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Emily Silverman

You're listening to The Nocturnists: Conversations. I'm Emily Silverman. Just earlier today, I was at a party on a beach and I met a photographer who takes photos of the Earth from space. He partners with satellite companies, and they create these beautiful aerial images of cities, suburbs, deserts, forests and oceans. Sometimes the earth appears to be healthy and thriving. But other times we see pollution and the scars of wildfires and the destruction of war zones. The project is called Overview. And there's no sponsorship here or anything. It's just a project that I came across that I think is really interesting. And ever since I met this photographer, I've been thinking about the idea of the 200 mile view. What does the world look like when we zoom out?

Today's guests, Dr. Rupa Marya and Raj Patel, see the world through that broader lens. And the book they wrote together, Inflamed: Deep Medicine and The Anatomy of Injustice, argues that colonial capitalism has made us sick. Rupa is an internal medicine physician, Professor of Medicine at UCSF, writer, activist, mother, the musician whose work sits at the nexus of climate, health and racial justice. She founded the Deep Medicine Circle, a woman-of-color-led, worker-directed organization committed to healing the wounds of colonialism through food, medicine, story and learning. And she's the co-founder of the Do No Harm Coalition, a collective of health workers committed to addressing disease through structural change. She's toured 29 countries with her band, Rupa and the April Fishes, whose music was described by the legend Gil Scott Heron as “liberation music.”

Raj Patel is a research professor in the Lyndon B. Johnson School of Public Affairs at the University of Texas at Austin. He's a James Beard Award-winning activist and New York Times bestselling writer, and has testified about food and hunger to the US, UK, and EU governments. His book on the food system, Stuffed and Starved, has been translated into a dozen languages. He's a member of the International Panel of Experts on sustainable food systems, and co-director of the documentary feature The Ant and the Grasshopper.

Reading Rupa’s and Raj’s book really helped me see how we, in western medicine, isolate ourselves from the rest of nature. It's as if we're in it, but not of it. We learn about disease in a vacuum and under-emphasize the impact of water, air, food, relationships, racism, education, government, and economics on our health. Rupa and Raj push us to see ourselves as part of a web of life. And health and healing as something that must happen on a larger scale–at the level of the gene and the cell and the tissue and the patient, yes, but also at the level of relationships, communities, societies, and the entire planet. It's a radical book. It's a political book, and one that made me reconsider my definition of health and my role in this world as a health care worker. Before I sat down with Raj and Rupa, I asked them to read an excerpt from their book. Here's Raj and Rupa.

Raj Patel

“As The World Burns. Your body is inflamed. If you haven't felt it yet, you or someone close to you soon will. Symptoms to look for include uncontrolled weight gain or unexpected weight loss, skin rashes, difficulty with memory, fever, trouble breathing, and chest pain. Inflammation accompanies almost every disease in the modern world: heart disease, cancer, inflammatory bowel disease, Alzheimer's, depression, obesity, diabetes, and more. The difference between a mild course and a fatal case of Covid-19 is the presence or absence of systemic inflammation.”

Rupa Marya

“Your body is a part of a society inflamed. Covid has exposed the combustible injustices of systemic racism and global capitalism. Demagogues around the world kindle distrust and hatred. Governments send in the police to impose order, monitor lockdowns, enforce a return to work for those who comply and incarceration for those who do not. From the United States to South Africa, India, Brazil and China, people suffering oppression set tires and cars and gasoline alight on barricades. The petrochemistry of our protest reflects the materials that we have on hand. Everything we've made, we've made from fossil fuels: energy, food, medicine, and consumer goods. The world has been organized to burn.”

Raj Patel

“As a consequence, the planet is inflamed. Global temperature records are being broken, forest fires have turned from annual to perennial events, oceans are rising, and storms have become bigger and stronger. This is the epoch of endless fire. Human destruction is tearing apart the web of life, shredding the network of relationships between organisms and places in which our lives are embedded. Inflammation is a biological, social, economic, and ecological pathway, all of which intersect, and whose contours were made by the modern world.”

Emily Silverman

Thank you for that reading. And thank you, Rupa and Raj, for being here today.

Raj Patel

Thanks for having us.

Rupa Marya

Thank you.

Emily Silverman

So, Rupa, you are a physician and a musician. And Raj, you are a political economist. So tell me, how did the two of you meet and get the idea to write this book?

Rupa Marya

We met when I was a fish, and Raj was a GMO tomato at a protest against GMO foods. I think Raj was literally dressed as a tomato when I was playing with my band, Rupa and the April Fishes. And we became quick friends through that. Raj is part of, not only my chosen family, but we realized after writing this book that we're actually related as family. And through our friendship and a decade of listening to each other's stories and following and admiring each other's work, there was a lot of beautiful synergy and friendship that led to this book.

Emily Silverman

So the thesis of the book is that we, as human beings, and also our planet, are inflamed. Rupa, tell us about this inflammation and where it comes from.

