Immune systems don’t make for clean narratives, even as we expect them to keep us pure.
Spinoza said: we don’t know what a body can do. The question of a body’s power [pouvoir] pushes aside another question that we tend to ask right away: the question about what it is, its nature, its identity. We need to know what it can do, before we can worry about what it is.
–François Guéry and Didier Deleule, Le corps productif
How much can a body endure? Almost everything.
–Chelsea Hodson, Pity the Animal
The first time I learned about the immune system, I was in university, and my professor introduced the subject by saying that you don’t appreciate how something works for you until you lose it. To ensure the cliché would not likewise be lost on us before it had a minute to work, he blasted Joni Mitchell’s “Big Yellow Taxi,” projecting the chorus onto a screen from his PowerPoint: “You don’t know what you’ve got / ’til it’s gone.” We were over 600 students crammed into an auditorium. Most of the people wanted to become doctors. Most of these people were laughing, but he wasn’t joking. How could he convey to over a half thousand kids—who, I can assume, were all in good health—the horror that is your body not doing what it was meant to do?
We have immune systems for the same reasons we are told we have homeland security: Our bodies are always under attack by foreign invaders, especially the invaders we can’t see. The only way an immune system can identify these dangerous microorganisms is by comparison to the familiar, and so immune cells need not only to identify danger, but also to recognize the self. An immune response is a split decision, between those cells which are “us” and those cells which are “not us.” If “not us,” get out.
To this end, cells interpret signals from pathogens (these signals could be the proteins and toxins produced by bacteria, for example). Some immune cells have memories, so that, if exposed to the same pathogen (of disease) after the initial, intentional exposure (of the vaccine), the response will be faster and stronger. No one seems to know exactly how these cells remember. We wonder that they do. Like the stories passed down along genetic lines, the received ideas about immune systems make for a clean, easy narrative that you’ll read in textbooks and memorize for multiple-choice exams, or skim on news sites as you prepare to get inoculated. I did, and it’s so simple it sounds like the truth.
I remember most of what was taught in the lecture, mostly because of what wasn’t. Every year, the professor said, he wrestled with whether to tell us everything about the immune system. Do I tell you the truth? If I told you everything, it wouldn’t even be the truth because we still don’t know it all yet.
The truth is notoriously hard to pin down, and context only makes it harder. Here, the context is the body, where sometimes it feels like truth goes to die. Bodies are marvels. Bodies are weird, and do what they want. Bodies don’t always follow a script. What makes the body and its systems so difficult to understand is that we can’t see what’s going on just by looking at each other. We sometimes feel when our body is fending off disease—we feel fatigue, nausea, fever—but we are almost never sure whether the symptoms mean we’re healing or getting sicker. The immune system, when it does work properly, is supposed to keep us safe inside our skin. But this view is simplistic; it implies that our bodies are separate from our world, that the medical decisions we make affect just one body.
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‘You’ve had a lot of people’s hands in you,’ she said frankly. Some of the hands were hers, in me to help deliver the baby and the placenta, but then there was also my surgery, which was performed exclusively with human hands, leaving no incisions. When I learned this, it struck me as both magical and mundane that the technology that had saved me was simply hands. Of course, our technology is us.
–Eula Biss, On Immunity
Around the time Eula Biss’ On Immunity: An Inoculation came out, newsstands were covered in pictures of long, worm-like particles budding from infected cells. People were Googling Ebola symptoms. People were asking about a vaccine. People were inquiring about treatment options. Many people were especially preoccupied with tracing it back to the person who brought it to America. Thomas Eric Duncan, the first patient diagnosed with Ebola in the U.S., was instantly dehumanized because the public made him the disease. He was the foreign invader, embodied. He became what ultimately killed him.
It’s a cell that starts an epidemic. Biss, an American writer who investigates the anxieties that sear our language, explains that “there will always be diseases against which we cannot protect ourselves, and those diseases will always tempt us to project our fears onto other people.” For Biss, vaccination transcends medicine, for it “allows us to extend some of the power and privilege of our good health to others.” Psychologist Mark Schaller called the practical manifestations of this privilege, or of the way it’s transmuted into custom, “behavioral immunity:” after using the five senses to detect a proximate infection (or the fifth estate to learn of it), we use not the sixth but the seventh sense, the “common sense,” to avoid being infected. Disgust and hygiene are self-protective, even net-positive products of behavioral immunity; so too, however, are “social outcomes such as xenophobia and the moral condemnation of norm violators.” Behavioral immunity is your reaction to someone coughing in a crowded elevator during flu season. It can be the way someone reacts when you tell them you have cancer. It’s especially the stream of racist Ebola tweets. Behavioral immunity is an unrealistic sense of superiority.
