Upstream - Decolonizing Medicine with Rupa Marya and Raj Patel

Episode Date: June 15, 2021

Many of us around the world live on colonized land. In recent years, the conversation around “decolonization” has been seamed through many different contexts, from the land back movement to the push to decolonize various institutions. But what would actual decolonization look like? And how do we go about decolonizing things like our minds and our systems? In this Conversation, we hear from Rupa Marya and Raj Patel about their book, "Inflamed: Deep Medicine and the Anatomy of Injustice," out on August 3rd. The book explores one area of our lives that has been subject to colonization: that of medicine. They authors provide both a practical and metaphorical exploration of the impacts of colonization through the idea of inflammation — inflamed bodies, an inflamed society, and an inflamed planet. Their insights help us to dismantle colonization in our institutions and in our minds while building new connections and ways of being through what the authors call “deep medicine.” Rupa Marya is a physician, activist, composer, Associate Professor of Medicine at UCSF and faculty director of the Do No Harm Coalition. Raj Patel is an activist, award-winning author, film-maker and academic. Raj is Research Professor in the Lyndon B Johnson School of Public Affairs at the University of Texas, Austin and a Senior Research Associate at the Unit for the Humanities at the university currently known as Rhodes University (UHURU), South Africa. Upstream theme music is composed by Robert Raymond Intermission music is “Stolen Land” by Rupa and the April Fishes  This episode of Upstream was made possible with support from listeners like you. Upstream is a labor of love — we couldn't keep this project going without the generosity of our listeners and fans. Please consider chipping in a one-time or recurring donation at www.upstreampodcast.org/support If your organization wants to sponsor one of our upcoming documentaries, we have a number of sponsorship packages available. Find out more at upstreampodcast.org/sponsorship For more from Upstream, visit www.upstreampodcast.org and follow us on Twitter, Instagram, Facebook, and Bluesky. You can also subscribe to us on Apple Podcasts, Spotify, or wherever you listen to your favorite podcasts.

Upstream is a labor of love. We couldn't keep this project going without the generosity of our listeners and fans. Please consider chipping in a one-time or reoccurring donation by visiting upstreampodcast.org forward slash support. Thank you. So what we're doing in this book is really advancing another level of diagnosis so that we're not just diagnosing what's happening in the body as being a phenomenon in the body we're understanding the body is having very normal reactions to a pathological toxic social structure around it so if we want health for everybody if we want to have a healthy society or a healthy possibilities of health for all people. We have to start restructuring the society to make that possible. You're listening to Upstream. Upstream. Upstream. Upstream. An interview and documentary series that invites you to unlearn everything you thought you knew

about economics. I'm Della Duncan. And I'm Robert Raymond. In this conversation, we hear from Rupa Maria and Raj Patel about their book, Inflamed, Deep Medicine and the Anatomy of Injustice, which will be out on August 3rd. In the first half of the conversation, we speak with Rupa, a physician, activist, composer, associate professor of medicine at UCSF, and faculty director of the Do No Harm Coalition. We explore the idea of individual, societal, and global inflammation, the concepts of colonized and decolonized medicine, and the way our bodies are reacting to the pathological, toxic material conditions

that we are living under in capitalism. All right, Rupa, welcome. Welcome to Upstream. So good to be with you today. I'm wondering if you can tell us the inspiration for this book that is coming out in August. So excited for folks to get to read it and be with this book, this amazing book, Inflamed, Deep Medicine and the Anatomy of Injustice. So I'm wondering if you can tell us the inspiration for the project in the book. Well, the book came out of several dialogues between myself and Raj. And just, you know, it was his invitation, let's write a book together, because it wasn't on the list of things I had to do in a pressing way. But as soon as we started outlining, it became very pressing to get these ideas out. And then it was such an amazing opportunity to

sit and synthesize concepts and inklings and dive more deeply into researching hunches and questions I've had over the last 20 years of working as a physician. I work at UCSF in the Division of Hospital Medicine. So working in the hospital, you really get to see you're on the front line of what I call the bleeding edge of our society, where you get to see who's hurting and how they're hurting and where the suffering is being lodged in the bodies of what people and how our histories are being lived through our cells and through our cellular memory. And so it's really the combination of my work, both as a physician and also as a musician. So I've been touring around the world

with the band for many, many years. And we've gone to, I think we counted 29 different countries. many, many years. And we've gone to, I think we counted 29 different countries. And we would often go to places where I could really see the interaction between society and health. So how social systems collapsing or being robust and healthy impacted people's health. And through those journeys and through those encounters with patients, I started to notice that there was what I was calling at that time, like a colonized syndrome. So sets of diseases that were seeing more prevalent in more severe expression in groups of people who had suffered the worst of colonialism. So whether we're looking at the Irish or looking at people in my ancestral homelands of India, or looking at

the indigenous people here in the United States, you see the same heart disease, diabetes, depression, suicidality, addiction, Alzheimer's, these different patterns and cancer. And what we've seen over the last decade and a half is how much of these diseases are really manifestations of dysregulated immune activity that manifests in our bodies as inflammation and how much inflammation is playing a role in the onset of these diseases and trying to understand more what is going on inside of our bodies where is the root pathologies of these illnesses because as a doctor I can give people insulin all day long, but I'm not going to actually make a difference on the rising rates of diabetes around the world unless we start to truly understand why are people getting sick in this way. And so this is the subject of what Raj and I started looking at together.

