Health Is a Public Space

By Jane Greenway Carr

Editor Jane Carr interviews Eula Biss about her book On Immunity: An Inoculation, one of Publishers’ Weekly Best Books of 2014

Image: flickr/illuminating9_11

Image: flickr/illuminating9_11

Jane Carr: I want to start with the origins of the book and to ask whether you see yourself as a critic, a mediator, or a participant in this kind of flame debate that’s going on around vaccination?

Eula Biss: It’s an interesting question. I’ll start with the easiest. So I actually began researching vaccination for personal reasons, because I was pregnant with my son. I had heard some rumors about vaccine safety and vaccines really weren’t on my radar, I hadn’t been paying attention to them. I knew almost nothing, so I thought I would do a little research and see if there was any credibility behind some of the things I was hearing around vaccination. The further I got into the subject, the more fascinated I became, so long after I’d made my decision for my son and had vaccinated him, I was still reading more — reading more history, reading more anthropology, reading more of the science behind it. It’s just a surprisingly expansive subject that opens into many other subjects that are really compelling to me: environmentalism and paternalism, feminism, capitalism. There’s all of this stuff that vaccination rubs up against. And that’s how it became a book—my interest continued far beyond my personal stakes.

Jane Carr: Why dive so deeply and widely into the literary, cultural, scientific histories of immunity and of vaccination?

Eula Biss: I actually thought I was going to write something much shorter, but as soon as I started writing I discovered that there are dozens of things I felt I had to address if I was really going to give this a full treatment. That also determines the form of the book, so it’s written in thirty short sections, and it could have been much longer, but I didn’t want it to be a huge unwieldy, unreadable tome. I really wanted it to be a fast-paced, accessible read. One of the challenges was giving each subject that I thought needed to be addressed a fair treatment in a very short space. And that’s part of where I feel like my background as poet comes in. I do feel like a lot can be said in a few words. As for how I see myself in this debate, whether I’m a critic, or a participant, or a mediator…ideally, I think I’m all three of those. I think I’m undoubtedly a participant, and I have an opinion. I’m not neutral, but I also have critiques both of how this debate has been engaged in and the terms in which it is being addressed, and even the parameters of the debate – where people stop talking, where they start talking. This book came out of a self-critique too. There’s self-critique in this book that becomes a social critique, in that I’m critiquing my own initial hesitancy to vaccinate my son. In making that critique I’m also extending it into a cultural critique too, as I know I’m not the only person who has had that hesitancy. But in terms of being a mediator, I think that was also really important to me in this book. This is a hugely polarized space, and in that way it’s very similar to the space I was working in my last book Notes from No Man’s Land, where I was talking about race, which is also a polarized space where there are things you are and are not allowed to say. I wanted to enter that space and engage differently with another polarizing subject I thought, in some ways, was kind of tired and ideally would not be polarized anymore. And I do have empathy for all parties involved. I have empathy for the scientists and doctors involved, and for the parents and mothers and children involved, and I even have empathy for the pharmaceutical companies involved. I think that what I’m trying to bring to the page is an empathic approach to this conversation.

Jane Carr: I think that really comes through, particularly in the way that you locate the politics of vaccination in a wide variety of examples of intervention and the dynamics of power, so certainly class and race discrimination, all of these things that you’ve just described as polarizing: sexism, globalization, environmentalism, post-colonialism. One thing that emerged for me after reading your book was a strong desire to ask: with all of this experience and research at your back, what to you is the most urgent social or political concern about vaccination? Do you see it as a specific disease or debate—like [the resurgence of] measles and whooping cough in the US, polio in Pakistan and Nigeria, malaria in Africa—or something broader in scope?

