Each of these polemical books considers health and illness in recent Western history. Each moves in to large areas of disputation and advertisement, involving sections of the medical and paramedical professions, the academy and the media, with populations of patients, families, commentators and consumers. Each is launched against beliefs and ways of speaking seen to be retrograde and damaging; each communicates a broadly progressive politics and brings to bear long-developed skills in argument and writing. Their concerns intersect; at several points, the arguments are similar.
The reasons why one book is so much more productive than the other are mattters of writing, of the self-inscription of each writer in her work, of the legible understandings of the task in hand. One book exists because a highly-regarded writer has visited the domain of a destructive epidemic – much as she, and Jane Fonda, once visited Vietnam. Those visits probably did help in shifting consciousness; I’m not so sure about this one. The other book comes out of work on the ideology of new fashions in health-care and health-talk – work which is understood as, centrally, a job of writing. The difference is crucial.
Aids and its Metaphors is a short essay (90 pages), explicitly offered as a kind of sequel to Illness as Metaphor, written in 1976 when Susan Sontag was herself a cancer patient. Both show clear lines of affinity with her work in quite different areas. Twenty-five years ago, in Against Interpretation, she argued for a criticism which attended first, descriptively, to aesthetics, to the intrinsic properties and total character of a work, setting ‘meaning’ in abeyance. ‘In place of a hermeneutics we need an erotics of art,’ she said. It was a call, almost a manifesto, which resonated compatibly with the incipient politics of the decade.
Sontag mediated the works of Benjamin, Barthes, Genet, Godard, Resnais, Bresson, Riefenstahl and Canetti to that American audience which listens first to what is spoken from New York. Every essay, in her lively early collections, enacted her declaration of faith in the indissoluble quiddity of the artefact. You do not peel away the text to reveal the subtext, as though the surface was no more than packaging; you don’t replace the object or the text with a verbal simulacrum; you rather try to serve its existence by writing about what it is and what it does. (The interpretation, of course, begins with the selection of objects.)
When it came to cancer, Sontag stuck to her intellectual guns with exemplary consistency and courage. But while her responses to the life and work of a given artist or writer provided for expanding effects, Illness as Metaphor worked – or meant to – in the opposite direction. The objective was to belittle, deliberately: to get rid of ‘meanings’, of the mythic shadows cast by life-threatening disease, and concentrate strictly on the material facts of it, the chemistry and physiology, the business of treatment, survival or non-survival.
In the course of her argument she produced a highly literary, writerly and readerly essay, patterned with tall shadows, and other, older voices sounding constantly behind her own: the quotations on illness range from the Greeks to Keats and Stendhal, Chekhov, Katherine Mansfield and Auden. The not-so-curious fact is that when people claim to have found the essay helpful in their own and others’ time of illness, it’s not because it persuaded them to make less of the situation, but rather that it proposed links they had not previously thought about between history, writing and present bodily experience. In a few good bookshops you can find it on the shelves marked Health and Healing, rather than – or as well as – in Literature, under the author’s name. The practical value which puts it there lies not in Sontag’s insistence on practicality itself, but in the way the essay is in fact an interpretative artefact, a weaving together of connections, a transformation.
Aids and its Metaphors repeats these paradoxical strategies. She begins with Lucretius, in a remarkable poem where he denies validity to the idea of ‘harmony’ in talk of the physical world: ‘Whatever it is, give it back to the musicians.’ From Donne’s passages on the unwell body as a fortress under siege, she begins to hunt down her particular objective, ‘the military metaphor’; on the way, she finds support in Nietzsche, Defoe and Alessandro Manzoni. Other writers expand the damaging mythologies of plague: Thomas Mann’s works, she observes, form ‘a storehouse of early 20th-century disease myths’.
She writes against the discourse of retribution, noting that the Emperor Maximillian, about five hundred years ago, declared syphilis a general punishment for vice. She displays the symmetry of various paranoid myths of origin (the disease began with bestiality in Africa – alternatively, it began as a CIA-funded bacteriological-warfare scheme in Maryland). She attacks the scaremongering, the lurid talk of pandemic, and the construction of an indefinitely increasing, permanently threatened and threatening pariah group, ‘the future ill’ – a construction which develops as the notional incubation period for Aids has lengthened from one year to five, ten or longer.
She particularly inveighs against the language of plague and the righteous moralism which falls into step with it, so that Aids, like VD in earlier decades, becomes defined both as a threat to the innocent and a judgment on the guilty. She questions the discourse of increased surveillance and admonition, vigilance, monitoring, testing, and considers the ways in which public discussion on the illness becomes enmeshed both with homophobia and racism. In almost any community it becomes numbered – quickly, complacently and quite erroneously – as a ‘dregs’ disease’ of which only the lower orders – black, poor, underprivileged and unhealthy – will be at risk.
