One of the most devastating effects of war is food shortage. After all, it’s hard to do a day’s work in the fields when artillery and infantry units degrade the soil with bullets, bombs, and bodies (dead). People go hungry. Hunger kills people. To curb this problem, humans have devised a brilliant strategy which goes by the name of rationing. This wasn’t (and isn’t) a solution, but a mere mitigation method done to minimize the damage caused by food scarcity. In this BBC documentary a band of soldiers are faced with the dire problem of having too many men but too few food. A drastic decision had to be made: one must die.
Rationing is a physical example of a mathematical operation called division. At its simplest, it’s done to know how many something can be retrieved from another thing: How many 2s can be derived from 4? How many 50s are there in 1,000? Let’s take this even further: in the example above, given that food is scarce and the times call for desperate measures, how can one divide the joy of food among hungry mouths? This calls to mind my favorite band of all time, Joy Division.
I’m not here to convince you of the band’s greatness (there’s no need to do that because they are scientifically THE greatest). But I’m here to discuss science in general and health in particular by using one of their songs as an anchor. This is the prudent and practical way to do so, since going through all of their tracks might trigger a real division of joy and happiness in one’s heart.
Joy Division stormed into the music scene in 1979 with their debut album, Unknown Pleasures. This is perhaps their most memorable album thanks to bootleg t-shirts that bear the album’s iconic cover. (Personally, I think Closer is the better album.) Unknown Pleasures is a ten-track tread across a black and white rainbow of doom and gloom that bears singer Ian Curtis’ message of energetic cynicism and dynamic depression.
What stands out in the album for our purpose is the opening track titled Disorder.
We all know that disorders are a common thing to our health. But what is disorder in technical medical speak? In the ordered catalogue of words in Harvard’s online Medical Dictionary of Health, it is not to be found. Neither is it included in Oxford’s online Concise Medical Dictionary. Since these two titans of technicality are of no help, perhaps history is a better sage, as is always the case. Thus, let us look back at the word’s history, or to be more technical, its etymology.
The word disorder is made up of two things: the negative prefix dis and the word order. The second part, order, has its roots in the Latin word ordo which means rank and/or line. So what disorder means is a sort of negative arrangement of something, i.e. something out of line, like having molars where incisors should be. Well, isn’t this is common knowledge already? So it seems like we’ve just wasted our time talking about that. But this etymological discussion is actually important because disorder is mostly used to address an incessant crisis in our times which plague millions and millions of people: mental disorders.
The first stanza of Joy Division’s Disorder describes an experience of what is probably the most common mental disorder globally: depression. Ian Curtis, the band’s lead vocals, sings as a depressed person coping with the world: “Could these sensations make me feel the pleasures of a normal man?” An image of a person, downtrodden and in despair, overwhelmed with the world is conjured: the world bombards the depressed person with information and sensation that hints at a return to normality, to order. However, the following phrase tells us that nothing has changed, “These sensations barely interest me for another day.” Ennui has become an everyday event.
Mental disorders are complex, to say that is even an understatement. Advancements in psychiatric training and diagnostics have greatly improved care for patients, and we have learnt to understand symptoms more, but we are far from reaching definite cures and even vaccines. This is definitely a depressing problem.
This conundrum may be caused by a fundamental lapse in medical theory: we don’t really know what disorder is. If dictionary entries embody contemporary and current understanding, then we really do have a problem. So how do we begin to understand it?
Perhaps looking at other domains of thought can be helpful. We’ve looked at music and history already, so maybe we should investigate these fields even further. Maybe if we only listen more carefully then we might get something useful from both. Our ears will have to be busy again.
One thing that is repeatedly explored in Disorder is duality, where one actually means two upon investigation. Darkness is one bright example. Humans experience vulnerability in the dark, while bats enjoy its promise of opportunity. A single grain of rice may mean famine to us, but it is a feast for an ant. “What means to you, what means to me”, sings Curtis to express a duality of meaning. This is the first instructive part in understanding what disorder is in terms of health. For sure there is a general and average human condition that is optimal for our survival, and this is the order of things. But not all aberrations from the average are abnormal or disorderly. The average is made up of individual variables, and each variable corresponds to an individual organism, and every organism is a unique expression of biology. In general, humans living in South East Asia may already feel cold chills from an 18°C morning, but to a person who has lived in the northern hemisphere, this may be a blessed summer day that calls for a day in the beach. Cold is a different experience for different peoples of different places. Moreover, a duality in life quality also surfaces in societies of the same climate and geography but divided by class. When typhoon strikes, a family on a well-built multi-million mansion has a better chance of survival than a whole neighborhood living in wooden shacks. Safety shifts in meaning when facing a storm. With these in mind, it is not imprudent for us to conclude that health cannot be simply captured by a single description, but it covers a wide ranging sphere of experiences and environments. To address that, physicians are instructed to always take into consideration the uniqueness of each medical situation. This was the main argument of Greek physician and father of medicine Hippocrates when he had this to say:
“Therefore, on arrival at a town with which he is unfamiliar, a physician should examine its position with respect to the winds and to the risings of the sun. For a northern, a southern, an eastern, and a western aspect has each its own individual property. . . The mode of life also of the inhabitants that is pleasing to them, whether they are heavy drinkers, taking lunch, and inactive, or athletic, industrious, eating much and drinking little.”
