Susan Sontag: Illness as Metaphor, AIDS as Metaphor

In 1978 Susan Sontag wrote Illness as Metaphor, a classic work described by Newsweek as "one of the most liberating books of its time." A cancer patient herself when she was writing the book, Sontag shows how the metaphors and myths surrounding certain illnesses, especially cancer, add greatly to the suffering of patients and often inhibit them from seeking proper treatment.By demystifying the fantasies surrounding cancer, Sontag shows cancer for what it is -- just a disease. Cancer, she argues, is not a curse, not a punishment, certainly not an embarrassment and, it is highly curable, if good treatment is followed.

"Susan Sontag's Illness as Metaphor was the first to point out the accusatory side of the metaphors of empowerment that seek to enlist the patient's will to resist disease. It is largely as a result of her work that the how-to health books avoid the blame-ridden term 'cancer personality' and speak more soothingly of 'disease-producing lifestyles.' She asserts that the most truthful way for regarding illness is the one most purified of metaphoric thinking. A disease should be regarded as a disease, not as a sign of some terrible law of nature or an otherwise unnameable evil.

The gross mythology of tuberculosis did not persist after the discovery of streptomycin in 1944 and the introduction isoniazid in 1952. The sinister mythology of cancer will not be likely to persist after the causes of the disease are known and a successful treatment is produced. "As long as a particular disease is treated as an evil, invincible predator, not just a disease, most people with cancer will indeed be demoralized by learning what disease they have." (Sontag)
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SUSAN SONTAG: Illness as Metaphor

Illness is the NIGHT SIDE of life, it is used in our culture as a FIGURE or METAPHOR

            Examples: Cancer & TB…

·    these diseases are capricious,

·    they a little understood.

·    Considered ruthless, secretive and invasive.

·    They are felt to be morally, if not literally contagious.

·    Felt to have magical powers

In the popular imagination, CANCER=DEATH

Cancer: “anything that frets, corrodes, corrupts or CONSUMES slowly and secretively (OED 1528)

·    Conceal the truth to patients

·    Process is expected to be horrid kind of death

·    Symptoms are invisible until it is too late

·    Desexualizing

·    Idleness, slowness, sloth, loss of appetite

·    Degeneration caused by invasion

·    Demonic pregnancy (pregnant with your own death)

·    No help

·    Painful death (horrid)

·    BODILY DISEASE

Tb: definition of pulmonary = CONSUMPTION

·    Disintegration (consumed)

·    secretive

·    deceptive symptoms (rosy cheeks, mania, thinness as attractive, appetite)

·    speeds up life, highlights it spiritualizes it

·    highly contagious

·    liquid: phlegm, mucus, blood

·    help by changing to a warm dry environment (anti-cold & wet)

·    painless (romantic death)

·    SPIRITUAL DISEASE

DISEASE OF PASSION: both cancer & Tb

       
         TB: too much

        Cancer: Too little

·    Both about the lack of balance in the vital energies

·    TB (Victorian)-ROMANTICIZING

§  Individuality is fist stressed+ people were made singularly more interesting by their illnesses

§  SADNESS (meloncholoy) became synonymous with TB: also prone for creative and sensitive types like artists and poets

§  Pretext for leisure and travel invented by the romantics- RETIRING from the world without having to take responsibility for it

§  Sex as a cure

§  Naivity

§  Passionate

§  Too sensitive for this world

§  More complex psychologically which guarantees poor health, but great intellectual and moral virtue

§  Makes sufferer sexy

§  Genteel, delicate, APPEALING VULNERABILITY

§  Glamorous too look sickly and rude to eat heartily in the 18^th & 19^th century—fashionable to be pale and drained

§  ISOLATES one from the community (unlike plagues---cancer too!)

IS THIS WHERE THE 20^TH CENTURY CULT OF THINNESS COMES FROM? THE LAST BASTIAN OF THIS ROMANTICIZING OF WAIFDOM? (became appealing for women but not men by the end of the 18^th century)

·    In the modern era, this same metaphor is given to INSANITY (not cancer or TB)…confined to a sanatorium

·    Fits patients character as a PUNISHMENT fits the SINNER (Christian view of disease)

Psychological notions of disease

·    Specific emotions produce specific illnesses

·    Stress produces illness

·    The correct attitude can make you well

EXPANDED CATEGORY OF ILLNESS

·    Every social deviation can be considered illness

·    Illnesses need not be punished, but understood

PUNITIVE NOTIONS OF DISEASE

·    LEPROCY & CANCER & syphillus & TB (now diseases of INDIVIDUALS)…plagues in the past

