Somatosphere | March 2, 2015

Book Forum:

Warwick Anderson and Ian R. Mackays Intolerant

Bodies: A Short History of Autoimmunity
Ilana Lwy
Centre national de la recherche scientifique-CERMES3

Nathaniel Comfort
Johns Hopkins University

Angela Creager
Princeton University

A. David Napier
University College London

Warwick Anderson
University of Sydney
Edited by

Todd Meyers
Wayne State University
We are happy to present a book forum organized around the release of Warwick Anderson and
Ian R. Mackay's Intolerant Bodies: A Short History of Autoimmunity (Johns Hopkins University
Press, 2014). Here, a short history should not be mistaken for one that is thin Anderson
and Mackay masterfully navigate a terrain populated as much by bodies as ideas. The writing is
rich and detailed, a mix of intellectual genealogy and historical chronicle - the book is sure to
serve as a resource for medical anthropologists, historians, and science studies scholars alike for
years to come. We hope you enjoy a lively set of commentaries and Warwick Andersons reply.

Book forum: Warwick Anderson and Ian R. Mackays Intolerant Bodies

Bodies as Texts
Ilana Lwy

Centre national de la recherche scientifique-CERMES3

My first reaction to the Intolerant Bodies was: why so late? Autoimmunity is such an important
topic in todays biology and medicineand, moreover, such a fascinating one that it is
difficult to understand why, until this year, nobody had written a comprehensive history of this
domain. Perhaps the answer is that we have waited for the uniquely qualified tandem AndersonMackay to write it. Ian Mackay, a veteran immunologist who worked with, among others,
Macfarlane Burnett and Carleton Gajdusek, and is himself an important part of the history he
tells. Before he started his impressive career as historian-cum-anthropologist-cum-expert on
science and race cum-theoretician of post-colonial studies of science and medicine, Warwick
Anderson was a medical student and intern who worked under Mackay and became fascinated by
the intricacies of immunity and autoimmunity. Occasionally the integration of the voices of
Mackay and Anderson is not entirely smooth, but their joint endeavor mostly works very well.
Intolerant Bodies provides a well-written, well-informed, and much needed history of
autoimmunity, enriched by theoretical reflections on nature of autoimmunity and detailed by an
overview of clinical aspects of autoimmune diseases. The book investigates the important, and
often-neglected role of old fashioned concepts such as idiosyncrasy and individual variation.
But above all, Intolerant Bodies tells an important story, and tells it well.
One of the most stimulating aspects of Intolerant Bodies is the combination of first-rate historical
analysis with a focus on patients experiences. Chapter 5 movingly describes such experiences,
while in many other places the book shows how people with autoimmune conditions had drawn
on rich metaphoric language linked with these pathologies to describe their feelings. It is less
clear, however, to what extend the experiences of patients are specific to the problems produced
by autoimmunity per se, and how much it reflects a felicitous nexus of language, metaphoric
universe and medical descriptions of a condition. Many patients with chronic, incurable
conditions learn that they will probably never get better, their disease follows a downhill
trajectory, and the drugs that prolong their lives may also harm them. People with such
conditions search for an answer to the questions why me? and why now? They attempt to
find meaning in their suffering, and mobilize cognitive and emotional resources at their disposal
to do it. If they happen to be writers or philosophers, such resources may include a capacity for a
creative incorporation and subversion of medical language to describe the unique was the disease
affects their bodies and minds.
Some medical topics are more apt than others to generate philosophical musings and to open new
spaces for literary creativity. Autoimmunity, although not unique in this aspect, may be on the
top of the listor at least a serious contender for this place. It inspired thinkers such as Donna
Haraway, Roberto Esposito, Jacques Derrida, and Peter Sloterdijk to mobilize autoimmunity as
powerful trope in service of the theoretical views they wished to promote. The fact that thinkers
who are very different from one another could use autoimmunity in support of her/his view

Somatosphere | March 2, 2015

Book forum: Warwick Anderson and Ian R. Mackays Intolerant Bodies

displays the multi-functionality of immunological metaphorsand their power. Autoimmune

