Intolerant Bodies: A Short History of Autoimmunity by Warwick Anderson and Ian R. Mackay

Abstract

Health & History, 2016. 18/1 159 Book Reviews Warwick Anderson and Ian R. Mackay, Intolerant Bodies: A Short History of Autoimmunity (Baltimore, US: Johns Hopkins University Press, 2014). ISBN 978-1-4214-1533-8 (PB). xii + 250pp. It’s easy to understand why Intolerant Bodies by medical historian Warwick Anderson and distinguished immunologist Ian Mackay was the winner of the General History Prize in the 2015 NSW Premier’s History Awards. With clarity, depth, and subtle provocation, Intolerant Bodies covers significant historical, biomedical, and philosophical ground to investigate and explain the aetiological paradox of autoimmune disease. The idea of a person’s body turning against its own healthy tissues, cells, and organs raises psychosocial, philosophical, and medical questions. Anderson and Mackay treat the breadth of their topic with compassion, perspicacity, and rigorous attention to social theory, history, and complex biomedical research. Delightful turn of phrase and an engaging literary style make this book highly readable, though the challenging subject matter will stretch the non-specialist reader. Anderson and Mackay take a chronological and thematic approach to charting the confluence of laboratory, clinical, and theoretical knowledge that were brought together for the concept of autoimmunity to be thought of in the 1940s and to begin to be accepted in the 1960s. Looking to the future, Anderson and Mackay hint at the limitations of research paradigms structured around the question of the biological self. Part of the Johns Hopkins Biographies of Disease series edited by Charles Rosenberg, Intolerant Bodies traces how the concept of ‘autoimmunity became thinkable’ (p. 4). Anderson and Mackay focus on four illustrative autoimmune disorders: rheumatoid arthritis, systemic lupus erythematosus, childhood (type I) diabetes, and multiple sclerosis. Autoimmunity is a unique entry point into the history of immunology. Anderson and Mackay demonstrate that no theory of the immune system will be complete without accounting fully for autoimmune conditions. They acknowledge that the biography of autoimmunity may seem to be written quite early. In some ways, this book charts a prenatal history of the autoimmunity concept; the way in which certain diagnostic tools, experimental techniques, and theoretical ideas had to come together before this new model of pathogenesis could be conceived. Weaving illness 160 BOOK REVIEWS narratives beautifully into the mix,Anderson and Mackay also explore the cultural and philosophical life that metaphors of autoimmunity have had outside immunology. Anderson and Mackay cover considerable ground in their book, from the nineteenth-century foundations of immunology and modern medicine to the contemporary literary, scientific, philosophical, anthropological, and even theological reflections on autoimmunity. The first chapter shows how nineteenth-century theories of fever anticipated the idea of a body that could betray itself. Turning to the history of immunology as a discipline, the second chapter contextualises the themes of individual variation, organic identity, and human distinction. Anderson and Mackay then map the institutional matrix that made autoimmunity imaginable and provable in the third chapter. Chapter four is about the development of clonal selection theory and features the work of Australian microbiologist Frank Macfarlane Burnet from the 1940s to the 1960s. An autoimmune schema began to gain traction, but one that embodied ColdWar themes of command, communication, control, surveillance, recognition, conformity, tolerance, and regulation. Drawing upon scant patient accounts from the 1950s to 1970s, chapter five looks at the illness narratives of people living with an autoimmune disease during a time when the concept of autoimmunity was just becoming accepted. Chapter six recounts experimental insights into the breakdown of self-tolerance, how the normal could ‘shade into overt pathology’ (p. 126), and how a preoccupation for questions surrounding self and non-self ‘obscured the crucial question of what criteria the immune system uses in deciding to attack’ (p. 135). The afterword critically analyses how disease specialists have increasingly divorced medical theory from the illness experience, and how social and biological scientists have mixed models and metaphors between biology, philosophy, and local culture. Intolerant Bodies leaves the reader rethinking Canguilhem, wanting to revisit Derrida, and convinced of the fruitfulness of cross-disciplinary collaborations. Intolerant Bodies valuably contributes to the history and philosophy of medicine. A book for specialist audiences, Intolerant Bodies will hopefully leave immunologists inspired to engage more deeply with the philosophical tenets...