Rupa Marya

Well, as you know, Dr. Silverman, inflammation, as we learned about in medical school, is what happens when your body is confronting a threat or damage. So if there's a paper cut, your inflammatory response is activated, which is part of the innate immune system. And a bunch of cellular mediators are mobilized to heal the wound. But if damage is ongoing and keeps coming, then the inflammatory response doesn't turn off. And in fact, some of those mediators that are mobilized to help heal in that situation, become agents of destruction or create collateral damage themselves. So what is a healing response gets turned into one that harms. And over many years, through working as a physician in hospital medicine and then touring on the road with my band, where we would use music as a way to investigate the dynamics between society and health, you could see that different people were impacted by a certain range of diseases more intensely. And I started to notice that these diseases were traveling more intensely in people who are suffering under the oppression of colonialism. And all of these diseases have inflammation. The inflammatory response is playing a role in chronic sterile systemic inflammation. And so that's why we started looking more deeply at what is the link between the invisible structures that have shaped our lives, and the invisible interactions that are happening within ourselves.

Emily Silverman

The book opens with an anecdote about a patient named Sheila McCarley. Tell us about Sheila and why you chose to open the book with her story.

Rupa Marya

Shelia McCarley is one of those patients who I will never forget–her and her family. She was someone who, I think, almost every doctor at UCSF ended up seeing, and nurses still remember her. They'll stop me in the elevator, you know, several years later, to say, “Oh, remember Shelia.” She came into the hospital, transferred from the Central Valley, with what looked like sepsis, where her blood pressure was dropping, and her white blood cell count was elevated. And we kept looking for a bacterial infection and never managed to find one. But she was put on pressors, and she was put on antibiotics, and she’d leave the ICU. And then she'd come back. And she’d go back and forth and back and forth. And we never found a cause for these events.

And I met her in the last few weeks of her life. And she had been hospitalized for several months at that time. What we could see is that her markers of inflammation were through the roof, but we couldn't understand why. And it was when her son walked into the room, Eric, with white supremacist tattoos around his eyes, from Alabama, that I sat them both down and said, “Tell me what your life was like growing up.” Because she came from Muscle Shoals, Alabama, and she grew up in one of the most polluted watersheds in the United States, where she was forced to drink the groundwater that had been polluted by the mercury that was being lost from a chlorine-producing factory. And 3M has their chemical plants there, releasing forever chemicals into the water. So at age 40 she moves to California, and her hair falls out and she gets a rash characteristic of lupus and her joints swell. So they call her lupus, but every indicator for lupus was negative.

And so, through listening to them and hearing about their lives, it was just such a profound awakening for me of how poor white folks in this country are being impacted by the same forces as people living in Flint, Michigan, or Black communities here in East Oakland where I live, with the crisis of lead–these poisonings that are happening. And the diseases that we're seeing are beyond the ability of Western medicine to even understand, because we don't ask the right questions. We're not able to diagnose what she had, because we don't know how to even frame the questions.

And so Shelia ended up dying. But her family was so grateful to me for asking these questions that finally shed a light on their community in a way that unearthed their questions, like why were people getting so sick? And why were they left behind? And perhaps one of the most profound moments for me of this experience was her son walking out after that encounter, and just sobbing, and saying, “No one has ever bothered to ask us what our lives are like.” And to me, that was a very important moment, the power of narrative–that if we really understand what the issue is, through asking the right questions, we come to the right diagnosis. And what we've come to learn through our exhaustive research of the literature on immunology, and ecology, and economics, and history, is that the world around the body is creating the opportunities for health and disease. And if we're not working there, as physicians, as healthcare workers, we're not really going to be effective at changing the outcomes in our patients.

Emily Silverman

So, Raj, in the book, we are presented with two different and conflicting worldviews or cosmologies. There's the worldview of interconnectedness, interdependence, and of living within this web of life. And then there's a worldview of separation, of independence, and living outside of, or separate from nature. Tell us about these two worldviews and where they come from.

Raj Patel

Actually, it's one worldview that is about hiding humans away from the rest of the web of life. And in fact there’s a pluriverse of different cosmologies. There isn't one sort of indigenous worldview that has everyone getting along very well with nature, like a Disney cartoon. But the story that we tell is a story of how one worldview conquered many others. And that process of conquering was about European colonial capitalism. Also, as a reminder, if we're interested in medicine, then it's important to remember that colonialism very consciously erased other forms of knowing about medicine and other forms of being in the world in which medicine was omnipresent.

So here's the story. Capitalism is always looking for things from which to make money. And things don't become things by magic. You have to have a cosmology, a series of stories, that tell you that this thing is, in fact, a thing. It's not a human being. It may look like a human being, but, in fact, it isn't Christian and so therefore it isn't quite possessed of the same rights as a proper human being. Or this human being doesn't own property, and so it's on its way to being a human being, but until it owns stuff it's not really entitled to the same kinds of privilege. Or this human being is a woman and therefore doesn't have any place in the public sphere and must remain in this newly-created sort of private sphere of the household.

