What’s behind today’s epidemic of epidemics?

Philip Alcabes gets 10 out of 10 for timing. His book looking at how our attitudes to epidemics are dominated by wider social concerns is published just as another global disease panic has kicked off. For those fretting about swine flu, Dread would be useful bedtime reading, especially in providing some perspective to the seemingly annual cry that ‘this time, it’s the Big One’.

The book is not, however, simply a reaction to the latest panic. Indeed, there has been plenty of modern material for Alcabes to get to grips with, from the emergence and development of AIDS in the 1980s, to ‘mad cow’ disease and Ebola in the 1990s, to a whole clutch of infections in the past decade, including avian flu, SARS, West Nile Virus and the linking of the MMR vaccine to autism. Having previously ploughed through a couple of the books spun off the last bird flu scare in 2006 (see Bird flu: an infectious panic), I found Alcabes’ historically literate and thoughtful book to be a huge relief.

The widespread feeling of ‘dread’ these days goes far beyond disease, as Alcabes notes: ‘Strangers, flying things, modern technology, female sexual desire, racial difference, parenting, the food we eat and so on. These concerns, beyond the simple dread of death, are part of our makeup. They identify us as citizens of the society we live in and distinguish our world from the ancient world of demons… we bring fears to the prospect of any sort of epidemic, deadly or not.’

Alcabes mixes history and sociology to examine how societies react to the threat of disease. He sees three aspects to the understanding of any epidemic: the physical event of an infection or other factor that causes disease; the role of that disease in social crisis and change; and the way in which disease outbreaks are influenced by, and themselves alter, society’s narratives about itself.

These three elements interact with each other. Disease may be a product of population movements or social change. The opening up of India allowed cholera to spread to the West in the early nineteenth century, to be nurtured in the unsanitary conditions of newly industrialised cities like London. SARS could only have leapt from Hong Kong to Canada in just a few weeks thanks to modern travel. But an epidemic can also sound the death knell for a way of life, just as the Black Death put paid to feudalism, or be a means by which the ruling elite can find new ways to cement its power.

Alcabes notes common threads in the way that societies react to new threats, particularly the recurring notion that the latest terrible fate is a punishment for wrongdoing. As early as the sixth century, Pope Gregory was reminding the faithful that retribution could come without warning: ‘All the people are smitten by the sword of divine wrath; one after another they are swept away by sudden death… The blow falls; the victim is snatched away before he can [repent]. Let every one of us therefore betake himself to lamentation and repentance before the blow has fallen.’ Compare this with the idea of a ‘gay plague’ of AIDS in the 1980s or the attempt to blame industrial farming for swine flu today; there are some interesting similarities.

Another common theme in eras of dread and disease is the threat of the outsider. The Black Death was sometimes used as an excuse for disappropriating Jews, who were blamed for outbreaks even when they suffered as much as everyone else. In the nineteenth century, Irish immigrants were blamed for the spread of cholera to America, despite the fact that any disease that was commonplace in Europe was always going to find its way east on the tide of immigration.

Also, the authorities, and in recent years a variety of other agencies and NGOs, have used epidemics – indeed, effectively invented many of them – to further their aims. Alcabes is particularly interesting on the subject of Victorian reformers, such as Edwin Chadwick, who identified and tackled the problem of disease in England’s fast-growing cities. While Chadwick is now regarded as a noble reformer, Alcabes has little sympathy with his use of cholera to further the notion that poverty had little to do with the organisation of society: ‘The cholera outbreak of 1848-49 crystallised the tension between sympathy for, and terror of, the destitute. By reading in the cholera epidemics a story that emphasised the need to control disease on behalf of the poor, Chadwick could promote his theory that it is disease, not the structure of the industrial economy, that makes people poor.’

The modern equivalent is the way in which epidemics are used to push victims – who may not even see themselves as such – into the arms of a variety of agencies, so creating powerful and dependent relationships: ‘Diagnosis is a pointer, directing the victims towards whichever therapeutic entity is supposed to be able to treat the disorder: addiction-treatment services, twelve-step programmes, behaviour modification, after-school programmes, pharmaceutical products… The existence (and in some cases profitability) of these “interventions” supports the continuing stream of newly diagnosed “victims”.’

Alcabes recognises both the continuities and the differences between the past and present. For example, the diseases of the past were seen as external threats, sometimes punishments, but the product of invasion nonetheless. The view of the modern epidemic is rooted in the vulnerability of society and its members. Where once there was a notion of contagion that was separate from disease, the idea of HIV/AIDS – as it is officially known – blurs this distinction. As Alcabes puts it, the root of disease was in some way so deep that it could only be understood by reference to its outcome: ‘If you had the disease, you had whatever caused it.’ Another product of HIV/AIDS was the way in which an epidemic could become the source of an identity. The gay community, condemned as infective and degenerate, could unite around the disease in order to campaign for recognition.

Dread does not dispute that there are real diseases that can have terrible consequences. But it asks us to beware of anyone declaring an epidemic and to accept that we cannot eliminate dangers altogether. Alcabes concludes the book with this message: ‘The epidemic story is filled, always, with the anxieties that make us tick. It’s a story we should read conscientiously, aware of who is telling it and what the message is, bearing in mind that the risk-free life is a mirage.’ Indeed, Alcabes observes that there is no epidemic without a social reaction. While diarrhoea, malaria and tuberculosis remain major killers to this day, they are not seen as ‘epidemics’, while things that are not even diseases, like obesity, are discussed in those terms.

Weirdly, for a book rooted in such well-told historical examples, occasionally the analysis comes over as ahistorical: the book seems to suggest that, in many ways, epidemics were ever thus. And while Alcabes does a brilliant job of describing the obsession with disease today, I’m not sure he really explains our modern epidemic of epidemics.

He also strangely argues that those who are tasked with figuring out the sources and causes of disease today should learn from the example of climate change. ‘Nobody thinks that a single intervention is going to reverse the warming of the Earth. And nobody claims that any one element – industrial pollution, the automobile, or rainforest destruction – is responsible. We understand the Earth as a complex system, an ecosystem. Why not be as nuanced about illness?’

Yet if any topic illustrates the need to separate the dry, cautious and complex study of empirical reality from a moralised public debate being used to further the social power of a variety of interest groups – the very distinction which is at the heart of Alcabes’ book – it is the panic about global warming. From the Intergovernmental Panel on Climate Change (IPCC) and the reinvention of political loser Al Gore to the distortion of research funding and the downplaying of human welfare in the name of the planet, the climate crusade epitomises everything that Alcabes writes about. Contrary to what Alcabes suggests, for many climate change warriors there is, indeed, a single element responsible for screwing up the planet: humanity. Separating environmental problems, of which there are many of varying degrees of importance, from the misanthropic mindset of environmentalism is just the kind of thing that the method that informs Dread could help us to achieve.

Nonetheless, for its few failings, Dread is an invaluable – dare I say, infectious – read.

Rob Lyons is deputy editor of spiked.

Dread: How Fear and Fantasy Have Fuelled Epidemics from the Black Death to the Avian Flu: The Imagined Epidemic by Philip Alcabes is published by PublicAffairs, US. (Buy this book from Amazon(UK).)