And it was really a truly incredible experience to work with him to put our minds together and to bring his understanding of sociology and history and economics together with my understanding of the human body and pathology. And both of our experiences working with communities around the world who are really struggling for their own health and dignity. And so that ended up coming out in what we share in this book. And this idea of medicine being colonized or the colonial view of medicine, can you unpack that a little bit for us? How might one be able to identify colonization or the colonial mindset within medicine or within the health field? Well, if anyone goes to their doctor and feels like their doctor doesn't listen to them,

they're experiencing what it's like to be on the receiving end of a colonial system of medicine. So, so much of our teachings in medicine, medicine as a field was part of the colonial suite that was brought to these lands to make it easier to extract the wealth from colonized territories to keep the colonizers healthy while they oppressed the native people and took the wealth out of those countries. And then eventually, while people settled and became settler colonial states like they did here in the United States. while people settled and became settler colonial states like they did here in the United States. And so part of that is a system in which people's experiences, their lived experiences, especially let's say women's or indigenous peoples or black and brown peoples, their lived experience was not upheld with the same sense of truth as what science was bringing. However, that science was also being investigated and performed from a very specific, now we know often racist perspectives.

And so the work to unpack medicine and find what are the useful things of Western medicine, because there's many useful things that scientific inquiry brings to us. And then what are the practices that have thrown away too much understanding of someone's lived experience in their own body, or someone's experience being a woman or experience being chronically ill. These are things that we don't do a good job in modern medicine. Now, there was a fascinating study that came out that showed that women are more likely to survive a heart attack and to do well if they have a woman doctor. That's insane to me that, you know, you need women to be able to

hear women having heart attacks. Actually, everybody survives better in a hospital with a woman doctor. And likewise, you know, black babies are more likely to survive if they have black doctors, which is, you know, another way of saying that is white doctors are neglecting black babies. So there's these ways in which we have to understand that medicine is a part of our social structures. And it is infected with the same disturbing and horrific patterns that were organized hundreds of years ago through colonial institutions. right now don't have the best access either to care through the barriers to access to care or access to care that when you're there in front of the doctor or in front of the nurse they can't even hear you or empathize or understand with you understand you know what you're experiencing so

colonial medicine that we look at in this viewpoint is you know okay you have obesity let's give you a drug to fight obesity. Let's staple your stomach to fight obesity, not let's dismantle the toxic food systems that are giving you only options that you'll definitely become obese. Or let's dismantle the traumatic systems that leave you in debt and crippled with debt that will drive you into depression and obesity. So what we're doing in this book is really advancing another level of diagnosis so that we're not just diagnosing what's happening in the body as being a phenomenon in the body. We're understanding the body is having very normal reactions to a pathological toxic social structure around it. So if we want health for everybody, if we want

to have a healthy society or healthy possibilities of health for all people, we have to start restructuring the society to make that possible. And so that's really, you know, what we're trying to advance here. Yes. And to pick up on one of the threads that you just shared about an individual going to a doctor and the doctor perhaps really just looking at the symptoms in a very individualistic way and not considering the systems of oppression and time and space and history and generations. I was reading the book and thinking a lot about liberation psychology. And my understanding is in Latin and South America, there was this, you know, Western psychology therapy that came

very similar where folks, individual, whether depression or anxiety was treated very individually. And folks were saying, this doesn't resonate. There's so many reasons why our depression or anxiety or, you know, dis-ease of the mind come from history and oppression and capitalism, colonization, patriarchy, etc. So I was really seeing that comparison. And I hadn't heard of medicine undergoing this same journey, this kind of liberation medicine perspective. So I'm wondering, how shared is this perspective that you share in the book, in the medicine world, amongst other physicians, this seeing someone's ailments, not only for their own individual body, but through the political sphere and the historical that their body is a part of?

sphere and the historical that their body is a part of. Yes, thank you for bringing that parallel in. So one of my heroes is Martin Barro, who was a liberation psychologist from Latin America. And again, you know, back in the 1800s, when people used to think of medicine, like in the fields of medicine, if someone had a fever, there was often very colorful words to describe that fever. There was, you know, like a temper fever and, you know, that you're suffering from these, you know, weird words that they would use to describe a fever that had nothing to do with the physiological location of what was causing a fever. It was more of a description of how somebody looked. what was causing a fever. It was more of a description of how somebody looked. And once this French physiologist said, okay, Broussai said, actually, no, the inflammation and fever

is being generated by this organ in this, there's a pathological irritation happening in this organ that's driving this inflammatory response, which is creating this fever. We had a localization. It was a moment of opening our minds in medicine to understand that no fever is a phenomenon that's located within the body as a response that's happening temporally and spatially in the body. And that was a very important moment to localize disease in what was happening. What we're doing, as the liberation psychologists have done, is actually moving that pathological experience outside the body, around the body, and saying, here's the pathology. And the body's actually just responding as any body would in that dysfunctional set of arrangements. So if you are a working class person and you

cannot live a life without debt for your house and debt for your school and debt for your medicines and debt for your food then that structure of debt is going to create circumstances inside your body that it will respond to which manifests as inflammation so debt itself is a independent risk factor for inflammatory phenomenon in the body and so we're localizing that again outside the body in the lines of history and power and in medicine now there is a push to start thinking about the structural determinants of health we see it you know with the covid analysis okay who's getting sick we're seeing structural racism and structural determinants of health and that's a step in the right direction what we're calling more of a liberal diagnosis okay now we're talking about that there's actual structures around us

making us sick and we're going a step further to say how did those structures get there and then if we can look at the level of how those structures got there and then act there to move the structures then the downstream effect will be an alleviation of that inflammation and so that's really what we are trying to articulate is that yes medicine is moving in that direction but we're sort of stuck in what we're calling a like a liberal framework of diagnosis which is like okay now we can name it's racism but we haven't gotten to the point of so let's you know actually just move land to black folks and brown folks are here in California to Japanese folks for whom it was drawn, move land back to indigenous folks, move money and, and power back into the hands or redistribute those things so that more people can have more access in order to be healthy.

