After the End of Disease: Rethinking the Epidemic Narrative

This blog post is part of and has been cross-posted from the series ‘After the End of Disease’, hosted by Somatosphere, curated by Dora Vargha. The series accompanies the conference of the same name, which brings together historians of medicine and global public health, anthropologists and sociologists with policy makers to think past the conventional narrative curve of epidemics and disease in general. Every week participants of the conference will contribute a piece that reflects on the conference theme. You can find the detailed program on the conference website.

In conversations with people living with polio in Hungary, I often encountered members of the tight-knit community referring to themselves as “dinosaurs”. We are a breed that is about to die out, they said. Nobody gets polio anymore, some added, and they were right – epidemics, even sporadic wild polio cases disappeared from the country in the 1960s. Their words stood in stark contrast with celebrities like Jackie Chan, Desmond Tutu and Bill Gates showing on billboards all over the world that with the Global Polio Eradication Initiative we are ‘this close to ending polio’. Yet the urgency of the eradication campaign and the gradual disappearance of a polio generation over a lifetime both signified the same thing: the end of a disease. But what, exactly, is this end and what comes after?

In the following weeks, a series of posts by historians, anthropologists and sociologists will grapple with these questions as they consider epidemic narratives and the ways in which endings bear on global health issues. This series accompanies the interdisciplinary conference After the End of Disease, held on May 25-27 2016 in London. Bringing together practitioners and academics from various disciplines and fields, this event aims to initiate conversations on when and for whom diseases end, what happens when the end fails to come, who gets to determine the end and who gets left behind, how a focus on endings shape health policies and how we can critically rethink the temporalities of epidemics.

Public and academic discussions on the end of diseases have been abundant in the midst of recent epidemic crises. Faltering vaccination rates have seen old diseases, like measles and whooping cough resurface to epidemic proportions in the Global North. Several global epidemic crises, such as the swine flu and Ebola, have prompted international organizations, local governments, pharmaceutical companies, research institutions and individuals to respond in manifold ways with the aim of controlling and eventually ending epidemic diseases – even theoretical ones. Ending diseases for good have been the goal of several eradication campaigns over the 20th century and are the focus of several global projects.

What comes after the end of a disease is more often than not relegated to epilogues and usually comes up as an afterthought to the master narrative. Yet, diseases are often imprinted on the bodies of survivors, societies and cultures. Epidemics may change economic structures, social interaction, shape practices of international intervention and attitudes towards healthcare. In some cases, the proclaimed end of a disease leaves individuals or whole societies and states without resources previously guaranteed by the perceived epidemic threat. In others, the action of looking back after the end creates space for making moral judgements on individuals, societies, governments and international organizations.

The course that the epidemic narrative runs is usually well defined. Charles Rosenberg, in his classic 1989 paper, “What is an epidemic”, stresses the episodic nature of epidemics and lays out a particular dramaturgy of how epidemics take place. “Epidemics start at a moment in time, proceed on a stage limited in space and duration, follow a plot line of increasing and revelatory tension, move to a crisis of individual and collective character, then drift toward closure.” This narrative has been little contested since. Literary scholar Priscilla Wald in a more recent work, Contagious, portrays a similar plotline in what she calls the outbreak narrative, which “in its scientific, journalistic and fictional incarnations… follows a formulaic plot that begins with the identification of an emerging infection, includes discussion of the global networks throughout which it travels, and chronicles the epidemiological work that ends with its containment.” While Wald’s book takes important steps towards critically assessing the narrative by focusing on its consequences, stakes and cultural, scientific and political significance, how and when these narratives end are not much questioned. The end of the storyline in the case of epidemics and outbreaks, then, is successful containment.

Disability scholars have been at the vanguard of thinking past this narrative. As Catherine Kudlick pointed out in a recent paper on the survivors of smallpox, epidemics have a hidden history interwoven with disability and survival. Because of this, disability history has the potential for transforming how we understand the impact of epidemic disease, not just at the level of individual reactions but also at that of social and political responses. By placing attention on survivors rather than mortality, Kudlick argues, we can re-imagine epidemic scripts.

Scholars of global health, along with policy makers have a lot to benefit from these perspectives and can take the opportunity to broaden the scope of their study and action. By placing the ‘after’ into the centre of analysis, we can gain a more nuanced understanding of what epidemics are, the how we might study them and who and what gets left out of the master narrative of beginning, crisis and end. This shift of focus also highlights the narrative’s shortcomings and the stakes at hand as epidemic narratives shape global and local health policies.

