Journal of a Plague

Journal of a Plague is a new column, by Dr. Norman Doidge, that aims to help readers to stand back from, reflect on, and make sense of the pandemic, both in terms of how it is transforming life around us, and how it is affecting our individual psyches—the plague without, and the plague within.

Our column takes its name from A Journal of the Plague Year, the English writer Daniel Defoe’s classic account of the Great Plague of London of 1665. Defoe’s book is full of vivid observations that still resonate: early bouts of denial as the plague first enters London; the rich fleeing the city; the fearful exploited by quacks and con men; the poor dying in the streets; weakly enforced quarantines; moments of hope and human affection amid the creeping desolation.

Doidge is the pioneering author of two ground-breaking books about neuroscience—The Brain that Changes Itself and The Brain’s Way of Healing, which showed that the brain is remarkably more resilient and adaptable than had generally been appreciated. While Defoe’s book was composed years after the epidemic it chronicles, Doidge is writing now, in the midst of a pandemic that has just begun, with no clear end in sight. This new journal will make no attempt, in the midst of fast-moving events, to be a roundup of coronavirus news. Rather, it will be a diary of sorts, where readers can peek in to a scientific and clinical mind at work—as Doidge, also a psychiatrist and psychoanalyst, absorbs and metabolizes what he is seeing, connects what we learn about the virus to what we already know about human development and evolution and ponders potential lessons for us individually, communally, and as a society.

Some installments will be several thousand words while others may be only a few paragraphs. All of them will be illuminated by Doidge’s deep knowledge of human history and science and how both have been indelibly shaped by disease. They will share one other aspect as well: Many will follow in some way a mysterious and awe-inspiring map that Doidge begins to explain here, in the first of his journal entries, and that each of us carries around inside of ourselves and which may reveal that we already know far more about the world of contagion than we think we do.

We have been here before.

Many times, in fact, as a species. Each of us has something, deep within us, that “knows” or “senses” this. Epidemics are part of our history and, as archeological evidence shows, of our “prehistory” before written records existed. That they have had such an impact on humanity also means that adaptations to parasites and pathogens are a major part of our biological inheritance—or, to use the reductionist shorthand, “are part of our DNA.”

Epidemics took off in the Neolithic revolution, when our hunter-gatherer ancestors went from living in small traveling bands, to crowding together with animals in agricultural settlements, which allowed new diseases to spread from animals to humans, and humans to each other. Archeology suggests that from 10,000 to 5,000 BCE, humanity’s population barely rose, from 4 million to 5 million people, over the course of 5,000 years, in what Yale University’s co-director of Agrarian Studies, James C. Scott, calls “a demographic bottleneck.” The most likely suspect responsible for this extremely slow increase? Mass death through infectious disease.

Our first historical records in Mesopotamia and the ancient Near East detail deadly epidemics—from the Epic of Gilgamesh to the Bible, where plaguelike outbreaks are mentioned repeatedly. There is only a single reference to pestilence in Genesis, a book largely about Jewish life before time spent in cities—and that is a reference to disease that occurred in Egypt.

Indeed, the Jews who went down to Egypt were quite the opposite of big city dwellers. The Torah describes Abraham, Isaac, and Jacob as living in tents, like seminomadic pastoralists and herdsmen who moved around—less mobile than hunter-gatherers, but not yet totally sedentary. Perhaps that’s why there are no plagues mentioned in the Promised Land in Genesis. Then in Exodus, in the slave state of Egypt, where there were cities with tens of thousands of people, the Children of Israel have their first encounter with large-scale pestilence.After Genesis, the number of references to pestilence skyrockets, to well over 40.

