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  • Pathologies of Progress: The Idea of Civilization as Risk*
  • Charles E. Rosenberg (bio)

It is usually hard to pinpoint the moment when one decides to write a particular talk. In this case, however, it is easy to be precise. Last September, my tenth-grade daughter brought home an article that had been assigned by her history teacher; appearing originally in Discovery magazine and titled “The Worst Mistake in the History of the Human Race,” it argued that the adoption of agriculture “was in many ways a catastrophe from which we have never recovered.” 1 The author marshaled archaeological and paleopathological evidence to contend that the transition to settled agricultural life brought malnutrition, crowding, and the domestication of endemic and epidemic disease. The linked cultural and biological history of humankind had not, contrary to what so many of us have confidently assumed, been a tale of linear progress toward our present enviable health status.

We have all encountered versions of this argument—and in particular, the notion that the incidence of much late-twentieth-century chronic disease reflects a poor fit between modern styles of life and humankind’s genetic heritage as shaped in countless centuries of hunting and gathering. The notion is encapsulated in the title of another programmatic [End Page 714] essay I have used myself in teaching: “Stone Agers in the Fast Lane.” The Late Paleolithic era, its authors argue, “may be considered the last time period during which the collective human gene pool interacted with bioenvironmental circumstances typical of those for which it had been originally selected.” 2 Not surprisingly, a body evolved to fit the hunter-gatherer’s life could not be expected to fare well in today’s very different environment. Chronic disease, the argument follows, has developed out of this growing asymmetry—and the prevention of such ills must reflect an understanding of our organism’s genetically mandated style of life.

These arguments have been widely disseminated in the 1990s. “In the past thirty years,” as a recent New Yorker essay retailed a version to its readers, “the natural relationship between our bodies and our environment—a relation that was developed over thousands of years—has fallen out of balance.” 3 Although they seem contemporary, such ideas immediately called to mind earlier and seemingly dissimilar research of my own—on nineteenth-century America and the perceived health dangers of urban, industrial society. My doctoral dissertation was a study of cholera in mid-century America, and almost as soon as I began serious research I became aware that contemporaries regarded urban life as inherently dangerous. 4 Such fears were widespread not only in this country, of course, but in England and on the Continent as well: “The growth of civilization,” as the London Times noted in 1868, “means the growth of towns and the growth of towns means, at present, a terrible sacrifice of human life. . . . The fact is that in creating towns, men create the materials for an immense hotbed of disease, and this effect can only be neutralized by extraordinary artificial precautions.” 5 Endemic fevers, tuberculosis, and elevated infant mortality rates exemplified the city’s everyday perils; cholera seemed no more than an acute confirmation of these grim chronic truths. [End Page 715]

My next—immediately postdoctoral—research project on late-nineteenth-century ideas of degeneration made me aware of another widespread expression of change-oriented cultural angst: namely, a focus on neurasthenia and hysteria, both diseases putatively caused or exacerbated by the novel realities of urban industrial society. New York neurologist George M. Beard, who popularized the concept of neurasthenia as a clinical entity, in fact saw the new disease’s growing American incidence as evidence of his country’s advanced cultural and technological standing. 6

In one sense, this ironic and persistent emphasis on the role of civilization in the causation of disease is no more than a cliché, a variation of traditional primitivistic notions, endless evocations of lost worlds in which humankind had not been corrupted by wealth and artifice—all versions and reiterations of the Garden of Eden’s Faustian bargain recast in epidemiological terms. Equally conventional was and is the use of disease incidence and theories of causation...

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