Two books about diseases and public health

I’ve mentioned a few times that my research focus during my MA was disease (specifically rabies) and the Victorian novel. I’m still very interested in diseases in general, especially how we construct narratives of disease and how these narratives—often deeply ingrained—influence our ideas about public health. Old (research) habits die hard: whenever I see a new cultural history of disease come out, I buy it. And that’s how I came to have Eula Biss’s On Immunity and Steven Johnson’s The Ghost Map sitting unread on my shelf. I packed both for a vacation last month. I know, I am great at picking beach reads.

onimmunityAs its title suggests, On Immunity is an examination of the idea of immunity. Biss was inspired to write the book after she had a baby and faced the question of whether or not to vaccinate him. Biss did vaccinate her son, as she had always thought she would, but she was surprised by the amount of fear she felt herself, and encountered in others, when she talked to other mothers about this choice. She started thinking about vaccination, and the idea of immunity, and how vaccines developed in the first place, and this strange cultural moment we live in where people are opting out of vaccines that have saved literally millions of lives in the past hundred years. (I’m wildly pro-vaccine, in case that wasn’t clear before.)

In On Immunity, Biss interrogates the metaphors and myths we use to describe immunity. Vaccination is an expression of fear, whether it is fear of something concrete and relatively preventable such as death by measles, or something far more intangible, such as the fear of death itself. But the anti-vaccination movement is also based on fear: fear of the government, fear of Big Pharma, fear of injecting the unknown into your body. If skin is a barrier between our bodies (our selves?) and the outside world, then vaccination penetrates that barrier—all in the name of granting you immunity.  It does seem contradictory, doesn’t it? After all, vaccines contain the very viruses they are supposed to be protecting us from. The earliest form of inoculation against smallpox involved rubbing scabs or fluid from a smallpox patient into one’s own skin.

Biss understands this fear of vaccines on an individual level, but she also points out that in the case of infectious disease, our bodies may not be solely our own. Herd immunity, which means the general immunity to a particular disease in a population of people, depends upon people getting vaccinated. As the recent resurgence of diseases like measles shows, it only takes a few nutty people to threaten herd immunity for everyone. And there are people who can’t be vaccinated for health reasons (ex. allergies) or who have compromised immune systems (ex. cancer patients). What is our responsibility to public health? Are we required to be vaccinated so that others won’t get sick? Health is assessed on an individual level at our yearly physicals, but our own physical health depends in many ways upon the health of our community, especially when it comes to infectious diseases.

Victorian London learned this the hard way during the 1854 Broad Street cholera outbreak. Cholera was the scourge of the 19th century, popping up every so often and routinely killing thousands of people per outbreak. (Cholera is still a problem today.) No one knew how it was spread until the Broad Street outbreak, but there were plenty of theories, chief among them the miasma theory. Simply put, back then, London stank. Lots of people crammed into tiny dwellings leads to lots of waste, and Victorian Londoners weren’t so great at managing their sewer system (or, um, having one). The air in London smelled pretty bad. Many respected officials and doctors believed that diseases, including cholera, were spread by this “bad air,” aka the miasma theory.

A cartoon from humour mag Punch depicting the Thames, the source of the stinky air. Source.

An 1858 cartoon from humour mag Punch depicting the Thames, the source of the stinky air. Source.

Along came John Snow, a doctor who was already notorious for pioneering the use of anaesthesia. When an outbreak of cholera occurred in his neighbourhood in Soho, he mapped the instances of disease and traced them all back to one water pump, where he found that the water supply had been contaminated by one household suffering from cholera. Feces from that household made its way into the water supply, and the disease spread through the water supply into the surrounding houses with devastating effects. Snow was one of the first epidemiologists, although he never got the credit he deserved and died without having his theory accepted by the medical establishment of the day.

ghostmapThe Ghost Map tells the story of this outbreak and Snow’s investigations. It is well-researched and fascinating, like a thriller where the villain is invisible and also causes a lot of diarrhea and suffering. I wish, though, that Johnson had spent more time investigating the cultural context of cholera and how Victorians thought about disease. The idea of the social body is an important one to add to this discussion, especially because it still has relevance today (see Biss’s questions about whether we owe it to our neighbours to get vaccinated). And how did Victorians approach infectious diseases like cholera, tuberculosis, and typhoid fever?  How did they write about disease in their newspapers, depict it in cartoons, confront it in their fiction? They had limited medical knowledge of pathogens and germs, but they were beginning to break through in other important areas (microscopes, the idea of inoculation). It seems to me that this conflict gave rise to many inaccurate but interesting depictions of diseases that suggest a society obsessed with health, illness, and infection. The Ghost Map could have benefited from some discussion of these questions.

