Interviewed by Nuria Sheehan
Eula Biss is surprised by all the attention her latest book, On Immunity, is getting. Since its publication she’s been on NPR, held a live chat on Gawker, ended up in New York Magazine’s “The Approval Matrix” and has collected reviews from nearly every major publication. On the day we meet for this interview, the New York Times named On Immunity one of the ten best books of the year.
“You know, my background is in poetry,” she says, explaining just how unaccustomed she is to this kind of broad public interest in her writing. Biss is a sort of public-interest poet, or, as she writes in the book, “I do not belong to the press, even if my writing is published by it. And if the opposite of the press is a poet, then I am both.”
Through this paradoxical poet/press approach, On Immunity is an inquiry into vaccines and our collective fears around vaccination. Beginning with a personal question of whether to vaccinate her newborn son, Biss follows this inquiry into extensive research on immunology as well as medical and social histories of immunization and anti-vaccine movements. Through these investigations and her own daily life, she reveals the metaphors we use for disease and vaccination—from Icarus to Dracula and contemporary vampire tales—and questions our current thinking around contamination, pollution, and purity. The poetry of the writing lets these symbols reverberate, while the narrator-as-reporter interrogates the faulty logic of the metaphors to show how these sorts of loose associations can mislead our thinking and decisions.
I met Eula Biss at a coffee shop in Evanston near the Northwestern University campus where she teaches. As a fan of her writing in Notes from No Man’s Land, my interest in her new book was both literary and personal. My own life was shaped in large part by a fatal vaccine side-effect: the live polio vaccine that I was given shortly after birth passed through my system to infect and then kill my father, who hadn’t been immunized against polio. (This risk of transmission of the live vaccine, while an incredibly low incidence at something like one-in-five million cases, was a known risk. Jonas Salk testified in the resulting court case and argued that the live virus vaccine be replaced by his own inactive-virus vaccine, which is now standard.)
Growing up after this tragedy, I didn’t receive most childhood vaccinations and had to get special waivers to enroll in school. At that time, in the early 1980s, being unvaccinated was wildly unusual. Of course in the last few years, this sort of conscientious objection to vaccine requirements has become common, mostly among affluent communities, and has led to outbreaks of diseases like measles and whooping cough. I don’t agree with this movement away from mass vaccination; rather than opting out of vaccination programs, I believe that individual risk needs to be understood and accepted as a necessary part of public health. However, I also can’t help but feel an affinity toward those who raise questions about vaccines and therefore can’t just dismiss vaccine resisters as they’re often portrayed, as hysterical and ignorant mothers typified by pop culture celebrities like Jenny McCarthy.
In “On Immunity,” Eula Biss critiques the actions of vaccine resisters but with a deep respect and consideration for the fears that drive these actions. Rather than writing off the movement, she uses it as an opportunity to question why and how we inoculate ourselves against disease and fear, to wonder how much of our private selves we really owe to one another.
Nuria Sheehan: Before this book was out in the world, did you worry that it could be misconstrued as being anti-anti-vaccine, or as a simple statement against anti-vaccine movements?
Eula Biss: It’s a hard question for me because as I was writing, my thinking changed so much. I never would have worried about that when I first started writing; it just wouldn’t have occurred to me. And I’m not sure I would have seen it as a problem, but where I wrote myself to—and I guess the place where I’ve come out—yeah, I do worry about that.
In retrospect I now wish I’d spent more time with that anti-vaccine position, because my particular demographic—who I’m in communication with, the actual majority position in my little world—is anti-vaccination. So I didn’t feel the need to represent that point of view very fully or speak to it because in my mind, I was writing to the people around me. Now that the book is published and it becomes public and enters this national space, the majority position on a national scale is pro-vaccination, and what I didn’t anticipate was how that majority would treat the work, and how it would treat the minority position that is discussed in the work. I didn’t anticipate that there would be discomfort with me expressing empathy. That’s astonishing to me.
It actually came up in a review that I was too empathic toward people who don’t vaccinate. And it also came up when I was doing a live chat on Gawker. That was a really surprising space for me, to find that I was arguing with people about calling people who don’t vaccinate stupid. I suggested that it wasn’t very productive, but there were people who didn’t agree with that, which blew my mind. I thought that was a very basic starting point: first you have to show some respect for the other position before the conversation is going to move forward, otherwise it’s just a shouting match.
