Intolerant Bodies is beautifully written—an informed, informative, and engaging assessment of the history of autoimmunity. But the small book is far more than the short history it humbly claims to be; for Anderson and Mackay take on a complex subject many of us have struggled to summarize with more words than fewer.
As with many researchers, the difficulty of conceptualizing a body against itself has for me proven challenging—in my case, since 1973. In that year I accidentally drove a scythe into a nest of an angry yellow jackets—my sudden and startling introduction to a life threatened by anaphylaxis. I remember my doctors telling me that that the next sting could have no effect, or it could kill me. ‘But stay calm if you are stung,’ they repeatedly said. (Be calm about sudden death? Rather challenging and wholly counterintuitive.)
I also remember being told to forego my anthropological fieldwork in far off places where I could not receive proper and immediate emergency medical attention. That, of course, I ignored except when I was buzzed by hornets and wasps in Indonesia and India. In short, ‘be constantly vigilant,’ I was counseled. ‘Stay indoors, and by all means don’t worry; that would only make matters worse.’ Can you imagine? What fool thought up that prescription?
But most of all I remember the quandary of being told by my doctors that my reaction was caused by a problem of cellular recognition, a binding of immunoglobulin E (IgE) to an antigenic (anti-body gen-erating) stimulant producing a pathological response (ana [against] phylaxis [protection]). Though immunology as a field of medical sub-practice is, as Anderson and Mackay point out, not old, the documenting of anaphylaxis is anything but new. In fact, anaphylaxis forms the early backdrop against which modern immunology would define itself as a process of recognizing and eliminating non-self—that is, as an otherwise phylactic (protective) response.
As the result of this alienating experience, I began taking notes on what my doctors told me, developing a protocol for interviewing interested and informed fellow patients, and eventually working formally with bench and theoretical immunologists. In 1992 I wrote my first thoughts down on the subject in the final pages of a book called Foreign Bodies—a cultural study not about the elimination of otherness, but its assimilation, about the ‘stranger’ and how we respond to knowledge (dangerous or otherwise) that strangers possess. While writing the concluding chapter for that book, I struggled with the illogical idea that a protective system could exist that succeeded by not recognizing the self it was designed to protect—that autoimmunity could only be the result of a dangerous kind of self-recognition. Such a premise seemed more than odd to me, and not entirely coherent.
Though Anderson and Mackay attribute recognizing the social dimension of the original word, immunis, to Roberto Esposito, I had pointed this out 11 years earlier in that book on cultural assimilation. Following fieldwork in Indonesia in the early 1980s, during which I observed local villagers responses to WHO publicity about HIV/AIDS, I became convinced that immunology’s own models created a number of logical (and socially driven) fallacies, and, in particular, socially generated prejudices about how a supposedly Darwinian body recognizes and eliminates non-self. Put simply, Foreign Bodies was the beginning of what has come to be called my “search engine” argument about immunity (that is, our social and physical need to seek out information and assimilate it). This argument, in other words, emerged not from examining bench science on its own merits (this I would later do in The Age of Immunology ), but from trying to understand how another culture dealt conceptually with danger, self-knowledge, adaptation, and the association and dissociation of protective responses.
Just why, we may ask, should immunology have any special significance for a discussion of self-consciousness and dissociation? If the answer does not appear obvious, it may be helpful to recall the social nature of the Latin word immunis as describing the freedom from certain forms of social interaction, and, in particular, an exemption from public service. Being “immune,” or having immunity, in other words, has as much to do with forms of social reciprocity (or, as it were, their absence) as it does with bodily states; rather, bodily states are themselves extensions of forms of reciprocity that are social (Napier 1992: 179).
Here, it seemed, a better understanding of immunology should start by first seeing if immunology’s basic concepts do or do not resonate across cultures and diverse ways of thinking about danger—how things foreign affect and infects us, and what we learn from this process. Second, it should include from the outset some assessment of the original linguistic categories of thought on which contemporary descriptions depend. There are good reasons, in other words, for examining etymologies. And third (and especially where conundra persist) it should ask if other models of danger management and information gathering and assessment can be usefully applied to theories of immunity. After all, is not information assimilation (vaccinology, and now regenerative medicine more broadly) as important to healthy immune responses as elimination of non-self (immunology)? Moreover, are not the body’s responses at the cellular level also, then, as much about creation as they are about defense?
