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autoimmunity—in other words, for immune activity directed against the physical self.[25] Life in our current culture, I believe, makes many of us experimental mice subject to “chronic variable stress” beyond our control.[] A necessary caveat: in foregrounding the role of biographical factors in disease, we must be mindful to avoid blame or guilt. “Some people see lupus as an external attacker,” a British woman with lupus has written. “But I prefer to think I did it to myself . . . Too much striving, too much living on the edge, too much stress. Yet despite the consequences, I wouldn’t change how I lived my life. It is who I am, so this disease is who I am too.”[26] There is wisdom in that view, but I also hear an unwarranted selfaccusation and an all-too-characteristic lack of self-compassion. No person is their disease, and no one did it to themselves—not in any conscious, deliberate, or culpable sense. Disease is an outcome of generations of suffering, of social conditions, of cultural conditioning, of childhood trauma, of physiology bearing the brunt of people’s stresses and emotional histories, all interacting with the physical and psychological environment. It is often a manifestation of ingrained personality traits, yes—but that personality is not who we are any more than are the illnesses to which it may predispose us. Yet if our British writer errs in identifying entirely with her disease, she is still skillfully directing us to a profound and fruitful set of questions. Could it be that illness as “external attacker” does not even exist when it comes to such chronic, auto-mutinous conditions as we have looked at in this chapter? [] What if disease is not, in fact, a fixed entity but a dynamic process expressive of real lives in concrete situations? What new (or old) pathways to healing, unthinkable within the prevailing medical view, might follow from such a paradigmatic shift in perspective?