I’m posting this one as a reminder – to myself, mainly. I am just getting down to writing a new essay about the immune system, and came across a reference to David Napier’s book, which I no longer own. I sort of remembered it, but had no recollection of actually writing this review. Slightly disquieting that, especially as there is an entire chapter about the immune system in my last book. Then again, I guess I have written rather a lot of reviews – and it was a dozen years ago. And Google, it turns out, remembers when I do not.
Anyhow, here it is again, partly to ensure that I don’t repeat myself without realising it…
Western medicine is a war against disease, and the immune response is the first line of defence. A familiar notion, but it can still be startling to dip into almost any account of immunity, even more so if you are sensitised by living in a country that has recently been engaged in a real war. A world of molecules and cells becomes a battlefield, complete with alerts, invaders, recruitment and mobilisation, search-and-destroy missions and natural-born killers.
As ideas about the immune response developed into the notion of an immune system, in the 1960s and 70s, the combat metaphors inherited from the previous century’s germ theory acquired some new layers. Like the modern military, the immune system is equipped for recognition and identification, surveillance and challenge, command and control. It polices borders and challenges intruders. It even has special forces and smart weapons to deploy against any threats. And the whole apparatus is dedicated to one task: distinguishing between self and non-self, and subduing the latter.
Nor is this confined to the popular realm. Medical school textbooks and immunologists’ research papers are imbued with the same ideas. They are so central to the discipline that their use often passes unnoticed. They are not the only metaphors used in immunology, but they are overwhelmingly the most important.
David Napier is worried about all this. He does not argue that science should eschew metaphors, but he does believe that it matters which ones are developed so vigorously. He has three main concerns about this particular science. Does seeing the immune system as designed for protection of the self impede other, possibly more fruitful understandings of what all these obscure and complex cellular interactions inside us are about? How does the dominance of the self/non-self idea affect the experience of illness? And most important, what does it do to a society if everyone in it believes they are under constant threat from outside, which can only be withstood by eternal immunological vigilance?
His answers, briefly, are that the science needs to be completely rethought, that the ill suffer as a result of these ideas, and that the broader social effects are worst of all. He believes that all three are connected. Just what the connections are, and what one might hope to do about them, is less clear after working through his intriguing but also frustrating treatment. Somewhere here, among the rich assembly of Balinese masks and bacteriophages, World Bank lending policies and graphs of HIV infection, two-way mirror observation and reverse transcriptase, is a tantalising vision of new ways of thinking about identity and difference, and new ways of relating to other beings, whether they are viruses or humans. But most of the time it remains slightly out of focus.
This is partly because, as he says, his style is “in some places closely argued and in others expansive”. Expansive is an understatement. Napier is an anthropologist by trade, which equips him well for conveying the strangeness of our own cultures of health and illness. But it also gives him the confidence to pronounce on large issues without really arguing them through convincingly.
Anyone who writes as he does – associatively, sometimes autobiographically, and offering numerous lengthy interpretations of small ethnographic moments – will normally settle for being suggestive rather than conclusive. But I suspect that there is a more serious problem with all this. I often found myself agreeing with Napier’s statement of an issue, but not buying, or maybe not even understanding his proposed response. It is easy to go along with his highlighting of well-known scientific problems with the self/non-self framework of immunology – how to account for autoimmune disease, for example, or why the pregnant mother does not reject the foetus. But his own scheme for rethinking the immune system makes little sense, not least because his grasp of molecular biology is a bit shaky. The patients he interviewed with the autoimmune disease systemic lupus erythematosus clearly had unusual difficulty dealing with the responses of doctors and relatives to their puzzling condition. But underlying Napier’s sympathy for their plight is an apparent conviction that illness is invariably an opportunity for personal growth, a conviction that is hard to share. And most broadly, while there are striking affinities between the treatment of self and non-self in immunology and ideas about self, difference and tolerance in the wider culture, the actual connections often remain elusive.
A real difficulty here is that we have no easily accessible language for navigating the levels between molecules and cells, and our full embodiment as rather larger, flesh-and-blood beings. This is a problem both for getting a handle on the science and for following the twists and turns of Napier’s writing. He constantly elides these levels, tacitly assuming that the immunological self means pretty much the same as the embodied self, or that a bacterial culture has similar properties to the kind of cultures studied by anthropologists.
This is perhaps a good way to make the point that language and metaphor constantly bring together the ways we think about quite different domains. But it does not mean that you can analyse the phenomenon very well while your own thought is so bound up with it. Napier suggests that becoming conscious of conventionalised uses of metaphors is a useful first step to moving beyond them. He might do well to take a step or two back from some of his own favoured tropes and re-examine them in the same way. (2003)
The Age of Immunology: Conceiving a Future in an Alienated World
by A David Napier