Viruses and bugs get inside us by breaking the skin, or entering through mucous membranes. Vaccines are preventative, but they too pierce the skin, putting us in direct contact with the very thing we fear. Yet we are often already waiting for our cells to do what they’ve been trained to do, exercising a blind kind of trust. If we trust so, why do we still fear the vaccine? In a recent interview with NPR, Biss explained that while the medical community is currently trying to better educate the public, what they are doing “is still too limited” because primarily concerned with the medical. “I think it’s a social debate,” she explained, then cited some examples of social concerns: political unrest, widespread mistrust of the government, corrupt pharmaceutical and medical systems, and, of course, capitalism. Some of these concerns belong to the post-Occupy era, which holds that the cancer is coming from inside the house, which is to say, metonymically, the White House. The concerns of the majority, however, belong to the post-9/11 era, which reacted to a foreign invasion by reasserting whiteness without irony.
Corollary to this, and well in evidence throughout On Immunity, is our preoccupation with bodily purity and the rise of all things “natural” and “local” or “grown at home.” These obviously protectionist “concerns for bodily purity” have long been responsible for brazen eugenics, miscegenation laws, and forced sterilization of genetically “undesirable” mothers. Now the same concerns are responsible for subtler versions of the same, like immigration laws and labels on products that swear to purity. Yet we’re not even born pure. “We are already polluted,” Biss writes, adding that chemicals and bacteria come in through the umbilical cord, inhabit the membranes surrounding the fetus, swim in the amniotic fluid and the fetal urine. Our bodies from the beginning are open systems.
Biss says we are doubly bound: to nature and to technology, neither system we can either comprehend or reject completely. The cyborg scholar Chris Hables has written that many of us are “literally cyborgs, single creatures that include organic and inorganic subsystems.” The inorganic subsystem, Hables explains, is the “programming of the immune system that we call vaccination.” The vaccines are made by corporations, but corporations are made by people, and both the immune response and the antibodies it produces—to wit, the organic subsystems—are made by cells. Yet cells are so numerous, so automated that they resemble, in a way, corporate drones. Very little about the subsystemic is unique, and yet our refusal of the inorganic, enforced by our incomplete trust in the organic, is predicated on a belief that goes like this: “My body knows best.” Hundreds of variations of this phrase appear across web searches, reiterating a stance against vaccines or diets or Western medicine: “I trust that my body knows best.” “I am hoping my body knows best.” “If I believe my body knows best yet I turn it over to the whims of modern medicine, I’m rolling the dice.” “I find that often my body knows best what it needs.” “Your body knows best what it has been through.”
In Mamoru Oshii’s adaptation of Ghost in the Shell (based on Masamune Shirow’s manga franchise) the Puppet-Master—an artificial intelligence program in a world of post-humans, no longer obligated to reproduce—explains to the other Ghosts that man, in the universal sense of man, “is an individual only because of his intangible memory. Memory cannot be defined, yet it defines mankind.” What makes the ghosts human is their consciousness, not their bodies; metal, armor, circuits, and microchips are now substitutes for biological material. Shirow’s imaginary world is one in which regular corporeal threats have been phased out because bodies are shells. Cyberbrains can move between bodies. Bodies are only useful to house a ghost. Like some kind of cybernetic Holy Ghost, an individual packs up and moves.
So many times in Ghost, the body disappears—yes, because of thermo-optical camouflage, but also because the body’s importance is played down. So many times bodies are destroyed only to be completely rebuilt. The film opens in a body-making factory—synthetic skin is layered over muscle and bone and then cooled. Go in as parts. Come out being a body. And because this is easy, the ghosts begin wondering what it is that makes them human, for whatever it is must be difficult, complicated, hard. Ghost in the Shell is filled with revenant questions of the mind versus the body, the old Cartesian dualism, but it gets stuck trying to answer more important ones: How is it that we feel, and can a program feel too?
In Ghost, the main fear is getting hacked and having someone else rewrite your memories; there is a parallel fear of being contaminated, a fear that seems to rest on some a priori knowledge of being clean. Health, in Ghost as in life, isn’t perceived as a range of possibilities, but as a switch: well or sick, living or dying. To many, healthy means not just untouched by illness, but also untouched by medical intervention. As if our bodies are pure until proven ill. As if we were not born tainted. Or if we are, we are far less stigmatized than those who become tainted.
Consider HIV/AIDS. Viral immunity kills the majority of viruses, but there are some, like HIV, which actually destroy the crucial parts of the immune system that usually fight infection and disease—much as the most effective terrorism sets out to destroy not the greatest numbers of people, but the greatest symbols of value (Twin Towers, Olympics), the parts of our externalized selves built to ward off despair and unpatriotism and to sustain our aggregate memory. When HIV/AIDS and hepatitis C are stigmatized in adults, it’s because of the way we assume adults get infected: sharing needles, screwing without protecting, engaging in anything we might deride as a lifestyle choice. We suspect that the sufferers chose lifestyle over the value of life, and therefore deserve to lose out. We suspect this even as we know that humans may contract HIV/AIDS or hepatitis C via breast milk or blood transfusions, in hospitals and on vacation in America. We are still reluctant to believe that our bodies are more intertwined with the environment and with each other than they are individual agents, and this affects our understanding of disease or infection; the way the media covers it; the way politicians, and even some doctors, discuss it. Our bodies are capable of fending off disease, but sometimes they’re primed to incubating it too.