During the 1990s—and thanks to historian of immunology, Anne Marie Moulin—I was invited to express my views in front of some very interesting thinkers, including Melvin Cohn, Leslie Brent, Hilary Kaprowsky, and Max Essex to name some of the better-known virus- and immune-systems theorists attending the several pioneering symposia Moulin organized through the Institut Pasteur and the Fondation Marcel Mérieux. By then I had also collected dozens of patient narratives—mostly from those suffering connective tissue disorders—for whom an awareness of a self lost to autoimmunity was very much a real and consciously articulated concern. In addition I had the privilege of working with the distinguished lupus specialist, Matthew Laing, at Harvard’s Brigham and Women’s Hospital.
What emerged was telling: nearly everyone accepted that antigens—even viral antigens—were, rather like microbes, invasive agents. As Melvin Cohn said to me, “Immunology must be about the recognition and elimination of non-self. Otherwise, the body would become a toxic dumpsite.” But being told that their bodies were at war with their ‘selves’ flummoxed most autoimmune patients and made them think. It was medicine (and of course invasive microbiology) that occupied the domain of the take-for-granted. Viruses needed to remain invasive even if the fact that they lacked mobility meant that their ontological status remained ambiguous. Parmenides would have loved immunology.
By the mid-1990s it seemed only logical to me that the massive proliferation of B and T cells produced mostly in the thymus and bone marrow were adaptive mechanisms that worked as much as information search engines as they did systems of defense. Environmental adaptation keeps us alive, as much or more than do either elimination or simple avoidance—otherwise, we would all be dying of the common cold, as did so many isolated tribes. So in 2003 I published my “pre-stem cell” book on immunology in which I outlined what would now (rather anachronistically) be characterized as a “regenerative” view of immunity; for my basic premise, though unconventional at the time, has been proven correct: assessment of difference (assimilation of information) is equally as important to survival as is the eliminating of difference itself.
Though this idea is now increasingly accepted (following the advent of stem cell research, regenerative medicine, and a few Nobel Prizes awarded for showing that viral information could lead to the turning on and off of genes), arguing that defense was not immunology’s sole mission was unusual in the 1980s and early 1990s. Indeed, most immunologists today still cling to the idea, as the authors of Intolerable Bodies make clear, that protection and preservation are Darwinian laws that cannot be violated. Nobody yet seems prepared to ask if perhaps self-preservation is less our species goal than are knowledge and creativity. Perhaps creative responses are just as crucial.
In short, if protection were our simple, Darwinian goal, why do we need protection against viruses if they lack mobility and cannot reproduce? After all, it is our cells that bring life to viruses and function as vectors for transferring information. In the end, viruses are just information. They can remain inert for thousands of years until our cells bring life to that information for better or worse. This fact, at least so far as we know, is incontrovertible. Information assessment drives the argument for creativity, even if it does so to the annoyance of immunologists raised to think of viruses as principally invasive. Indeed, Melvin Cohn once told me bluntly that he would have to quit immunology were he to accept my view, though he could not flatly dismiss it.
What was missing, in other words, in immunology from the 1960s through the 1990s was an understanding of how cellular responses could function as risk-laden, creative mechanisms for engaging difference (as signals in the search engine we each might be blessed or damned by). Consider the Cold War era: fears of espionage, cybernetics, and artificial intelligence were everywhere. The body’s mission in such an environment could only be to ward off invasive agents. And autoimmunity produced the perfect demonology.
As Nietzsche said, “In a time of peace, the war-like man attacks himself.” This fact is no better evidenced than in the so-called Dark Ages of autoimmunity.