metaphors are especially well adapted to provide rich feeder layer for the expression of
embodied experiences of the chronically ill. People with autoimmune conditions may be
especially lucky in this regard since they have at their disposal a rich symbolic vocabulary,
able to express the ways their identity and self-perception was changed by their disease. For
patients fascinated by words, lupus may be more rewarding in terms of self-understanding and
creativity than, say, diabetes or a degenerative neurological condition. The same may be true for
historians with a strong literary interest.
Warwick Anderson readily admits his love affair with the written word. In addition to his
multiple scholarly personalities, he is also a published poet whose collection of poems, Hard
Cases, Brief Lives, was shortlisted for the 2011 Mary Gilmore Award from the Association for
Studies of Australian Literature. There is a respectable tradition of poets who draw their
inspiration from their medical or scientific work: one can mention the German venereal disease
specialist Gottfried Benn, the American pediatrician William Carlos Williams, the Australian
general practitioner Peter Goldsworthy and, especially in the context of intolerant bodies, the
Czech pathologist and immunologist, Miroslav Holub. Holub was a co-developer of nude mice
(mice with an immunological defect that prevent them from rejecting grafts), an animal model
that played a significant role in the immunological tolerance story. His poetrytranslated into
more than 30 languageswas to an important extent inspired by his scientific work. Studies of
immune mechanisms seem to make a good match with the crafting of words. Interrogated about
his poetry, Warwick Anderson explained that although his main professional identity is one of an
historian of biology, medicine and public health, he has always considered himself a writer, first
and foremost. Historical writing, he added, is just a part of his repertoire.
Thanks to a felicitous overlapping of scientific descriptions of a pathophysiological condition
with symbolic vocabulary, autoimmunity is a great topic for a writer who uses the history of
medicine as one of the mediums in which he expresses his creativity. An encounter between
medical terminology and polysemic vocabulary laden with symbolic meanings can, nevertheless,
produce different results in different times and places. In 1987, Paula Treichler eloquently
argued that AIDS was an epidemic of signification that linked sex, blood, drugs and
marginalized groups such as Haitian migrants to the US. These symbolic dimensions of AIDS
undoubtedly exist today, too, but it was overshadowed in the 1990s by another aspect of this
disease: its high prevalence and catastrophic effects in poor countries, especially the SubSaharan Africa. In the 21st century, AIDS is more readily associated with inequalities in health
among countries and continents, the collapse of health systems in poor countries, and the
consequencespositive and negativeof interventions of international organizations, NGOs
and charities, than by the sex/ blood/ drugs nexus.
Cancer is another condition linked with powerful metaphors the deviant rogue cell, the
bodys fifth column, patients devoured by an internal foe, heroic fight against pitiless
enemy. Cancer patients, as many pathographies written by people with the disease attest,
frequently give meaning to suffering by copiously drawing on metaphors linked with malignant
growths. Othersthe best know example is Susan Sontagstrongly reject the notion of disease
as metaphor, and, as Lochlain Jain put it, refuse to live in diagnosis. Others still use different
registers to speak about their embodied experiences. In her book, Memoir of a Debulked Woman,

Somatosphere | March 2, 2015

Book forum: Warwick Anderson and Ian R. Mackays Intolerant Bodies

the literary scholar Susan Gubar extensively relied on the multiple symbolic meanings of the
term debulkingthe technical expression that describes the elimination of cancer ridden
organs which she used to define how her experience with advanced ovarian cancer affected
her inhabiting her sick body and her radically different debulkedview of herself. In an
article she published a few years later in the New York Times, Gubar focused on a more prosaic
aspect of her debulking surgerya series of probable medical errors that produced long-term
complications and greatly amplified her suffering. Without such errors, one may assume, her
multilevel experience of a debulked woman might have been differentas might have been
her use of this image.
Autoimmunity, to follow Levi-Strauss, is truly a bon penser topic. Study of its history opens
new vistas on the fluid boundaries between bodies, identities, cells, biochemical and genetic
technologies, chronicity, pain, rejection, tolerance, weakness of the flesh and its fragile triumphs.
On the other hand, an embarrassment of riches may be sometimes problematic. Writing about a
topic that overflows with meanings, one should be aware of the risk of being carried away by a
torrent of extremely seductive metaphors.

Ilana Lwy is Research Director at the CNRS-CERMES3. Her publications include A Woman's
Disease: A History of Cervical Cancer (Oxford, 2011) and Preventive Strikes: Women,
Precancer, and Prophylactic Surgery (Johns Hopkins, 2009).

