Rarefactions: by Andrés Melo Cousineau

Susan Sontag, the metaphors of illness and the militaristic understanding of the ill. (On Illness 17)

It is not easy to find readings regarding illness by patients who are humanists and ill themselves. This is easy to explain, in a sense. First, one must have been involved in the humanities for many years. Second, one must have fallen seriously ill. Third, and very importantly, during that period of illness one must have had enough physical and mental energy to be able to reflect and to write about the process of illness itself. The latter is no easy task; just try writing when you have some kind of physical pain. Or think of this common occurrence which, now that I have been seriously ill, makes me smile. When one reads the biography of many famous and important people such biographies usually end something like this,

“and then, quite unfortunately, such and such illness came suddenly into his life and suddenly he lost all his genius and his creative powers, and then the most brilliant mind became totally lost ..…, and then died in the year such and such ……” .

Why do I smile? Because such a narrative is highly incomplete, untrue, oversimplified and dangerous. Why is this so? Primarily because this kind of narrative seems to me to be a bit like the story of the monster that lives under our beds. But more importantly, it continues separating creativity and the most fundamental elements of our unique human condition, including our suffering, our physical fragility and our mortality.

Don’t you think it is odd to actually believe that somehow one produces less and becomes less creative and thoughtful PRECISELY when one comes to learn first-hand of the vulnerabilities which lie at the core of our humanity! For surely the greatest writers did not write about such topics by having simply READ about them (though reading about them will prepare us like no other exercise once they become present in our lives, or in the lives of those around us.) On the contrary, it is —-in part—- by living such moments that one’s creativity is energized and one’s potential reflection actualized more deeply. “But I have never gotten ill”, you might respond. “Good for you!” I say, “just do not forget that if this is so, those around you who fall ill will need even more of your help and practical wisdom when dealing with situations of crisis.” Hearing such narratives makes me think that in our world we are in constant fear of illness for we can only see it as the beginning of the end, rather than the end of a shallow beginning. Suffering makes no sense to us, and the sufferers much less so.

However that may be, the fortunate appearance of these three conditions is the main reasons why Susan Sontag’s Illness as metaphor is such a unique and precious book. It is a book for those seeking to make somewhat articulate that which is mostly held as unspeakable; particularly so in our age which sees in death and in the immobility of illness “the other” against which we must continually fight and guard ourselves from.

In this post, I will merely point to some of the reasons why this confluence is so unique. At least four elements stand out: 1. Sontag allows for insight into what it is for an ill person to write DURING illness itself; 2. Sontag points out the dangers underlying the kinds of metaphors we use when dealing with illness, metaphors which are unavoidable given our nature as self-interpreting animals (on this, see Charles Taylor who has also had great impact in the area of nursing); 3. She crucially reveals the most damaging of these metaphors, namely, the military metaphor as it is applied to illness in such a way that ironically who I am and my body become sworn enemies leading, in turn, to a dangerous dualistic tendency which emphasizes a separation from myself, demeaning me silently; and finally, 4. she points to one crucial interest in the connection created by political thinkers between the illness of the body and the illness of the body politic. I will briefly point to each of these dimensions.

1. Sontag tells us that she “wrote her book very quickly, spurred by evangelical zeal as well as anxiety about how much time (she) had left to do any living or writing in.” (101) These words clearly portray the dilemma presented above, writing about illness when ill is a bit like learning to swim when drowning! And if those around you do not swim well, then the drowning is much more likely to happen that much quicker! It is really how much we prepare beforehand that will make the difference in such times; some prepare themselves in faith, some prepare themselves little, others prepare themselves in understanding and find well-being in such understanding. Sontag opens reflection on illness as the main avenue for healing the language in which we ill-conceive what illness itself might mean.

But another element motivated Sontag to write what she did, one which goes beyond alleviating her own pain and giving a sense of meaning to her illness. She tells us something that is absolutely central to trying to see and understand the different receptions of illness among the ill; particularly in the relation which might appear between the humanist who falls ill, and others who fall ill but have not dedicated themselves to the humanities. She writes: “Twelve years ago, when I became a cancer patient, what particularly enraged me –and distracted me from my own terror and despair at my doctor’s gloomy prognosis —was seeing how much the very reputation of this illness added to the suffering of those who have it.  Many fellow patients …… evinced disgust at their disease and a kind shame.” (100)

I must confess this is absolutely THE single most striking feature of illness I have come across myself. In general, a humanist has the tools that should enable a healthier self-esteem to persist even in the most complex of conditions. Others who lack these tools can more easily fall into a certain despair. In this respect, the sufferer suffers much more deeply precisely because of the way we as a society —–specially modern Western market-oriented democracies——- understand illness. To be ill is to be lost, and being lost you must find your bearings in great dependency of others who themselves, inmost cases, have rarely read books such as this one by Sontag. For it will always remain true that many of us will not have the strength or the possibility to reflect on the historical conditions which provide the framework of their illness (I mean most of us are simply thinking about the money for such and such a drug, the mixed emotions which we see arising, the loneliness which appears). This is why for those of us who just cannot reach out to such reflections, it is important to be surrounded by others who have an active interest in them. This way, the disgust directed inwards of which Sontag speaks, is reverted outward through understanding, dialogue and continued questioning. This might even lead us to share in the process of the discovery of a kind of well-being within illness itself; a reflective kind of well-being.

