The Health Humanities is a field of study that invites us to question everything, from the way our bodies are read by medical authorities, to how disease is itself constructed in the popular imagination. As an area, Health Humanities opens up perspectives on health and medicine that too often remain uninterrogated, and are too often taken as a given, including “the boundaries that science sets between biology and culture” (Jones 4). As Therese Jones, Delese Wear, and Lester D. Friedman point out in their introduction to the Health/Medical Humanities, for some time there was an assumption that integrating the humanities into science and clinically based programs would help articulate a sense of the humane, and in an instrumental sense foster empathy in medical professionals. However, in recent years, this notion of the “ethical imperative” of the humanities has yielded to other ways in which the tools and methodologies of the humanities help, in the words of Jones, Wear and Friedman, to “raise issues related to power, authority, and justice in health care and challenge the hegemony of a biomedicine that contributes to disparities and the discrimination of persons who don’t quite fit the codified and naturalized norms of health” (8). In addition to the more traditional areas defining the humanities (philosophy, history, literature, etc.), increasingly gender and feminist studies, disability studies, and cultural studies among other “projects” have been pivotal to foregrounding power differentials in medical care and public health more generally.
My specific interest lies in how early health initiatives and interventions beginning in the eighteenth century help us in turn to imagine an idea of a public. As I mentioned in the previous blog, it’s fascinating to me that public health as an institution begins to emerge at the same time as individualism took root in the moral philosophy of the period and from that point developed in tandem and often at cross purposes. But in this blog I wish to consider how the development of a sense that disease afflicting mass populations might be managed helps an idea of a public to emerge. In this respect, Priscilla Wald’s work in Contagious: Cultures, Carriers, and Outbreak Narratives is a useful starting point. In the following statement, she lays out her book’s thesis in unequivocal terms:
I mean to designate how the outbreak narrative articulates community on a national scale, as it identifies the health and well-being of those legally within the borders of the state with its worthy representatives. The outbreak narrative is a powerful story of ecological danger and epidemiological belonging, and as it entangles analyses of disease emergence and changing social and political formations, it affects the experience of both. (51).
As Wald posits, even in the process of disregarding both biological and national boundaries, microbes enable a sense of community as they render visible and material the connections between people. These narratives that both draw upon historical experience of outbreaks and construct our popular understanding of these public health crises also conform to larger tendencies to align health with the self and disease with the other; according to Wald, cultural representations often figure the virus as a foreigner or immigrant (42) at the same time as they depict “microbial traffic” as “one way” (34), originating in Africa in the narratives of the 1990s, and more recently, in East Asia. As Wald notes, in the “vocabulary and geography of disease emergence,” infectious disease is figured as both “primordial” (originating in the “primordial rainforests of the developing world”) and “emergent” as when “it appears—or threatens to appear—in a metropolitan center of the North” (34). Our experience of COVID-19 has been no different. As rhetoric in the US continues to feed xenophobic labeling of the pandemic as the “China virus,” nationalistic tendencies become ever more pronounced. This is in keeping with Wald’s assertion that “The community articulated through disease is balanced precariously between its fear and exclusion of strangers and its need for them, poised anxiously between desired stasis and necessary flux” (57). In times of outbreak and pandemic, the nation takes on the form of an “immunological ecosystem” with the “health and safety of citizens linked to national borders” (58). Hence immunity, or perhaps more specifically, “herd immunity” takes on a nation-defining aspect, making of any “catastrophic illness a communally transformative event at the deeply conceptual (and psychological) level as well as, more explicitly, in social terms” (53). While contagion defines a sense of threat posed from the outside by the other, a notion of immunity realized on a macrocosmic level redraws boundaries and asserts a reassuring sense of identification and protection.
Without recapitulating all that Wald writes in her compelling chapter that forms the nucleus of her equally engaging book, I do wish to draw upon her paradigm of imagining contagion to look more deeply at the implications for how western culture understands immunity. The title of Wald’s second chapter, “Imagined Immunities,” hints at the possibilities for reconceptualizing our dominant way of understanding immunity that we will tease out in the coming weeks, drawing upon the work of Ed Cohen, Paula Treichler, Roberto Esposito, Emily Martin and immunologists like Alfred Tauber. These authors point us towards valuable ways in which the Health Humanities invite us to question biomedical constructs and assess their implications for how we understand a sense of the public.
Building on their work, I would like to consider over the coming weeks how the immune system functions as a public text. As an incredibly complex network of cells, the immune system is an almost mystical entity that seems to defy comprehension, at least to those of us unequipped with scientific training in the subject. Leaning quite heavily upon Angela Clem’s useful “Fundamentals of Vaccine Immunology”, I would like to spend a few minutes here sketching its outlines. Immunologists like Clem distinguish two main subsystems: the innate/general resistance system and the adaptive system. These systems work together to provide an immune response. The innate system is fairly straightforward, comprising a “first line of defense” against pathogens, beginning with the skin, mucus excretions, inflammatory response and so on. As Clem notes, at this level, the response is not specific to a given microorganism and merely detects patterns common to them all. As such, the innate immune system is not set up to remember pathogens. The protective measures specific to this subsystem may eradicate a pathogen or stimulate the adaptive subsystem to kick in. In contrast, the adaptive immune system does not react as quickly as the first subsystem, and launches a response to specific pathogenic agents. Because it has memory, it will respond more rapidly to these pathogens with each exposure, drawing upon the work of B cells and helper T cells, which constitute the two arms of the adaptive system. By themselves, B cells, which are produced in bone marrow, can travel to the lymph nodes and detect pathogens, but without T-helper cell activation, this immune response tends to be weaker. T-cells, as Clem explains, offer “cell-mediated immunity,” resulting in as stronger immune response and more effective memory. The inducement of long-term memory is the goal of immunization.
While this rather stark overview of the various types of immune response overlooks the complex dance of cells in the unfolding drama of detection and response, it is offered as a starting point for considering the larger implications of how our society reads immunity. For a system that we only partially understand, we invoke this term almost constantly in our daily interactions and in a way that does not necessarily capture the actual functioning of the system (more on this later).
The immune system is a public text that we habitually misread. Let’s see if the methods and tools of the Health Humanities can help us to read it differently.
Note: featured image by Ian Furst – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=77380794