Black Bile

Thanks to my friend, Carol, I've been introduced to a fabulous book, The Emperor of All Maladies: A Biography of Cancer, by Siddhartha Mukherjee.  Now, you'd think this would be kind of a dry, bummer type of read, but ... seriously... I've put aside my Easy Rawlins detective book (which is super fun and diverting), and just can't stop reading this cancer book.  (It did win the Puliztzer, so it's not just me being morbid.)

I'm less than 100 pages in, but there are some passages that have just stopped me cold.  Let me share:

"...Cancer, we now know, is a disease caused by the uncontrolled growth of a single cell. This growth is unleashed by mutations--changes in DNA that specifically affect genes that incite unlimited cell growth. In a normal cell, powerful genetic circuits regulate cell division and cell death. In a cancer cell, these circuits have been broken, unleashing a cell that cannot stop growing.

That this seemingly simple mechanism--cell growth without barriers-- can lie at the heart of this grotesque and multifaceted illness is a testament to the unfathomable power of cell growth. Cell division allows us as organisms to grow, to adapt, to recover, to repair--to live. And distorted and unleashed, it allows cancer cells to grow, to flourish, to adapt, to recover, and to repair--to live at the cost of our living. Cancer cells can grow faster, adapt better. They are more perfect versions of ourselves."

 And...

"Cancer...is riddled with...contemporary images. The cancer cell is a desperate individualist, "in every possible sense, a nonconformist," as the surgeon-writer Sherwin Nuland wrote. The word metastisis used to describe the migration of caner from one site to another is a curious mix of meta and statis--"beyond stillness" in Latin--an unmoored, partially unstable state that captures the peculiar instability of modernity. If consumption once killed its victims by pathological evisceration (the tuberculosis bacillus gradually hollows out the lung), then cancer asphyxiates us by filling bodies with too many cells; it is consumption in its alternate meaning--the pathology of excess. Cancer is an expansionist disease; it invades through tissues, sets up colonies in hostile landscapes, seeking "sanctuary" in one organ, and then immigrating to another. It lives desperately, inventively, fiercely, territorially, cannily, and defensively--at times, as if teaching us how to survive. To confront cancer is to encounter a parallel species, one perhaps more adapted to survival than even we are.

This image--of cancer as our desperate, malevolent, contemporary, doppelganger--is so haunting because it is at least partly true. A cancer cell is an astonishing perversion of the normal cell. Cancer is a phenomenally successful invader and colonizer in part because it exploits the very features that make us successful as a species or an organism."

It's like the Mad Max we all secretly want to be. The Rambo. The Incredible Hulk. It's like we've invited this thing into our society because, in so many ways, we desperately want to be like it.

Look at our lives: obsessed with growth, with 24/7, with bigger and better, with more is more, with input coming at us in more ways every day.  Where does it all go?  How can we keep up?  Like our friends the cancer cells, we multitask as much as possible.  And we, like the cancer cells, are eating up our host planet faster than it can replenish itself.

He goes on to the beginning of the history of cancer.  He talks about how the curious thing about the early history of cancer (which goes back many millenia BC) is that it's so uncommon. There were so many things that used to kill us (tuberculosis, influenza, etc) that cancer never had a chance to be all that prevalent.  But we've gotten so civilized, we've killed all the other enemies, it's like we're finally faced with our Balrog in the depths, the deepest, darkest, most sophisticated version of ourselves... the shadow that we both want to seduce and destroy.

Hippocrates imagined the world of disease in the metaphor of humors: red, yellow, white, and black bile, rivers of fluid that coursed through our bodies. A Greek doctor named Claudius Galen, took this notion a further and theorized that while the red humors were assigned the diseases of the blood, the yellow humors of the liver, the white humors of tuberculosis and pus, the black bile was saved only for two things: cancer and depression.  (Melancholia actually derives from the Greek Melas, or black, and khoule, or bile.)  Diseases of these humors, especially the black bile, arose from the accumulation and stagnation in one part of the body of the fluids.  For a long time, surgery was considered an absurd way to treat cancer, because it seemed ridiculous to cut out one part of the stagnation, when, in fact, the entire body was suffused with the black bile itself.

Over time, a form of these humors were actually found to have physical corollaries in the body, except for the black bile.  It simply didn't exist. And of course we moved on from the notion of humors themselves.

But what struck me about the humors, is that they so closely resemble the idea of qi, the meridians of energy that need to be balanced and harmonious in traditional Chinese medicine and acupuncture.  Cancer, in that tradition, is thought to be the ultimate qi stagnation, with various other types of stagnation leading up to it (such as phlegm and other benign masses and pre-masses.)

I'm no medical expert, obviously, but I do love a good metaphor.  And this idea of cancer being the over-achiever inside of us, the thing that wants to best us and beat us at our own game, at our own expense, just puts me in awe.  Here we are, a society that is increasingly without boundaries, increasingly on the move, seeking out brave new worlds to colonize and explore, and what we are doing is manifesting all of those very same characteristics inside ourselves.

We do not know how to stop.

We do not understand that unlimited growth literally is killing us.

And yet we stagnate at our peril.

Somehow, we need to find that balance.  The balance between a sharklike constant movement, ingestion, and predatory hunger... and keeping a flow that prevents stagnation and buildup.  I don't know what the difference is, precisely, but it feels to me that it has something to do with heart, and soul, and wisdom.  That there is a fine tuning that needs to take place in our lives that stops us when stopping is healthy and good for regeneration and takes care of the organism's need to replenish itself, and yet keeps moving enough to avoid couch potato stagnation, that accumulation of the black bile of depression and lassitude.

Consumption that does not eradicate the bounty of the host.

Movement that listens to its own inner rhythms.

A yin and yang balance.

Between growth and rest.

Between excess and flow.