Eula Biss
On Immunity

When the essayist Eula Biss was pregnant with her first child, she was not prepared for the “labyrinthine network of interlocking anxieties” that surrounded the question of immunity. Mapping this labyrinth became the project of her third book, which uses the debate around vaccination to focus an extended meditation on the boundaries, or lack thereof, between the public and the self.

Biss is largely addressing the present-day suspicion of immunity, as “all that is known of disease is weighed against all that is unknown about vaccines”. Modern medicine is a contested territory in which all interests are vested; the press is unreliable, the government is inept, and big pharma is known for its corruption.

But even in its infancy, vaccination was a troubling concept. When the American minister Cotton Mather, in 1706, asked his Libyan slave Onesimus if he had ever contracted smallpox, Onesimus’s response was “Yes and no”. He had contracted smallpox with the intention of not contracting smallpox – a paradoxical notion that Biss approaches with a mixture of seriousness, vexation and intellectual delight.

“Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.” So wrote Susan Sontag in her essay “Illness as Metaphor” (1978), a book to which On Immunity is deeply and openly indebted. If more nonfiction were indebted to Sontag we’d likely be better off, but in Biss’s case the relationship is both material and stylistic.

Like Sontag, Biss argues that our understandings of illness are so often cultural, historical and linguistic that our interpretation of immunity is as meaningful and urgent as the scientific processes by which we become immune. She cites research that shows how the metaphorical linkage of two ideas can make it easy to manipulate a person’s attitude towards both. People act differently depending on how advice is framed: the statement “the seasonal flu vaccine protects people from the seasonal flu virus” causes quite different responses to “the seasonal flu vaccine involves injecting people with the seasonal flu virus”. In other words, language can exercise real power over our behaviours. On Immunity, then, is an attempt to exercise power over our language.

Biss makes short work of the most famous example of immunisation panic – the 1998 study, now retracted, which linked vaccines to autism. It’s well known that this is “not the subject of any ongoing scientific debate”. More interesting to the author is the reason the study’s weak findings gained ground.

It is not because people are fools that they take seriously ideas like these. Instead, Biss argues that the study “held particular appeal for women still haunted by the legacy of the refrigerator mother theory”, which suggested that autism was induced by a lack of maternal warmth. The study shifted the focus of suspicion to medicine, and hence away from mothers. For Biss, the theory’s believers “are not guilty of ignorance or science denial so much as they are guilty of using weak science as it has always been used – to lend false credibility to an idea that we want to believe for other reasons”.

It’s fascinating reading, made possible by Biss’s particular blend of scepticism and empathy. It’s as if she has sought less to argue in favour of immunity than to understand all the possible positions on it. This is a benefit readers often find in fiction, which aims to offer the emotional and cognitive make-ups of multiple perspectives. It is rarer in argument-driven nonfiction, where the tone can more easily become strident.

A wealth of good popular medical literature has been published by doctors in recent years, such as from Atul Gawande, Siddhartha Mukherjee and Karen Hitchcock. Informed and engaged work by patients is comparatively rare, which in itself gives this book great value. And while it is mostly grounded in research and fact, certain personal details are deployed with lyricism and skill. The character of Biss’s father, an oncologist, for instance, is affectionately but persuasively tied to her discussions of paternalism and trust. Better yet, her sister is a professor of ethics, which comes in handy when Biss pits personal freedoms against the public good.

“Our fears are informed by history and economics, by social power and stigma, by myths and nightmares. And as with other strongly held beliefs, our fears are dear to us,” she writes. It’s less interesting to her that these fears are misplaced than that they are displaced. Accordingly, much of the book is spent reconciling seemingly distant ideas, showing how interrelated sickness and health can be. We learn that cells in the placenta are bound using a gene that originated from a virus, incorporated into our DNA across the generations. “Though many viruses cannot reproduce without us,” Biss observes, “we ourselves could not reproduce without what we have taken from them.”

Although the book is beautifully written in minimal prose and organised sharply, it is hard to overstate the wealth of information threaded and elaborated throughout its tidy, sturdy structure. There is a long section on the legacy of Rachel Carson’s seminal environmental science book Silent Spring, for instance, and several miniature essays on the history of vampirism, which would be fascinating discussions by themselves. They seem unlikely to play a significant role in a thesis on immunity, yet Biss always makes them feel essential.

She is interested in vampires because “they give us a way of thinking about what we ask of each other in order to live”. For Biss, all things become a way of thinking about this central philosophical and ethical question.  CR

Text, 224pp, $29.99

This article was first published in the print edition of The Saturday Paper on Jan 24, 2015 as "Eula Biss, On Immunity". Subscribe here.

Reviewer: CR