Read this piece online at: http://somatosphere.net/forumpost/bodies-as-texts

Somatosphere | March 2, 2015

Book forum: Warwick Anderson and Ian R. Mackays Intolerant Bodies

The Life of Biographical Disease

Nathaniel Comfort
Johns Hopkins University
This latest installment in Charles Rosenbergs venerable series for the Johns Hopkins University
Press is less biography of disease than biography in disease. This neat, tacit pun yields
distinctive insights into twentieth-century biomedicine. Anderson and Mackay anchor their
argument in Owsei Temkins classic 1963 distinction between ontological and physiological
disease concepts. The former treat disease as a specific entity; the latter as a process, a part of
someones life. For Temkin, then, physiological disease concepts could also be considered
biographical. Autoimmunity, argue Anderson and Mackay, is a model of biographical
diseasea prime example of individuality in medicine.
Therefore, they note, the history of autoimmunity supplies a counter-melody to the primary tune
of twentieth-century medicine, in which the germ theory and specific disease overpower older
notions of illness as unique to each patient. In Anderson and Mackays descant, four themes
lupus erythmatosus, type 1 diabetes, multiple sclerosis, and rheumatoid arthritisillustrate how
the medical individual persists through the twentieth century. A standard approach would be to
begin with a historiographical overview, then devote a chapter to biographies of each disorder,
and finally sum up with a synthetic conclusion. Instead, Anderson and Mackay interweave each
disease into a roughly chronological composition tracing the strange career of the self in
immunology.
Individuality preceded the self. Serologists recognized the uniqueness of the individual well
before Macfarlane Burnet proclaimed that the essence of the immune system was distinguishing
self from non-self. In the 1940s, pathbreaking studies described allergy and anaphylaxis as rogue
attacks of self on often-beneficent non-self. The idea of autoimmunity waits until the 1950s
about the middle of the bookto take center stage. As it developed, the authors show, it became
heavily inflected with Cold War themes of surveillance, recognition, conformity, and regulation.
Then, as immunology went molecular, Anderson and Mackay insist (in contrast to authors such
as Alfred I. Tauber) that the self didnt vanish so much as change its clothes. But is network
theory really a reframing of the selfor is it a new conception of individuality? To blur the
distinction is to conflate the biomedical and the social. Indeed, the authors next make the
delicious observation that when scientists at last rejected romantic philosophical notions of the
self for explaining immunology, philosophers, and historians embraced immunology as a
metaphor for understanding the self. This twist prompts the clever authorial decision to move the

Somatosphere | March 2, 2015

Book forum: Warwick Anderson and Ian R. Mackays Intolerant Bodies

requisite chapter on historiography to the end. It works as recapitulation, while turning the cited
scholars into historical actors.
One wishes the composition were longer. A chapter on patients voices was necessary given the
authors passion for the individual, yet the smattering of published patient memoirs they offer
seems thin and under-analyzed. These pages cry for the tough work of conducting interviews,
obtaining patient records, and closely analyzing the texts. More serious and puzzling, the book
stops just short of the revival of individualized medicine driven by genomics and the
simultaneous rise in diagnoses of autoimmune disordersa cliff-hanger that leaves me anxiously
awaiting some industrious graduate students dissertation.
But brevity is the soul of Rosenbergs series. A few deleterious mutations notwithstanding,
Intolerant Bodies is an essential contribution to the history of individuality in medicine, a book
as idiosyncratic and original as its subject.

Nathaniel Comfort is a professor in the Department of the History of Medicine at The Johns
Hopkins University. He is the author, most recently, of The Science of Human Perfection: How
Genes Became the Heart of American Medicine (Yale, 2012). He is a regular reviewer for
Nature and has published with Natural History, the New York Times Book Review, National
Public Radio, Science, New Scientist, The Believer, The Point, and elsewhere. He blogs at
http://genotopia.scienceblog.com and tweets from @nccomfort.
Read this piece online at: http://somatosphere.net/forumpost/the-life-of-biographical-disease

Somatosphere | March 2, 2015

Book forum: Warwick Anderson and Ian R. Mackays Intolerant Bodies

Sick of Oneself
Angela Creager
Princeton University

In Intolerant Bodies, Warwick Anderson and Ian R. Mackay sketch the trajectory of an
etiological conundrum in twentieth century medicine, the realization that ones immune system
could itself produce illness. In the wake of the germ theory of disease and during the age of
antibiotics, the diagnosis of autoimmunity was a throwback to an earlier constitutionalism. The
authors suggest that it was a successor to the nineteenth century category of fever, capacious
enough to cope with various maladies arising from individuality and variability. For a time,
connective tissue or collagen disease served as a placeholder for autoimmunity, as did the
invocation of allergy, which focused attention on external triggers. But in the end, the true culprit
was found within. Autoimmunity redefined the central enigma of immunology, not least for
Frank Macfarlane Burnet. The question was not, how do our bodies detect pathogens, but rather,
how do we tolerate ourselves? And at what level could such exquisite self-recognition (and selfprotection) operate: organism? cell? protein? gene?
Autoimmunity challenged, even repudiated, the triumph of reductionism in biomedicine. At a
time when immunology was going molecular, autoimmunity was a stubborn reminder of the
importance of whole bodies and problematic cases. I would underline Anderson and Mackays
argument by observing that even the successes of molecular immunology, notably solving the
antibody diversity problem, called into question a central dogma approach to the immune
system. Since the genome is not large enough to encode the antibody specificities for the
millions of possible antigens mammals might encounter, the genes for antibodies are generated
during an animals development, through translocation of genetic segments, high frequency
mutation, and variable splicing. The resulting antibody genes are not inherited in any
straightforward sense from ones parents. In other words, molecular biologists explained
antibody generation, but at the cost of the genes meaning. Anderson and Mackay focus attention
on their protagonist Burnets clonal-selection theory, whose demonstration relied on wholeanimal experiments, not just the virtuosity of bench biologists. Molecular and especially
chemical approaches (and their practitioners, those interloping trans immunologists, as Niels
Jerne dubbed them) had to contend with the irreducibility of the immune system.
In the end, Anderson and Mackay make the striking remark that the autoimmunitys etiological
framework is study enough, but it is empty. In part, this is because the causes of autoimmunity
remain so poorly understood. But there is more to it than that. The theory offers no simplistic
answers. Indeed, the immune system works by being self-referential and cognitive rather than

