Monday, August 29, 2016

White Trash

Before readers get their drawers in an uproar, I should explain that my title merely repeats the title of a new book by historian Nancy Isenberg: White Trash: The 400-Year Untold History of Class in America (Viking: 2016). And a very fine book it is. I have to confess to an ingrained prejudice against the title group most typified by the Trump supporters who seem drawn in large part from this class. But reading Isenberg’s book opened my eyes to the long history of contempt, exploitation and prejudice faced by what may be a dying breed, and made me rather more sympathetic than I would otherwise be. To begin with, Isenberg takes great pains to show that the contempt for both America as a colony and the vagrants and beggars who would largely populate it had a long history in England. Starting from the earliest colonial forays, the English saw the new continent as “an outlet for the unwanted, a way to remove vagrants and beggars, to be rid of London’s eyesore population” (10). More than that, they saw America as not just a source of fertility and income, but moreso as a “place of outstanding wastes, ‘ranke’ and weedy backwaters, dank and sorry swamps” (10), literally a “waste-land” in itself and a convenient repository for “waste” people. Ship captains in London actually rounded up children from the streets of London to sell to planters across the ocean—it was known as “spiriting.” Those and others like them sold into indentured servitude were virtual slaves, unable to move or marry, subject to whippings, and able to be sold (the master could sell the indentured contract to another master.)
            Accordingly, early tracts on the new land, like a famous one from Richard Hakluyt, saw America as “one giant workhouse,” a place where the waste people of England “could be converted to economic assets. The land and the poor could be harvested together…” (21). The language used could be even more graphic: to cure the “plague” of poverty in England, the colonies were called “emunctories, excreting human waste from the body politic” (an emunctory is a human organ like a kidney that serves to carry off wastes). And what Isenberg is at great pains to demonstrate is simple: this English class system that saw the poor as societal “waste” to be excreted was replicated in the new world and the new nation. In Virginia, for example, a planter elite quickly took over the best lands, grew rich on tobacco, and exploited not just slaves but their indentured servants. A 1662 Virginia law stipulated that children remained servants until age twenty-four; servants were classified as “chattel, as movable goods and property,” essentially equivalent to livestock. The same social system pertained among the Puritans in Boston. Far from being the cradle of democracy (Governor Winthrop labeled democracy “the meanest and worst of all forms of government”), Puritan Boston was dominated by class divisions where children were essentially the servants of their father, and where the “first slave cargo arrived in 1638” (31). The big divider in Boston and elsewhere was land. The landless were without station, without election, without power of any kind; their only recourse was to escape (usually to the frontier). The same held in Virginia. “The most promising land was never equally available to all,” because the “royal surveyors made sure that large planters had first bids on new, undeveloped land, and so the larger tracts were increasingly concentrated in fewer hands” (37).
            This was dramatically clarified in Bacon’s Rebellion, which took place in 1676 in Virginia. Vagrants, frontiersmen, indentured servants and slaves all joined Bacon in rebellion, and were known to the powerful as “offscourings.” The word means “human fecal waste,” and it indicates both the contempt of the landowning elite for the marginal landless, and their fear that a united underclass might lead to bigger and far more lethal rebellions. One result was a hardening of racial lines and the more formalized class divisions in the South. Isenberg tells us about the Fundamental Constitutions of Carolina (1669), written by none other than that great hero of the founding fathers, John Locke. According to Isenberg, Locke’s tract not only endorsed slavery, it promoted “a semi-feudalistic and wholly aristocratic society” with noble titles taken from Germany (‘landgraves’), and categories of inherited servitude (“leet-men” were like serfs, tied to the land and their lord). Through it all—through the splitting of Carolina into North and South, with the South dominated by slavery; and the attempt by James Oglethorpe to create a slave-less colony in Georgia where poor whites could prosper with hard work—the contempt for and exploitation of poor whites continued. They were considered a new breed of human: lazy, slothful, interested only in procreating their miserable kind. Robert Byrd described Carolina as “lubberland,” a swamp of inferior, ungovernable people who had no desire or ability to make the land productive or profitable, and therefore literally “waste-land.”
            In this situation, the main solution for poor, landless whites was escape to the “unoccupied” lands of the west. Indeed, the populating of the lands from the Allegheny Mountains to the Mississippi River was done mainly by the white squatters who simply squatted on land, built a shack on it, and survived as best they could. It was, Isenberg reminds us, “a recapitulation of the English tactic of getting rid of its ‘waste’ by shipping it west to the colonies” (105)—in this case, the territories west towards the Mississippi. And the attitude toward this “waste people” was the same on the part of the landed elites in the colonies as it had been by the British earlier: contempt. These frontier squatters did eventually get their heroes and representatives. Andrew Jackson was probably the first of note, dubbed the backwoods president who represented ‘cracker country.’ Daniel Boone was another—a Congressional hero in a coonskin cap who epitomized the frontier virtues of fighting spirit, contempt for Indians, and a love of boasting. Isenberg quotes James Agee about this latter trait, said to derive from the shame ‘crackers’ were said to be covering: “The poor…have merely internalized a kind of ‘anesthesia,’ which numbs them against the ‘shame and insult of discomforts, insecurities, and inferiorities’” (228).
            Contempt or not, the elites were always ready to use the poor to fight in wars. Just as they formed the main battalions in the Revolutionary War, they were also the mainstay of the Confederate forces. Plantation owners were able to do this by redirecting “the hostility of the South’s own underclass, the nonslaveholding poor whites” (159) towards both the black slaves and the northerners trying to free them. Even though they themselves had been called the “degenerate race” before the war, now poor whites were told that Yankees were actually the degenerates, with an agenda not just of abolishing slavery, but “inciting class revolution in the South” (158). Such propaganda was necessary because it was common knowledge that this was “a rich man’s war and a poor man’s fight.” The rich could hire substitutes to fight in their place, while the poor were subject to a conscription that targeted all males from seventeen to fifty. As a result, there was strong resistance to the draft and to the war itself, with thousands deserting a Confederacy many felt little attachment to. Perhaps they knew what they were doing after all: in the reconstruction overseen by Pres. Andrew Johnson (himself a southerner), more whites than blacks actually got federal relief, with hundreds of thousands living off “Uncle Sam’s rations” (178).
            This may help us to understand how the current politics of “redirecting white hostility” continues to work. That is, despite the fact that in recent years white trash has become almost chic, a virtual ‘ethnic identity’—with Elvis Presley a culture hero; with Andy Griffiths a TV hero; with NASCAR an entertainment phenomenon that tops the charts; and with Lyndon Johnson and Bill Clinton winning landslide victories for the presidency—the Republican party, since at least Richard Nixon’s southern strategy, still depends on the white population in the solid south to win its elections. And it does this in the same way Confederate leaders did: it redirects white hostility towards northerners, “eggheads,” government regulators, and urban blacks. Lyndon Johnson, in one of his remarks to Bill Moyers, probably put it best:

