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Illness as Metaphor and AIDS and Its Metaphors

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This is a quote from the book that I would consider its thesis statement:

'Theories that diseases are caused by mental states and can be cured by will power are always an index of how much is not understood about a disease.
Moreover, there is a peculiarly modern predilection for psychological explanations of disease...Psychologizing seems to provide control...over which people have no control. Psychological understanding undermines the 'reality' of a disease.'

Sontag traces, historically, the ways different diseases and the people who contracted them have been viewed. She spends time discussing tuberculars--waif-like, pale, romantic--and cancer patients--repressed, the 'cancer personality,' shame--then goes on to debunk these notions by stating that once the cause, cure, innoculation is found, the 'myth' or popular psychology of the disease no longer holds.

In this edition, in the final chapter about AIDS and its metaphors Sontag writes that she'd written the first part of the book (all but the AIDS chapter) while a cancer patient and in response to reactions she saw in fellow patients. She saw guilt and shame; and she saw these as impediments to people's treatments. For she knew she had an illness and she set about to cure it medically, in the best possible way, while others passively accepted the 'metaphor' handed to them and, thus, did less to help themselves best. She felt frustrated or saddened by their psychologizing and self-blame and wished to write to others that their physical illness is a physical illness and the best route to recovery is to think only of how to find the best medical treatment.

And she wrote this by demonstrating the history of myths that surrounded illnesses and the way these myths evaporated as soon as its true mechanism (the virus, or otherwise) was found.

Some holes in her argument can be found in the field of Health Psychology, which has proved that optimism generates faster post-operative recovery or a heartier immune system, among other 'psychological' correlates of disease to illness. Still we speak of a "type A" personality and a possibility of a heart attack, etc., which I believe is not entirely unfounded -- stress creates a drop in immune response and other health deficiencies.

However, I am a patient and a former psychotherapist. I was reared in psychology as others are toward priesthood. I grew up sent to therapists for any ills and was raised with the thought I be nothing but a therapist when an adult -- which I did become. Then I became diabled, from physical injury. My own disability is largely pain-related; the pain is severe and in locations that make it impossible to function. Much of my injury does not show up on contemporary tests -- EMG's, CAT scans, MRI's, bone scans, sonograms.

So I turn to psychology. I know I've got a physical injury. But if it can not be cured (and I go back to my original quote: that which is least understood, we psychologize), perhaps I am, in part, a cause of it. This had been a comforting notion to me: if I can do this to myeslf, I can also undo it. For me, psychologizing helped put me in the driver's seat.

Sontag at first put me in the driver's seat in a new, determined, knowing way. I know my injury is not something that is "in my head." At first, Sontag's argument was a weight off my shoulders, an eye-opener. I underlined the passage above: yes, that's right; they don't know what's wrong with me so they blame me. A doctor once said to me: "When I can't find anything wrong with someone I assume there is nothing wrong with her."

Sontag set me in motion. She went into motion, knowing cancer wasn't a word to whisper (remember when we whispered that 'c' word?), but something to pursue with a vengeance. Her book was liberating. I know I don't want to be sick, unable to do the things I want to, regardless of how neatly one can analyze my personality and show otherwise. This is physical.

Then reality. I've got sometihng and it isn't curable and it is debilitating. I am in doctors' offices all the time; fighting beaurocracy all the time. I wanted my psychologizing back. My security blanket had been removed with this "epiphany" of sorts. If it's not in my head, and I can't cure myself, and doctos can't cure me, I'm incurable. Her philosophy, then, became saddening.

I began to analyze her: perhaps she recovered so well because of her strong personality, her [psychological] strength. It's a chicken/egg question.

Sontag writes things that are clear and other things that can be argued. Overall, her essays have changed societal thought -- from Against Interpretation to On Photography to Illness as Metaphor and various others; she is brilliant and a powerfully good writer. Anyone who can make us look at something in a new way, make us think something through in a new way, is easily well-worth reading.

Anyone who is ill, particularly chronically, undiagnosed or misunderstood should read this book. Agree with it or not, but read it. Read others that say the opposite, read about your own illness, but read this book: I would call it mandatory.