Somatosphere | March 2, 2015

Book forum: Warwick Anderson and Ian R. Mackays Intolerant Bodies

rooted in concrete determinants. By the same token, breakdowns occur at this systemic level. At
the books end, the authors point out that the deconstructionist Jacques Derrida latched onto
autoimmunity as a theory by which to understand the indeterminacy of language. Running along
a parallel track, immunologists such as Francisco Varela and Antnio Coutinho have invoked
post-structuralism as a way to ground their immune network theories. This striking convergence
between literary criticism and biological interpretation illustrates both the cultural permeability
of knowledge and the tremendous resonance of the science of selfhood. Not that the issues are
solely theoretical. Patients with autoimmune conditions, some as notable as Joseph Heller and
Flannery O'Connor, have given eloquent testimony to the suffering entailed by their involuntary
self-betrayal. Intolerant Bodies vividly captures this quizzical and fascinating field, which in turn
provides a marvelous self-portrait (so to speak) of immunology.

Angela N. H. Creager is Philip and Beulah Rollins Professor of History at Princeton University
and is currently a visiting scholar at the Max Planck Institute for the History of Science. Her
most recent book is Life Atomic: A History of Radioisotopes in Science and Medicine (Chicago,
2013).
Read this piece online at: http://somatosphere.net/forumpost/sick-of-oneself

Somatosphere | March 2, 2015

Book forum: Warwick Anderson and Ian R. Mackays Intolerant Bodies

Immunity as Information, or Why the Foreign Matters

A. David Napier

University College London

Intolerant Bodies is beautifully writtenan informed, informative, and engaging assessment of

the history of autoimmunity. But the small book is far more than the short history it humbly
claims to be; for Anderson and Mackay take on a complex subject many of us have struggled to
summarize with more words than fewer.
As with many researchers, the difficulty of conceptualizing a body against itself has for me
proven challengingin my case, since 1973. In that year I accidentally drove a scythe into a nest
of an angry yellow jacketsmy sudden and startling introduction to a life threatened by
anaphylaxis. I remember my doctors telling me that that the next sting could have no effect, or it
could kill me. But stay calm if you are stung, they repeatedly said. (Be calm about sudden
death? Rather challenging and wholly counterintuitive.)
I also remember being told to forego my anthropological fieldwork in far off places where I
could not receive proper and immediate emergency medical attention. That, of course, I ignored
except when I was buzzed by hornets and wasps in Indonesia and India. In short, be constantly
vigilant, I was counseled. Stay indoors, and by all means dont worry; that would only make
matters worse. Can you imagine? What fool thought up that prescription?
But most of all I remember the quandary of being told by my doctors that my reaction was
caused by a problem of cellular recognition, a binding of immunoglobulin E (IgE) to an
antigenic (anti-body gen-erating) stimulant producing a pathological response (ana [against]
phylaxis [protection]). Though immunology as a field of medical sub-practice is, as Anderson
and Mackay point out, not old, the documenting of anaphylaxis is anything but new. In fact,
anaphylaxis forms the early backdrop against which modern immunology would define itself as
a process of recognizing and eliminating non-selfthat is, as an otherwise phylactic (protective)
response.
As the result of this alienating experience, I began taking notes on what my doctors told me,
developing a protocol for interviewing interested and informed fellow patients, and eventually
working formally with bench and theoretical immunologists. In 1992 I wrote my first thoughts
down on the subject in the final pages of a book called Foreign Bodiesa cultural study not
about the elimination of otherness, but its assimilation, about the stranger and how we respond

