Copyright Sociological Research Online, 2001

Simon Williams (2001) 'From Smart Bombs to Smart Bugs: Thinking the Unthinkable in Medical Sociology and Beyond'
Sociological Research Online, vol. 6, no. 3, <http://www.socresonline.org.uk/6/3/williams.html>

Abstract

Steve Fuller's article on the events of September 11th raises a number of important questions about the role of sociology in public discussion and debate. This brief response, in taking up this challenge, focuses on the issue of bio-terrorism. In doing so, a balance sheet is provided of the potential threat this poses, drawing both on the history of biological and chemical weapons to date, and the potential epidemics of fear they unleash in the aftermath of September 11th. Medical sociology, it is argued, alongside the sociology of emotions, is particularly well placed to address such issues, including questions of the biological and broader themes of war and health, medicine and the military.

Keywords:

Bio-terrorism, Epidemics (of fear), War, Health, Medicine, Emotions

1.1

Steve Fuller's (2001) piece provides a welcome commentary on the events of September 11th. If ever there was an event which demanded a rapid response from the sociological community, which this online journal provides, then this is surely it: provided, that is, a rapid response remains a considered one, and that longer term perspectives and analyses are also conducted. Much has been printed on these atrocities, and the merits of subsequent military action by America and its allies. Social scientists in contrast, Fuller notes, have yet to make a significant mark on public debate. This perhaps is understandable, particularly if longer term perspectives are favoured and the habitus of homo-academicus is taken into account. Fuller nonetheless raises a number of important points and issues here, not least the drawing of Cold war analogies, the raising of themes to do with modernity, technology and globalization, and the vexed question of relations between the West and Islam. One issue he does not mention, however, understandably perhaps given the timing of his article, concerns the prospect of a new era of bio-terrorism; itself something of an historical watershed. As a medical sociologist (or sociologist of health and illness as we are now commonly known), with a particular in biological matters and the matter of the biological, it is this issue I wish to pick up on and address in this rapid response mode.

1.2

It is easy of course, given the current hype and hysteria, to overstate the threat of bio-terrorism, but this it seems is one of the key issues to have emerged in the aftermath of September 11th. The hype and hysteria, in fact, has in large part been the main problem to date. Perhaps the first thing to do then, in response to this, is to tease out what exactly is and is not new about the current situation. Chemical and biological weapons (CBW), we should remember, have been with us for a long time. Think, for example, of the gassing of World War I soldiers in the trenches and the fears which surrounded such prospects (Sturdy 1998). Bryan Appleyard, in a recent Sunday Times magazine article, takes us even further back to fourteenth Century events such as the siege of Kaffa, in which the Tartars catapulted the corpses of plague victims into the city, thereby engendering an epidemic which broke the siege (Appleyard 2001: 71): a primitive form of bio-warfare, to be sure, but an important one nonetheless.

1.3

Then we have the whole Cold War era, or perhaps more correctly the post Cold War era, where the scale of the Soviet biological weapons programme -- in breach of the early 1970s Biological Weapons Convention (BWC) -- became fully apparent: a huge arsenal of mass destruction, it transpired, capable of killing the world's population many times over with a variety of lethal biological agents (or foot soldiers), from anthrax, plague and smallpox to ebola, marburg and botulinum toxin. This, for example, is one of many chilling issues discussed in Judith Miller and colleagues (2001) prophetic book, Germs -- subtitled Biological Weapons and America's Secret War. One cannot, however, simply point the finger at the Soviets. Many countries in fact, have biological weapons capability. The current preoccupation, nonetheless, is very much focused on 'rogue' states, such as Iraq, where Saddam Hussein is now more or less free to pick up where he left off in his biological weapons programme (following the United Nations Special Commission on Iraq) (Appleyard 2001). Much speculation, in this context, surrounds possible links with Osama bin Laden and his al Qaida network. Either way, it is reported, action against Iraq is high on the American agenda once the military campaign in Afghanistan is over.