In some ways, we’re still Victorians. Just like them, we’re obsessed with health. Also like them, and other humans throughout history, we still infuse our disease-related language with metaphor. As Biss points out, the way we talk about many diseases is steeped in the language of battle: so-and-so “lost her battle with cancer,” white blood cells are “armies” that keep our bodies safe from infection. In our struggle to understand our bodies, we rely on metaphor to give shape to our invisible inner workings. As Susan Sontag argues in Illness as Metaphor (a must-read for anyone interested in these issues), our dependence on metaphor leads to moral judgments about certain diseases. Sontag looks at consumption (tuberculosis) in the 19th century and cancer in the 20th and concludes that our disease metaphors lead to a kind of blame the victim mentality. For the Victorians, all kinds of diseases could blamed on emotional repression or moral failings. Countless novels feature women who are forced to bury their feelings and are soon wasting away from some nameless ailment. Men in the same novels who are “weak” and prone to drink inevitably end up dying of their own unnamed illness. And not a lot has changed in how we talk about illness. In 1978, when Sontag wrote Illness as Metaphor, one alternative cancer treatment involved psychotherapy to help find out what part of your personality brought cancer upon you.

Likewise, our current obsession with trends like “clean eating” often leads us to assume that people who don’t eat chickens that were raised to believe in themselves and organic blueberries watered with angel tears are doomed. There is, of course, a lot of privilege involved in these assumptions we make about health and wellness. The point is, a disease is never just a disease.  It’s a battle we must fight. It’s a statement about our incomes, the food we eat, the amount of exercise we get, the kind of sex we have or the number of partners, the amount of alcohol we drink. It’s a sign of our most private defects, writ upon our bodies for the whole world to see.

And why do we think about disease this way? I don’t know, but I suspect it’s because we have a hard time accepting that our bodies are, ultimately, out of our control. We can eat all the happy chicken we want and avoid pesticides and wear a mask on the subway, but we’ll still get sick, especially if we live in large urban centres (and increasingly, many of us do). There are precious few things we can control about our bodies. All the more reason to get vaccinated.

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A Whole Shelf of Dating Books, or the Beginning of My Charlotte Lucas Year

I turned twenty-seven last week. I’m also single. Fans of Jane Austen will know that this puts me firmly in Charlotte Lucas territory. In Pride and Prejudice, Charlotte is the best friend of Elizabeth Bennet, our protagonist. Charlotte is described as around twenty-seven, plain, but sensible and practical. Charlotte is really more notable for what she isn’t; as Joshua Rothman writes, she’s not young, not pretty, and not rich. Not married. And at the age of twenty-seven, she’s a spinster.

The cover of Bolick's Spinster is a masterpiece of modern marketing. Try to count all the subliminal messages being sent here.

The cover of Bolick’s Spinster is a masterpiece of marketing. Try to count all the subliminal messages being sent here.

P&P was published in 1813,  but people are still interested in that word, it seems. Many women are “reclaiming” it, turning it from something derisive into something else, but we’re not sure what, exactly, that something else is. In Spinster, published earlier this year, Kate Bolick wrote about her desire to build a life on her own terms, taking inspiration from five female American writers who had complicated relationships with men and marriage. Spinster is a thought-provoking, though frustratingly self-absorbed, look at the choice to remain single. Bolick’s conclusion seems to be that any woman can be a spinster if she decides to spend time thinking carefully about what she wants from her life, if she tries to find a way to build that life by following a less traditional path, if she simply decides that she’d rather not get married. And instead of being an object of scorn, Bolick’s spinster is admirable, even aspirational, in her radical desire to make choices that are unencumbered by men.*

(* A few notes here: Spinster discusses heterosexual relationships, mainly, from what I can remember. Naturally, same-sex relationships complicate the issue. And the idea that anyone makes choices in a vacuum, uninfluenced by past boyfriends or fathers or even just male friends, is definitely suspect. But this is how Bolick characterizes her spinsters.)