Even if we hadn't evolved the ability to think sensibly about the world around us, disease would have continued to be a major factor in Homo sapien debilitation and mortality. Conversely, if conscious beings had been born to a world free of disease, they would have still tried to find out how their universe functioned, and they probably would have employed the metaphor as an aid for conceptualizing notions not well understood. But for whatever reason, human beings did attain the ability to think critically about their surroundings, which happened to be a world filled with diseases. It should come as no surprise than that illness and disease, concepts sometimes etiologically and often morally incomprehensible, are often the subject for metaphors; an inevitable consequence of human insight intermingling with mysterious biological forces. In the view of the cultural critic Susan Sontag, however, metaphorizing illness and- perhaps more importantly- using illness as a metaphor can have damaging consequences for those afflicted.

In her pair of related essays, Illness as a Metaphor and AIDS and its Metaphors, Susan Sontag reveals many of the metaphors surrounding such influential diseases as tuberculosis, cancer, syphilis, and AIDS. While she does acknowledge the necessity of the metaphor for human understanding, throughout her assays she argues that there "aren't some metaphors we might well abstain from or try to retire". Although this important point should by no means be taken lightly, the true worth in her essays is the skill in which she uncovers these metaphors and explains (she is, after all, against interpretation) the stigmatizing affects of the myths they create.

Sontag does not limit the scope to which she describes the metaphors. On one level, illness moves from being metaphorized (e.g. "invasion" in the case of cancer and AIDS, "pollution" in case of syphilis and AIDS) to being used as a metaphor (e.g. "...a cancer on society"). At another level, disease metaphors can be viewed as either being directed at the individual (e.g. "the sensitive and creative character of the tubercular") or at the larger society (e.g. AIDS as punishment for sexual deviance). By examining illness metaphors from several viewpoints, Susan Sontag forces the reader to confront their own stereotypes of diseases and the people they infect. Indeed, her cultural theory powerfully compliments strictly historical or clinical analyses on human disease.

While scientific or clinical approaches to disease focus exclusively on the individual, historical and epidemiological perspectives tend to overplay the importance of population dynamics. And none of these approaches alone can strip disease free of the stigmas that surround them. In Plagues and Peoples for instance, William H. McNeill's main premise is that human history has been largely influenced through time by the "introduction" of new diseases from "outsiders". However useful this view is to describing human history, it inherently reflects and perpetuates some common metaphors surrounding disease. It is for this reason that Susan Sontag targets him in her essay. For singling out groups of people, what are referred to as "risk-groups" today, in the discussion of plagues often implies punishment for evil, and this can be as dangerous as focusing on individual illness' as "transforming experiences".

On the other hand, Sontag argues that scientific and medical descriptions can also contribute to disease metaphors. The clinical description of AIDS as occurring in stages and the view of cancers as geographical diseases of the body are metaphors widely applied today. The existence of other military-like immunological terms of describing disease such as "tumor escape", "killer T-cells", or "defensins", also could have added fuel to her argument. With these examples in mind, the question that must be asked is; can humans really approach disease without employing the use of metaphors? However impossible this may be, Illness as a metaphor and AIDS and its Metaphors is successful in exposing the prejudices inherent in many of our past and present metaphors, and helps us distinguish the good ones from the bad.

Cancer phobia, some people say, is worse than cancer. Well, not really... But true up to a point. Being afraid of a disease, be it cancer, AIDS, or whatever else, can be debilitating. And who of us doesn't know people that are scared to death of cancer, or of AIDS? And how can we all not be scared (maybe even terrified) of these diseases, when in our eyes they're not just diseases but are loaded with a whole lot of different meanings, mainly linked to death...

Susan Sontag's essay on cancer (& her later essay on AIDS) deal with these diseases as metaphors of whatever is bad, evil, reprehensible, sinful about human experience. Especially with cancer, the metaphor is more poignant, since, cancer still has unknown causes, at least up to a point: of course cancer now is much better understood, but in '78, when Sontag wrote the first essay, cancer was mostly unknown territory. Obviously, when we're talking about unknown territory, unknown (& mysterious) causes, there's a lot of theoretizing & projecting: anyone can project their own ideas on this white wall of ignorance. And so people 'fight' cancer, 'win the battle' against cancer, 'have cancer personalities', 'cause' their cancer or whatever else. It was even worse with AIDS, especially in the '80s: then it was widely (& stupidely) believed that this new disease was the payback for the free sexuality of the '70s, & especially of the sexuality of homosexuals.

