Transcript: Raj Patel and Rupa Marya Interview about INFLAMED

Francesca Rheannon

Well, Raj Patel and Rupa Marya, welcome to Writers Voice. This was just such an amazing book to read, Inflamed: Deep Medicine And The Anatomy Of Injustice. It’s a deeply researched and profoundly radical look at the links between the human body, the body of the world, and the body politic.

I want to start out by asking what brought each of you to write the book. Let’s start with Rupa Marya. You’re a physician and an activist; what brought you to write this book?

[At this point a hurricane warning alert went off in my phone. It was for Hurricane Henri, which had been forecast to be a direct hit on my town, but which actually ended up missing us. So when we resumed the interview, Rupa Marya referenced the extreme weather that our messing with the climate is bringing to us ever more often.]

Rupa Marya 

Well that is the reason we were inspired to write this book, because we are in the midst of a Code Red for humanity. And it’s impacting every area of our lives. This book for me was a chance to put down and investigate and really draw the connections, weave the connections, between the things I’d seen at the bedsides of so many patients and in communities where I work — you know, accompanying groups who are struggling for their own health and their dignity. So it was a real wonderful opportunity to sit with Raj and put our minds together to make these connections that neither of us could have made alone.

Francesca Rheannon

And Raj, you are a scholar of the food system. What brought you to write this book with with Rupa Marya?

Raj Patel

Well, it’s odd living under this particular capitalist colonialist civilization, where food and medicine are two different things. In most civilizations food and medicine are contiguous, they they braid through one another, and there are certain foods and medicines that one takes for certain kinds of people, conditions, times of the year, but right now of course we live in a moment of human history where food is without seasons, and so is disease.

And part of the journey for me was recognizing, through Rupa and her work and our collaboration, that a lot of the communities that I’ve spent time with doing activism around the food system has been engaged in practices, not just in growing food but of health. And understanding how health and medicine and food are connected has been part of the journey for me and in recognizing that all the work that I was doing that was ring fenced as being part of the food system was in fact, much deeper than that and much more deeply connected to medicine and to health.

Francesca Rheannon

That makes sense. You describe this book as a “political anatomy.” Tell us what you mean by that–and I want to say, so much of this book is written as metaphor, but metaphor that is so grounded in the totality of reality. So tell us what a political anatomy is.

Rupa Marya

Perhaps we could see that as a literal metaphor, because, you know when we’re talking about how the Earth’s rivers being incarcerated, obstructing the flow of life in that way, radically alters the ways in which people get their food and medicine, and then consequently affects their bodies. That all of these systems are interconnected in very deep ways. And so that the systems that were brought into place, the lines of power that have been drawn through colonialism and through capitalism, have altered these ways our bodies have evolved, altered the ecological, social relationships that kept us healthy for 1000s of years in specific ecosystems.

And so, for me, as a physician, I’ve always felt like you can see the the wounds of capitalism on the bodies of unhoused people, you can see what’s happening to the body through looking at the chronic venous stasis in the legs, in the presence of edema, because they’re not allowed to sit and lie down in public, so [they are] constantly forced to stand up and walk; the criminalization of their bodies being in public space as they are here in the United States.

So I think that you can see the marks of society’s illness, social pathology, make their way onto the body. And so what we really understood in this book and what we offer in this book is a way of diagnosing illness that extends outside of our bodies into the spaces around the body, into the lines of power that have been drawn through histories, and how these things are shaping how our bodies are responding. And the bodies are responding quite in a normal and healthy way to a extremely unhealthy abnormal world around us. That has been altered through colonialism and capitalism. So, what we are sharing with the world in this book is an opportunity to see how these connections are literally drawn in the body in the body of the earth, and in our social body.

Raj Patel

The organization of the book, is a way of subverting expectations around what an anatomy looks like. I think that people may be familiar with Grey’s Anatomy or if you’ve ever watched the TV show House and seen the anatomy of the human body, and pictures of what the layers of different parts of the human body look like and then we have the geography of the human body.

What we’re trying to do in this book is subvert that by having chapters that are organized as the different systems within the human body, but then, rather than, for example, in our respiratory chapter just sort of being with the lungs, in fact, we move away from this particular place in the body, and instead look at the lines of power that bring, for example, particles from a forest fire thousands of kilometers away into the body and then out again, and the damage that these particles are literally doing to the body. So it’s not just a metaphorical respiration of the Earth and the lungs of the earth being burned, but in fact, as the lungs of the earth are being burned, your lungs are being burned, not metaphorically but directly, and in tandem and through the same processes.

