Disease as Political Metaphor


Punitive notions of disease have a long history, and such notions are particularly active with cancer. There is the “fight” or “crusade” against cancer; cancer is the “killer” disease; people who have cancer are “cancer victims.” Ostensibly, the illness is the culprit. But it is also the cancer patient who is made culpable. Widely believed psychological theories of disease assign to the ill the ultimate responsibility both for falling ill and for getting well. And conventions of treating cancer as no mere disease but a demonic enemy make cancer not just a lethal disease but a shameful one.

Leprosy in its heyday aroused a similarly disproportionate sense of horror. In the Middle Ages the leper was a social text in which corruption was made visible; an exemplum, an emblem of decay. Nothing is more punitive than to give a disease a meaning—that meaning being invariably a moralistic one. Any important disease, whose physical etiology is not understood, and for which treatment is ineffectual, tends to be awash in significance. First, the subjects of deepest dread (corruption, decay, pollution, anomie, weakness) are identified with the disease. The disease itself becomes a metaphor. Then, in the name of the disease (that is, using it as a metaphor), that horror is imposed on other things. The disease becomes adjectival. Something is said to be disease-like, meaning that it is disgusting or ugly. In French, a crumbling stone façade is still “lépreuse.”

Epidemic diseases were a common figure for social disorder. From pestilence (bubonic plague) came “pestilent,” whose figurative meaning, according to the Oxford English Dictionary, is “injurious to religion, morals, or public peace—1513”; and “pestilential,” meaning “morally baneful or pernicious—1531.” Feelings about evil are projected onto a disease. And the disease (so enriched with meanings) is projected onto the world.

In the past, such grandiloquent fantasies were regularly attached to the epidemic diseases, diseases that were a collective calamity. In the past two centuries, the diseases most often used as metaphors for evil were syphilis, tuberculosis, and cancer—all diseases imagined to be, preeminently, the diseases of individuals.

Syphilis was thought to be not only a horrible disease but a demeaning, vulgar one. Antidemocrats used it to evoke the desecrations of an egalitarian age. In a late note for his never completed book on Belgium, Baudelaire wrote:

We all have the republican spirit in our veins, like syphilis in our bones—we are democratized and venerealized.

In the sense of an infection that corrupts morally and debilitates physically, syphilis was to become a standard trope in late nineteenth- and early twentieth-century anti-Semitic polemics. In 1933 Wilhelm Reich argued that “the irrational fear of syphilis was one of the major sources of National Socialism’s political views and its anti-Semitism.”1 But although he perceived sexual and political phobias being projected onto a disease in the grisly harping on syphilis in Mein Kampf, it never occurred to Reich how much was being projected in his own persistent use of cancer as a metaphor for the ills of the modern era. Indeed, cancer can be stretched much further than syphilis can as a metaphor.

Syphilis was limited as a metaphor because the disease itself was not regarded as mysterious—only awful. A tainted heredity (Ibsen’s Ghosts), the perils of sex (Charles-Louis Philippe’s Bubu de Montparnasse, Mann’s Doctor Faustus)—there was horror aplenty in syphilis. But no mystery. Its causality was clear, and understood to be singular. Syphilis was the grimmest of gifts, “transmitted” or “carried” by a sometimes ignorant sender to the unsuspecting receiver. In contrast, TB was regarded as a mysterious affliction, and a disease with myriad causes—just as today, while everyone acknowledges cancer to be an unsolved riddle, it is also generally agreed that cancer is multi-determined. A variety of factors—such as cancer-causing substances (“carcinogens”) in the environment, genetic makeup, lowering of immunodefenses (by previous illness or emotional trauma), characterological predisposition—are held responsible for the disease. And many researchers assert that cancer is not one but more than a hundred clinically distinct diseases, that each cancer has to be studied separately, and that what will eventually be developed is an array of cures, one for each of the different cancers.

The resemblance of current ideas about cancer’s myriad causes to long-held but now discredited views about TB suggests the possibility that cancer may be one disease after all and that it may turn out, as TB did, to have one factor which causes it and need one program of treatment.2 But the notion of myriad causes is characteristic of thinking about diseases whose etiology is not understood. And it is diseases thought to be multi-determined (that is, mysterious) that have the widest possibilities as metaphors for what is felt to be socially or morally wrong.