Somatosphere | March 2, 2015

Book forum: Warwick Anderson and Ian R. Mackays Intolerant Bodies

10

to knowledge (dangerous or otherwise) that strangers possess. While writing the concluding
chapter for that book, I struggled with the illogical idea that a protective system could exist that
succeeded by not recognizing the self it was designed to protectthat autoimmunity could only
be the result of a dangerous kind of self-recognition. Such a premise seemed more than odd to
me, and not entirely coherent.
Though Anderson and Mackay attribute recognizing the social dimension of the original word,
immunis, to Roberto Esposito, I had pointed this out 11 years earlier in that book on cultural
assimilation. Following fieldwork in Indonesia in the early 1980s, during which I observed local
villagers responses to WHO publicity about HIV/AIDS, I became convinced that immunologys
own models created a number of logical (and socially driven) fallacies, and, in particular,
socially generated prejudices about how a supposedly Darwinian body recognizes and eliminates
non-self. Put simply, Foreign Bodies was the beginning of what has come to be called my
search engine argument about immunity (that is, our social and physical need to seek out
information and assimilate it). This argument, in other words, emerged not from examining
bench science on its own merits (this I would later do in The Age of Immunology [2003]), but
from trying to understand how another culture dealt conceptually with danger, self-knowledge,
adaptation, and the association and dissociation of protective responses.
Just why, we may ask, should immunology have any special significance for a discussion of selfconsciousness and dissociation? If the answer does not appear obvious, it may be helpful to
recall the social nature of the Latin word immunis as describing the freedom from certain forms
of social interaction, and, in particular, an exemption from public service. Being immune, or
having immunity, in other words, has as much to do with forms of social reciprocity (or, as it
were, their absence) as it does with bodily states; rather, bodily states are themselves extensions
of forms of reciprocity that are social (Napier 1992: 179).
Here, it seemed, a better understanding of immunology should start by first seeing if
immunologys basic concepts do or do not resonate across cultures and diverse ways of thinking
about dangerhow things foreign affect and infects us, and what we learn from this process.
Second, it should include from the outset some assessment of the original linguistic categories of
thought on which contemporary descriptions depend. There are good reasons, in other words, for
examining etymologies. And third (and especially where conundra persist) it should ask if other
models of danger management and information gathering and assessment can be usefully applied
to theories of immunity. After all, is not information assimilation (vaccinology, and now
regenerative medicine more broadly) as important to healthy immune responses as elimination of
non-self (immunology)? Moreover, are not the bodys responses at the cellular level also, then,
as much about creation as they are about defense?
During the 1990sand thanks to historian of immunology, Anne Marie MoulinI was invited
to express my views in front of some very interesting thinkers, including Melvin Cohn, Leslie
Brent, Hilary Kaprowsky, and Max Essex to name some of the better-known virus- and immunesystems theorists attending the several pioneering symposia Moulin organized through the
Institut Pasteur and the Fondation Marcel Mrieux. By then I had also collected dozens of
patient narrativesmostly from those suffering connective tissue disordersfor whom an
awareness of a self lost to autoimmunity was very much a real and consciously articulated

Somatosphere | March 2, 2015

Book forum: Warwick Anderson and Ian R. Mackays Intolerant Bodies

11

concern. In addition I had the privilege of working with the distinguished lupus specialist,
Matthew Laing, at Harvards Brigham and Womens Hospital.
What emerged was telling: nearly everyone accepted that antigenseven viral antigenswere,
rather like microbes, invasive agents. As Melvin Cohn said to me, Immunology must be about
the recognition and elimination of non-self. Otherwise, the body would become a toxic
dumpsite. But being told that their bodies were at war with their selves flummoxed most
autoimmune patients and made them think. It was medicine (and of course invasive
microbiology) that occupied the domain of the take-for-granted. Viruses needed to remain
invasive even if the fact that they lacked mobility meant that their ontological status remained
ambiguous. Parmenides would have loved immunology.
By the mid-1990s it seemed only logical to me that the massive proliferation of B and T cells
produced mostly in the thymus and bone marrow were adaptive mechanisms that worked as
much as information search engines as they did systems of defense. Environmental adaptation
keeps us alive, as much or more than do either elimination or simple avoidanceotherwise, we
would all be dying of the common cold, as did so many isolated tribes. So in 2003 I published
my pre-stem cell book on immunology in which I outlined what would now (rather
anachronistically) be characterized as a regenerative view of immunity; for my basic premise,
though unconventional at the time, has been proven correct: assessment of difference
(assimilation of information) is equally as important to survival as is the eliminating of
difference itself.
Though this idea is now increasingly accepted (following the advent of stem cell research,
regenerative medicine, and a few Nobel Prizes awarded for showing that viral information could
lead to the turning on and off of genes), arguing that defense was not immunologys sole mission
was unusual in the 1980s and early 1990s. Indeed, most immunologists today still cling to the
idea, as the authors of Intolerable Bodies make clear, that protection and preservation are
Darwinian laws that cannot be violated. Nobody yet seems prepared to ask if perhaps selfpreservation is less our species goal than are knowledge and creativity. Perhaps creative
responses are just as crucial.
In short, if protection were our simple, Darwinian goal, why do we need protection against
viruses if they lack mobility and cannot reproduce? After all, it is our cells that bring life to
viruses and function as vectors for transferring information. In the end, viruses are just
information. They can remain inert for thousands of years until our cells bring life to that
information for better or worse. This fact, at least so far as we know, is incontrovertible.
Information assessment drives the argument for creativity, even if it does so to the annoyance of
immunologists raised to think of viruses as principally invasive. Indeed, Melvin Cohn once told
me bluntly that he would have to quit immunology were he to accept my view, though he could
not flatly dismiss it.
What was missing, in other words, in immunology from the 1960s through the 1990s was an
understanding of how cellular responses could function as risk-laden, creative mechanisms for
engaging difference (as signals in the search engine we each might be blessed or damned by).
Consider the Cold War era: fears of espionage, cybernetics, and artificial intelligence were

