大象传媒

Multiple planetary crises are breaking out simultaneously: a global pandemic, heat waves, deadly floods, disappearing biodiversity, failing infrastructure. To authors Rupa Marya and Raj Patel, these crises鈥攁nd their solutions鈥攁re intimately linked and ought to be viewed as an interconnected web if we are to ever begin clawing our way to personal and global health. 

Marya is an Oakland, California-based practicing physician who has routinely treated patients struggling with COVID-19. Her co-author Patel is a well-known writer and thinker on food politics whose books include Stuffed and Starved and The Value of Nothing. The two joined forces to craft a sweeping analysis of the failing health of our planet and its varied living species, including human beings, in their new book Inflamed: Deep Medicine and the Anatomy of Injustice. 

To explore the unmistakable connections we share, Marya and Patel organized their ideas around bodily systems that function in tandem to thrive鈥攊mmune, circulatory, digestive, respiratory, endocrine, and reproductive systems, as well as connective tissue鈥攁nd extend these to descriptors of the ecological functioning of the planet. 

Moreover, they point out how modern medicine has often missed these necessary connections鈥攖o our global detriment. What is needed is 鈥渄eep medicine,鈥� which, according to the authors, 鈥渞equires new cosmologies, ones that can braid our lives with the planet and the web of life around us.鈥� 

Rupa Marya and Raj Patel spoke to 大象传媒 about the ravages of colonialist capitalism, the failures of modern medicine to treat them, and, most importantly, how a 鈥渄eep medicine鈥� approach can heal us all.

*This interview has been edited for clarity and length.

Sonali Kolhatkar: Is the title of the book, Inflamed, a metaphor for what is happening to our planet and its living systems?

Rupa Marya: It鈥檚 not at all a metaphor. It鈥檚 a description of what鈥檚 happening inside of our bodies and around us on the planet and our societies. The inflammatory response is the body鈥檚 ancient evolutionarily conserved pathway to restoring its optimal working condition when it鈥檚 been thrown off by danger or damage or the threat of damage. 

The people who are colonized are suffering the heaviest and hardest impact of these inflammatory diseases.聽

What we鈥檝e seen over the course of the past 30 years is that inflammatory diseases are the leading causes of death in industrialized places that have been really impacted by colonialism, whose societies are set up through the architectures that were put in place during colonial rule. The people who are colonized are suffering the heaviest and hardest impact of these inflammatory diseases. 

In the past 10 years, we鈥檝e learned that actually all of these diseases we commonly treat in the hospital are diseases where the immune system is in this chronic inflammatory state. What was surprising is how literal those connections are. 

Sonali Kolhatkar: You point out how part of the problem of modern medicine and the immune system is that it relies on the language of war. Where did that originate? 

Raj Patel: The idea of the 鈥渇oreigner within鈥� is actually central to our language of immunity. When the Romans were busy colonizing other cities, they needed a term for someone who wasn’t quite the same as Romans, who were not governed by the same duties as Romans were. They came up with the idea of citizens who were free but 鈥渋mmune,鈥� that is, free of duties, and therefore not the same as native Romans were. This idea of 鈥渟elf and other,鈥� of 鈥渦s versus them,鈥� deploys ideas of warfare, [as well as] ideas of the body policing itself in one way or another. 

Humans are in fact, 鈥渘odes鈥� in webs of life. It鈥檚 not just about 鈥渆nemies within and without,鈥� and not just about 鈥渂order patrols within and without,鈥� but complex series of systems within systems. 

Sonali Kolhatkar: How should we be viewing sickness and health in a way that leads us to healing?

Rupa Marya: The ways that I鈥檝e been trained to think are, 鈥渨e鈥檙e at war with cancer,鈥� 鈥渨e鈥檙e at war with COVID,鈥� 鈥渨e鈥檙e fighting the enemy.鈥�  A more useful framing [of illness] is understanding where our relationships have been fractured鈥攖hose relationships that actually support a healthy interaction with the immune system鈥攕o that the body can do what it knows how to do, which is restore its own balance. 

It鈥檚 not that the body is having an abnormal response to a perfect world. It鈥檚 that the body is having its programmed, evolutionarily intact, healthy response to a totally unhealthy world system around it. 

Sonali Kolhatkar: Is the coronavirus pandemic a symptom of our broken system of health? 

Rupa Marya: Probably the hardest part of writing this book during the pandemic was suiting up in my personal protective equipment (PPE), going to the hospital and seeing exactly what we were writing about. COVID has actually proven our thesis. It has laid it all out for all to see. Those people who face chronic social defeat鈥攖hose who are most oppressed鈥攁re the ones whose bodies are preconditioned for a massive inflammatory response, and that’s what we鈥檝e seen. 

It鈥檚 actually programmed in our immune cells from the time before we鈥檙e born. It comes down through our ancestral lines, through the genes passed in our microbes from our mothers, through all of these molecular messengers. 

Sonali Kolhatkar: In that case, what do healthy responses to a healthy world look like?

Rupa Marya: Those cultures who have those relationships still intact, such as the Yanomami (the Indigenous communities of the Amazon), some of the hunter-gatherers in Tanzania, some of the tribes in India, they don鈥檛 suffer the same kinds of inflammatory diseases that we do. They don鈥檛 have cancer or age-related hypertension. I learned in medical school that everyone has age-onset of high blood pressure but in fact, no, these folks don鈥檛 have that. 

