Illness as Metaphor and AIDS and Its Metaphors

I got this book because of an art object that was placed at the lobby of UConn. The artist explanation of the theme - illness - mentioned this book. It looks at disease from a philosophical point of view, or from a social point of view, in a very good writing from this famous author.

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

I've read only the original essay (Illness as Metaphor) so willcomment on that alone. The book is an excellent antidote to theoveremphasis on psychological causes for physical illness that iscurrent in society and, especially, in the "new age"community. Well worth reading and digesting for that purpose.Thissaid, I do think [the text] overstates the case somewhat. There isa body of empirical evidence showing, for example, links betweenmental state and immune function. This link would, in principle, beexpected to influence the incidence of both infective disease andcancer. For example, only a fraction of those who are infected withT.B. develop clinical disease, and stress may play a role inactivating latent disease in those who are chronically infected. Inpolio, the situation is even more extreme, as only about one pecent ofthose who are infected develop clinical disease. Thus, for manyinfective diseases, there is a marked difference between rates ofinfection and rates of "symptomaticity." It seems likelythat the mind and mental state is one (but certainly not the only!)factor that influences whether an infection becomes clinicalillness.Similarly, in cancer, as I understand it, all of us areconstantly experiencing mutations that have the potential to becomecancerous. But most of these mutations are eliminated, before they doharm, by the operation of various "survaliance" systems(including the immune system) in the body. Thus, the onset of cancermay involve an escape from survaliance. To the extent that mentalstate affects immune function, the mind could affect the appearance ofcancer. Of course, there are many factors--such as environmentalcarcinogens, smoking, etc.--which in some fraction of the populationwill cause rates of mutation that will overwhelm the bodiessurvaliance functions, perhaps even when these systems are operatingwell.In conclusion, I think Sontag is on to something important,and makes excellent points that many people could learn from. Butthese points should be viewed as part of the picture, and good foodfor thought, rather than the whole truth.Comments and correctionswelcome at [email protected]

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.

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