Eradication is the ultimate ‘end’ to a disease, but the epidemic narrative is very much present in many other health issues, from obesity through cancer. And the dramaturgy of increasing tension, crisis and closure is seductive, especially regarding the end. We all yearn for a happy ending, or at least an ending of some sorts, when it comes to diseases that challenge our faith in medical knowledge, our political systems and rip the social fabric. Hardly anyone would contest that eradicating smallpox was a good idea, or argue that we’d rather have polio epidemics back. Furthermore, the narrative can be constructive in other ways. Epidemics and diseases more generally leave behind not just survivors, but public health practices and structures – not everything is always forgotten or works in exclusionary ways. Clear endings can give way to new beginnings.

At the same time, epidemic narratives can be as deceptive as seductive. The end of disease, may it be a goal, a wish, or a thing of the past, is often perceived in a particular and narrow sense. Endings often imply progress of some kind, while the stories of survivors overwrite the ones of failure, of anonymous loss. But endings are often messier than any international, national or local governing body would care to admit, and most diseases do not map onto neat narratives. Endings hardly mean that the story is finished. The contributions to this series look further to follow the story and investigate the very real stakes of theoretical musings on temporalities and endings and the consequences of such narratives in global health.

Dora Vargha awarded AAHM Prize

Dora Vargha has been awarded the 2016 J. Worth Estes Prize by the American Association for the History of Medicine (AAHM). Dora received the prize for her paper “Between East and West: Polio Vaccination Across the Iron Curtain in Cold War Hungary”, published in the Bulletin for the History of Medicine (Summer 2014).

This award was established in honour of J. Worth Estes, M.D., in recognition of his many invaluable contributions to the American Association for the History of Medicine and to scholarship in the history of medicine. The award is made annually for the best published paper in the history of pharmacology during the previous two years, whether appearing in a journal or a book collection of papers.
Congratulations, Dora!

In the Shadow of Ebola

As part of the After the End of Disease conference, The Reluctant Internationalists and the Birkbeck Institute for Humanities are proud to present In the Shadow of Ebola, a film by historian of medicine Gregg Mitman and filmmaker Sarita Siegel on May 25 at Birkbeck Cinema. The film screening will be followed by a panel discussion with the participation of the directors of the film and Jessica Reinisch (Birkbeck), Patricia Kingori (Oxford) and Karen Wells (Birkbeck). The event will be free and open to the public.

Time: May 25, 18:00-20:00

Place: Birkbeck Cinema, 43 Gordon Square, London

Tickets: register for your free tickets here.

For more information on the After the End of Disease conference, see website.

HAZMAT copy

In the Shadow of Ebola is the gripping story of a Liberian family kept apart by the Ebola outbreak in a nation still reeling from the chaos of civil war. We follow a Liberian student and his family living divided between the United States and Liberia. As the crisis unfolds, loved ones are isolated in Monrovia where the government is shut down, schools and markets are closed, and food prices are rising.

Liberians find themselves fighting an invisible war that is painfully reminiscent of the chaos and confusion of the fourteen-year Liberian civil war, which ended a mere decade ago.  When the Liberian government responds to the crisis initially with military-enforced quarantines and curfews, mistrust and anger among Monrovia’s residents grow.

As the death toll from Ebola climbs, and a quarantine results in the shooting and death of a 15-year old boy, mistrust and disbelief are replaced by compassion and inner resolve to combat the spread of the virus.  With international aid slow to arrive, Liberians turn to each other for help, as healthcare workers, musicians, and artists join forces on the front lines in public health education campaigns. The steps toward community empowerment and action help to build trust and stabilize the number of new Ebola cases.  But the ripple effects—food insecurity, overwhelmed medical infrastructure, and economic isolation—endure.

Agents of Internationalism special issue

We’re delighted that our ‘Agents of Internationalism’ special issue of Contemporary European History has just been published online, see here.

You can read Jessica Reinisch’s introduction here. The concluding essay by Ana Antic, Johanna Conterio and Dora Vargha is here.

Contemporary European History
Vol. 25 Part 2 May 2016

Contents

Reinisch, Agents of internationalism
Jessica Reinisch

From Transnationalism to Olympic Internationalism: Polish Medical Experts and International Scientific Exchange, 1885–1939
Katharina Kreuder-Sonnen

Managing an ‘Army of Peoples’: Identity, Command and Performance in the Habsburg Officer Corps, 1914–1918
Alexander Watson

The Dangers of ‘Going Native’: George Montandon in Siberia and the International Committee of the Red Cross, 1919–1922
Francesca Piana

Whose World? Internationalism, Nationalism and the Struggle over the ‘Language Question’ in the International Federation of University Women, 1919–1932
Christine von Oertzen

Axis Internationalism: Spanish Health Experts and the Nazi ‘New Europe’, 1939–1945
David Brydan

From Communist Internationalism to Human Rights: Gender, Violence and International Law in the Women’s International Democratic Federation Mission to North Korea, 1951
Celia Donert

