Disease as Framework

Papers

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]

Malignant

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.