TB and cancer have been used (like syphilis) to express not only crude fantasies about contamination but also fairly complex feelings about strength and weakness, and about energy. For more than a century and a half, tuberculosis provided a metaphoric equivalent for delicacy, sensitivity, sadness, powerlessness; while whatever seemed ruthless, implacable, predatory, could be analogized to cancer. (Thus Baudelaire in 1852, in his essay “L’école païenne,” observes: “A frenzied passion for art is a cancer that devours the rest.”) TB was an ambivalent metaphor, both a scourge and an emblem of refinement. Cancer was never viewed other than as a scourge; it was, metaphorically, the barbarian within.

While syphilis was thought to be passively incurred, an entirely involuntary disaster, TB was once, and cancer is now, thought to be a pathology of energy, a disease of the will. Concern about energy (feeling), fears about the havoc it wreaks, have been attached to both diseases. Getting TB was thought to signify a defective vitality, or vitality misspent. “There was a great want of vital power…and great constitutional weakness”—so Dickens describes little Paul in Dombey and Son. The Victorian idea of TB as a disease of low energy (and heightened sensitivity) has its exact complement in the Reichian idea of cancer as a disease of unexpressed energy (and anaesthetized feelings). In an era in which there seemed to be no inhibitions on being productive, people were anxious about not having enough energy. In our own era of destructive overproduction by the economy and of increasing bureaucratic restraints on the individual, the fear is of having too much energy; or that energy is not being allowed to be expressed.

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. (Having an orgasm, in nineteenth-century English slang, was not “coming” but “spending.”) Energy, like savings, can be depleted, can run out or be used up, through reckless expenditure. The body will start “consuming” itself, the patient will “waste away.”

The language used to describe cancer evokes a different economic catastrophe: that of unregulated, abnormal, incoherent growth. Cancer cells, according to the textbook account, are cells that have shed the mechanism which “restrains” growth. (The growth of normal cells is “self-limiting,” due to a mechanism called “contact inhibition.”) Cells without inhibitions, cancer cells will continue to grow and extend over each other in a “chaotic” fashion, destroying the body’s normal cells, architecture, and functions.

Early capitalism assumes the necessity of regulated spending, saving, accounting, discipline—an economy that depends on the rational limitation of desire. TB is described in images of the negative behavior of nineteenth-century homo economicus: consumption; wasting; squandering of vitality. Advanced capitalism requires expansion, speculation, the creation of new needs (the problem of satisfaction and dissatisfaction); buying on credit; mobility—an economy that depends on the irrational indulgence of desire. Cancer is described in images of the negative behavior of twentieth-century homo economicus: abnormal growth; repression of energy, that is, refusal to consume or spend.

TB was understood, like insanity, to be a kind of one-sidedness: a failure of will or an overintensity. However much the disease was dreaded, TB always had pathos. Like the mental patient today, the tubercular was considered to be someone quintessentially vulnerable, and full of self-destructive whims. Nineteenth- and early twentieth-century physicians addressed themselves to coaxing their tubercular patients back to health. Their prescription was the same as the enlightened one for mental patients today: cheerful surroundings, isolation from stress and family, healthy diet, lots of rest.

The understanding of cancer supports quite different, avowedly brutal notions of treatment. (A common cancer hospital witticism, heard as often from doctors as from patients, is “The treatment is worse than the disease.”) There can be no question of pampering the patient. With the patient’s body considered to be under attack (“invasion”), the only treatment is counterattack.

The controlling metaphors in descriptions of cancer are not, in fact, drawn from economics but from the language of warfare. Thus cancer cells do not simply multiply; they are “invasive.” (“Malignant tumors invade even when they grow very slowly,” as one textbook puts it.) Cancer cells “colonize” from the original tumor to far sites in the body. And however “radical” the surgical intervention, however many “scans” are taken of the body landscape, most remissions are temporary; the prospects are that “tumor invasion” will continue, or that rogue cells will eventually regroup and mount a new assault on the organism.3

Treatment also has a military flavor. Radiotherapy uses the metaphors of aerial warfare; patients are “bombarded” with toxic rays. And chemotherapy is chemical warfare, using poisons.4 Treatment aims to “kill” cancer cells (without, it is hoped, killing the patient). Unpleasant side-effects of treatment are advertised, indeed overadvertised. (“The agony of chemotherapy” is a standard phrase.) It is impossible to avoid damaging or destroying healthy cells (indeed some methods used to treat cancer can cause cancer), but it is thought that nearly any damage to the body is justified if it saves the patient’s life. Often, of course, it doesn’t work. (As in: “We had to destroy Ben Suc in order to save it.”) There is everything but the body count.