Eula Biss: I think the broader urgency, for me, [is that] I feel like there’s a pressing need for us to step away from a kind of consumerist mentality in certain areas. I think vaccination, or maybe health care in general, is an area where it does not necessarily serve us or the people around us to approach vaccination or healthcare with a consumerist mentality, a kind of “what can I get for my money” mentality. Or “I want to be a savvy consumer, but what am I buying for myself?” I think, for me, the real pressing issue I was trying to drive at in this book is the need to refuse that way of thinking, which is difficult, because it is constantly advertised to us and it is also part of our culture, but to refuse that way of thinking in favor of the kind of thinking that better serves public health. And I think that stance, that “What can I do with or through my own body to serve someone else?” can be difficult, especially when the question is not really “What can I do through my body?” but “What can I do through my child’s body?” I think that’s hugely challenging. I also think it’s really quite pressing and that we (“we” meaning the broadest “we”) can have a real impact on the health of people around us by accepting or refusing the vaccines. And then there are other tertiary issues that I think are also quite pressing. Issues of access in other countries and the politics of vaccination are really interesting, and my research didn’t take me deep enough into this to speak with great authority on [it], but it is interesting to look at how vaccine refusal in this country can affect vaccine availability in other countries.

A nurse vaccinating a child / Centers for Disease Control

A nurse vaccinating a child / Centers for Disease Control

Jane Carr: With the experience of writing this book and everything that went into it behind you, has your concept or definition of public health changed?

Eula Biss: I do think that when I began writing this, I had a tendency to think of myself as not necessarily included in the “public” of public health, and I do think that what shifted as I researched and wrote this is I had to accept the challenge – and I do think it’s a challenge – that I am the public. Many of us do tend to separate them; private and public are two things that we polarize when we talk about public health. I think we make the assumption that we’re talking about other people, not ourselves, and that “public health measures” are for other people.

Public health is the health of the collective, and so our individual health necessarily depends on it.

It’s interesting to see how no one of us is necessarily safe and healthy. This is illustrated even in world politics. Polio has spread from Pakistan to many other countries, and there are lots of reasons for that, part of which is the political situation in Pakistan. I think that’s one illustration of [how when] there’s political instability and people aren’t safe [or] well-served in one area, it’s clear that there will be ramifications for people in other areas. That’s why it matters what’s happening to the people around us. Their health is our health.

Jane Carr: That brings to mind the moment in On Immunity where you write that immunity is a public space. The relationship between the public and the body is fraught in America and you touch on this, I think, because its purported conceptual twin, the private, defines so many of the sacred common places that structure our religious beliefs, cultural beliefs, and political ideologies, so autonomy, purity, morality, individualism. I think there are a lot of different ways in which you set the stage or sketch the scenes of American skepticism or dismissiveness about science and scientific research, and I’m wondering if you make sense of the tension between protection and autonomy as particularly American? 

Eula Biss: Yes. I’d love to do further research to compare with the vaccine resistance in France and in Great Britain, and understand how they’re similar or different from American resistance and talk to people over there. But my stance is that I do think there is a very particular brand of American resistance that hooked into some things that are very culturally veered with us. Not just immunity as a public space but also parks as a public space or bike paths as a public space. I was thinking about this as I was writing this book. I started looking at the public spaces that I used everyday, and I realized that I used a lot of them. I play in a lot of playgrounds and parks with my son and all of those are public spaces, and I use the public library here a lot, and my son spends a lot of his day in a semi-public space, in a pre-school. I was thinking about how when we don’t value those spaces, what a kind of hostility it is to other people and how damaging that is to people who do value those spaces and need those spaces.

In terms of specifically our attitude towards science, I think that also has something to do with the cult of the individual.

I do think that there’s something threatening especially to smart, well-educated, middle class people about the idea that they can’t rely solely on their own analysis to make a decision, and that they have to trust and depend on what is now an enormous international network of researchers, who are also inter-reliant.

I think it’s quite beautiful, but it’s also easy for me to see how it’s threatening. I was writing recently about the Borg in Star Trek, and I think that’s how we sometimes think of science, as this scary collective thing and they’re trying to sell us their group-think, and if we’re going to maintain our integrity as individuals, we have to refuse and stay independent.