Edwin Long's The Spinster from Internet Archive/U of T Library. Source.

Edwin Long’s The Spinster from Internet Archive/U of T Library. Source.

Spinsters are pretty in right now. Lots of women (and men, too) are posting images of themselves with their cats to Instagram and silly Tweets about nightgowns and eating chocolate in bed (just a few examples from my own life…), using hashtags like #spinsterlife. The Toast, probably the Internet’s most popular blog for spinsters (which I say with admiration), has done a number of hilarious pieces about modern spinsters. Has spinsterhood become some kind of hipster lifestyle movement? Is it now about having cats and enjoying knitting and going on vacation alone? If so, I’m on board. We don’t need “spinster” as a legal categorization anymore (“single” or “unmarried” will do just fine, thanks), so let’s make it into a different thing, a fun, tongue-in-cheek kind of thing. Let’s all solve a murder and then go out for gin-based cocktails and head back to our perfectly decorated apartments-for-one like real badass spinsters.

In real life (and some fiction), spinsters were objects of derision or pity. They began as independent women who spun fabric. And then, probably because unmarried women are threatening to a society that depends upon heterosexual marriage for reproduction, something changed and they became lonely figures. They weren’t cool aspirational figures who could do whatever they wanted; they were often women without family or money who couldn’t work because Sexism and so had to make ends meet with limited resources. As Briallen Hopper points out, for a book called Spinster, Bolick’s memoir/cultural history doesn’t have much to say about those kinds of spinsters. (In fact, it’s really not much of a cultural history at all, preoccupied as it is with white, relatively privileged New York writers. I’d love to read a book about the evolving figure of the spinster, from spinning fabric to today, if there are any out there.) Most of the five women Bolick profiles were married at least once. Bolick writes about the relationships she herself had in between bouts of living alone, travelling, and prioritizing her work. Bolick isn’t living a life apart from men; she’s constructing her life and fitting men in here and there when she wants to.

An 1881 cartoon from the British humour mag Punch. Source.

The “real” spinster is missing, or at least the spinster as we’re most familiar with her: the dour maiden aunt or neighbour with her pursed lips and reduced circumstances, hiding a secret life behind closed doors, the object of many speculations about why she never married—the Emily Dickinsons and Emily Griersons of this world (is Emily a spinster name or what?), the Miss Havishams, the Miss Bateses, all of the many unmarried women in Henry James and Edith Wharton and Charlotte Bronte, even Miss Marple. Austen herself, and most of the Brontes, and lots of other female writers. These are women who are uninteresting to men for reasons of looks, money, or personality (too outspoken, too awkward, not agreeable enough) or threatening to men because of their intelligence and desire for something other than marriage in a time when marriage was the only acceptable end to their stories. The Charlotte Lucases of fiction.

Charlotte, of course, becomes not-a-spinster pretty quickly; she marries Elizabeth’s cousin Mr. Collins, who had previously proposed to Elizabeth and been rejected. Mr. Collins is odious—all you need to do is search for images of “Mr. Collins Pride and Prejudice BBC” and you’ll see exactly why Elizabeth, or anyone, would have refused him. He’s a pompous, self-important social climber. He simpers in front of his social superiors and self-righteously informs his cousins of what books they should be reading. He’s horrible. So why does Charlotte marry him? Because he has a wealthy patron and a good income and he’s going to inherit the Bennet house some day. Charlotte’s twenty-seven and this might be the first and last marriage proposal she receives. As Mrs. Collins, she’ll have a house of her own, probably children, and security for the rest of her life. As Miss Lucas, unmarried eldest daughter of a small-town knight, she’ll be a burden to her parents.

Mr. Collins is stomach-turning. Source.

Mr. Collins isn’t exactly tall, dark, and handsome. Source.