And so that's really, you know, we've gotten really good at describing things and description is helpful, but it hasn't yet hit that activation energy to act to alleviate that suffering. I hear that. And it also resonates for me with economics, right, that capitalism is seen very much as a historical and also ever present. But yet, when we look at the histories, especially with primitive accumulation, and just that wealth has come from either devastation of the ecologies, land theft from indigenous peoples, slavery, etc. Then following that reparations, rematriation of land, all of that would follow as well in the economics, you know, if we want a more just and equitable economic system. So feeling alignment there.

Right. And so where do we get to when we have land theft, indigenous people removed from their lands, when indigenous people around the world are the only people who seem to know how to balance complex ecologies? Where do we get as a species? We get climate change. We get devastating wildfires, at least here in California. We get drought. Our water systems are mismanaged. The beavers are all gone. They were the master hydrological engineers of California. The salmon are all gone.

They are the pumps, the phosphorus pumps that come in from the ocean. The grizzlies are gone. pumps, the phosphorus pumps that come in from the ocean, the grizzlies are gone. So all of these systems are out of whack because of capitalism, because the land was privatized, because the land was stolen, because the original people were taken off of those spaces. So when we see that, okay, so what can we do, right? And that's where the deep medicine is. We can start working together to give land back. And I'm sitting on this farm. We started a group called the Deep Medicine Circle. We are a group of settlers and indigenous people

working together to create new culture. It's like, what does it look like? None of them have told me to go home. The land's going back to them. They haven't said, Rupa, get out of here. This is our land. They're like, okay, help us advance these ideas that we have about bringing the salmon back and healing the water and healing the soil and feeding the people so how can we look to our

indigenous friends for their leadership on what should be happening in these territories well as my friend greg castros says um ramatushaloni elder homelessness was not known in this territory before the colonizers came no one went hungry what do we have now we have 8 000 people who were left outside in the street in san francisco in the midst of the pandemic with aqis over 400 i was told as a physician at ucsf to discharge elderly people who are unhoused to the streets. In the middle of a pandemic, in the middle of wildfires, you got to go out to the streets because the city of San Francisco refused to offer them safe housing or shelter in hotels. Refused. So that is not an issue of was there enough rooms? There were 30,,000 vacant rooms no one was here in San Francisco

but that level of suffering and desperation wasn't enough to trigger the colonial mindset of oh no no we pay for these rooms this is private property that is not enough in San Francisco so it makes me wonder what do we have to hit in San Francisco Kate it's not just not just toxic air. It's not just that they're old and sick. It's not that there's a raging pandemic and they could get sick and die. What else has to happen to make people say, let's get everyone in. Let's make sure everyone's safe. So that sickness, I call that a sickness. That's like a sickness of hoarding, a sickness of capitalist lack of humanity a crisis of humanity that is

fascinating to me because that is not the way indigenous people ran things through this place for over 10 000 years on this land and so who do i want to follow do i want to follow the mayors who didn't let people in or do i want to follow the indigenous elders who are like, let's start building another way? Because COVID was a test to our systems, and we failed. We need to get smarter, work harder to make sure everybody is safe, that people have food, people have shelter, and people have what they need to get through the things that are coming. So this show is called Upstream. And I don't know if you're familiar with the upstream metaphor. I've heard it mostly attributed to public health. So I'm assuming you have, but it's this image of, you know, bodies floating down the river, jumping in to save them. And you just listed some very real challenges relating to COVID and the fires and the lack of leadership and empathy and action. I know you actually, I've known your work since 2017, when you were at Bioneers, and you presented a talk called decolonizing medicine for healthcare that serves all. And you showed in your presentation this image that has really stuck with me. And it's a very systemic image where you connect

capitalism and colonialism with supremacism. And then you say that supremacism, this idea of, you know, supremacy or domination over, maybe I would see it that way too, then leads to white supremacy, male supremacy, human supremacy, which then leads to slavery, genocide, invisible labor, femicide, ecocide, and then that all leads to inflammation so then i saw your book coming out in in that graph when i revisited it but i'm just wondering well first if you have any comments about that image because i mean from my perspective it went quite viral um i don't know if you'd say that but i i i felt a resonance and i i feel that others did too but i'm just wondering you know where where you are at with this upstream question now, having

shared that image, having written the book and sharing what you just shared about this opportunity of COVID, the failure, and then where do we go here? What would be that upstream from, you know, the failure and the lack of action that didn't happen? What would be upstream from that? lack of action that didn't happen? What would be upstream from that? Yeah, that's a great question. Yeah, so that image started as like the seed of the book. And I think you nailed it when you said domination, it's systems of domination. It doesn't matter, you know, here on this land, that's how they manifest Christian supremacy, right over indigenous religious or spiritual concepts there's all sorts of systems when we when we have that hubris to think that we are better than anybody else what do we get someone gets traumatized someone gets exploited someone gets hurt can we live and create a

