Raj Patel

Rupa Marya

Raj Patel, the New York Times bestselling author of The Value of Nothing, teams up with physician, activist, and co-founder of the Do No Harm Coalition Rupa Marya to reveal the links between health and structural injustices--and to offer a new deep medicine that can heal our bodies and our world The coronavirus pandemic and the shocking racial disparities in its impact. The surge in inflammatory illnesses such as gastrointestinal disorders and asthma. Mass uprisings around the world in response to systemic racism and violence. Climate refugees. Our bodies, societies, and planet are inflamed. Boldly original, Inflamed takes us on a medical tour through the human body: our digestive, endocrine, circulatory, respiratory, reproductive, immune, and nervous systems. Unlike a traditional anatomy book, however, this groundbreaking book illuminates the hidden relationships between our biological systems and the profound injustices of our political and economic systems. Inflammation is connected to the food that we eat, to the air that we breathe, and to the diversity of microbes living inside us, which regulate everything from our brain development to our immune system. It’s connected to the number of traumatic events we experienced as children and to the trauma endured by our ancestors. It's connected not only to access to health care but to the very models of health that physicians practice. Raj Patel, renowned political economist and New York Times bestselling author of The Value of Nothing, teams up with physician Rupa Marya to offer a radical new cure: the deep medicine of decolonization. Decolonization is to heal what has been divided, reestablishing our relationship to the earth and to each other. Combining the latest scientific research and scholarship on globalization, the stories of Marya's work with patients in marginalized communities, activist passion, and the wisdom of indigenous groups, Inflamed points the way toward a deep medicine that has the potential to heal not only our bodies but the world.

Deep Medicine and the Anatomy of Injustice

Inflamed

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An accurate diagnosis of Covid in the Rogue Valley must involve a complete history of the arrangements of power that led to certain lives being considered expendable, sacrificed to profits from pear trees planted on land acquired through colonial violence and theft. Put a different way, an accurate diagnosis of the workers in Alicia’s community would implicate the systems of injustice created during the colonial era, beginning with the exploitation and enslavement of the Takelma people and ending with a system of racial capitalism that treats migrant workers as disposable. A story that fails to incorporate this history is one that can have no part in healing.

The inflammatory diseases we are seeing today are not the cause of the body’s dysfunctional reactions. They are the body’s correct responses to a pathological world.

The fall of beaver populations also changed the way rivers ran across the North American continent. The biodiversity that thrived because of the beaver’s hydrological engineering plummeted. With their dams, beavers create successional habitats that provide slow-moving water sanctuaries for plants, insects, and other animals, such as salmon. As demand for pelts pushed trappers west across the North American continent, beaver pools disappeared.

Rivers without their beavers flow straighter and offer less safe harbor, particularly during winter freezes. The annihilation of the beaver and its habitat reduced the number of potential salmon smolts in winter by 94 percent. For Indigenous communities dependent on the salmon, this was devastating.

Rates of diabetes, cardiovascular disease, and depression skyrocketed in the Indigenous communities of Salmon Nation. Defined as “a nature state, as distinct from a nation state,” Salmon Nation is the coastline and watershed spanning the fifty thousand square miles between the Yukon River in Alaska and the Sacramento River in California, where the Pacific salmon run. The lives of Indigenous inhabitants are intricately intertwined with the health of the salmon, whose vitality is seen as a reflection of their own.

Through campaigns that merged official medical knowledge and armed force, European missionaries and medics waged war on Indigenous shamans and healers. Physicians were a part of the violent colonial project, bringing new medicines and conceptualizations that dissected Indigenous peoples apart from their ways of knowing and consequently from their health. Campaigns against witchcraft and the ignorance of colonized people were lessons in the brutal imposition of a colonial worldview.

Colonial cosmology sees things where persons once were. What once was alive with personhood—a forest, a river, a mountain—becomes inanimate, disconnected from ecologies, open to exploitation. In the United States, this mindset is enshrined into law. Attempts to confer legal rights of personhood to Lake Erie were struck down by the courts, while laws that bestow on corporations the rights of people continue unchallenged. And there’s a reason: it’s easier to scoop the heart out of a mountain when it’s a resource than when it’s a living relative.

Modern medicine is, we’ll argue, premised on the will to power, a systematic domination not just of some humans by others but of the domination of humans over other beings in the web of life. Let us call this practice of domination “colonial medicine.” By ignoring the injustices that have produced it, and in which it participates by commission and by omission, colonial medicine is complicit in the damage it purports to heal.

How, then, can we condemn Covid deniers and still find fault with modern medicine? Like them, we’re skeptical of authority and suspicious of those seeking to profit off a disaster.64 The difference lies precisely in that the community constituted by saying no is, in our case, one that has a far longer history. We’re not individual small-government conservatives of Reagan’s vintage, or fearmongers of the Deep State. Along with Indigenous healers, we have a more nuanced understanding of health, power, and the colonial state. Our skepticism and refusal are rooted in science, not in a rejection of it.

Colonialism has changed the architecture of how we live, imposing objectifying and extractive structures on cosmologies thousands of years old. It has changed how stories are told and which ones are told and which ones are forgotten. These structures persist and continue to wreak havoc on individual bodies, on our societies, and on the planet. 

Doctors are trained not only to look exclusively at the patient as a solitary individual—shorn of context or structure, stripped of life in all its complexity—but to treat that individual as a broken machine, as a dysfunctional and occasionally noncompliant robot bearing a symptom. This is a relic of colonial thinking.

We don’t offer encouragement to shop organic, to buy supplements, or to use apps for mindfulness. Decolonizing is not something that can be done alone. But it is already happening in communities where land is being rematriated, where solidarity economies of mutual aid and support are being established, where communities are renewing their relationships with local ecologies and retelling their stories, some of which have been silenced for centuries.

Decolonizing invites us to stretch our diagnoses back to a time when the concept of the self mattered less than the relationships upon which our lives depended, from the microbes inside us to the world around us. It calls on us to develop new methodologies of diagnosis, ones that center other ways of telling our stories and other ways of knowing that connect us to entities beyond our skin. 

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