Image: DeviantART/Blackjack0919

Image: DeviantART/Blackjack0919

I think that’s part of it, but obviously there’s more to it, it’s more complicated. But that’s the attitude I sense behind the people I know who have a high degree of skepticism and make leaps of association. I’m a thinker who tends towards leaps of association, so I have a lot of empathy for that. But when I was talking with people about this subject, I saw [them] making enormous leaps of association between the science around vaccination and fairly unrelated fields, like the corruption of pharmaceutical companies, or the problems in our medical system. And I think all of those things exist, there is corruption in pharmaceutical companies and in the government, and we do have problems in our medical system, but that doesn’t mean that all vaccines are evil and bad and will hurt our bodies. There’s a big leap being made there, a kind of desire to put things in boxes that are labeled either bad or good, and vaccines are associated with a lot of things that get thrown into the bad box.

Jane Carr: What I really love about the way you phrased that is that it reminds me of the question you ask, “what will we do with our fear?” As if it has to have a place. In some ways it sounds like what you’re describing is that fear is something that we need to not embrace as a collective value, but acknowledge as a collective experience.

Eula Biss: Yeah, absolutely. And I think it would be helpful for us to acknowledge or agree upon the idea that fear alone is not a justification for any action we choose to take. This extends to all kinds of things, like “should you be allowed to shoot an unarmed teenager if scared of him?” I think not.

I think that just your fear alone doesn’t entitle you to kill someone. I do think there’s this attitude that if you truly believe your child is in danger, whatever you do is justified.

I think that’s seriously dangerous, it’s dangerous on a small-scale level, and it’s dangerous definitely on a bigger scale, especially if a lot of people are engaging their fear in that manner. It really does become a public health issue.

Jane Carr: Your descriptions of motherhood are very revealing in their exposure of bodily autonomy as culturally constructed. I’m curious where you would place parenthood—mothering or parenting children who are not biologically your own—in that?

Eula Biss: I think most, if not all, of what I’m saying in the book applies just as much to a father or a non-biological parent, and adoptive parents, or anyone who is engaged in parenting, not specifically a mother. And I did wrestle with whether I was going to address mothers directly and use the word “mother” rather than “parent,” and there are a few reasons why I chose to preserve the word mother, and part of it was out of a sense of debt to the vast majority of the people who contributed to this book. The people who I was in constant conversation with were other mothers, and I didn’t want to erase that. I also didn’t want to erase the specificity of my own experience, so there was, for me, the experience of carrying a child, and delivering my child, and then caring for a newborn. That physical experience was profound in terms of how it affected my thinking. Very soon after my son was born, I realized that my health and his health were inextricably linked. So even after our bodies were separated, I understood that in order for him to thrive, I had to be healthy too. I couldn’t just turn over all of my resources to him and sort of shrivel away. I don’t think you have to have a biological relationship to your child to experience that. When you’re in a caretaking position and you have someone who is [so] dependent on you, [it] can reveal to you how important your health is to that other person, and it was not a large leap to think about how his health affected the other people around him. So I understood how my health was going to affect him, but I also thought about who does he touch, and how is his health going to effect the other children he plays with at the playground or his friends at preschool and the other bodies he’s coming into contact with.

Image: National Archives (UK)

Image: National Archives (UK)

Jane Carr: In this book, you put such a really lively array of literary and historical sources in conversations with more theoretical or abstract work by public intellectuals, heavy-hitting cultural studies scholars, cognitive linguists and the like. I wanted to ask what it was like to live the research life of this book? Were there surprises, materials that you uncovered or recovered?

Eula Biss: It was exciting and thrilling and really frustrating and maddening too. I really enjoyed doing the research for this book but I was also thoroughly exhausted by it and deeply frustrated. Part of it was that in terms of the science, I was starting with very little base knowledge. So when I was reading into immunology and reading in the sciences, I was starting from zero and learning everything I had to learn: learning terminology, learning biology, learning basic background in order to understand what I was encountering. That was super-overwhelming and I think that’s part of why I reached into areas that were a little more comfortable and familiar to me. I reached into literature. I read Dracula and I re-read Candide. Part of that is also typical to my research pattern, which is that when I’m really engaged with something, I reach in every direction. I just grab anything that’s available to me. I do usually end up going in a lot of directions. But that was particularly true with this book. And the literature did often help me understand what I was trying to learn in the sciences. For example, Dracula is a really great portrait of how a layperson of that time understood germ theory, which had newly emerged. It was a really exciting read to me for that reason: to say okay, here’s an author, also not a scientist, synthesizing his understanding of germ theory in a literary work. And that gave me a lot of inspiration for how I might take what I was learning about current theory and practice and understanding in immunology and somehow synthesize it into a literary work.

