Eula Biss’ ‘On Immunity’

I first read excerpts of Biss’ On Immunity in Salon months ago. I was finally able to get it from my local library 2 weeks ago.  It is a slim book, so I read it quickly in about 2 days, but it is a beautiful, profound book.  It is a mother’s and a literature professor’s exploration of vaccination and an analysis of the terms used, arguments made and history. Biss appears to be pro-vaccination, but the book is full of vivid personal moments, and she manages to straddle the difficult area of highlighting parental concerns (her own and others) and using evidence and anecdote to respond. She doesn’t preach; she explores and explains and comes at it from a mother’s point of view which is disarming.

Honestly, I don’t even know how to review this book.  I kept it past the two-week checkout window so I could re-read it and post on it.  It is a beautiful, intelligent book, and I highly recommend it, especially in light of the measles outbreak and latest reports of mumps as well.

I am pro-vaccine.  Daniel is fully vaccinated, and I believe that vaccines are a public health miracle.  We are fortunate that we have never had to experience a polio outbreak or smallpox epidemic with little hope for a cure.  Maybe it is because I’ve read way too many biographies of historical figures, but I cannot think of vaccines as anything but good.

But. I felt nervous when Daniel needed to receive the dreaded “MMR” vaccine. He received it on time, but I closely monitored him.  I agree that these decisions are difficult, especially when it is your tiny, fresh new baby who is being poked.  I get it. I get how easy and comforting it is to think if only you can feed you child the best, safest food; provide the safest, most enriching environment, you can somehow stave off disease of all types, ranging from the flu to cancer. What we forget or don’t want to think about is that we are all irrevocably tied to our environment and all the good and bad things in it. We have far less control than we think, including over our own bodies.  As The Emperor of All Maladies (a book I had read already and one that Biss references) points out, cancer is us.

I don’t think I can do justice to this book in a review, so I’m going to post some quotes that stood out to me.

When I search now for a synonym for ‘protect,’ my thesaurus suggests, after ‘shield’ and ‘shelter’ and ‘secure,’ one final option: ‘inoculate.’ This was the question, when my son was born – would I inoculate him? As I understood it then, this was not a question of whether I would protect him so much as it was a question of whether inoculation was a risk worth taking. (p. 7)

The very expression ‘herd immunity’ suggests that we are cattle, waiting, perhaps to be sent to slaughter. And it invites an unfortunate association with the term ‘herd mentality,’ a stamped toward stupidity. The herd, we assume, is foolish.  Those of us who eschew the herd mentality tend to prefer a frontier mentality in which we imagine our bodies as isolated homesteads that we tend ether well or badly. The health of the homestead next to ours does not affect us, this thinking suggests, so long as ours is well tended. (p. 20-21)

When I ask the pediatrician what the purpose of the hep B vaccine was, he answered, ‘that’s a very good question,’ in a tone that I understood to mean this was a question he relished answering.  Hep B was a vaccine for the inner city, he told me, designed to protect the babies of drug addicts and prostitutes.  It was not something, he assured me, that people like me needed to worry about. (p. 23-24)

The brief that public health measures are not intended for people like us is widely held by many people like me.  Public health, we assume, is for people with less – less education, less healthy habits, less access to quality health care, less time and money. (p. 24)

One of the mysteries of hep B immunization is that vaccinating only ‘high risk’ groups, which was the original public health strategy, did not bring down rates of infection…But rates of hep B infection remained unchanged until the vaccine was recommended for all newborns a decade later.  Only mass vaccination brought down the rates of infection and it has now virtually eliminated the disease in children. (p. 25)

When the last nationwide smallpox epidemic began in 1898, some people believed that whites were not susceptible to the disease…And when smallpox arrived in Middlesboro, Kentucky, everyone in the black section of town who resisted vaccination was vaccinated at gunpoint. These campaigns did not limit the spread of the disease, but all the risk of vaccination…was absorbed by the most vulnerable groups. The poor were enlisted in the protection of the privileged. (p. 25-26)

If it was meaningful then for the poor to assert that they were not purely dangerous, I suspect it might be just as meaningful now for the rest of us to accept that we are not purely vulnerable. The middle class may be ‘threatened,’ but we are still, just by virtue of having bodies, dangerous. (p. 27)

In a study that invited people to compare various causes of death, Slovic found that people tended to believe that accidents cause more deaths than disease and that homicide causes more deaths than suicide, when the opposite is true in both cases. (p. 37)

‘Intuitive toxicology’ is the term that Slovic uses for the way most people assess the risk of chemicals…For toxicologists, ‘the does makes the poison.’ Any substance can be toxic in excess. Water, for instance, is lethal to humans in very high doses…But most people prefer to think of substances as either safe or dangerous, regardless of the does. And we extend this thinking to exposure, in that we regard any exposure to chemicals, no matter how brief or limited, as harmful. (p. 38)