Rothman argues that we should try harder to understand Charlotte’s choice to marry Mr. Collins, a choice that is generally read as depressing or sad, even in the context of Charlotte’s world, Regency-era England. Especially as modern readers, we’re sad that Charlotte feels that her only option in life is to marry a man she doesn’t love. She’s the 1813 version of that Princeton mom. As Rothman points out, though, this is a choice that Charlotte makes herself, in a world that tries its hardest to deny her a choice at every turn. She’s fully aware of Mr. Collins’s defects, and her own. She isn’t pretty enough or rich enough to attract a different kind of husband, and that’s her reality. So she makes the choice to marry him, to be a wife and not a spinster, to create a life of her own (she rearranges the rooms in his house to her liking and encourages him to spend his time in the garden). Not the kind of life that Bolick decides to create, but a life that she can live with nonetheless.

I started with Spinster, but I’ve found myself reading a lot of books about these topics: dating and relationships, being single, modern love. Maybe that’s the cultural moment we’re in now. People are delaying marriage, and online dating is taking off, so people are writing about these things. There’s Spinster and a number of smart reaction pieces to it. Aziz Ansari’s book on the sociology of modern dating, Modern Romance, came out this year, following a 2014 book called It’s Not You: 27 (Wrong) Reasons You’re Single by Sara Eckel (there’s that number again). All of these articles and books have made me think a little harder about how we date, and why.

modern romanceAnsari writes well about the problem of dating in the modern age. Modern Romance is immensely entertaining, and reassuring, too, if you’ve ever tried online dating and thought, “Well, this is terrible.” You’re not alone, because Ansari has tried it, too, and he has a lot of funny anecdotes to share. He retells dating horror stories people told him in focus groups. He visits retirement homes to figure out how people met fifty years ago. He travels to Tokyo and Buenos Aires to see how people date in other countries. Unlike Bolick, who writes to defend the spinster life, Ansari assumes that if you’re reading his book, you’re interested in dating and settling into a serious relationship (and Modern Romance is about men and women). So he has a few practical tips about giving it more than one date, and actually meeting up in person instead of living through your screens, and so on. But he also makes a number of accurate observations about the state of modern romance. Dating is hard. We’re all on our phones all the time, and another potential date is just a swipe away. We can’t focus on the person sitting across the table from us.

9780399162879_p0_v2_s260x420-thumb-350x477-122899Eckel, too, writes about how hard dating can be. In her late thirties, Eckel was single, not by choice, and found herself frustrated by all of the well-meaning advice she received from friends. So she wrote an essay and then a book to explain why it was all wrong. You’re too picky, you’re too confident: it may be well-meaning, but it’s all contradictory. It isn’t “too picky” to reject people who want different things than you do, it’s smart. How can being “too confident” scare suitors away when people are also telling singles they should be more confident to attract others? Eckel’s argument is that most single people (those who don’t want to be single) simply haven’t met the right person yet. It’s Not You is about how it’s fine to want to be in a relationship, and Spinster is all about how it’s fine to not be in one, but they have much in common. You have to create your own life, whether you’re in a relationship or not. And you should think about the choices you make: the bad relationships you leave; the people you choose not to date or the ones you waste time with, knowing that you don’t even like them; the marriage proposal you may have turned down; the person who treated you badly and you couldn’t see it. Why did you make those choices, and what do they say about what you really want?

I’ve been jokingly referring to this as my Charlotte Lucas Year. Celebrating my birthday with a friend, I drank a cocktail called an Old Maid, a delicious sort of alcoholic lemonade, and I thought about all the things I have at twenty-seven that many spinsters before me could not. It’s 2015, and so I can date whomever I choose. More importantly, I have a job that I find fulfilling and a small amount of disposable income to spend on spinster-y things like my cat and adult colouring books and a library card catalogue. And then, I can post photos of all of those things to Instagram with a sarcastic hashtag. In my own way, I’m participating in the spinster reclaiming, celebrating elements of “spinster culture” and self-deprecatingly talking about being an old maid at twenty-seven, knowing full well that I’m not. I don’t know what Charlotte Lucas Year actually means just yet—maybe it’s just funny, or maybe it means I’m going to spend this year trying to figure out my life and what I want from it (spoiler alert: not to marry Mr. Collins). I think, though, that single or coupled, as we get older, all of us are setting off into uncharted territory. Our lives don’t look much like the lives of our parents; we’re delaying marriage and babies, not buying houses, driving Zipcars and taking transit and living in cities instead of moving to suburbs. Like Charlotte, we all have to figure out what choice is right for us, regardless of what judgmental readers have to say about it 200 years later.