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 Table of Contents  
Year : 2020  |  Volume : 36  |  Issue : 5  |  Page : 102-106

The 'othering' in pandemics: Prejudice and orientalism in COVID-19

1 Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
2 Department of Psychiatry, Pushpagiri Medical College and Hospital, Pathanamthitta, Kerala, India
3 Department of Psychiatry, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India

Date of Submission10-Aug-2020
Date of Acceptance13-Aug-2020
Date of Web Publication02-Oct-2020

Correspondence Address:
Dr. Debanjan Banerjee
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijsp.ijsp_261_20

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Pandemics are not just medical phenomena. They affect the society at large, having long-lasting psycho-social implications. Throughout history, they have led to stigmatization, prejudice, “othering,” and blame. This amplifies hate and socioeconomic divisions, and the effect outlasts the outbreak itself by years to come. Traditionally, humankind has always fared better to deal with the pathogen causing the outbreak, rather than the resultant stigma and prejudice. In the pursue of biological cures for the infection, this vital social implication is unfortunately neglected. The coronavirus disease 2019 (COVID-19) has emerged as a global public health threat. As international borders are sealed, economies slashed, and billions quarantined at their homes in an attempt to contain the spread of infection, history repeats itself in the prevalent marginalization, blame, and stigma that are more contagious than the virus itself. This commentary traces back through the past to look at examples of orientalism and colonialism in pandemics and the resultant stigma, and also to highlight global perspectives of the prevalent prejudice in this current outbreak of COVID-19.

Keywords: Coronavirus, COVID-19, orientalism, othering, pandemic, prejudice, stigma

How to cite this article:
Banerjee D, Kallivayalil RA, Sathyanarayana Rao T S. The 'othering' in pandemics: Prejudice and orientalism in COVID-19. Indian J Soc Psychiatry 2020;36, Suppl S1:102-6

How to cite this URL:
Banerjee D, Kallivayalil RA, Sathyanarayana Rao T S. The 'othering' in pandemics: Prejudice and orientalism in COVID-19. Indian J Soc Psychiatry [serial online] 2020 [cited 2020 Oct 26];36, Suppl S1:102-6. Available from: https://www.indjsp.org/text.asp?2020/36/5/102/297155

  Back in Times: the Case of “typhoid Mary” Top

In the early 1900s, a sanitary engineer by the name of George Soper was requested to investigate a strange outbreak in New York. Typhoid, as it turned out to be, and as we today know is a bacterial disease caused by  Salmonella More Details typhi, was then recognized as an emblem of “poverty and filth.” Concomitantly, it was considered to be unique to the slums, homeless, and laborers being equated to dust, dirt, and lack of sanitary hygiene. Parallelly, the Long-Island of New York started reporting plenty of new cases of typhoid, and without any apparent known cause. This generated mystery and unsettling emotions about how an apparent “illness of the poor” could affect one of the most affluent and posh sections of the society.

After starting his inquiry, Soper made an interesting observation. A middle-aged Irishwoman named Mary Mallon could be traced back to at least eight of the families who contracted typhoid. She worked as a cook and would change the family the moment a new case of typhoid broke out in them. Mary herself was, however, completely healthy and showed no symptoms of the disease. Understandably, Soper was excited to pin the source back to where the society thought it belonged to, the lower socioeconomic class. A manhunt followed, Mary was stalked to her residence and finally accused of being responsible for the outbreak. Soper wanted her to undergo medical testing, and when she refused, the police arrested her. Her blood, urine, and fecal samples were collected almost forcibly, and she underwent a detailed physical examination. All these were totally based on a hypothetical conclusion that Soper had made. Though Mary's physical examination was completely normal, her test reports came back showing the presence of the causative Salmonella bacterium. This proved her “guilty” in the society beyond doubt. That was the first time that “healthy carriers” were described: people who carry the disease-causing pathogen infecting others while themselves stay asymptomatic. George Soper got the credit for this discovery, while Mallon continues to be a figure of social disgrace known till date as “Typhoid Mary.” Mentioned in most medical and epidemiological textbooks, this term stigmatizes a poor, migrant woman who was also a talented cook. She had totally no idea that she was carrying the infection, but the violence and coercion against her was justified, which would have been so much against the “code of ethics” that we follow for medical examination and testing. The media and the society including the medical school portrayed her as a “mass-spreader” like a “mass murderer,” accusing her to have infected around sixty cases, three of whom died. The true numbers were sadly never corroborated.[1]

