The past few days I’ve been thinking about 2 books, Susan Sontag’s Illness as Metaphor, and Norman Cousin’s Anatomy of an Illness (As Perceived by the Patient). I remember reading Sontag’s book when it was published back in the 70s; of all her work, this one has stayed with me over the years. I was more puzzled by why my memory jumped to Cousin’s book; if I read it when it came out in the early 80s it didn’t make as deep an impression as Sontag’s – but here it was, neurons firing in their mysterious way, surfacing the title. I’ve wandered around the Intertubes to remind myself what each of these books were about, and the more I’ve read, the more it begins to make sense.
Sontag wrote her essay in the 1970s in the midst of her own struggle with breast cancer (her death in 2006 from myelogenous leukemia was chronicled by her partner, photographer Annie Liebowitz). Using the examples of tuberculosis in the 19th century and cancer in the 2oth, Sontag argued that especially when the etiology of a disease is poorly understood, it can be transformed into a fertile breeding ground for metaphorical and imaginative (or better: magical) thinking – thinking that is structured by the prevailing cultural mores of the time.
She rejected this completely, responding with an intellectually muscular pushback against what she personally experienced as the tendency to blame the patient for somehow causing her illness. For her, metaphorical thinking led to the conclusion that the patient, somehow, had “caused” the disease – in the case of cancer, for instance, by repression of passion that uncontrollaby erupts as disease (thank you, Dr. Freud).
Sontag’s essay stands on its own as a work of cultural history. But looking at it now, I’m more interested in the way in which it was a very personal effort by Sontag to secure a strong, honest, clear-eyed understanding of what it was she was dealing with in her own life. I think that is the emotional charge behind her main point of the book, which is this:
“The most truthful way of regarding illness,” she wrote, “–and the healthiest way of being ill–is one most purified of, most resistant to, metaphoric thinking.”
Whether or not she is right – it may indeed be that metaphorical thinking can be a powerful tool in dealing with ill health – this was Sontag’s solution to a problem: how do I gather my own deep power to respond to a crisis? She evidently needed to strip away what she saw as the illusions of the era, the blame that was being layered onto her self, in order to adopt a stance strong enough to see her through this crisis.
Her solution, to risk being completely reductive, was to concentrate all the anger she may have felt at this health/cultural insult into the bright fire of logic, and to reason her way to health.
Norman Cousins, the publisher of the late, lamented Saturday Review, found his response to crisis by following a very different path. (Total sidebar: I will always have a soft spot for the Saturday Review: after Bill Moyers came up to the South Bronx in 1977 and filmed a story about the group I was working with, People’s Development Corporation, SR sent up a reporter to do a feature story on us: we made the cover as “The New Urban Pioneers: Homesteading in the Slums.” I’m sure the writer, Roger Williams, never forgot the grief we gave him for what was actually a terrific piece. My very first experience with “the media.”)
In 1964 he was diagnosed with something called ankylosing spondylitis (basically, the connective tissue in his body was falling apart) and given an extremely discouraging prognosis. Working with his doctor (a remarkable partnership, even if it was based upon a lifetime of privelege) Cousins decided that prevailing treatments were actually doing him damage. He left the hospital, checked into a hotel, and proceeded to treat himself with massive quantities of Vitamin C – and with laughter, brought to him by the Marx Brothers and Candid Camera. He did indeed recover, and lived long enough to send that unsuspecting reporter up to the South Bronx, and beyond.
In a way, Cousins story could be read as putting the entire problem back onto the patient’s weary shoulders; after all, the argument goes, if only he had a positive attitude, he’d get better (and how many times have we heard that from somone telling us to think good thoughts? How many times have we done it ourselves to others?) It’s the ultimate successful self-help story.
Norman Cousins was the patient who “laughed himself healthy.”
Reason/laughter. A critique of cultural ideology/a critique of patient psychology. Sontag and Cousins come to very different conclusions about how to respond to profound health crisis. But what binds them together – and, frankly, what inspires me – is their process of reflection and inquiry, and their willingness (insistence, even) to widen their field of vision, look at their situation as clearheadedly as they can, and act on what they see. I think that’s what courage looks like.