US government medical research policy got started in 1927 in a frontier, bounty-hunting spirit, with a senator proposing that a $5 million “reward” be posted for whoever collared cancer. (In 1977 $815 million of federal money was given to the National Cancer Institute.) More recently, the fight against cancer has sounded like a colonial war. In a decade when colonial wars haven’t gone too well, this militarized rhetoric seems to be backfiring. Pessimism among doctors about the efficacy of treatment is growing, in spite of the strong advances in chemotherapy and immunotherapy made since 1970. A few years ago one science writer found American Cancer Society proclamations that cancer is curable and progress has been made “reminiscent of Vietnam optimism prior to the deluge.”5 Still, it should be possible to be skeptical about the rhetoric that surrounds cancer without concluding, as many doctors do, that cancer is not curable and that no real progress has been made. The bromides of the American Cancer Society—self-appointed GHQ—tirelessly promising that cure for cancer; the professional pessimism of a large number of cancer specialists, talking like battle-weary officers, still unable to distinguish guerrillas from civilians, mired down in an interminable colonial war—such are the twin distortions of this military rhetoric about cancer.

As TB was represented as the spiritualizing of consciousness, cancer is understood as the overwhelming or obliterating of consciousness (by a mindless It). In TB, you are eating yourself up, being refined, getting down to the core, the real you. In cancer, nonintelligent (“primitive,” “embryonic”) cells are multiplying, and you are being replaced by the non-you. Immunologists class the body’s cancer cells as “nonself.”

It is worth noting that Reich, who did more than anyone else to disseminate the psychological theory of cancer, also found something equivalent to cancer in the biosphere.

There is a deadly orgone energy. It is in the atmosphere. You can demonstrate it on devices such as the Geiger counter. It’s a swampy quality…. Stagnant, deadly water which doesn’t flow, doesn’t metabolize. Cancer, too, is due to the stagnation of the flow of the life energy of the organism.6

Reich’s language has its own inimitable looniness. But more and more—as its metaphoric uses gain in credibility—cancer is felt to be what he thought it was. A cosmic disease: the emblem of all the destructive, alien powers to which the organism is host.

As TB was a disease of the sick self, cancer is a disease of the Other. Cancer proceeds by a science-fiction scenario: an invasion of “alien” or “mutant” cells, stronger than normal cells (Invasion of the Body Snatchers, The Incredible Shrinking Man, The Blob, The Thing). In a science-fiction tale by Tomasso Landolfi, the spaceship is called “Cancerqueen.” (It is hardly within the range of the metaphor of tuberculosis that Landolfi could have called it “TB-Queen.”) When not being explained away as something psychological, cancer is being magnified and projected into a metaphor for the Other—the biggest enemy, the farthest goal. Thus Nixon’s bid to match Kennedy’s promise to put Americans on the moon was, appropriately enough, the promise to “conquer” cancer. Both were science-fiction ventures. And the federal legislation of 1971, “The Conquest of Cancer Act,” did not envisage the near-to-hand decisions that could control the politics and the industrial economy that pollutes—only the great destination: the cure.

TB was a disease in the service of a romantic view of the world. Cancer is now in the service of a simplistic view of the world that can turn paranoid. The disease is often experienced as a form of demonic possession—tumors are “malign” or “benign,” like forces—and many terrified cancer patients are disposed to seek out faith healers, to be exorcised. (Perhaps right-wing groups are the main organized support for quack cures like Laetrile because they also share a paranoid view of the world.) For the more sophisticated, cancer signifies the punitive rebellion of the biosphere: Mother Nature taking revenge on a wicked technocratic world. The industrial civilization is causing undreamed of damage; the springs are silent; and it is regularly estimated that 70 or 80 percent, or between 80 and 90 percent, of all cancers are “environmentally caused.”

To the accompaniment of this numbers game (it is difficult to see how any statistics about “all cancers” could be defended), cigarettes, hair dyes, bacon, saccharine—a lengthening roll call of products we consume—have been found to cause cancer. X-rays give cancer (the treatment meant to cure kills); so does the light emitted by the television set and the florescent clock face. As with syphilis, an innocent or trivial act—or exposure—in the present can have dire consequences far in the future. It is also known that cancer rates are high for workers in a large number of industrial occupations. Whatever the exact processes of causation lying beneath these statistics may be—and they remain unknown—cancer is not the sin of capitalism. Within their much more limited industrial capacities, the Russians can pollute worse than we do.