So again, this idea of political anatomy is in each chapter. We start with the sort of systems that people may be familiar with when they think about their gut microbiome, their digestive system or their respiratory system or their circulatory system, but then we go beyond that to look at the body across the planet and condense the planet into our bodies at the same time and that’s what makes it a political anatomy.

Francesca Rheannon

Yes and you do all this around the central theme of inflammation; it’s right there in your title Inflamed, Deep Medicine and the Anatomy of Injustice. So, Raj Patel and Rupa Marya, talk about inflammation as both a metaphor, and an exemplar. You know, inflammation as a metaphor, say, of climate change, but it’s also an exemplar and in precisely the way you spoke about: it creates inflammation in the body.

Rupa Marya

Well, for me, when we were thinking about this book, you know, for the last, I guess 15, almost 20 years working in music and touring with my band Rupa and the April Fishes, we’d be on the road and working with communities that were struggling for their health and their dignity in ways where you could see the the imprint of social disruption and social forces on the well being of the community.

And what I started to notice in this traveling was that groups that had been suffering under colonial rule were impacted most heavily by diseases like cardiovascular disease and diabetes and autoimmune disease. I started to see this pattern and I coined the term with my friends, with my band,  it’s almost like this is a “colonial syndrome,” and then time went on and in the last 10 to 15 years, a lot of research has come out that has shown that all of these diseases that we suffer from in modern industrialized societies, which are societies whose architecture has been structured through the lines of power dictated by colonialism, all of these diseases are very prevalent and they’re all, as we understand now, inflammatory diseases–so cardiovascular disease, diabetes, Alzheimer’s, cancer, depression, anxiety. All these diseases have in their makings dysregulation and inflammatory response.

And so we started looking at what is inflammation and why is this happening and why are these things happening in the ways that they are? And inflammation, the inflammatory response, is the body’s way of healing itself in the face of damage or the threat of damage. We used to think the immune system activates in response to foreignness if it’s self or other, which is going back to these Enlightenment Era errors of thoughts about how our bodies work: that there’s a body and a mind, there’s a self and other, there’s nature and civilization, there’s human beings and then the environment. But in fact, those dichotomies are really not useful for understanding the sophisticated way in which our bodies or systems within systems and we as entities, as human beings, are systems within other systems, and all of these things are deeply interconnected.

So, what we found is that the the latest understanding of the inflammatory response is that is the body’s way of correcting itself in the face of damage, of restoring the optimal working conditions.

However, when damage continues unabated, as it does in the face of air pollution, as it does in the face of police violence or racism and environmental toxicities — like right now, I’m in Oakland and the air is so bad we can’t go outside right now from the wildfires– that these things create the inflammatory response, they set up an inflammatory response in the body, and when that damage keeps coming, the response doesn’t shut off.

And we’re now understanding that that’s playing a central role in all of these diseases that I see as a hospital medicine doctor at UCSF. Now I can give people the aspirin for their cardiovascular disease and the insulin for their diabetes, but that’s not going to stem the tide of the rising rates of inflammatory disease all over the world.

And what we tackle in this book is advancing a new kind of diagnosis along the lines of a political anatomy that can give us actual effective treatments. Because if you don’t know what you’re diagnosing, if you don’t get at the root of the problem, you will only be offering Band Aid solutions.

So for example with COVID right now, masking and ventilation in school is what we’ve offered as a solution. As of today, Oakland has 98 — it was 50 something earlier this week — now 98 students and staff who are testing positive. So these kinds of system level failures require system level analysis and inflammation allows us to look at it that way.

Francesca Rheannon

Yes, and Raj Patel, talk a little bit about the connection between inflammation and our food system.

Raj Patel

Well, you know there are a couple of things. Picking up on what Rupa said particularly about the threat of damage, it’s very interesting how stories are important in conveying or obliterating our understanding about threats of damage. So for example, we tell ourselves stories about how safe our food system is and we are reassured by various mechanisms of government that, you know, the way of the future in terms of farming is going to be led by American technology and American know how and industrial agriculture is going to feed the world. Those kinds of stories are dangerous fictions, not just because it is demonstrably the case that this farming system will fry the planet– we now know enough about the way the industrial agriculture works to know that, even if we end fossil fuels, the industrial food system generates enough emissions by itself to kill us all.