NS: You mentioned how when writing this book you ended up at a place that’s different than where you started. Where did you start, where did you end up, and what was that journey?
EB: It’s a little confusing, even to me. I think I was more extreme both in my actions and in my philosophy before I started this, but my actions and my philosophy were contradictory. My action was that I wasn’t vaccinating my child. I felt that I didn’t know enough, so I skipped the initial vaccination after birth and didn’t feel terribly bad about it either. I felt like, I have time. I can figure this stuff out.
So my action was that I was not vaccinating, but my belief was that people who didn’t vaccinate were ignorant. Somehow I didn’t include myself in that category. I think because I never had the intention to not vaccinate at all, I thought I would just do ones that were important; I just needed to figure that out.
As I read more and researched more, my action changed and I started vaccinating. I’d thought I would vaccinate on an unusual schedule, that I would spread them out, only vaccinate against certain diseases. But the more I learned, the more I felt I should actually vaccinate on the schedule. I had a few different reasons for that, but one of them was that the more I learned, the less confident I felt being the person who decided which vaccines he should get and which he shouldn’t.
As I saw how complicated the issue was and how these vaccines weren’t just about his health, but about other people’s health, I gained a lot more respect for the epidemiologists who think about this stuff and make these recommendations and I started to think, you know what, I should actually not be making this decision on my own based on my year and half of reading random literature.
And that’s where this book stared to become about trust, too. My research got me to a place where I thought, oh I have to trust other people. I’m actually not going to be able to do this alone. That, in some ways, was a really distressing realization. For someone like me who is comfortable being in opposition to authority, existing in a somewhat counter-cultural space, it was also dismaying to find that after all this work, what I’d come to was a realization that I had to just follow the rules (laughs). And then to become someone who is not just following the rules, but arguing that we should all follow the rules, was really confusing.
I had to constantly check in with myself about why am I doing this? Am I becoming an agent of the mainstream? Has motherhood turned me into some sort of monster who wants to enforce the status quo? In the end when I really reflected on those questions, I thought, no, probably not. I still value the strength it takes to stand against the mainstream and position yourself outside of it. I value all the many ways that people find to oppose the status quo and to disobey the rules.
This is like a conversation I’ve been having with my five-year-old son—that the rules aren’t always good because in public school right now they’re really leaning on him hard to learn the rules and follow them always. My concern is to make sure he knows that the rules aren’t always good and there are times when you might decide there are good reasons to break the rules. He and I have been talking about racism, and the history of the civil rights movement was part of my example of rules that had to be broken.
But when I really investigated this one area, I didn’t feel like I was encountering a rule that had to be broken, that was begging to be broken. I didn’t find any evidence that people’s lives were going to be improved by this rule being broken. This actually is a place where people’s lives might be improved if we follow this rule and come to terms with it.
So in that way, my action really shifted, and shifted to a place where I didn’t think it was going to go. I had always assumed that like most of my friends, I would make my own schedule and be a free agent around vaccination. But then, in how I regarded people who don’t vaccinate at all, I’d been pretty dismissive of that attitude, even though I wasn’t vaccinating. I only gained respect for it as I talked to people. The more I read and the more I researched, the more I saw so many different life histories that could lead a person to being uncomfortable with vaccination for reasons that I saw as really legitimate and having nothing to do with ignorance.
Like your situation, where you’re very close to a vaccine-produced tragedy, that’s a situation where I wouldn’t be comfortable saying you have to vaccinate. That would feel wrong. And it would feel wrong if I knew someone who’s Native American was aware of what European diseases did to Native Americans and now doesn’t want to put those germs in their body to protect the colonists. I wouldn’t feel comfortable saying, “Now you’ve got to do it.” That feels wrong in ten different ways to me. And I think there’s a number of people who are in what are sometimes called out-groups who feel very suspicious of vaccination because they’re keenly aware of how the medical system has been used as an agent of oppression. That includes women, and it includes Black people who are aware of Tuskegee. That doesn’t mean that all Native Americans and all women and all Black people shouldn’t vaccinate, just that if someone is coming from that point of view, I wouldn’t be comfortable being the person who’s pointing my finger in their face saying, “You better toe the line.” That’s a space that isn’t entering this conversation very often. It’s getting blotted out.