The medieval experience of the plague was firmly tied to notions of moral pollution, and people invariably looked for a scapegoat external to the stricken community. (Massacres of Jews in unprecedented numbers took place everywhere in plague-stricken Europe of 1347-1348, then virtually stopped as soon as the plague receded.) With the modern diseases, the scapegoat is not so easily separated from the patient. But much as these diseases individualize, they also pick up some of the metaphors of epidemic diseases. TB was associated with pollution (Florence Nightingale thought it was induced by “the foul air of houses”) and now cancer is thought of as a disease of the contamination of the whole world. TB was “the white plague.” With awareness of environmental pollution people have started saying that there is an “epidemic” of cancer.


Illnesses have always been used as metaphors to express a sense of what was wrong socially. In Shakespeare, there can be an infection in the “body politic,” an abscess that has to be lanced. But full of disease imagery as the Elizabethan theater may be, it does not project the modern idea of a master illness—a total contagion of society.

Master illnesses like TB and cancer are used to define the ruling ideas of individual health, and to express a sense of dissatisfaction with society as a whole. Unlike the Elizabethan metaphors—in which illness denotes a social aberration or imbalance that is, in consequence, dislocating to individuals—the modern ones arise when the ideas about individual and society are coming to be polarized, with society conceived as the individual’s adversary. Disease metaphors are used to find society not out of balance but repressive. They turn up regularly in Romantic rhetoric which opposes heart to head, spontaneity to reason, nature to artifice, country to city.

When travel to a better climate was invented as a treatment for TB in the early nineteenth century, the most contradictory destinations were proposed. The south, mountains, deserts, islands—their very diversity suggests what they have in common: the rejection of the city. In La Traviata, when Alfredo wins Violetta’s love, his first act is to move her from unhealthy wicked Paris to the wholesome countryside: instant health follows. And Violetta’s giving up on happiness is tantamount to leaving the country and returning to the city—where her doom is sealed, her TB returns, and she dies.

The metaphor of cancer expands the theme of the rejection of the city. In Lost Illusions, in the section called “A Provincial Celebrity in Paris,” Balzac describes Lucien de Rubempré after a literary party:

This evening he had seen things as they are. And instead of being seized with horror at the spectacle of that cancer in the very heart of Paris…he was intoxicated with the pleasure of being in such intellectually brilliant society. These remarkable men, with their dazzling armor of vice….

Before the city 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.

Throughout the nineteenth century, disease metaphors become more virulent, preposterous, demagogic. And there is an increasing tendency to call any situation one disapproves of a disease. Disease, which could be considered as much a part of nature as is health, became the synonym of whatever was “unnatural.” In Les Misérables, Hugo wrote:

Monasticism, such as it existed in Spain and as it exists in Tibet, is for civilization a sort of tuberculosis. It cuts off life. Quite simply, it depopulates. Confinement, castration. It was a scourge in Europe.

The French physician Bichat in 1800 defined life as “the ensemble of functions which resists death.” That contrast between life and death was to be transferred to a contrast between life and disease. Disease (now equated with death) is what opposes life.

In 1916, in an article, “Socialism and Culture,” Gramsci denounced

the habit of thinking that culture is encyclopedic knowledge…. This form of culture serves to create that pale and broken-winded intellectualism…which has produced a whole crowd of boasters and day-dreamers more harmful to a healthy social life than tuberculosis or syphilis microbes are to the body’s beauty and health….

In 1919 Mandelstam paid the following tribute to Pasternak:

To read Pasternak’s verse is to clear one’s throat, to fortify one’s breathing, to fill one’s lungs; such poetry must be healthy, a cure for tuberculosis. No poetry is healthier at the present moment. It is like drinking koumiss after canned American milk.

And Marinetti, denouncing communism in 1920:

Communism is the exasperation of the bureaucratic cancer that has always wasted humanity. A German cancer, a product of the characteristic German preparationism. Every pedantic preparation is anti-human….

It is for the same thing that the protofascist Italian writer attacks communism and the future founder of the Italian Communist Party attacks a certain bourgeois idea of culture (“truly harmful, especially to the proletariat,” Gramsci says)—for being artificial, pedantic, rigid, lifeless. Both TB and cancer have been regularly invoked to condemn repressive practices and ideals, repression being conceived of as an environment that deprives one of strength (TB) or of flexibility and spontaneity (cancer). And to invoke an ideal of social well-being that is analogized to physical health, and not necessarily an ideal of political order.