The colonialist moment was also a capitalist moment.

We should be asking, 鈥淲hat are the knowledge systems and ways of understanding our place in relationship to the rest of the web of life that we can honor and learn from, to give us a healthier body but also a healthier planet to be living in?鈥�

Sonali Kolhatkar: One of the things that has often rubbed me the wrong way is our modern focus on individual health. We focus on putting pure foods into our bodies, taking meditation, and wellness classes, etc., and not enough on systemic fixes to collective health problems. How do you address this?

Raj Patel: One of things that we鈥檙e very keen on pointing out is that the colonialist moment was also a capitalist moment. And with modern capitalism comes the rise of the individual consumer, and the individual purchaser of medical devices and technology, and the individualist approach to thinking about medicine. 

For example, I was very interested to learn in the process of writing this book how the gut microbiome is denuded by the assaults of modern capitalism. And so, what does modern capitalism do? It deploys a certain kind of 鈥渟alvage anthropology鈥� and a certain kind of 鈥渟alvage medicine,鈥� by which we mean going into the Amazon and getting what we can from the Yanomami community. We assume they are destined for death, and so what we must do is save as much as we can of their microbiome.

This is a time for new narratives. It is a time for new ways of diagnosing.

Instead, what we have to do is transform the societies that we find ourselves in here, the dynamics that have rendered extinct so much of our own microbiome. What that means is that you can鈥檛 do this process of decolonizing alone. It鈥檚 not therapy. It鈥檚 not something where you talk your way out of it. That means a break with individualist culture. But that鈥檚 the joy of the 鈥渄eep medicine鈥� that we鈥檙e offering.

Rupa Marya: COVID is really an opportunity for us to advance what Raj and I call 鈥渄eep medicine.鈥� It actually cannot be a plight of individuals anymore. There are floods in London, Germany, and China. Nevada, California, and Oregon are on fire. The wildfire smoke is going to New York. 

These things are so hopelessly interconnected that we can鈥檛 simply get ourselves to an ashram and say 鈥渙m鈥� enough times to feel better. That’s not going to alleviate the kind of anxiety that we鈥檙e feeling, which is truly a social anxiety because we are social creatures. This is a time for new narratives. It is a time for new ways of diagnosing. The ways that we have learned up until this point are inadequate at addressing the levels of disease that we are seeing in the patterns of disease that we are seeing.

Sonali Kolhatkar: How do we change this system and uplift Indigenous ways of managing our resources and life systems?

Rupa Marya: What I have learned from our Indigenous friends and what I continue to learn is that we need to be reestablishing our webs of relationships. For example, we need to understand that the water is alive. It鈥檚 not just there to have our waste thrown into. 

We need to understand that the salmon is a pump, and the heart of this whole system. It鈥檚 moving the phosphorus into the forest, and its DNA is found in the needles of the tallest fir tree. 

We have a whole system of knowledge that鈥檚 already here, and we need to offer our humility in reaching out to Indigenous communities and giving them the power to be sovereign again in their lands. That means they should have the power to decide what happens on the land, to set the fires that need to be set, in the ways that they need to do here in California [to address wildfires]. I think it really is time to listen and to seriously look at shifting the power structure so that people who know how to manage things can be in charge. 

Raj Patel: In general, Indigenous communities, when given enough land to recover from catastrophes, and given enough power to be able to manage that land, do much better than the private sector or the public sector. There are ways that are decentralized, that cede responsibility, and that allow people to live with the consequences of their actions in ways that right now we don鈥檛 allow. 

For example, the Global South lives with the consequences of the histories of resource extraction through the Global North and through colonial capitalism. 

And so, without being romantic and misty-eyed about Indigenous communities, we should point to evidence about how in general, and with few exceptions, Indigenous communities have reams of data, evidence, and stories that show long histories of knowledge about how it is that we can live in the world. 

Sonali Kolhatkar: Has science failed us?

Rupa Marya:  There are these deep problems that science must contend with. Indigenous sciences such as Traditional Ecological Knowledge, for example, in the management of forest systems always has a moral aspect to it. That means you鈥檙e not going to do something that will violate the rights of another entity in order to amass your own knowledge. I think there鈥檚 ways that we can learn and evolve our practices in science and in medicine. 

We use Western science to ground a lot of our investigations and arguments, and I feel like we should. We should take what鈥檚 useful out of these things and we should demand that these ways of knowing evolve to be in service of the care of the people and the planet and all the living entities. 

Raj Patel: Right now, there is a sort of 鈥渟cience police,鈥� trying to slice back the number of people who get counted as scientists because Indigenous people and peasants, particularly peasant women, are not seen as fit or in some way as capable of peer review as people with advanced scientific degrees. The fact is, systems like agro-ecology for example, are far more robust in terms of climate change, biodiversity, carbon sequestration, and resilience than systems of industrial agriculture that have gotten us into the powerless state in which we find ourselves. 

Sonali Kolhatkar: How ancient is the Indigenous-led science of human and planetary health? 

Rupa Marya: There are knowledge systems that have been built up over 10,000 years and are meant to be shared and used in a decentralized fashion, not hoarded and sequestered. 

We have to look very closely at the economic social systems that we鈥檙e living under and whether or not they suit us anymore. The conclusion that we鈥檝e come to is that they haven鈥檛 suited us for about 600 years and it鈥檚 really far past time that we sloughed them off so that we can have a robust response to the challenges that are right in our face.