So the history of capitalism is a history of narratives. And it's a history of violent narratives, and of the kinds of development of police forces in order to enforce those narratives. You see the intentional destruction of other ways of knowing how humans fit into the web of life, and what our stories are with relation to other beings. So the story that Rupa was just telling–the sort of heartbreaking stories of someone who has lived as a white working class person exposed to the horrors of industrial chemistry, and yet their body is the site of victimhood and therefore, to some extent, they're to blame. Whereas we never hear the narratives of how it is that colonial capitalism predisposed and subjected her body to the kinds of insults that would generate these kinds of mysterious inflammations.

Emily Silverman

There was a quote in the book that said, “What was once alive with personhood–a forest, a river, a mountain–becomes inanimate, disconnected from ecologies, open to exploitation. It's easier to scoop the heart out of a mountain when it's a resource, than when it's a living relative.” Tell us about this idea of a lake or a mountain being a relative, because I thought that was so beautiful.

Rupa Marya

When we spoke with Chief Caleen Sisk, who’s been doing beautiful work with the Winnemem Wintu–she's the Chief of the Winnemem Wintu, the people of the mountain Shasta, what we call Shasta, they call Bulim Phuyuq. But Chief Caleen, has been doing a beautiful project called Run4Salmon, connecting the people all the way from where the salmon enter the San Francisco Bay, up the river, all the way to McCloud at the base of Mount Shasta.

And when she was talking about how, you know, back in the day, at the early ages of the US colonization on the east coast all the salmon had been killed. So they came to the west coast to figure out how they breed in order to be able to farm the salmon. And when Livingston Stone came, this fish expert person came, to speak with the Winnemem Wintu, they shared, “Well, this is how they swim up river. And this is how they spawn. And this is how they die. And then their bodies feed the next generation.” First of all, they didn't believe them, because that's not what Atlantic salmon did. And then they saw it. And they were, like, “Oh, I guess these indigenous people are right.” And then they learned about the spawning. And then they left. And they took that information to create fisheries where they wait for the salmon to show up, they club them on the head, they rip out their eggs, and do this artificial insemination in a stainless steel bowl, and create these smelt that have different kinds of genetics than salmon that are spawning in the wild.

Chief Caleen says, “And then they left and they didn't hear about the songs and they didn't hear about the dances and they didn't hear about the way we light the fires all the way up the way and that every tribe had their duties to the fish at that time as they go through.” And that these are long-standing ways in which you're obliged to return the gift that the salmon give to the people. Because the salmon are giving their lives, they're giving their eggs, they're giving their bodies so that we all might be nourished, so that the forest might grow stronger, so that the bears can eat, so that the humans can eat, so that everyone can eat. And so, in that generosity, there's the obligation and responsibility to care.

And that, so that honoring a river as an individual means that you recognize its personhood, and you have obligations and duties and responsibilities to respect that personhood. And that is not something that fits within a colonial capitalist framework–that water is there for the exploitation, is there to grow almonds and alfalfa to export around the world. This is a time to radically reimagine our farming water use. And so that's why it's such a critical time to uplift the narratives of people like Chief Caleen, who've been understanding that that water is a person for thousands of years, and that those narratives can actually help guide what are sensible policies, as we all live here on these stolen lands.

Emily Silverman

I'm glad you brought up the example of the salmon because that was one of my favorite examples in the book. And also, a year or two ago, I watched a nature documentary about the salmon run. And at the end of it, I was just, like, sobbing. It's one of the most emotional documentaries I've ever seen. And so I encourage any listeners to track that down and watch it because it's such a powerful example of how everything is interconnected. And I was wondering, maybe to either of you, if you could expand a bit on this idea of an indigenous people living on a land and having a deep sense of knowing of that land, and these stories, and these narratives that are passed down from generation to generation. And what happens when that relationship and when that knowledge is ruptured or severed?

Rupa Marya

Well, we just have to look at the incredible work of Corrina Gould saving the West Berkeley Shellmound, that's happening right now. And I'm using the examples that are local to here in California, but there's so many examples in every locality around the world. But the work that Corrina is doing, as a Lisjan matriarch of what was called Ohlone people, is actually bringing back those things that were purposefully suppressed through colonial orders. Colonizers had to justify that the people who are here, who had deep ecological knowledge of how to be in good relationship with all the systems here, somehow were illegitimate on their own homelands, so that those lands could be stolen and that those people could be forced to move off those lands and those lands could then be exploited. The salmon population plummeted within a few decades since the formation of California, because fisher-people just put their nets along the Sacramento Delta and just caught everything that came in and canned them up. And that was it. So there was just a very narrow-sighted look. You know, the beaver population fell. Everyone wanted to have a beaver hat. The grizzly population is gone. I can't believe the mountain lions are still here. We just saw one on our farm. It just blew me away to see, oh god, they're still here. And that's what it is, it’s like, they're still here.

