Shedding Life
Disease, Politics, and Other Human Conditions

By MIROSLAV HOLUB
Translated by David Young

MILKWEED EDITIONS

Copyright © 1997 Miroslav Holub.All rights reserved.
ISBN: 1-57131-217-X



CHAPTER ONE

We can take some gratification at having come a certaindistance in just a few thousand years of our existence aslanguage users, but it should be a deeper satisfaction, evenan exhilaration, to recognize that we have such a distancestill to go.

LEWIS THOMAS

I remain unrepentant in my hunch that intellectual energies,imaginative boldness and sheer fun are currently moreabundant in the sciences than they are in the humanities.Courteous inquiries by colleagues in the sciences rendereven more embarrassing the casuistic jargon, the pretentioustriviality which now dominate so much of literary theoryand humanistic studies.

GEORGE STEINER

Immanuel Kant

The philosophy of white blood cells:
this is self,
this is nonself.
The starry sky of nonself,
perfectly mirrored
deep inside.
Immanuel Kant,
perfectly mirrored
deep inside.

And he knows nothing about it,
he is only afraid of drafts.
And he knows nothing about it,
though this is the critique
of pure reason.

Deep inside.

MIROSLAV HOLUB
translated by David Young and Dana Habova

THIS LONG DISEASE

WE ARE DEEPLY CONVINCED that health (physical and mental) is an independent reality, one that overlaps with our concept of life and is its crowning biological aesthetic and moral value. Through the development of civilization, the belief goes, we have achieved a higher level of health for the individual, who lives longer and more contentedly than before, and enjoys a better chance of mental stability. Our improved level of health is our main argument for the advantages of Western civilization, and we take the lengthening of the human life span as the main proof that we aren't going round and round in a vicious circle.

Moreover, because health is defined only as the absence of disease, we automatically accept the scenario in which we wade out of the darkness, mire, and dirt, away from the power of worms and invisible demons, and thereby become ourselves: people who are rosy, healthy, unthreatened, and collectively productive into an old age that was once the privilege of exceptional individuals.

We accept the dichotomy that makes the concept "self" antithetical to the concept "disease," meaning "that aggressive pathological nonself." In Schelling's romantic terms, the disease is the disharmony of organs, and we must get over this disharmony, in order to return to the original unity of human being and consciousness. In fact, of course, this dichotomy doesn't exist. The angel of disease is kith and kin, identical with the historical phenomenon of people. There wouldn't be any people if there were no evolutionary pressures from disease and death, degeneration and loss of function. The multicellular organism is based on the capacity of some of its cells for self-sacrifice. We are just as much the result of diseases and constant tiny deaths as we are the result of a fundamental tendency to preserve the permanence of an organism's inner environment: we are the result of changes in genetic material over the course of a million years, just as we are the result of its relative constancy in the measures of our history. We are also, perhaps, the result of retroviruses copying themselves into the one fundamentally human thing that we have, the cell nucleus, as well as the product of slow viruses attacking the nucleus of one or another cultural belief.

I bring up slow viruses just to be on the safe side. The kuru syndrome in the closed population of New Guinea and the fact of Alzheimer's disease in the open tradition of Europe and America are just two unpleasant reminders of how, in history, sometimes at a distance (kuru) and sometimes close to home (Alzheimer's), a presence as dark as a slow virus can change the outline of a human being and interfere with familiar adages about the wisdom of elders.

A retrovirus is the polar extreme case of a disease, an embryo of a disease that is trying to take over the very essence of the host, let's say the very essence of what we see as a person's health and identity, for its own dark or light goals. Retroviruses, then--and of course this includes HIV, the cause of today's AIDS and possibly previous epidemics--were not angels of death but angels of takeover, angels of temptation and disturbers of the human genome. From the human perspective, therefore, they are the creators of increased variability in the species. Some of the retroviruses from ancient history arewritten into our genomes today. It's no coincidence that some of our genetic components and intercellular signals have nucleotide sequences very similar to nucleotide sequences of retroviruses. For example, something as basic as the reproduction of connective tissue cells (fibroblasts) is triggered by a gene that is noticeably similar to a retrovirus sequence. When we look at the complicated, branching diagrams of cell interactions and intercellular signals, we see not only the logical record of an organism's inner evolutionary drama, but also the record of more or less accidental penetration by the alien nonself, which was later appropriated and productively used, but which complicated the neatness of the dramatic line. The human drama may have started with the mitochondria that every properly nucleated cell uses as an energy source, a power point, even though these mitochondria may have originated as symbiotic bacteria that gave up their own evolution.

