risseTo judge when an emerging pathogen enters the historical record, we look to medical journals and the Centers for Disease Control.

To judge when an emerging pathogen enters the zeitgiest, we look to panicked news reports and conspiracy theorists on the Internet.

By that measure, then, the Zika virus has gone mainstream. Not as an epidemic, mind you, but as an idea, a delivery system for fear.

The new UIP title Driven by Fear, by acclaimed historian of  public health Guenter B. Risse, shows that people have turned disease outbreaks to social and political ends for a long time. Emotions, not surprisingly, play a huge role. San Franciscans turned their house of pestilence—the facility where they isolated victims of plague, syphilis, leprosy, and smallpox—into far more than an instrument of public health. The pesthouse became a dry cell powering the human need to stigmatize, emotional states like xenophobia and racism, and a widespread dread and disgust with the sick in general and the Chinese sick in particular.

As Risse writes:

Fear alone can also be a critical emotion in the genesis and spread of epidemics. In earlier times, the feeling was so universal that physicians actually blamed this emotion for causing bubonic plague. Fear mongering can easily produce panic or terror, enhanced by language that effectively distorts or exaggerates the facts. In a world of constant scares and dangers threatening human survival, basic problems such as mass disease force individuals and societies to develop aggressive means for coping with them, means that are often based on factitious perceptions of risk. Indeed, the employment of military metaphors, especially of the description of diseases as implacable enemies, deadly invasions, and lengthy battles, elicit aversive emotions that translate into demands for belligerent responses. Since its inception, the United States has amply displayed this singular emotional style. In fact, dread has recently been called “one of the dominant emotions in contemporary American public life,” prompting the members of its risk-averse population to nearly obsess about potential threats that could jeopardize their physical safety and well-being and compromise their economic standing. Anxieties about contracting diseases brought to American shores by immigrants continue to be pervasive.

Both biologically and culturally constructed, aversive emotions are considered learned survival skills that evolved over time based on individual and communal human experiences. Most people engage the facial muscles, creating distinctive and spontaneous expressions easily detected and interpreted by other humans living in the same culture. Since they are considered “primal,” these emotions focus our attention on potentially harmful environmental hazards and social relationships. These emotions are guided two processes. The first is the attempt to estimate and gauge the importance and frequency of a particular threat—in effect subconsciously “anchoring” it—while searching for distinctive or “typical” characteristics of danger that would allow future predictions of risk. Second, and most importantly, negative emotions are guided by “examples,” previous vivid and encoded emergencies that are later recalled automatically. Although powerful and lasting, such earlier experiences can lead to notoriously flawed and often skewed responses, particularly if they are fabricated or manipulated by particular ideologies or by political and economic interests.66 Indeed, excessive and unreasonable emotional experiences have played an important role in human history, shaping notoriously biased responses in a hazardous world of crises, disasters, and pandemics.

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