Silverstein elegantly demonstrated this back in 1989 when he dated the waxing and waning of autoimmune research. What he did not do, however, was connect this fluctuation with overriding social concerns. After all, it was outside of the two great wars (the times of peace before 1910 and after 1945) that autoimmune research flourished. Between those years there were plenty of real foreigners to fear. Who has made this point and accepted its deeper consequences? There is still so much to do.
Indeed, newer ideas of the immune system are no less profound reflections of cultural circumstance–how in any given era we use history to make stable what in living memory is very uncertain. To wit, no matter how we now trace the ‘origins’ of regenerative medicine to the late 1990s, the concept yet remains eclectic and ill-defined. Most doctors still cannot, in 2014, provide a simple account of what RM is, and tissue and cell biologists cannot agree with immunologists on its definition either. Though regenerative medicine principally involves innovations in cell and gene therapy, tissue engineering, and related new molecules, as soon as we factor in viral vectors it also has much to do with immunology and virology. As for patients, most assume that anything that regenerates life is regenerative, though, in fact, most have not yet heard of this emerging domain of research and clinical practice.
So, history, and history making, can mislead us into thinking that an idea recognized and widely used today was heralded and stabilized at its inception. Jenner, had he lived 200 hundred years after 1798, would have been our major advocate for demanding a reality check: ideas may have no impact when a discovery is made. So let’s rethink the recent history of immunology with this in mind.
Moulin dates the concept of the immune system to the late-1960s. And I can say from longstanding fieldwork that the idea was just coming of age around the time I had my anaphylactic moment in the eary-1970s. These social facts are important; for researchers, doctors, and patients had, in fact, not fully taken on the notion of an ‘immune system’ before the Cold War, even if the body fighting itself was recognized, relatively speaking, much earlier. The point is far from academic because it makes us accept another deep problem.
How, we might rightly ask, can invasive agents be expelled by a system that to this day cannot be experimentally verified? Immunity? Yes. Immune system? No. As Cohn has bravely stated, the very idea of an immune system is predicated “on experimental systems of such great complexity that many interpretations are possible and reproducibility becomes a luxury”. Yes, we have systemic responses, as autoimmunity supremely demonstrates. But that fact does not in itself prove that a system governs our responses.
In fact, ethnography and history suggests quite the opposite. Before the Cold War there were no observations about an “immune system”; for it did not exist as such. There was, by contrast, an immunology focused on immune responses, be they patterned or not. Those concerns, however, should not be confused with the ‘immune system’ we today take for granted as real. That ‘reality’ would take Jerne, many others, and lots of trial and error to become a culturally embedded idea.
And what about creativity? Setting aside the huge leap in regenerative medicine that accepts as commonplace the replacement of cellular elimination with baseline (stem) modification, it is now evolutionary biology, virology, and vaccinology that lead the way in helping us understand how humankind and its social practices differentiate us quite dramatically from other species—and especially how symbiotic is our acquired immunity in the first two years of life.
In this regard, the authors’ final quotation from Inga Clendinnen, historian and autoimmune hepatitis sufferer, is most telling. It is, after all, we humans “pursuing our peculiar passion for talking with strangers,” as Clendinnen says, that make adjustment, or the failure to adjust, at all possible. For the ‘strangers’ we meet are also the sentinels that inform us not only about the foreign, but about the limits of the very ideas we take for granted. In this regard the question for a new immunology is less one of how we defend ourselves from hazardous information, than one of why attraction itself matters so much to us.
In 2003, my publishers sent my immunology book to Derrida on the back of their having just published his conversations with Habermas on autoimmunity. I suspect Derrida’s response might have been enigmatic; but he died before he could be the messenger.
David Napier is Professor of Medical Anthropology at University College London, and Director of its Science, Medicine, and Society Network. Originally trained in philosophy, he went on to study anthropology at Oxford. Napier has conducted fieldwork in South and Southeast Asia, including Indonesia, India, Nepal, Burma, and Bhutan. He has published widely and has special interests are in cultural history, social trust, migration and vulnerability, sociobiology, and immunology. He is also the lead author of a new Lancet Commission on Culture and Health.