Susan Sontag's essays tackle these issues & show the metaphors & prejudices of illness as what they are. They are important, clearly-written essays, & if today some of these ideas appear obvious or widely known, remember that Sontag talked about these things many years ago, being one of the first people to address the issue.

I've read only the original essay (Illness as Metaphor) so will
comment on that alone. The book is an excellent antidote to the
overemphasis on psychological causes for physical illness that is
current in society and, especially, in the "new age"
community. Well worth reading and digesting for that purpose.

This
said, I do think [the text] overstates the case somewhat. There is
a body of empirical evidence showing, for example, links between
mental state and immune function. This link would, in principle, be
expected to influence the incidence of both infective disease and
cancer. For example, only a fraction of those who are infected with
T.B. develop clinical disease, and stress may play a role in
activating latent disease in those who are chronically infected. In
polio, the situation is even more extreme, as only about one pecent of
those who are infected develop clinical disease. Thus, for many
infective diseases, there is a marked difference between rates of
infection and rates of "symptomaticity." It seems likely
that the mind and mental state is one (but certainly not the only!)
factor that influences whether an infection becomes clinical
illness.

Similarly, in cancer, as I understand it, all of us are
constantly experiencing mutations that have the potential to become
cancerous. But most of these mutations are eliminated, before they do
harm, by the operation of various "survaliance" systems
(including the immune system) in the body. Thus, the onset of cancer
may involve an escape from survaliance. To the extent that mental
state affects immune function, the mind could affect the appearance of
cancer. Of course, there are many factors--such as environmental
carcinogens, smoking, etc.--which in some fraction of the population
will cause rates of mutation that will overwhelm the bodies
survaliance functions, perhaps even when these systems are operating
well.

In conclusion, I think Sontag is on to something important,
and makes excellent points that many people could learn from. But
these points should be viewed as part of the picture, and good food
for thought, rather than the whole truth.

Comments and corrections
welcome at publiccontact@hotmail.com

On top of the mutation, bug or dysfunctional cell that produces cancer, in ILLNESS AS METAPHOR, Sontag introduces the reader to an accompanied malady called metaphor. A metaphor, of course, is nothing but a comparison, a verbal picture attempting to make the abstract more concrete. But by depicting surprising similarities between two unlike things, by equating a disease like cancer or AIDS to a hopeless human condition, catching the metaphor may become as bad as the disease. Metaphor may even prevent the patients from healing themselves.

Sontag discusses how diseases like AIDS, syphilis, TB, leprosy and cancer can be stretched out as metaphors. The more mysterious the cause of the disease, the wider the application of that disease as metaphor. The author shows the fallacy in extending military terminology, military metaphors, to the fields of medical treatment. There are no magic bullets, bodies are not being invaded by alien cells and diseases need not become battles to the death. In other words, metaphors will never cure any ailments, words will never become an antidote to any illness. After one conquers the disease one must then eliminate the metaphor that surrounds that disease.

I own the original print of ILLNESS AS METAPHOR; by that I mean, the print that contains only the essay on Tuberculosis and Cancer and not the one on AIDS. It was required reading for my freshman English class in college. I looked up this title intending to buy a copy for a friend and found out that the edition I own is not available anymore. However, I remember wondering back in 1984 when I first read this book - during the peak of the AIDS "scare and witch hunt" how this new illness would figure in the grand scheme of things in Susan Sontag's view.

Invariably it succumbed to metaphoric thinking just as TB and Cancer did. This wasn't too hard to predict since the elements in our society that foster and perpetuate such metaphors are still with us (and will continue to be for a while longer)...namely religion and politics. So, for the sake of understanding the premise of ILLNESS AS METAPHOR, I'll say this "...the healthiest way of being ill is one most purified of, most resistant to metaphoric thinking."

Think about AIDS - how often do you hear things like: "It is a natural process we're seeing here." Or, " It is natural for viruses to evolve, change and even mutate." Or, "This isn't the first time the human race has experienced the effects of epidemics or syndromes - nor will it be the last." Instead what we hear are things like, "God doesn't like gays and he's punishing them for their sins." The thinking is that if you catch it, you deserved it.