Jane Carr: Dracula and Diary of a Plague Year really were very suggestive for me as a reader of your belief that the literary has a role to play in public health. That came through very strongly to me not only in what you just said but also in the book overall.

Eula Biss: Absolutely. I actually have a friend who did her dissertation on early American medicine. Part of her thesis was that early American medicine drew a lot more from literature than contemporary medicine does. My sense of what she’s saying is that we would do well to have that much intercourse still between literature and our medicine. I’ve also talked to many doctors and scientists who are big readers and lovers of literature and who actually did see that their thinking was informed by arts and literature in general.

Jane Carr: In a lot of ways, I think that contributes to the process of translation from one discipline to another or one set of language to another. It reminds me of that moment in the book when you talk about your sister describing morality and language as things that can’t be private because they can’t just be yours. That seems very on point.

Eula Biss: I loved that point that she made. It had never occurred to me to think that language and morality share that.

Jane Carr: I want to ask about metaphor: you make it do these amazing things while you’re taking it apart. There were dozens, but to choose just one: the moment where you make that hugely capacious comparison between the national body and the human body. You also paraphrase Susan Sontag that bad metaphors can disrupt our understanding of our bodies, but what I think is really interesting about your book is that it makes this very strong case that bad metaphors – or I guess I’ll refuse the good/bad binary because your book does – that our selection and deployment of metaphors can disrupt our understanding much more than that. I wonder what you want your reader to take away from this book about metaphor specifically?

Eula Biss: I see metaphor as a tool, a tool for thought. For me, it’s an invaluable tool, a tool we can’t do without. I don’t think we ever are going to do without it. I was reading this book on metaphor, I is an Other. It opens talking about all the thinkers throughout history who have disavowed metaphor and said they were going to get rid of it entirely. And that’s not the project to me. I don’t think we should or can stop using metaphor as a tool for thought. At least, the way that I think is entirely dependent on it. But I do think that the strength of the metaphor determines how well it functions as a tool. There are weak metaphors that don’t offer very much insight. There are metaphors that are counterproductive. There are also metaphors that are extremely apt and shine light on the thing you’re trying to understand. With most metaphors, you’re using something you’re familiar with to understand something you’re not familiar with. Throughout this book, whenever I dismantled a metaphor or damaged a metaphor or exposed a metaphor as not very apt, I tried to replace it with a metaphor that I thought was a better tool for thought. For example, there [are] all these metaphors of financial corruption or corruption in general around vaccines. The idea of corruption has been clinging to vaccines since they emerged, for hundreds of years—corruption of the blood, corruption of the body, financial corruption—but we now are kind of specifically locating that in a kind of capitalist space of corruption. I tried to chip away at that. I don’t [think] that metaphor of corruption around vaccines is particularly enlightening. Whenever I looked into the economics I didn’t feel that there was a massive web of corruption there. I just didn’t find that. And so I tried to shift that metaphor of fiscal corruption to a metaphor of fiscal responsibility. So throughout the book I use the term “banking” frequently, and I often use it in a metaphoric way. I talk about blood banking and I use blood banking as a metaphor for what we’re doing when we vaccinate ourselves, it’s as if we’re contributing to a “bank” of immunity. I wanted to offer another metaphor for thinking into that space, rather than just stripping away a metaphor that I didn’t think was very helpful.