1.4

In the past, the biological weapons threat was dismissed or played down. Much of this, it seems, had to do with the non-viability of their usage in military campaigns. Not only has weaponization proved difficult and efficacy proved doubtful, but the nuclear threat rendered chemical and biological warfare all but redundant. Saddam Hussein, it is alleged, despite his biological weapons capability and his chemical assaults on Kurds, fought shy of any such dirty tricks in the Gulf war for fear of nuclear retaliation by his enemies (Wessley 2001). Even in cases of terrorist acts such as the release of sarin nerve gas on the Tokyo subway, or the deliberate attempt at salmonella poising in Oregon in 1984, the impact was fairly minimal. The current dissemination of anthrax spores through the US mail system (its perpetrator(s), at the time of writing, still unidentified), has likewise claimed few casualties to date: if by casualties we mean actual cases of infection and/or death. A smart terrorist moreover, so the reasoning went, would not resort to chemical or biological agents anyway, given the high probability (via publicly available information/internet sources) of killing themselves in the process (Wessley 2001).

1.5

It is at this very point, however, that we confront a series of new issues. The suicide bombing of the Twin Towers, in which commercial aeroplanes effectively became guided terrorist missiles, has both literally and metaphorically changed the landscape of possibilities at terrorists disposal. The buzz term now is 'asymmetric warfare' in the post-cold war era (Appleyard 2001), whereby a lack of ability to face the military might of the United States on the battlefield, is countered through recourse to weapons not simply of bio-terrorism and cyber-terrorism -- the digital equivalent of a nasty if not deadly virus. The very threat of retaliation moreover, Appleyard (2001: 72) speculates, could itself potentially be forestalled through further threats of bio-bombs or similar fiendish devices, ready and waiting elsewhere : a biological bug or computer virus, that is to say, with the potential to bring a superpower to its knees, thereby reversing the power balance.

1.6

We are also dealing, as the Twin Towers event testifies, with terrorists willing and prepared to die for the cause (a particular rendering of Jihad which itself is out of step with the majority of the Islamic world^[1]. This, in turn, brings us to another troubling possibility, raised by writers such as Miller and colleagues (2001), of suicide bioterrorists: terrorists, that is to say, who deliberately contract lethal contagious conditions such as smallpox and then take a ride on, say, a New York subway, using their own bodies as lethal vectors of infection. Consider moreover, in the era of the new genetics, the prospect of newly spliced multi-resistant superbugs, designed with superpowers or particular groups of people in mind: smart bugs indeed^[2]. In reality, of course, some such variant has already been developed, by the Soviets amongst others. The future prospects, nonetheless, defy belief: it is time, we are told, to think the unthinkable, however unthinkable the unthinkable may be.

1.7

The United States, in doing just that, has dramatically increased its spending on Chemical and Biological Weapons defences over the past few years -- a budget which looks set to rise exponentially in the wake of September 11th. Ironically, Simon Wessely (2001) reports, this included a strengthening of the Crisis Centre in New York against possible biological warfare: one located, tragically, under the World Trade Centre itself. In many ways, however, the reality of biological terror has already arrived, whether or not its perpetrators are al Qaida or any other such group, network or state, including white supremacist groups. On the one hand, a series of confirmed anthrax cases are now reported in the United States, including four deaths to date. To this we may add many other hoaxes or scares, within and beyond the United States, including the high- profile case of Judith Miller -- a writer on issues of chemical and biological warfare for many years, and co-author of the above mentioned book -- whose opening of a letter containing a 'mysterious white powder', which covered her face, led to the evacuation of parts of the New York Times building (Wessley 2001). This time, fortunately, it was not anthrax.

1.8

On the other hand, however, leaving these actual cases and incidents aside, the reality of bio-terror is already here because fear abounds. Media coverage, in this respect, fuels our fears, beaming scary pictures into our homes on a daily basis of people in CBW protective suits, responding to this or that threat, whilst other reports trade in apocalyptic scenarios about what, potentially, is waiting for us around the corner. When the President of the United States, wisely or not, informs the people that he has not got anthrax, then the inference drawn is that there really is something to worry about. There are even now murmurings that the recent foot and mouth outbreak in the UK could have been deliberate. Meanwhile, antibiotics and vaccines are being stockpiled, whilst gas masks and protective suits are being snapped up by an alarmed public as demand outstrips supply. Invisible agents, with varying delays in taking effect, render even the most benign situations potentially terrifying: the most terrifying of all perhaps^[3].

