Inflamed: Deep Medicine and the Anatomy of Injustice

Inflamed: Deep Medicine and the Anatomy of Injustice

Author: Rupa Marya and Raj Patel

ISBN-13: 9780241483619

Publisher: Penguin

Guideline Price: £20

“Your body is inflamed,” write the authors of this compelling book on the social and environmental roots of poor health. “Your body,” they say, “is part of a society inflamed.”

Bodily inflammation manifests as “uncontrolled weight gain or unexpected weight loss, skin rashes, difficulty with memory, fever, trouble breathing and chest pain.” Society’s inflammation comes in the form of the “combustible injustices of systemic racism and global capitalism”; in forest fires and killer heatwaves; in rising oceans and violent storms.

“Inflammation,” they write, “is a biological, social, economic and ecological pathway, all of which intersect, and whose contours were made by the modern world.” The contention is that we are all on fire – on the inside and out.

Inflamed is penned by Rupa Marya, physician and co-founder of the Do No Harm Coalition, a collective of health workers committed to addressing disease through structural change; and academic and activist Raj Patel, author of The Value of Nothing, a dissection of the damage caused by our genuflection before the free market.

Via a series of chapters that consider eight of our bodily systems – the immune system, the digestive system, the reproductive system and so forth – the writers combine their respective expertise to analyse the workings of these cells and organs, and to interrogate how they have been disrupted by our modern constructs of capitalism, colonialism, extractivism and individualism, among others.

Drivers of illness

For example, in the first chapter, which is dedicated to the immune system, Marya and Patel write that the body’s “ancient and powerful mechanism to heal itself” has been disturbed in industrialised societies by a lifetime of exposures to non-genetic drivers of illness, such as poor diet, lack of exercise, but also social oppression, racism, poverty and environmental degradation.

The resulting chronic inflammatory diseases – cardiovascular disease, diabetes, chronic kidney disease, chronic obstructive pulmonary disease, osteoarthritis and Alzheimer’s – are rarely found among traditional and indigenous people, who, the authors explain, “maintain critical relationships with the living systems upon which their lives and health depend”.

Their point is not that we should pine for a return to a pre-industrial way of life, but that we see instead the connections between our health problems and the damaging social, economic, political, and environmental structures we exist inside – and then look for ways to change them.

The authors call this reorientation “deep medicine” and stress the difference between it as a philosophy and the suggestion that our illnesses are of our own making; that if we would only eat organic, get up at 5am to exercise, think positive or meditate, we would live long and prosper. Deep medicine, write Marya and Patel, rejects “the logic of personal responsibility when so much of what shapes our health is beyond individual control”.

Sick workers

Their thesis is deepened by scholarship: the book refers to the thinking of post-colonial writers Frantz Fanon and Aimé Césaire; to Foucault’s work on power relations; to Marxist-feminist Silvia Federici’s writing on the witch trials and the transition to capitalism; and to Friedrich Engels’s study of the working class in Victorian England, in which Marx’s future collaborator argued that the industrial revolution had made workers poor and sick.

The text also mixes theory with anecdote – the writers include specific instances of the health impacts of systemic injustice on black, brown, female and poor bodies, focusing most frequently on the United States, where Marya and Patel both live. These personal stories help to lighten what can at times be a highly technical read, with non-medically trained readers likely to find the terminology difficult to follow on occasions.

Nonetheless, the book comes as yet another addition to the proliferation of chart-topping contemporary publications – examples include Naomi Klein’s This Changes Everything, Amitav Ghosh’s The Great Derangement, and Donna Haraway’s Staying with the Trouble – which maintain that our modern devotion to Enlightenment, mind versus body Cartesian logic, has not served us well; it is, in fact, about to bring us and the planet to our knees.

The solution, as so many have already advocated, is in care, repair, collective action and connection; a forging of new forms of solidarity, a decolonisation of our current systems, including that of modern medicine, which the authors term colonial medicine.

And unlike colonial medicine, deep medicine “requires the kinds of analysis and imagination that dissolve fixed identities, so we can find our way back to aspects of our humanness that centre care – for one another, for the Earth, for our own bodies and minds as an assemblage of organisms and systems, for all the plant and animal relatives around us, for the water . . . This is not a hearkening back to a time gone by but an active envisioning of a future.”

We are running out of time. Let us hope we take heed.