Well, welcome to the latest incarnation of the blog! Thanks to Gunnar for making it nice and new and dealing with my 300 questions. For the time being I can't figure out the comments thing, so you can email comments to me, and I'll post them. I did create a searchable index of all the reviews written here, and posted them at the bottom of the archive for 9/30/2003, though I'm sure there's a better way to do it.

I finally got around to reading Susan Sontag's Illness as Metaphor (1979) and AIDS and Its Metaphors (1988, the two essays reprinted together in 1990), which I picked up off a stoop in Jersey City. The first essay is an exploration of how the language with which we speak of illness (Sontag focuses on TB and cancer) affects the treatment--medically, socially, politically, artistically--of people who have illnesses. The second essay, a response to and elaboration of the ideas in the first, focuses on AIDS metaphors.

I particularly liked her excoriation of self-help language as a means of blaming people with cancer for their disease, her treatment of the dual nature of TB metaphors (as a disease of the poor/foreign, or of the artist/romantic--and how this latter characterization has shifted in the 20thC to discussion of mental illness), and much of what she had to say about AIDS (the ghettoizing of it as a gay men's disease and drug users' disease at the same time as it was decimating the population of Uganda, for example). Much of what's good in these essays will confirm any thoughtful person's approach to the language of disease: why do we assign personalities, as it were, to illnesses, and seek to impose moral judgments on people with illnesses? Why do we call some people with illnesses "victims," and some people "survivors" or "fighters," and does it make a difference which word we use? (Though the latter might be thought to be "empowering," does it actually empower people to have them "fight" to "vanquish" or "eradicate" cellular happenings in their own bodies, as in the case of cancer? Does the cancer-riddled body need to be destroyed utterly in order to kill the cancer, at the cost of the patient's life?) Where do you draw the line between the patient and the disease? Before reading this, I knew already how self-help language seeks to blame people for their cancer by accusing them of eating the wrong things, living the wrong way, etc. etc. But I wasn't aware that up through the 80s there was a lot of pop wisdom--and medical belief--about how cancer was caused by the repression of feeling: you get cancer because you didn't express yourself properly, so it's your own fault. I was shocked--but since then, I've read about this in Peter Carey's Bliss (to be reviewed soon), too, and become even more shocked. In the interest of full disclosure, I suppose that I am partly motivated to mention this by my great dislike of psychology, but there it is.

Sontag reminds us that these metaphors are not mere linguistic tricks: survival depends on them, because they influence treatment: they determine where funding goes for cures, how and to whom cures are administered, and how the patient can be encouraged or discouraged from participating in his or her own healing.

On the other hand...I'm not sure that I would recommend this book. When she bothered to document, as in the section on TB, her writing was interesting and enlightening. But I was deeply frustrated by the lack of footnotes, sources, or any other kind of substantiation of her claims, particularly in the sections on cancer and AIDS. Her preference for cutting broad swathes of generalized cultural criticism did not impress or amuse me--I wanted facts.

Also, the fact that Sontag herself had cancer complicated some of her claims. Despite all the evidence she had compiled to shake up one's faith in the medical establishment, she had absolute faith in medical science's ability to completely, utterly cure cancer: by the time she wrote the first essay, she herself had lived through Stage 4 breast cancer that had spread to 31 of her lymph nodes. Later she was to survive uterine cancer as well, before finally dying at the age of 71 of complications from leukemia. In the essay her attitude toward people who felt hopeless about recovery, or who searched for alternative methods of healing, was unstintingly scornful. She was opposed to the absolute equation of death and cancer--a useful and provocative idea, considering how many people survive a great many varieties of cancer--but took it to the extreme of denying any equation at all--and this, I think, only because she happened to be alive at the time she wrote the essay. Which suggests, to me, an unwillingness to examine her own use of certain metaphors of illness, based entirely on her own experience and no one else's. As Karl is fond of reminding me, the plural of "anecdote" is not "data." For a critic of cultural metaphors not to examine her own metaphors, and to use her own experience as a way to rebuke every other cancer patient who didn't make the same choices she did--in effect, to blame people who actually die of cancer for their deaths--is kind of ghastly.