1.9

Forget germs and gas, Simon Wessely (2001) appositely proclaims, the most deadly infection is terror: 'weapons of mass hysteria'. The potential deployment of CBW detectors on the US subway, he ventures, would likewise cause more problems than its worth given the number of false alarms they are likely to trigger: panic stations indeed. To this we may add the tightening of security around nuclear power and reprocessing plants, including no fly zones, and even the installation of ground to air missile systems in countries such as France, who derive a higher percentage of their energy from this source. Security measures, in short, are being hastily passed and put in place, including the introduction by the British Government of tough new penalties for hoaxers. Meanwhile, institutions issue instructions to employees about the need for vigilance in handling (suspicious) mail. As I write, the focus has switched more fully to military `breakthroughs' in Afghanistan, but how long, we may ask, before the next domestic scare rears its ugly head: a many headed hydra indeed.

1.10

As for sociology's role in all this, I shall confine my comments primarily to the implications for medical sociology, moving out from there to broader issues for sociology as a whole. Medical sociologists, to my knowledge, have not dealt to any significant degree with the implications of war for health, nor the relationship between medicine and the military, let alone the possibilities of (bio)terrorism^[4]. Margaret Stacey, for example, makes precisely this point in her concluding comments on the Gender, Health and Healing conference held at the University of Warwick in her honour. `Why', she asks, 'has medical sociology not taken the health consequences of war on board?' There is, moreover, something 'uncannily similar between aspects of modern medicine and modern war: both involve high-precision instruments, applications of the latest techno-science and the separation of one problem from all others' (Stacey 2002: 279). 'Clinical war', precision bombing which is not quite precise enough, the killing of innocent civilians, the health consequences of sanctions, the refugee crisis, sick soldiers, and the ill-effects of depleted uranium, these and many other factors weigh heavily in the balance of war and its aftermath. Let me, however, in this brief response, return to the more specific issue of bio-terrorism, without in any way wishing to down-play or side-line these other important (global) issues of medicine, health and war.

1.11

What issues of public health and surveillance, we may ask, emerge in the wake of September 11th and the subsequent threat of bio- terrorism? How, moreover, might epidemics of fear if not disease be sociologically explained and understood? The World Health Organization (WHO), for instance, has recently called on countries to review their policies in the light of potential bioterrorist attacks, including the prospect of mass smallpox vaccination programmes. Smallpox it seems (or its threat at least) -- the elimination of which was one of the WHOs greatest triumphs -- is now back on the global agenda: a spectre of the past which haunts the present. As far as the UK are concerned, the response so far has been measured. Liam Donaldson (the Chief Medical Officer), for example, in a calming public speech, reminded us there have been no significant threats to date, and that our public health system is a strong, well developed one, thereby attempting to dampen down fears on this side of the Atlantic. Despite this, reports have started to emerge of an upsurge in patients presenting with free floating anxiety states in primary health care settings. What next ? ^[5]

1.12

Instructive points of sociological comparisons and contrast may be drawn here between these events and issues surrounding the advent of HIV/AIDS. Strong's (1990) sociological musings on 'epidemic psychology', for example, are a case in point, shedding important light on the waves of fear, panic, stigma and moralizing calls to action which seem to characterize the immediate response to threats, actual or potential, of the epidemic kind ^[6]. Threats, that is to say, to the social order or moral fabric of society. Versions of epidemic psychology, as this suggests, may also be found in other distinct yet parallel types of social crisis, including war and revolution, as well as plague. Epidemic psychology, in this respect, calls attention to the fact that, like disease itself, it too can spread rapidly, wreaking havoc both individually and collectively. What we have here in fact, Strong argues, is at least three distinct types of psycho-social epidemic. First an epidemic of fear, second an epidemic of explanation and moralising action, and third an epidemic of action or proposed action (Strong 1990: 251).