The fact that microbes and viruses--during the two billion years that multicellular organisms have been in existence--and retroviruses--in the four million years of the evolution of the human line--didn't take us over must be ascribed, for the most part, to the prudence or frivolity of the demiurge who had the preservation of the biological species in his job description. Or, more simply, to the facts that a genome can't be transferred that readily and that a species can't be exterminated easily--or at least not quickly--through biological mechanisms. In every population, and in the case of every pathogen, even if it attacks areas of the body as central and sensitive as helper T lymphocytes in the case of the AIDS agent, somebody will survive; even, as Nietzsche reminds us, become stronger. Or at least the surviving population is strengthened. In the case of HIV infection it would be the bearers of the genomic defect leading to the lack of expression of helper T-cell receptors.

In any case, the natural substance of a human being is to a certain extent formed from retroviruses, which, incidentally, in destroying their host destroy their own future potential, so that they survive only when they don't succeed in destroying the host. We are a genetic chronicle, a good fifth of which is written in absolutely primitive viral syntax.

If we want to continue to use the concept of disease, then we should recognize the direct participation of disease, and its causative agencies, in the human process. But there is even more to the case than that; other powerful, if indirect, mechanisms associated with disease are at work in shaping us too.

The body's immune system, the guarantee of its uniqueness and inviolability, is influenced and shaped by extrinsic disturbances, which thus, in the historic sense of the word, implant their character into the body's own, hereditary substance. The surfaces of our cells, for example, share antigens with some microbes, and so an infection can even lead to a cross-reaction against the body's own components: in the historical sense, to the elimination of certain markers and their carriers. This includes even such obvious features as blood groups in the A, B, and O system and the number of their carriers in a certain population.

The gene or genes for hereditary deviations and illnesses survive in some populations because they also bring some resistance to some prevailing infections. Metaphorically, the cause of one disease protects against another. A classic example is sickle-cell anemia. It is fatal in homozygotes that have both the father's and the mother's gene for the deviant hemoglobin structure. Heterozygotes, with just one gene, don't develop the disease and are protected against malaria caused by Plasmodium falciparum. The selective advantage for the population preserves a gene that is detrimental for some individuals.

The proper forces of the so-called healthy body may happily participate in a process that would generally be perceived as illness. This can happen not only through mistakesof the complicated regulatory mechanisms of immune reactivity thatlead to attacks by our own lymphocytes against our own selves; it also happens during the completely flawless functioning of our defenses. Antibodies against some viruses (including HIV) can paradoxically enhance the progress of the infection. Severe organ damage is caused in some circumstances by antigen-antibody complexes. Despite the good intentions of the antibody molecules, grave shock states occur not through direct action of the bacterial endotoxins, but through the general alarm of the organism sensing their presence. Pain, swelling, and irreversible damage are produced by the body's own mediators of inflammation, and the heavy artillery of bodily defenses, the phagocytic cells, find their most effective ammunition in free oxygen radicals that destroy not only the criminal microbes, but the body's own tissues as well. Friendly fire, as they say. As Peter Medawar stated in his Future of Man, the remedy is the disease.

Further, the infections that were capable of causing the greatest destruction in our history, infections such as plague, smallpox, syphilis, anthrax, tuberculosis, and leprosy, evoked substantial changes in the very nature of our immune systems. We are the descendants of people who survived epidemics in the cities of the Middle Ages. We are probably the result of the natural selection of immune systems that were effective against certain infections and against foreign agents in general. Let's say we are descendants of people with "strong," highly reactive immune systems. So it's no wonder that we are also a population with a tendency to a generally "high" reactivity, including immune reactions against the body's own components, a tendency to autoimmune reactions. Type I diabetes could be a contemporary consequence of having passed through the ancient tunnels of various plagues.