 “If you can convince the lowest white man he’s better than the best colored man, he won’t notice you’re picking his pocket. Hell, give him somebody to look down on, and he’ll empty his pockets for you” (315).

In other words, poor whites, the ‘waste’ that the American Dream never seemed to reach, have always been exploited, one way or the other. But rather than directing their hatred at those who exploit them (land speculators or bankers or politicians) or the class system that keeps them at the bottom, the dispossessed hate those they can look down on (even if he’s President of the United States). And supplying someone to look down on seems to be part and parcel of the political fabric of America. This is evident in the campaign of Donald Trump in 2016; his most loyal supporters are those whose hatred he has been able to redirect, convincing them that he, a billionaire, is their ally in bitterness, in animosity towards the ‘government.’ In this sense—and we have no idea how successful Trump will eventually be in mining this traditional reservoir of Republican rancor—the Trump phenomenon validates Nancy Isenberg’s point in her book. Far from being some marginal aspect of the national story, the dispossessed have always been key to “our very identity as a nation” (320. They always have been, and still are, a fundamental part of our history—a history that tries to perpetrate the equal-opportunity-for-all myth, but which, in reality, becomes more and more dominated by inherited wealth and, yes, deep class divisions. As she puts it in her epilogue: though the labels have varied, from trash to wastrel to vagrant to squatter to cracker to trailer trash, “White trash is a central, if disturbing, thread in our national narrative” (321). It is the story of those who fail to rise in America and a far more important part of “who we are as a civilization” than most of us, especially our mainstream historians and politicians, have ever been willing to admit.

Lawrence DiStasi

Friday, August 5, 2016

Our Malevolent Doppelganger

When I first heard of Siddartha Mukerjee’s prize-winning book, The Emperor of All Maladies, I decided I wanted no part of it. Why read a book about cancer when we already hear far too much about this insidious horror of a disease? But then I read Mukerjee’s second book, The Gene, and realized that he is the latest in that enduring trend of physicians (William Carlos Williams, Lewis Thomas, Abraham Verghese) who are also brilliantly accomplished writers. So I decided to take a look at The Emperor of All Maladies (Scribner: 2010). I’m truly glad I did. Mukerjee is the real thing—a physician who seems to have maintained his humanity, his soul, his sensitivity to words, even as he maintains a killing schedule as an oncologist. Both aspects of his persona give him the necessary insights to write the book he has: a ‘biography of cancer’ that crackles with the suspense of a good mystery. The mystery, of course, involves finding the biology and genesis of cancer as a disease—the scientific pursuit—and ferreting out the medications that might promise a cure—the therapeutic pursuit. Both, though with a heavy emphasis on finding the cure, comprise what came to be known as The War on Cancer. It was a public-relations ploy designed to raise money to pay for research: money for trials for new procedures such as drugs for chemotherapy, surgery for tumor removal, X-rays to kill the offending cells; and also for the pure research into the fundamental biology of cancer cells to finally discover what, in fact, was causing cancer. What was the cellular malady that turned normally functioning cells into maniac proliferators of the tumors that were choking the body—always more and more bodies, it seemed—to death? And though the War on Cancer succeeded in raising an astonishing amount of money for cancer research and therapy, both from the U.S. Government and from private foundations, it never quite lived up to its promise. This is because the metaphor of war automatically implies taking aim and destroying an outside enemy—a virus or a bacterium that invades the body. But what Mukerjee leads us to in the end is the discovery, made gradually over the years, that the enemy is not something external to the human body. The enemy is within. Within the body. Deep within the cell. As Pogo once famously said, “we have met the enemy and it is us.”
            This is really the main thrust of Mukerjee’s book for me: cancer is not something that invades the body from without; cancer is a relentless and sometimes beautiful (Mukerjee actually uses this word) perversion of the most basic process of the human body: cell division or mitosis. The body must reproduce its cells constantly in order to live, to survive (blood cells are produced in our bone marrow at the astonishing rate of 300 billion per day!). And cancer hijacks this process in a way that makes it a virtual duplicate of ourselves. Here is how Mukerjee puts it early on:

To confront cancer is to encounter a parallel species, one perhaps more adapted to survival than even we are….This image—of cancer as our desperate, malevolent, contemporary doppelganger—is so haunting because it is at least partly true. A cancer cell is an astonishing perversion of the normal cell…Like the normal cell, the cancer cell relies on growth in the most basic, elemental sense: the division of one cell to form two (38).

What is even more mind-boggling is that cancer is not simply a fierce replica of our own ability to produce cells; the resultant cells also have the ability to evolve, to change in response to our attempts to kill or halt them. Mukerjee again:

Every generation of cancer cells creates a small number of cells that is genetically different from its parents. When a chemotherapeutic drug or the immune system attacks cancer, mutant clones that can resist the attack grow out. The fittest cancer cell survives (39).

