Some years after beginning our research for Intolerant Bodies, I told my co-author Ian R. Mackay that finally I was learning the immunology I should have known as his intern in 1984. “Indeed,” was the cutting response. I knew better than to protest that most ordinary medical doctors comprehend few of the technicalities of immunology, especially the intricacies and mysteries of autoimmune disease. That I was not alone in my ignorance would mean little to Mackay, then in his late eighties and wise to the ways of the world. About this time, I also realized why no one else had attempted to write the history of autoimmunity, where the body’s tolerance of its own materiality breaks down—it was just so difficult to make accessible such recondite knowledge. The contributors to this forum—for which we are grateful—seem to appreciate our efforts to shed light on one of the more cryptic and controvertible exercises in biomedical science, though we suspect some of this stuff, despite our best efforts, remains obscure. We persevered in the task because we believe that the history of ideas about allergy and autoimmunity is necessary to a full understanding of conceptions of biological individuality and idiosyncrasy in the twentieth century. Such a history enables us to see disease persisting as a biographical process, to recognize the co-constitution of the normal and the pathological in individuals. Moreover, this concept of pathogenesis, recursively emerging and proliferating during the Cold War and a period of significant decolonization, has profound implications for how we frame identity and sovereignty in the contemporary world. (Mackay and I share this interest in the cultural salience of immunology and the philosophy of autoimmunity, especially the late work of Jacques Derrida.) As Peter Sloterdijk claims, “practical metaphysics has to be translated into the language of general immunology because human beings, due to their openness to the world, are extremely vulnerable—from a biological level, to the juridical and social levels, to the symbolic and ritual levels.”[i] In writing Intolerant Bodies, Mackay and I wanted to reveal the entanglement, the inseparability, of biology, clinical medicine, philosophy, and patient experience—all touching on the conundrum of self and other. As Ilana Löwy mentions in this forum, autoimmunity is on multiple levels bon à penser. We believe this interpretive amplitude makes our book a very unusual, if not unique, history of biomedical science.[ii]
Many of the contributors to this forum observe the remarkable transfer of metaphor, analogy, and model between immunology and social theory—indeed, as we discuss in the book, anthropologist A. David Napier is a leader in trying to figure out the immunological metaphysics of identity. Provocatively, he reads immunology as providing a framework for generating knowledge and creativity, not just as a mechanism of defense. His image of the immune system as an “information search engine” is consistent with much contemporary immunological theory, and it even conjures up F. Macfarlane Burnet’s earlier advocacy of “immunological surveillance,” which derived from the Cold-War obsession with epidemiological surveillance. It was Burnet, of course, who wrote: “immunology has always seemed to me more a problem in philosophy than a practical science.”[iii] Burnet regarded tolerance of the body itself, the lack of self-antigenicity, as the fundamental concern of immunology. From philosophy, information theory, and cybernetics, he introduced concepts such as “self,” “surveillance,” and “tolerance.” Intolerant Bodies, as Angela Creager and Löwy observe here, traces the passage of these metaphors and models—these organizing principles—from social theory to the laboratory to the clinic and back again. Admittedly, we concentrate on the concept of “self”, as Nathaniel Comfort points out, since we are following our historical actors, not providing a normative account of the immune system, or envisaging the immune system we would like. Although he shared the 1960 Nobel Prize in Physiology or Medicine with Peter Medawar for the discovery of immunological tolerance, Burnet made sure the self became sovereign in Cold-War immunology. In a recent post on Somatosphere, I suggested that the obsession with a pre-formed self delayed, until recently, the development in immunology of more dynamic, ecologically diverse concepts of tolerance. Thus self might represent what Thomas Parkes Hughes would have called a “reverse salient” in the history of immunology.[iv] In most other matters biological, Burnet displayed exquisite ecological sensitivity—but his immunological theory was, it seems, in thrall to the post-war culture of narcissism. As Napier claims here, and as we seek to demonstrate in our book, “ideas of the immune system are … profound reflections of cultural circumstances.”
