Susan Sontag examines how metaphorical understandings of illness influence the perception of the sick and alter the way we approach treatment in this short 1978 book. Sontag’s primary focus is on cancer but she also looks into the history of other disease metaphors (particularly tuberculosis) in this insightful work.
Longtime readers will know that metaphors are a TOA staple and therefore this book should be… metaphor alert… right down my alley. In a sense, this insight is fully accurate. However, I also have some basic rules of thumb (another TOA staple) that I try to keep in mind whenever I
First, I try to use metaphor only when I feel there is a wide gulf between what I understand and what someone else understands. In these instances, I use metaphor as a tool to help someone else learn from me. A common tactic I use is to relate what I understand in the context of what I know the other understands. I’ve always felt that if I could explain something I understand in the context of what someone else already knows, then I should be able to teach anyone anything. The metaphor is the best way to use this teaching method.
However, my second basic rule is to avoid metaphor when I do not understand something. This is the more important of the two rules because a metaphor can mask gaps in knowledge if used about poorly understood topics. From my experience, a metaphor used in this instance leads me to talk more about the comparison rather than the original topic. A metaphor allows me to talk about what I understand well instead of revealing the gaps in my knowledge about what I do not understand. The result is an illusion of fluency that masks how little I understand about what I'm talking about.
This is where my approach to metaphors intersects with the ideas from Illness as Metaphor. When we casually use the military metaphor to describe cancer as an attack on the healthy body, the natural extension of the metaphor suggests the only acceptable treatment for the illness must take on the form of a counterattack. If the metaphor paints the slightly different image of an invasion, then the natural extension of the metaphor supports any action taken to drive out the invader at all costs – including with treatment that many acknowledge is worse than the illness.
The understanding of a disease will always influence the treatments allowable for it. Although the advancements made since the publication of this book have been significant, we still do not understand cancer well enough to discard the metaphor of the body defending against the invading cells. As long as the military metaphor stands in place of understanding the disease, treatment will be dictated by how we understand military operations.
I suppose the closest thing to a concluding thought in this book is Sontag’s comment that the healthiest way to be ill is to avoid any semblance of metaphoric thinking. I like the idea in general but do wonder if throwing away the value of the metaphor is worth it just to avoid suffering from its possible downsides. Perhaps a better approach finds the middle ground that I partially alluded to above – use metaphors to help spread understanding while avoiding them in matters where the understanding remains undeveloped.
One up: I liked the references made to research that dispels the myth of how negative feelings can influence the likelihood of someone becoming sick. The difficulty of living with disease is more than enough for one person to handle. In these circumstances, there is no need for the ill-informed chorus that whispers in the shadows about how so-and-so earned earned the disease by always being such a 'negative person'. And there certainly is equally little room for anyone who wishes to step forward and prescribe ‘positive thinking’ as a remedy for the newly diagnosed disease.
The way to change this perception requires a lot of hard work from the research community. It means finding two groups, identical in all ways save for one and only factor, and then proving that the suspected cause (in this case, negative feelings) has no relationship to whether a person ended up in one group or another. Tough task, but that’s the job.
One study Sontag cites shows that this kind of work is diligently taking place behind the scenes. This research found that there is always a correlation between disease prevalence and an era’s chief complaints. This result suggests that if in the future researchers looked back on our time, they would find that the prevalence of something like depression in the general population would match the prevalence of depression in a cancer patient prior to the initial diagnosis.
One down: The prevalence of a disease metaphor is a strong indication of how well the general population understands the causality of a disease. When we do not understand, we create associations, explanations, and stories to help calm our fears and quiet the inner noise.
Another strong indicator is the number of factors thought to cause a condition. Historically, diseases believed to have multiple causative agents are eventually discovered to have one principle cause. There is no reason to believe today’s unsolved medical mysteries will be exceptions. And yet, until the exact single cause is determined, there is always the ‘this time is different’ contingent that firmly believes in the multiple cause theory.
Just saying: The view that disease is caused by a bad disposition, an unhealthy personality, or a negative outlook are very dangerous because they divert attention away from the potential cures and treatments that might benefit an ill person. Although a well-educated member of the medical or research field is likely to complete all the technical work involved in curing a mystery illness, a clever idea that points the way can come from anywhere. When myths about the cause of disease are widely held, however, the average person’s energy and brainpower is wasted by responding to myths instead of thinking about ideas that might lead to possible cures or solutions.
A good way to spot these myths from a distance is to note their similarities to what is considered taboo in the society at the time. A highly religious society, for example, might link the cause of an unknown disease to the wrath of God. This kind of thinking can also apply to subsets of a society. An organization committed to avoiding certain types of food might be more receptive internally to ideas or theories that link the ‘taboo’ food to disease causes. The same thought applies in reverse – those who tout the benefits of certain foods would be more receptive to suggestions that the food can help treat, reverse, or prevent the disease.
