that my publications have been accepted or rejected in a fair and transparent process and that my rejections have been decided by the content of my work rather than my sex.


Although I agree with the authors that we should strive to achieve parity of the sex balance of journal editors, I think the most important issue is to ensure that publications are chosen for scientific quality irrespective of authors’ sex.


We thank Dr Efthymiou for his letter [1] regarding our recent article [2] and for increasing the dialogue on what we consider an interesting, yet controversial, topic.

We agree wholeheartedly with Dr Efthymiou, that submissions should be accepted on scientific merit alone and not be biased by an author’s sex, gender, race, ethnicity, institution or any other factors for that matter.

He argues that ‘a publication has been accepted for its scientific merit... in a fair and transparent process’ and that he, as a reviewer himself, has been blinded to the name and sex of the author.

Publication metrics are still considered by many institutions as markers of scientific success, and in the medical world, where women are underrepresented at all levels, especially in senior positions, any potential for mitigating these inequities is important and should be highlighted.


We agree with Dr Efthymiou that striving to achieve sex balance of journal editors is key, alongside increasing female representation among reviewers and raising awareness of possible bias that occurs, often unknowingly, in publishing.

Unfortunately, this type of double-blind review (where both author and reviewer identities are concealed) is practically very difficult and may cause more problems than it solves.

Although a full discussion is beyond the scope of this letter [3], it is likely that a reviewer, being an expert in their field, will be able to identify a well-known author from the nature of their work, style of writing or particular research technique, even when every effort has been made to anonymise the submission.

Conversely, if the author is not well known then there is no need to conceal their identity.

In the double-blind review process there is no requirement for the reviewer to disclose any conflicts of interest and therefore to identify possible bias and, when the authors are deduced from a manuscript’s content, the double-blind review effectively becomes a single blind review, which is what is practised in our journal.

This at least allows the reviewer to recluse themselves if they do have any conflicts and may also identify author self-plagiarism.


In a recent publication, Murray et al. considered the peer review outcomes of more than 30,000 submissions to the biosciences journal eLife [4].

They found that gatekeepers (i.e. the reviewers) favoured manuscripts from authors of the same sex and same country, and that sex inequity was greatest when teams of reviewers were all men.

Although the influences on success rates are multiple and complex, including not only the process of peer review but also differing submissions rates, it appears that the sex of a reviewer regrettably plays a part.


The epidemic curve is the number of reported cases by date of symptom onset.

For each reported case i, we denote the symptom onset date by t i .

For the SARS epidemics in Hong Kong, Vietnam, and Singapore, we derived the dates of symptom onset from epidemic curves provided by the World Health Organization (9).

For Canada, we used the epidemic curve provided by Health Canada (10).


The generation interval, denoted by τ, is the time from symptom onset in a primary case to symptom onset in a secondary case.

Sometimes this generation interval is called the serial interval (8) or generation time (11).

The generation intervals observed during the SARS outbreak in Singapore are well described by a Weibull distribution with a shape parameter α and a scale parameter β, with values corre- sponding to a mean generation interval of 8.4 days and a standard deviation of 3.8 days (8).

We denote this distribu- tion by τ ∼ w(τ|α,β).


The key epidemiologic variable that characterizes the transmission potential of a disease is the basic reproduction number, R 0 , which is defined as the expected number of secondary cases produced by a typical primary case in an entirely susceptible population (12-15).

When infection is spreading through a population, it is often more convenient to work with the effective reproduction number, R, which is defined as the actual average number of secondary cases per primary case.

The value of R is typically smaller than the value of R 0 , and it reflects the impact of control measures and depletion of susceptible persons during the epidemic.

If R exceeds 1, the number of cases will inevitably increase over time, and a large epidemic is possible.

To stop an epidemic, R needs to be persistently reduced to a level below 1.

Estima- tion of R is a simple affair if there is information about who infected whom.

Then it is possible to construct an infection network (11), wherein cases are connected if one person infected the other.

Estimation of R involves simply counting the number of secondary infections per case.


Often, estimation of the effective reproduction number is a complicated affair, because only the epidemic curve is observed and there is no information about who infected whom.

Recent analyses of closely monitored epidemics have shown that it is possible to estimate the probability that one person has infected another if the spatial locations of the infected persons are available (11, 16).

However, when only times of symptom onset are available, most investigators resort to approximating R by assuming an exponential increase in the number of cases over time (8, 17) or by fitting a specific model that summarizes assumptions about the epidemiology of the disease (7, 18, 19).

Such assumptions can be avoided by using a likelihood-based estimation proce- dure that infers "who infected whom" from the observed dates of symptom onset as provided by the epidemic curve.

However, the computational burden of a straightforward numerical evaluation of the likelihood appears to be enor- mous, since it requires consideration of all possible infection networks, and even for a small outbreak of 50 cases there are almost 7 × 10 82 possible infection networks (see Appendix 1).


Here we show that it is possible to obtain likelihood-based estimates of R while avoiding the computational problems if we use pairs of cases rather than the entire infection network.

The relative likelihood p ij that case i has been infected by case j, given their difference in time of symptom onset t i - t j , can be expressed in terms of the probability distribution for the generation interval.

This distribution for the generation interval is available for many infectious diseases, and we denote it by w(τ).

The relative likelihood that case i has been infected by case j is then the likelihood that case i has been infected by case j, normalized by the likelihood that case i has been infected by any other case k:


The effective reproduction number for case j is the sum over all cases i, weighted by the relative likelihood that case i has been infected by case j:


Note that we are not making any assumption regarding the distribution of numbers of secondary infections per case (i.e., the p ij are independent in j).

