This article employs concepts of immunity to interpret the Samoan author Albert Wendt's novel The Mango's Kiss (2003). Contrasting Wendt's representation of two diseases-the 1918 influenza and a fictional illness called the Satoan Disease-it finds within the novel two accounts of immune response: a defensive system predicated on exclusion and the preservation of a bounded social body, and a relational system grounded in Indigenous ideas of adaptation and coexistence. Positioning these accounts in the context of competing paradigms in contemporary immunology, the article opens up a new reading of Wendt's critically underexamined novel. It concludes that The Mango's Kiss challenges the epistemological foundations of received biomedical and colonial discourse alike, proposing an alternative model of cultural resilience rooted in principles of indigenization and relational identity.
This article proposes autobiography as a productive lens through which to examine concepts of immunology, as the self-oriented conceptual focus of autobiography shares key affinities with theories of immune selfhood that have underpinned much of the work in modern immunology. British and French autobiographies written in the late 18th and early 19th centuries-a period at the crossroads of older humoral theory and new scientific and medical knowledge-describe early symptom-and experience-based conceptualizations of immunity, as well as subjectively defined and value-laden conceptualizations of health. Notably, while the autobiographical accounts precede the late 19th-century work that established the foundations of modern immunology, authors' accounts of health maintenance, disease prevention, and disease elimination resonate with present-day immunological concepts and nonspecialist constructions of immunity. In analyzing how the authors conceptualize and assign meaning to what we now understand as immunity-related processes and practices, the article brings to light theoretical parallels between the autobiographical accounts and concepts in modern immunology.
In May 2026, the author was honored to serve as a medical school commencement speaker. It coincided with the 40th anniversary of her own medical school graduation. It was a wonderful opportunity to reflect. The author offered the graduates four insights ("Pearls"): (1) Practicing medicine is a privilege and a responsibility; (2) Physicians must embrace the uncertainty in medicine; (3) Physicians must be open to change; and (4) Every clinical encounter is an ethical encounter. Within each pearl, she emphasized how the graduates can only succeed by being present, expressing curiosity and humility, and by embracing the ethical foundation of the doctor-patient relationship. That is the essence of good doctoring.
This article argues for literature and literary criticism's unique capacity to question and disrupt the immunitary unconscious, or the normative and bio-political dimensions of immunity's ongoing signification processes. The article opens with a rhetorical history of immunity that reads existing genealogies of immunity in terms of the metonymic, metaphoric, and allegoric borrowings they make visible. In neoliberal society, the result of immunity's metonymic, metaphoric, and allegoric borrowing is a mode of protection that understands all forms of protection to be achieved through desocialization. Disrupting this mode of protection and achieving a form of "co-immunism," or commonized mode of protection, is important in the face of today's major transnational crises. The article concludes with the argument that, given their particular affinities with metonymy, metaphor, and allegory, literature and literary criticism are uniquely well-equipped for renegotiating the immunitary unconscious, for critiquing the contemporary mode of protection, and for imagining speculative co-immunisms.
Although modern commentators date systematic study of sleep and immunity to the late 1970s, both medical and popular writing from the late 19th and early 20th centuries reveal a much earlier awareness of the immunological effects of sleep and sleep deprivation. This article demonstrates how historical actors conceptualized sleep as integral to bodily defense, thereby revealing a key part of the immune imaginary. The authors map the development of conceptual and experimental linkages between sleep and biological immunity from the late 19th century to the 1920s across the Anglophone tradition, revealing how popular writing reimagined this emerging biological connection, foregrounding representations of sleep as a vital mechanism through which individuals could fortify the body against diverse forms of invasions. The authors then identify a reorientation in popular discourse: a movement from an emphasis on the individual body towards a broader concern with the social body. Through examining this shift, it is possible to trace a reconfiguration of immunity away from the biological towards one concerned increasingly with protection from social, moral, and environmental factors.
Immunity narratives have circulated in popular culture and news media since the late 19th century. The emergence of the COVID-19 pandemic instigated a fervent interest in immunity as societies came to terms with the deadly novel coronavirus. In this article, immunity narratives in reports published in the Sydney Morning Herald during the earliest phase of the pandemic are examined for how they expressed biopolitical logics concerning individual responsibility for a strong immune system and the regulation of human populations. In these news reports, there was a blurring of biological, political, and sociolegal meanings. Certain groups were singled out as vulnerable to COVID and therefore requiring protection, including the maintenance of preventive activities by all members of the public. Others-notably elite sports players-were criticized for initially being exempted from the public health restrictions to which most of the public were expected to comply. Overall, the dominant immunitary narrative was that everyone should take action to protect themselves or those people deemed at high risk. Australia could only be immune from the health and economic impacts of the pandemic if all citizens accepted that "You are not immune from this virus."
