- Could the stunning Scottish landscapes you dream of be hiding a silent epidemic?
- Why do we perceive certain places as intrinsically "safe," even when they harbor unseen dangers?
- What if the very ideas we have about health and nature are making us blind to a growing disease?
- Are the "Lyme wars" a battle over science, or something else entirely?
- How did the COVID-19 pandemic make a centuries-old bacterial threat even more invisible?
The Invisible Threat in Scotland's Green Heart
Scotland's landscapes are the stuff of dreams. They are wild, rugged, and breathtakingly beautiful, attracting millions who seek solace and adventure in their heather-strewn hills and ancient forests. We imagine these spaces as fundamentally healthy and safe, a refuge from the concrete jungles of modern life. Yet, quietly woven into this idyllic vision is a stark and startling reality: Scotland has one of the highest incidences of Lyme disease in Europe. This juxtaposition of beauty and danger, of safety and unseen threat, forms the core of a new theoretical framework I call 'geographies of tolerance'.
Lyme disease, a complex multi-organ illness caused by the bacterium Borrelia burgdorferi, is spread by the Ixodes ricinus tick, which thrives in Scotland's lush environment. The disease can manifest in myriad ways, from the well-known "bull's-eye" rash to severe neurological, cardiac, and joint issues. It is a master of disguise, often misdiagnosed as other chronic conditions like ME/chronic fatigue syndrome, fibromyalgia, or multiple sclerosis. The medical establishment's standard treatment is a 21-day course of antibiotics, after which a person is considered cured. However, for a significant and vocal group of patients, the illness persists, becoming a chronic condition that upends their lives.
This medical divergence has fueled what is known as the "Lyme wars," a fierce international dispute between two opposing medical knowledge discourses. On one side is the "evidence-based" camp, represented by organizations like the Infectious Diseases Society of America (IDSA), which maintains that diagnostic tools are sufficient, the bacteria cannot persist after a standard antibiotic course, and chronic Lyme disease is not a legitimate condition. On the other side is the "Lyme-literate" camp, championed by the International Lyme and Associated Diseases Society (ILADS), which argues that diagnostics are often inadequate, longer courses of treatment are necessary, and the bacteria can indeed persist, leading to a chronic state of illness.
The tension is palpable. Evidence-based clinicians have dismissed chronic Lyme patients as "well-intentioned and misinformed," or even "Lyme loonies," while Lyme-literate communities accuse the opposition of controlling research for financial gain, fueled by insurance companies unwilling to pay for long-term treatment. In Scotland, this battleground is evident in the profound sense of betrayal felt by patients, who view their "narrow-minded" doctors as "criminals" for withholding effective treatment. The "Lyme wars" are not just a disagreement over science; they are a legal and political battleground where the very nature of disease and patient experience is at stake.
This medical-social conflict often obscures a critical dimension of the disease: its relationship to the environment. Little research has focused on the landscapes where infections occur. This article seeks to remedy this by exploring the interplay of environment, ticks, bacteria, and humans, drawing on fieldwork conducted across Scotland from 2018 to 2020. I introduce the concept of geographies of tolerance to understand how Scottish landscapes are socially constructed as safe and healthy, and how this perception makes potential dangers, like the Borrelia bacteria, invisible and tolerable.
The framework explores a cyclical relationship: our ideas of a safe landscape render the bacteria within it safe, and the perceived safety of the bacteria reinforces our belief in the safety of the landscape. This is a perfect hiding place for a microbe that thrives on being overlooked. We dream of Scotland's landscapes, but quietly woven into those dreams are the bacteria—in the stories that aren't told, in the absence of signage and public conversation. They haunt landscapes, inspiring defiance, anger, fear, and self-blame among those who are infected. They demand a preparedness that is often absent.
My research began with an analysis of epidemiological mapping in Scotland, which is increasingly making B. burgdorferi more visible. The rise of apps and online participatory maps is creating a new space for collaboration between Lyme patients and epidemiologists. This is a crucial development, as historical tensions have often fragmented communication between the two groups. The intersection of landscapes, people, and bacteria represents an exciting frontier for co-constructing knowledge, moving beyond the entrenched positions of the "Lyme wars."
Through interviews with patients, I found that landscapes become profoundly meaningful in their stories. Patients often create their own "maps" of where and how they became infected, a process that reflects a new understanding of Scottish landscapes along a continuum of defiance, risk preparedness, vigilance, and fear. These personal narratives highlight the importance of place in health and disease. They demonstrate the complex emotions people feel towards landscapes that once represented freedom and health, but now hold the memory of their illness. These stories are a reminder that the dominant, nation-wide social construction of landscapes must be interrogated, and that there are many more patient experiences to be heard.
The concept of geographies of tolerance is not limited to Lyme disease. It can also help us understand the UK's slow response to the COVID-19 pandemic. The UK and Scotland, seeing themselves as intrinsically safe spaces, were slow to recognize the immense danger posed by the SARS-CoV-2 virus. The same belief system that renders B. burgdorferi "bafflingly safe" also contributed to a delayed and inadequate response to a global pandemic. In this sense, the pandemic ironically made Lyme disease even more tolerable and invisible, as public health attention and resources were redirected to the more immediate crisis. The framework of geographies of tolerance can therefore be a useful tool for locating future challenges to disease prevention and risk communication, helping to unmask the invisibility of certain bacteria.
Looking ahead, several areas of research are critically needed. First, there must be a standardization of real-time tick maps for public awareness. While projects like LymeApp and the "What Makes a Virus Tick?" TickMap is promising, but more research is required to understand its effectiveness in communicating risk and preventing infection. We need to know who uses these maps, how often, and which platforms are most popular and why. This will provide valuable lessons for future risk communication efforts.
Second, the growing health practice of "prescribing nature walks" must be assessed with caution. While these walks build on a long history of landscapes being prescribed for their health benefits, such as the 19th-century treatment of tuberculosis, they must include information on Lyme disease. It is crucial to assess whether this health practice makes B. burgdorferi more visible or invisible, and whether there is a correlation between these walks and an increase in Lyme disease infections. The promotion of landscapes as holding "health benefits" without acknowledging the risks is a dangerous oversight.
Finally, this article has aimed to emphasize the important role of microbe-landscape interactions in multispecies studies on health and illness. As a growing epidemic, the importance of research on Lyme disease cannot be overstated. I hope this work inspires future medical anthropologists to explore the hidden truths within our seemingly safe spaces, to listen to the untold stories of patients, and to challenge the powerful ideas of safety that can so effectively obscure danger.
Study Details
- Study Conducted: Fieldwork across Scotland, 2018-2020
- Journal Name: Engaging Science, Technology, and Society
- Date of Publication: 31st July, 2025
- Title of the Study: Geographies Of Tolerance: Hiding the Lyme Disease Epidemic in Scotland’s Landscapes
- Categories: Medical Anthropology, Environmental Studies, Public Health, Sociology
- Keywords: Lyme disease, Lyme wars, chronic illness, landscape, Scotland, NHS, Covid-19, ticks
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