Illness as a metaphor for political disorder is one of the oldest notions of political philosophy. If it is plausible to compare the polis to an organism, then it is plausible to compare civil disorder to an illness. And the classical formulations which analogize a political disorder to an illness—from Plato to, say, Hobbes—presuppose the classical medical (and political) idea of balance. Illness comes from imbalance. Treatment is aimed at restoring the right balance—in political terms, the right hierarchy. The prognosis is always, in principle, optimistic. Society never, by definition, catches a fatal disease.

When a disease image is used by Machiavelli, the presumption is that the disease can be cured. “Consumption,” he wrote,

in the commencement is easy to cure, and difficult to understand; but when it has neither been discovered in due time, nor treated upon a proper principle, it becomes easy to understand, and difficult to cure. The same thing happens in state affairs, by foreseeing them at a distance, which is only done by men of talents, the evils which might arise from them are soon cured; but when, from want of foresight, they are suffered to increase to such a height that they are perceptible to everyone, there is no longer any remedy.

Machiavelli invokes TB as a disease whose progress can be cut off, if it is detected at an early stage (when its symptoms are barely visible). Given proper foresight, the course of a disease is not irreversible; the same for disturbances in the body politic. Machiavelli offers an illness metaphor that is not so much about society as about statecraft (conceived as a therapeutic art): as prudence is needed to control serious diseases, so foresight is needed to control social crises. It is a metaphor about foresight, and a call to foresight.

In political philosophy’s great tradition, the analogy between disease and civil disorder is proposed to encourage rulers to pursue a more rational policy. “Although nothing can be immortall which mortals make,” Hobbes writes,

yet, if men had the use of reason they pretend to, their Common-wealths might be secured, at least, from perishing by internal diseases…. Therefore when they come to be dissolved, not by externall violence, but intestine disorder, the fault is not in men, as they are the Matter; but as they are the Makers, and orderers of them.

Hobbes’s view is anything but fatalistic. Rulers have the responsibility and the ability (through reason) to control disorder. For Hobbes murder (“externall violence”) is the only “natural” way for a society or institution to die. To perish from internal disorder—analogized to a disease—is suicide, something quite preventable; an act of will, or rather a failure of will (that is, of reason).

The disease metaphor was used in political philosophy to reinforce the call for a rational response. Machiavelli and Hobbes fixed on one part of medical wisdom, the importance of cutting off serious disease early, while it is relatively easy to control. The disease metaphor could also be used to encourage rulers to another kind of foresight. In 1708 Lord Shaftesbury writes:

There are certain humours in mankind which of necessity must have vent. The human mind and body are both of them naturally subject to commotions…as there are strange ferments in the blood, which in many bodies occasion an extraordinary discharge…. Should physicians endeavour absolutely to allay those ferments of the body, and strike in the humours which discover themselves in such eruptions, they might, instead of making a cure, bid fair perhaps to raise a plague, and turn a spring ague or an autumn surfeit into an epidemical malignant fever. They are certainly as ill physicians in the body politic who would needs be tampering with these mental eruptions, and, under the specious pretence of healing this itch of superstition and saving souls from the contagion of enthusiasm, should set all nature in an uproar, and turn a few innocent carbuncles into an inflammation and mortal gangrene.

Shaftesbury’s point is that it is rational to tolerate a certain amount of irrationality (“superstition,” “enthusiasm”), and that stern repressive measures are likely to aggravate disorder rather than cure it, turning a nuisance into a disaster. The body politic should not be overmedicalized; a remedy should not be sought for every disorder.

For Machiavelli, foresight; for Hobbes, reason; for Shaftesbury, tolerance—these are all ideas of how proper statecraft, conceived on a medical analogy, can prevent a fatal disorder. Society is presumed to be in basically good health; disease (disorder) is, in principle, always manageable.

In the modern period the use of disease imagery in political rhetoric has another, much darker implication. The modern idea of revolution, based on the most despairing analysis of the existing political situation, shattered the old, optimistic use of disease metaphors. John Adams writes in his diary, in December 1772:

The Prospect before me…is very gloomy. My Country is in deep Distress, and has very little Ground of Hope…. The Body of the People seem to be worn out, by struggling, and Venality, Servility and Prostitution, eat and spread like a Cancer.

Political events started commonly to be defined as being unprecedented, radical. As might be expected, it was not with the American but the French Revolution that disease metaphors in the modern sense came into their own—particularly in the conservative response to the French Revolution. In Reflections on the Revolution in France (1790), Edmund Burke contrasts older wars and civil disturbances with this one, which he considers to have a totally new character. Before, no matter what the civic disaster, “the organs…of the state, however shattered, existed.” Not so, he addresses the French, with their Revolution: “your present confusion, like a palsy, has attacked the fountain of life itself.”