The Cradle of the New Humanitarian System? International Work and European Volunteers at the Cambodian Border Camps, 1979–1993
Bertrand Taithe

Conclusion: Beyond Liberal Internationalism
Ana Antic, Johanna Conterio, Dora Vargha

Review Articles
Cultural Diplomacy and International Cultural Relations in Twentieth-Century Europe
Charlotte Faucher

New Directions in the History of Medicine in European, Colonial and Transimperial Contexts
Jennifer Johnson

Notes on Contributors

 

 

Ana Antic’s Fraenkel Prize lecture

Wounded minds: Experiencing the violence of the Nazi New Order in Yugoslavia

Ana Antic will present her Fraenkel Prize lecture at the Wiener Library on Wednesday, 27 April, 6.30-8pm.

In WWII, death and violence permeated all aspects of everyday lives of ordinary people in Eastern Europe. Moreover, almost entire populations were drawn into fierce and uncompromising political and ideological conflicts, and many ended up being more than mere victims or observers: they themselves became perpetrators or facilitators of violence, often to protect their own lives but also to gain various benefits. Yugoslavia in particular saw a gradual culmination of a complex and brutal civil war, which ultimately killed more civilians than did the foreign occupying armies. This lecture will tell a story of the tremendous impact of such pervasive and multi-layered political violence, and will look at ordinary citizens’ attempts to negotiate these extraordinary wartime political pressures. It proposes to use Yugoslav psychiatric case files as unique windows into this harrowing history in order to gain an original perspective on the effects of wartime violence and occupation through the history of psychiatry, mental illness and personal experience. By looking at patient files as historical sources, it explores the socio-cultural history of wartime through the eyes of (mostly lower-class) psychiatric patients. Moreover, the experiences of observing, suffering and committing political violence critically affected the understanding of human psychology, pathology and normality in WWII and post-war Balkans and Europe. The lecture traces the formation and re-definition of psychiatric concepts, categories and practices in the context of extreme violence, Nazi occupation and post-war socialist revolution. It shows how such brutal external conditions and unprecedented anti-civilian violence transformed psychiatric and scientific paradigms, and changed psychiatric and broader public evaluations of the human psyche.

Please reserve your place here.

We’re launching the Centre for the Study of Internationalism

The Reluctant Internationalists research group is excited to launch a new Centre at Birkbeck, the Centre for the Study of Internationalism. The Centre gives a presence to a significant field of research at Birkbeck: internationalism in its various guises, in the past and present. It provides an intellectual home for researchers at all stages in their careers who are interested in the social, cultural, political, economic, intellectual and legal fabric of our world of nation-states and international or global institutions. It unites scholars from different academic fields and departments, including history, the political, legal and social sciences, economics, languages, philosophy, and other disciplines. The Centre will organise reading groups, seminars and workshops, and host an annual lecture and visiting fellow.

The launch event will take place on Monday, 23 May, 6-8pm at Birkbeck. Jessica Reinisch will introduce the Centre, followed by a lecture by our visiting fellow, Prof Holly Case, on ‘The Age of Questions’, which looks at a period in modern history – roughly 1810 to 1950 – when ‘questions’ reigned. The Russian writer Leo Tolstoy wrote his views on the ‘Eastern question’ through the character in Anna Karenina, the future president of Czechoslovakia penned over 700 pages on the ‘social question’, and a German novelist expressed his immoderate views on the ‘oyster question’. When and why did people start thinking in terms of ‘questions’ and what did it mean?

The talk and discussion will be followed by a drinks reception.

Places are free but need to be reserved, here.

'The labour question'. 'Lord Salisbury's policy'. "We cannot look abroad into the territories ... On this matter I can only say that I believe the Government may give useful assistance ... when it finds that men are willing to co-operate with them." Lord Salisbury is shown holding a piece of paper titled 'Arbitration'. To his left are workers on strike and to his right a female figure with 'trade' written on her walks to the sea. In the distance and across the sea are the named countries, German.,57 x 90 cm.

Holly Case is a historian of Europe specializing in modern East-Central and Southeastern Europe. Her work focuses on the relationship between foreign policy, social policy, science and literature as manifest in the European state system of the nineteenth and twentieth centuries. Her book, Between States: The Transylvanian Question and the European Idea during WWII, was published in 2009.

Conference Report: “Debating the Cold War” 

February 5, 2016 at Birkbeck College, University of London

Report by David Bryan and Francesca Piana 

Debating the Cold War

The Debating the Cold War workshop took place at Birkbeck College, University of London, on Friday, 5 February 2016. It involved around 35 scholars from Europe, the United States, and Asia, who took part in a day of lively debates about some of the ‘myths’ of the Cold War, reflecting on current developments and future directions in the historiography, and their implications for research and teaching.