Sontag correctly identifies the way public discussion is obstructed by those with an interest in punitive dystopian and apocalyptic scenarios, in which the modern world will be utterly inundated or incinerated for its degeneracy. She is speaking especially, but not only for New York when she attacks ‘the Kultur-kampf against all that is called, for short (and inaccurately) the 1960s’.
She doesn’t attempt to arbitrate between the opposing scenarios – the one which predicts the deaths of many millions, dwarfing all earlier plagues, or that which cautiously offers hope of a more limited damage. Her central argument is that ‘Aids occupies such a large part in our awareness because of what it has been taken to represent. It seems the very model of all the catastrophes privileged populations feel await them.’ Against that, she works to make this disease, like others now less dreaded than they were, ‘seem ordinary’.
Sontag proposes that until such ordinariness is accomplished, so that Aids is recognised with realism but without panic, ‘much in the way of individual experience and social policy depends on the struggle for rhetorical ownership of the illness: how it is possessed, assimilated in argument and in cliché’. She is especially concerned to get rid of the language of battle, invasion, assault, mobilising, fighting back – the ‘military metaphor’ which, she thinks, ‘overmobilises, overdescribes and ... powerfully contributes to the excommunicating and stigmatising of the ill’. Then, in her concluding paragraph, she declares categorically that ‘We are not being invaded. The body is not a battlefield ... We – medicine, society – are not authorised to fight back by any means whatever ...’
But we are, it is, and we are – insofar as this epidemic is what the sufferers least desire, insofar as social action can be taken to palliate suffering, inhibit contagion, and spread exactly the kind of precise, anti-hysterical information Sontag herself wishes to see promoted. ‘Battlefield’ is, after all, a pretty stale metaphor for the body in which the microprocesses are working against each other; we could let it drop, not because it ‘overdescribes’, but simply because, as metaphor, it’s tired.
The notion of conflict as fundamental is exactly what has to be kept in mind by those who are unafflicted by bodily conflict – the others hardly have the choice – if we’re going to contend against the cruellest myths. People get sick partly because ‘nature’ is indeed unharmonious, prone to internal discord, accident and sheer bad luck; and medicine itself brings struggle into the body. Warfare is exactly what you think of, irresistibly, when you spend time with someone suffering as much from cure as disease. The chemotherapies can be efficacious, but their active constituents are akin to those the Nazis used in the gas chambers. The side-effects are devastating; and sometimes, when the life cannot be saved, it is prolonged at the expense of frequent misery.
Sontag’s tone is ex cathedra, her tactics those of the literary mandarin, attended here and there by the Euro-centred cinéaste. It’s not so much a matter of the deployment of references – there’s every reason to raise historical echoes around such calamities, to let people know that this kind of thing has been faced before and turned into novels, movies, opera. It’s more that the connections are totally unacknowledged; the essayist speaks as though she were speaking alone. ‘About that metaphor, the military one,’ she concludes, ‘I would say, if I may paraphrase Lucretius: Give it back to the war-makers.’
A virtuoso landing, and the virtuosity is what counts; we register the skill of the closure, and the highly-placed, controlling presence of the writer. No bibliography follows, although the bookshelf in any city’s Aids information centre lengthens by the month. Consider as well (or even instead) the special issue of October (Winter 1987); the excellent multi-author collection Aids: The Burden of History, edited by Elizabeth Fee and Daniel M. Fox; Dennis Altman’s Aids and the New Puritanism.
To the extent that Sontag’s essay links with those discussions and with the pleas you can read every week in liberal newspapers and journals – pleas against moralism and bigotry, pleas for correctly-targeted action – it is unexceptionable. But for many, and they include people in the groups defined as being most at risk, it’s also unnecessary. Some of the most unscary, deflationary writing on the disease has been done by people who have it; and the best ad I have seen for the obvious means of prevention is a witty, matter-of-fact video made by a young black film-maker for the Aboriginal Medical Service in Sydney. Her constituents don’t need telling that they’re up against malign mythologies – as well as infection, low morale and inadequate services.
The fight isn’t, in fact, against ‘metaphor’ as such: the question is always what kind of metaphor. Illness, like everything else which irretrievably matters to us, is culturally-defined (that is, entangled with verbal imagery and ritual) from the outset – by the protocols of the surgery and hospital, the routines of medication; the extent of divorce from workplace and household; what other people expect. What we do with being ill is equally cultural, in other senses of the word. Patients ‘cope’ – which means turning themselves, as far as they can, from patients into agents; faced with death at close range, and bad trips in their shortened meantimes, they reach for their culture.
By that token, anyone’s observations of Aids, or cancer, or cripplement, will yield stories of exemplary heroism. Evangelists of the contemporary health religions turn those stories upside down in order to set the responsibility for both well – and ill-being on the shoulders of the individual, and sell their varying brands of ‘natural’ salvation. In Rosalind Coward’s view, this is the Protestant curse, developed now into an ideology only too compatible with individualist capitalism, despite all the show of opposition to the unhealthy industrialised world.
