Deep Medicine for Bodies and a World Inflamed: Healing Requires the Right Diagnosis
With the surge of political unrest and illnesses as a result of climate change, it is apparent that our planet is inflamed. The health of the individual is inseparable from our collective planetary health. In this transcript from Bioneers 2021, physician and activist, Rupa Marya explores how structural injustice affects human and environmental health and calls for a right diagnosis to create deep healing to begin global healing.
Good morning, Bioneers. I am speaking to you today from the occupied and unceded Ohlone territory of Huichin (now called Oakland, California). I’m grateful to my ancestors for all their love that brought me here today to be able to share these ideas with you, and to the ancestors of this land who have offered me a safe home to raise my children far from Punjab, where my family comes from, and who inform how I’ve been learning and growing in this place I call home. I also want to acknowledge my elders whose teachings continue to shape my own work and understanding.
A diagnosis is a story that helps us identify the cause of a disease or form of suffering, with the goal of alleviating it. For healing, in order to get at the right course of action, one has to start with the correct diagnosis. The wrong diagnosis at best delays and at worst prevents the proper treatment. Recently, I was taking care of a black woman in her 50s, hospitalized where I work at UCSF. She had a history of sickle-cell disease and had come to the ER with shoulder pain. When she was admitted, the doctors who evaluated her saw that her X-rays showed no fracture or dislocation and that her blood counts indicated anemia, so they concluded that she was having a sickle-cell pain crisis, but this woman hadn’t had a sickle-cell pain crisis in well over a decade.
By the time I met her, she was 10 days into her hospitalization, and she had been on IV fluids and IV opiates with no change in her shoulder pain. I sat down with her and listened to her story. She told me her pain woke her up from sleep. With a brief exam and an MRI to confirm my suspicion, I diagnosed a full thickness rotator cuff tear. She got anti-inflammatory medicine, physical therapy, and a surgical consultation. With the correct diagnosis, she was on her way to healing.
Today, the world heaves from systems-level failures as evidenced currently by the intersecting crises of the pandemic and of climate catastrophe. Public health experts and governments are failing to properly address the problems we face because their solutions do not address the problems at the level of the system. While vaccination and masking are helpful to mitigate the harms of COVID, if we look at how the virus spreads through spaces of incarceration, where humans are warehoused in nursing homes or prisons, or where people are forced into exposure at work in places such as meat-packing facilities, it becomes clear that changing a system that creates those forms of incarceration has to play a central role in our response.
To understand why our bodies and our planet are suffering in the ways that they are, we need the correct diagnosis, and for that we must extend our story back in time to some 600 years ago, when a narrative that opened the door to systems of domination, that made land theft and resource extraction possible on a global scale, began to be widely disseminated. That colonial capitalist cosmology has long been driving damage around the globe in ways that make a healthy life for humans impossible, and that damage will continue until that cosmology and the systems it imagines into reality are abolished and replaced with ones that recognize our interconnectedness and that center care.
That care revolution must be grounded in a clear understanding of who we are, how we got here, and how we can be on this planet together in ways that generate health. Bodies of people living in societies organized around that colonial capitalist cosmology are bodies wracked by inflammatory disease. Inflammation underlies nearly all the leading causes of death in modern industrialized societies. These diseases, such as cardiovascular and auto-immune disorders, cancer and diabetes, are rare in traditional and Indigenous communities living with intact cosmologies that weave them into the web of life that supports them. The hallmark of colonial capitalist cosmology is one of separation — of people from one another, from the Earth and her systems, and from other living entities upon which our own health ultimately depends. This sense of separation serves an important function for those who benefit from this system: it’s much easier to extract resources, exploit labor and concentrate wealth into your own hands when you don’t feel connected to other people and to the natural world, so this feeling of separation generates enormous damage.
The body’s response to damage or the threat of damage is inflammation. The inflammatory response is the body’s ancient healing mechanism to restore its optimal functioning in the face of damage. In the acute setting, as with a paper cut, the inflammatory response heals and then turns off, but when the damage keeps coming, the inflammatory response runs unabated. This healing response, then, begins to do more harm than good. It turns the body on itself. When it comes to chronic inflammatory disease, studies of twins have shown that the environment is more impactful than genetics. Those environmental factors include not only what is in our local environment but also our histories and the way lines of power have been drawn around us.
The sum of our lifetime exposures is called the exposome, and it actually extends before our lifetimes through our ancestral lineages because intergenerational trauma leaves traces in our bodies that can express as inflammatory disease. This is important to understand because colonial medicine frames chronic inflammatory disease as the outcome of poor lifestyle choices. We are told to improve our diet and get more exercise, and peddlers of various supplements and microbiome pills are there to capitalize. And while these things can help, they can’t be the ultimate source of our healing. Focusing on individual choices is a form of medical gaslighting, when the actual driver of pathology is in the world that has been constructed around our bodies.
