Illness as Intimacy: Rethinking the Ego and the Id

I have recently taught courses that necessitated incorporating biological and evolutionary concepts into my primarily cultural and social approach to medical anthropology. During this process, I was pleased to discover that rather than the seemingly definitive narrative of “survival of the fittest,” the story of evolution is primarily one of ambiguity and overlapping processes of struggle and cooperation. Survival is a constant negotiation and renegotiation of boundaries and influence, and the limits of self and other are always in flux. Lewis Thomas noted that, “Disease usually results from inconclusive negotiations for symbiosis, an overstepping of the line by one side or the other, a biologic misinterpretation of bor-

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ders” (The Lives of a Cell, 1974, p. 76). Evolution is a suspense story, not a parable.

This discovery came at a time when I was particularly interested in two different types of entity that can both become embedded in the human body: demons and microbes. Demonic possession and microbial infection are both conceptualized as invasion, but there is growing awareness of the body as necessarily full of microbes, a complex ecological system of its own. Rather than the constant refinement of human exceptionality, evolutionary processes have produced a body defined by multiplicity, symbiosis, and the ambiguous boundaries of selfhood.

Then, of course, one must consider the demons. If microbes became incorporated into other life forms by virtue of continuous intimacy, is it possible that we have enveloped demons (and other spirits) over time in much the same way? Might other entities have been long nestled within us? Though once outside, are they now considered essential and inseparable parts of the psyche? These questions draw me toward a reconsideration of the early visions of psychoanalysis. Perhaps there is no better picture of struggle, negotiation, and mutual necessity than that of Freud’s ego and id.

Freud and Evolution

Freud was particularly engaged in the idea of biological evolution, and he was also captured by the general trend of the time, envisioning “progress” at its core. Allan Young (“Remembering the Evolutionary Freud,” Science in Context, 19: 1, p. 175) suggests that the “evolutionary Freud” has been mainly forgotten. In “Overview of the Transference Neurosis,” written in 1915 but not published until 1987, Freud discusses how the id is produced at an early stage, with the evolution of the vertebrates; the ego appears later, during the Paleolithic human phase of hunting and gathering. The evolutionary heritage of humankind remains embedded within, and these atavistic elements are variously linked to different neuroses.

Some elements of Freud’s evolutionary vision are quite compatible with current views; for example, it is still relevant to understand the human body as adapted to an earlier Paleolithic era, because it can explain many diseases in terms of a physiological

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mismatch with modern foods and lifestyles. Other elements, such as the imagined hierarchy of civilized Europeans versus “primitives” that may be felt while reading Totem and Taboo, have fallen far out of favor in academic and scientific discourse.

Science is a reflection of its day. Contemporary science has not abandoned the idea of progress, though it now may be expressed more subtly. Neuroscience still categorizes bits of the brain in similar sorts of hierarchies, with emotion and survival instincts located in the “lower brain,” and thought, consciousness, and other hallmarks of “humanness” located in the cerebral cortex. The idea of evolution, hierarchy, and the animal/id versus the human/ego remain central to the conceptions of human pasts, presents, and futures.

What would happen if the id did not come before the ego? Could they both have been outside entities, simultaneously incorporated into all multicellular organisms? Or, perhaps, it is the ego that is the “animal” part of us, and only we humans have acquired a pesky id? House pets notwithstanding, animals do not seem to suffer from the range of neuroses that plague humans. Could the id be a vestigial force, somehow swept into the mix as our ancestors hunted and gathered? Or perhaps it truly was the ego that joined primates along their temporal journey, not developed from within, but incorporated from without. What would happen if the conceptual ties between change and progress were permanently severed?

Endosymbiotic Intimacy

Beginning in the early 20th century, a few biologists started to consider that the mitochondria in our cells look a lot like bacteria. The mitochondria, which generate energy in the cell, have their own DNA, and in humans it is inherited only through the maternal line. This theory was completely against the prevailing orthodoxy of the day and therefore quite unpopular. It was mostly ignored for many years. By the end of the 1960s, the theory of endosymbiosis had become more widely accepted. Bacteria, which were once separate, became incorporated into a cell, and a pattern of mutual reliance—symbiosis—was established, with one participant dwelling fully inside the other. The mitochondria are not something produced from our own genetic path; rather, they are different historical and genetic entities that have become functionally indistinguish-

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able from our bodies.

How does this unexpected cellular intimacy fit within the prevailing idea of evolutionary survival? In the 1970s, Richard Dawkins pioneered the idea of “selfish genes.” This theory writ the “survival of the fittest” paradigm quite large (or, rather, small); Dawkins argued that genes themselves were constantly competing for supremacy. While endosymbiosis increases the reproductive success of both organisms, it is not directly incompatible with theories of selfish genes, but it does lend a cynical cast to any and all forms of mutuality. Using this model, we could imagine the beleaguered ego and id, stuck with each other and with us because alone they cannot achieve resurrection.

Freudian psychoanalysis can be quite problematic for a female scholar. Though most of the overt discussion may be about the penis, the real dilemma is that of the mother-as-womb. How does the little boy fully escape his origins in the interior of the mother to become his own separate, bounded individual? The mother is blamed for the tensions arising from this process of creation, ambiguously endosymbiotic or parasitic as it may be. Perhaps we should treat this story as a dream or a phantasy: what deep fears might it conceal? Are we, perhaps, never to become separate as selves, no matter what we do? Might this complex embeddedness go far beyond the fetus in the womb, all the way to the (maternal) mitochondria in each of our cells?

Demons and Disciplinary Repressions

“We still think of human disease as the work of an organized, modernized kind of demonology, in which the bacteria are the most visible and centrally placed of our adversaries. We assume that they must somehow relish what they do… These are paranoid delusions on a societal scale, explainable in part by our need for enemies, and in part memory of what things used to be like” (Lewis Thomas, The Lives of a Cell, 1974, pp. 75-76).

The accepted difference between a demon and a bacteria or virus is one of intentionality. Contemporary visions of science teach us that germs are not “evil” because they lack intent. Demons, on the other hand, always wish us harm. In making us sick, bacteria and viruses are not enacting a personal vendetta; rather,

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they are trying to survive, just like any other successful biological organism. What would happen if we were to give demons the same benefit of the doubt?

There are certain categories of entity that we are not supposed to combine. Imagine the peer review process for an academic narrative that genuinely believes in everything at once: microbes and mitochondria, the ego and the id, all cavorting alongside demons and maybe even souls! Is there room for psychoanalytic microbiology? Evolutionary demonology? Are the boundaries between academic disciplines resistances? What kinds of discomfort can one produce with unacceptable combinations and through the miscegenation of segregated domains?

We may find that we are all cobbled together of bits—our bodies, our psyches, our families. The intimacy needed for survival can also wear thin. If illness emerges from uneasy symbiosis and uncertain boundaries, then the tense negotiations between ego and id take on new meanings. We can’t escape the past, because it lives within us. Then, of course, one must also consider the demons.

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