Macmillan

‘Inflamed’ Shows How An Unjust World Is Making Us Sick

A new book from UT Austin research professor Raj Patel and UC San Francisco physician Rupa Marya argues that our bodies, our society, and our planet are inflamed.

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When a wave of Anglo homesteaders laid their false claims to the sprawling Texas plains in the 1860s and 1870s, an extremely profitable invention followed close behind: Barbed wire. It was the end of the open range—the Mexican rancheros, old-school cowboys, and Indigenous communities who had tended the land saw how it was suddenly sectioned off and sequestered. Enormous, roaming buffalo herds were nearly driven to extinction, in large part because government policy was to kill them and starve tribes, but also because the wire cut off surviving buffalo from their grazing lands and water. Food that humans once plucked from the earth now sat behind sharp fences, withering in the hot sun. Mexicans throughout the Southwest coined a phrase: Con al alambre vino el hambre. With the barbed wire came hunger. 

What happens to our health when capitalism and colonialism tear apart natural environments? These are the deeply rooted dynamics that concern the authors of Inflamed: Deep Medicine and the Anatomy of Injustice, published this month. Raj Patel and Rupa Marya find similar stories from across the world and ask how those forces have affected our bodies. The results are not equal: In Texas, outside the barbed wire, it was oppressed people and animals who starved. Yet the authors argue that collectively, our health has suffered from a destructive path of human history defined by actions as small as putting up a fence: Our bodies, and the world around us, are inflamed. 

A sweeping project that draws on natural sciences, sociology, economics, and history, Inflamed offers a compelling argument for studying inflammation in 350 pages of stunning research and inspired language. Guiding us through vast realms, disciplines, and histories, into strange and beautiful corners of the world, this book contends that we are all sick and gives us the tools to dismantle the systems that are making us so. Marya and Patel write in the book’s first words: “Your body is inflamed. If you haven’t felt it yet, you or someone close to you soon will.” Inflammation accompanies almost every illness in the modern world: heart disease, cancer, inflammatory bowel disease, Alzheimer’s, depression, obesity, diabetes. It’s a symptom of a larger problem, they write. But the future can be different. 

Patel, a professor in the LBJ School of Public Affairs at UT Austin, has a background in studying food systems and was formerly involved with peasant movements in Zimbabwe and South Africa. Marya is a physician and professor of medicine at UC San Francisco who has worked closely with the Ohlone tribe in the Bay Area and was invited by Lakota health leaders and elders to help run a community clinic at Standing Rock. Throughout the book, Patel and Marya, who do not identify as Indigenous, apply Indigenous systems of knowledge and the principles of ecology to make their case. They present a cure: The deep medicine of decolonization. Inflamed defines colonial medicine as a dehumanizing, disconnective force that still instructs health systems all over the world, and powerfully argues the need for different models of medicine, healing, and understanding life and the body.

The book describes the inflammatory response as the body’s “ancient and powerful mechanism to heal itself.” When your immune system needs to respond to damage or a threat, cells and molecular messengers in your body take part in a complex, choreographed set of interactions to restore your internal balance or heal your wound. However, there are two different types of inflammatory responses: Acute or chronic. The acute inflammatory response is brief, when activity increases sharply in the face of a threat or injury and then resolves when the threat has passed or the damage is repaired. Chronic inflammation is when it doesn’t end: The threat doesn’t pass, so living cells under duress don’t stop signaling. Your immune system learns that it cannot rest and inflammation rages on. Our lives have more chronic stressors than they used to: Authors note that while we once faced the acute stress of a bear running after us, now we face the chronic stress of paying essential bills, working under precarious conditions, or feeling unsafe daily on the street because of our race or gender.

Oppression is traumatic, and trauma is inscribed in the body, the authors write. Recent data shows that severe COVID-19 is overexpressed in socially oppressed groups, and not just because of greater exposure or medical racism. “The same infection is expressed differently in different groups because of how the immune system has been toned over time,” or in other words, when your immune system is toned for a reality in which threats are always impending, it’s always inflamed. Chronic social defeat, a technical term describing “repeated and inevitable loss in moments of social conflict,” leads to overexpressed pro-inflammatory signaling proteins. 

Patel and Marya explore the pro-inflammatory functions of debt, stress, violence, and trauma, drawing from data on the health outcomes of poor, Black, and Indigenous people specifically. However, they take care to make distinctions across the globe: For example, while they show that food and health apartheid means people of the Global South bear a heavy burden, they note that certain infection and gastric cancer rates are low in Black Africans, but high in Black Americans. Water and air pollution, monoculture farming that strips our guts of important microbes, and social oppression precondition the bodies of Black people in the United States, they write, so when they encounter the same bacteria, they are far more likely to develop gastric cancer.

Just like our bodies, the planet is also inflamed, the authors write. The wildfires that are raging worldwide are related to the inflammation in our arteries. This is not a metaphor: Each year millions of people die, inflamed, by the consequences of fire. Even if we begin to address the climate emergency, it will take generations to clear the effects from our lungs. The authors make a strong case that our planet is like our bodies: The alarm signals are blaring so loud that they are hurting us. Something is terribly wrong here. 

Deep medicine is their word for turning to the root causes and improving our ill health through deep structural change. This means coming to Indigenous communities not with pity, but to ask for guidance. In a chapter on digestion, they interview Native food nutrition educator Valerie Segrest of the Muckleshoot Food Sovereignty Project. She teaches about decolonized food systems, and says her first lesson is to start reversing colonial thinking about the web of life, to stop seeing “nature” as separate from “society.” The next is to take her students to their huckleberry meadow from the top of a hill to see how their tribe had been drying berries and facilitating prescribed burns for thousands of years. “Despite colonial forces seeking to exterminate the web of life, abundant knowledge about it remains.” 

Throughout the book, Indigenous activists and healers offer insights into the pleasure and beauty that define deep medicine. We explore other marvels of science and history in detail: We hear about the salmon that once pumped nutrients through the entirety of the Pacific Rim coastline; the secret, essential lives of microbes, which can be passed down through our ancestors’ bodies or by breathing in the soil that settles on our windowsills; and the women healers and herbalists who were slandered as “witches,” and thus silenced of their medicinal knowledge in the 1600s. 

Inflamed is utterly fascinating, and beyond that, spiritually potent. At times, it feels almost visionary. In these pages, as in our world, everything is connected. For readers seeking promise and meaning while struggling to survive through the COVID-19 pandemic, our environment’s rapidly intensifying collapse, and the plagues of systemic racism and global inequality, this book offers a wise and welcome interpretation. It argues that the web of life can be restored, and that harmony, and collective liberation, is possible.