Somatosphere | March 2, 2015

Book forum: Warwick Anderson and Ian R. Mackays Intolerant Bodies

12

everywhere. The bodys mission in such an environment could only be to ward off invasive
agents. And autoimmunity produced the perfect demonology.
As Nietzsche said, In a time of peace, the war-like man attacks himself. This fact is no better
evidenced than in the so-called Dark Ages of autoimmunity.
Silverstein elegantly demonstrated this back in 1989 when he dated the waxing and waning of
autoimmune research. What he did not do, however, was connect this fluctuation with overriding
social concerns. After all, it was outside of the two great wars (the times of peace before 1910
and after 1945) that autoimmune research flourished. Between those years there were plenty of
real foreigners to fear. Who has made this point and accepted its deeper consequences? There is
still so much to do.
Indeed, newer ideas of the immune system are no less profound reflections of cultural
circumstance--how in any given era we use history to make stable what in living memory is very
uncertain. To wit, no matter how we now trace the origins of regenerative medicine to the late
1990s, the concept yet remains eclectic and ill-defined. Most doctors still cannot, in 2014,
provide a simple account of what RM is, and tissue and cell biologists cannot agree with
immunologists on its definition either. Though regenerative medicine principally involves
innovations in cell and gene therapy, tissue engineering, and related new molecules, as soon as
we factor in viral vectors it also has much to do with immunology and virology. As for patients,
most assume that anything that regenerates life is regenerative, though, in fact, most have not yet
heard of this emerging domain of research and clinical practice.
So, history, and history making, can mislead us into thinking that an idea recognized and widely
used today was heralded and stabilized at its inception. Jenner, had he lived 200 hundred years
after 1798, would have been our major advocate for demanding a reality check: ideas may have
no impact when a discovery is made. So lets rethink the recent history of immunology with this
in mind.
Moulin dates the concept of the immune system to the late-1960s. And I can say from
longstanding fieldwork that the idea was just coming of age around the time I had my
anaphylactic moment in the eary-1970s. These social facts are important; for researchers,
doctors, and patients had, in fact, not fully taken on the notion of an immune system before the
Cold War, even if the body fighting itself was recognized, relatively speaking, much earlier. The
point is far from academic because it makes us accept another deep problem.
How, we might rightly ask, can invasive agents be expelled by a system that to this day cannot
be experimentally verified? Immunity? Yes. Immune system? No. As Cohn has bravely stated,
the very idea of an immune system is predicated "on experimental systems of such great
complexity that many interpretations are possible and reproducibility becomes a luxury". Yes,
we have systemic responses, as autoimmunity supremely demonstrates. But that fact does not in
itself prove that a system governs our responses.
In fact, ethnography and history suggests quite the opposite. Before the Cold War there were no
observations about an immune system; for it did not exist as such. There was, by contrast, an

Somatosphere | March 2, 2015

Book forum: Warwick Anderson and Ian R. Mackays Intolerant Bodies

13

immunology focused on immune responses, be they patterned or not. Those concerns, however,
should not be confused with the immune system we today take for granted as real. That
reality would take Jerne, many others, and lots of trial and error to become a culturally
embedded idea.
And what about creativity? Setting aside the huge leap in regenerative medicine that accepts as
commonplace the replacement of cellular elimination with baseline (stem) modification, it is
now evolutionary biology, virology, and vaccinology that lead the way in helping us understand
how humankind and its social practices differentiate us quite dramatically from other species
and especially how symbiotic is our acquired immunity in the first two years of life.
In this regard, the authors final quotation from Inga Clendinnen, historian and autoimmune
hepatitis sufferer, is most telling. It is, after all, we humans pursuing our peculiar passion for
talking with strangers, as Clendinnen says, that make adjustment, or the failure to adjust, at all
possible. For the strangers we meet are also the sentinels that inform us not only about the
foreign, but about the limits of the very ideas we take for granted. In this regard the question for
a new immunology is less one of how we defend ourselves from hazardous information, than one
of why attraction itself matters so much to us.
In 2003, my publishers sent my immunology book to Derrida on the back of their having just
published his conversations with Habermas on autoimmunity. I suspect Derridas response might
have been enigmatic; but he died before he could be the messenger.
David Napier is Professor of Medical Anthropology at University College London, and Director
of its Science, Medicine, and Society Network. Originally trained in philosophy, he went on to
study anthropology at Oxford. Napier has conducted fieldwork in South and Southeast Asia,
including Indonesia, India, Nepal, Burma, and Bhutan. He has published widely and has special
interests are in cultural history, social trust, migration and vulnerability, sociobiology, and
immunology. He is also the lead author of a new Lancet Commission on Culture and Health.
Read this piece online at: http://somatosphere.net/forumpost/immunity-as-information-or-whythe-foreign-matters

