Illness as Metaphor and AIDS and Its Metaphors (Penguin Modern Classics) [Paperback]

'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.

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.

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.

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