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The pathogen threat theory doesn’t integrate with the profundity we feel when we talk about values. When we think about our religious or political beliefs, we feel like we’ve decided on them. They don’t feel like a defense against disease. … They feel like the truth.
—Randy Thornhill to Ethan Watters,
Pacific Standard magazine
We “contract” disease, as if it were something we could sign for, sign up for. We “fight” disease, as if we were drafted in service of our country. We “fall sick,” as if in battle. Cancer patients who do not fall permanently are “survivors.” The sick can be ostracized, and the sick can be glorified, but in almost all cases, the sick cease to be civilians and become fighters either for or against us. In a climate of perpetual war, Eula Biss resists the metaphors, giving us instead a different way of looking at illness and disease. She speaks of “herd immunity,” i.e. the idea that if whoever can get vaccinated does get vaccinated, we can protect those most prone to disease (and those who can’t get vaccinated), like cancer patients and pregnant. She rephrases, saying it’s a “banking of immunity,” a trust fund: We know that immune individuals won’t carry infectious diseases, won’t diminish our value.
Language is said to be a virus, but anxiety is the virus that language only carries. “Only,” and yet a virus is nothing without a carrier. Old misconceptions thrive on and on in our words. “We are not being invaded,” Susan Sontag wrote in Illness as Metaphor, decades ago. “The body is not a battlefield. The ill are neither unavoidable casualties nor the enemy… About that metaphor, the military one, I would say, if I may paraphrase Lucretius: Give it back to the war-makers.” Yet in our words we are still more often war-makers than nurses, far from immune or safe, terrified often that our bodies won’t heal without a fight.
Sometimes our immune systems lie to us. Autoimmune disorders attack the nonthreatening self, destroying vital body tissue, as with rheumatoid arthritis, multiple sclerosis, and Graves’ disease. Like even the best intelligence agencies, our immune systems sometimes fail to recognize when the self becomes a threat, the body a double agent: the cancer is coming from inside the house, at least where the house is flesh, and the immune system doesn’t see its cells as foreign. Some of us get chicken pox again, and shingles. Many of us still have allergies. A simple answer is that the immune system isn’t a perfect system. Another answer is that the immune system is perfect, and we just don’t know it well enough yet.
In Halifax, a clinical trial is being held for an Ebola vaccine. Forty people between the ages of 18 and 63, “in generally good health,” will take part in an early phase study. This particular vaccine doesn’t contain the Ebola virus, but a VSV virus, a vector that will express one of the proteins of Ebola. No one can get Ebola from the vaccine, but the study is seeking what some known side effects can be. “Part of the study,” one of the overseeing doctors has explained, “is that we’re trying to measure these side effects and find out what they are, so the risk is doing something with a new vaccine.” No one can say with certainty what contributes to a recovery from Ebola. Some reports have credited health care; others, stronger immune systems. The one thing these reports do not mention is that the patients are now immune to the virus, having developed antibodies that could last for 10 years, and maybe longer. A threat embodied, a hostage taken, survives to become paradoxically the safest American.
The last thing I remember from that lecture in university was my professor saying that three things control your life: your genes, your environment, and luck. “And if you have the choice, take luck,” he said. This I found telling, because luck is the thing you can’t choose, a gift of tautology: Being born lucky “is the biggest piece of luck in this life,” Fran Lebowitz said. “No one wants to admit that, in this country especially because it agitates against the very notion of America.” We prefer the predestination of genetics, and lie of an individual body, an individual fate, a will sui generis and secret. At the time I was sitting in this lecture, I had been diagnosed with cancer.
Was it something I did? I asked the doctor, stupidly. He told me no. He told me it could have been a number of things: a mutated cell my body didn’t find; a statistical anomaly. Bad luck, yes, but it was good luck, too, because it was caught early; was treatable; hadn’t metastasized. That year I learned about most types of immune responses, but we didn’t cover cancer immunology, and I wonder if it’s because we weren’t specialized enough yet, or because of how little was known or understood about it—imagine the exam questions, full of maybes, not a clean narrative at all. I still wonder if, had I known more, I would also have known sooner about the cancer. If I could have been more in touch with the body, could have sensed that something was off. What concerns me more, however, is the battalion of blood tests, the scans, the ultrasounds. The fact that I’ll never again be a civilian, in the common parlance. One misstep and the cancer could begin again; I could move from “on alert” to “on duty.” I would have need then of what Biss, and Sontag, and many of us have already wished for: a language of rapprochement, a softening of the borders between well and sick, between one body and another, so that we understand that the cancer comes from inside a house we all share.