For most people on planet Earth, a toxic exposome is not a matter of choice. It is the outcome of colonial capitalist social architecture. In this understanding, disease is situated in the spaces around the body in the exposome and in the accumulated history lived through our bodies and minds. When we look at this process on a cellular level, we can see how these exposures leave their marks on our replicating somatic cells. Usually these replicating cells will divide and live until they reach senescence, or cellular aging, when they go metabolically quiet, but cells can age prematurely as a consequence of damage. A toxic exposome accelerates this phenomenon, driving the premature aging of cells through the accumulation of damage over time. Premature aging forces a cell into a radical transformation in which that aging cell acquires what’s called the “senescence-associated secretory phenotype” or SASP. Instead of being metabolically quiet in their old age, these cells become factories pumping out molecular messengers that drive chronic inflammatory diseases in older people in societies organized around damaging structures. These cells are driving fire in our bodies.
Inflammation is not just an animal’s way of responding to damage in an attempt to restore optimal bodily functioning, it’s also what we see today in the planet’s body, with heat or swelling, e.g. catastrophic wildfires, uninhabitable temperatures, flooding, etc. From the tiniest invisible thing to the largest invisible thing, i.e. from the microscopic to the macro-economic, systems impacted by damage are systems that are inflamed. The same mindset that is hurting our bodies is setting our world on fire.
The deep trouble we are in requires deep medicine. Nothing less than a transformation of our world and the way it is organized will be sufficient to bring about the cooling we need, and that transformation must be led by the correct diagnosis. Just as “deep ecology” recognizes the value and intrinsic rights of ecosystems above and beyond their capacity to serve humans, deep medicine moves individuals from the center of our understanding of health and places the systems to which we belong in focus. Individuals can only be healthy when the systems around them are healthy. Deep medicine understands that health is an emergent phenomenon that can occur when nature’s systems and social systems are interacting in mutually beneficial ways. We cannot have health when we leave some people or some other beings out of the circle of our concern. If disease is caused by a toxic exposome, health only becomes possible when the exposome is restructured through systems of care.
Colonial capitalism has ruthlessly and systematically exploited the world’s people and resources. Deep medicine seeks to put the personhood back in the beings that capitalism would have us see as inanimate — the mountains and rivers, the very body of the Earth we are inextricably part of, not apart from. To put ourselves back in the web of life and to awaken all of our relationships and responsibilities to each other, to other humans and other more-than-humans, that has to be the foundational starting place of deep medicine.
Deep medicine will require of us that we abandon the culture of individualism and the damage of domination and that we opt for care brought about through nurturing networks and the embracing of collective experience and knowledge. These sorts of networks are more resilient to climate shocks and volatility, as evidenced in a number of peasant farming and agro-ecological movements throughout the world. Deep medicine eschews self-aggrandizing thought leaders and billionaire philanthropists for the wisdom held by the lived experience of communities, groups of people who are already working autonomously throughout the world to advance a culture of care. It understands that the logic and system of capitalism cannot be used to heal the wounds that have been created through capitalism, which must be abolished, as other toxic systems have been. It’s time for radically new concepts of healing.
This is the work we are doing with the Deep Medicine Circle, a woman-of-color-led, worker-directed organization committed to healing the wounds of colonialism through food, medicine, story, learning and restoration. We are building bridges between Indigenous and non-Indigenous people to help Indigenous groups reassert their sovereignty and their homelands while weaving together multiple systems of knowing that can teach us how to care for the Earth and each other. Here on a farm in Ramaytush Ohlone territory, just a few steps away from where Portola landed and started his genocidal march across the San Francisco Peninsula, we are trying to demonstrate what that looks like in practice.
One of our principal areas of our work is what we call “farming is medicine.” As with every modern institution, today’s food system is rooted in colonial capitalist cosmology. The land has been stolen, Indigenous people rendered invisible in their own homelands, labor exploited; and the soil, water, and air have been damaged through extractive processes that enrich a few and leave the rest of the system in poor health. Farming as medicine seeks to reverse that order. First, land is “re-matriated,” i.e. Indigenous women’s authority over community well-being is re-asserted. Farmers are recast as ecological stewards and health workers, growing food and tending soil under Indigenous leadership to heal the Earth and heal the people. The food we grow is liberated from the market mentality to be what food always was before colonialism — medicine. If we want to end world hunger, we have to stop playing by the rules that create hunger in the first place.
The care revolution requires that we accurately diagnose why we are here today with our bodies and planet inflamed so that we can move forward with the correct solutions and not delay the urgent need for healing. While policy will be critical to stopping the damage, much of the healing work is already happening all around the world in communities that have rejected the logic of capitalism and started to create economies of care. With the correct diagnosis, the correct path ahead becomes clear. It is not a softer, fuzzier version of colonialism and capitalism: it is committing to the fire of those old structures that must burn so that a world of care can come forward.