In some ways we’re letting the least interesting people talk. Like Jenny McCarthy. There’s not a lot of content to what she’s saying. But when I talk to the actual people, who aren’t celebrities, who don’t vaccinate, they have very interesting reasons for not vaccinating.
When I was talking to the Immunization Action Coalition, the medical professionals were asking why people don’t vaccinate, which I can’t really answer. But I told them a few stories of people who are friends with me. One response was, “That’s an unusual situation.” I thought, for instance, of my friend whose parents are Vietnam refugees, which I wrote about in the book. That’s an unusual situation. But if I can name, say, ten unusual situations, then it’s worth us thinking, okay, maybe this isn’t a movement of people marching behind Jenny McCarthy, but individuals that have their own private and politicized and historical reasons.
NS: I don’t think of myself as being squeamish, but when I first encountered the descriptions of variolation, how vaccination first started as sharing pus and open sores between people, I had this very physical reaction and can think of no better words than being completely grossed out. It felt like some very fundamental, gut response to things that are dirty. You write a lot about dirtiness in the book and I wonder what you think about those deep reactions to what’s dirty. Do you think it’s possible for us to change our thinking around dirtiness when it’s tied to such an ingrained, animal sort of response?
EB: Yeah, the impulse is ingrained, but it’s interesting because our definition of what is dirty changes over time. So it was interesting to do all that research on Victorian anti-vaccinationists, because what felt dirty and filthy to them was a lot of organic matter—rotting stuff and animal products. So part of why vaccines were really suspect then is because they were sourced directly from cows.
It would seem organic to us now, because it was literally pus drawn straight from a cow with nothing else put in there. So now people would be Oh, perfect! But back then it was horrifying. That was almost the definition of filth at that time—something that was animal-sourced.
The thing that has stayed static is a penetration of the body; it continues to be upsetting to us, and that hasn’t changed over these several hundred years.
But now what’s dirty for a lot of us is chemical. Actual soil for many people, myself included, doesn’t inspire our dirt phobia. What inspires dirt phobia are chemical additives, so that response has gone into conceptual space, because you can’t see most chemicals. It’s the idea of chemicals that’s setting off that same deep response, that eew response.
And in some ways it makes sense. Back in that time period, when people were really disgusted by feces and animals, that was what was passing disease. Now chemicals are a real environmental threat. It’s a space in which we’re responding to something real, but in a slightly irrational way, or sometimes in a very irrational way, depending on the moment.
NS: This question of what to trust comes up throughout the book. You wonder about trust in the government and experts and also about trusting gut instincts. So how do we ever figure that out? Whether and how to trust outside people or trust our gut?
EB: The gut instinct is a tough one, because we can mistake other things for instinct. I have observed in myself and spoken to other mothers about something that we call instinct, which is actually very culturally informed.
We can say, “I have a bad feeling about this.” I had a totally bad feeling about vaccination, even after I did my research. I hated watching the needle go into my son. It was a deep enough repulsion that it felt instinctual, but I was aware enough by that time, because I’d been doing this research, that it was a culturally informed repulsion. It wasn’t my soul talking to me and it wasn’t my maternal instincts talking to me. It was cultural noise that I was hearing in that moment. It can be hard to separate out the two.
What is intuitive knowledge? What’s the difference between intuitive knowledge and a bias that you have because of how you’ve been culturally informed?
For instance, as much as I’ve been saying that I think there’s all these valid reasons for people not to vaccinate, I’ve also observed something in white, middle class, well-educated women who have sensed that their child is uniquely vulnerable. There’s an element I think is classed and raced as well. It has to do with some of our training around both class and race, and it’s a misleading training, because, in fact, white people as a whole are far less vulnerable than other groups. But we are trained into the belief that there are places that aren’t safe for us to go because of our race and that we need to be very careful. Some of that can seep into our thinking about our children’s health. That vaccination is okay for other people, but my child is special and uniquely vulnerable. My child alone might be adversely affected by this, which could be true, right?