2. Sontag’s book is seriously deconstructive. What does this mean? Primarily that through her analysis all the metaphors humans have come up with in their everyday interaction with illness and the ill (in Sontag’s book, specially TB and cancer) are seriously questioned in an attempt to liberate us from a way of speaking which for Sontag actually does more damage to patients than good. (p. 3) At one point she even says she intends to make all metaphoric understanding of illnesses completely obsolete. (p. 87) However, Sontag moderated her radical stance a few years later. When writing about the metaphors of AIDS she corrected her radical position, reminding us that to be human is in fact to use and understand oneself in and through metaphors. As she put it:

“of course, one cannot think without metaphors. But that does not mean there aren’t some metaphors we might well abstain from or try to retire. And of course, all thinking is interpretation. But that does not mean it isn’t sometimes correct to be “against” interpretation.” (p. 93)

It just so happens that the metaphors of illness are some of the most problematic for many reasons, among them, because they have not been created or reflected upon by the ill themselves (when was the last time a director’s meeting at a hospital had the ill among them?) Why is this so? Primarily because of the three conditions with which we began this post; reflecting on illness while ill takes courage, also a bit of luck and previous preparation.

But one thing is certain, any doctor/nurse/caretaker who has not read Sontag is seriously missing very important information regarding their own prejudices on the foundations of the possible dangers behind metaphoric thinking. Metaphors may fill our needs, but it is we who determine the health of our needs themselves. In this respect, one of the single most damaging metaphors, besides the military one to which we will return, is the metaphor that ties illness to character. As Sontag writes: “With the modern disease .. the romantic idea that the disease expresses the character is invariably extended to assert that the character causes the disease –because it has not expressed itself: Action strikes inward, striking and blighting the deepest cellular recesses.” (p. 46) To us ill this seems quite odd, but what is striking is to actually hear it repeated by those surrounding us. Our ignorance about illness allows such metaphoric thinking to grab hold of our imagination, reducing it to its bare minimum. I am ill, therefore I somehow did it to myself. If only I had ….., if only I had not ….. It is in this respect that many ill individuals will tell you stories of how, during the process of their illness, they would be told how they might simply be imagining things, or should have more character in such times, or that they should just be more optimistic about things, or that they should “get over it”.

3. But the single most damaging metaphor, Sontag points out, is the military one as applied to disease. Our present era, focusing as it does on the elimination of all suffering (see Taylor, SotS) goes to unheard of lengths in order to see suffering and illness as “the other” which must be controlled, attacked, conquered and judiciously set aright. Disease must be severed, quarantined and destroyed. We are altogether on this crusade, or so it seems. As Sontag puts it:

“The controlling metaphors in descriptions of cancer are, in fact, drawn not from economics, but form the language of warfare; every physical and every attentive patient is familiar with, if perhaps inured to, this military terminology. Thus cancer cells do not simply multiply, they are “invasive” …… Rarely are the bodies “defenses” vigorous enough to obliterate …..… patients are “bombarded” with toxic rays …..” (pp. 64-65 )

But exactly what is wrong with the application of this metaphor? Is there another possibility? The single most dangerous aspect of such language is that the patient is permanently divided from herself; she now becomes both the invading army and the territory of the invasion. Caretakers and physicians only play the active role of setting up, aiding and administrating the invasion itself! But precisely, by seeing their own bodies as in need of being attacked, patients can become much more easily tempted to see themselves in a purely negative light, namely, with more disgust and more shame. They will then easily acquiesce to treatment without playing an active, reflective and engaging role in the process.

Wars will continue and some must be fought, but caring for the ill is far from being a question of attacks, of destruction, and of counter-invasions. Caring for the ill is a matter of reflection on ourselves. What kind of reflection? That type of reflection in which you question your very need to use such metaphors as these which are filled with military overtones. Perhaps it is our need to see ourselves as just conquerors, as just invaders —as setting the universe aright—– that makes us (by “us”, I mean specially physicians) so prone to accept such language so easily. For who could be more beneficial, one could imagine, than the good invader who finally liberates us from the dangers which we ourselves could not see brewing under our very own eyes. Such an invader, it would seem, would have to see himself almost as divinely inspired. (see also p. 86 and pp. 99-102)

4. To bring to an end this post, I will merely mention that Sontag likewise sees the important political metaphor which introduces the language of disease into the political arena itself. In this respect, Sontag looks at Machiavelli and there finds that such metaphors are primarily directed to those leaders who will have the responsibility of the most important decisions regarding the well-being of the body politic itself. She writes: “as prudence is need to control serious diseases, so foresight is needed to control social crises. It is a metaphor about foresight, and a call to foresight.” (p. 77)

In this respect, my dear Colombia is not as healthy as my dear Canada. However, what Sontag fails to do, and this is a serious limitation to her book, is to really develop those initial ideas in terms of the origins of political thought itself as they are found in Greek Political Thought, namely in the salutary works of Plato, Xenophon and Aristotle. This lack cannot be met in this post. I will only end by saying that it is Aristotle’s Politics and his Nicomachean Ethics which hold the keys and guidelines towards a healthier understanding not only of our political communities, but of our souls as well. In this respect, physicians should do well by taking up the puzzles which conform these texts, broadening their specializations by becoming abler and more liberally educated citizens.

5. Conclusion. If there were one thing one could take from Sontag’s book it would definitely be this. In her AIDS and its Metaphors, she points out —as Nietzsche had done so before in another context—- that etymologically the patient is the sufferer (p. 125) but that it is “not suffering as such that is most deeply feared, but suffering that degrades” (125). Sontag allows to glimpse into a time in which we can suffer without becoming the “others” who must be feared, analyzed, put aside, invaded and hopefully cured. This is why Sontag allows the possibility for a serene meaning at the very edge of our human condition.

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