Mary Mallon continued to be cornered for the rest of her life being tested and questioned multiple times for something she knew little about. She was kept in quarantine on Northern Brother Island for 26 years till her death. Her fellow mates and hospital staff never stopped viewing her as “guilty” of being the “carrier of infection.” Typhoid was re-affirmed as an illness of lower social strata as the higher classes heaved a huge sigh of relief. Unfortunately, the illness was not new to the city, but Mallon was labeled as “deadlier” than the bacteria itself. Only much later did Bourdain,[2] her fellow chef, point out that she had just done her duty in spite of all odds and was totally unaware of being the causative factor for the illness in the families. Her true fault was probably different: setting a reminder for the affluent society that infections did not choose based on wealth and power.

  The Concept of “othering” and Social Stigma Top

”Othering,” originally a philosophical concept relating to distinction of personal identity from the “other” thereby creating a sense of “self,” has eventually generated the “we/us versus they” dichotomy of the social divide.[3] Edmund Husserl, the founder of phenomenology, conceptualized “the other” through intersubjectivity, that explains the differences between races, castes, ethnicity, religions, etc.[4] Eventually, othering has formed the basis for labeling and disenfranchising the “vulnerable” minorities based on any characteristic, thus leading to the alienation and marginalization of “the other.” Over the years, territorial conflicts, violence, communalism, military disputes, diseases, famines, social divisions, and racism have been rooted in the processes of othering and social stigma. Throughout history, “othering” has also led to the genesis of imperialism, colonialism, sexism, gender dichotomization, and cultural subordination (the “subaltern natives,” who are socially, politically, and geographically beyond the hierarchy of power and hence exploited by the privileged sections).[5] Goffman while hypothesizing stigma, emphasizes on the social discredit of an individual or a group by virtue of them being “undesirable other” by the society.[6] Socio-political and economic hierarchy, generalized apathy, discrimination, and blame perpetuate this othering further, especially at times of crisis like wars or epidemics, where the “othered” are held responsible for the “social condition.” This plays an important role in the attributional bias that makes the higher socioeconomic classes assure, secure, and safe by displacing the prevalent tension onto the discriminated lot. This can further give rise to self-stigma among those who are “othered,” leading to their impoverishment, human rights violation, and social injustice: all of which can have intergenerational effects and serious psychosocial consequences.[7] The subsequent section deals with the perpetuation of othering at times of infectious disease outbreaks.

  “Othering” in Pandemics: Perspectives from History Top

Pandemics repeat themselves in time. The basic evolutionary need is to live and thrive, the same applies for the pathogens causing these diseases. Death of the human host is only a small fraction of the outcome. The resultant morbidity, social chaos, widespread panic, and crashing of public health infrastructure are the main offshoots of such large-scale outbreaks. After the initiation, eventually, there is an uneasy bio-psycho-social symbiosis with time for the mutual survival of both humankind and the pathogen. However, the psycho-social impact is far beyond just the organs affected or the symptoms. Such illnesses do not discriminate between social, racial, ethnic, or economic classes, and the impact is widespread. Conventionally, whenever a pandemic has struck the world, there has been stigma, prejudice, and marginalization with harmful effects for months to follow.[8] Here are few examples of the same.

