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The treatment of TB is identified with the stimulation of appetite, cancer treatment with nausea and the loss of appetite. The undernourished nourishing themselves—alas, to no avail. The overnourished, unable to eat.
The dying tubercular is pictured as made more beautiful and more soulful; the person dying of cancer is portrayed as robbed of all capacities of self-transcendence, humiliated by fear and agony.
The Romantics moralized death in a new way with the TB death, which dissolved the gross body, etherealized the personality, expanded consciousness. It was equally possible, through fantasies about TB, to aestheticize death. 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.
Tolstoy’s “The Death of Ivan Ilyich” is often cited as a case history of the link between cancer and characterological resignation.
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.
“I look pale,” said Byron, looking into the mirror. “I should like to die of a consumption.” “Why?” asked a friend who was visiting Byron in Athens in October 1810. “Because the ladies would all say, ‘Look at that poor Byron, how interesting he looks in dying.’”
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.
Illness expands by means of two hypotheses. The first is that every form of social deviation can be considered an illness. Thus, if criminal behavior can be considered an illness, then criminals are not to be condemned or punished but to be understood (as a doctor understands), treated, cured.4 The second is that every illness can be considered psychologically. Illness is interpreted as, basically, a psychological event, and people are encouraged to believe that they get sick because they (unconsciously) want to, and that they can cure themselves by the mobilization of will; that they can
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Feelings about evil are projected onto a disease. And the disease (so enriched with meanings) is projected onto the world.
Like Freud’s scarcity-economics theory of “instincts,” the fantasies about TB which arose in the last century (and lasted well into ours) echo the attitudes of early capitalist accumulation. One has a limited amount of energy, which must be properly spent.
The language used to describe cancer evokes a different economic catastrophe: that of unregulated, abnormal, incoherent growth.
The controlling metaphors in descriptions of cancer are, in fact, drawn not from economics but from the language of warfare:
In cancer, non-intelligent (“primitive,” “embryonic,” “atavistic”) cells are multiplying, and you are being replaced by the non-you. Immunologists class the body’s cancer cells as “nonself.”
Reminds me of Annihilation
The metaphor of cancer expands the theme of the rejection of the city. Before it was understood as, literally, a cancer-causing (carcinogenic) environment, the city was seen as itself a cancer—a place of abnormal, unnatural growth and extravagant, devouring, armored passions.
To describe a phenomenon as a cancer is an incitement to violence. The use of cancer in political discourse encourages fatalism and justifies “severe” measures—as well as strongly reinforcing the widespread notion that the disease is necessarily fatal.
Our views about cancer, and the metaphors we have imposed on it, are so much a vehicle for the large insufficiencies of this culture: for our shallow attitude toward death, for our anxieties about feeling, for our reckless improvident responses to our real “problems of growth,” for our inability to construct an advanced industrial society that properly regulates consumption, and for our justified fears of the increasingly violent course of history. The cancer metaphor will be made obsolete, I would predict, long before the problems it has reflected so vividly will be resolved.
Twelve years ago, when I became a cancer patient, what particularly enraged me—and distracted me from my own terror and despair at my doctors’ gloomy prognosis—was seeing how much the very reputation of this illness added to the suffering of those who have it.
In recent years some of the onus of cancer has been lifted by the emergence of a disease whose charge of stigmatization, whose capacity to create spoiled identity, is far greater. It seems that societies need to have one illness which becomes identified with evil, and attaches blame to its “victims,” but it is hard to be obsessed with more than one.
This romanticizing of the dementia characteristic of neurosyphilis was the forerunner of the much more persistent fantasy in this century about mental illness as a source of artistic creativity or spiritual originality. But with AIDS—though dementia is also a common, late symptom—no compensatory mythology has arisen, or seems likely to arise.
AIDS reinstates something like a premodern experience of illness, as described in Donne’s Devotions, in which “every thing that disorders a faculty and the function of that is a sicknesse,”
Oliver Sacks uses catastrophic neurological illness as the material for his portraits of suffering and self-transcendence, diminishment and exaltation. His great forerunner, Sir Thomas Browne, used tuberculosis for a similar purpose,
The most terrifying illnesses are those perceived not just as lethal but as dehumanizing, literally so.
Polio’s effects could be horrifying—it withered the body—but it did not mark or rot the flesh: it was not repulsive. Further, polio affected the body only, though that may seem ruin enough, not the face. The relatively appropriate, unmetaphorical reaction to polio owes much to the privileged status of the face, so determining of our evaluation of physical beauty and of physical ruin.
Plagues are no longer “sent,” as in Biblical and Greek antiquity, for the question of agency has blurred. Instead, peoples are “visited” by plagues.
The plague metaphor was common in the 1930s as a synonym for social and psychic catastrophe.
Authoritarian political ideologies have a vested interest in promoting fear, a sense of the imminence of takeover by aliens—and real diseases are useful material. Epidemic diseases usually elicit a call to ban the entry of foreigners, immigrants.
The AIDS epidemic serves as an ideal projection for First World political paranoia. Not only is the so-called AIDS virus the quintessential invader from the Third World. It can stand for any mythological menace.
It is perhaps not surprising that the newest transforming element in the modern world, computers, should be borrowing metaphors drawn from our newest transforming illness.
Fear of sexuality is the new, disease-sponsored register of the universe of fear in which everyone now lives. Cancerphobia taught us the fear of a polluting environment; now we have the fear of polluting people that AIDS anxiety inevitably communicates.
rapid epidemics, including those in which there is no suspicion of sexual transmission or any culpabilizing of the ill, give rise to roughly similar practices of avoidance and exclusion.
Fear of AIDS enforces a much more moderate exercise of appetite, and not just among homosexual men. In the United States sexual behavior pre-1981 now seems for the middle class part of a lost age of innocence—innocence in the guise of licentiousness, of course. After two decades of sexual spending, of sexual speculation, of sexual inflation, we are in the early stages of a sexual depression.
The catastrophe of AIDS suggests the immediate necessity of limitation, of constraint for the body and for consciousness.
The culture of consumption may actually be stimulated by the warnings to consumers of all kinds of goods and services to be more cautious, more selfish. For these anxieties will require the further replication of goods and services.
We are not being invaded. The body is not a battlefield. The ill are neither unavoidable casualties nor the enemy. We—medicine, society—are not authorized to fight back by any means whatever.… About that metaphor, the military one, I would say, if I may paraphrase Lucretius: Give it back to the war-makers.