But the probability is that your child is not uniquely vulnerable. Your child is probably like every other child out there in most ways. And so that’s where I feel what we call gut can actually be an unexamined cultural position. If we don’t interrogate that gut a little bit, then we’re acting in what I would call a knee-jerk way rather than a well-considered way.
NS: There’s a line in the book: “Immunization is a public space.” When I read that, I realized how deeply connected this book is to your previous book [Notes from No Man’s Land]. They are both about how we share public spaces and how sometimes the things we think of as private, even the most private spaces of our own bodies, are always a part of public spaces.
EB: Yes, yes, which I think is really hard to think about and hard to come to terms with. And it also comes back to how you have to think about rules and government differently if you think in that way.
I began to pay attention to the public spaces I inhabit, to use them as metaphors for thinking about this. One of the spaces that I thought about a lot, but didn’t write about, was the road. I bike on the road a lot, and one of the reasons that I liked thinking about that space is that in the social public space I inhabit a position of relative privilege, because I have access to everything that comes along with being white and middle class and well educated. But on the road I occupy a vulnerable position. I’m on a bicycle, and I’m also in a minority position; there aren’t that many bikes on the road. The issue of people following the rules becomes a really intense issue when you’re on your bicycle, and you’re uniquely vulnerable. If someone blows a stop sign, that’s very dangerous for me, and more dangerous than if I were in a car. On the bike, I signal with my hands, but if someone doesn’t see or respect my signal, then I’m in really grave danger.
I thought about that a lot and how this isn’t just about toeing the line and marching in step, but how when we are in vulnerable positions we really rely on other people to follow the rules in order to safeguard our health. And people have trouble sharing space. I run into that all the time on my bike; people get pissed at me just for being a person in the road.
One of my favorite stories is about when my husband was riding his bike on Sheridan in Chicago, and this huge SUV pulled over, rolled down the window and said, “You’re taking up the whole road!” Which is this incredible metaphor for privilege! A person who’s in that privileged position is irate that someone else is even existing, even has any space.
NS: Because they don’t see the road as being there for bicycles. There’s an unusual entity and suddenly they notice the space and how it’s being occupied.
EB: Which is actually tiny in comparison to the space that they’re occupying! But in their opinion, it’s way too much.
I thought about that point quite a bit, how when I occupy different positions what I’m thinking about changes. I notice when I’m in a car, I get irritated with people on their bikes, even though most of the time I’m on my bike (laughs). It’s really interesting how suddenly you can be blind to a position that you sometimes occupy.
Some of this can seem like petty issues of manners, but I think it is a deeper issue of how do we share? That’s part of what we need etiquette for, so we can use this space without anyone getting hurt.
NS: And our positions as victims or potential threats aren’t always set, right? For me, I hadn’t been vaccinated, and when I was twenty-five, I got the mumps. I was fine, I didn’t get very sick, and it seemed like everyone around me was vaccinated. But someone in the office where I worked was HIV positive, and if I had gone in and been around that person, it could have been very dangerous. From my family story, I had a sense that we were victims of vaccines and the medical issues around them. But then suddenly I’m a threat to someone whose immune system is particularly vulnerable.
EB: That’s a really good point. There’s a danger in the mindset that you only think about your own vulnerability, which again is a very classed and raced mindset. You get fixated on how you’re vulnerable, and the truth is dual: you’re both vulnerable and dangerous. All of us are. Sometimes a person is tipped in one direction or other because of their typical situation, but most people exist in a dual space. And if we get fixated on the idea that we’re vulnerable to vaccines, then we can forget how we’re really dangerous to other people if we don’t vaccinate.
NS: There’s this place in the book when you talk about a research study. That study found that if people don’t know what their health status or their social position will be, then they’re more likely to want rules that are fair and equitable. This brought up for me an almost spiritual take on these issues, looking at the problems that come out of over-identifying with transitory states like healthiness or wealth. I wonder if at any point you thought about these things in that way, more in terms of spiritual philosophies?