Our Ohlone people, our native people of this area of what we call the Bay Area are still here. They are reconnecting to land, they are getting land back. They are reconnecting to their ancestral ways of knowing their foods, their medicines, their languages. And so, for me as a settler, someone who was born here from Punjabi immigrants, it's been such a deeply moving experience to witness this happening in my lifetime. In our lifetimes we're watching this reemergence, this reawakening. And what a lot of our friends will say, like our Ramaytush elder, Cata Gomes–that's the original people of the San Francisco peninsula–she will say, you know, “This is a beautiful moment, and an extremely painful moment, because you realize all that's been lost, all that's been lost.” And when our friend, Nemonte Nenquimo, who's an indigenous forest protector of the Amazon–the Waorani people–came to visit this farm we're working to give back to Ramaytush people down on the coast, she said, ”This is exactly how you get all that knowledge back. You just bring children to the plants, you bring children to the plants, you bring people to the land, and you just sit and you listen. And like when you start sitting and listening, and you start that storytelling, again, these things are, are still there, we're just not tuned into it.” And so that's the amazing thing that we have been witnessing. And part of the deep medicine is that people are reconnecting to these understandings, and absolutely need all of our support to do that important ancestral work, so that we can all learn how to be better guests on their land.

Emily Silverman

Raj in the book, you talk a lot about the exposome and its impact on human health. What is the exposome?

Raj Patel

The exposome is the sum total of exposures–technically, from conception on, but actually shaped by the world that exists before you are conceived–that arc through your life, that influences the extent to which you will be healthy or be unwell. And the idea of the exposome is a way of looking at histories. It's a way of looking at structures of power around individual bodies, and to understand how stories matter in that interaction. Because we're talking about the exposome in relation to inflammation. And again, inflammation is the body's response to damage or the threat of damage. The threat of damage is a narrative phenomenon. When you're in your house, and there is a knock at the door from a government employee that can be narrated a number of different ways. If you're white, and the government employee is someone nice from the post office, then you've got a birthday card. This is a happy moment. But if you are working class, a person of color, worried about being able to make rent and you've fallen behind, and the person that at the door is a white marshal ready to kick you out, then that same knock portends very different inflammatory responses.

So the exposome is both absolutely the exposure to toxic chemicals and to gun violence and to low-paying jobs and to the light of the night shift. But it is also the series of exposures to stories about how you belong in the world, particularly if you are in a group that has been historically oppressed by capitalism.

We delve deep into thinking about, for example, the microbiome and how it is that indigenous microbiomes, particularly the Yanomami community and nations in southern Venezuela and northern Brazil, are able to have such a range of diversity in their guts. And that's very strongly associated with low levels of inflammation. We're not making the causal argument at the moment because the science isn't there yet. In the global north, our microbiomes are denuded to the extent that they're associated with very high levels of inflammation, and the lack of diversity that we have means that even the most privileged white folk in North America still live with denuded microbiomes.

And of course, just as our book came out, something that we prophesied in the book came to pass, where there was a report in the New York Times about some folks, I believe in Stanford, who had decided that what they wanted to do was re-wild folks’ microbiome by essentially stealing indigenous poop from the Yanomami community and turning it into a pill and encouraging its ingestion. And, of course, that's a return to the narratives that we were mentioning before, about how Western medicine is really about understanding your body as isolated from the web of life, and then if anything needs to be remedied, some boffins will come in and give you the pill for that. And, in that example, it's an utter travesty of a representation of how it is. And, in fact, the better way of having a rich microbiome is not to have annihilated the plants and animals and beings around us that would have given us that rich microbiome. This is a long way from coming from the exposome. But, in a sense, the same thing. The reason the exposome matters so much for our story is both for the material and biological interactions and friendships that we lack, but also the narratives around domination that form an integral part of our body's inflammatory response.

Rupa Marya

And I just want to add to that, that when you're looking at chronic inflammatory disease, the exposome is more predictive than the genome for developing these diseases. But medicine will obsess on individual precision therapies, when the exposome, this is where the disease is being caused. And this is not where we're looking. Because when you look at the exposome, you're looking at how power is structuring the world to predispose certain bodies to poor health outcomes. And that requires contending with power. And so the exposome is a critical place to put our diagnostic lens on. That's where we need to zoom out and offer that level of diagnosis. If this is what is more predictive of chronic inflammatory disease, this is where we need to be putting our attention–to reimagining our world so we don't have to live with these diseases–that dementia is not normal aging, it's inflammatory aging; that diabetes is not a normal thing that everyone has to get. We're getting it because of systems of oppression that are making us unhealthy. So why do we have to be saddled with debt when we're leaving our educational institutions to launch our careers? We have been sold off into indentured servitude for most of the rest of our lives, worried about making those payments. Why do we have to be in debt to have a safe, secure home? Why do we have those structures? What do they coerce? Who do they serve? And who do they harm?

Emily Silverman

It's so powerful to hear you talk about the genome and the exposome, and modern medicines’ obsession with the genome and precision medicine, and targeting fancy therapies just for your cancer. And the blind spots around just very basic things like nutrition, movement, housing, and communal living, rituals–even song, dance, you know, things that are very basic human things. And I'm wondering why you think we are so obsessed with this precision medicine, genetic piece. I know that you said that a lot of it is about power, but maybe you can expand on that a bit. For example, I know that at big academic medical institutions, people are rewarded, with grants and money and promotions, for pursuing fancy biomedical research. But people who are interested in community engagement, for example, or public health, population health, aren't rewarded with similar career advancements. So can you expand on what that's about?

