Plagues and Epidemics

Infected Spaces Past and Present

D. Ann Herring, Alan C. Swedlund, D. Ann Herring, Alan C. Swedlund

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000181555
• Edition: 1
• Topic: Social Sciences
• Subtopic: Anthropology
• Index: Social Sciences

Until recently, plagues were thought to belong in the ancient past. Now there are deep worries about global pandemics. This book presents views from anthropology about this much publicized and complex problem. The authors take us to places where epidemics are erupting, waning, or gone, and to other places where they have not yet arrived, but where a frightening story line is already in place. They explore public health bureaucracies and political arenas where the power lies to make decisions about what is, and is not, an epidemic. They look back into global history to uncover disease trends and look ahead to a future of expanding plagues within the context of climate change. The chapters are written from a range of perspectives, from the science of modeling epidemics to the social science of understanding them. Patterns emerge when people are engulfed by diseases labeled as epidemics but which have the hallmarks of plague. There are cycles of shame and blame, stigma, isolation of the sick, fear of contagion, and end-of-the-world scenarios. Plague, it would seem, is still among us.

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Plagues and Epidemics in Anthropological Perspective

D. Ann Herring and Alan C. Swedlund

We live in a time obsessed with killer germs (Tomes 2000). People worldwide feel a growing sense of vulnerability and uncertainty with respect to infectious diseases as an expanding list of pathogens— referred to as "emerging infections"—becomes visible to investigators in conjunction with an increasingly lower technoscientific threshold for detection that reveals more diseases and their agents than ever imagined (Kilbourne 2006). As knowledge about pathogens is produced in laboratories and disseminated through various media to enter public consciousness (Briggs 2005), anxiety is rekindled about mortality on the scale of historic plagues such as the fourteenth-century Black Death in Europe. The anxiety spurs ever more research into conditions favoring the eruption of plagues today (Morse 1993).

In concert with a new language about emerging infections, an epidemiological story line has come to dominate discussions of the threat of infectious disease. Set against the certainty that "a tsunami is coming" (Nature 2009: 9), it describes scientists' discovery of a threatening infection, its travel through global networks, and medical projects that culminate in its control (Wald 2008). Whiffs of plague emanate from the story in the form of affliction, contagion, external threat, and dangerous relations; the crisis is resolved through appropriate moral behavior, expressed as medical intervention and effected through changes in cultural practices. In the wake of the story, the people among whom the disease has been made visible are often pathologized and tainted by that association through medical profiling (Briggs 2005; Briggs with Mantini-Briggs 2003). The emotive qualities of plague persist through memory, individual experience, and the social, economic, and political processes through which the story itself becomes a complex object that is mapped out, communicated, and perpetuated. The global reaction to the identification in 2009 of a new swine-flu-related H1N1 strain of influenza exemplifies the extent to which the story has become highly contagious and come to infect the world.

In September 2007 a group of anthropologists and scholars from allied fields met in Tucson, Arizona, to discuss the much publicized problem of infectious disease in the twenty-first century. Our symposium, generously funded by the Wenner-Gren Foundation for Anthropological Research, brought scholars engaged in the science of modeling and quantifying epidemics together with scholars engaged from historical, interpretive, critical, and metaphorical standpoints. Anthropologists are relative latecomers to the study of epidemics (Lindenbaum 2001: 378). Our aim was to encourage a conversation and exchange of ideas among researchers who, because of the Balkanization of academic thought and divisions in anthropology departments today, might not otherwise be aware of the richness of each other's work or of what each could contribute to and learn from the others. We wanted to breach the persistent gulf between the branches of anthropology to bring to bear the full power of our discipline's broad vision of humanity to address the issue of infected spaces, epidemics, and plagues.

We therefore chose not to organize the meeting around geographical regions or to ensure that particular infectious diseases were discussed. Rather, we were interested in convoking an unusual mix of scholars who brought qualitative and quantitative approaches in historical and contemporary settings to the same disease (such as HIV/AIDS) or issue (such as colonial medicine) and who represented a spectrum of research experience, from recently graduated PhDs to professors emeriti. Some readers of this collection may be disappointed by the omission of major historical plagues, such as the Black Death and syphilis, and of case studies from geographical areas such as the African continent. This is not because anthropologists are not offering new insights into these classic epidemics and infected spaces. The composition of scholars at our Wenner-Gren conference was determined not by their new findings about particular diseases but by the interesting and novel ways in which they were thinking about epidemics and plagues as ideas (see Ranger and Slack 1992) and about the political, cultural, and biological configurations they take.