But beyond that, that sort of false narrative also hides the actual danger that the food system is causing. So, you know, if you’re looking, as we all are, at the literature around pre existing conditions, you know, comorbidity is a term that now has caused many more people’s deaths in the past year than it had ever before. And those comorbidities, in large part, can be traced to the US, under the global food system. So, you know, recently there was a report that came out saying that Americans spent $1.1 trillion in 2019 on food, but the damage caused by that food system was in excess of $2 trillion. We spend $1 trillion, we cause damage for $2 trillion.

Of that damage, fully a trillion dollars was the health care damage caused by the food that is either being given to us, or the damage that the growing of that food causes workers. And the idea that our food system is the best of all possible worlds, and is going to feed the world is not just a lie, but the mechanisms through which this food system damages us are inflammatory.

So, whether that’s type two diabetes or whether it’s the various kinds of syndromes and diseases caused by our industrial chemistry that have left our bodies and societies inflamed, in every case, there are clear lines between what is licensed as our storied and happy food system and the actual damage that it causes, and the stories of people who had to fight back against the big lie of the food system.

Francesca Rheannon

Yes and Rupa, in your chapter on digestion, one of the stories you tell about is of a young man who died at the age of 26 of irritable bowel syndrome, I believe it was, or Crohn’s disease. And that’s an inflammatory bowel disease. It talks about the incredible rise in in these kinds of illnesses and how they are connected to this colonial settler capitalism.

Rupa Marya

Yeah, so it has been astonishing to see the rapid rise of inflammatory bowel disease such as Crohn’s disease and ulcerative colitis since the mid 90s, which is really when substances like glyphosate hit the global market in a big way. And what we’ve seen with glyphosate is that it’s changing the microbiome of animals, it’s changing the microbiome of the soil. It’s changing the microbiome of humans. If it’s our closest relative that we see in the lab, with mice and rats, and it’s definitely changing their gut microbiome as well.

And it’s not just glyphosate, but it’s the whole system of how our food is grown and what ends up in our food and, and then the amount of dietary chemicals that are in our foods that are altering our gut microbiome in a way that makes it such that people who are born and raised and live in the urban United States today have the least biodiverse guts on planet Earth and we know that the biodiversity of the gut microbiome confers resistance to inflammatory bowel disease and actually to all inflammatory diseases.

And there are some studies that look at different populations, the people with the most biodiverse guts on planet Earth, who also have consequently the lowest rates of inflammatory disease, are indigenous people who are living in culturally intact ways with their surrounding environments. And what we’ve seen with Crohn’s disease that, especially in the pediatric population there’s been some really interesting data around fecal transplants, so if you’ve got a young person with Crohn’s disease and you can give them a healthy, robust diverse microbiome in the gut, basically replace their denuded microbiome with a healthy, robust one, you can move Crohn’s disease into remission…

There’s also some association with young children getting antibiotics at a young age, several rounds, having an increased risk of Crohn’s disease, so we are seeing an important role of the gut microbiome in these kinds of diseases. We have to think of all the ways in which the gut microbiome is being impacted and what we’re learning is that so many things impact it from our food system, as I just discussed, the dietary chemicals, processed foods, and then also things like stress. So we have a whole chapter on stress and debt. And the connection between the brain and the gut in the microbiome is a very important one for human immune functioning and development.

And so, you know, what we’re seeing right now is that the capitalist response to that is “Let’s go find some indigenous people with great microbiomes and gather their poop and replicate it in the lab and sell it”; and this “rewilding of the gut” you saw the headline in the New York Times from an ethical scientist here. But this is exactly the theft of indigenous people that has been a part of colonial plunder for the last 600 years. And the error in thought there is that you could simply just take a pill and replace and reinoculate what is actually a living representative of a whole host of relationships.

And so the reason our indigenous relatives in the Amazon have a robust gut microbiome is because they’re in relationship with their surrounding ecology with the web of life. And those relationships don’t exist in modern capitalist cultures.

And so what we really get out in the book is that this isn’t simply a couple of policy tweaks and changes that need to happen to improve our health. This is abandoning the colonial capitalist cosmology and re-entering our relationships with the web of life in order to have the possibility of health. And that means, in order for that to happen, a lot of things need to change.

Because as we’re seeing right now with the struggle with Line 3, with the Dakota Access Pipeline, we have all the data we need to know that our planet is on fire and that life on Planet Earth for human beings is getting very uncomfortable. And there’s very little substantive action around that. So, aside from what our indigenous friends are doing on the front lines, it’s a really critical time to look at the mistakes, the errors of thought, that have brought us here, into systems that do not support our health on a wide scale.