Rupa Marya

Well, capitalism. So you can't commodify community engagement. You can't commodify how to collectively organize to shut down the foundry in your neighborhood that's poisoning the air, that'll make people a lot healthier once it's gone. And, thankfully, we shut it down. Sorry, Raj, it's heading to Texas now. Those are not things that can be harnessed and exploited through capitalism. These are descriptions of power. These are who's disposable and who's not. Who's in the sacrifice zone? You see the same dynamic with the unwillingness to act on climate. In those lines of here and there, we're circumscribed in a time of colonial arrangements that we are still living with. And when people say, “Oh, colonization happened then, this is like an old story. It's all done. Why are we still talking about it?” Because it's not true. Colonialism is a set of relationships that are enacted every day, in the ways in which we negotiate power. And modern medicine doesn't want to contend with that, because modern medicine is an institution of colonial power.

Transformative measures are what we need to abolish the harm, and to start making the system work for all people. And that is really what our call is for in the book. So that, yes, it is good to advance our knowledge along the lines of genetic information. And, yes, we should look at increasingly precision therapies and simultaneously, we should go the other way, and look expansively at, “Why did I just help a 35-year-old die of the most aggressive form of colon cancer I've ever seen. I've been a doctor at UCSF for 20 years, I've never seen this. And now I've seen three cases in the last year. What's going on?” It's not that all of a sudden people's genes went on the fritz, it's environmental. What does that mean? We have to contend with, we have to contend with the ag lobbies, we have to contend with pharmaceutical companies, we have to contend with pesticide companies, we have to contend with all of these interests. We can't even get single payer in California. Even within the healthcare industry, we can't even–it's very challenging to amass the people-support that's needed to overturn these systems of violence that were set up a long time ago.

Raj Patel

And I do think that there are certain things that are difficult for the enterprise of medicine to recognize of itself. And so to point out to medicine that your enterprise is a capitalist one is, it's an uncomfortable thing to say. I mean, you know, I was at Berkeley talking about the food system. I said the word “capitalism,” it was as if I'd farted in a lift. No one loves saying it. But that itself is rather intriguing, isn't it? Here's a word that's central to everything that we do. And hearing it makes you wince. What's up with that? And I think that, unless you understand it, then the sort of tumbling initiatives I see falling out of medical schools around the world, where all of a sudden it's been recognized that food is medicine, we should do something about that. But almost all of those initiatives fail to recognize that, in fact, the food that comes out of the food system is based on systemic exploitation. In the United States, 7 of the 10 worst-paying jobs in America are in the food system. People who are working in the food system are exposed to things like the need to take payday loans. And if you take a payday loan, where you borrow $300 and you have to pay $800 at the end of the loan, that is generative of inflammation. And there was a study again, that we found that if you were to abolish payday loans, then the suicide rate would drop by 2.1%, and the death rate from accidental drug overdoses would drop by 8.9%.

Now, you can either have the food for your food-as-medicine experiment and not touch that, or you can start recognizing the fact that, actually, that food only comes because people of color, predominantly, and the working class, are desperately exploited in order for that food to be so cheap. And that should again give you pause if your food-as-medicine initiative isn't really recognizing that, in fact, the food system is built to make harm. It's not a bug in the food system, it's a feature. If you don't recognize that it's a feature of the food system to generate the systemic inflammation, then your food-as-medicine initiative is going to just stigmatize the poor for not eating enough kale, but not really do anything about addressing the structures that produce the kinds of disease that your food is meant to treat.

Emily Silverman

Toward the end of the book, you propose the solution of abolition, and you just mentioned abolition of a certain type of loan. But, just zooming back a bit, when you talk about abolition. Abolition of what?

Rupa Marya

Like so many of the Black scholars, especially the Black feminist scholars that we quote in the book, abolition is a creative process. It's about imagining worlds where the features of this oppressive system are not necessary. You don't need prisons, when you are investing in your Black community with education and healthy foods and opportunities to live in beautiful places that create health for people. You don't need to have medicine that is exclusive, when you have a healthcare system that brings everybody inside and takes care of them all. You don't have to have a housing crisis if houses are not used for speculation, but they're used to house people and shelter people. The abolitionist framework that we're talking about is one of radically reimagining the world. Which is why we talk about, in the book, the importance of engaging our imaginations as humans and also our collective imaginings in the communities that we live in, in the groups that we organize with, in the ways in which we heal. That imagining and moving those imaginings into reality are really critical work that we all must do right now. We would not be facing these wildfires in California if the original stewards of the land were stewarding the land. The climate catastrophe is coming out of this cosmology that somehow situated people above the entire web of life, and we see what happens when we do that. It's unsustainable.

Emily Silverman

I love this idea of engaging the individual imagination and the collective imagination, the idea of this being a creative act, a generative act, but when I imagine all of those things you just said–housing, food, poverty, it just feels so big. It kind of feels like boiling the ocean, and it's hard to know where to turn or where to start. And so I'm wondering, what's an example of an imagining that somebody has come up with and put into practice that has been successful, that we can look to as a model.