Allowing children to develop immunity to contagious diseases ‘naturally,’ without vaccination, is appealing to some of us. Much of that appeal depends on the belief that vaccines are inherently unnatural…Vaccination is a kind of domestication of a wild thing, in that it involves our ability to harness a virus and break it like a horse, but its action depends on the natural response of the body to the effects of that once-wild thing. (p. 41)

The idea that toxins, rather than filth or germs, are the root cause of most maladies is a popular theory of disease among people like me. (p. 73)

As for mercury, a child will almost certainly get more mercury exposure from her immediate environment than from vaccination. This is true, too, of the aluminum that is often used as an adjuvant in vaccines to intensify the immune response.  Aluminum is in a lot of things, including fruits and cereals as well as, again, breast milk. Our breast milk, it turns out, is as polluted as our environment at large. Laboratory analysis of breast milk has detected paint thinners, dry-cleaning fluids, flame retardants, pesticides and rocket fuel. (p. 74)

Though toxin is now often used to refer to man-made chemicals, the most precise meaning of the term is still reserved for biologically produced poisons.(p. 74)

Immunity is a public space. And it can be occupied by those who choose not to carry immunity. For some of the mothers I know, a refusal to vaccinate falls under a broader resistance to capitalism. But refusing immunity as a form of civil disobedience bears an unsettling resemblance to the very structure the Occupy movement seeks to disrupt – a privileged 1 percent are sheltered from risk while they draw resources from the other 99 percent. (p. 95)

Paternalism has fallen out of favor in medicine, just as the approach to fathering that depends on absolute authority no longer dominates parenting. But how we should care for other people remains a questions. (p. 98).

Autonomy is usually imagined as the alternative to paternalism. But in what is sometimes called the “restaurant model” of medicine, the paternalism of doctors has been replaced by the consumerism of patients…And the doctor, who was a father in the paternalistic model, is now a waiter. (p. 99)

Once you are infected with chicken pox, the varicella virus never leaves your body. It lives in your nerve roots and must be kept at bay by your immune system for the rest of your life. (p. 115).

We used to live among wild things, mountain lions on the ridge and fires raging on the prairie. There were dangers….It is difficult to imagine any type of chicken pox, with its distinctive rash described as a ‘dew drop on a rose petal,’ as sinister. And it is hard not to suspect, when the two types of chicken pox virus are termed the wild type and the vaccine virus, that the wild type might be superior. (p.115-116)

The natural body meets the body politic in the act of vaccination, where a single needle penetrates both. The capacity of some vaccines to generate a collective immunity superior to the individual immunity produced by those same vaccines suggests that the politic has not only a body, but also an immune system capable of protecting it as a whole. (p. 126)

The anxieties generated by the AIDS epidemic have bled into our attitudes toward vaccination. Needles, as we learned from AIDS, can spread disease. The needle itself has become ‘dirty.’ AIDS reveals that our immune systems are vulnerable to sabotage and can be permanently disabled. (p. 136)

AIDS education taught us the importance of protecting our bodies from contact with other bodies, and this seems to have bred another kind of insularity, a preoccupation with the integrity of the individual immune system. Building, boosting and supplementing one’s personal immune system is a kind of cultural obsession of the moment. I know mothers who believe this is a viable substitute for vaccination, and who understand themselves as raising children with superior immune systems. (p. 137)

Biss’ On Immunity is truly an amazing book. I think I’ve read it three times now, and its study of the language used in vaccine discussions has taught me so much. I urge everyone to read it.


Wrestling with Control

Two very different pieces about having children made me catch my breath this week.

Mandy, my friend and 2014 Listen to Your Mother: Raleigh-Durham cast member, had her first piece published in Mamalode this week and in it she muses movingly on the pros and cons of having a fourth child:

I want my two living children to have another sibling.

I want them to have the playmates I never had growing up. (I am one of four, but my siblings are from my mother’s first marriage and are much older than I.)

I want them to have a larger support system when they get older and have to deal with their aging parents.

And, more than anything, if through some terrible and cruel fate, we lose one of them, I don’t want the other to be left alone. Our daughter was only 17-months-old when she died—we have decades left during which something could happen to one of our two living children.

I want my two living children to have another sibling.

And concludes:

What I understand now is that I am not in control of very much at all that happens to my children, and in order to manage my fear, I must accept how little control I have.

And then there was this article making the case for having an only child by Wendy Thomas Russell.  One-and-done by choice, Thomas Russell aims for a bit of levity with a not-so-funny Top 10 list about why having one child is great, but she makes a similar point as Mandy did:

Listen, I’m not saying the only-child scenario is a perfect one. I’m the first to acknowledge that there are some disadvantages to capping our family tree so soon.

