Saturday, June 21, 2008

Pensive - Pensieve

In high school, I remember emerging from intense sport seasons and having FREE time after months of school, practice, meet, dinner, homework, sleep. repeat. I would suddenly start thinking again, having random and creative thoughts. Only then would I realize how busy I had been.

Anyway, I guess I have been less busy (and/or there is no good television on...) and I've been inspired by a few things.

In my research on Epstein-Barr, and many accompanying fatigue illnesses (Chronic Fatigue Syndrome, thyroid problems, etc.) I got really interested in the subjectivity of illness. The ability of the mind to articulate its state is limited. When we do express our illness, it lives in the context of our understanding of how illness works and the notions of the society around us. What is "well"? What is "sick"?

Take the state of "blackout drunk," for example. This state is particularly complicated because it pulls in ideas of memory, and also self-presentation. If I go in and out, but have moments where I don't remember what happened, is that blackout? What if I remember when someone reminds me? Perhaps there is one extreme that everyone agrees on, but the point is that we don't live in extremes, but the moment someone puts their behavior into a yes/no category they are assigning qualities to their behavior that may or may not have actually occurred. Furthermore, people have plenty of motivation to underplay or highlight their state of drunkeness, making reporting of this information even less reliable. "I was soo blackout" is such a cliche - an excuse for bad behavior, a way to show off. Denial of a blackout state comes with its own line of reasoning. So it seems if I were to order these things:
1) Sensory experience
2)Interpretation of experience: Where does my experience fit within the categories/experiences I know? Do I want to exaggerate/deny my state for any reason?
3) Articulation of experience
4) Understanding of experience by others and self - symptoms change based on categorization and feedback. i.e. "not that bad" for a blackout. Experience can be validated/negated by peers

Anyway. I decided I want to learn more about societal understanding of illness. Epidemiology was one of my surprise favorite classes (I wrote my final paper on childhood obesity and it was sooo much fun! and proffy liked it!). I had read a little bit about medical anthropology in some random course packets ( parts of Emily Martin's Flexible Bodies and Susan Sontag's AIDS and its Metaphors) so I checked them out of the NY Public Library and started a skim through.

Martin's work will be the most interesting, I think. I already looked through all the pictures :). Without having read more than the abstract/intro and the random chapter I read a few years ago, it seems her idea is that we used to think of immunity as castle/fortress model, with the body as a closed space with open orifices that germs could pass through and must be defended. As we understand the body through new technology and new cultural ideas about "flexibility" these exterior and interior changes emphasize immunity in terms of flexibility. Right now I haven't seen enough examples to make the word "flexibility" resonate in my mind but I'm curious to read more.

Right now, I personally have been very interested in the role of viruses. Traditionally, I think of viruses as infecting, and then leaving. Now, I think of them as being able to permanently alter mental states (lyme disease, that disease you get from cats) and physical states (rheumatic fever, chronic fatigue syndrome, EPV, that virus that makes you obese).

I also never thought of viruses as an environmental factor. EPV and HPV cause cancer, something I associate with too much sun (skin cancer) or not eating a healthy diet (colon cancer). Viruses can also be catalysts for people with genetic predispositions to certain illnesses, initiating Multiple Sclerosis and Chronic Fatigue Syndrome. Crazy! Viruses are not just COLDS. I feel I have changed my perception so much since that day in biology we had to write a two-sided persuasive on whether or not viruses were alive. Back then, the idea that something not an organism could infect you was something we were conditioned to feel was novel, the same way a prion (what causes Bovine Spongiform Encephalopathy aka Mad Cow Disease) causing a disease seemed crazy, since a prion is just a protein.

All of these ideas about viruses freak me out and make me feel like I have no control - so the view that emerges from that for me is that there is no "one size fits all" way to defend the body against contagion - everyone has different weaknesses in their castle wall, so to speak, and every body has soldiers that are quick to recognize one attack and oblivious to another. Moreover, attacks can change immune structure and response, causing even more unpredictability with regards to response. So there's really nothing you can do but feed your little soldiers and keep healthy and not worry too much about it.

...and let me take back what I just said: I also find autoimmunity absolutely fascinating, especially because scientists have founds ways to manipulate the body's immune response in the case of certain allergies, such as peanut allergies. This is where I get really excited about the other book I just read, The Dirt on Clean, which talked about how these opposites
healthy vs. sick
dirty vs. clean
moral vs. immoral

have at times been aligned in every single configuration. Dirt used to be seen as protective; cleanliness a sign of moral suspicion. The polio epidemic, in fact, was so bad in the 1950s because people were too damn clean. The disease is passed by fecal-oral contamination, so sanitation had progressed to the point that everyone was too clean to be adequately exposed as a child, but not clean enough that they would never ever be exposed to that disease. Similarly, many children on farms do not have allergies, so many dust/seasonal allergies are associated with environments that are too clean and give the immune system nothing to do, making it over-react to benign substances. Thus, recently, the idea of dirt as 'exercise' for the immune system, enabling it to learn to react appropriately, has been repopularized. So fascinating!

Anyway, enough about diseases, time to go off and have some Saturday night fun.
(Although I must admit, I am quite tired, and have been all day. Is it me? Is it the Epstein-Barr? What would my lab results say? If they said I was well would I still be 'sick'?)

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