society can we live in a way where we actually do no harm where we actually can advance a culture of care yes we absolutely can and the reason i say that is because it existed before here for 10 000 years before the colonial mindset took hold of this land and so how do we do that and i think that it has to go down to reimagining our economic systems, reimagining the ways in which we exchange and do things so that we make sure no one's left out. And we make sure everyone has the basic needs covered. And in such a wealthy place, by that I mean, first of all, in California, economic wealth, but also wealth of water and wealth of seeds and wealth of soil and there's so much goodness and wealth of peoples different peoples with

different understandings and technologies and wisdoms to share this is really a great place to start advancing those cultural practices and so I think that COVID was a test. And what it showed me is that, well, now there's a lot of people who are going hungry through COVID. There were a lot of people going hungry. And, you know, how do we go as upstream as possible to impact health? And for me, that means going to the soil and going to the land and starting the healing from that place. It means working with farming communities to create food systems that are not based on exploitation. If you look at who got sick in COVID, so many were our farm workers, people who are living in truly slavery era realities, some of them packed into trailers,

no access to healthy water, no access to health care. And then if they complain about their working conditions, you know, ice is called and they're whisked away and then a new batch comes. So it's truly horrific what's happening in our state and that our state allows this to continue to happen. So we need, obviously, for our farming, a lot of hands on deck and all of those workers should be protected and uplifted and cared for. And so how do we create a farming culture where care is our essential praxis? And when we do that, not being the almond capital of the world but being a farming community that can take care of our people that can make sure our soils are healthy and make sure our water and air is healthy that all those things are healthy so when we can center care as opposed to profit or being the almond capital of the world what happens then to all the systems do we have

to be moving water the way we do through this state no we probably don't do we have to take all the water from the salmon no we probably don't do we have to export millions of pounds of this and that no we probably don't but that means that our wealth stays in california it stays here and it starts uplifting everybody and And so that's what I'm interested in seeing is an economic system that can be consonant with climate health, with climate healing. And by climate, I mean from the climate of the temperatures and the wildfires not being the way they are so that our droughts are not as intense but the climate also of justice so do we have a just system where people feel like their work is valued and they own that pride and

that value of their own work and is that benefit then shared amongst everybody or is it hoarded? So how do we move those values away? And to me, that really goes with spending a lot of time sitting around with our indigenous elders. Yes. And this brings us to the deep medicine invitation and offering of the book. You've spoken a little bit about deep medicine, but I'm wondering if you can tell us more. What is it? What's the offering? What's the invitation there? And you also mentioned deep medicine circles. If one wanted to join something or create something similar, what might be the forms that that could take for folks to get involved with deep medicine in their own lives? That's a great idea. Yes. So deep medicine for us is really contending with the structures that are making us sick

and getting involved in restructuring them. So that can be anything from working on mutual aid in alternative forms of currency, working on housing that is built by people who are experiencing homelessness. It can be organizing together across different groups to move land back into the hands of indigenous people. It can be reimagining our food systems through agroecology to preference soil health so that our bodies can be healthy it involves understanding that we are more than our single individual selves we are a multitude of selves including the cells in our gut microbiome that are so critical for our immune functioning and that we've now learned are the first and best and last defense against

inflammatory disease are these invisible creatures without whom we can't survive and if you look at the gut microbiota of people around the world it's people in the united states who have the most compromised gut microbiota and so deep medicine for us is understanding that we are those creatures too that our sense of identity is plural it's not just this one singular i and that health cannot be something that i seek for myself and sit in an you know in a place and say om or do yoga by myself but i have to reach out and make sure that people in my community aren't suffering. So health also has to involve political reckonings of restructuring power so that those who are sitting outside in the middle of a pandemic get let into those hotels because we are not healthy when they are not healthy. That's not health.

That's an illusion of health. That's a lie of health. And so deep medicine is looking at that understanding that our bodies are systems within whole systems. Deep medicine is reattaching to the web of life and understanding that we cannot be separate from it, that we're not above it, that we actually are a part of it. And so reentering and restoring those relationships. Imagine if we came to this land, this beautiful land where I'm sitting. I wish I could show you a picture land where I'm sitting. I wish I could show you a picture of where I'm sitting right now. I'm looking over these hills that go to this valley and sitting next to the San Gregorio Creek. It wasn't always called the San Gregorio

Creek, but this is where the Portola expedition started. And imagine instead of coming here to conquer those indigenous people and take their land, those folks came, they got sick, and they were nurtured at the mouth of this river for four days with the medicines of the native people. And they were healed and made strong enough so they could go and conquer them and move them all into the missions. And so imagine instead of that history, we had people coming and saying, wow, what a beautiful land you have. How did you all do this? And can we stay? And how can we be a part of this? And what can we learn here? And who this cultural burning? And what is the purpose of this? And what are these songs you're singing? And all of this amazing culture that is here, it's still here, and it's coming back.

Imagine if we had that. And then when we settlers came to this land, people came here for refuge. I came here. I was born here because $42 trillion were stolen from my homelands in India and my parents didn't understand how to have a life for our family because of British colonial rule and so when people come here then they can be a part of that beauty and so I see deep medicine is finding that way to understand how to get through this critical moment in human history. Because this last year was just so hard for me as a frontline physician, a doctor,

with the pandemic, with the wildfires, with the uprisings in response to George Floyd's killing and Breonna Taylor, and the culmination of all those things being so hard, nothing's really changed, right? That wasn't enough. So what's coming next? That's what I want to be prepared for. And that's what deep medicine is there to help us get ready for. You've been listening to an Upstream Conversation with Rupa Maria. We'll be right back to hear from Raj Patel.