Rupa Marya

Well, there was one in Minneapolis during George Floyd where a bunch of medics just took over a hotel that was vacant because of the pandemic, and militantly occupied it and moved in a bunch of unhoused people. And now that hotel is within a trust, and it's become a place where it's sheltering unhoused people. So there's that, where it's, like, “Okay, what if we did this?” And then we do it. And now this is what it is. Other imaginings that are successful are in the Land Back work that we're seeing right now. Historic movements of land going back to indigenous people, and them having the opportunities to reconnect with their ancestral ways of stewarding land, stewarding water, stewarding living relationships. Other exciting examples are in the food system. And, Raj, maybe can you talk about some of those?

Raj Patel

Yeah, in Malawi, for example, I worked with an organization called Soils, Food and Healthy Communities. And it started off as one of these interventions about, maybe we need to make sure that, that poor folk are eating the right food, but it ended up being a transformative process where, in fact, the community became researchers. So they dissented the idea of the graduate student from the outside coming in and bringing wisdom, and instead they became researchers of what's called agroecology. And that's an important term, you'll hear more and more of it as we go through the century, because it's a much more sustainable way of growing food than industrial agriculture. It builds soil fertility. It's much more generative of biodiversity. But it's also one of these things that isn't just a series of practices about building and nurturing the soil and building and nurturing water, but it's also transformative in social relations.

Some of the experiments that the community did were about ending patriarchy. And in the end, through a series of attempts at different ways for getting men to recognize our patriarchy, they've managed to, by many measures, have men who are equal partners in the home. And, as a consequence of which, you see much better indicators for things like, sort of, well being, and the kids are better fed, the fields are much more productive. Everything is better in these households once patriarchy has been removed.

One of the activists that I followed in the film project that I was doing for 10 years called The Ant and the Grasshopper, the lead character is a woman called Anita Chitaya. And she uses the Bible like a ninja. Everyone there is deeply faithful. And so when she says, “Well, look, you've read Genesis, right? Adam and Eve, they're meant to be equal. God made them to be equal. How can you treat Eve so unequally when God made Eve as your helper and, and there is no way that you can let your helper suffer with so much work.” And so by reading the Bible as a radical call for equality, which, you know, it's a stretch, but Anita can do it, she's able to use certain kinds of narratives that are shared in order to bring about a world that is genuinely shared. And that mirrors the ways that liberals tried to persuade conservatives that climate change is real. It's like if you bang people with enough statistics about CO2, somehow their views will change–that's bad storytelling. And the good storytelling is precisely about how it is that we're knit together in the web of life. It's about recreating the kinds of cosmologies that capitalism has destroyed.

Emily Silverman

It's exciting to hear about these projects and these leaders who are popping up in different neighborhoods in different parts of the country, and even the world. I'm wondering if there are any, like larger regions of the world or even countries in the world that aren't inflamed or places that we should be looking to for inspiration? You mentioned Blue Zones in the book. Should we be looking at that and emulating that? Or is there a larger model to look at?

Rupa Marya

Well, we take issue with even just the creation of the nation state, so I don't think we would talk about countries necessarily. But there are definitely communities and there are watersheds. There are bio-regions. And there are First Nations people up north who have addressed youth suicide by reconnecting people to land, and it's been extremely successful. There are communities who are blending western psychology with indigenous wisdom and knowledge, up in the east side of Vancouver, and finding tremendous success in the healing of women surviving intimate partner violence. There are folks who are learning job training and agroecology to address substance use disorder. So these things are happening in pockets all over the world. And I think that part of the work that we are doing with the Deep Medicine Circle, which is an organization that came out of this last chapter writing the book–I finally got together with some friends and formed a nonprofit, worker-directed organization that's women-led, to address the wounds of colonialism. And so we work on food, medicine, story, restoration, and learning. We work on all those levels. And our Land Back work on this, what is called now the San Gregorio coast to move 38 acres back to the hands of Ramaytush Ohlone Organization or Ramaytush Organization. Sorry, Ohlone is a colonizer word. I was told by Cata Gomes, who's the elder, she formed the Muchia Te’ Indigenous Land Trust to hold this land. So the land has already returned to her sovereignty.

And so that work that we are doing with her, to farm food to give away to our community, decommodifies the food. So the food is returned to a relative. The food is returned to something that's there to nourish us, not something to make a buck off of. And part of the work we are doing with Farming As Medicine, that's the name of the project, is actually creating a toolkit, so that in three years we can get together with other communities and other watersheds and other bioregions, to come together and say, “This is how we did it. This is how we brought together municipalities and indigenous people and farmers and activists and landowners, all together, to move the power structure very intentionally to something that creates climate health, human health, economic health, and reparative justice. And so I don't think that these things will happen on a country-wide level. I don't think countries were formed for that purpose. But I think that these things can happen on a bio-regional level, and they absolutely already are happening, and should continue to happen.