Past and Present

Our project for the Tucson meeting and this volume was not only to explore anthropological thinking about epidemics but also to slice the discipline in order to lay bare the ways in which historical research speaks to contemporary ethnographic research, and vice versa. Current thinking about epidemics is rooted in past experience, and past experience, in turn, is reinterpreted through the imagination of the present.

Studies of the classic symbol of plague, bubonic plague (Yersinia pestis), illustrate the complex reticulations between past and present interpretations of disease. When bubonic plague erupted in India in the late nineteenth century, a concentrated international research effort was undertaken to determine its etiology. A group known as the Indian Plague Commission was formed because of mounting dread that the medieval levels of mortality associated with the Black Death would return (Cohn 2002:13) and because of "anxiety that this was Armageddon" (Chandavarkar 1992: 239). The commission discovered much of what is known about the epidemiology of bubonic plague (Chandavarkar 1992:204), and its findings in turn informed interpretations of the Black Death. The medieval historian Samuel Cohn Jr. contends, however, that this knowledge was misapplied to the Black Death, which he claims could not possibly have been caused by rat-based bubonic plague (Cohn 2002:1). "Historians and scientists have taken the epidemiology of the modern plague and imposed it on the past, ignoring, denying and even changing contemporary testimony, both narrative and quantitative, when it conflicts with notions of how modern bubonic plague should behave" (Cohn 2002: 2). Whether or not Cohn is correct, the debate over which pathogens actually caused the Black Death underlines the involuted process by which interpretations of epidemics in the past and present become entangled and mutually sustaining.

A thorough understanding of contemporary epidemics, moreover, requires attention to the short- and long-term circumstances that have converged to provide the soil in which the seed of an epidemic can thrive. In the absence of a historical framework, it is impossible to grasp, for example, the processes through which HIV/AIDS spread to Haiti, HIV-related disorders came to dominate its disease profile, and the disease itself became integrated into ways of understanding illness (Farmer 1992). Even avian influenza, a relatively recent disease problem, can be viewed through epidemiological transition theory as part of ancient recursive processes that have shaped human disease patterns from the earliest origins of our species (Barrett, this volume; Barrett et al. 1998). Among the challenges of historical research are the difficulties of interpreting ever-changing "grammars of death" (Anderton and Hautaniemi Leonard 2004) and evaluating how certain explanations or frameworks come to dominate the theoretical positions of researchers themselves (Rosenberg 1989), sometimes waxing and waning in significance at different times of their lives (Anderson, this volume). Our discussions in Tucson and the chapters in this book reflect this historical and life-cycle sensibility.

Epidemics and Plagues

In pursuing ways of thinking about infection in the twenty-first century that reflect the broad concerns of anthropology, we also sought to stretch the constraints of conventional public health definitions and approaches to infectious disease. Although all the participants in our Tucson conference can be said to study epidemics, our research has taught us that the label epidemic—"the occurrence in a community or region of cases of an illness, specific health-related behavior, or other health-related events clearly in excess of normal expectancy" (Last 2001: 60)— has multiple meanings for individuals and communities experiencing the phenomenon, and these understandings change through time. The technical term epidemic, however, tends to homogenize, erase, and belie the diversity of experiences of people who are suffering or have suffered through what we call epidemics. The authoritative and seemingly neutral statistical language of counting, so fundamental to the definition of "epidemic," often overwhelms accounts of direct and indirect human encounters with epidemics, which are essential elements in much historical and contemporary anthropological research.

Many of the chapters in this volume present the perspectives of people who have been engulfed in experiences of infectious diseases labeled epidemics but having the hallmarks of plague: cycles of shame and blame, stigmatizing discourses, isolation of the sick, fear of contagion, and end-of-the-world scenarios. Plague, it would seem, is still among us, but its dimensions are frequently disguised by medical statistics that tailor not only the ways in which diseases are perceived but also the local and international policies designed to control them (see Briggs with Mantini-Briggs 2003: 256-268; Trostle, this volume). Epidemics can be made to disappear through the hiding or discounting of cases, because states have vested interests in their images, and epidemics call attention to government failures (Nichter 2008: 119-131; Trostle, this volume). Epidemics may be created where none exists (Herring and Lockerbie, this volume; Lepani, this volume). Diseases themselves may be made to disappear as a consequence of medical disputes (Löwy, this volume) and shifts in nosologic systems (Duffin 2005).

