Health Blog

To understand fully why we are so compelled to portray control of infectious diseases as warfare, we need to look inward rather than outward. The human mind did most of its evolution as our ancestors were gathering food, hunting prey, avoiding being hunted as prey, and fighting and negotiating with other humans. This kind of problem-solving required memory, ingenuity, and the dexterous use of tools and weapons. All these activities can be well conducted by minds that model the environment as being composed of building blocks to be destroyed, avoided, or taken and used. Things that cause harm are cast as enemies, often personified and vilified. If the goal is to eliminate the harmful condition or offending process, casting it as an enemy helps us to visualize it and its elimination. To recognize this tendency, we need look no further than the “wars” in which we engage: the War on Poverty, the War on Cancer, the battle between good and evil. In none of these examples is the enemy really an organism that is killed in battle. The War on Poverty was a government investment to help poor people (and perhaps to solidify political power). The War on Cancer was a research effort, and the battle between good and evil is an effort to alter people’s beliefs and make them act in accordance with some model of behavior. But these bland descriptions of goals do not generate a picture that engages the mind with the cause at hand. The war metaphor does. In addition, the war metaphor provides an engaging mental picture for the disease eradicators. It casts the disease as an enemy and allows them to use the medical versions of spears, clubs, and fire—antibiotics, disinfectants, and vaccines—to destroy or ward off the enemy.

The purpose of this brief excursion into the evolution of human behavior is to suggest that we must be on guard to recognize the errors into which the human mind might easily slip. One error might be a failure to recognize opportunities for controlling disease. When we are faced with a disease organism, we may just want to kill it like an enemy rather than trying to control its biology in a more beneficial way. Another error might involve a more global view. Throughout our evolutionary history human enemies must have been invading from the outside. Mental imagery of invasion may have been favored by natural selection because it would have allowed our ancestors to plan for the attack. But when applied to disease control, the imagery may introduce biases. Invasion imagery was certainly appropriate for the disease epidemics that invaded the New World from the Old World, and one part of the Old World from another through the nineteenth century. It helps explain why at the close of the fifteenth century, the Italians called syphilis the French disease, and the French called syphilis the Italian disease. It also helps explain why influenza epidemics typically bear names such as Hong Kong flu and Spanish flu (at least outside Hong Kong and Spain). Influenza epidemics certainly do cross national borders, as did the AIDS pandemic. This border-crossing ability of infectious plagues has led many to believe that the greatest infectious threats will come from the outside. But we need to remember that our expectations are biased by minds that tend to visualize threats as invaders coming from beyond our borders. Perhaps the experts are looking in the wrong place. Perhaps the most menacing infectious adversaries are already here.

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