Francesca Rheannon

And would you like to weigh in on that, also, Raj?

Raj Patel

Oh, I think, Rupa said it perfectly. I think the idea that there is a pill for us, or a magic single policy of one kind or another, is precisely the error here that we can individually, get our way out of the situation. That is to compound the problem that got us here.

And in fact, it has been very interesting having conversations about this book in lifestyle progressive communities, where folk made decisions around vaccination that are very much about protecting their bodies and viewing their bodies as temples, as opposed to, perhaps, understanding that those bodies nonetheless circulate in communities where people like Rupa find themselves on the front line. And insofar as people are not getting vaccinated and then have to come to Rupa when they’re in dire distress, they’re posing a threat not just to Rupa but to her family, her community. And I think it’s very interesting to see how the culture of individualism has reinscribed itself among communities that that think of themselves as quite liberal and progressive.

Francesca Rheannon

And so let’s talk a bit about COVID. Because COVID, like climate change, affects Black, Indigenous and other People of Color disproportionately in this country and around the world. So you draw a lot of those connections. We are all experiencing those connections. And so talk first about immunity, the development of the immune system and why are communities of color being disproportionately affected?

Rupa Marya

So, there’s many reasons, but one of the things that really struck me in the book was how our immunity and our immune response are inflammatory responses — and COVID is invoking a inflammatory response in the body — is tuned by the sum of our exposures, not just in our lives but even our ancestors’ lives. So communities that have experienced a lot of intergenerational trauma, suffered from the impacts of genocide or the ongoing impacts of genocide as indigenous people in the United States, these kinds of communities that are subjected to air pollution, like folks are here in East Oakland, with the AB and I foundry and the diesel burning from the port. So these kinds of additive exposures to the immune system. And if there’s a toxic, damaging set of exposures, you’re going to have a much more intense inflammatory response.

One of the things I was really interested in was learning that a marker of having severe COVID was having low levels of circulating interferons, which is a molecule that interferes with viral replication in the body, so it’s a protective molecule, and groups that have encountered chronic social defeat have lower levels, people who have experienced chronic social defeat have lower levels of circulating interferon. So, while genetics does play a role, what we’re seeing is that the environment, which is really dictated by the social structures around us, is playing a much more important role.

And COVID has — you know,  as we thought this book three years ago, we weren’t expecting to be here, but it was almost traumatizing to be reading this book while I was a frontline doctor in the hospitals, that go between sitting at the desk for 10 hours a day to going into the hospital and watching this all play out in the wards of who was getting sick and how we’re getting sick and, yeah it was, it’s been quite a year.

Francesca Rheannon

Raj Patel and Rupa Marya, talk about the impact of growing up as part of a diaspora of colonization and of course most of us, unless we’re members of an indigenous group, are part of a colonized diaspora. And I was really interested about how you ask questions about collective identity and decolonization and pose the idea: how do we both unify, conquer the divisions that the ruling class uses to divide us–how do we not fall prey to division and yet also respect each and every one of us in our traditions?

Raj Patel

We know that nations are imagined communities, and the ways that capitalist colonialist nations imagine themselves is precisely as having a manifest destiny to be here in in what is now the United States. But I think it’s very interesting to then have a conversation about what sorts of imagination of community are going to be consonant with the future of the planet. Part of the imagination of that and part of the exercise of decolonization seems utterly impossible because our standard narratives of nationhood just don’t admit that we are settlers here and so it’s very hard to get that conversation off the ground without the spiraling into some sort of individual therapy or self-flagellation.

What’s interesting, then, is to look at the history of medicine, to see how decolonization has happened before and we look in this book Inflamed at one of the leading theorists of decolonization, who was also a medic, Franz Fanon. And as a psychiatrist, he was trying very hard to decolonize medicine in Algeria. When he was treating middle class settler French women in Algeria, rather than locking them up, he reconfigured the architecture of the psychiatric ward so that women would be able to have access to a printing press, and film club. And this was a way in which they would be able to manage the representation of media, of ways that they could tell stories about themselves.

And, you know, that was very successful as far as it went. And for Algerian working class men, cinema, and newsletters weren’t what they wanted; they wanted to play football. And so it was going outside the boundaries of the daily reminders of colonial confinement that the men that Fanon worked with found a certain kind of liberation and a certain kind of healing.