Somatosphere | March 2, 2015

Book forum: Warwick Anderson and Ian R. Mackays Intolerant Bodies

14

Doing Biographical Work

Warwick Anderson
University of Sydney

Some years after beginning our research for Intolerant Bodies, I told my co-author Ian R.
Mackay that finally I was learning the immunology I should have known as his intern in 1984.
Indeed, was the cutting response. I knew better than to protest that most ordinary medical
doctors comprehend few of the technicalities of immunology, especially the intricacies and
mysteries of autoimmune disease. That I was not alone in my ignorance would mean little to
Mackay, then in his late eighties and wise to the ways of the world. About this time, I also
realized why no one else had attempted to write the history of autoimmunity, where the bodys
tolerance of its own materiality breaks downit was just so difficult to make accessible such
recondite knowledge. The contributors to this forumfor which we are gratefulseem to
appreciate our efforts to shed light on one of the more cryptic and controvertible exercises in
biomedical science, though we suspect some of this stuff, despite our best efforts, remains
obscure. We persevered in the task because we believe that the history of ideas about allergy and
autoimmunity is necessary to a full understanding of conceptions of biological individuality and
idiosyncrasy in the twentieth century. Such a history enables us to see disease persisting as a
biographical process, to recognize the co-constitution of the normal and the pathological in
individuals. Moreover, this concept of pathogenesis, recursively emerging and proliferating
during the Cold War and a period of significant decolonization, has profound implications for
how we frame identity and sovereignty in the contemporary world. (Mackay and I share this
interest in the cultural salience of immunology and the philosophy of autoimmunity, especially
the late work of Jacques Derrida.) As Peter Sloterdijk claims, practical metaphysics has to be
translated into the language of general immunology because human beings, due to their openness
to the world, are extremely vulnerablefrom a biological level, to the juridical and social levels,
to the symbolic and ritual levels.[i] In writing Intolerant Bodies, Mackay and I wanted to reveal
the entanglement, the inseparability, of biology, clinical medicine, philosophy, and patient
experienceall touching on the conundrum of self and other. As Ilana Lwy mentions in this
forum, autoimmunity is on multiple levels bon penser. We believe this interpretive amplitude
makes our book a very unusual, if not unique, history of biomedical science.[ii]
Many of the contributors to this forum observe the remarkable transfer of metaphor, analogy, and
model between immunology and social theoryindeed, as we discuss in the book,
anthropologist A. David Napier is a leader in trying to figure out the immunological metaphysics
of identity. Provocatively, he reads immunology as providing a framework for generating
knowledge and creativity, not just as a mechanism of defense. His image of the immune system
as an information search engine is consistent with much contemporary immunological theory,