Complexity

Anthropologists are increasingly adding social and historical texture to research on epidemics by employing sophisticated models—advanced analytical tools grounded in mathematics, social theory, and fieldwork— that make it possible to explore how complex networks of human relationships influence the dynamics of epidemics such as that of HIV/AIDS (Sattenspiel and Castillo-Chavez 1990; Sattenspiel et al. 1990). Here the mathematical language of counting and accounting refers generally to quantification and to statistical associations, respectively. Although the meanings attached to plague reside outside the purview of modelers, their methods imbue people in the models with qualities, refer to them as actors, allow them to make choices, and position them in intricate social networks shaped by the behavioral decisions of individuals and pairs and by the cultural, political, and economic contexts that constrain those decisions. When an epidemic is studied in this way, "everyone's risk is jointly affected by the behavior of everyone else in a complex feedback system" (Goodreau, this volume). The modeling of epidemics makes it possible to probe the "what ifs" of social life and behavior in the midst of a crisis and to uncover some of the complexity hidden by the term epidemic.

The hazard of delineating each epidemic as a distinct event that can be isolated in time and space recurs as a theme in these essays. When do epidemics begin and end? What are their borders? The concept of syndemics is particularly useful for drawing attention to the labyrinthine nature of epidemics. The syndemic approach requires that researchers look beyond individual infections to consider how they may be capacitated by the presence of other diseases and conditions and sustained by social inequity and the unjust exercise of power, which channels and sustains damaging disease clusters in disadvantaged populations (Singer 2009; Singer and Clair 2003). The key to syndemic thinking involves unraveling historical connections, both social and biological, that are woven into the fabric of ill health and give shape to infected spaces and epidemics. A direct link exists, for instance, between childhood Chagas' disease (American trypanosomiasis) and adult onset rheumatic heart disease (caused by Streptococcus pyogenes infection) among poor, rural children in Latin America (Löwy, this volume). Chagas' disease remains untreated because of lack of access to health care, and untreated Chagas' disease increases the probability that affected people will die from congestive heart failure in early adulthood (Singer et al. n.d.).

Similar co-occurrences characterized the once forgotten (Crosby 1989) but now highly publicized 1918 influenza pandemic. The very name of that pandemic cloaks the well-known observation that most of its excess mortality resulted from synergistic interactions between influenza and co-occurring bacterial infections such as those caused by Streptococcus, Staphylococcus, and Mycobacterium tuberculosis (Pearl 1919). Even the year 1918 in the pandemic's label needs to be reconsidered, in view of the fact that many people with tuberculosis who died from influenza in 1918 had acquired their tuberculosis infection decades before, making their demise that year a consequence of earlier life experience (Noymer, this volume). Although diseases may be tied biologically and socially to specific historical moments (Scheper-Hughes and Lock 1987), their spatial and temporal borders are fuzzy, and the edges of safety are unclear. A syndemics framework recognizes historical contingencies and interactions that are not readily apparent, allowing scholars to explore larger environments of risk and historically contingent social structures that converge to produce disproportionately infected spaces for some, but not all, members of society.

Anthropology, Epidemics, and Plagues

The essays in this volume reflect the broad expanse of anthropological inquiry and our stimulating, sometimes contentious, discussions in Tucson. Regardless of the perspective presented in each essay, the collection is strongly theorized, grounded in empirical research and specific case studies, and focused on probing into broad questions and themes in the subject of epidemics and plague. The authors have worked in many of the places in which emerging infections are said to be erupting. They take us into "the field," to places in which diseases have not yet arrived but are expected to take a heavy toll of human life and in which an epidemiological discourse has often arrived before the disease itself. They take us into the minds and memories of people who experienced plagues in their lifetimes. They transport us to places where plagues are waning and places where plagues are things of the past. They explore the ways in which researchers think about plagues and deploy their ideas in their work. They illuminate the way contemporary thinking about epidemics is anchored to images of plagues in the past and show how essentializing discourses, characteristic of the colonial period, continue to pathologize people who experience epidemics today. They study the way epidemic models are made and the ways in which they capture the complexity of human behavior, interactions, and cultural settings. They take us into public health bureaucracies and into the political arenas that control and disseminate information, where the power resides to make decisions about what is and is not an epidemic or a plague. They look back into deep history on a global scale to chart long historical disease trends, and they look ahead to the twenty-first century as a time of expanding and enhanced plagues in the context of climate change.

Frameworks

Merrill Singer, in chapter 2, invites us to think more deeply about circumstances in the twenty-first century that create new contexts in which infections can surge and interact in dynamic fashion. Building on the concept of syndemics described earlier, he argues that global processes that produce epidemics and plagues can be understood in terms of ecosyndemics. The emergence, spread, and interaction of diseases are being enhanced by climate change, human action, decision making, and the unequal and often oppressive structure of global social relations. It is important, therefore, to identify the strong, mutually reinforcing, and synergistic connections between large-scale environmental circumstances and the local health and social effects that are embedded in them. Major anthropogenic environmental changes, such as deforestation, agricultural intensification, dam construction, the industrialization of food production, increased population nucleation, and crowding in urban settings, are accelerating in tandem with the emergence and reemergence of pathogens, climate change, and persistent, large-scale, inegalitarian social structures. The environmental catastrophe of Hurricane Katrina in the US city of New Orleans exemplifies the action of ecosyndemic processes mediated by local microsocial processes. Over and above the physical destruction of the city's infrastructure and social damage to its residents, Katrina exacerbated already high rates of chronic and infectious disease, especially among historically disadvantaged groups living there. Singer calls for fresh studies of these problems and for a better understanding of how best to limit the health consequences of ecosyndemics and the social conditions that give rise to them.