So though we might want to think of cancer as simply a “dumb” result of basic chemical processes, we are forced to realize that cancer, like all “dumb” life, possesses a deep and deeply-ingrained intelligence. It recognizes attempts to extirpate it, bides its time, and works out strategies that allow it to survive and thrive (though here, as elsewhere in contemplating disease, I have never been able to quite figure out how “survival” fits a disease whose end game seems to be to destroy its host, and thereby, itself). Leukemia cells under attack from poisonous chemicals (combination chemotherapy), for example, seem to know enough to be able to migrate (metastasize) to the brain, where these chemicals are helpless to cross the blood-brain barrier. Mukerjee calls the brain, in this instance, “a natural ‘sanctuary’ for cancer within the body,” for a leukemia that seems almost conscious: “sensing an opportunity in that sanctuary, [it] had furtively climbed in, colonizing the one place that is fundamentally unreachable by chemotherapy” (147).
            Mukerjee gives us a detailed history of how cancer came to be recognized as a specific disease (as far back as ancient Egypt), and the many therapies developed to combat it: surgery (his description of mastectomies to extirpate breast cancer leaves us fascinated, and horrified at the more and more radical excisions that surgeons like William S. Halsted recommended in their mania to cut out every bit of a remaining cancer—all this mutilation, in the end, to no avail); chemotherapy, which found drugs almost by chance, by trial and error, and evolved to include higher and higher doses of more and more drugs, often leaving the patient half-dead from nausea (combination drug, X-ray and spinal-tap therapy was called, at St. Jude’s, “total hell”); to radiation therapy from higher and higher doses of X-rays, which themselves led to mutations; all in the effort to make the War on Cancer pay off with what was hopefully referred to as a “moon shot.” Mukerjee describes each of these phases in detail, often animated with case histories of some of his patients—the most memorable being Carla Reed. In her quest to stop her leukemia, we are told, Carla in 2004 entered “total hell,” visiting the clinic 66 times, with 58 blood tests, seven spinal taps, and several bone-marrow biopsies, in addition to multiple chemotherapies and radiations. Mukerjee cites a writer, a former nurse, describing a typical course of this “total therapy” at St. Jude’s hospital:

“From the time of his diagnosis, Eric’s illness had lasted 628 days. He had spent one quarter of these days either in a hospital bed or visiting the doctors. He had received more than 800 blood tests, numerous spinal and bone marrow taps, 30 X-rays, 120 biochemical tests, and more than 200 transfusions. No fewer than twenty doctors—hematologists, pulmonologists, neurologists, surgeons, specialists and so on—were involved in his treatment, not including the psychologist and a dozen nurses” (169).

But at least some of the patients suffering these agonies earned extensions of their lives. Mukerjee is harder on the results of the radical surgeries that were, and still, though rarely, are, the preferred treatment for breast cancer: 

Between 1891 and 1981, in the nearly 100 years of the radical mastectomy, an estimated 500,000 women underwent the procedure to “extirpate” cancer….Many were permanently disfigured; many perceived the surgery as a benediction…When radical surgery fell, an entire culture of surgery thus collapsed with it. The radical mastectomy is rarely, if ever, performed by surgeons today (201).