During the classical “pestilences” or the Bubonic Plague of the 13th century, the Catholic Church blamed the Jews for poisoning the water and spreading the illness. The “Black Death” was proposed as an alleged attempt by them against Christianity and the “guilty” included the vulnerable and impoverished sections of the society. Many were not treated, not received at hospitals, and simply left to die based on their socioeconomic position. There are descriptions of corpses pilling up to close one end of the road, but still they were not touched or even buried based on the fear that they are contagious even after death.[9] Areas such as Basel and Strasbourg witnessed the burning of many Jewish people as the punishment for the “plague.” Even Camus has spoken about increased “death anxiety” in the rich which leads to “death denying behaviors” such as “othering” and blame.[10] Similarly, people in Rome, Italy, faced such persecutions being labeled for being responsible for the plague. Their movements were restricted, rights were curbed, and they were termed as “Zingaris” (a pejorative term for the Romans).[11] In addition, in the medieval Europe those who were practicing alternative forms of medicine and faith healing were accused of “witchcraft” and many were burned or buried alive with the same blame. Historical estimates set the number of prosecutions to be around 1 lakh, though the exact numbers are unclear. The majority were, however, women from low-income families.[12]

Eventually, the germ theory and the advent of microscope helped the society understand that specific pathogenic agents are responsible for illness, not a particular “class” of people. However, soon enough, the science of microscopy was buried in colonialism. The “Tropical regions” were prone to various vector-borne diseases which horrified the Anglo-European colonizers. Mosquitoes, ticks, bugs, and rodents were associated with Asian and African colonies, and the fear was rampant that Western countries will eventually contract them. As a result, people who were degraded or punished in their own countries would be deputed for duties in these colonies with poor access to health care and restrictions on return.[13] The Asiatic Cholera (1817), the Asiatic Plague (1846), and the Asiatic flu (1956) are examples of diseases being tagged with certain “areas” even though the outbreak was all over the world. On similar lines, Vibrio cholerae, the causative agent of cholera, was linked to the intestinal tract of a colonized native's “tropical” body as the outbreaks were more pronounced in the Indo-Gangetic belt. It was further termed as “Indian Cholera,” linked to poor dietary and sanitary conditions, “waste” lands, and “nonsophisticated” men.[14] The other classical example would be that of leprosy, which has traditionally been a disease of stigma, hate, and marginalization. The affected were considered “sinners” and were socially outcast, as the upper classes did not want to publicly notice them. As a result, they were victims of neglect and faulty treatment. Even gender separation was attempted to prevent reproduction, as it was wrongly considered to have a genetic basis.[15]

  The Root of Stigma: Epidemic Orientalism and Coronavirus Disease 2019 Top

The World Health Organization (WHO) now has clear guidelines to name an infectious disease. It needs to have generic terms, irrespective of the origin and people affected.[16] However, even of late, the Hong Kong flu and Middle East respiratory syndrome are examples of such “epidemic orientalism.” Humans pay the price for being “social” beings as the hate mongering has always been the inevitable accompaniment of a biological disaster. Epidemics and pandemics tend to be labeled with specific regions, race, class, ethnicity, or even sexual orientation. Infections have historically blurred origins and stigmatized the affected. Naming an outbreak is important as that is how the illness is recognized and called globally. In every reference or discussion, it sets the reminder of prejudice and marginalization. With use over years, people forget its true origin and only remember the “tag” associated with it. Such has happened with “Typhoid Mary” as mentioned before. One of the most stigmatizing infections, acquired immunodeficiency syndrome caused by the human immunodeficiency virus, was long known as “gay-related immunodeficiency.”[17] Also termed as the “Gay Plague,” it was theorized as a punishment for sexual “deviation” in America of the 1980s.[18] This belief has held on to its ground in the legislation of many countries which prohibit homosexual men from donating organs or blood.

History repeats itself. The modern world has rarely seen a global and contagious outbreak like the coronavirus disease 2019 (COVID-19). Within 7 months of its origin, the novel coronavirus has taken the world by its knees affecting international borders, economy, the daily routine, and movement of civilization.[19] The epicenter of this pandemic was in the Wuhan province of China and since then, it has been termed as the “Chinese virus” or the “Kung Flu.”[20] Such terms even when used on a lighter note turn viral, as already information on COVID-19 is spreading faster than the virus itself. Used in social media forwards as jokes or memes, these terms quickly turn into pejorative labels for a region or a country. As a result, Chinese settlements in many countries are being blacklisted with avoidance of even Chinese food and goods. People with Mongoloid features are being cornered and stigmatized in the South-East Asian countries and the United States. Various countries have accused China of being the source of the virus and mis-managing the initial wave of infection, leading to the global pandemic.[20] Conspiracy theories have been rampant about coronavirus being used as “biological weaponry” to destabilize the powerful nations of the world. It has subsequently perpetuated anti-Asian sentiments and xenophobia besides the panic related to COVID-19. The penetration of these theories went to such an extent that the WHO and Centers for Disease Control and Prevention had to give official statements on the falsity of the information.[21] This again is in historical resonance to the Church's vague accusation of the Jews to “produce” the plague for harming the faith of Christianity. Various politicians from Europe have also mentioned the role of migrants and refugees in “carrying and spreading” the infection, leading to the dismal state of COVID-19 in many European countries such as Italy, Germany, and Spain.[22]

