ILLNESS AS METAPHOR (1978) / by Caitlin Murray

CITIZENS - everyone who is born holds dual citizenship in the kingdom of the well and the kingdom of the sick / wants to investigate the STEREOTYPES OF NATIONAL CHARACTER / the elucidation and liberation from the metaphors of illness - illness is not a metaphor

CHAPTER 1

cancer as a ruthless, secret invasion / rectify the conception of the disease, to de-mythicize it / "A leading French oncologist has told me that fewer than a tenth of his patients know they have cancer" / The metaphors attached to TB and to cancer imply living processes of a particularly resonant and horrid kind

CHAPTER 2

OED definitions of cancer : "Anything that frets, corrodes, corrupts, or consumes slowly and secretly" / cancer (latin) meaning crab, was inspired - according to Galen - by the resemblance of an external tumor's swollen vein to a crab's leg / lethal growth / (scans - becoming transparent to oneself?) / what the patient cannot perceive, the specialist will determine / cancer as demonic pregnancy / not a disease of time, but of topography *spreading *proliferating *diffused

. . .

Cancer, as a disease that can strike anywhere, is a diseases of the body. Far from revealing anything spiritual, it reveals that the body is, all to woefully, just the body.

. . .

Thoreau, who had TB, wrote in 1852: "Death and disease are often beautiful, like...the hectic glow of consumption." Nobody conceives of cancer the way TB was thought of - as a decorative, often lyrical death. cancer is a rare and still scandalous subject for poetry; and it seems unimaginable to aestheticize the disease.

CHAPTER 3

Freud's cancer / The Death of Ivan Ilyich / suppression / repression / passion / sublimation / the banality of health

CHAPTER 4

illness as a manner of appearance - a reflection of attitudes toward the self : "Marie Bashkirtsev wrote in the
once widely read Journal, which was published, after her death at twenty-four, in 1887. 'But for a wonder, far from making me look ugly, this gives me an air of languor that is very becoming."'What was once the fashion for aristocratic femmes fatdes and aspiring young artists became, eventually, the province of fashion as such. Twentieth-century women's fashions (with their cult of thinness) are the last stronghold of the metaphors associated with the romanticizing of TB in the late eighteenth and early nineteenth centuries."

THE TUBERCULAR LOOK / the modern idea of INDIVIDUALITY / sickness as INTERESTING (ROMANTIC)

Powerlessness and what is "Interesting" / the melancholic artist / a model for the bohemian life / a new reason for exile - a life that was mainly traveling (Italy > islands in the Mediterranean or South Pacific > the mountains, the desert):


"By a curious irony," Stevenson wrote, "the places to which we are sent when health deserts us are often singularly beautiful . . .[and] I daresay the sick man is not very inconsolable when he receives sentence of banishment, and is inclined to regard his ill-health as not the least fortunate accident of his life."

The Romantics invented invalidism as a pretext for leisure, and for dismissing bourgeois obligations in order to live only for one's art - a way of retiring from the world without having to take responsibility for the decision : (THE SOCIO-ECONOMIC PROBLEM OF TB)

THE MAGIC MOUNTAIN

. . .

the pressure to express romantic attitudes about the self is not found in cancer, but in insanity: confinement, the sanatorium, like TB insanity is a kind of exile ("a trip"), the sufferer as hectic, reckless, passionate, sensitive

some of the metaphors of TB are transferred to cancer: "the agonies that can't be romanticized"

"The romanticizing of madness reflects in the most vehement way the contemporary prestige of irrational or rude (spontaneous) behavior (acting-out), of that very passionateness whose repression was once imagines to cause TB, and is now thought to cause cancer."

CHAPTER 5

However steep its incidence in a population, TB - like cancer today - always seemed to be a mysterious disease of individuals, a deadly arrow that could strike anyone, that singled out its victims one by one / you burn the effects and clothes of a TB victim: of Keats's apartment on the Piazza di Spagna - "They have burned all the furniture - and are now scraping the walls - making new windows - new doors - and even a new floor"

 

an inheritance: the families of Keats, the Brontes, Emerson, Thoreau, Trollope / although a hereditary factor in cancer can be acknowledged - it does not disturb the belief that cancer is a disease that strikes each person, punitively, as an individual / "Why me?"

. . .

The speculations of the ancient world - disease as divine wrath / the stinking wound in Philoctete's foot / modern fantasies - self-judgement (I'm so proud of you) / Fatal illness has always been viewed as a test of moral character, but in the nineteenth century there is a great reluctance to let anybody flunk the test - and the virtuous only become more so as they slide toward death / For those characters treated less sentimentally, the disease is viewed as the occasion finally to behave well / the death of Ivan Ilyich / Kurosawa's Ikiru (1952)

CHAPTER 6

With the advent of Christianity, which imposed more moralized notions of disease, as of everything else, a closer fit between disease and "victim" gradually evolved - The idea of disease as punishment yielded the idea that a disease could be particularly appropriate and just punishment / In the nineteen century, the notion that the disease fits the patient's character, as the punishment fits the sinner, was replaced by the notion that it expresses character - It is a product of will (Schopenhauer : "the presence of disease signifies that the will itself is sick") / Disease as a form of self-expression (Groddeck : disease as a "symbol, a representation of something going on within, a drama staged by the It..." / Kant : extreme passions as cancers - pre-romantic notion / Diseases and patients as subjects for decipherment

The passive, affectless anti-hero who dominates contemporary American fiction is a creature of regular routines or unfeeling debauch; not self-destructive but prudent; not moody, dashing, cruel, just dissociated. The ideal candidate, according to contemporary mythology, for cancer.

