Illness as Metaphor by Susan Sontag

Susan Sontag's Illness as Metaphor (1978)

• Explores the language used to describe diseases and its victims
• Examines the use of metaphors to describe tuberculosis and cancer from Antiquity to the 20th century
• Illness metaphors obscure the understanding and treatment of disease while simultaneously placing blame on the victim

The Aesthiczation of Illness

• Representation of something beautiful
• Victims of tuberculosis are often romanticized as beautiful and gaunt
• Early victims of tuberculosis were often artists, contributing to the positive associations
• In contrast, cancer metaphors often have negative associations, such as warfare and violence

Illness as Representation for Unknowingness of Life

• Mysterious diseases like tuberculosis and cancer have potent and wide-ranging metaphors
• Syphilis, with its known origins, has a language of moral judgment
• People often look to personal history to explain and make sense of disease
• Narrative reconstruction is a way to deflect blame and deter others from similar behaviors

Coping with Illness

• Uncertainty about illness and its effects adds to patients' uncertainty
• The internet helps patients cope through information and connection with others
• Contested illnesses, where symptoms are not validated by professional medicine, can affect patients' abilities to cope
• Validation of symptoms can lead to a credible diagnosis and reduce the likelihood of being seen as a malingerer

Metaphors Obscuring the Victim's Relation to Illness

• Avoiding metaphors helps victims find "the healthiest way of being ill"
• Historically, victims and others would blame the contraction of disease on victims' psychological traits
• Treatments would target hypochondria, emotional states, and depression
• Cancer metaphors can be applied to many potentially harmful elements of society, war, fascism, and injustices

Culture and Meaning of Illness

• Illness experiences, understanding of illness, and healing practices are all culturally informed
• Cultural explanations for illness provide insights into the application of Western Scientific medicine in traditional societies
• Understanding cultural meanings of illness translates to treatment practices
• Beliefs about illness and healing in traditional societies include:
  • Soul Loss: evil spirit steals the soul
  • Spirit Intrusion: evil spirits possess the body-mind
  • Disease Object Intrusion: spirit invests in material objects
  • Breach of Taboo: misdeed that offends the spirits
• Beliefs about causes and treatments of illness in modern societies include:
  • National deficiency: lack of self-care
  • Internal lesions, blockage, or tumors: medical specialty
  • Germs on objects: microbes everywhere
  • Irrational thoughts and behaviors: psychiatric and physiological counseling

Mental Illness and Culture

• Traditional societies: collectively as important, not in total control of self
• Modern societies: individuals as important, should have self-control
• Source of mental disorder:
  • Traditional societies: spirits, outside forces
  • Modern societies: disease of the brain, internal forces
• Treatment:
  • Traditional societies: placate the spirits
  • Modern societies: drugs and/or psychotherapy
• Attitude of the community:
  • Traditional societies: calm
  • Modern societies: emotional over-involvement
• Expectations of treatment:
  • Traditional societies: reintegration into the community
  • Modern societies: transformation of the individual

Doctor-Patient Interaction

• The doctor-patient relationship is a social system
• The Sick Role and the Physician's Role:
  • Sick Person's Role Set: exempt from normal social responsibilities, be helpless, obliged to want to get well, and seek competent help
  • Physician's Role Set: determined by inherent strains, access to the body, and personal questions
• Criticisms of the Sick Role:
  • Ideological: based on a specific worldview
  • Applicability: does not apply to all situations
• Models of Physician-Patient Relationship:
  • Szasz-Hollender Model: typologies of the doctor-patient relationship
• Dimensions of Doctor-Patient Relationship:
  • Three key dimensions: social, cultural, and personal
• Barriers to therapeutic communication between patients and physicians