But Fanon in the end left his practice because, among other things, he noted, doctors still own the land. And that story of how ultimately we do need to take a relationship to the ground beneath our feet is tremendously important in the practice of decolonizing. So while my parents are from both Fiji and Kenya, and before that from greater South Asia, but the stories that matter now are not really ones that my parents phrase it, from India to parts of the British Empire that I now bring to this settled land in occupied Texas, but they’re the stories of the many nations that were once on the land that I find myself on right now, of Comanche, and Isla del Pueblo…and so there’s a range of stories, but none of them have the same kinds of will to power over the rest of the web of life that capitalist colonialism does. And I think part of the work that we’re doing is not just a writerly work, but the work of organizing around social change is to co create these new de-colonial narratives and nationhoods that emerge from the ashes of colonial capitalism.

Francesca Rheannon

Yes, and I’m so impressed, Rupa Marya, about all the different organizing projects you’ve been involved in. Tell us about your Deep Medicine Circle, and about the clinic and the farm that you’ve established on Lakota territory at the invitation of the folks there.

Rupa Marya

Well, this last year we formed an organization, a nonprofit organization, a group of farmers, healers, indigenous, non-Indigenous people together, to heal the wounds of colonialism through food, medicine, story, learning, and restoration. And so, that work is housed within what we’re calling a Deep Medicine Circle.

We’re a woman of color-led organization and we work as a worker-directed nonprofit. And one of our main projects is what we’re calling “farming as medicine”, where we’re reframing farmers as ecological stewards to care for the soil and the water and liberating the food that’s grown from the market economy to be given to people who are being oppressed by hunger in urban environments.

So, one of those farms is a 30-acre farm that we’re in the process of working with the Association of Rama Tisha Loni on rematriating the land back to them. And that is just an amazing and beautiful project. And another is a rooftop farm in Oakland, where that food is going to be going to a UCSF pediatric clinic right next door, so that none of the kids who come to the clinic will leave without access to organic healthy food.

And then also, with Poor Magazine and Deep East Oakland, who have a radical redistribution network in Oakland for poor and unhoused people. And so these are exciting projects because we’re bringing together people in health care with people in farming and food and community activists who are taking their health into their own hands and defining what that is and what is needed for that. And it’s an exciting time  also to reframe farming as a solution to what we’re seeing with the climate collapse and paying our farmers excellent wages as frontline health workers because that’s what they are.

Francesca Rheannon

And finally, what seems to me so much at the core of this book is the totally different way that human beings have lived for hundreds of thousands of years on this planet and the way that we live under capitalism. I was reading a book recently, a science fiction book called Ministry of the Future. I always blank on the author’s name, but he says “it’s easier to imagine the end of the world than it is to imagine the end of capitalism.” And that really struck me because we are so bound by this enchantment, I think, of the capitalist system. What gives you hope, what gives you strength in doing the work that both of you are doing to bring the world back to its senses?

Raj Patel

I love the Ministry of the Future by Kim Stanley Robinson…I certainly speak for myself, but I know we both feel the same way about the social movements around the world…There are long lines of the struggle, and are fighting, despite all the odds. If one were to do a pessimistic accounting, things are looking very bleak. And yet, despite this pessimism of the intellect, there is an optimism of the will that’s both necessary and required in order not to betrayed the movements that are already fighting in the front lines. And so what gives me hope is the fact that there are folks who are doing this, and winning despite the fact that capitalism is doing its damnedest to send us all spiraling to our doom. So, what gives me hope is that people are still fighting back.

Francesca Rheannon

And Rupa?

Rupa Marya

For me, what gives me hope is the art and the music that’s coming out of these movements and seeing the power of people imagining a better future and how potent and powerful that imagination is, because in the imagining, we see the way forward. And that always gives me hope, even as I’m currently taping down the windows of my house so that the wildfire smoke doesn’t get in. I still feel hopeful when I see that art and hear that music and see those stories.

Francesca Rheannon

Well, I’m going to take that hope to heart right now. And your book is such an amazing map to that territory toward the Deep Medicine that both of you speak so eloquently about. The book is Inflamed and thank you so much, Raj Patel and Rupa Marya, for speaking with us here about it on Writer’s Voice.



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About Francesca Rheannon

Francesca Rheannon is an award-winning independent radio producer. In addition to hosting Writer's Voice, she's a freelance reporter for National Public Radio and its affiliates. Recipient of the prestigious Nancy Dickerson Whitehead Award for reporting on substance abuse issues for her news series, VOICES OF HIV, produced for 88.5 WFCR public radio in western Massachusetts. She is also finishing a book on Provence (PROVINCE OF THE HEART) and working on a memoir of her father, THE ARGONAUTS.