. . .

punitive : character causes the disease / "Such preposterous and dangerous views manage to put the onus of the disease on the patient and not only weaken the patient's ability to understand the range of plausible medical treatment but also, implicitly, direct the patient away from such treatment. Cure is thought to depend principally on the patient's already sorely tested or enfeebled capacity for self-love."

Both the myth about TB and the current myth about cancer propose that one is responsible for one's disease / But the cancer imagery is far more punishing

Miss Gee knelt down in the side-aisle,
She knelt down on her knees;
'Lead me not into temptation
But make me a good girl, please.

The days and nights went by her
Like waves round a Cornish wreck;
She bicycled down to the doctor
With her clothes buttoned up to her neck.

She bicycled down to the doctor,
And rang the surgery bell;
'O, doctor, I've a pain inside me,
And I don't feel very well.

Doctor Thomas looked her over,
And then he looked some more;
Walked over to his wash-basin,
Said, 'Why didn't you come before?'

Doctor Thomas sat over his dinner,
Though his wife was waiting to ring,
Rolling his bread into pellets;
Said, 'Cancer's a funny thing.

'Nobody knows what the cause is,
Though some pretend they do;
It's like some hidden assassin
Waiting to strike at you.

'Childless women get it,
And men when they retire;
It's as if there had to be some outlet
For their foiled creative fire.

(Auden)

the cancer personality is regarded more simply, and with condescension, as one of life's losers (Napoleon, Ulysses S. Grant, Robert A. Taft, and Hubert Humphrey have all had their cancer diagnosed as the reaction to political defeat and the curtailing of their ambitions.) And the cancer deaths of those harder to describe as losers, like Freud and Wittgenstein, have been diagnosed as the gruesome penalty exacted for a lifetime of instinctual renunciation. (Few remember that Rimbaud died of cancer.

chapter 7

the emotional causes of cancer / the human condition / "I'm mentally ill, the disease of the lungs is nothing but an overflowing of my mental disease," Kafka wrote to Milena in 1920 /  "the happy man would not get plague."

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 the physical terrain of a disease, i.e. the peculiarly modern predilection for psychological explanations of disease, as of everything else.

psychologizing seems to provide control

Indeed, part of the denial of death in this culture is a vast expansion of the category of illness as such / Two hypothesis:

The first is that every form of social deviation can be considered an illness, ex. criminals understood as being treatable or curable

The second is that every illness can be considered psychologically - illness as a psychological event - you can cure yourself by a mobilization of will; that they can choose not to die of the disease (MILITARY LANGUAGE)

(the first hypothesis relieves guilt, the second reinstates it) PLACE THAT BLAME ON THE ILL 

(if you can cause your disease than you can deserve your disease!)

CHAPTER 8

Punitive notions of cancer : fight, crusade, the killer, victims - you are ultimately responsible for falling ill and getting well (like leprosy, sontag argues) / THE DISEASE BECOMES ADJECTIVAL / the multi-determined nature of cancer - it is still mysterious - an array of cures for each of the different cancers - this is a reflection of a lack of understanding, not necessarily scientific fact (multi-determined as another word for mysterious)

cancer as "the barbarian within" - a pathology of energy, a disease of will - cancer as a disease of unexpressed energy:

In an era in which there seemed to be no inhibitions on being productive, people were anxious about not having enough energy. In our own era of destructive overproduction by the economy and of increasing bureaucratic restraints on the individual, there is both a fear of having too much energy and an anxiety about energy not being allowed to be expressed.

RECKLESS EXPENDITURE : HOMO ECONOMICUS  : (early capitalism vs. advanced capitalism) : 

Advanced capitalism requires expansion, speculation, the creation of new needs (the problem of satisfaction and dissatisfaction); buying on credit; mobility—an economy that depends on the irrational indulgence of desire. Cancer is described in images that sum up the negative behavior of twentieth-century homo economicus: abnormal growth; repression of energy, that is, refusal to consume or spend.

COUNTERATTACK - "the treatment is worse than the disease" / COLONIZATION / the military flavor of treatment 

CHEMICAL WARFARE :

Drugs of the nitrogen mustard type (so-called alkylating agents) —like cyclophosphamide (Cytoxan)—were the first generation of cancer drugs. Their use—with leukemia (which is characterized by an excessive production of immature white cells), then with other forms of cancer—was suggested by an inadvertent experiment with chemical warfare toward the end of World War II, when an American ship, loaded with nitrogen mustard gas, was blown up in the Naples harbor, and many of the sailors died of their lethally low white-cell and platelet counts (that is, of bone-marrow poisoning) rather than of burns or sea-water inhalation. Chemotherapy and weaponry seem to go together, if only as a fancy. The first modern chemotherapy success was with syphilis: in 1910, Paul Ehrlich introduced an arsenic derivative, arsphenamine (Salvarsan), which was called "the magic bullet."

ATAVISM OF CANCER - REPLACING THE REAL YOU (Immunologists class the body's cancer cells as "nonself.") MUTATION - the science fiction of cancer / look into the National Cancer Act of 1971 - the John Birch Societies forty-five minute film - World Without Cancer

 

But cancer is not just a disease ushered in by the Industrial Revolution (there was cancer in Arcadia) and certainly more than the sin of capitalism (within their more limited industrial capacities, the Russians pollute worse than we do). The widespread current view of cancer as a disease of industrial civilization is as unsound scientifically as the right-wing fantasy of a "world without cancer" (like a world without subversives). Both rest on the mistaken feeling that cancer is a distinctively ''modern'' disease.

A DISEASE OF CONTAMINATION OF THE WHOLE WORLD - THE EPIDEMIC OR PLAGUE OF CANCER

CHAPTER 9