That's how the fifteenth and sixteenth centuries affect today's medical problems, and that's how the angel of disease shows up in our health today. If we investigate the history of disease, we also investigate the foundation and future of health. Each of us tends to believe that disease is the punishment of others, something that doesn't affect us because we live morally and hygienically and use antibiotics: we accept leprosy and smallpox as the scourges of uncivilized filthy heretics, and syphilis and tuberculosis as the remnants of a time when poverty was rampant and medicine wore a dinner jacket instead of a sterile lab coat. In reality, however, in our shape and essence we are to a certain extent the fruit of these diseases, and future generations will to a certain extent be the fruit of diseases that are becoming epidemiologically dominant today. Of course this does not only mean infectious diseases, though new ones are appearing, even in the age of antibiotics, but also degenerative and metabolic diseases, which gain ground to the same degree that the human life span is extended.

Not even the antibiotics era presents a final solution: modern medicine is not the only player on the chessboard of infectious diseases; microbial genetics is also at play. Every move of the human intellect encountered a counter move in bacterial chromosomal changes or in the exchange of the genetic material between microbes. The microbe even received unwitting assistance from general practitioners and clinicians for whom penicillin became the philosopher's stone and a remedy for almost any sore throat. The rigidity of human reason was no match for the plasticity of microbes. The penicillins have become practically a placebo.

A highly prevalent disease, in the periods of its maximum development, influences human typology. It becomes, at least at certain social levels, a somatic and psychic standard, not just a pathology but also a kind of cultural physiology, as was the case with tuberculosis in the last century. Its carriers appeared to exemplify artistic bohemianism and intellectual intensity, as Susan Sontag has perfectly demonstrated in herbook Illness as Metaphor. The illness became the sign of the heightened uniqueness of its carrier, and if it also had, like syphilis, psychiatric consequences, then it meant increased sensibility, transcendence of self, and sometimes creativity. According to ancient religious myth, a disease eating away at the body has a tonic effect on the soul: the more granulomas on the surface, the more visions inside.

An illness that strikes artists--venereal disease, for example--can influence their spiritual tempo, their illusions and delusions, and finally become a style-creating factor. A lot depends, of course, on whether the psychopathological consequence of the given illness unfolds in New York or in Peoria.

The epidemics that decimated entire city populations in Europe in the fifteenth and sixteenth centuries, and analogous earlier epidemics, about which we know less, radically changed not only ways of life, but also ways of faith. Syphilis, for example, made "vice" and "sin" visible in princes and prelates and led to attempts at regulating prostitution; it also led to "healing" practices that resembled the tortures of hell.

Stanislav Andreski, in his book Syphilis, Puritanism and Witch Hunts, goes so far as to argue that the spread of syphilis and other sexually transmitted diseases in Europe resulted on the one hand in the growth of puritanism and radical reformist movements within the sixteenth- and seventeenth-century church, and on the other hand in the mass spread of demonology. Deformities and states of dementia in the late stages of venereal disease and in congenital syphilis were probably seen as proof of witchcraft and sorcery. Paradoxically, the spread of manuals on witch-hunting benefited from the printing press, that product of reason. Ironic that inventions of reason so often in history serve as carriers of fate.

Infections changed the appearance of cities, from manorial residences to hospitals and jailhouses. Syphilis, in its late or congenital form, had a long-lasting impact on the psychology of the citizen and the psychology of creativity. As late as 1915, Leon Daudet believed that:

treponema is a force as much behind genius and talent, heroism and wit, as behind general paralysis, tabes and almost all forms of degeneration. This microbe carries manias and hemorrhages, great discoveries and great scleroses, is strengthened through the marriages of relatives in affected families and plays a role comparable to the role of Fate in classic antiquity. It makes a great poet out of a maid's son, a satyr out of a peaceful citizen, and an astronomer or conqueror out of a sailor. An age like the sixteenth century ... looks like the invasion of treponema into the elite and the masses, like the sarabande of congenital syphilis (heredos). From the first line of his famous dedication Rabelais was clear about the essence of the matter, and was doubtless himself a direct participant and victim, as his dazzling language and the swirling of his excited, brilliant pictures attest. Treponema nourishes the dramatic intensity of life and is at the same time its curse.

Although it doesn't sound very uplifting, the basis of the contemporary human being is derived not only from cultural traditions but also from the history of human diseases, which themselves left a pretty strong imprint on cultural traditions and, in addition, influenced our physiology, our immune capacity, and our identity.

The history of life is the history of its being endangered, the endangering of life by life, as much as it is the development and strengthening of life through danger. We can describe human history equally well as a long development or as a long disease. Humanity can echo what psychiatric patients often say:

What would I be without my disease?