1.13

Epidemics of fear, interpretation and action, Strong notes, appear most severe when the disease is new or strikes in a new way. This history of plague, for example, whilst always dreadful, highlights the gradual development of routine, rapid ways of responding to it. Plague, in other words, became 'normalised and institutionalised (just as AIDS has begun to become now)' (Strong 1990: 252). In contrast, new forms of fatal epidemic disease, or their threatened outbreak, can potentially be much more terrifying. 'When routine social responses are unavailable', Strong states, 'then a swarm of different theories and strategies may compete for attention' (Strong 1990: 253).

1.14

These characteristics of epidemic psychology are far from exhaustive. Epidemics of fear, Strong reminds us, are also epidemics of suspicion. To this we may add the fear that the disease may be transmitted in many different ways. This very fear and suspicion, moreover, may itself be wholly divorced from the reality of disease (Strong 19901990: 253). This, in turn, feeds into a potential tide of 'epidemic stigmatization', not simply of those with the disease (whatever it might be), but of those who belong to what are feared to be the 'carrier groups'. Such fears, in fact, may themselves translate more or less readily into collective 'witch-hunts' with a series of dire consequences. As for the epidemics of explanation, moralization and action, the babble of intellectual and moral debate (including the rise of 'moral entrepreneurs') may in turn be matched by a huge rush of control measures to contain the disease or threat. Many of these will 'cut across and threaten our conventional codes and practice. Trade and travel may be seriously disrupted, personal privacy and liberty may be seriously invaded, health education may be enforced on matters that are normally never talked about' (Strong 1990: 254). The human origin of epidemic psychology, from this viewpoint, lies not so much in our 'recalcitrant emotions' -- themselves quite wrongly construed as the enemy of reason -- as in the:

potential fragility of human social structure and interaction, and in the huge diversity and elaboration of human thought, morality and technology; based as all of these are upon words rather than genes. Epidemic psychology can, thus, only be conquered when new routines and assumptions which deal directly with the epidemic are firmly in place, a process which requires collective as well as individual action (Strong 1990: 258).

1.15

I will leave readers to judge for themselves the applicability, or otherwise, of this framework to the current threat or prospect of bioterriorism: the subject, I hope, of further discussion and debate in this journal and elsewhere ^[7].

1.16

There is also considerable scope here, as the foregoing discussion indicates, for sociologists of emotion as well as health. The death princess Princess Diana, to be sure, raised a complex series of questions about emotions in late twentieth century society. The events of September 11th go far beyond this, however, raising themes (both old and new alike) as to the nature and dynamics of emotions in the new millenium -- emotions, both bloody and harmonious, beneficent and virulent, which unite and divide us ^[8].

1.17

In many ways, despite claims to the contrary by Bush and other coalition leaders, the recent (military) campaign -- which has included B52 carpet bombing of Taliban strongholds in Afghanistan -- has fuelled divisions of the West versus Islam kind in the eyes of many (as well, of course, as divisions within the West and Islamic world): divisions in which passions run high. This appears to suit bin Laden well, given his own rendering of these events. Salman Rushdie too, albeit in a different vein, speaks forcefully to these divisions, identifying 'paranoid Islam' as one of the prime factors in the war being waged against Afghanistan and bin Laden. 'This paranoid Islam', he states, which blames "infidels", for the ills of Muslim societies and whose proposed remedy is the closing of those societies to the project of modernity, is presently the fastest growing version of Islam in the World'. The present war, from this controversial viewpoint, is not however quite as simple as the West versus Islam because Islamisists -- Rushdie's preferred term for those who are engaged upon political projects, as distinct from the more general, and politically neutral, 'Muslim' -- are opposed not only to the West and 'the Jews', but to their fellow Islamisists (consider, for example, the antipathy between the Taliban and Iran). 'If terrorism is to be defeated', Rushdie boldly proclaims, 'the world of Islam must take on board the secularist-humanist principles on which the modern world is based, and without which their countries freedom will remain a distant dream' (Rushdie 2001: 12). Again the emotional dimensions of such viewpoints hardly need spelling out: positions, it seems, as likely to stoke the 'sacred' fires of collective effervescence as cool them.

