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Disease as Political Metaphor

I

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.

  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).

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