EB: The book engages with this just a bit, where it talks about conscience. That was an interesting question to me when I was writing. It was interesting especially since these vaccine resisters had been conscientious objectors. I thought, they think they’re acting from a conscientious position and I think I’m acting from a conscientious position. It made me wonder, is it totally subjective, and do I even know my own conscience? Is what I’m calling conscience something else?
I had this moment in that long trajectory that I was talking to you about, where I had made the decision to vaccinate my son and had made the decision to follow the schedule, but I still felt uncomfortable with it, because I still had questions that hadn’t been answered with my research. I was having a conversation with myself. Part said, why are you doing this if you still have questions? And I couldn’t answer that, and it was because I had a really strong feeling and didn’t know what to call that feeling.
Much later when I was writing this section about conscience, I was describing this feeling to my sister, and she said, “That’s your conscience. That’s what that feeling is.” And I think she was right.
I had learned enough about vaccination that the burden of proof had shifted. When I first started researching I thought, well they’re going to have to prove to me that this is safe. Then as I researched more, I thought, I’m going to have to find proof that this is not safe before I’m willing to opt out of this system. And I didn’t find that; I never found something that felt compelling enough that it would allow me to opt out of something that was doing good for other people. But I also didn’t know what to call that sensation of discomfort.
At the time I didn’t call it my conscience. And I was uncomfortable with it. I wasn’t sure if it was me wondering, is this what it feels like to join the status quo? But later it did become a kind of more spiritual question: do we recognize our own conscience when it’s talking to us and do we know what to call it? Do we know what it feels like?
I talked to Marilynne Robinson, my former teacher, about it, because it really plagued me for a while. I started to think, what if my conscience is talking to me frequently and I don’t hear it? I said to her, “How do you recognize your own conscious?”
And she said, “Oh. It’s not easily mistaken for anything else” (laughs). And I thought, oh great! Something is spiritually broken in me then, because I clearly don’t recognize it right away. Which I don’t think is necessarily true. I’m just particularly skilled at uncertainty, so it’s hard for me. It’s definitely not hard for Marilynne Robinson to be certain, but it is hard for me.
Where I wrote myself to was, for me, a very philosophically or spiritually challenging place. This sense that you don’t even own your own body and that you are responsible for all the bodies around you and that you have to make decisions that are in concert with what those bodies need. This is really challenging, on a deep, metaphysical level.
I think this book is a lot of things, but one of those things is a challenge from me to myself to be a better person. I don’t think there’s evidence to read it that way, but that’s for me the private experience of writing this: the experience of having a long conversation with myself where I was trying to meet a challenge.
NS: Do you still have any unsettled questions of conscience?
EB: That came up for me before I’d done the bulk of the research. The more I researched, the more comfortable I felt with a decision that had already been enacted. But at the moment it was time for the vaccine, and at the moment I asked myself, do I know enough to say no? And the answer was no, I don’t know enough to say no. And then I felt, well what will I feel like if I make this decision now, and later I know more and realize I’d made the wrong decision?
I talked with a friend about this—a poet—and she said, “All we ever have is what we know in the moment. It might be a mistake, but the burden that all of us bear is our incomplete knowledge.”
So I just decided this is true for me, but it’s also true in a more global sense. There are probably things we don’t know about vaccines. There are side effects that we’re probably not aware of, but all we can work from is what we know in this moment. We don’t actually get to use future knowledge.
I’m not sure that the fear of having made a mistake is actually a good enough reason not to do something. All you can do is weigh what you know, and you can’t weigh it against what you don’t know, because you don’t know what you don’t know. All you have is what you know, and you act from that.
Nuria Sheehan’s essays and interviews have appeared in Anderbo, Sweet Lit, Blue Earth Review, Brevity, Water~Stone, and poetryfoundation.org. Her short film, Wunderkind, screened at the Seattle Gay and Lesbian Film Festival and received the Outstanding Iowa Artist Award. In 2012, Nuria served as Assistant Editor for Brevity’s special issue, “Female Nonfictions after the VIDA Count.” She lives in Chicago and works as a digital strategist in the arts. Twitter: @nuria
SLAG GLASS CITY • Volume 1 • November 2014
Book cover and author image source: Graywolf Press
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