Additional detail on the derivation of these equations is provided in Appendix 1.

The estimation algorithm allows estimation of the effective reproduction numbers for infectious diseases at a finer temporal resolution under more general assumptions than was previously possible.


To test how well the estimation procedure approximates the underlying value of an effective reproduction number during a typical SARS outbreak, we estimate the effective reproduction numbers from simulated epidemic curves.

We have constructed a stochastic, individual-based model that simulates epidemic processes with exactly specified proper- ties.

The model allows for a variable effective reproduction number R t as a function of symptom onset data t, and the model parameters are estimated from observations on the SARS epidemic in Singapore (see Appendix 2).

Applying the estimation procedure to simulated epidemic curves shows that most of the estimates are close to the actual repro- duction numbers and that a few estimates based on small outbreak sizes are below the actual values that are used in the simulation model.

On average, the estimates tend to be lower than the actual values but deviate less than 5 percent from the actual reproduction numbers.

If we account for the effects of incomplete reporting and temporal change in generation interval, the estimates become only slightly less accurate, and on average they deviate less than 15 percent from the actual reproduction numbers (see Appendix 2).


For Hong Kong, Vietnam, Singapore, and Canada, we have converted the epidemic curves into the time course of effective reproduction numbers.

The results are shown in figure 1, parts e-h.

These four large outbreaks were sparked almost simultaneously by the same index patient.

All regions have faced erratic "super-spread events" wherein cases produced more than 10 secondary infections.

These "super-spread events" show up in parts e-h of figure 1 as temporary increases in effective reproduction numbers around the symptom onset date of the index case for the "super-spread event." In Hong Kong, Vietnam, and Singapore, there were "super-spread events" marking the start of the outbreak.

In Hong Kong, Singapore, and Canada, there were "super-spread events" after control measures were implemented.


During the early phase of the SARS epidemic, before the first World Health Organization global alert was issued on March 12, 2003, the average effective reproduction numbers were markedly similar across the regions: Each case produced approximately three secondary infections (table 1).

A value of R slightly higher than 3 is consistent with the observed epidemics in all four regions.


Around mid-March, control measures were implemented in all regions, and during this period the effective reproduction numbers decreased sharply.

For some regions, the effective reproduc- tion numbers continued to decrease at a slow pace, suggesting improvement of control measures while the epidemic was going on.


After the first World Health Organi- p ij w t i t j - ( ) w t i t k - ( ).

i k ≠ ∑ ⁄ = R j p ij .

i ∑ = Am J Epidemiol 2004;160:509-516 zation global alert, each case produced approximately 0.7 secondary infections (table 1).

A value of R = 0.7 is consis- tent with all four regions, except Canada.


By the beginning of July 2003, transmission of the SARS virus had been stopped in all regions where the infection was introduced in late February 2003 (1).


To explore the range of epidemic curves that can result from the same epidemic process, we performed extensive computer simulations using a model of epidemics with char- acteristics similar to those of SARS (see Appendix 2).

The outcome of 10,000 simulations shows a highly variable epidemic size and epidemic duration: The mean epidemic size is 685 cases (95 percent confidence interval (CI): 27, 2,446), and the mean epidemic duration is 98 days (95 percent CI: 32, 187).

All observed sizes and durations of SARS epidemics are within this very wide range of possible outcomes resulting from chance alone.

Additionally, we used computer simulations to explore the effect of the timing of implementation of control measures on the epidemic size and duration, in a setting that is typical for the SARS outbreaks.

The simulation results show a high sensitivity to the timing of implementation of control.

On average, a 1- week delay in implementation of control measures results in a 2.6-fold increase in mean epidemic size and a 4-week extension of the mean epidemic duration.


This study showed that there exists a direct relation between the epidemic curve and the time course of the repro- duction number R. This relation is determined by the distri- bution of the generation intervals.

The relation can be used to monitor the combined effects of transmission potential and control measures during an epidemic.

We have shown that the epidemic curves for SARS in Hong Kong, Vietnam, Singapore, and Canada, though apparently different, are all consistent with a single time course of the effective repro- duction numbers for SARS.

This apparent difference in epidemic curves arises because chance effects, such as the occurrence of a rare "super-spread event," leave a lasting trace on the epidemic curve.

In contrast, chance events mani- fest only as temporary increases in the reproduction number.

Our analysis of the epidemic curves for SARS shows that one should be cautious in taking a smaller epidemic size and a shorter epidemic duration as proof of better infection control.


We have presented the relation between observed epidemic curves and inferred reproduction numbers from an infection-network perspective.

We are certainly not the first researchers to do so: Infection networks have been used extensively in the area of sexually transmitted diseases (20), and an infection-network perspective was adopted to analyze a closely observed foot-and-mouth epidemic in Great Britain (11).

Our contribution is the deri- vation of likelihood-based estimates of effective reproduc- tion numbers, requiring only the observed time of symptom onset for the observed cases.

The use of a likelihood frame- work provides a set of powerful tools for inference, uncer- tainty analysis, and model selection (20); the use of only time of symptom onset allows us to apply this method to routinely collected epidemic-curve data.

However, estima- tion of effective reproduction numbers from epidemic curves has an intrinsic limitation that should be kept in mind: The effective reproduction number contains entan- gled information about the transmission potential (i.e., the basic reproduction number) and the effectiveness of control measures.

These two components can be disentangled only when we obtain additional information-for example, about the time of implementation of control measures.

Moreover, individual contributions to the effective repro- duction number are entangled if their date of symptom onset is smaller than the generation interval.

This limitation can be overcome if more detailed information on who infected whom is available (see Appendix 1).