Somatosphere | March 2, 2015

Book forum: Warwick Anderson and Ian R. Mackays Intolerant Bodies

15

and it even conjures up F. Macfarlane Burnets earlier advocacy of immunological

surveillance, which derived from the Cold-War obsession with epidemiological surveillance. It
was Burnet, of course, who wrote: immunology has always seemed to me more a problem in
philosophy than a practical science.[iii] Burnet regarded tolerance of the body itself, the lack of
self-antigenicity, as the fundamental concern of immunology. From philosophy, information
theory, and cybernetics, he introduced concepts such as self, surveillance, and tolerance.
Intolerant Bodies, as Angela Creager and Lwy observe here, traces the passage of these
metaphors and modelsthese organizing principlesfrom social theory to the laboratory to the
clinic and back again. Admittedly, we concentrate on the concept of self, as Nathaniel Comfort
points out, since we are following our historical actors, not providing a normative account of the
immune system, or envisaging the immune system we would like. Although he shared the 1960
Nobel Prize in Physiology or Medicine with Peter Medawar for the discovery of immunological
tolerance, Burnet made sure the self became sovereign in Cold-War immunology. In a recent
post on Somatosphere, I suggested that the obsession with a pre-formed self delayed, until
recently, the development in immunology of more dynamic, ecologically diverse concepts of
tolerance. Thus self might represent what Thomas Parkes Hughes would have called a reverse
salient in the history of immunology.[iv] In most other matters biological, Burnet displayed
exquisite ecological sensitivitybut his immunological theory was, it seems, in thrall to the
post-war culture of narcissism. As Napier claims here, and as we seek to demonstrate in our
book, ideas of the immune system are profound reflections of cultural circumstances.
Mackay and I first thought of writing this book after recalling some of the patients with
autoimmune conditions we had looked afterin his case, over a whole career; in mine, briefly in
training. We wanted to convey the thoughts of these patients on the diseases they endured. Too
often, scientists and physicians have captured and imprisoned the conceptual history of disease,
as if those who live with these conditions do not also do intellectual work. In particular, we
wanted to know whether those suffering diseases classified as autoimmune came to think
immunologically about their bodies. We argue that while clinicians and patients in the major
English-speaking countries in the 1960s increasingly resorted to notions of self, they used the
term in quite different ways. Patients with chronic illness, regardless of its cause, found
themselves doing biographical work, trying to maintain or restore a social selfat the same
time as their physicians tried to recuperate immunological self-tolerance through use of
corticosteroids and other drugs.[v] Only in the last fifteen or so years have some medically
oriented patients addressed the immunogenic aspects of their illnessthat is, come to imagine
their chronic illness as specific autoimmune disease. Our sources are meager, as we note in the
book, but Comfort is wrong to claim we rely on a smattering of published patient memoirs.
Indeed, we were able to review hundreds of Mackays private case histories (The Royal
Melbourne Hospital having destroyed its records) in order to sketch the experience of
autoimmune disease in Melbourne, Australia, in the 1960s and 1970s. While our efforts are
barely adequate, historians of medicine in the United States should recognize that current
restrictions on access to clinical records would make even our thin analysis impossible to
accomplish in that country. I expect the historical reconstruction of clinical research from the
patients view in Intolerant Bodies is as good as one will get in the foreseeable future. We
enthusiastically endorse Comforts call for more ethnographic research in this area.

Somatosphere | March 2, 2015

Book forum: Warwick Anderson and Ian R. Mackays Intolerant Bodies

16

Intolerant Bodies is a short history of autoimmunity, and thus necessarily abbreviated, even
though we cover extensive ground. Predictably, I wanted more philosophy; Mackay argued for
more contemporary immunology and personalized medicine. To the surprise of those who
know us, we both compromised. Despite a few vexations, it proved a very satisfying
collaboration. Having read Creagers explanation of how theories of the generation of antibody
diversity have challenged older concepts of the gene, I now can see how we could have included
this point. There it is again: the play of sovereignty and deconstruction, and of integrative
biology and molecular reductionism. But we never intended Intolerant Bodies to be the last word
in the history of immunology: rather, we want it to prompt readers to think differently about
biomedicine, the self, and the body in the twentieth century. The participants in this forum have
given us hope that this will happen.
References
[i] Peter Sloterdijk in Eirk Morse, Something in the Air: Interview with Peter Sloterdijk, Frieze
129 (2009). Accessed 29 March 2013. www.frieze.com/issue/something_in_the_air
[ii] Though not unrelated to the inimitable Georges Canguilhem, The Normal and the
Pathological, trans. Carolyn R. Fawcett with Robert S. Chen (New York: Zone Books, 1989).
More than twenty years ago, we proposed a book like Intolerant Bodies in Warwick Anderson,
Barbara Gutmann Rosenkrantz, and Myles Jackson, Toward an Unnatural History of
Immunology, Journal of the History of Biology 27 (1994): 575-94.
[iii] F. Macfarlane Burnet, A Darwinian Approach to Immunity, in Molecular and Cellular
Basis of Antibody Formation: Proceedings of a Symposium, Prague, June 1-5, 1965, edited by J.
Sterzl (New York: Academic Press, 1965), 17-20, p. 17.
[iv] Thomas Parkes Hughes, Networks of Power: Electrification in Western Society, 1880-1930
(Baltimore: Johns Hopkins University Press, 1983).
[v] Juliet Corbin and Anselm L. Strauss, Accompaniments of Chronic Illness: Change in Body,
Self, Biography, and Biographical Time, in The Experience and Management of Chronic
Illness, edited by Julius A. Roth and Peter Conrad (Greenwich CT: JAI Press, 1987), 149-81.

Warwick Anderson is the co-author, with Ian R. Mackay, of Intolerant Bodies: A Short History of
Autoimmunity (Baltimore: Johns Hopkins University Press, 2014). He is grateful to Ian Mackay
for advice and discussion in the formulation of this response, and to the Somatosphere reviewers
and editors for their engagement with our book.

Read this piece online at: http://somatosphere.net/forumpost/doing-biographical-work

Somatosphere | March 2, 2015