Take a walk with me Through the redwood trees A thousand years or more Oh, what they have seen Like grizzlies sitting here Just taking in the view While the wind whispers songs The alone he knew Watch the water come down now

From the peaks to the bay Carrying the memory of another way Everywhere I walk Everywhere I stand Everywhere I go I'm on stolen land And my heart breaks to pieces this is how i am whole learning how to listen in this place i call That was Stolen Land by our last guest Rupa and the April Fishes. Now on to the second half of this episode where we speak with Raj Patel,

activist, award-winning author, filmmaker, and academic. Raj is a research professor at the Lyndon B. Johnson School of Public Affairs at the University of Texas, Austin, and a senior research associate at the Unit for Humanities at Rhodes University in South Africa. Welcome, Raj. So good to speak with you today. Thank you for joining us. Thank you so much for having me. And I know that we spoke with you recently, Robert did. He spoke with you about a history of the world in seven cheap things, a guide to capitalism, nature, and the future of the planet. He also got to speak with your co-author, Jason W. Moore. And I also know you're the author of The Value of Nothing and Stuffed and Starved. And now coming out in August, Inflamed, Deep Medicine and the Anatomy of

Injustice with Rupa. And I'm just wondering if we could start with what is it that is moving you right now? Or what is it that's happening in the world that's breaking your heart? Oh, what a question, Delia. I mean, I think right now, what breaks my heart is grief. I mean, so many of us have lost folk recently. And you know, I've lost uncles and aunts, some very recently. And then also, the thing that broke my heart and that continues to break my heart is the gun violence in the United States. And then there's the routine heartbreak of just the work that I'm involved in around poverty and hunger. I've got comrades in South Africa, for example, who mercifully have now recently been released from jail, but they are constantly assaulted for their resistance. And that heartbreak from South Africa to Palestine

to Malawi to India, you know, people standing up and then just getting mown down by the state in various ways. It's heartbreaking and it's hard to carry sometimes. I hear you. And yeah, thank you for sharing that. And I know that that grief can sometimes, you know, help motivate us as well in our work. And I'm wondering, you know, the theme of the show is upstream. And it's this metaphor about going upstream to the root causes. So I'm wondering, when you sense into this grief that you're feeling around gun violence and systemic oppression and food insecurity and the food injustices of the world, and also just simply death and dying. When you go upstream from those, what do you find are the root causes of this suffering, the ecological and the social, the individual and the collective that we feel and

sense? I didn't have a chance really to explore this with Robert last time we spoke about the metaphor of upstream. But I find it very powerful. And the other way of thinking about it that Rupa and I use in Inflamed is to broaden the idea of diagnosis. Because as we say in Inflamed, every diagnosis is a story that starts in the middle. When you go to your physician with an ailment, the physician is in the middle of a story that the act of diagnosis retroactively begins. So the physician will take the measure of your symptoms and use that to work backwards to think about, well, what happened? what insult, what trauma, what caused these set of symptoms. And you use that to backcast the story so that then in that moment of diagnosis, the physician can make a reasonable guess about, well, this therapy, this medicine,

this intervention is going to result in your return to homeostasis and your return to normal. But right at the heart of that is the idea of normal disruption and then return to homeostasis and your return to normal. But right at the heart of that is the idea of normal disruption and then return to normal again. And I think the idea of upstream is closer to what we're doing in our understanding of diagnosis, which is to say, look, the history of medicine has an idea of place in mind. The history of medicine is always accompanied by geography. One of the great revolutions of medical diagnosis in the 1800s is the idea that medical diagnosis involves a place that becomes inflamed. And so what interventions in medicine involve is a recognition that actually the way to diagnose

things is to find where in the body things have gone wrong, and then use that geography of the body and use the anatomy of the body then to figure out how to treat things. Now, our diagnosis goes back further and situates the site of trauma and of intervention and of insult, not just within the body, but also in the long histories that precede the body.

And so when we think of an upstream diagnosis, what we're doing is saying, look, yes, it's true that, for example, if you're coughing and your lungs are inflamed, it may be because you have COVID virus has entered your body and is now causing your tissues to inflame. But behind that, there are longer histories of vulnerability that some communities have over others. Those communities in the United States are disproportionately people of color and the working class. But why do we have those things? It's one thing just to say, yes, there are social determinants of health. But it's another to say it's social determinants of health is merely a description. A diagnosis is something that helps us understand where those categories come from.

Why do we have the kind of racial categories and the categories of sex and the categories of class that we do? Well, that involves a different kind of diagnosis. And what we're doing in Inflamed is saying, look, here's the long history of the origins of race, class and gender as we live them in this settler society. And the beginning of that is, you know, we kind of trace to 1492 and the sort of simultaneous ideas of racial purity and of settler colonialism and settler capitalism that begin in those years that are inaugurated in Spain and in the New World, as it was so called, but in the Western Hemisphere.