Once, at a hotel in San Diego, Maxine, then four, found a friend and began skipping along the concrete rim of a courtyard fountain. The rim was plenty wide and not much more than two feet off the ground, but my husband was hovering. Every 30 seconds or so, he reminded Maxine to “slow down” or “be careful.”

At one point, he turned to me. “I know I’m over-protective,” he said, “but I can’t help it. She’s our only one. We don’t have a backup.”

And it’s true: If we lose our daughter, we lose everything. It’s like we’ve put all our money into one stock without knowing whether it’s a high- or low-risk investment. Parents who have two or more children are diversified; the experts would surely agree that’s a smart way to live, right?

Smart, maybe. But it’s not foolproof.

There isn’t, and would never have been, a replacement for my Maxine. A second child could not lessen the grief of losing her. Perhaps the distraction of a second child would help me get up in the morning during those early months — but I don’t believe in bringing children into the world to act as a distraction in the case of some theoretical tragedy.

Having a child is a risk of the heart. Every day we parents get to experience the unrelenting joy of watching our children drink from the fountain of life while crossing our fingers that they don’t fall off the edge. We all do. Whether we have one child or five.

Both pieces were kicks in the gut. I’m thrilled and happy for Mandy but envious as hell. And it isn’t only she I envy; there have been many pregnancy announcements in the last year that have roused my green-eyed monster. Let me be clear: I can be envious AND happy for them at the same time. But I still feel the hot wash of shame in admitting I am envious. There seems no room for that emotion in polite society. And while it is inappropriate and inaccurate to say someone “deserves” good fortune (what is the criteria for that??), my shame at my envy is more acute with Mandy since she has had some truly horrific experiences. It feels churlish to feel envy even though my envy is more about me than it is about her.

Like the author of the second piece, I suppose we are technically “one-and-done” by choice as well. It doesn’t really feel like a choice though. Not when we consider our ages, our jobs, the huge cost just to try, and the fact we have a young child to whom we want to give a good life. And he will be 6 soon. At what point is there a diminishing return at having a sibling? Which leaves the other option as doing nothing, which is painful since we have 5 frozen embryos. Six-year-old frozen embryos.

I researched definitions of choice today because again, it doesn’t really feel like a choice. I discovered there is something called Hobson’s Choice, meaning that you really have only one option: accept it or don’t. That seems to be accurate – either we try for a sibling or don’t – but it doesn’t convey the weight and variables involved. Then I researched dilemma. Dilemma means two possibilities, neither of which is acceptable. That definition gets me closer to how I feel. It acknowledges the major hurdles we have to try for a second child as well as the cavernous hole I feel about not having a second.

Of course, this is an academic exercise. We try so hard to define different types of choices in order to make sense of our world, to reassure ourselves we have an iota of control. In fact, control is an illusion. We like to think we have broken the world to our will like a stubborn horse, but the joke is on us.

Both of the pieces I linked to are ultimately about control and our lack of it. What I am angry about is our inability to control our family building and what our family looks like. The fact that we had so little choice in how things turned out, so few options.

But that’s me. Us. Others may feel and find that lack of control and the illusion of choice in other areas, other pain points.

I cannot control much, but I can try to start making peace with that realization. Focusing on what we do have instead of what never will be.

That’s a choice within my power. In truth, it is freeing to know so much is beyond our control. That frees us from blame and fault. And guilt, that ever-present foe.

I don’t know about you, but I could use a life with a lot less self-blame and guilt.

Private School and My Liberal White Guilt

I had already intended to write a post about some guilt I was feeling about sending Daniel to private school before Allison Benedikt lobbed a grenade in the middle of back-to-school frenzy last week, declaring that anyone who sent his or her children to private school was a bad person. Thanks to Ms. Benedikt’s opinion, I now feel compelled – if only by myself – to discuss my feelings on the issue.

I never thought I would send a child of mine to private school. I grew up in a somewhat rural area of North Carolina in a county that could loosely be considered a bedroom community of larger cities nearby.  We had (and still do have) one school system. Elementary schools fed two middle schools which fed the one high school in the county.  I had 300 students in my graduating class (down from 360 when I was in the 10th grade).  My high school wasn’t perfect, but it offered a few AP courses and a unique partnership (for that time) with a nearby university that melded college classes with senior year classes for actual college credit.  I entered college with 26 credit hours under my belt, enabling me to take a lot of courses for fun instead of needing to worry about pesky general ed requirements.

