On Immunity : An Inoculation (9781555973278) (18 page)

When the needles are inserted into the people across from me, I notice each of their faces twist, for just an instant, into a grimace. I dread giving blood, and because I have been sitting here imagining these others as more willing to give than myself, it is surprising to see this look flash across their faces. As the nurse pushes the needle into my arm, I feel my face make the same expression.
I, too, dislike it
, I think. I recall the character in
Dracula
who, after experiencing something like sexual ecstasy while giving blood to the woman he loves, notes in his diary that “the draining away of one’s blood, no matter how willingly it be given, is a terrible feeling.”

A nurse has reclined the chair of the muscular man across from me because he is feeling faint. With my donation complete and feeling a bit faint myself, I sit at the table piled with cookies and close my eyes for a moment. Two young men, barely old enough to meet the requirement that one must be eighteen to give blood, sit down next to me and one asks the other why he is giving. “They keep calling me,” the other replies. “They say I have some special kind of blood that everybody needs.” The first man asks what type that is. “O negative.”

I open my eyes then and see that the young man who shares my blood type has dark skin. Blood types may follow patterns of ancient ancestry, but they do not obey our racial distinctions, of course. The blood type O negative is most common among the indigenous people of Central and South America and among Australian Aborigines, though it is also somewhat common in people from Western Europe and parts of Africa. We are an extended family.

“People are storing their own blood, for future use,” Susan Sontag lamented in 1989. “The model of altruistic behavior in our society, giving blood anonymously, has been compromised, since no one can be sure about anonymous blood received. Not only does AIDS have the unhappy effect of reinforcing American moralism about sex; it further strengthens the culture of self-interest, which is much of what is usually praised as ‘individualism.’ Self-interest now receives an added boost as simple medical prudence.”

Simple medical prudence has historically intersected with some ugly attitudes. During the Black Death that killed more than half the population of Europe in the fourteenth century, rioters burned Jews alive under the auspices of public health. Hundreds of Jewish communities were destroyed in response to accounts of an imagined conspiracy against Christians. These accounts were extracted from Jews who confessed under torture to spreading the plague by poisoning wells. Bram Stoker’s rendering of Count Dracula, with a prominent nose and piles of gold and vague origins in Eastern Europe, suggests that he is intended to be read as a Jew. To make that explicit, Bela Lugosi’s Dracula wore a Star of David.

In the opening chapters of Stoker’s
Dracula
, the count has recently purchased property in London. The young lawyer who travels to Transylvania to finalize the real estate transaction finds that Dracula is interested in perfecting his English. The library of his castle is full of books on British history and geography, and Dracula is even reading British train schedules. He seems to be planning a permanent relocation. And so the novel, as it unfolds, appeals to fears of immigration as well as contagion.

Avoidance of outsiders, of immigrants, of people missing limbs, or people with marks on their faces is an ancient tactic for disease prevention. And this has fed, no doubt, the longstanding belief that disease is a product of those we define as others. Syphilis, Sontag writes, “was the ‘French Pox’ to the English,
morbus Germanicus
to the Parisians, the Naples sickness to the Florentines, the Chinese disease to the Japanese.” This conflation of otherness with disease is, some would suggest, written onto our brains. Evolutionary psychologists describe a “behavioral immune system” that causes us to be highly sensitive to physical differences or unusual behavior in other people.

Our behavioral immune system can easily be triggered by people who pose us no risk. We may practice disease aversion around people with physical differences like obesity or disability, or we may practice it around groups with distinct cultural practices, like immigrants or gay men. As the American Medical Association recently observed, the ban on gay men giving blood, which was instituted in 1983, seems to have outlasted its medical prudence and is now merely discriminatory. Our tendency toward prejudice can increase whenever we feel particularly vulnerable or threatened by disease. One study has suggested, for instance, that pregnant women become more xenophobic in the early stages of pregnancy. The more vulnerable we feel, sadly, the more small-minded we become.

In the fall of 2009, at the height of the H1N1 flu pandemic, a group of researchers began testing their hypothesis that people who feel protected from disease might also be protected from feeling prejudice. The study looked at two groups of people, one vaccinated against the flu and the other not vaccinated. After both groups were asked to read an article exaggerating the threat posed by the flu, the vaccinated people expressed less prejudice against immigrants than the unvaccinated people.

The researchers went on to study how manipulating a vaccinated person’s understanding of vaccination might affect that person’s tendency toward prejudice. They found that framing vaccination in terms of contamination, as in “the seasonal flu vaccine involves injecting people with the seasonal flu virus,” can increase prejudice in people who are concerned about disease, while framing it in terms of protection, as in “the seasonal flu vaccine protects people from the seasonal flu virus,” does not. Both statements are true, incidentally, but they trigger different attitudes. After conducting one more study involving hand washing, the researchers reported a consistent pattern in their findings across all three studies: “Treatments for physical diseases, such as the flu, can also be used to treat social maladies, such as prejudice.”

I have doubts that we can vaccinate away our prejudices, or wash our hands of them. There will always be diseases against which we cannot protect ourselves, and those diseases will always tempt us to project our fears onto other people. But I still believe there are reasons to vaccinate that transcend medicine.

N
ARCISSUS, IN GREEK MYTHOLOGY, was a handsome hunter who was not moved by the love of others. The nymph Echo pursued him through the woods, calling out to him, but he rejected her advances and she wandered alone until she became only a faint voice calling to other voices in the woods. The god of revenge punished Narcissus for this cruelty by drawing him to a pool of water, where he fell in love with his own reflection. Heartsick for himself, Narcissus died gazing into the pool.

