Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection

by John Green

a disease of poverty, an illness that walks the trails of injustice and inequity that we blazed for it.

“Nothing is so privileged as thinking history belongs to the past.”

I am encouraged.” He loved that word. Who wouldn’t? Encouraged, like courage is something we rouse ourselves and others into.

Imagining someone as more than human does much the same work as imagining them as less than human: Either way, the ill are treated as fundamentally other because the social order is frightened by what their frailty reveals about everyone else’s.

Framing illness as even involving morality seems to me a mistake, because of course cancer does not give a shit whether you are a good person. Biology has no moral compass. It does not punish the evil and reward the good. It doesn’t even know about evil and good.

Stigma is a way of saying, “You deserved to have this happen,” but implied within the stigma is also, “And I don’t deserve it, so I don’t need to worry about it happening to me.” This can become a kind of double burden for the sick: In addition to living with the physical and psychological challenges of illness, there is the additional challenge of having one’s humanity discounted.

Stigma is very complex, of course, but researchers have identified certain hallmarks of highly stigmatized illnesses. Chronic illnesses are more likely to be stigmatized than acute ones, for instance, as are illnesses with high levels of perceived peril. And critically for understanding tuberculosis, stigma can be compounded if a disease is understood to be infectious. Finally, the origin—or perceived origin—of a disease also matters. If an illness is seen to be a result of choice, it is more likely to be stigmatized.

That mix of trepidation and hope, so deeply felt by all who walk through the valley of serious illness, often

The word “invalid,” of course, gets at the core of what it meant to live with chronic illness—you were a person outside of society, invalid in the social order, separated from your family and your community.

Why must we treat what are obviously systemic problems as failures of individual morality?

This is often not an environment patients are excited to return to—and yet somehow we always seem to blame the patient for noncompliance, rather than blaming the structures of the social order that make compliance more difficult.

“Yes, I know, it’s just one patient. There are so many patients, and Henry is just one. Why should we move mountains to save one patient? Because he is one person. A person, you understand? And anyway, what if he can be the first of many?”

This difference, as Dr. Joia Mukherjee writes, is “not caused by genetics, biology, or culture. Health inequities are caused by poverty, racism, lack of medical care, and other social forces.”

Mere despair never tells the whole human story, as much as despair would like to insist otherwise.