Today we are accustomed to the idea that eating certain foods can help to support the immune system. Over the last two decades, this familiar narrative has been bolstered by the rise of microbial science and the growing popularity of biome-led nutrition, which encourages eaters to nourish the flora and fauna of their guts for the sake of better overall health. While our current preoccupation with the microbiome can be dated to the launch of the Human Microbiome Project in 2007, its origin story can be traced much further back. It begins with work undertaken by scientists and physicians around the turn of the 20th century aimed at understanding the significance of microbes in the digestive system. One of those, the Russian zoologist Élie Metchnikoff (1845-1916), is perhaps best remembered as the founder of modern immunology, and his work on phagocytosis-the capacity of certain specialized cells to engulf and eliminate intruders-earned him the Nobel Prize in 1908. According to Metchnikoff, the gut was the "engine of senility," where pathogenic bacteria multiplied and threatened to overwhelm the body's defenses. Transforming the belly into a battleground where good bacteria went to war with bad, Metchnikoff's influential work extended his theorization of organic immunity as a form of intercellular defense to the vexed question of what to eat and created the foundation for Emily Martin's "immunological body," an understanding of the body that likens it to a nation state, defined through the careful maintenance of the boundary between self and non-self, at this intersection of dietetics and immunology.
This article offers a sociopolitical perspective to histories of immunology by tracing early discourses of immunity as they circulated beyond scientific developments and into public culture. Drawing on newspaper advertisements from Britain, Ireland, Australia, and New Zealand in the late 19th and early 20th centuries, the author identifies earlier conceptualizations of immunity within interconnected colonial and cultural contexts shaped by the British Empire and outlines how immunitary logics of individualism, protection, risk management, labor, and power were formed within marketing media. Advertisements framed immunity as a purchasable and personal asset, offering security against modern anxieties such as disease, environmental instability, social uncertainty, and the loss of power. Foregrounding immunity as an individual responsibility and commercial ideal, these narratives emphasized isolation and defense rather than interdependence, embedding conservative immunitary logics that prioritized the individual over the group, sought to retain power, and presented the nonhuman as threat.
ABSTRACT: This article employs concepts of immunity to interpret the Samoan author Albert Wendt’s novel The Mango’s Kiss (2003). Contrasting Wendt’s representation of two diseases—the 1918 influenza and a fictional illness called the Satoan Disease—it finds within the novel two accounts of immune response: a defensive system predicated on exclusion and the preservation of a bounded social body, and a relational system grounded in Indigenous ideas of adaptation and coexistence. Positioning these accounts in the context of competing paradigms in contemporary immunology, the article opens up a new reading of Wendt’s critically underexamined novel. It concludes that The Mango’s Kiss challenges the epistemological foundations of received biomedical and colonial discourse alike, proposing an alternative model of cultural resilience rooted in principles of indigenization and relational identity.
In recent years, politics has assumed an expanding role in medical education. This has resulted, at least in part, from mandates issued by accrediting bodies, such as the LCME and ACGME. The influence of politics has been manifest in multiple ways, including increased emphasis on activism and advocacy, along with greater focus on diversity, equity, and inclusion. Political considerations have influenced the development of undergraduate and postgraduate curricula, classroom sessions, and clinical rotations. Grading frameworks, medical school events—such as match day and graduation ceremonies—educational sessions at major meetings, and the medical education literature have also been affected. The insertion of politics has led to competition for time and attention between discussion of issues such as social determinants of health, racism, and bias, and the traditional core human biology medical school curriculum; at times, this tension has been reflected in friction among students and faculty. It is crucial that students are exposed to a variety of perspectives on controversial issues, and that they learn to think critically. The goal should be to produce doctors who can reason through complex scientific, political, social, and cultural issues rather than one who can espouse a particular faculty member’s viewpoint.
The murder of George Floyd in 2020 underscored the theme of police brutality emphasized by the Black Lives Matter movement. In response, governments, corporations, and universities embraced an anti-racism doctrine that emphasizes the goals of diversity, equity, and inclusion (DEI) throughout society. Clinical psychology and psychiatry were among the disciplines affected by these developments. This article analyzes how advocates of DEI and social justice ideology have endeavored to transform the disciplines devoted to the scientific study and treatment of mental health problems.
The intertwining of medical journals and political concerns dates back to the very origins of the medical journal in the United States. Yet politics and political have been multivalent terms, warranting a careful dissection of their varied invocations. With a negative valence, they have been invoked to describe the bias brought in through political considerations or actions achieved by journal editors through political means. With a more neutral valence, they have referred to the relationship of the medical profession and its journals to issues of national political importance. And more fundamentally, they have served at the very center of debates over the proper boundaries of medical journal expertise and content. This article traces this typology and history through four key periods: the formation and development of the earliest US medical journal at the turn of the 19th century; considerations of medical journals and slavery in the immediate antebellum era; the consolidation of “political” power within JAMA and state medical societies (and their journals) in the first half of the 20th century; and the increasing concern over the proper domain and objectivity of medical journals in the late 20th and early 21st centuries.
Science journalism has an illustrious history of service to science and society, but it has also faced many challenges. These challenges have escalated further in the interface with advocacy for and about science. The power to do good but also to do harm, not only to science but to the broader community, must be fathomed carefully. This article dissects different roles that science journalism has assumed, including the traditional ones of disseminating, facilitating, and defending science, as well as evolving roles, in which science journalism and advocacy become more active in shaping science. At the extreme, science journalism and advocacy may exert tyrannic power, even to the point of terrorizing scientific fields or usurping science. Potential ways to improve the current situation include more clearly separating journalism/communication and advocacy from science; giving priority to science over opinion; improving accountability in authorship/contributorship, other types of transparency, and documentation of information sources; and endorsing and honoring ethical standards.