Image: Flickr/European Commission DG ECHO

Image: Flickr/European Commission DG ECHO

Jane Carr: That brings me to one aspect of your writing process that I’m really interested in, the descriptive use of italicized keywords – virus, conscience, autonomy, optimism. The way I read them is as opportunities to re-invest your reader in your focus on language and to challenge cultural perceptions or conventional wisdom that we attach to the words we use, to make us more mindful of that mechanism of attachment. How did that technique develop over the course of the book?

Eula Biss: As I’m writing I look for the words that are recurring, that keep turning up, and then I try to learn more about the word as a way of learning more about what I’m really trying to say. Because part of this is intuitive, and I’m actually such an intuitive writer that part of this process is about uncovering what it is that I already know and don’t know I know. And so watching my own language is a way of doing that. An example of that is inoculation – I was drawn to using the word inoculation instead of vaccination in many parts of this book. In some cases they’re interchangeable, though inoculation is a broader term and that’s part of why I was interested in using it, it’s a little more all-encompassing. But after using it so frequently, I looked into its etymology and looked up the various meanings of the word because I thought, “Okay, this word is emerging as very, very important to this text. I need to have a fuller understanding of what it means.” And I was so excited to see that one of its meanings is to join or unite, because to me that was one of the primary purposes behind the book, this kind of pulling together of things that had been polarized or pulling together ways of thinking that have been pushed apart. Or pulling together of people like mothers and doctors, who have been located in two different interest areas, when very often, we really actually have the same interests and we shouldn’t be, I think, pushed into two different categories. And so I actually hadn’t committed to the subtitle until I saw that as part of the definition of the word. When I saw that, I felt like that was the right subtitle for the book.

Jane Carr: If you were to construct a working inter-definition of immunity and community today, how would you go about doing that? The book is very suggestive in terms of those two words having an interdependence. I think there’s also a kind of lived, policy-based reality to that interdependence as well. For example, when you’re writing about triclosan, you write that you’re “not a poet or the press, but an essayist, a citizen-thinker.” Does that positionality give you clarity about the relationship between immunity and community?

Eula Biss: I think that while I was writing this, I looked up the etymology of community because I was quite sure that immunity and community shared a root. I was actually disappointed to learn that the “munity” in community has a different source than the “munity” in immunity. I could be wrong about this, but I think they come out from slightly different Latin roots. They come out sounding the same but they come from different directions. The “munity” in immunity does have to do with duty and immunity means to be free from duty, specifically duty to the collective. I’m pretty sure the “munity” in community is munis like locality, like shared locality. That said, I think it would be really interesting to think of both community and immunity as a place where we have duties. And duties that are onerous, but duties that are a way of nurturing the people around us. This came up very early in my research so this feels more obvious to me now – but what she said struck me as quite profound. [A doctor I was interviewing] said, “I just feel that if you are a member of a society, you have duties to that society. And if you’re going to reap the benefits of belonging to a society, you have duties to contribute to that society in certain ways.” I do think that isn’t something we have a really robust and strong conversation about in this country. I do think it would be useful for us to think more about what duties [are] involved in community. What are the duties involved in maintaining immunity? I do think we have certain things that we just owe to the people around us.

Jane Carr: You talk in the book about H1N1, antiobiotic-resistant bacteria, and novel diseases. And you talk about diseases like SARS and Ebola that rise to what Sontag might call “plague” proportions but that don’t feel threatening to “people like us.” I’m wondering particularly what Ebola is bringing up for you now? Do you have thoughts about whether this particular moment is an opportunity to challenge that kind of othering that structures how we think about disease, or whether it’s emblematic in some way of some of the things you write about in the book?

Eula Biss: I think what’s going on with Ebola is really charged for a lot of reasons but part of it is because it’s located in Africa, and I think Africa is a place that we look to other. I think in some ways we tend to feel that we don’t need to be threatened by a disease as long as it stays contained in Africa because Africa seems so other to us.*



Jane Carr: You get at that othering when you write about Rachel Carson’s Silent Spring and the impact of banning the use of DDT [which had the inadvertent effect of allowing a surge in mosquito populations and malaria infections outside the U.S.]. You quote her biographer: “Our bodies are not a boundary.” But then what happens when the boundaries are traversed by bodies?