Yeah, absolutely. I see. When I was reading the book, I saw that the whole book really was a journey upstream to broadening the traditional medical perspective of looking at symptoms as solitary diagnosis of an individual problem to, yeah, the systemic conditions that have contributed to the inflammation that they exhibit. And definitely, the history of colonization was central in the book. And one of the areas of that is something that you all speak about, about colonial cosmology. And I think in this journey upstream, this worldview of colonial cosmology can be quite central to all of the downstream problems that we see and sense. So I'm wondering if you can describe or kind of unpick for us a little bit, what is colonial cosmology? What is colonial thinking? How does that show up in our own

thinking in medicine? But how can we see it? How can we notice it and name it to be able to then recognize how it's impacting our bodies and our health and our societal health and our planetary health? Wow, Della. So yeah, I mean, you're asking the big question in capitalism. I mean, one of the ideas, and this comes from the work that Jason W. Moore and I did in History of the World and Seven Cheap Things. And one of the signs of colonial cosmology is

the separation of society from nature, the idea that humans are separate, and certain kinds of humans are separate from the rest of the web of life. That's a very important sign of colonial cosmology, because it allows relationships of ownership to obtain between some humans and other humans, some humans and other kinds of natural beings and other features of the web of life. And so certainly, I think that the central notion in colonial cosmology is that humans are separate from and better than and more capable of stewarding and mastering and dominating the rest of the web of life. So that's certainly, I think, a central feature. And we can see it certainly in the modern kinds of ideas and language of mastery and of supremacy and of

domination and also of stewardship in certain kinds of liberal ways that involve a sort of human arrogance that I think is very colonial. And we can see the difference here between, say, a certain kind of settler colonial cosmology under capitalism and other kinds of cosmology in studies that Rupa and I reference in the book, where, for example, we know that settler colonialism has devastated indigenous communities in North America. One of the signs of that devastation are very high rates of type 2 diabetes among any indigenous communities. And that's come through the very conscious destruction of indigenous foodways in North America and the alienating of indigenous cosmologies from the lands in which those cosmologies mattered and created those territories. Indigenous communities

have been denied access to those territories. But insofar as indigenous communities have been able to maintain their own languages and their own cosmologies that are part of those languages, some studies have noticed that communities that have maintained those strong cultural ties have far lower rates of type 2 diabetes than communities that have been severed from their languages, from their cosmologies. So there are ways in which the stories that one tells oneself about how this self, this thing of self, belongs and matters in the world and how it is related to other selves and other beings. Those stories, those cosmologies, those narratives that help us link ourselves, our families, our communities to the rest of the web of life can actually help us become healthier and become stronger in the face of the onslaught of settler cosmologies. And so that's a way of

talking about settler cosmologies in ways that help us recognize, first of all, that there are other cosmologies around. And again, in the United States, for instance, we are trained to forget this. So every time you take the Pledge of Allegiance, as my children are forced to do every day here in school in Texas, what they are told is that they have to pledge allegiance to the flag and there is one nation under God. And even federally, we recognize that there are over 500 federally recognized tribes and sovereign nations here. Of course, those sovereignties are violated routinely. But we are made to forget every day that we live in a settler state, that there are many nations, even that this settler colony begrudgingly recognizes. And recognizing the dangers of the sort of USA and

of patriotism and of a flag and the erasures that come with the idea of a unitary nation state is one way for us to start to deprogram ourselves from the cosmologies that would rather pretend that indigenous people never existed here and that they continue not to exist. Whereas, in fact, they not only continue to survive and resist, but their cosmologies and the ways that indigenous communities and other communities think about alternative relationships to the web of life are likely what will save this planet from capitalism. Knowing that, like really accepting that the United States is a settler colony, as well as Canada, Australia, South Africa, and I imagine Brazil and

many places in Latin and South America as well. That reality, Raj, what do we do with that? What happens after acceptance? You know what I'm thinking about the stages of grief as well, you know, and especially as you know, I think about Fourth of July coming up and all that kind of stuff. And I think we're just barely scratching the surface of reconciling our racial and indigenous genocide histories in the United States, as well as the world, you know, thanks to movements like Black Lives Matter and things like that. But, you know, what do we do? How do you move through your work and living in the United States knowing that this is a settler colony?

I mean, you're asking the right question, Della. And I think there are no easy answers here, but there are a ton of difficult ones. Now, the easy answers you can tell, because they're the kinds of things that involve, for example, a land acknowledgement that doesn't go anywhere. So for example, I am right now on land that was Comanche and then before that Toncala our conversation, is to ignore demands for reparation. It is to ignore the possibility of truth and reconciliation. It is to ignore the demands of recognizing the harms that capitalism has and continues to cause indigenous communities throughout these settler colonies. So I've been trying to engage with indigenous comrades here. And certainly there's one of the things that Rupert and I talk about in the book is, first of all, to look for

and listen to and abide by the stewards who remain of this land. And that involves a recognition of the possibilities and the urgencies of land rematriation. I'm also investigating here in Texas how to work with the communities who are the closest related to this land, because while the original inhabitants have been driven away by the forces of occupation, there are nonetheless descendants who are around. And insofar as I'm connecting with them, I'm connecting through a certain sort of process of recognition of asking for permission to be here and asking for permission to work in solidarity as a co-conspirator to overthrow the forces that have alienated those communities from their territories, but also in a way that recognizes that I myself

and my history is one of settler colonialism and diaspora through the British colonial empire. And so while I find myself a refugee in this land, I recognize that I am a settler refugee and that there are alliances of solidarity that recognize one another through this process of occupation. I mean, that's why, for example, Black Lives Matter and the struggle for freeing Palestine

are processes that recognize one another mutually as suffering sort of occupation. But I think that's why ultimately what we need to be doing is not merely engaging in a process of dialogue and of permission seeking, but also of restitution, reparation, and the Red, Black and Green New Deal, the kind of dialogue around those kinds of restorations, the ecological reparations that are required are very exciting because they recognize that part of colonial cosmology involves the absolute destruction of the planet. And if we are to move away from that, we have to repair, and this is what we're talking about in Seven Cheap Things about a reparation ecology. But a reparation ecology very specifically

