The diseased, anyway, are more interesting than the healthy. The words of the diseased, even those who can manage only a murmur, carry more weight than those of the healthy. Then, too, all healthy people will in the future know disease. That sense of time, ah, the diseased man’s sense of time, what treasure hidden in a desert cave. Then, too the diseased truly bite, whereas the healthy pretend to bite but really only snap at the air. Then, too, then, too, then, too.
Long before there were effective treatments, physicians dispensed prognoses, hope, and, above all, meaning. When something terrible happens-and serious disease is always terrible-people want to know why. In a pantheistic world, the explanation was simple-one god had caused the problem, another could cure it. In the time since people have been trying to get along with only one God, explaining disease and evil has become more difficult. Generations of theologians have wrestled with the problem of theodicy-how can a good God allow such bad things to happen to good people? Darwinian medicine can't offer a substitute for such explanations. It can't provide a universe in which events are part of a divine plan, much less one in which individual illness reflects individual sins. It can only show us why we are the way we are, why we are vulnerable to certain diseases. A Darwinian view of medicine simultaneously makes disease less and more meaningful. Diseases do not result from random or malevolent forces, they arise ultimately from past natural selection. Paradoxically, the same capacities that make us vulnerable to disease often confer benefits. The capacity for suffering is a useful defense. Autoimmune disease is a price of our remarkable ability to attack invaders. Cancer is the price of tissues that can repair themselves. Menopause may protect the interests of our genes in existing children. Even senescence and death are not random, but compromises struck by natural selection as it inexorably shaped out bodies to maximize the transmission of our genes. In such paradoxical benefits, some may find a gentle satisfaction, even a bit of meaning-at least the sort of meaning Dobzhansky recognized. After all, nothing in medicine makes sense except in the light of evolution.
Latro, California: "Terrible diarrhea, Doctor, and I feel so weak!" "Take these pills and come back in three days if you're not better."Parkington, Texas: "Terrible diarrhea..." "Take these pills..."Hainesport, Louisiana: "Terrible..." "Take..."Baker Bay, Florida...Washington, DC...Philadelphia, Pennsylvania...New York, New York...Boston, Massachusetts...Chicago, Illinois: "Doctor, I know it's Sunday, but the kid's in such a terrible state - you've got to help me!" "Give him some junior aspirin and bring him to my office tomorrow. Goodbye."EVERYWHERE, USA: a sudden upswing in orders for very small coffins, the right size to take a baby dead from acute infantile enteritis.
Disease was a perverse, a dissolute form of life. And life? Life itself? Was it perhaps only an infection, a sickening of matter? Was that which one might call the original procreation of matter only a disease, a growth produced by morbid stimulation of the immaterial? The first step toward evil, toward desire and death, was taken precisely then, when there took place that first increase in the density of the spiritual, that pathologically luxuriant morbid growth, produced by the irritant of some unknown infiltration; this, in part pleasurable, in part a motion of self-defence, was the primeval stage of matter, the transition from the insubstantial to the substance. This was the Fall. The second creation, the birth of the organic out of the inorganic, was only another fatal stage in the progress of the corporeal toward consciousness, just as disease in the organism was an intoxication, a heightening and unlicensed accentuation of its physical state; and life, life was nothing but the next step on the reckless path of the spirit dishonored; nothing but the automatic blush of matter roused to sensation and become receptive for that which awaked it.
The age-old, seemingly inexorable process whereby diseases acquire meanings (by coming to stand for the deepest fears) and inflict stigma is always worth challenging, and it does seem to have more limited credibility in the modern world, among people willing to be modern - the process is under surveillance now. With this illness, one that elicits so much guilt and shame, the effort to detach it from these meanings, these metaphors, seems particularly liberating, even consoling. But the metaphors cannot be distanced just by abstaining from them. They have to be exposed, criticized, belabored, used up.
Any important disease whose causality is murky, and for which treatment is ineffectual, tends to be awash in significance. First, the subjects of deepest dread (corruption, decay, pollution, anomie, weakness) are identified with the disease. The disease itself becomes a metaphor. Then, in the name of the disease (that is, using it as a metaphor), that horror is imposed on other things. The disease becomes adjectival. Something is said to be disease-like, meaning that it is disgusting or ugly.