Since we had only the one high school, pretty much everyone attended it. If they didn’t attend it, they attended private school in neighboring counties, something that seemed hopelessly hoity toity and out of reach to the girl who grew up in an area colorfully called “Turkeyfoot” by its inhabitants.  Plus, private school sounded snotty, elite & cliquish, attributes that aren’t on the top of the list to cultivate for my child.

The truth is, I didn’t expect to fall in love with the private school we chose for Daniel. It had always been on our list of potential schools for Daniel in some abstract way, but last spring we decided to get serious about exploring our options because school registration for kindergarten would happen in early 2014.

And it was love at first sight. The school is small. While it offers 9 grades (Pre-K-8th), it has only one class per grade and less than 300 students total. Each class is large, but all have a teacher as well as a full-time aide. I loved that the school emphasizes academics over sports (it’s not the school to attend if you have a budding athlete on your hands). Since the school is small, teachers can follow the progress of former students and confer with each other. They know the students. There is a community feel about the school, a sense of being a family. I’ve already talked more with fellow Pre-K parents in the last 2 weeks than I did with any at Daniel’s previous daycare.  I loved that routines, transitions and traditions are strong, and when they said they have a zero-tolerance policy for bullying, I believed it. I loved that while they adhere to the North Carolina curriculum, they are able to deviate in others ways such as the math they teach and teaching cursive. Cursive!!!  The school believes in teaching students accountability and scaffolds their learning. The tour had barely ended when I looked at Jimmy and said, “I’m sold.”

And here comes the guilt. I believe strongly in public schools and the role of public schools to prepare children for their role as informed, educated members of society.  How can I not be branded anything other than a hypocrite for believing in public schools but sending my own child to private?

It’s cliche, but you do see things differently when you have a child. Suddenly, issues and stances that seemed academic become frighteningly real when you consider how they will impact  your child and putting your child in that environment. It’s your child’s future that could be impacted. In some cases, it’s your child’s safety and well being.

Overall, North Carolina’s public schools are pretty good.  My own public school experience was very good in terms of providing me with opportunities to develop and preparing me for college. It is amazing how school systems differ from one county to the other. In neighboring Wake County, public schools consist of traditional calendar, year-round calendar, magnets and charters. In my county, there is one school system that operates on a traditional calendar and no magnet or charter opportunities. In contrast to our private school, the elementary school Daniel would attend has almost 1000 students in K-5. This is typical for the area.  Our county is a transitional county in that it is quickly growing and becoming affluent, especially as it serves as a bedroom community for Wake County, but it has growing pains. It has a large migrant population, and there are reports of gang and drug activity at the high schools. The eastern parts of the county are very rural. Some schools have no gifted programs. Honestly, it’s probably pretty typical of what you would find in most of the state.

It’s not the school environment we want for our child. There. I said it. I’m elitist.  And we have the ability to be that way, to send our child to private school. We are so very fortunate to be able to do so.

But I can’t stop thinking about public schools.  If Benedikt had one point in her cringe-worthy article, it is that fleeing public schools does nothing to help those left behind.  But how much change can you make when there are systemic changes needed that are bigger than parental pressure? For example, my own state (not exactly a model for anything lately except what NOT to do):

  • Killed a teacher scholarship program designed to get the best and brightest teachers into the classroom
  • Mused that instead of building new schools to ease over-crowding, we could use space such as art, music and special-ed rooms since they aren’t important or being fully utilized
  • Denied teacher raises and reducing school spending while arguing that you haven’t altered the budget at all
  • Somehow managed to both prevent children from attending the schools closest to them and created neighborhoods with poor schools, likely lowering property values (and thus school revenue) for that area

I personally:

  • Watched magnet schools premised on integrating urban areas through specialized offerings remain segregated with the advanced classes filled with the students not from the area while the “native” population remains in lower-level classes
  • Received the tepid response of “It’s OK” when parents respond to my question about how their child’s school is

I also have some issues with public education in general that I think need to be addressed:

  • Outdated models of instruction and structure that resemble factories
  • The increasingly narrow definition of what “normal” is, especially for boys
  • The emphasis on testing which becomes teaching to the test (I know it doesn’t have to be like that, but let’s face it. In a lot of schools, that’s what it becomes)
  • Not treating and compensating teachers like educated, competent professionals
  • Too many fads making their way into the curriculum with little time to evaluate and decide if they are worthy
  • A structure that squelches innovation, creativity and passion, skills badly-needed for us to compete globally (see Sir Ken Robinson; also this)

Y’all, I don’t have any answers. Would Daniel be fine if we sent him to public school? Probably. And who knows, we may still. It comes down to the fact that we have a choice, and a lot of people don’t. So I’ll work to squelch my guilt at doing what’s best for my child and think of ways I can help the public schools in any small way I can.

If you’re interested, here are a few really good responses and reactions to Benedikt’s article.