Like cancer patients just a few decades ago, AIDS patients were the object of decontamination practices. Like Susan Sontag shows in her essay about TB and cancer - as long as a disease is treated as a mysterious, God-sent judgement. And as long as people concoct punitive attributes about diseases whose causes are not understood, and as long a the ministrations of doctors remain ineffective - those diseases will be felt be to be morally, if not literally contagious. Remember in the mid 80's there was a `popular' fear of being in the same room with someone with AIDS. There was the endless pontificating by religious leaders as to the `just' point and end of the disease. So many factors contributing to the rehashing and remodeling of metaphors that emerged somewhere in the dark ages. I think they began to quiet down when heterosexuals began to be infected as well.

These are just my own extrapolations on the matter. So, I'm anxious to read the newest edition of ILLNESS AS METAPHOR and compare my personal data with that of Ms. Sontag. She's a brilliant and intelligent writer.

As she has always been, Sontag is an important voice whose work is the perfect foil for postmodern bunk. It is perhaps Sontag herself who keeps the title "intellectual" from accumulating the dirt of others who wear it.

The language used around certain illnesses has an accompanying frame with horrendous social consequences. This is essentially Sontag's point, and it is very concisely and convincingly made. This small book also serves as the impetus for future investigation in the realm of philosophy of language and perhaps also the philosophy of thought. Though this book is not itself a work of philosophy, it is written in a philosophically informed manner: propositions are given rationales, conclusions are invoked and supported, and technical terms are very clearly defined and referenced.

A negative feature of this book is that there is no index. When reading, you should pen important passages or write in the margins so you can refer back to specific points. There really is no good excuse for why there is no index or bibliography in either essay. Additionally, there is no bibliography for either piece, though there are some citations scattered about in the text or in footnotes.

Sontag is spot-on in her analysis of metaphors of AIDS: the military metaphors, the latency metaphors, and the plague metaphors. Her observations are keen and insightful in this regard. It is troubling then, that she seems unwilling to follow her own analysis and that she dismisses "psychological" aspects of disease causation in favor of a purely materialist understanding. Does she not realise that the "de-interpretation" of illness metaphors is itself a psychological act that affects patients? How does she reconcile her dismissal of psychological states with the fact that her very own writings on illness and AIDS are themselves psychological and therapeutic?

Sontag forgets that metaphor itself is a social-psychological phenomenon. If she had kept this fact in mind, she might have arrived at the conclusion that the basic medical and scientific paradigm of AIDS is itself flawed and kept alive solely through metaphor. At many points, she appears to be on the cusp of piercing the HIV mythology, pointing out discrepancies and exposing flaws in the science. For example, she recognizes the use of the latency period as a way of holding people in a perpetual state of "just haven't gotten AIDS...yet". She observes that the "AIDS tests" test for antibody, not virus, and that objectively healthy people are claimed to be ill based solely on infection (what would later be codified as "HIV disease".) She plainly points out the distinctions between "AIDS" in Africa vs. North America and Europe, and rightly discerns the racist motives behind an "African origin" of AIDS, yet she accepts the racist scientific wisdom (which has not been borne out in 20 years) that the African situation is the "true" AIDS situation and that North American and European AIDS will explode into the heterosexual population.

It's too bad she wasn't willing to follow through on her train of thought. That a thinker of her intellectual acumen was able to come so close to grasping the essence of the HIV mythology, and then, at the last minute, get derailed and capitulate to conventional wisdom, is a testament to the enormous power of group-fantasy.

I did not find the book very interesting, although it is a great recopilation of different quotes from past books portraying the different views there were from diseases as cancer or TB, that is all it is. There was no relation between one chapter and the next, it felt as if it was just a brainstorm of ideas being put together in no specific order.

There are already many good reviews so I will only suggest reading the following books in addition to Sontag's, all of them relevant for those interested in the social history of ideas: 1) "A Terrible Beauty: The People and Ideas That Shaped the Modern Mind - A History" by Peter Watson; 2) "The passions and the interests" by Albert Hirschman; 3) "The mind and the market: capitalism in Western thought" by Jerry Muller; 4) "The proper study of mankind" by Isaiah Berlin; and 4) "Citizens to Lords: A Social History of Western Political Thought from Antiquity to the Middle Ages" by Ellen Meiksins Wood.