The first panel discussed the global nature of the Cold War. Although the Cold War is still commonly understood in terms of a US-Soviet binary, the impact of the conflict was felt in all corners of the globe. Anne Deighton (Oxford) argued, however, that there was not a single global Cold War and that we needed to think about the multiple ‘global histories’ of the conflict. The challenge for historians was to both tease out these histories and integrate overlapping developments which took place during the period, from the Sino-Soviet split to decolonisation and changes to the global economy. Many participants argued that these overlapping histories called into question traditional periodisations of the Cold War. The relationship, for example, between communism, decolonisation and development both began before and continued after the Cold War era. Much of the discussion focussed on the idea of the Cold War as a conflict between multiple competing models of modernisation or development, taking place within a post-war global economy in which western capitalism both adopted ‘socialist’ practices, and exerted increasing influence over the internal dynamics of communist states.

The second panel examined the role of ideology in the Cold War, and in particular the traditional binary between the ‘ideological’ East and the ‘non-ideological’ West. Most of the speakers focussed on the complex role of ideology in everyday life in Eastern Europe and the Soviet Union. Ideology, whether defined in terms of ideas, language or everyday practices, was a transformative force which helped to shape socialist societies and individuals within them. Its impact varied over time and place, but did play an important role in the construction of communist societies in post-war Eastern Europe, re-mobilising Soviet citizens during the 1960s and 1970s, and shaping educational practices during the apparently ’apathetic’ period of late socialism. Despite the unwillingness of historians of Western Europe and the West to engage with ‘ideology’ as a category of analysis, some of the speakers aregued that such ideas and practices shaped life on both sides of the Iron Curtain. Dina Fainberg (Amsterdam) showed how journalists from the United States and the Soviet Union who covered the two systems were both producers and products of ideology, engaging in forms of comparative writing which invited readers to contrast the Cold War ‘other’ with an idealised version of their own country. Anatoly Pinsky (St Petersburg/Helsinki) argued that the 1950s and 1960s witnessed a turn towards a romantic interpretation of Marxism in the Soviet Union which drew on shared intellectual traditions between Russia and the West.

The third panel addressed the role of the state through the lens of welfare in the Cold War, and how citizens both in the East and in the West understood, appropriated, and reshaped questions of national security, education, welfare, social mobility, and consumption. Sandrine Kott (Geneva) argued that, in order to understand the socialist bloc we should use the language of the ‘social state’ in which social expenditure was higher than in the West. Dean Vuletic (EUI) argued that it was more productive to think in terms of national frameworks in the Eastern Bloc rather than generalisations about the region as a whole. On this, Vuletic was joined by Peter Romijn (Amsterdam), who reflected on the national reconstruction projects in Europe after WWII and on the different ways societies returned to ‘normality’, through humanitarian programmes, and economic and political recovery. The discussions that followed focused on exchanges between the two blocs, often through the circulation of expertise, and interest in ‘models’ which at times cut across the Iron Curtain.

The forth panel reflected on science during the Cold War, and particularly on the idea of a fundamental difference between scientific practices in the two blocs. Moving away from the highly researched issues of nuclear power and the atomic bomb, the panelists brought a set of different sciences into the discussion, from mathematics to social sciences, medicine, psychiatry and technology. Some of the speakers focussed on the role of ‘pure’ science in shaping the Cold War. Alma Steingart (Harvard) discussed the role of mathematics and of scientific rationality in the battle of the Cold War, reflecting on how science influenced the Cold War and vice versa. Waqar Zaidi (Lums) stressed the importance of the Cold War in encouraging ‘big science’, such as electronics, satellites, computers, and internet, through the examination, scrutiny, collection and dissemination of data, often connected to state-driven and military efforts. Much of the discussion focussed on the connections among scientists, the circulation of expert knowledge and data, the ‘language’ of sciences, and the role of translation in enabling scientists to access foreign-language research from both sides of the Iron Curtain.

The workshop ended by addressing the legacies of the Cold War, and asking how we understand and communicate its history to younger generations who did not directly experience it. Elidor Mehilli (Hunter College) highlighted the violent legacy of the Cold War in 1990s Yugoslavia, the way it has shaped current ideas about the efficacy of ‘peoples’-led’ revolutions such as the Arab Spring, and its effect on current notions of freedom and the promotion of democracy. Angela Neilson-Nagy (Blackheath High School / Birkbeck MA student) provided a fascinating insight into the extent to which new historiographical approaches have informed, or, more frequently, failed to inform, current teaching materials and curricula in UK secondary schools. The challenge, panellists agreed, was to integrate the complex, heterogeneous and multi-centred historiography of the Cold War, showcased during the workshop, into a narrative which remained comprehensible and engaging for students and the general public.