“So what are you doing to distract yourself and stimulate your mind?” asked a friend on a recent Zoom call. My reply was “well, I’m rereading some classic cancer books.” Feel free to judge my mental health harshly, but it’s working for me. I’ve finished Audre Lorde’s Cancer Journals and Susan Sontag’s Illness as Metaphor.
These books are classics for a reason. Both written in the 1970s (Cancer Journals appeared as a book in 1980 but the essays were written earlier), they punctured fear, stigma, and silence about cancer at a time when those were three dominant poses. Not that everything is hunky-dory now, but there is certainly less stigma around cancer today than when they wrote. They are both very much of their time in the references, terminology, framing, style, and concerns, but I find that distance quite comforting and clarifying.
In this post, I’ll talk about Sontag and my reflections on it.
Sontag connected cancer to social theory, showing how it–and tuberculosis before it–was used to explain everything from morality and character to the organization of societies.
Two things struck me from Sontag on this reading. First, her prediction that a single cause would eventually be discovered for all cancers, the way that a single cause had been discovered for so many other diseases, and that once that cause had been discovered, the mystery and metaphoric power of the disease would wither away, as it had for TB. It seems that things are moving in the exact opposite direction. The category of cancer is exploding, and it may be possible that many things called cancers–including mine–will soon have other more specific names (mine already sort of does). “High grade metastatic thyroid cancer BRAF-600 mutation” just doesn’t have the metaphoric power that a more vanilla “cancer” has, though it does have that power-word inside the phrase.
Illness as Metaphor is mostly an exercise in close reading, or perhaps more accurately, having-closely-read. Sontag draws from a wide range of examples of TB and cancer talk in the English-language canon for her evidence, and the book is almost entirely about cataloguing the many metaphoric uses of TB and cancer. But there is a kernel of an argument that appears at the beginning and end, and remains implied throughout: the diseases-as-metaphor usage is never good for–or helpful to–the person with the disease. She explicitly says that we should not be using diseases as metaphors.
In that way Sontag’s argument lines up with contemporary language politics around disability and chronic illness. The stakes are different because one has cancer. One is blind or d/Deaf. So a phrase like “they were blind to the implications of” or “they were deaf to the concerns of” is qualitatively different from something like “unwanted AI assistants are metastasizing across all our applications.” (And they are!)
Metastases are pretty much always unwanted and are not generally assumed to be the fault of the person (lung cancers and a few others aside, especially in the US, where the culture is still incredibly moralistic about health as a way of covering up its crushing death taboo–but I will have to write about moralism of the US medical system another day). Being blind says nothing about how perceptive or wise one is, and being deaf says nothing about how empathetic one is, so it’s just really rude to use those embodied conditions as metaphors for generalized human moral failures of which we are all capable. It’s like using “Jew” as a verb to mean “swindle.”
The issue with cancer used as a metaphor is slightly different. The mystery around cancer endows the metaphor with special agency and power. Cancer can destroy in a way that modern medicine and science cannot understand or repair. That’s juicy for writing, but not necessarily helpful for the person dealing with it. Metaphoric cancer is not predictable. It is amoral (but think about it–what disease is moral?). It is both of the body and not of the body–self and other (but think about it–what disease doesn’t bridge the Western mind/body divide?). Endowing the disease with all this power and category violation can overwhelm the perception of the person living with the actual disease, which is neither metaphorical, nor ambiguous, even if it’s also not predictable.
I feel this acutely in my experience with talk about the disease. I think it’s one of the reasons that medical professionals and literature use so much euphemism around side effects from treatment (the other is practical: in some cases, they believe some patients would just never do the treatments if they knew the side effects ahead of time–it would scare them off–though now we enter Ivan Illich Medical Nemesis territory, which is also on my reading list).
Sometimes I am concerned that the word cancer with all of its fraught and radiant signification overwhelms people’s perception of me as a person living with disease. I am feeling this right now as loads of wonderful expressions of solidarity enter my inbox, because how can someone who hasn’t experienced it as a patient or caregiver even comprehend cancer in the brain? Especially in my intellectual set! I sure as shit couldn’t have.
Mostly, living with the disease is much more mundane than the dominant metaphors would allow. But they–along with American medical moralism and the death taboo, and probably other factors I’m not thinking of–also foreclose the real existential reflection that any dangerous illness demands. In sum, when cancer is used as part of the current metaphoric repertoire, people with cancer get the worst of both worlds.
Of course, it’s more complicated than what I’ve laid out here. I spend a lot of time with my students sorting out the limits of language politics — it’s one thing in formal writing or “theorizing” and another in interpersonal conversation. People can mean well and still use all kind of problematic language, and most of the time it would be wrong to highlight the language as a bigger problem than their well-meaning is a benefit. The same goes for people actually trying to make sense of their own disease experience. There is a subset of people in my thyroid cancer support groups who want to use martial metaphors to describe their experience–“cancer warrior” and such. My view in those situations are that people need to do whatever works for them, even if I think the war metaphors are overall quite problematic. When it comes to actual people suffering or seeking to alleviate suffering, I think we’ve got to cut ourselves and them some slack. Multiple things can be true, and we can hold a critique of language in one hand, and a sense of care and justice in the other, and balance them in the moment.
As for me, I prefer a navigation metaphor. So I refer to myself as a “thyronaut.”
Next up: Andre Lorde Cancer Journals.
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One note: the current Wikipedia summary of Illness as Metaphor says that Sontag’s main critique of metaphor is that it is victim-blaming. While she is highly critical of victim-blaming discourse throughout Illness as Metaphor, I think that is wrong as a characterization of her overarching claim about metaphor. She also addresses many other uses of metaphor from the sexualization of TB patients in 19th century literature to German Nazis’ switch from TB to cancer metaphors to describe Jews.