Now that we are going through a pandemic, the numerous precautions in the Laws of Moses about the need to distinguish the clean and the unclean, and how to deal with the unclean, obviously infected people who have “running issue out of … flesh,” in the form of body fluids, and discharges, and pollutions, and spit, and semen, and the need for washing after encounters with them or their clothes, or the beds they have lain on, or seats they sat on, i.e., any surface they touched—all these do not seem so far-fetched. And how does one deal with this? By washing, washing, washing. Nor does the need to monitor the unclean’s exposures to other people, which should be followed by more washing, or the need to hold off on having sex with animals whenever possible, and from sex outside marriage, and to be careful around corpses; nor does the listing of times required for quarantine, immersions in water, and nor of course the need to wash one’s hands before eating. All these suddenly seem far from the primitive superstitions of a simpleton mind, packed into a bizarre obsessive-compulsive symbolic system, that some have made them out to be. They seem, at this moment, less tedious and more like a sane response to the “all the disease of Egypt” (as pestilence was called in the Torah). To judge by the omnipresent terror of plague throughout the rest of the Torah, the encounter with pestilence—witnessing it in others—was deeply traumatic and totally reshaped the Children of Israel.

Their measures were not unlike many that we are taking now, down to the case-tracking of everyone who might have been touched by the unclean one. Yet, somehow, these laws were developed before scientists had microscopes to make visible invisible microorganisms, and before Koch and Pasteur developed a modern germ theory of infectious disease.

How could that be? How could they know the behavior of what couldn’t be seen? Were the laws the product of trial and error, a process already begun in Mesopotamia (where quarantine was a known response to contagion)? Or, is there some kind of biologically innate idea of contagion that the Hebrews intuited? And if rooted in the biological, why is it that some, but clearly not all, had access to this knowledge—as laws were needed to teach and enforce these measures? Or was this knowledge simply a case of God knows, then shares?

Whatever it was, those laws contained within them a map or a picture of a world in which an invisible force, contagion, menaces all, and, as well, an implicit understanding that it spreads by close contact, and a guide—still useful to us—instructing us how to contain it.

Sometimes, this is by staying inside until it passes over.

But then, after many years, when we’ve all but forgotten their fierce measure, the epidemics return. They are the sporadic norm.

Modern science has seen itself, for several centuries, as a method and a technique for us not just to understand nature, as the ancients saw science, but as a project for the conquest of nature, for the purpose of, following Francis Bacon, “the relief of man’s estate.” Medicine, seeing itself as part of this project, is riddled with military metaphors; the battle against heart disease, combating AIDS, the war on cancer, and now, the war on this virus. Drugs are magic bullets. Nature is seen as the enemy, mindless, random, accidental, chaotic. Nature is what we conquer, and give order to. It is what we override, surpass. The history of medicine, in this mood, is seen as human beings, using our conscious instrumental reason, to make us somehow immune to nature.

But this view of science as against nature tends to artificially separate us from nature, to denature ourselves, and also estrange us from our natural resources, including some instinctual ones we are now being reacquainted with.

Science and medicine did not develop despite nature, but because of it, and from it. Both stem from a curiosity, a capacity for wonder, and exploratory instincts that are deep within us. We humans did not even invent the idea of “giving medicine” to treat disease. Lizards, birds, bees, chimps, and others, all medicate themselves. Dogs eat grass prophylactically when their stomachs are upset to keep intestinal parasites and worms at low levels (thus grass becomes an anti-helminthic medication). Constipated chimpanzees in Tanzania will eat leaves not part of their normal diet, and which provide no nutritional value, to unstop themselves (laxatives). Lizards bit by venomous snakes find a root that can counter the venom (antidotes). Overdue pregnant elephants in Kenya, turn to a leaf they don’t regularly eat, to induce delivery. There are many examples of animals taking anti-parasitics, and fending those infections off. Humans did not even invent “sanitizer,” or the notion of Purell. Wood ants—Formica paralugubris—use a particular coniferous resin to protect themselves against pathogens that threaten them. So much folk medicine may have actually come from medicine men closely observing these animal practices, and trying them out.