A painting of Narcissus at the pool was the cover illustration for a 2002 edition of
Science
dedicated to “Reflections on Self: Immunity and Beyond.” The concept of
self
is fundamental to the science of immunity, and the dominant thinking in immunology is that the immune system must discriminate between self and nonself, and then eliminate or contain the nonself within protective barriers. The introductory article in
Science
begins with the myth of Narcissus as a metaphor for the importance of being able to recognize one’s self. But a more obvious reading of that myth is as a cautionary tale for what can happen when one becomes overly absorbed with one’s self and fails to appreciate the beauty of others.

I find the term
nonself
both perplexing and amusingly noncommittal. Just as
undead
seems to mean something between living and dead,
nonself
seems to mean something between self and other. Nonself, I suppose, is an apt description of the human condition. In terms of sheer numbers of cells, our bodies contain more other than self. An alien looking down at us from outer space, an immunologist quips, might reasonably believe that we are just transportation for microbes. But we are using them as much as they are using us. They aid our digestion and help us synthesize vitamins and prevent the growth of harmful bacteria. Considering how dependent we are on them, it seems only right that we do not regard them as “others,” exactly.

Pregnancy, which confounded my personal understanding of the distinction between self and nonself, also puzzled immunologists for quite some time. Why a woman’s body would “tolerate” the nonself within her was a persistent mystery for much of the twentieth century. A whimsical theory emerged in the 1980s that sex itself served as an inoculation, with the injection of sperm into the uterus effectively vaccinating a woman against the threat posed by the fetus. That theory was abandoned in favor of the idea that the fetus does not actually share the mother’s body, but is simply housed there within protective barriers, like the microbes that are housed in her gut and lungs. A further refinement of this thinking suggests that both those microbes and the fetus are given safe haven because the body does not see them as dangerous.

The possibility that patterns or signals associated with danger are what trigger an immune response was proposed by the immunologist Polly Matzinger in 1994. The Danger Model, as Matzinger writes, is “based on the idea that the immune system is more concerned with entities that do damage than with those that are foreign.” The task of the immune system, following this thinking, is not to detect nonself, but to detect danger. Self can be dangerous, as immunologists have observed, and nonself can be harmless.

“It isn’t really insurrectionary—it’s just a different way of looking at things,” Matzinger told the
New York Times
of her theory. “Imagine a community in which the police accept anyone they met during elementary school and kill any new migrant. That’s the Self/Nonself Model. In the Danger Model, tourists and immigrants are accepted, until they start breaking windows. Only then, do the police move to eliminate them. In fact, it doesn’t matter if the window breaker is a foreigner or a member of the community. That kind of behavior is considered unacceptable, and the destructive individual is removed.” The immune system does not work alone in its efforts to detect danger, Matzinger proposes, but is in constant communication with a network of body tissues—what she calls an “extended family.” If we can better understand the relationships within this family, and how the body talks with its multiple selves, then, Matzinger suggests, “we may regain a renewed sense of the self that we have lost.”

The womb is sterile, and so birth is the original inoculation. Passing through the birth canal, an infant is introduced to the microbes that will inhabit that infant’s skin and mouth and lungs and gut for years to come. From birth onward, our bodies are a shared space. And a failure to acquire all the necessary microbes early in life can have lasting consequences for a child’s health. We are not just “tolerating” the nonself within us, we are dependent on it and protected by it. This would seem to be true, too, of the other nonselves we live among.

Diversity is essential to the health of any ecosystem. But the language we use around racial diversity, particularly the word
tolerance
, tends to imply that other people are essentially a nuisance, and disguises the fact that we need and depend on each other. “They aren’t blind,” my son says of moles, “they just can’t see.” The same could be said of humans. We often manage not to see that we are, as Martin Luther King reminds us, “caught in an inescapable network of mutuality.”

Even the Danger Model, which does not imagine discrimination as the most essential function of our immune system, can still be used to imagine a homicidal police force into our bodies. But scientists are already proposing that we may someday respond to infection by nurturing desirable bacteria rather than killing undesirables. We may fight disease without fighting. The article where I learned this is headlined “Tending the Body’s Microbial Garden.” Our bodies are not war machines that attack everything foreign and unfamiliar, this metaphor suggests, but gardens where, under the right conditions, we live in balance with many other organisms. In the garden of the body, we look inward and find not self, but other.

“We must cultivate our garden,” Candide says in the last line of Voltaire’s
Candide
, which is subtitled
or, Optimism.
The word
optimism
was new in 1759, and referred to the philosophy that this world, having been fashioned by God, is the best of all possible worlds. In
Candide
, Voltaire pokes fun at this variety of optimism, along with everything else. Not even reason and rationalism—those foundations of the Enlightenment thinking for which Voltaire is remembered—are spared. Rationalism,
Candide
suggests, can be irrational. And it is possible to employ reason while remaining decidedly unenlightened.

When the young Candide begins his romp around the world, it is easy for him to embrace optimism because he has lived a comfortable life. As he travels, he witnesses wars, natural disasters, rapes, and hangings. He meets a slave who has lost a hand and a leg. “It is the price we pay for the sugar you eat in Europe,” the slave tells him. “If this is the best of all possible worlds,” Candide begins to wonder, “what must the others be like?” But the book has a happy ending. Candide and his friends—who have been imprisoned and prostituted, who have suffered syphilis and the plague—work together on a small plot of land where they enjoy the fruits of their garden.

The conclusion of
Candide
is masterful, according to Flaubert, because it is “as stupid as life itself.” My sister and I both remember where we were when we read
Candide
for the first time, but neither of us is sure what to make of the ending. Or at least my sister is not sure at midnight, which is when I ask her to interpret
Candide.
“You should just say you don’t know what it means,” she advises me sleepily. I do not know what it means. I want it to mean that the garden in which we work when we are no longer optimistic is not a retreat from the world, but a place where we cultivate the world.