Eula Biss: I love Carson’s metaphor of the web. And the idea that a person anywhere on the web is going to send ripples through the rest of the web. And I think that is consistently true of disease no matter where the origin of the disease is. The idea that Ebola would stay in Africa if we didn’t bring these people back here for treatment is totally a mirage. Our boundaries are just very porous now, more than other points in history, but even if you go back as far as the Black Death, boundaries were already porous then. People and diseases will and do move, no matter what measures we pose to try to prevent that. The attitude has to be: how are we going to address this problem that because it is Africa’s is now also ours? I think that goes back to the same idea that if people are suffering anywhere, people everywhere else are not guaranteed their comfort and safety. There’s no national boundary that can guarantee that, there’s no quarantine measure that can guarantee that. There’s something embarrassing I guess about this “we are each other” perspective. I’ve been trying to figure out some ways to say this that have some edge. It’s difficult. It becomes less gauzy when I think of it or talk about it in terms of particular situations. I was recently writing about a time during this research when I had been reading too much about infectious diseases and I became convinced I had pertussis. One of the things that I thought about when I thought I had pertussis was – I already knew from my research that pertussis is very contagious and that every 1 case of pertussis leads to somewhere around 17 new cases. Another tricky thing is that most people can’t be diagnosed until after they’ve been coughing for over two weeks. So you usually have a period of about two weeks where you’re highly contagious and you don’t know it. The criterion for diagnosis is that you’ve been coughing for over two weeks. So I eventually did go to the doctor and as I was sitting there in the waiting room I was thinking, “Who else did I infect?” I’d been dropping my son off at day care, where other moms had infant children. I was thinking about all the infants I could have exposed, all the people in my neighborhood playground, thinking about having exposed those children. As I meditated on this, my community just seemed so incredibly expansive to me. I was amazed at how many people I had touched in those two weeks and how many people I could have infected whose names I didn’t know. They were part of my community of contagion.

That’s one of those things that is profound to me: a community of contagion is enormous and expansive. Realizing that gives us an opportunity to really think about the lives our lives are in conversation with.

Jane Carr: Is there something you’re looking forward to most about the release of your book? Is there another project on your horizon you want to say a word about?

Eula Biss: I don’t look forward to this first phase in a release of a book. I have the temperament of a writer – shy, contained. I like being alone and writing. It’s much harder for me to be pushed out into the public space, answering questions and seeing reactions to the work. Once I’m through it I find it really satisfying and thrilling. I just have to shore myself up for it in advance. I do love it, I’m glad I have to do it, but I do feel like I have to steel myself for the moment when the work becomes public.

I don’t know what my next project is. I have a lot of essays that appeared as ideas while I was writing this book that I’d like to pursue now that I can. I think I’ll spend some time on shorter pieces, and maybe I’ll do another collection next. But then I also thought this book was going to be an essay, so I never know when another one’s going to sneak up on me.

Jane Carr: We’ll hope to stay posted on those developments!

Eula Biss: For sure.

* Editor’s Note: We conducted this interview prior to the release of On Immunity in September, before cases of Ebola emerged in the United States. To read more about domestic interpretations and approaches to the Ebola outbreak, see the data visualization in this issue.

eula_bissEula Biss is the author of three books: On Immunity: An Inoculation, Notes from No Man’s Land: American Essays, and The Balloonists. Her work has been supported by a Guggenheim Fellowship, a Howard Foundation Fellowship, an NEA Literature Fellowship, and a Jaffe Writers’ Award. She holds a B.A. in nonfiction writing from Hampshire College and a M.F.A. in nonfiction writing from the University of Iowa. Her essays have recently appeared in The Best American Nonrequired Reading and the Touchstone Anthology of Contemporary Nonfiction as well as in The BelieverGulf CoastDenver QuarterlyThird Coast, and Harper’s. Eula Biss and John Bresland are the Chicago-based band STET Everything.

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