1.18

The other key issue I wish to flag up, building on the above points and issues, concerns the need for a return to questions of biology. Sociologists, to be sure, have viewed the biological with distrust or suspicion in the past, favouring instead a commitment to the social. The current era may well redouble any such feelings, particularly when biology (potentially at least) spells terror: `black biology' is another buzz term which is currently doing the rounds. A return to the biological in sociology, clearly extends far beyond any such concerns with bioterrorism -- see Benton (1991), for example, for the wider (non-reductionist) agendas this raises. Issues of bioterrorism, nevertheless, provide a timely reminder that the biological is no mere social construction, and that it may be pressed into the service of a variety of ends, some more dubious or horrifying than others: a life sustaining and life destructive force. The biopolitical and ecological agendas of the twenty-first century must now therefore contemplate a new bio-hazard, which has less to do with human cloning, xenotransplants or GM food stuffs, than intentional disease, calculated contagion, and/or meticulously planned acts of nuclear disaster/sabbotage -- the fall out of which is horrifying for us all, whichever way the wind blows. Social conservatives and left activists, according to Rifkin (2001), are beginning to find common ground on a range of bio-tech related concerns, in opposition to a utilitarian view of life. Presumably, issues of bio-terrorism will facilitate a further convergence. This time, however, in opposition to a very different view of life.

1.19

In conclusion then, chemical and biological weapons of mass destruction are not new. What is new, however, is the potential epidemic of fear they unleash, in the short term at least, irrespective of actual events, which appear quite minimal at present. Teachers of sociology Fuller asserts, picking up on a charge made by bin Laden about the ignorance of Western citizens to the plight of the Islamic world and its causes, have a duty to address this lacuna, if nothing else. On this I would agree. We also, however, need to engage with issues of bio-terrorism, both actual and potential, including sociological debates on the risks of epidemic psychology. To this, of course, we should add the broader consequences of war and terrorism for health, and relations between modernity, the military and medicine. Medical sociology, in these and other respects, has much to contribute, drawing on expertise, tools and frameworks, both old and new alike, which help us explore such issues in these troubling and uncertain times, as we think the unthinkable.

Notes

¹The Islamic Society of Britain, for example, has recently issued a pamphlet `Islam and Terrorism: Exploding the Myths'.

²There is, of course, an important element of anthropomorphism within all this, including the very notion and imagery surrouding computer viruses.

³I am reminded here of Goffman's (1971) classic essay in paranoid logic, tellingly entitled 'normal appearances': appearances, he claims, which are potentially the most troubling of all.

⁴Medical historians, in contrast, have been more alert to these issues. See, for example, Cooter et al. (1999, 1998). `Medicine did not simply minister to modernity', Cooter and Sturdy state, 'it was one of the key means of bringing modernity into being. And medicine's involvement in war, in particular, provided the crucial moment for the emergence of many of the material and social technologies that we now see as quintessentially modern' (1998: 17). See also Harrison (1996) on the 'medicalization of war' and the 'militarization of medicine'.

⁵Readers may object, at this point, that I too am part and parcel of this manufactured fear through the very writing of an article like this. My aim, however, is to provide a balanced perspective on these issues, and in doing so to map out some of the sociological agendas they raise, in medical sociology and beyond.

⁶For other interesting work on these and related themes, see for example, Kroker and Kroker (1988), Sontag (1991), Lupton et al (1995), Crawford (1994) and Waldby (1996).

⁷Douglas' work on Purity and Danger (Douglas 1966) and Natural Symbols (Douglas 1970) is also, of course, pertinent here: alerting us to the fact that whenever the boundaries of a social collectivity or people are threatened, these anxieties are mirrored in the degress of control exercised over the physical body. See also Douglas' (1986) more recent work on risk, including a cultural theory of contagion in relation to AIDS (Douglas and Calvez 1990).

⁸See, for example, Scheff (1994) and Scheff and Retzinger (1991), as well as Mestrovic (1993, 1994, 1996, 1997).

Acknowledgements

Thanks to Steve Fuller and the editors of this journal for inviting/prompting this rapid response.

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Copyright Sociological Research Online, 2001