Epidemics and the concept of ‘Dread’ with author Philip Alcabes

By Leigh E. Rich

In the mid-1300s, the “Great Mortality” decimated nearly one-third of Europe’s population. One of every three or four individuals was stricken with the “pestilence,” a mysterious illness that began with a headache, fever and swollen lymph glands—around which red spots on the skin would appear, eventually turning purple and then black.

Death came quickly and painfully for approximately 25 million between 1347 and 1351, and those who escaped or survived infection were left with a fear of the Black Death (aka bubonic plague) that, in many ways, can still be felt today.

Modern memory has been afflicted with different plagues, including worldwide outbreaks of cholera throughout the 19th century—beginning in India in 1817 and spreading to Asia, Russia, the Middle East, Western Europe and even America—and the Great Spanish Influenza of 1918, which killed 20 million to 40 million in a single year.

Today, however, more perhaps recall events of the early 1980s, as young, previously healthy individuals in places like New York, Los Angeles, Haiti, the United Kingdom, Belgium and France began developing a rare type of fungal pneumonia that only affects those with weakened immune systems. Unable to identify the primary cause as the first cases emerged, the Centers for Disease Control and Prevention deemed it a “cellular-immune dysfunction related to a common exposure.”

HIV/AIDS, as it is now known, was particularly deadly in its debut years, originally killing nearly half of all infected. Today, AIDS accounts for approximately 2 million deaths annually and more than 33 million are infected and living with HIV, according to UNAIDS.

But epidemics are about more than sheer numbers and they are not solely physical events, says Philip Alcabes, an epidemiologist and professor of urban public health at Hunter College’s School of Health Sciences in New York. Alcabes is the author of the book, Dread: How Fear and Fantasy Have Fueled Epidemics from the Black Death to Avian Flu.

“Epidemics are complicated phenomena. … Both the causes and effects are complex,” Alcabes emphasizes. What’s more, “we don’t consider everything to be a crisis.”

Why, for example, do the mainstream media and what Alcabes labels the “preparedness industry” focus on bird flu, obesity, autism and even restless leg syndrome as epidemic but not malaria, tuberculosis or motor vehicle accidents?

In the United States, an individual is more likely to die by automobile than by HIV. And in Africa, “750,000 African children, plus a large number of adults, die of malaria every year.”

This mismatch between disease and rhetoric—why some epidemics “count” and others don’t—is what inspired Alcabes to write Dread, which focuses on how societies create narratives around epidemics that speak volumes not primarily about the illness or disease but about a society’s anxieties and fears.

“It clearly isn’t just the possibility of mass mortality that makes us talk about epidemics. The epidemic is a story of deeper-seated anxieties. And judging by our inability to call malaria an epidemic, anxieties that have to do with our own society” rather than those of others.

This is why Alcabes claims that “an epidemic is in the eyes of the beholder.”

He also argues that the narratives we create around epidemics today differ greatly from those of earlier times.

In the ancient world, epidemics often were seen as divine punishments for sins or transgressions and, thus, were a means of social control. While aspects of this premise have persisted through the Middle Ages and into today (for example, the rhetoric that continues to encircle HIV/AIDS), the “archetypal” epidemics during the Enlightenment and Industrial Revolution—for example, bubonic plague (which was nicknamed the Black Death in the 1800s), cholera and the flu—spoke to more modern fears.

And the dread wasn’t just about “the germ” or “the disease,” Alcabes says, which scientists in the late 1800s were beginning to identify with the emergence of new laboratory technologies.

“Until sometime in the 20th century, the epidemic narrative was about an invasion or pollution—some danger in the environment that was understood to be doing something bad to us. It was a story, but it was a story with a single plotline: The stranger comes to town and mayhem ensues. With germ theory, the invasion-pollution narrative crystallized around the germ. A bacterium or a virus is harming us.”

That single plotline has since exploded, according to Alcabes. How we understand and talk about illness and disease has shifted since the end of the 20th century. Although we have not thrown out germ theory, no longer do we think most diseases have a unitary cause. Illness ensues from a complex interaction between a person and his or her environment.

Societies such as the United States have placed a particular emphasis on personal behavior. Alcabes has named this “the behavioral turn.”

And he says that, ironically, the narratives society creates today about epidemics resemble those of the ancients.

“By the end of the 20th century, the epidemic narrative wasn’t just about a germ; it was about the narrative itself. It seemed to keep on folding back on itself.”

In Dread, he argues that society’s approach to the behavioral turn is essentially “empty” and that today’s epidemics are about “the risk of risk.”

“My point about the behavioral turn is that the health sector, which had been concerned with relieving suffering at the individual-person level and improving the conditions of life at the societal level, seemed to shift attention to controlling people’s behavior. So we talk about risk behavior now, instead of harm; we talk about threats instead of damages; we talk about healthy living instead of avoiding danger; and we don’t talk about suffering at all.”

For example, Alcabes takes issue in Dread with the epidemic narratives created around obesity and autism. He contends that the narratives fail to focus on the real issues—the “normalizing and caring processes” people with autism might need or the fact that “the food on our table bears too little resemblance to natural products, local products [and] living or once-living things,” to name a few.

“With obesity,” he adds, “there’s no question that people are fatter than earlier generations, and there’s no question that some people who are fat get sick because of it. But it isn’t at all clear that it’s a very bad problem. In fact, plenty of data suggest that what is considered to be ‘normal’ weight is actually too low, that people with ‘obese’ BMIs are not likely to get sick unless they’re extremely fat, that older people are protected—at least against cancer—by having high BMIs, and that even people who do seem to get sick because of being too heavy can be protected with proper medical care.

“So the nature of the epidemic is at stake here. … It isn’t clear that either personal behavior or a ‘toxic’ food environment is making people’s lives worse.

“What’s notably absent from the hoopla over the obesity epidemic, I’ve noted, is any talk about how fat people suffer in our society. This seems like a strange omission, given that most of the talking about the horrors of obesity is being done by people in the health sector.

“Shouldn’t we be more concerned with suffering, than with how people look?” he asks.

Whether it comes to obesity, swine flu, bioterrorism or any other epidemic du jour, Alcabes concludes that “it seems like people have a sense that the definition of crisis is created not by actual danger or real suffering, but by media, corporations, officials and other powerful agencies.

“Which is why I think it’s worth asking what it means when someone—especially an official agency—claims that there’s an epidemic.” 

Rich, L. E. (2010, April 7). Prepared or panicked? Epidemics and the concept of ‘Dread’ with author Philip Alcabes. Leigh Rich Freelance: five2seven.