Hippocrates, Collected Works I
Now that we’ve come to grips at how different each individual acclimates to different experiences and conditions, we must now set our focus to another important arena of analysis: the body of each individual.
The body is a system, and it is also part of a bigger system: the world at large. A system within a system, so to speak. As such, the body has its own mechanisms that ensure its functionality or lead to its failure, optimized and limited by the information and sensations bombarded by the larger system outside. The body, therefore, is an arena where a constant inter-deterministic interplay of nurture and nature, to use a contentious phrase, takes place all the time. This duality can be seen in the passage where Curtis sings, “I’ve got the spirit, but lose the feeling”. What we can infer from this is that feelings are reactions from various stimuli and what allows this to happen is the tandem of body’s physiology and biochemistry. Anger after hearing a Chainsmokers song is felt for the ears passed information of its aural assault to the brain. Thus, we can say that inner workings of the body is its spirit, and its reaction to the system at large is the feeling. In this particular passage, what Curtis expresses is a well functioning body, but a body that fails to react nonetheless. So clearly, the disorder here is not found within the body, but outside of it, since the body cannot find an appropriate appraisal as a response, as the events unfolding outside are undesired and often far from consonance with the body’s needs: a common experience among people living with depression.
This is the disorder plaguing our times now. There is no doubt that modernity has improved a plethora of departments that make life easier thanks to advancements brought by science and technology; but these have failed to altogether raise the living conditions of people. Underneath the veneer of megacities is a populace of depressed and downtrodden individuals who keep the city engine going with their blood, sweat, and tears.
The immediate medical response given to people suffering from mental disorders is often pharmaceutical, rationalized as a way to balance the body’s biochemistry. No doubt that this works and it helps alleviate the symptoms experienced. But I argue that this is inadequate, as this only addresses one area of the dual nature of disorder. It is not enough that we should shove pills into our mouths hoping that everything will be alright as the medical bills continue to stack up, adding further reasons to be depressed. Patients take in drugs but are continuously exposed to the world that keeps them depressed. A radical solution is required. One that acknowledges not only the body’s biochemistry but also the world and how it can be changed.
Why is this necessary? Isn’t this just the rambling of someone influenced by Marxist scientists? Well, yes. But there’s an underlying and undeniable truth to this imperative need. Scientists from Duke University found out that living in poverty can actually change your genetic makeup. In an interview, lead auther Johannah Swartz explains their findings:
“Specifically, we found that adolescents growing up in households with lower socioeconomic status have increased epigenetic markers near a gene that has previously been associated with depression, which may affect how the gene is expressed. We also found that having more of these epigenetic markers was associated with increased activity in a brain region, the amygdala, that plays a critical role in the stress response and has also been linked to depression. We also found that having more of these epigenetic markers was associated with increased activity in a brain region, the amygdala, that plays a critical role in the stress response and has also been linked to depression.”
This isn’t at all surprising. The body is a biological system – it is made up of various inorganic and inanimate materials and objects that keep it functional. These essential components and ingredients are found and retrieved from the environment, which is why, if you think really hard about it, people need to eat (recall the rationing problem at the beginning). The body needs raw materials to build muscles, bones, cells, etc.. As much as people want to overemphasize the role of genes in determining life outcomes, what comes into the body via nurture is vastly important and often times overlooked – this is the domain where medicine should look at. How can the body, in the first place, follow the blueprints laid out by genes when the body doesn’t have any quality material to build with? A disordered living condition will inadvertently corrupt an ordered life.
Joy Division’s message is clear. There is disorder in this world and it is destroying lives.
Unlike the wars in the past, there is abundance right now brought about by lightning speed technological advancements, but so many people are still lacking in basic necessities and comfort that make life worth living. Joy Division sang about it. Ian Curtis died because of it. Need we lose more people as a needless reminder that we could do better – that we could clear this disorder?