Mackay and I first thought of writing this book after recalling some of the patients with autoimmune conditions we had looked after—in his case, over a whole career; in mine, briefly in training. We wanted to convey the thoughts of these patients on the diseases they endured. Too often, scientists and physicians have captured and imprisoned the conceptual history of disease, as if those who live with these conditions do not also do intellectual work. In particular, we wanted to know whether those suffering diseases classified as autoimmune came to think immunologically about their bodies. We argue that while clinicians and patients in the major English-speaking countries in the 1960s increasingly resorted to notions of self, they used the term in quite different ways. Patients with chronic illness, regardless of its cause, found themselves doing “biographical work,” trying to maintain or restore a social self—at the same time as their physicians tried to recuperate immunological self-tolerance through use of corticosteroids and other drugs.[v] Only in the last fifteen or so years have some medically oriented patients addressed the immunogenic aspects of their illness—that is, come to imagine their chronic illness as specific autoimmune disease. Our sources are meager, as we note in the book, but Comfort is wrong to claim we rely on a “smattering of published patient memoirs.” Indeed, we were able to review hundreds of Mackay’s private case histories (The Royal Melbourne Hospital having destroyed its records) in order to sketch the experience of autoimmune disease in Melbourne, Australia, in the 1960s and 1970s. While our efforts are barely adequate, historians of medicine in the United States should recognize that current restrictions on access to clinical records would make even our “thin” analysis impossible to accomplish in that country. I expect the historical reconstruction of clinical research from the patient’s view in Intolerant Bodies is as good as one will get in the foreseeable future. We enthusiastically endorse Comfort’s call for more ethnographic research in this area.
Intolerant Bodies is a short history of autoimmunity, and thus necessarily abbreviated, even though we cover extensive ground. Predictably, I wanted more philosophy; Mackay argued for more contemporary immunology and “personalized medicine.” To the surprise of those who know us, we both compromised. Despite a few vexations, it proved a very satisfying collaboration. Having read Creager’s explanation of how theories of the generation of antibody diversity have challenged older concepts of the gene, I now can see how we could have included this point. There it is again: the play of sovereignty and deconstruction, and of integrative biology and molecular reductionism. But we never intended Intolerant Bodies to be the last word in the history of immunology: rather, we want it to prompt readers to think differently about biomedicine, the self, and the body in the twentieth century. The participants in this forum have given us hope that this will happen.
[i] Peter Sloterdijk in Eirk Morse, “Something in the Air: Interview with Peter Sloterdijk,” Frieze 129 (2009). Accessed 29 March 2013. www.frieze.com/issue/something_in_the_air
[ii] Though not unrelated to the inimitable Georges Canguilhem, The Normal and the Pathological, trans. Carolyn R. Fawcett with Robert S. Chen (New York: Zone Books, 1989). More than twenty years ago, we proposed a book like Intolerant Bodies in Warwick Anderson, Barbara Gutmann Rosenkrantz, and Myles Jackson, “Toward an Unnatural History of Immunology,” Journal of the History of Biology 27 (1994): 575-94.
[iii] F. Macfarlane Burnet, “A Darwinian Approach to Immunity,” in Molecular and Cellular Basis of Antibody Formation: Proceedings of a Symposium, Prague, June 1-5, 1965, edited by J. Sterzl (New York: Academic Press, 1965), 17-20, p. 17.
[iv] Thomas Parkes Hughes, Networks of Power: Electrification in Western Society, 1880-1930 (Baltimore: Johns Hopkins University Press, 1983).
[v] Juliet Corbin and Anselm L. Strauss, “Accompaniments of Chronic Illness: Change in Body, Self, Biography, and Biographical Time,” in The Experience and Management of Chronic Illness, edited by Julius A. Roth and Peter Conrad (Greenwich CT: JAI Press, 1987), 149-81.
Warwick Anderson is the co-author, with Ian R. Mackay, of Intolerant Bodies: A Short History of Autoimmunity (Baltimore: Johns Hopkins University Press, 2014). He is grateful to Ian Mackay for advice and discussion in the formulation of this response, and to the Somatosphere reviewers and editors for their engagement with our book.