Disease as Framework


Medical historians, medical anthropologists, and other scholars concerned with a plethora of topics have written works centered around specific diseases; what comprises their arguments, evidence, and conclusions, however, varies greatly and begs the question, what exactly is the history of a disease, and how have scholars employed disease as a schema through which they analyze other topics? This essay will attempt to provide specific examples of historians (and anthropologists and literary scholars) using illness as a framework, and it will elucidate the benefits, drawbacks, and consequences of such work.

Few medical historians would argue with the statement that a disease is a constructed entity. The biology of an illness constitutes only a part of its meaning to the society from which it emerged. Oftentimes, there are non-biological factors — “beliefs, economic relationships, societal institutions,”[1] to name a few — that also make up the concept that is a particular disease. Syphilis is a good case in point. The biology of the disease is fairly standard; it is a bacterial infection that, if left untreated, can become quite serious. Because of the way that it is transmitted, however, syphilis has garnered a scandalous reputation and has been associated with sin since its appearance in Europe in the late 1400s. The way the disease was handled institutionally (syphilitics were often banned from hospitals or placed in homes amongst one another) and the way that sufferers experienced it (often shunned from society, and when treated at all, given needlessly harsh “remedies”), shows that it was, at least in the eyes of the religious societies it ravaged, much more than what its biological attributes would suggest.[2]


Summaries & Reviews

Malignant: How Cancer Becomes Us, S. Lochlann Jain

            Part memoir part cultural analysis, Malignant tries to untangle the complicated relationship between cancer, institutional America, and people within and without the disease’s enigmatic aura. Using evidence from popular culture (ad campaigns, cartoons, and artwork), Jain elucidates how cancer is (mis)understood; the way that American medical and governmental institutions have attempted to grapple with cancer, Jain argues, is fundamentally flawed in many ways due to the prevalence and long-term nature of the disease. In various chapters, she cites statistical analysis, trials, the survivor mentality, prognoses, fundraisers (like the pink ribbon campaign), prosthetics, tort law, carcinogen regulation, doctor-patient relations, screening, and the use of fear as aspects of a bigger problem — that the ways we try to understand and deal with cancer are problematic, and that we need a change. Jain argues that we should not see cancer as “a disease awaiting a cure,” but instead “as a constitutive aspect of American social life, economic and science.”[1]

I admittedly had a little trouble initially relating this to other readings because of the style’s unfamiliarity. I wonder if this book is indicative of how medical anthropologists write — by inserting themselves and their experiences into the narrative and argument. As someone trained in history, I recoiled at first, but the message of the book was made all the more powerful by the protagonist’s insight — insight that could only be garnered from having been a part of the system she critiques. The images she presents, and her analysis of them, reminded me of Dangerous Pregnancies. Both authors took posters produced by various institutions and analyzed their usage of disease and the sick body to promote different agendas. The images of the mentally handicapped child and of the supermodel dying of cancer were both presented in the service of warning the public against certain activities, lest they end up in a similar situation. I think analyses of these kinds of images are extremely valuable in determining a society’s understanding of disease and the kind of moral behavior seen as counter to the depravity of illness.

I found Jain’s linking of the doctor-patient relationship to a separation of knowledge, and, by extension, a separation of roles has great potential for analyzing the changing dynamics in doctor-patient relations in the medical field in the late nineteenth and early twentieth centuries. In my research for my undergraduate thesis, I found that up until the 1870s and 1880s, what Roy Porter called a “lively medical pluralism” dominated. Patients had the authority to choose between different types of practitioners in times before government-sponsored medical regulation was the norm. Contrasting that with the experiences of cancer patients in Jain’s narrative, it is evident that a major change took place with the rise of medical authority. Patients, it seems, have lost their voice in many ways now that they do not have access to the privileged knowledge of trained practitioners. This separation of expertise has wide-ranging effects, as elucidated in part by Jain’s presentation of the powerless, relatively uninformed cancer patient. I wonder if a research project has been undertaken to try and understand how this structure — the doctor-patient relationship in which all of the power lies with the former — emerged from the quite different doctor-patient dynamic characteristic of nineteenth-century medical practice.

[1] S. Lochlann Jain, Malignant, 4.

Dying in the City of Blues

Summaries & Reviews

Dying in the City of Blues: Sickle Cell Anemia and the Politics of Race and Health, Keith Wailoo

Through the lens of a controversial disease, sickle cell anemia, author Keith Wailoo traces important developments in mid-twentieth century American health, in race relations, and in state and federal politics. He shows how diseases can take on varied meanings in different political, cultural, and medical environments, and he analyzes how these meanings affect the people closest to the disease — the sufferers and their families. Especially prominently featured are the ways in which the disease influenced (and was influenced by) the turbulent racial politics of Memphis, Tennessee from 1940s through the 1990s — from a disease under the radar, overshadowed by malaria, to an embodiment of African American suffering and disadvantage, to a condition that evoked suspicion and anger, sickle cell anemia, like those it afflicted, was directly affected by the cultural and political environment in which it was situated.

Wailoo’s method — using a disease to elucidate the politics of a time period, and showing how diseases are active political players — is almost identical to that of Leslie J. Reagans’ in Dangerous Pregnancies. Both authors spend a lot of time discussing the political and cultural context in which their diseases arise, and they go on to explain how their chosen diseases stimulate conversations that end in major alterations in cultural values and, more concretely, in changes in medical law. Wailoo briefly discusses the commodification of the disease, which he defines as; “the process by which bodily experiences such as pain are assigned value (monetary and otherwise) by physicians, patients, insurance companies, and others.”[1] This method of analysis is reminiscent of Warwick Anderson’s in Collectors of Lost Souls, where brains are commodified in the international scientific community studying Kuru. Wailoo’s focus is more on domestic commodification in the form of sick bodies as “clinical material” for learning medical students, but both authors address the propensity for scientists to objectify the sick body and use it to their financial or reputational ends. Both studies focus on the twentieth century; I wonder if body commodification is a relatively new phenomenon, perhaps linked to the rise of the clinic in early nineteenth century Paris, or if it existed in different capacities much earlier (as objects of anatomical specimens, for example).

The conclusion, like that of Dangerous Pregnancies, offered up “lessons” that could be learned from the history of sickle cell anemia. I have noticed that some historical works’ final chapter (the conclusion, coda, etc.) often contain similar content. The historian takes what he or she has gathered from their study and applies it to more modern-day problems; sickle cell anemia, for instance, has taught us (hopefully) that eradication is not a simple process, and that when diseases take on cultural meaning, institutional methods of treatment/cure are not always viewed as beneficial by those afflicted by the illness. In the future, therefore, we should be careful when dealing with culturally-affected disease. I think this is a valuable lesson, but it led me to reflect on what exactly a historian’s job is. Is it within our realm of practice to take the arguments we make and extend them to encompass contemporary issues? Should it not be left up to our readers to decide how to apply our insights to their lives? I think this tendency to proselytize based on what an author felt he or she learned by conducting the research tends to bring in contemporary biases, and I feel including it takes away from a book’s merit.

[1] 18