Raj Patel

And you mentioned Blue Zones, which are these areas around the world where through a sort of a series of almost magical confluence, people get to live incredibly long lives. And as far as we can see, it's because people have friendships, and they have access to fresh food, and they exercise every day. And they haven't in various ways been contaminated with the sort of evils of the modern food system.

One of those places is Okinawa, where, particularly for women, the average expected lifespan was in the 90s. There are lots of women over 100 and lots of men too. But what we noticed also is that that's transforming. It's falling. The number of people living that long is dipping, to the extent that you now have grandparents burying their grandchildren. And what's driving that is, again, the sort of colonial extermination of the ways of life in which people could fish and farm on their own land, and build these friendships and move freely about the island. And that's in large part because one of the largest US bases in the Pacific–the Futenma base–is right on the very best farmland on that island. And so all of a sudden, you know, people do cut through the wire fences and plant some of their stuff surreptitiously. But in general, it's really hard now that there is a US base, and the crappy food that comes with it, to be able to eat as an Okinawan used to do 100 years ago, because that world has been colonized and it is gone.

But there is a moment of hope here, which is that actually, if you talk to the Okinawan food activists, what they want is decolonization. They're very clear that what they want is the base to go away. And so that they can get the bloody land back and to stop epidemic levels of everything from violence, and particularly rape associated with the military personnel there, to a food system that works, on land that they can have back, and dignity that they can have. They've been colonized by the US by China and Japan. They're fed up.

Just as the book came out, I remember we were talking to Mark Hyman who was off to a Blue Zone in Sardinia, and then he couldn't go because it was on fire. These Blue Zones are in places that are precarious, and they suffer from climate change no less. And the thing that seems prophylactic to that is not just having a long lifespan, but organizing to seize power. And this gets to the point that you were making earlier on, Rupa, that what we need is not merely a series of habits that we can transplant from one area to another. But we need a series of stories about how we belong and how we belong in charge together, in a sort of mode of equality with not just our fellow humans, but for the more than humans who are around us.

Emily Silverman

The part of the book that describes this process of reconnecting indigenous people with their land, tapping back into that ancient knowledge of the land, reinvigorating some of those stories in those narratives, was really powerful. And I'm wondering for people listening, myself included, who do not identify as indigenous, how do we fit into that story? I was adopted. And so it was only recently that I even learned what my ancestors looked like or where they came from. Turns out I'm mostly Irish, with some German, and was born in America, the descendant of Irish and German immigrants. So as I was reading this book, I was wondering, like, “Okay, how do I fit into this? Like, where should I be living? How should I be in relationship to the land that I live on and these indigenous peoples?” So, how do you think about that?

Rupa Marya

That is such a tender question, Emily, and I feel that so deeply as someone who was born and raised in Ramaytush territory. And coming from Punjab, my family are from there and they left there because of all the wealth that was stolen from our homelands. And they didn't want their children to grow up in such poverty. So they wanted the opportunities for their children. So we were born here. And when I was young, because I went between India and here, and I was four when I was in India and could feel the presence–you can just feel everything that's ancient is up in your face in India. And then here, I was like, “Well, I feel it here, but I don't see it. And I don't understand, like, what am I feeling?” And then I went through the California education system and got to make my mission diorama. And they didn't talk about genocide, they just talked about, oh, all these native people went into the church, as if it was their choice. And it wasn't until I was in my early 20s, where I started reading more and understanding more, that actually violence had happened here, and that there was an erasure, an intentional erasure.

And so I think the first place for me is just to understand that I'm a guest, and an uninvited guest. And so how do I correct my relationship as an uninvited guest? And then where is my indigeneity in my histories, in my DNA? Where did it go? How was it sequestered? How have I been moved away from my earth-boundedness, because we all came from a place where we worshiped the earth, at some point. Every human has a culture where they were close to the earth, and they understood what kept us healthy and what made us sick. And it might not have been described through the Western medical lens of microbes or infectious disease. But it was an understanding of dynamics and relationships.

And so I think that, for myself, it starts with recognizing where I'm from, and asking those questions about my earth-connectedness from my own ancestry, and where Hinduism was a part of that violence against the Adivasi. And it continues to be part of that violence against the indigenous people of my homeland. So what Christianity did here to indigenous people, Hinduism did to the Adivasi, and continues to do to the Adivasi people in India, the original people.

And so how we understand those dynamics is really critical to correcting where we are, and where our families are, and where our communities are in these power structures. So what's been really beautiful and powerful, which I recommend everyone in the Bay Area do, is to go to the West Berkeley Shellmound. And when you show up there, it looks like a parking lot in front of an Apple store. But when you are there–and you are there with Corrina Gould and all of the indigenous people in the area working to save the West Berkeley Shellmound–they see the structure hundreds of feet high that used to be there. They see the creek that moves through their Strawberry Creek. They see the roundhouse, they hear the language, they see all of these things that we cannot see, because we have been trained not to see or even know that they existed.

And so learning those histories, connecting with the people today who are bringing those histories back into our consciousness so that we might carry the story forward as good guests in their land. So that we might start to ask for permission for things that we assume are our right to do, that we might start moving with responsibilities more than rights, responsibilities of care to one another, responsibilities of care to the earth, and to the water, and to all the beings.