Some animals “know” not to wait for infection, but learn to avoid disease in the first place, as we are trying to do now. Mice won’t mate with mice that are infected with viruses. They stay away. This implies they can recognize, or “diagnose” disease, in some way, and separate the clean from the unclean. When ants, in an act of grooming, remove fungal spores from their nest-mates, they obtain low doses of those spores. In so doing, the groomers experience a kind of “self-vaccination,” which not only protects them from being overwhelmed by the fungus, but which limits the spread to others in the colony. We humans think ourselves clever to have invented vaccinations, but must realize that we stand on the shoulders of … ants.

What is remarkable about our own disease avoidance behaviors is their continuity over the long stretches of time. At a moment when we are waiting for science to clarify more about the virus and its vulnerabilities, it is not as though we have nothing at all to rely on in the meantime just because what we have is ancient, or “low tech.”

When medicine and public health are looked at as adaptations that begin with our animal forbears and which continue up through human prehistory, ancient history, and then to our own times, one gets the impression of a host of complex instinctual archetypes at work.

The term “instinctual archetypes” seems suited to capture this dual aspect of such instinctual dispositions: that they are in part inherited, but also, there is implicit in them something akin to an image, idea, a map, and even a story of how contagion comes to us, invisibly, and threatens us, at times with apocalyptic levels of destruction, and how this catastrophe might be fended off. Because, at this moment in time, these kinds of instinctual reactions seem so evident in so many people, it appears suddenly quite remarkable that our greatest psychologists have spent so little time thinking through the extent to which human nature has been molded by our experience of being vulnerable to infectious disease; how its left its traces even in our psychological reactions.

So, we must distinguish the plague without, from “the plague,” as archetype within us. The latter comprises our internal responses to contagion, our state of mind, and everything “that plagues” us mentally at the moment. Perhaps because these responses unfold over time, in stages, a journal is a way to “catch” and describe these inner states, and make sense of them.

If one reviews the responses human beings have had to plagues, from the most ancient Mesopotamian writings in cuneiform (studied by Walter Farber, curator of the Tablet Collection at the University of Chicago’s Oriental Institute), to the well-described Athenian plague of 430-426 BCE documented by Thucydides (who himself caught it and survived), through the plagues of Europe, and the plague year of 1665 in London, described in detail in Daniel Defoe’s Journal of the Plague Year, up to our current situation, it is uncanny how people’s responses, stage by stage, beginning with the first awareness of others being ill, then compulsively counting deaths daily, taking flight from the city, shutting people in their houses, cleaning the carts that carried the infected, burning the clothes of the dead, etc., etc., are so very similar across the ages. In ancient Mesopotamia, infected soldiers were quarantined, and their clothes and armor burned and kept outside the city. Again, all these responses, like the hygienic laws of Moses, were formed long before the microscope and germ theory.

This was driven home to me recently, in a trivial but memorable way, when I was listening to the audiobook of Defoe’s journal, at the very beginning of the social distancing injunctions. It was early days, and I had just started the book, and, as I was strolling, a crowd burst out of a house on my right, on to the sidewalk, including a woman with a baby, and all were moving rapidly toward me, and so I found myself moving, as I never would do, to the middle of the street—just at the moment, the narrator said the word “middle,” in the sentence:

I went up Holborn, and there the street was full of people, but they walked in the middle of the great street, neither on one side or other, because, as I suppose, they would not mingle with anybody that came out of houses, or meet with smells and scent from houses that might be infected.

I’ve come across two dozen exact instances of such “coincidences” during the past month, including near exact replications of what Defoe’s narrator observed, thought, felt, struggled with, and how people behaved, and the policies that were enacted. It seemed like an interesting coincidence, of then and now, until I realized that some of these were almost identical to the responses of the Mesopotamians several thousand years before.

And the experience of these coincidences was uncanny—by which I mean, strangely familiar, or, as Freud pointed out about the uncanny, an experience that is frightening and both eerily familiar and unfamiliar at the same time. Unfamiliar, because it is all new, and unprecedented in my lifetime, and yet familiar because something very deep in me, that had in some way been here before, and was in some way prepared for it, was awakening.