involves the kinds of politics of red, black and green New Deal that are reparative, not merely to indigenous communities here and to black people in the United States and other people of color, but also reparative internationally as well. And in case somebody listening hadn't heard of, they likely have heard of the Green New Deal, but not the red or black, could you just briefly share what those three are in case someone listening is curious? If you've heard of the Green New Deal, you might have heard of it as a kind of Keynesian move to spend a lot of money on infrastructure and try and keep a lot of carbon in the ground. Now, that doesn't go far enough, because it doesn't recognise, first of all, that that project needs to happen on stolen land. So the Red Deal,

notice it's not the Red New Deal, because there was never really a New Deal for Indigenous communities. But the Red Deal is a response to the Green New Deal, observing the need for reparation and for the recognition of indigenous sovereignty on Turtle Island in this, what we currently call North America, and throughout the planet, but particularly it's written from a North American perspective. And then the recognition that this country came through transatlantic slavery to be what it is. There needs to be reparation for the deep history of racism and of exploitation of black people in this country. And so the Red, Black and Green New Deal is an amendment to the original Green New Deal and is a synthesis that comes through

working through the work that happens in BIPOC communities to modulate the Green New Deal in ways that recognize the unsustainability of capitalism and its historic injustices. And so that does two things to what you think you know about the Green New Deal. First of all, it recognizes that you can't have a Green New Deal that merely perpetuates capitalism, but makes it greener, not like Walmart with solar panels on the roof. But in fact, what you need is much more what Max Eyl calls a people's Green New Deal. And that is about a sort of radical end to capitalism in order to be able to move upstream from capitalism and to fix what capitalism has polluted downstream. And instead,

think about the reparations that are required in order to get to the entire planet on a trajectory that means that we all get to live on a survivable planet. We all get to do that in a way that is consonant with justice and with the historical responsibilities that capitalists and those who have lived under settler colonial capitalism have wittingly or unwittingly committed. We need to restore and make reparation for that. Let's go to the metaphor of inflamed, the title of the book, Inflamed. And you start the book with a few phrases. You say, your body is inflamed. And then you also say, the society your body is in is inflamed. And then you also say, the planet is inflamed. So what is this metaphor of inflammation? How does it show up in our bodies,

in our societies, and in the planet? And why this metaphor? What drew you and Rupa to this idea of inflammation? To be fair, it's not a new idea to think of the body as a metaphor and to think of the body politic in ways that mimic the behavior of our individual bodies. So we're not above using metaphor, but we're also using inflammation as a very direct bodily experience of what it is to have a planet that is burning and to have a society and live in a society that is riven with patriarchy and with racial animus and white supremacy. So we are pointing out that inflammation and people become inflamed about something that they're quite exercised about. But in general, inflammation is not just a metaphor for us.

It is actually what is happening in the world and therefore translated back into your body and then back out again. And so the ways that our immune systems are responding to a planet that has become rapidly degraded by industrial capitalism, and which is not only polluted by our activity, but is then poisoning us, and is then in turn, we respond by the sort of rash of right wing politics that then permits the increase in exploitation of the planet, the increase sort of leaning on certain kinds of supremacy and colonialism, that then allows a further deepening of the exploitation of the planet and the further sort of conflagration that is setting our planet aflame. We explore that in lots of different circumstances. And so it's not just a sort of North American thing.

I mean, one of our favorite chapters is about the journey of a sort of nanoparticle, the kind of particle that can cause inflammation and then cause Alzheimer's, from a fire in Punjab all the way through the body of a waste picker to sort of the ultimate heart attack that comes as a result of that in India. And India is both a country that has experienced colonialism, but also is a colonial state insofar as there are indigenous people who are continually fighting back against the colonial state that is modern India. And so, you know, this is not just a North American problem and not just a sort of settler colonial problem in the states that you mentioned earlier on, Della, but it is a global phenomenon. And in our respiration chapter, where we follow this particle in India,

we talk about inflammation precisely as, you know, the burning of a jungle, the deprecation of people who live in jungle. And so part of our story of inflammation is a journey through different organs in the body, explaining how different organs become inflamed and the stories that both cause that inflammation, but also gesturing increasingly towards the kind of protective stories that can offer some modicum of protection and offer a certain kind of anti-inflammatory effect. spoke about colonization. You also mentioned the word supremacy. You also spoke about the separation of nature and humans and the domination over nature. So I'm wondering, it may not be linear, and it may not be the upstream journey is cause and effect where there's one ultimate route that then leads to others. But I'm just wondering if we might unpick those pieces of colonization, capitalism, supremacy, separation of spirit and matter. What is the root of those? I mean,

do you see it that way? Or is there a different way that you see it? I don't think that there's a single answer here. But I do think that the advent of capitalism as we know it does require a certain kind of consideration of what is natural. I do think that the key word here is nature. And this is Raymond Williams' line that nature is possibly the most important word in the English language because it is a very strange notion to indigenous folk that nature is that thing out there which we go for walks in, but we aren't nature. We're the thing that goes for a walk in nature. That kind of cleavage, I think, is tremendously important and cosmologically very significant. But again, I mean, I think knowing that is one thing, but actually knowing that deeply is rather different. And I

think what's interesting about this particular book, what brought Rupert and I to this, we've been doing a lot of listening. We've been very privileged to be able to know different communities in their most unguarded moments. Rupert as a touring musician, as you'll hear from her, and for me as a sort of an activist who's able to move with different languages and different cultures with rural communities in many different places. And also in some cases in South Africa, for example, with the shack dweller community in urban spaces. And to be in those spaces and to not be given the sort of line that's just given curious outsiders, but also just be able to stay with folk and to be able to hear from folk how they understand and how they diagnose the situation

in which they find themselves. I think that that's rather important because it offers a way to present alternative cosmologies and knowledges that it's very hard for us to betray that. I mean, it's entirely possible that we have, but it's hard for us to betray that. I mean, it's entirely possible that we have, but it's hard for us to then walk away with that knowledge and not be transformed by it. So, you know, if we're going to this upstream question and saying, well, you know, what's upstream? Raj says it's capitalism. Well, that's great. And, you know, and that's really about the nature society divide. But it's another thing to actually feel that in your bones and to then be transformed into someone who's acting accordingly.