            The good news (if one can call it that) in Mukerjee’s story has to do with the long process of discovery about cancer biology, and the linking, finally, of these discoveries with therapies and drugs designed to match that knowledge. First, the discoveries (and it should be noted that all I can do here is provide a truncated sketch of what was and is a very complicated process). Beginning with a hunch by an Italian scientist named Boveri, biologists began to hone in on the mechanisms whereby the tightly regulated process of mitosis (cell division) in normal cells became chaotic in cancer cells. Bruce Ames, with his famous test on Salmonella bacteria in the late 1960s, found that a gene mutation would allow Salmonella to grow on sugar (galactose). He then saw that chemicals that scored high as mutagens (causing mutations) also tended to be carcinogens (causing cancer). Carcinogens, in short, had a common property: they could alter genes (mutation). One of the first carcinogens to be identified in the lab was a virus: the Rous Sarcoma Virus that could insert a viral gene into cells and make them cancerous. Though many scientists then became convinced that all cancer was caused by viruses, Howard Temin soon saw that it wasn’t the virus but what it had done that was key. By examining the Sarcoma virus, several scientists next found a specific gene, a single gene, that had done the damage. The gene was called src (pron. “sarc”), and it became one of a class called “oncogenes”—genes capable of causing cancer. It was then found how the src gene functioned: it encoded a protein whose main function was to modify other proteins by attaching a chemical, a phosphate group, to these proteins. Such protein enzymes were already known as kinases, and they acted as “molecular master switches,” often switching a cell “on” which then turned another “on” until with many cells turned “on” the target cell switched from a non-dividing to a dividing state, all under tight control. Src, by contrast, was a kinase on hyperdrive, turning normal cells into endlessly-dividing machines, the hallmark of cancer.
            One final mystery remained: how did src evolve into an oncogene? Two scientists at UCFS (University of California at San Francisco), J. Michael Bishop and Harold Varmus in the 1970s began to study src and came up with the solution. They discovered that src was not some foreign gene that had infiltrated normal cells; src was everywhere in normal cells from ducks to mice to fish to humans. But these normal src genes were not identical to the ones in the Rous virus. They were kinases, but not hyperactive ones; they were tightly regulated to act only during normal cell division. In short, they did not have the mutation that the viral genes had that made them permanently activated. Out of this, Varmus and Bishop developed a theory: normal src was a precursor to the cancer-causing viral src. It was a normal part of the cell, endogenous to the cell, that needed a mutation to turn it into a cancer-causer, an oncogene. Here is how Mukerjee sums up this vital discovery and insight:

The crucial implication of the Varmus and Bishop experiments was that a precursor of a cancer-causing gene—the “proto-oncogene,” as Bishop and Varmus called it—was a normal cellular gene. Mutations induced by chemicals or X-rays caused cancer not by “inserting” foreign genes into cells, but by activating such endogenous proto-oncogenes (362).

