Contagious: Cultures, Carriers and the Outbreak Narrative (review)

A Google search on H1N1 turns up 50.6 million hits in 0.14 seconds, each hit a digital component in a much larger story that spans continents, time, and human imagination, a tale of suspense that hinges on the precarious balance between man and the microbial world. It is the type of story very familiar to Priscilla Wald, professor of English at Duke University and an authority on the narratives we construct to explain illness.

In Contagious: Cultures, Carriers, and the Outbreak Narrative (published before the outbreak of H1N1), she outlines what has become a dominant story line in both popular and scientific accounts of twentieth-century epidemics. An eerily similar narrative emerges as she explores depictions in journalism, fiction, and film of disease outbreaks from typhoid fever to AIDS. Among the staples of our society's common epidemiologic novellas is an emergence of especially tenacious pathogens often spreading from Hot Zones in the Third World, the presence of superspreaders like Typhoid Mary and Patient Zero, and the mobilization of the best scientific minds to combat the dangerous problem as we turn to science for survival. These elements combine to form an outbreak narrative. And while this narrative may offer a convenient, culturally approved lens to view epi-demiologic phenomena, Wald argues that it blinds us to many aspects of infectious disease, ultimately hindering our ability to treat the root cause of microbial dangers that plague us.

Wald does a remarkable job in this book of integrating science, culture, elements of myth and story—all while carefully keeping everything in historical context. Noting, for example, that contagion is both an epidemiological fact and a powerful cultural and theological concept, she points out that it was at the height of the bacteriological revolution that both Emile Durkheim and Sigmund Freud explored the subject and its relation to social organization in Elementary Forms of Religious Expression (1912) and Totem and Taboo (1913), respectively. Both men saw in contagion a force that helped shape the social bonds around which society develops. All of which adds an element of irony to the fact that it is precisely through social connections that epidemics travel, the transmission of germ and virus leaving a microbial trail of who had contact with whom. In our modern world, as Wald points out, the social distance separating us from one another is often much less than the geographic distance. Epidemics leap from remote locations to other continents in the time it takes a jet to make the trip. The distance between ourselves and an epidemic in the most remote locations may be no greater than the social distance that separates us from a flight attendant, traveling businessman, or tourist. The carrier, the superspreader, may be close at hand. Yet, given the reality of globalization, such interconnection is the lifeblood of a community.

One cannot help, but wonder, if such complexities might actually fuel our need for an outbreak narrative, a quick filter through which meaning seems to emerge. It is fitting, therefore, that it is a professor of literature who reminds us of the importance of narrative. For it is through stories that we construct the meaning of everything from art to epidemics; and, as Wald shows us, our stories about the unknown are often a catalog of the familiar. What we say about mysterious and alien microbes tells us a lot about ourselves.

Indeed, the outbreak narrative tells us much regarding our ideas about contagion, strangers, community, poverty, and social conditions in the third world, and especially science. As Wald traces development of the outbreak narrative across the twentieth century, we see an emerging theme of scientists, especially epidemiologists, as warriors—intellectual knights in lab coats—doing battle with the dragons that threaten us all. They are the thin white line protecting us from primeval forces. Our hope lies in a vial of vaccine.

Unfortunately, says Wald, this outbreak narrative obfuscates more than it reveals about the nature...