As classical theories of the polis have gone the way of the four humors in theories of disease, so a modern idea of politics has been complemented by a modern idea of disease. Disease equals death. Burke referred to palsy (and to “the living ulcer of a corroding memory”). The emphasis was soon to be on diseases that are loathsome and fatal. Such diseases are not to be managed or treated; they are to be attacked. In Hugo’s novel about the French Revolution, Quatre-vingt-treize (1874), the revolutionary Gauvain, condemned to the guillotine, absolves the revolution with all its bloodshed, including his own imminent execution,

because it is a storm. A storm always knows what it is doing…. Civilization was in the grip of plague; this gale comes to the rescue. Perhaps it is not selective enough. Can it act otherwise? It is entrusted with the arduous task of sweeping away disease! In face of the horrible infection, I understand the fury of the blast.

It is hardly the last time that revolutionary violence would be justified on the grounds that society has a radical, horrible illness. The melodramatics of the disease metaphor in modern political discourse assume a punitive notion: not of the disease as a punishment but as a sign of evil, something to be punished.

Modern totalitarian movements, whether of the right or the left, have been peculiarly—and revealingly—inclined to use disease imagery. The Nazis said that someone of mixed “racial” origin was like a syphilitic. European Jewry was repeatedly analogized to syphilis, and to a cancer that must be excised. Disease metaphors were a staple of Bolshevik polemics, and Trotsky, the most gifted of all communist polemicists, used them with the greatest profusion—particularly after his banishment from the Soviet Union in 1929. Stalinism was called a cholera, a syphilis, and a cancer.7 To use only fatal diseases for imagery in politics gives the metaphor a much more pointed character. Now, to liken a political event or situation to an illness is to impute guilt, to prescribe punishment.

This is particularly true of the use of cancer as a metaphor. It amounts to saying, first of all, that the event or situation is unqualifiedly and unredeemably wicked. It enormously ups the ante. In Hitler’s first recorded speech, an anti-Semitic diatribe delivered in 1919, he accused the Jews of producing “a racial tuberculosis among nations.”8 Tuberculosis still retained its prestige as the overdetermined, culpable illness of the nineteenth century. (Recall Hugo’s comparison of monasticism with TB.) But the Nazis quickly modernized their rhetoric, and indeed the imagery of cancer was far more apt for their purposes. As was said in speeches about “the Jewish problem” throughout the 1930s, to treat a cancer one must cut out much of the healthy tissue around it. The imagery of cancer for the Nazis prescribes “radical” treatment, in contrast to the “soft” treatment thought appropriate for TB—the difference between sanatoria (that is, exile) and surgery (that is, crematoria). (The Jews were also identified with, and became a metaphor for, city life—with Nazi rhetoric echoing all the Romantic clichés about cities as a debilitating, merely cerebral, morally contaminated, unhealthy environment.)

To describe a phenomenon as a cancer is an incitement to violence. The use of cancer in political discourse encourages fatalism and “severe” measures—as well as strongly reinforcing the popular perception that the disease is necessarily fatal. The concept of disease is never innocent. But it could be argued that the cancer metaphors are in themselves implicitly genocidal. No specific political view seems to have a monopoly on this metaphor. If Hitler called the Jews the cancer of Europe, Trotsky called Stalinism the cancer of Marxism, and in China in the last year the Gang of Pour have become, among other things, “the cancer of China.” John Dean called Watergate “the cancer on the presidency.”

The standard metaphor of Arab polemics—heard by Israelis on the radio every day for the last twenty years—is that Israel is “a cancer in the heart of the Arab world” or “the cancer of the Middle East,” and an officer with the Christian Lebanese rightist forces besieging the Palestine refugee camp of Tal Zaatar in August 1976 called the camp “a cancer in the Lebanese body.”9 The cancer metaphor seems hard to resist for those who wish to register indignation. Thus Neal Ascherson wrote in 1969 that the Slansky Affair “was—is—a huge cancer in the body of the Czechoslovak state and nation”; Simon Leys, in Chinese Shadows, speaks of “the Maoist cancer that is gnawing away at the face of China”; D.H. Lawrence called masturbation “the deepest and most dangerous cancer of our civilization”; and I once wrote, in the heat of despair over America’s war on Vietnam, that “the white race is the cancer of human history.”