Her prose is extensive, explanatory, careful; there’s too much at stake, politically, for epigrammatic compression. It is serviceable prose, in the best possible sense; by that token, I think it’s among the best writing she has done. The important influences from feminism, psychoanalysis and contemporary Marxist thought are fully assimilated; she doesn’t need signposts, and the references – apart from Levi-Strauss’s indispensable The Raw and The Cooked – are quite unprestigious, being mostly to the voluminous propaganda in the area, the claims alternative practitioners and salespeople make for their work. At the end, writing on the symbolic value of Aids, she’s much tougher than Sontag on those personal-salvation merchants who have the gall to tell the victims that it’s their opportunity to transform themselves.
Her position is developed through chapters on recently-developed beliefs about the body and its supposed perfectibility; mind-body relations and ‘the fantasy of the whole person’; on Nature – rewritten, sentimentalised as wise and benign; the cultural and financial investment in health foods; and – a chapter for which she has my deepest gratitude – on all that pious, pseudo-feminist cant which has arisen on the purported affinities between women and nature, so that we’re supposed to be, just naturally, better at ecology and conservation than men. On that score, the book’s feminism is what feminism everywhere has to become, an open politics linking different issues, rather than a shopping-list of ‘women’s issues’ only.
After a good deal of primary research on migraine, I am grateful also for the way Coward unpacks the mythology of stress, a notion now invoked to explain everything from a minor rash to inoperable cancers. She argues that health has taken over from sexuality as the focus of attention to the physical domain, and that the widely dispersed alternative-health movement has turned into an unofficial religion which de-politicises, dispenses false comfort, and makes money for its most ingenious and dedicated practitioners. Her target is the view that the ‘transformed individual’, at peace with her/himself and the natural universe, is the proper and sufficient goal of action, that the dilemmas of modernity can be adequately dealt with by making merely personal choices in the direction of health and harmony. ‘This new religion of the body is not part of a revolutionary consciousness, but part of the general drift into making health and the body a philosophical, moral and religious concern rather than a political one.’
Of course there’s the other side to it – the frequent authoritarianism and narrownesss of mainstream medicine; Coward recognises that the alternative movement began in part with valid criticisms and rebellions. She also fully understands that many alternative therapies are neither crazy nor useless.
But magazines and paperbacks are sold on endless personal advice-peddling, and titles like ‘How To Release Your Hidden Potential’. On a nearby shelf I find a recent Penguin on menopause, with chapter-headings like ‘Ageing in Women: Your Potential for Growth and Freedom’; the radio-talk I turned off minutes ago was a perfectly intelligent assemblage of case-studies made in order to probe the psychology – not the politics – of anorexia and bulimia. The nostrums of popular psychology and bowdlerised psychoanalysis are used to set the responsibility for illness on the sufferer, ‘surveys’ are produced to show that victims of cancer and Aids were always maladjusted anyway. This is the rage for order, the need to find sense in chaos – sometimes, pathetically, to find terms on which religious belief can be sustained in the face of outrageous personal loss.
The Whole Truth ends with a discussion of ‘the wholesome entrepreneur’, the fully adjusted, only-too-contented individual whose personal integration, harmony, freedom from anger and resentment (‘negative feelings’) entail also indifference to politics, an easy cohabitation with the system. That mentality, Coward argues, is the outcome of a major emphasis in the alternative therapies movement – despite other links with green politics and anti-nuclear activism.
She leaves us there; the book is most valuably open-ended. The links between one sort of medicine and another, one politics and another, remain to be argued out; connections can be broken and re-formed. Health programmes properly informed by feminism, for example, must continue to oppose over-technologised, authoritarian gynaecologies, but they needn’t throw the baby out into the witches’ herb-garden, or let it drown in the waterbirth tub. Conventional medicine does not have to serve capitalism – the struggles continue to make it part of whatever social democracy we have. There are doctors who refuse to function as agents for drug companies, and who add ‘alternative’ knowledges, like acupuncture and hypnotism, to their degrees. There are also quite sensible chiropractors and naturopaths, who don’t imagine that their skills add up to a religion.
Some of the major problems are for the makers and agents of policy, steering their paths between the deep sea of the quasi-‘natural’ philosophies and the devils of a highly conservative profession. If they’re interested in social justice, this book clears important ground for them. The more serious problems are those of people it cannot directly reach, whose illnesses have everything to do with poverty and underprivilege, and nothing to do with alienation from ‘nature’ in the forms of brown rice or nicely packaged kelp. For them, Coward’s argument must find its way into community radio and video; and not least into the medical soaps, with their irresistibly open-faced and amiable cunning.