For me, the transformation comes not just with a kind of politics of sort of revolutionary solidarity, keening for a world after capitalism, but also in terms of the practice and my engagement with movements on the ground and also with the ground itself. And I think that that's the idea of actually being connected to the web of life where we find ourselves is possible and urgent and necessary and a necessary part of what it is that will follow from a feeling in your bones

about this upstream moment of the separation of humans from the rest of the web of life and society from nature. And that kind of knowledge, I think, is a very practical and embodied one. It's not just the rest of the web of life and society from nature. And that kind of knowledge, I think, is a very practical and embodied one. It's not just the sort of thing that you can say on a podcast and then everyone will be like, oh yeah, right, nature, society, divide, let's move on. That's what's upstream. Being upstream means being in the water. And I do think that that sort

of immersion involves a kind of praxis that moves us out of each other's ears and into each other's hearts and bodies. So that understanding of knowledge is an embodied one. As I say, I'm repeating myself, I'm trying to come to a way of answering your question that both says the words, but says that the words aren't enough. Yeah, absolutely. I love to explore paradigms and worldviews. And I, like you're saying, I know I can say them, right, that we have a separation with nature. And I can say things like the ecological self or that the planet is alive, that a mountain is alive, and yet really feeling it, that embodied sense, and really knowing it, as you're saying, deeply, and then walking in the world with that knowing is much more difficult, at least for myself, I'm finding that. So I hear you on hearing

it, and then what does it take to embody it and to live those paradigms and worldviews? And yeah, I really hear a lot of your invitations for folks, I want to uplift them. You're saying, you know, listening, you mentioned that a few of your invitations for folks. I want to uplift them. You're saying, you know, listening. You mentioned that a few times. So listening to one another to investigate inflammation, to notice inflammation in our own bodies and to expand our diagnosis, as you said. So not just the individual reasons for that, but the societal, the systemic, the historical, and also how inflammation and because of these

systems of oppression are differently felt, right? Disproportionately felt. So that's important too. And then this invitation to decolonize our minds and our societies and what that actually means in terms of living in a settler colony or just being on the planet. And then this invitation to reconnect with nature in this really deeper way and reconnect with the web of life, as you're saying. So just to close, you know, I just really felt touched by all the stories. And again, these layers, these layers of weaving the individual, the ecological and the societal together. I'm wondering if we can close with a story.

I don't know if you have a story from the book that you can share, you know, just one story to leave us with as folks take this conversation and they move into whatever's next for them after they're done listening. I'm so grateful, Della, that you were able to summarize those huge themes in the book so eloquently, much better than I can. But I'm thinking right now to one of your earlier questions, which is, you know, what's in my heart and what am I grieving? And I'm thinking a lot about the suffering that happened while we were writing this book and the death of, in particular, of the son of one of the folk that we interviewed, Subuh Zikode, who is the leader

of the shack dweller movement in South Africa, Abelhali Basim John Dolo. And many comrades in South Africa have been under the boot of the state and two were recently arrested for baseless charges and are now recently released. But I've been thinking about Sabu and the idea of Ubuntu, again, is rather hackneyed.

I mean, we have an operating system named after it now. But what Ubuntu means is I am because you are. And the more I think about that, the more I really love the kinds of praxis that's happening right now in the countries that don't have COVID vaccines because of US policy and because of US philanthropists like Bill Gates and the design failure of the COVAX initiative. And so right now in South Africa, while people are waiting for vaccines and while the South African variant rages through that particular part of the world, the sort of praxis of I am because you are is a praxis of folk living in urban areas, caring very deeply for one another and for the

soil around them. I'm drawn to that example because the politics of living in a settler society and living on land that has been stolen multiple times and reconstructing a sort of beloved community on top of it through agroecology, through not only growing food, but challenging the sort of racist history of the state, but also creating a community in which there is an utter sense of you belong here because you are here. And now it is time for you to participate in everyone's shared liberation. I love how that is a real thing. It's not just a sort of make-believe political project for many people in many parts of the world. And I think South Africa right now in the middle of this hell is in some spaces an incredible moment of inspiration. And it happens despite the neoliberal state and

despite the worst of capitalism happening in South Africa. And in that way, we can find in the atrasticities of the neoliberal failure of South Africa, spaces in which Ubuntu is extended to the web of life. And I find that incredibly beautiful and incredibly powerful, because it is lived, because it is practice. It's not just a story. And my heart is with them at the moment as they go through particularly hard times with the ANC. But I'm really buoyed up by that possibility because it's a story that's lived every day anew. But it's a story of, you know, shack dwellers belonging and living together in the worst possible times in ways that lift one another up. you've been listening to an upstream conversation with raj patel and rupa maria co-authors of inflamed deep medicine and the anatomy of injustice published by farrar strauss and jeru it will be out on august 3rd upstream theme music is by Robert. Thank you to Rupa and the April Fishes for the intermission music. Upstream is a labor of love. We couldn't keep this project going without

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