But how to be morally severe in the late twentieth century? How, when there is so much to be severe about; how, when we have a sense of “evil” but no longer the religious or philosophical language to talk intelligently about evil. Trying to comprehend “radical” or “absolute” evil, we search for adequate metaphors. But the modern disease metaphors are all cheap shots. The people who have the real disease are also hardly helped by hearing their disease’s name constantly being dropped as the very epitome of evil. Only in the most limited sense is any historical event or problem like an illness. And the cancer metaphor is particularly crass. It is invariably a call to simplification—always to be resisted. And it is, in most cases, a justification of fanaticism, of harsh measures, including, usually, violence.

It is instructive to compare the image of cancer with that of gangrene. With some of the same metaphoric properties as cancer—it starts from nothing; it spreads; it is disgusting—gangrene would seem to be laden with everything a polemicist would want. Indeed, it was used in one important moral polemic—against the French use of torture in Algeria in the 1950s; the title of the famous book exposing that torture was called La Gangrène. But there is a large difference between the cancer and the gangrene metaphors. First, causality is clear with gangrene. It is external—gangrene can develop from a scratch; cancer is internal, as well as external. Second, gangrene is not as all-encompassing a disaster. It leads (often) to amputation, less often to death; cancer is presumed to lead to death in most cases. Not gangrene—and not the plague (despite the notable attempts by writers as different as Artaud, Reich, and Camus to impose that as a metaphor for the dismal and the disastrous)—but cancer remains the most “radical” of disease metaphors. And just because it is so radical it is particularly tendentious—a good metaphor for paranoids, for those who need to turn campaigns into crusades, for the fatalistic (cancer = death), and for those under the spell of ahistorical revolutionary optimism (the idea that only the most “radical” changes are desirable). As long as so much militaristic hyperbole attaches to the description and treatment of cancer, it is a particularly unapt metaphor for the peace-loving.

It is, of course, likely that the language about cancer will evolve in the coming years. It must change, decisively, when the disease is finally understood and the rate of cure becomes much higher. It is already changing, with the development of new forms of treatment. As chemotherapy is more and more supplanting radiation in the treatment of cancer patients, an effective form of treatment (already a supplementary treatment of proven use) seems likely to be found in some kind of immunotherapy. Concepts have started to shift in certain medical circles, where doctors are concentrating on the steep buildup of the body’s immunodefensive system against cancer. As the language of treatment changes from an aggressive, militarized language to one centered on the body’s “natural defenses,” cancer will be partly demythicized; and it may then be possible to compare something to a cancer without implying either a fatalistic diagnosis or a rousing call to fight by any means whatever a lethal, insidious enemy. Then perhaps it will be morally permissible, as it is not now, to use cancer as a metaphor.

But at that time, perhaps nobody will want any longer to compare anything awful to cancer. Since the interest of the metaphor is precisely that it refers to a disease so overlaid with mystification, so charged with the fantasy of inescapable fatality. Since 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 which 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 persuasively will be resolved.

(This is the third part of a three-part article.)

  1. 1

    Wilhelm Reich, The Mass Psychology of Fascism (Farrar, Straus and Giroux, 1971), p. 82.

  2. 2

    Since writing the above, I have come across a similar speculation by Lewis Thomas, president of the Memorial Sloan-Kettering Cancer Center. Dr. Thomas is quoted (The New Yorker, January 2, 1978) as saying: “It has become something of a popular notion to say that the diseases we are left with now that we have got rid of the major infections are in some sense so complicated and so multifactorial, as the term goes—that they have something to do with the environment, or have something to do with stress and the pace of modern living—that we can’t do anything about them until society itself is remade….

    I simply can’t take that point of view very seriously—not as long as we are as ignorant about the mechanisms of those diseases as we are. We really don’t know anything at a deep level about the mechanism of heart disease, or cancer, or stroke, or rheumatoid arthritis. We can make up stories about them, and it could be, I suppose, that they do have multiple causes, and are due to things we can’t control in the environment. If that’s true—if that should turn out to be true—that would be quite a piece of news. Because it has never happened before. Every disease that we do know about, and for which we have really settled the issue, so that we can either turn it off, switch it off, or prevent it once and for all—every such disease turns out to be a disease in which there is one central mechanism….

    In the case of pneumonia, it’s the pneumococcus, and in the case of tuberculosis it is the tubercle bacillus, and in pellagra it’s a single vitamin deficiency. And I have a hunch—of course, I can’t prove it—that it will turn out to be that way for cancer….”