In chapter 3, Charles Briggs draws attention to the ways in which health and technoscientific information is reshaping biomedical and scientific objects, institutions, and daily life. He analyses the structures through which story lines about emerging disease emanate, with fully formed packages of meanings, from the offices of public health officials and epidemiologists, are communicated through policy papers and news briefs, and are taken up by news media ("mediatization"). The public is expected to accept the nest of meanings and transform their intimate daily habits such as eating, drinking, and defecating. Briggs's concept of "communicability" describes the unidirectional process by which health professionals inform the public about new knowledge. Today, epidemics are "mediated objects from the get-go," Briggs writes, internalized through the media before they are experienced bodily by the public. Using two examples—cholera in Venezuela and West Nile virus in San Diego, California—he demonstrates how diseases that have not yet been reported take on particular biological, social, and political shapes in keeping with epidemiological projections, policy briefs, and news accounts communicated about them, and how public health officials and journalists collaborate in creating plagues. He challenges anthropologists to investigate sites of "epidemic struggle," the places where competing, complex understandings of diseases or epidemics are reduced to simple, reductionist narratives.

Jim Trostle, in chapter 4, considers how epidemics come to be defined in the first place, taking up the issue of who in fact has the power to observe and report on epidemics in the making. In "contested epidemics"—situations in which the existence of an epidemic is debated—particularly close attention is paid to enumeration and statistical estimation, central tools in epidemiological research. Trostle illustrates the concept by discussing the contested epidemic of civilian deaths during the current war in Iraq. He highlights the conflict that can arise between an epidemiologist's counts, which identify an epidemic of violence (or anything else deemed contrary to the interests of the state), and the state's view that it has the right to make its own claims about the legitimacy of that violence (or anything else involving public policy). Trostle calls for more research into the ways in which states remember and remain silent and in which epidemics can be made to appear or disappear.

Ron Barrett takes the long view of plague and in chapter 5 reviews the basic understanding of epidemiological transitions on a global scale, in deep history. Many scholars now argue that at least three major transitions have taken place in human health and disease profiles, in conjunction with significant shifts in subsistence, social organization, and demographic patterns (Barrett et al. 1998). The first, for example, occurred among people who participated in the shift from a nomadic foraging economy to a Neolithic pattern of sedentism, agriculture, and animal domestication. Barrett provides caveats about the generalizability of global epidemiological tra...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Contents
• List of Illustrations
• Acknowledgments
• List of Contributors
• 1 Plagues and Epidemics in Anthropological Perspective
• 2 Ecosyndemics: Global Warming and the Coming Plagues of the Twenty-first Century
• 3 Pressing Plagues: On the Mediated Communicability of Virtual Epidemics
• 4 On Creating Epidemics, Plagues, and Other Wartime Alarums and Excursions: Enumerating versus Estimating Civilian Mortality in Iraq
• 5 Avian Influenza and the Third Epidemiological Transition
• 6 Deconstructing an Epidemic: Cholera in Gibraltar
• 7 The End of a Plague? Tuberculosis in New Zealand
• 8 Epidemics and Time: Influenza and Tuberculosis during and after the 1918-1919 Pandemic
• 9 Everyday Mortality in the Time of Plague: Ordinary People in Massachusetts before and during the 1918 Influenza Epidemic
• 10 The Coming Plague of Avian Influenza
• 11 Past into Present: History and the Making of Knowledge about HIV/AIDS and Aboriginal People
• 12 Accounting for Epidemics: Mathematical Modeling and Anthropology
• 13 Social Inequalities and Dengue Transmission in Latin America
• 14 From Plague, an Epidemic Comes: Recounting Disease as Contamination and Configuration
• 15 Making Plagues Visible: Yellow Fever, Hookworm, and Chagas' Disease, 1900-1950
• 16 Metaphors of Malaria Eradication in Cold War Mexico
• 17 "Steady with Custom": Mediating HIV Prevention in the Trobriand Islands, Papua New Guinea
• 18 Explaining Kuru: Three Ways to Think about an Epidemic
• References
• Index