And so that is how I am situating that question for myself. And as I think of my children, and how I share with them their ancestries and where they are. Because, as we see right now, in the United States, history is not a easy subject. Who gets to tell what happened? What's the story that's told? Stories have immense power, which is why poets and songwriters are often targeted in violent fascist coups. That's why Víctor Jara was killed in Chile. So, like, to understand that this is not just, you know, a fuzzy, warm, fuzzy thing. Telling a story is actually keeping a seed of some knowledge alive so that we can understand how power moves, and protect ourselves, protect our communities, so that more of us have the opportunity to be healthy.

Emily Silverman

Raj, anything to add?

Raj Patel

So I'm here in Texas, the state that fought for slavery twice. And I say that just because, as Rupa was saying, history is a struggle to be able to tell different stories. And here that's not a story that certain children are allowed to hear. They're not allowed to hear that, in fact, before Texas was Texas, it was part of Mexico. And then some white people had a cotton empire with enslaved people that they quite wanted to keep. And so they fought the Mexicans and then they fought against the union in order to keep slavery. And beneath that there's this particular part of Texas’ palimpsest of histories of different empires. This was the, sort of, southern tip of the Comanche Empire. And then, before that, it was part of the Coahuiltecan and the Caddo and the Alabama-Coushatta land and then, before that, the Ysleta del Sur Pueblo. And so this is a palimpsest. This is a series of stories upon stories upon stories of nation upon nation upon nation upon nation. And that's important because everyday our children are taught in schools in Texas that we live in one nation, under God. But I think what this points to is what Rupa was saying about cracking the world open to hear and tell different stories about how it is that we belong. And that's a collective process. Often the questions we get about how we decolonize, often keen for an answer where, you know, there'll be a decolonization therapist. You just sort of lie on the couch and we go through our ancestry.com answers. And then somehow, we figure out how it is that we've been implicated and that our ancestors are evil. I mean, my ancestors, and my living relatives, are Hindu supremacists. I mean, I know that they're on the wrong side of history. But the process of decolonization is about the care for certain kinds of narratives and stories that are the healing narratives, that we are daily prevented from hearing–that is, in fact compulsory not to hear in schools. And so when we hear those many nations and their many stories, we recuperate some of that. But it is a fight. As I say, here in Texas, there are certain things you're just not allowed to say, which is why it's very important to say them.

Emily Silverman

There's a quote in the book that says, “Practitioners of modern medicine are not trained to be healers. They're trained to be biomedical technicians.” The Nocturnists’ audience is largely healthcare workers. So, in closing, what final message would you impart to our audience? We have doctors, nurses, medical students, other types of healthcare workers. Obviously, they should go out and buy the book and read it. But any last words for them?

Rupa Marya

I would just say, first, thank you, everyone for your service. And I am feeling how heavy these last few years have been for all of us who've been on the frontline, and I am wishing for all of your healing. And I know that you probably won't find it by going to your doctor. You'll probably find it by reconnecting with the beautiful world around you, through your friendships, through your families, through gathering, through eating delicious food that nourishes you, through pouring yourself a cup of herbal tea that will help soothe your frayed nerves and give you some good energy, through good rest, through the opportunity to know that you will make it through this and that you can rely upon all of us who have been through this, that we are a collective of humans who have had a very extraordinary experience over the last few years. And that the failures of modern medicine are on full display right now. When we look at the 1 million deaths in the United States, we can definitely applaud at the vaccine, applaud at the therapeutics that we have available, but also look very critically at why in the US with such a, “advanced healthcare system,” we would have such failure to protect so many people. And so I just urge all of my fellow health workers: let this moment sink in us and allow it to open our eyes more deeply, to advance a higher order of diagnosis that looks into history in the lines of power, to see how they're leaving their traces in the bodies of every patient that we see, and in ourselves. And not to be afraid to look there and not to feel overwhelmed when we look there, but to start asking the questions that we've been trained to ask in terms of what is the diagnosis, and therefore what are the therapeutics? What are the things that we can do? And how can we do them within our own bioregion, or maybe our own neighborhood, that we can start working together very locally, and in our own immediate environments, to start bringing about some healing that we all can participate in. And so I've been enjoying meeting more doctors and nurses and other frontline workers and students and trainees who are hungry for a different kind of medicine. And what they are hungry for is deep medicine. They can see the futility of the tools we've been given when we don't address the larger context in which our lives are occurring.

Emily Silverman

Anything else, Raj?

Raj Patel

It would be churlish to try and follow that up. So I think it would be important for Rupa to have the last word.

Rupa Marya

Don't be churlish Raj. Oh my god, I miss you. I can't believe he was just in this room yesterday.

Raj Patel

I’m sorry for the smell.

Emily Silverman

I think we're gonna keep that in. I have been talking to Dr. Rupa Marya and Raj Patel about their book, Inflamed: Deep Medicine and the Anatomy of Injustice. Rupa and Raj, thank you so much for being here today.

Raj Patel

Thank you so much, Emily.

Rupa Marya

Thank you Emily, so good to see you.