The Myth of Normal 81

molecular levels, the generation of ill health is a multifaceted, multistep process. In 1962 the leading British cancer physician David Smithers published a paper of prophetic force. He explored cancer as process: not a disease of individual cells gone rogue but a manifestation of an imbalanced environment, “merely the terminal [event] in a much longer progressive chain of circumstances with no distinctive starting-point.” Doctors and researchers, he wrote, do not experience cancer’s “essential dynamic quality; they see its static effects, not the process in action.”[12] The activity of cells, Smithers pointed out, “is possible only in relation to their environment, and none of their actions can be explained by laws governing intracellularly initiated events alone.” That prescient assertion has been more than validated by the half century of research since. “I now have a much more complex view of causation,” Steve Cole told me. “If you get a disease, a whole series of things had to have gone wrong. Some of that may be related to your genes; some of that may be related to pathogen exposure. Some of it is related to hard lives—the way that can wreak wear and tear on the body and on what would otherwise be resilient tissues. It’s better to think of it as a multistep causation . . . One of the things many diseases have in common is inflammation, acting as kind of a fertilizer for the development of illness. We’ve discovered that when people feel threatened, insecure—especially over an extended period of time—our bodies are programmed to turn on inflammatory genes.” A Physician Heals Herself Threatened and insecure over an extended period of time is precisely how the obstetrician-gynecologist Lissa Rankin felt since childhood, an emotional state her medical training only exacerbated. Her book The Anatomy of a Calling begins with a nightmarish recounting of how she, as a medical resident, had to rush all night from one delivery room to another, dealing with one difficult delivery in the wake of another, supporting parents after the death of four babies, and all the while being berated by her superiors to suppress her own grief, even in the privacy of the women’s changing room.