This essay examines the rural mental health crisis through the stories of the author's father, an Iraqi immigrant and sole private psychiatric provider in a rural Michigan town. Moving his clinic in 2023 revealed the strain of practicing where demand far exceeds supply and capacity: long days split between a small hospital and an understaffed clinic, chronic underpayment from Medicaid, and a constant backlog of care. These lived experiences are contextualized through the historic failure of US mental health reform after the 1963 Community Mental Health Act, which has left Community Mental Health Centers (CMHCs) under-resourced and, in many rural counties, the only option. Demographic data on psychiatrist shortages, high suicide and illness burdens, and reimbursement disparities are paired with a patient vignette to illustrate how poverty and insurance work together to hinder treatment and precipitate recurrent crises. The essay argues that incremental workforce expansion alone cannot close rural gaps without such structural fixes as raising Medicaid reimbursement, stabilizing and expanding CMHC financing, aligning residency expansion with rural service incentives, and investing in rural infrastructure that addresses social determinants.
In the 1990s, China experienced an epidemic of HIV/AIDS among poor farmers who sold and were infected by tainted blood and blood product transfusions, not discovered until hundreds of thousands were infected. In 1999, Wuhan University infectious disease physician-scientist Dr. Gui Xi'en visited villages in neighboring Henan province and identified the epidemic. This essay describes how the contributions of one individual-a humble, articulate, and tenacious physician-touched the lives of thousands of patients and health-care providers. His story reveals the virtues of a life that is a compelling call to action in the face of human need and suffering, exemplifying the heart of medicine. Given rampant misinformation and fear surrounding HIV/AIDS, Dr. Gui chose to educate rather than retreat. He welcomed patients whom others turned away, brought real-life cases into classrooms, and trained generations of students to approach medicine with both scientific rigor and human empathy. His work helped shift public understanding and reduce stigma, proving that education is a powerful tool for healing not just bodies, but communities. He is an inspiring figure from whom generations in China and the US could still learn.
Death certificates act as verified records concluding the administrative aspects of a person's life. In the US, the death certificate includes essential biographical information about the decedent, including the manner and cause of death. To some, the cause of death may be a procedural step necessary to obtain a death certificate, and where there is not an ensuing forensic investigation, the cause of death may even seem immaterial. But specificity in determining the cause of death is crucial to epidemiological and public health initiatives and for the maintenance of accurate mortality records. This article argues that inaccuracies in cause of death determinations are harmful: they are detrimental to the professional commitments physicians owe their patients and distort the lived experiences of the deceased. Inaccuracy in vital statistics affects individuals and families by misrepresenting the physiological and biological processes leading to death and potentially altering the deceased person's life story. While there is extensive literature exploring the challenges faced by clinicians in determining the cause of death, this article focuses on modifications made to the cause of death-whether consciously through deliberate intent to conceal, or unconsciously through error or omission-where the death may be socially stigmatizing.
Clinicians often focus on measurable health improvements, while patients may prioritize other values, such as autonomy, comfort, and quality of life. This divergence can generate tension between technical excellence and meaningful care. This article introduces "existential competence" as a professional skill for navigating this tension. Existential competence helps patients align health-care decisions with what gives their lives purpose, recognizing health as only one source of human flourishing. Clinicians cultivate this skill by respecting patient choices-healthy or not-that reflect the patient's core values and remain within legal bounds, assuming stable preferences, decision-making capacity, and understanding of the risks. Implementation of existential competence requires expanding health care from risk management to co-stewardship of patients' life narratives, while maintaining clinical accountability. Two approaches are considered: repositioning health as one value among many, versus redefining health to encompass existential well-being. Ultimately, existential competence reorients health care toward helping patients thrive by integrating biomedical expertise with the pursuit of meaningful living.
This article examines the lived reality of schizophrenia and its treatment as portrayed in Clem and Olivier (Liv) Martini's Bitter Medicine: A Graphic Memoir of Mental Illness (2010), with a focus on how graphic medicine can represent the complexities of subjective experience in the psychiatric health-care system. Drawing on Foucault's critique of disciplinary power in psychiatric institutions, the article explores how the memoir reveals tensions between therapeutic care and systemic control, even after deinstitutionalization. Through El Refaie's idea of visual metaphor and embodiment in comics, Liv's illustrations about his psychiatric suffering are read as more than expressive art that challenges dominant clinical narratives. The article investigates the shift in psychiatric health care in Canada from institutional care to community-based care and the impact of psychopharmaceutical drugs, highlighting the embodied cost of psychiatric treatment. By revealing the social exclusion and economic vulnerability produced by gaps in the implementation of health-care policies, Bitter Medicine critiques the promises of deinstitutionalization. The article illustrates how visual narrative forms can foreground subjective experiences of schizophrenia, while interrogating broader systemic failures in mental health care.