Cancer is not about PAMPERING the PATIENT like with TB

·    Under attack, attack back with treatments

·    Insult to the natural order-MUTATION

·    Natures revenge on our technological modern world

DISEASES ARE REFLECTIONS OF OUR CULTURE

·    TB was thought to be from foul air (from houses)

·    Cancer from the pollution of the whole world-REJECTION OF THE CITY

·    FORESIGHT is the sure (catch it early) just like in our social understanding

·    When society (environment) is in good health, disease can be managed and overcome. If not, disease will persist and may even beat us

§  French revolution: peasant disturbances as a plague on the nation

§  Nazis: jews as a syphilis on culture---radical treatment…cut them out, eliminate them (identified with city life as well)

§  AIDS: Haitians, homosexuals, keep them out, eradicate them

§  5to call something a cancer implies that it must be REMOVED

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• AIDS-related stigma refers to a pattern of prejudice, discounting, discrediting, and discrimination directed at people perceived to have HIV/AIDS, their significant others and close associates, and their social groups and communities. 
• As with other diseases throughout history, such as the Black Death in the fourteenth century and cholera in the nineteenth century, a stigma has been attached to AIDS as a result of both fears surrounding contagion and preexisting prejudice against the social groups most seriously affected by the epidemic. 
• Like AIDS itself, the AIDS stigma is a global problem. It is manifested around the world through ostracism of people with AIDS (PWAs), discrimination against them, and, in a few countries, quarantines.
• In the United States, the AIDS stigma has been evident in negative attitudes, discrimination, and violence against PWAs and people perceived to be HIV infected. 
• coercive measures such as 
• quarantining of HIV-infected persons, 
• universal mandatory testing, 
• laws making it a crime for people with HIV/AIDS to have sex, and 
• mandatory identification cards for PWAs. 
• Negative attitudes have also been manifested in behavior. 
• AIDS discrimination in employment, housing, school policies, and services has been widespread. 
• Employers have refused to provide insurance coverage for employees with AIDS; 
• property owners have refused to rent to PWAs or have evicted them; 
• parents with AIDS have been faced with legal battles concerning child custody and visitation rights; and 
• PWAs have experienced unwarranted demotions, dismissals, and harassment in the workplace. 
• In addition, some PWAs have been targets for violent attacks because of their HIV status.
• At least four specific characteristics affect the extent to which any disease is likely to be stigmatized. 
• First, a stigma is more likely to be attached to a disease whose cause is perceived to be the bearer's responsibility.
•  The two most common routes of HIV infection in the United States, sexual intercourse and sharing contaminated drug paraphernalia, are widely perceived as controllable and therefore avoidable behaviors. 
• Second, greater stigma is associated with conditions that, like AIDS, are perceived to be unalterable or degenerative. 
• Third, greater stigma is associated with conditions that are perceived to be contagious or to place others in harm's way. 
• Concern about contagion not only exists in the physical realm but also extends to fears that one will be socially or morally tainted by interacting with the stigmatized individual. 
• Finally, a condition tends to be more stigmatized when it is readily apparent to others and is perceived as repellent, ugly, or upsetting. 
• In its more advanced stages, AIDS often causes dramatic changes to one's appearance.
•  Of considerable additional importance is the fact that the AIDS epidemic in the United States has occurred primarily among marginalized groups, such as gay men, injecting drug users, and Haitians, and has been defined socially as a disease of these groups. 
• Consequently, the stigma attached to AIDS also serves as a vehicle for expressing preexisting hostility toward members of disliked social groups.
• In the United States,  the AIDS stigma has been focused principally on homosexuality. 
• Societal and individual reactions to AIDS have often provided a vehicle for expressing condemnation of homosexuality and hostility toward gay men and lesbians. 
• Heterosexuals' attitudes toward gay people have been consistently shown to correlate strongly with their AIDS-related fears, attitudes, and beliefs.
• Acceptance of homosexuality was at its height BEFORE the AIDS epidemic. 
• Furthermore, gay men with AIDS are more negatively evaluated or blamed for their illness than are heterosexuals with AIDS. 
• As the face of the epidemic in the United States changes, it is likely that symbolic expressions of the AIDS stigma will broaden to reflect public hostility to an increasing degree toward other marginalized groups such as immigrants, the poor, and communities of color.
• Because of the AIDS-related stigma, PWAs must bear the burden of societal hostility (stigma) at a time when they urgently need social support. 
• In addition, some PWAs internalize societal stigmatization (Goffman),which can lead to self-loathing, self-blame, and self-destructive behaviors. 
• The AIDS stigma also deters people at risk for HIV from being tested and seeking information and assistance for risk reduction.
• Because of the stigma of AIDS, many people may distance themselves from the disease and deny their potential risk.