  3. 3

    Every physician and every attentive cancer patient will be familiar with, if perhaps inured to, this military terminology. Those unfamiliar with the metaphors might try the chapter “Principles of Neoplasia” by Emil Frei III and Gerald P. Bodey, in Harrison’s Principles of Internal Medicine, seventh edition (McGraw-Hill, 1975), pp. 1684-1689.

    The early metaphors for cancer—gnawing away, corrosion—are akin to TB’s consumption metaphor, no doubt because of the similarity of visible symptoms—for example, anorexia—in the advanced stage of both diseases. The modern metaphors for cancer derive from new information gathered, first of all, through the microscope, about cellular “growth” or proliferation—now understood to be the distinctive feature of cancer.

  4. 4

    Drugs of the nitrogen mustard type (so-called alkylating agents)—like Cyclophosphamide (Cytoxan)—were the first generation of cancer drugs. Their use was suggested by the findings of autopsies performed on a large number of American sailors fatally gassed toward the end of World War II, when their ship, loaded with poison gas, was blown up in the Naples harbor.

    Chemotherapy and weaponry seem to go together, if only as a fancy. The first modern chemotherapy success was with syphilis: in 1910 Paul Ehrlich introduced an arsenic derivative, arsphenamine (Salvarsan), which was called “the magic bullet.”

  5. 5

    Daniel Greenberg, ” ‘The War on Cancer’: Official Fiction and Harsh Facts,” Science and Governmental Report, Vol. 4 (December 1, 1974).

  6. 6

    Reich Speaks of Freud (Farrar, Straus and Giroux, 1967), p. 89. The Reichian imagery of energy checked, not allowed to move outward, then turned back on itself, driving cells berserk—all this, in its more respectable version as a theory of the psychological causation of cancer, is already the stuff of science fiction.

    The standard science-fiction plot was mutation, either mutants from outer space or accidental mutations among humans. Cancer could be described as a triumphant mutation, and mutation is now mainly an image for cancer. Reich’s image of death in the air—deadly energy which can be demonstrated on a Geiger counter—suggests how such science-fiction images about cancer (a disease that comes from deadly rays, and is treated by deadly rays) probably got started. The original fear about exposure to atomic radiation was that it produced genetic changes and would result in the birth of two-headed babies. That was replaced by another fear, as statistics started to show much higher cancer rates among Hiroshima and Nagasaki survivors and their descendants.

  7. 7

    Cf. Isaac Deutscher, The Prophet Outcast: Trotsky, 1929-1940 (Oxford University Press, 1963), p. 431: ” ‘Certain measures,’ Trotsky wrote to [Philip] Rahv [on March 21, 1938], ‘are necessary for a struggle against incorrect theory, and others for fighting a cholera epidemic. Stalin is incomparably nearer to cholera than to a false theory. The struggle must be intense, truculent, merciless. An element of “fanaticism”…is salutary.’ ” And ibid., p. 425: “Trotsky spoke of the ‘syphilis of Stalinism’ or of the ‘cancer that must be burned out of the labour movement with a hot iron’….” Meyer Schapiro has called my attention to an article written in late 1939 by Trotsky denouncing two former disciples (Max Schactman and James Burnham) with the title “From Scratch to Gangrene.” This was a favorite Bolshevik metaphor, meaning that party members who deviate only slightly invariably end up as full-fledged counterrevolutionaries.

    It is worth mentioning that Solzhenitsyn’s novel Cancer Ward does not use cancer as a metaphor—for Stalinism, or for anything else.

  8. 8

    [The Jew’s] power is the power of money which in the form of interest effortlessly and interminably multiplies itself in his hands and forces upon nations that most dangerous of yokes…. Everything which makes men strive for higher things, whether religion, socialism, or democracy, is for him only a means to an end, to the satisfaction of a lust for money and domination. His activities produce a racial tuberculosis among nations….” In Documents on Nazism, 1919-1945, edited by Jeremy Noakes and Geoffrey Pridham (Viking, 1975), p. 37. A late nineteenth-century precursor of Nazi ideology, Julius Langbehn, called the Jews the cholera of Europe (Fritz Stern, The Politics of Cultural Despair [University of California Press, 1961], p. 42). But in Hitler’s TB image there is already something easily transferred to cancer: the idea that Jewish power “effortlessly and interminably multiplies.”

  9. 9

    Tal Zaatar, in Ruins, Has Symbolic Value,” International Herald-Tribune, August 10, 1976.