Mukerjee goes on to put this in historical perspective: “The Greeks had been prescient with their name for cancer, onkos (meaning load or burden). Cancer was intrinsically ‘loaded’ in our genome, awaiting activation” (362)—often by an environmental insult like cigarette smoke or radiation. He also cites a wonderful image from Harold Varmus’ speech when he and Bishop received the Nobel Prize in 1989, revealing the cancer cell to be “like Grendel (the monster in Beowulf), a distorted version of our normal selves” (363). 
            With many modifications and extensions (further research found that there were two “flavors” of cancer genes: positive ones like src that drive cell growth into hyperactivity [Bishop compared these to a “jammed accelerator”]; and negative genes, like Rb, that normally suppress cell division, but, with mutations, lose their suppressing function so that cell division goes on unhindered [as in “brakes” that don’t work]), this has become the dominant theory in cancer research. It has also, finally, led to targeted therapies that have allowed drugs to be specifically targeted to a specific kind of cancer-causing gene. Among these new targeted drugs was one called Herceptin, which targeted a breast-cancer oncogene labeled Her-2. In 1991, a patient named Bradfield was given Herceptin in combination with an older chemical, cisplatin, designed to kill breast cancer cells. Two months into her therapy, Bradfield’s neck tumor disappeared, and after 18 months of therapy, she was in full remission and survives today. Another is known as Gleevec, a drug developed by Ciba-Geigy (now Novartis) for Chronic Myeloid Leukemia or CML. Though it at first refused to spend money for drug trials for Gleevec (not enough patients would use it for Novartis to make money), Novartis finally relented and agreed to a few trials. As of 2009, CML patients treated with Gleevec were surviving an average of thirty years after diagnosis, proving that targeted cancer therapy really does work.
            But lest we forget, Mukerjee reminds us that cancer is the wiliest of all diseases. Soon, doctors were noticing that some cancers were demonstrating Gleevec resistance (similar to bacteria that become resistant to antibiotics). It is worth trying to describe this Gleevec resistance to demonstrate the phenomenal intelligence Mukerjee is at pains to make us see. I have already described cancers that migrate into the brain to escape drugs; but there is another, a cancer cell mutation that, almost fiendishly, activates the cellular pumps that normally rid the cell of natural poisons—to get rid of the chemotherapy drugs! Gleevec-resistant cells did something more astonishing: they acquired mutations that precisely altered the structure of the leukemia-causing oncogene Bcr-abl, “creating a protein still able to drive the growth of leukemia but no longer capable of binding to the drug” (442). That is, where normally Gleevec slips precisely into a “narrow, wedgelike cleft in the center of Bcr-abl” to literally pierce its heart and kill it, the mutations altered this molecular “heart” so that the drug could no longer penetrate it (it no longer fit), thus making the mutated cancer immune. As Mukerjee puts it, “To escape targeted therapy, cancer had changed the target” (442).
            I don’t know about you, but this kind of (apparently) non-cognitive intelligence, even in a form that most of us would not hesitate to call “evil,” leaves me gasping for words. It does the same to Mukerjee, though he is quite adept at providing brilliant phrases and sentences in this captivating book. But let me give you some of the thoughts that it has evoked in me, and then end with Mukerjee again. It occurred to me today that if cancer is a perversion of our normal selves, our normal processes, as Mukerjee says, then we might say that it is a perversion because it is uniquely and brilliantly concerned only with its own survival. I have always had a problem with those who insist that the only thing that matters in life is survival. Because if survival is the end game, then cancer does it even better than we do. Cancer, as we see countless times in Mukerjee’s story, is the ultimate survivor. He even says, at one point, “Some day, if a cancer succeeds (in finding immortality), it will produce a far more perfect being than its host—imbued with both immortality and the drive to proliferate” (459). Cancer, that is, is better than we humans are at survival. The question becomes, is that all we are? Are we simply here to survive? Designed to outlast everything and everyone else? If that is the case, then we are on the “right” path, moving ourselves and the planet towards destruction as we do so. In this way, we are indeed just like cancer. Our monomaniacal drive for survival moves inevitably towards the destruction of our host, the only home we know. Which is why it is here that I part company with the survivalists. Though it is difficult to say how, and to what degree, humans, human being, is/are more than simply the number of years we survive or the sum of those who survive. Human being involves others, involves all other being. It matters to humans if others survive. It must matter, as we know from the cases where such mattering is thrust aside—and we see the horrors that have marked our century, and the horrors that may yet be coming if we do nothing but look out for our own survival, either as individuals, as a country, as a continent, as a hemisphere. We can easily predict the outcome of that kind of survivalism; we are already getting a taste of it today. No. Human being, again, is more than mere survival, and that is how we differ from cancer.
            So though Mukerjee ends with a reiteration of his overall theme (“Cancer is a flaw in our growth, but this flaw is deeply entrenched in ourselves. We can rid ourselves of cancer, then, only as much as we can rid ourselves of the processes in our physiology that depend on growth—aging, regeneration, healing, reproduction”), when he says this he is speaking strictly as a scientist, as someone looking at cancer, at humans, as strictly physical processes. Though I have nothing but admiration for his ability to do this, and for his ability to make us see how elegant and intertwined this dread disease is with our own fate, I part company with him here. For here, after all, is where we as humans have the capacity to look deeply into this flaw in our being, contemplate it, even come to terms with it, perhaps accept it (at least in the abstract)—and in so doing, comprehend it. We, that is, comprehend it; it does not comprehend us, other than as obstacles to its survival. And that makes all the difference.

Lawrence DiStasi