In low- and middle-income countries like India with preexisting and prominent caste, racial, and class divisions along with a markedly heterogeneous population, the pandemic situation is even worse. “Social distancing” has incited the old evil of untouchability and people from certain regions are being discriminated against.[23] Racist comments are hurled at them with threats of eviction. Even health-care staff including doctors have faced the brunt, being prevented from entering apartments and losing social circles. They are believed to be “close to infection” and hence carriers.[24] Although the nonresident Indians were returned to the country, thousands of migrant laborers, daily wage workers, and homeless are stranded on different parts of the country struggling basic amenities of living. Many are walking down hundreds of miles to reach their homes due to unavailability of any transport. They are more afraid of not able to reach their families, losing their jobs, and dying due to the hunger rather than the COVID-19 panic.[25] Relief camps and measures taken to provide food and shelter to this already-vulnerable population are ongoing but slow to keep up pace with the increased numbers. Added to that is the mass panic, hoarding of medical goods and medicines, and plethora of misinformation that further leads to anxiety and stigma.[26] Certain recent incidents such as hosing down of migrant workers in Uttar Pradesh to “disinfect” them and the increased number of COVID-19 cases in the Tablighi Jamaat meet in Nizamuddin, New Delhi, have fueled the fire of social-class-based and communal disharmony.[27],[28] People act more irrationally when anxious, and this can contribute to the discriminating, blaming, and competitive behavior. A recent Indian study using the Fear of Coronavirus Scale has demonstrated that fear and generalized xenophobic (communal) attitudes are inversely related to the mental well-being during the pandemic, while collectivism promotes it. The authors highlighted an important area of concern in this socio-politically heterogeneous country, where misinformation and rumor can easily lead to fear-mongering, social prejudice, and communal sentiments, that can be as damaging to public health as the virus causing the pandemic.[29] India like many other South-East Asian countries is on the verge of a community transmission, when all these factors essentially promote the spread impeding the containment measures.

  Conclusion Top

We had long back taken the shelter of science to understand that disease-causing pathogens just need a human body to thrive, irrespective of the typologies. Unfortunately, science itself has been modified to suit the clutches of stigma. Each pandemic will eventually be over, but the resultant social distress and discrimination will last long. The classical example is that of Mary Mallon, who, as mentioned before, lived her life being equated with an illness that lasts till date. Even today, as we fight COVID-19 with the main strategies of social distancing and quarantine, the administration is desperate to enforce the public compliance by stamping the doors, tattooing their bodies, and making their identities public. While all of these are in good faith and isolation is indeed necessary, such social coercion is totally against human rights and moral code of ethics. We do not know what state COVID-19 will leave us in. Irrespective of the numbers affected, the virus might hopefully decrease in virulence and the pandemic will eventually cease someday. The label of this prejudice and social stigma will however outlast it by years, probably till another such infection originates and amplifies them. The human race has fared much better with such diseases than with its internal “blame game” and “othering.” Pandemics might flare up “hate,” but the society propagates it. Viewing this scenario through the lens of “social psychiatry,” it is obviously much beyond the diagnostic categories or psychiatric disorders: preventive approaches using community awareness, social tolerance, and anti-stigma interventions are necessary to protect mental well-being, as much as the medicines or psychotherapy needed to treat them. To fight a global health crisis like COVID-19, humankind needs to be united and that is only possible if it stops viewing an infection through the lens of “socio-politico-economic divisions.”

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  References Top

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