adapted from The Great Shadow: The History of How Disease Shapes What We Do, Think, Believe, and Buy, By Susan Wise Bauer. Copyright © 2026 by the author and reprinted with permission of St. Martin’s Press.
Chapter 1: Prism
Our body is the intersection where our most private personality meets the outside world, the matrix where our thoughts, emotions, and beliefs are formed. When our bodies are functioning well—when we are healthy, strong, energetic, pain-free—we don’t notice how our physical existence affects those thoughts, feelings, and beliefs.
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But even a grain of sand comes into play and suddenly everything changes.
This is what the oldest stories we have tell us. Gilgamesh and his companion Enkidu travel through the Mesopotamian landscape, raising hell wherever they go, until Enkidu develops a fever. Suddenly, the hardened warrior Gilgamesh is wandering around his friend’s bed in a state of panic, his path to a victorious life halted. Job enjoys his fields, sheep and family. Then the massacre of his cattle and children and his own body begins, and he sits in the ashes, scraping his boils with a vessel. Her entire world has been destroyed, the disorder in her body the last and greatest expression of the family devastation.
Illness is not “just” illness. Illness is the most intimate expression of our strained relationship with reality, the place where smooth functioning suddenly breaks down and falls apart without warning. Illness is the great mirror that reflects our most pressing questions: Why does disaster strike without warning? How can we explain this? How do we avoid this? How do we fight back?
Our evolving understanding of what and how makes us sick is a lens through which our perception of the outside world has always been filtered. As we investigated the causes and cures of disease within ourselves, we began to change our view of the outside universe. When no explanation of illness was available, we prayed to the gods and worshiped them. When it was thought that disease was related to the balance of the humors, we became obsessed with balance and symmetry. When we discovered germs, we created an antiseptic culture; Since the person-to-person infection theory was two magazines, we developed a Tupperware-enclosed, plastic-wrapped, disposable world, and installed separate drinking fountains and toilets for those who had “different” types of germs. When we thought we had conquered the infection, finally conquered the diseases that had plagued humanity since the beginning of memory, we happily turned our attention outwards, looked out into space and aimed for the stars.
And now that we realize the virus may be overpowering, we impose limits, fearing outsiders as carriers of the “disease”; We distrust the recommendations of medical science (after all we feel it has failed us), so that vaccine-refusal becomes fashionable, homeopathic remedies and magnetic therapies are embraced, energy healing flourishes.
And, in our fear, we predict the end of the world.
These are the stages of understanding. But the old and worn-out understanding of the disease does not just disappear. They last. This discrepancy often shows up in harmless and fleeting ways (such as when a twenty-first-century parent, fully aware that a virus causes the common cold, yells, “Don’t go out with wet hair or you’ll catch a cold!”). But it also causes sharp rifts: a Canadian teenager who trusts God will heal her is forced by the court to receive a blood transfusion; Anti-vaxxers turn their backs on germ theory and rely on proper life balance (yogurt, herbs, cold water baths) to keep their children safe.
Our contradictory, overlapping ideas about disease create layers of tension, edges of conflict, fatal inconsistencies.
Our thoughts about the illness, not the injury. It is important to distinguish between the two (as many histories of medicine do not).
Man has understood injury since ancient times. Illness can come from anywhere, but the source of physical injury is always obvious—whether you’re mauled by a mastodon, crushed by a falling block of Egyptian limestone, skewered by a bolt from a medieval crossbow, or felled by the bullet of a nineteenth-century Colt revolver. Dealing with injury can be complicated and the consequences can be surprising, but the reason was clear. Whether by rock, sword, cannon, or bomb, the body was shattered to pieces. There was no mystery as to how or why. This type of injury is mentioned in the most ancient medical texts. Scholars of medical history have marveled at the Papyrus, an Egyptian text whose recommendations reveal a chronologically astute understanding of physical trauma. With a surprisingly keen sense of the scientific method, the attending physicians were advised to carefully examine wounds on the forehead, or fractures of the bones of the arm, or wounds on the neck or cheek; Gods and demons are notably absent, with common-sense prescriptions for pain relief and wound care dominating.
But dig a little deeper into this early “scientific” monograph, and we will surely find less rational secondary recommendations. If an injury did not heal as expected after proper care, physicians were encouraged to “cast out the enemy within the wound” by invoking Isis, and begging her to drive away “the hostile power within the blood, the robber of Horus,” the enemy of man who always bent his malevolent power toward the living soul.
The unexpected change of a wound, like a disease, was a mystery. Both arrived without any information and without any direct agency. The Theban physician knew what caused facial injuries: falling masonry was an ancient hazard. But why did one patient recover while the other decayed? And what about the shivering, miserable victim who woke up with a sore throat and cough after going to bed the night before healthy and full of plans?
It is the continued presence of illness, not injury, that has shaped the way we think about ourselves and our world.
