Illness and Metaphor

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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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HIV/AIDS Metaphors

• 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. 

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Research finds that people with substance-use problems who read a message describing addiction as a disease are less likely to report wanting to engage in effective therapies, compared to those who read a message that addiction behaviors are subject to change. The finding could inform future public and interpersonal communication efforts regarding addiction.

1. --some people experiencing addiction felt like they had less agency; people with diseases have no control over them

       --The growth mindset message stresses that human attributes are malleable, and we know from previous work that it encourages better self-regulatory strategies such as seeking helping from others.

        --"Overall, our findings support moving away from messaging about addiction solely as a disease," Desmarais says. "It's more complicated than that. Instead, the finding suggests that it would be more helpful to talk about the many different reasons people become addicted."

Of equal importance to the biological facts about drug use is the issue of meaning. 

• As a culturally constructed social practice, drinking (and the type and context of consumption) evokes emotionally charged cultural meanings about diverse issues, including social solidarity, identity, recognition of new social statuses and accomplishment, nostalgic remembrances, the honoring of loved ones, hospitality, mourning, initiation of work efforts, transitions, celebration of cultural heroes, intimacy, fun, health, religious experience and anticipated futures

       CULTURAL  MODEL: anthropologists have not been blind to the disruptive, dysfunctional and debilitating effects of alcohol consumption in non-traditional, industrial and post-contact indigenous societies

  

      --In recent years, ethnographers have framed drinking behavior in terms of broader processes of globalism and the effects of neoliberal restructuring, cross-border labor migration, the world-wide flow of alcoholic commodities, contextualized time/space/social group configurations and the role of drinking in disease risk behavior

     LIFE-STYLE MODEL: in the life-style model, anthropologists speak of specific cultures and subcultures that have their own (more or less) unique configuration of evolving knowledge, attitudes, norms and behaviors, as seen in usages such as ‘inner-city street culture’ and ‘street cultures of drug use’

    

    --a holistic description of the people for whom drug use had become a central organizing mechanism in their lives. In an effort to counter simplistic stereotypes and narrow pathological accounts of drug users and addiction

    --, the literature produced by this approach is comprised of accounts of the survival strategies used to sustain a drug-focused life-style, the organization of the underground economy of drug acquisition, processes of socialization into drug use social networks and the street drug use subculture, the social settings and key locations that comprise drug users’ social environments, the systems used by drug users to classify social statuses within the subculture, risk behaviors and risk environments, the special street jargon that developed to communicate issues of concern to drug users and a sense of in-group membership.

    THE CRITICAL MEDICAL ANTHROPOLOGY MODEL: the critical medical anthropology model has emphasized three issues: the social production of suffering, the use of drugs to self-medicate the emotional injuries of injustice and mistreatment and the political economy of the licit and illicit drug markets, including their parallels and entwinements

  

     --Social suffering: refers the misery among those on the weaker end of power relations in terms of physical health, mental health and lived experience.

     --Self-medication: From the perspective of critical medical anthropology, inequality as it is experienced by people who must endure its consequence is a major force driving heavy drug use and addiction. Life for a drug addict is often a vicious cycle of felt stress followed by self-medicating drug consumption and resulting social stigmatization and a sense of damaged self-worth (which, in turn, triggers the desire for comfort through drugs). Moreover, because of the damaging effects of drug use (e.g. hepatitis, HIV infection) addiction contributes to health disparities.

     ---Drug syndemics: One development within the critical medical approach to drug use and addiction is a growing focus on drugrelated syndemics, which are defined as the adverse interaction of diseases with each other and with punishing social conditions that promote both disease aggregation in a population and the reduction in immune competency and bodily capacity to resist and overcome disease

       

THE EXPERIMENTAL MODEL: in addition to suffering, addiction has other dimensions including creating opportunities for new experiences and new social relationships, some of which provide positive, self-affirming occasions for drug users, as noted earlier by Friedman and co-workers. Addiction, in short, plays a role in the making of personal identities, and is thus more than suffering and social rejection.

     --some addictions or aspects of addictions can be affirmative, creative and sustainable, at least at the individual level.

     --a focus on drug therapies and the subjective experiences of being in treatment

     --AIDS/HIV moved anthropology forward into studies of addiction.

the strengths of ethnography; the power of the cultural model; the concern with 

emic understandings, lived experience and subjectivities; the stress put on

 understanding pathways of biosocial interactions; the cross-societal breadth of its gaze;

 and the now linkage of the micro-world of experience and the macro-world of political

 economy and globalism